Purpose Decreased wrist flexion and/or extension after trauma or surgery can be a challenging problem. Physical therapy, orthoses, and additional surgical interventions may not restore the desired ...range of motion or functionality. The purpose of this study was to assess the total arc of motion and the satisfaction scores of patients who had wrist stiffness and who were treated with a bidirectional, patient-directed orthosis that used the principles of static progressive stretch. Methods Forty-seven patients who experienced posttraumatic or postsurgical wrist stiffness were treated with a patient-directed orthosis. Treatment consisted of a 30- to 60-minute stretching protocol performed 1 to 3 times per day. Compliance with the device, treatment duration, mean total arc of motion, patient satisfaction, and complications were evaluated. Results The total arc of motion increased by a mean of 35° (range, 5° to 100°) after a mean of 10 weeks of treatment (range, 5 to 26 weeks). The mean flexion and extension increased by 18° (range, 1° to 50°) and 17° (range, 3° to 50°), respectively. Assessment of age, gender, and time before commencement of treatment showed that these factors did not significantly affect the magnitude of improvement or the final arc of motion. The mean patient satisfaction score was 8.2 points on a scale of 0 to 10 points. All patients completed the treatment, and there were no complications reported with use of the device. Conclusions All of the patients who used this protocol improved their total arc of motion. A splinting device that uses the principles of static progressive stretch is a useful treatment for patients who have posttraumatic or postsurgical wrist stiffness and whose progress has plateaued after a course of conventional physical therapy. Type of study/level of evidence Therapeutic IV.
Abstract Background Studies on outcome of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) and acute promyelocytic leukemia (APL) are limited. Methods We compared outcome of AYAs ...(19-30 years) and pediatric patients (0-18 years) with AML (pAML) and APL (pAPL) utilizing Surveillance Epidemiology and End Results (SEER)-18 registry. Early mortality rate (EMR), defined as mortality within 1 month of diagnosis, was used as a surrogate for treatment related mortality. Survival statistics were computed using Kaplan-Meier method. Multivariate analysis was done using logistic regression and Cox proportional hazard regression model. Results 6343 AML patients were identified; 44.7% AYAs. pAML had lower EMR 6.2% vs 9.2%; p<0.01 and higher overall survival (OS) 1-year: 70.3% vs 62.1%; 5-years: 48.2% vs 36.4%; p<0.01. 920 APL patients were also identified; 59.5% AYAs. No statistically significant difference was found between AYAs and pAPL in EMR 11.4% vs 14.1%; p=0.23 and OS 1-year: 83.8% vs 81.2%; p=0.31 and 5-years: 68.2% vs 73.1%; p=0.11. Comparing all AML and APL patients, AYAs and pediatric APL patients had higher EMR 11.4% and 14.1% vs 6.2% and 9.2%; p=<0.01 but better OS than AYAs and pediatric AML patients 5-year OS: 68.2% and 73.1% vs 48.2% and 36.4%; p=<0.01. Conclusion Our analysis shows AYAs with AML have worse EMR and OS compared to pAML. AYAs with APL and pAPL patients have similar outcomes. To our knowledge, this is the first study reporting outcomes of AYAs and pediatric APL patients using large population based registry with comparison to same age AML patients.
Kernel-based non-parametric models have been applied widely over recent years. However, the associated computational complexity imposes limitations on the applicability of those methods to problems ...with large data-sets. In this paper we develop a filtering approach based on a Gaussian process regression model. The idea is to generate a small-dimensional set of filtered data that keeps a high proportion of the information contained in the original large data-set. Model learning and prediction are based on the filtered data, thereby decreasing the computational burden dramatically.
New Insulin Delivery Recommendations Frid, Anders H.; Kreugel, Gillian; Grassi, Giorgio ...
Mayo Clinic proceedings,
09/2016, Letnik:
91, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage ...these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes.
This article provides a brief history of Rural Enterprises Inc. of Oklahoma (REI), a private nonprofit corporation focusing on job creation. The evolution of REI from a regional program to current ...statewide efforts is reviewed. Key activities and lessons learned are emphasized throughout the article.
Research studies show that social media may be valuable tools in the disease surveillance toolkit used for improving public health professionals' ability to detect disease outbreaks faster than ...traditional methods and to enhance outbreak response. A social media work group, consisting of surveillance practitioners, academic researchers, and other subject matter experts convened by the International Society for Disease Surveillance, conducted a systematic primary literature review using the PRISMA framework to identify research, published through February 2013, answering either of the following questions: Can social media be integrated into disease surveillance practice and outbreak management to support and improve public health?Can social media be used to effectively target populations, specifically vulnerable populations, to test an intervention and interact with a community to improve health outcomes?Examples of social media included are Facebook, MySpace, microblogs (e.g., Twitter), blogs, and discussion forums. For Question 1, 33 manuscripts were identified, starting in 2009 with topics on Influenza-like Illnesses (n = 15), Infectious Diseases (n = 6), Non-infectious Diseases (n = 4), Medication and Vaccines (n = 3), and Other (n = 5). For Question 2, 32 manuscripts were identified, the first in 2000 with topics on Health Risk Behaviors (n = 10), Infectious Diseases (n = 3), Non-infectious Diseases (n = 9), and Other (n = 10).
The literature on the use of social media to support public health practice has identified many gaps and biases in current knowledge. Despite the potential for success identified in exploratory studies, there are limited studies on interventions and little use of social media in practice. However, information gleaned from the articles demonstrates the effectiveness of social media in supporting and improving public health and in identifying target populations for intervention. A primary recommendation resulting from the review is to identify opportunities that enable public health professionals to integrate social media analytics into disease surveillance and outbreak management practice.
Large carnivores face serious threats and are experiencing massive declines in their populations and geographic ranges around the world. We highlight how these threats have affected the conservation ...status and ecological functioning of the 31 largest mammalian carnivores on Earth. Consistent with theory, empirical studies increasingly show that large carnivores have substantial effects on the structure and function of diverse ecosystems. Significant cascading trophic interactions, mediated by their prey or sympatric mesopredators, arise when some of these carnivores are extirpated from or repatriated to ecosystems. Unexpected effects of trophic cascades on various taxa and processes include changes to bird, mammal, invertebrate, and herpetofauna abundance or richness; subsidies to scavengers; altered disease dynamics; carbon sequestration; modified stream morphology; and crop damage. Promoting tolerance and coexistence with large carnivores is a crucial societal challenge that will ultimately determine the fate of Earth's largest carnivores and all that depends upon them, including humans.
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