Surgical techniques for neuroma prevention
Which method has the best results on post op pain ,
As systematic review.
Centro-central union - finger amputations
All techniques demonstrated efficacy in the prevention of neuropathic pain – major limb amputations
Targeted muscle reinnervation.
Targeted nerve implantation
Concomitant nerve coaptation, and
Regenerative peripheral nerve implantation
Pain medication ranged between 16% and 50%
"A Randomized, Observer-Blinded Determination of the Median Effective Volume ...Lucie Beylacq
"A Randomized, Observer-Blinded Determination of the Median Effective Volume of Local Anesthetic Required to Anesthetize the Sciatic Nerve in the Popliteal Fossa for Stimulating and Nonstimulating Perineural Catheters" Dr Xavier Paqueron, Dr Patrick Narchi, Jean-Xavier Mazoit, Dr François Singelyn, Dr Alain Benichou, and Dr Philippe Macaire
Austin Journal of Musculoskeletal Disorders is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of diseases and disorders that may adversely affect the function and overall effectiveness of the musculoskeletal system. The Journal focuses upon all the related aspects of musculoskeletal system disorders and the new advancements in the related treatments including Complex issues and injuries involving the musculoskeletal system and surgeries.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Austin Journal of Musculoskeletal Disorders accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of diseases and disorders that may adversely affect the function and overall effectiveness of the musculoskeletal system.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
"A Randomized, Observer-Blinded Determination of the Median Effective Volume ...Lucie Beylacq
"A Randomized, Observer-Blinded Determination of the Median Effective Volume of Local Anesthetic Required to Anesthetize the Sciatic Nerve in the Popliteal Fossa for Stimulating and Nonstimulating Perineural Catheters" Dr Xavier Paqueron, Dr Patrick Narchi, Jean-Xavier Mazoit, Dr François Singelyn, Dr Alain Benichou, and Dr Philippe Macaire
Austin Journal of Musculoskeletal Disorders is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of diseases and disorders that may adversely affect the function and overall effectiveness of the musculoskeletal system. The Journal focuses upon all the related aspects of musculoskeletal system disorders and the new advancements in the related treatments including Complex issues and injuries involving the musculoskeletal system and surgeries.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and technology with intent to bridge the gap between academia and research access.
Austin Journal of Musculoskeletal Disorders accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all related aspects of diseases and disorders that may adversely affect the function and overall effectiveness of the musculoskeletal system.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
Transcranial Magnetic Stimulation ( TMS) for Chronic PainDr. Rafael Higashi
Aula sobre avanço no tratamento da dor crônica com o uso de Estimulação Magnética Transcraniana (EMT) ministrada por Dr. Rafael Higashi, médico neurologista, no departamento de tratamento da dor do Centro Médico da Universidade de Nova York, NYU, EUA.
www.estimulacaoneurologica.com.br
Anesthesiology And Intraoperative Neurophysiological Monitoring Anurag Tewari MD
Anesthesiologists play a central role in optimizing IONM.
Intraoperative neuromonitoring (IONM) offers a near-real-time assessment of the functional integrity of the neuronal pathways during surgery. Evoked Potential signals may thus be regarded as surrogate markers of neuronal function and can be thought of as a repeated but limited neurological examination under general anesthesia. Optimization of anesthetic management contributes to the successful integration of IONM into perioperative care
A guide to beginners helping writing thesis protocol.
Comparison between USG guided Suprascapular Nerve block and Interscalene Nerve Block post operative analgesia after arthroscopic shoulder surgery- a prospective randomized double blind study.
Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.
The term Spinal Cord Injury is used to refer to neurological damage of the spinal cord
Any lesion involving the spinal cord result a syndrome called a “myelopathy”
Spinal cord injuries are defined as complete or incomplete according to the International Standards for the Neurological Classifification of SCI and the American Spinal Injuries Association Impairment Scale (AIS)
Complete lesions are defifined as AIS A, and incomplete lesions are defifined as AIS B, AIS C, AIS D or AIS E (Harvey, 2016)
Inguinodynia: Chronic pain after inguinal hernia surgery by Dr. Avisak Bhatta...abhishak bhattacharjee
This is the presentation on Inguinodynia where a complete definition has been formulated. It was presented in conference of Asia Pacific Hernia Society 2017 in Kaohsiung, Taiwan.
Le degré de relâchement musculaire en chirurgie coelioscopique de la vésicule biliaire fait partie du quotidien des discussions entre anesthésistes et chirurgiens au bloc opératoire. Au fond tous sont convaincus de l'efficacité du curare : le chirurgien qui le demande et l'anesthésiste qui pense lui à sa décurarisation.
Cette étude teste curarisation profonde versus curarisation de routine dans la chirurgie coelioscopique de la vésicule biliaire. Avec comme première question "est-ce qu'une curarisation profonde permet de travaillert avec une pression abdominable moindre?", pression dont on sait qu'elle est pourvoyeuse de douleur post-opératoire.
La réponse est que le degré de curarisation participe de façon marginale au confort du chirurgien... et ne permet pas plus fréquemment de travailler à pression abdominale basse.
AI in Healthcare APU Using AI in Healthcare for clinical Application research...Vaikunthan Rajaratnam
Discover how generative AI is transforming the face of healthcare. From accelerating drug discovery to empowering personalized treatment, this technology is reshaping the way we deliver and experience care."
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
A scoping review of the literature, its impact and challenges in healthcare, and a personal experience of its application in practice, teaching, and research.
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Transcranial Magnetic Stimulation ( TMS) for Chronic PainDr. Rafael Higashi
Aula sobre avanço no tratamento da dor crônica com o uso de Estimulação Magnética Transcraniana (EMT) ministrada por Dr. Rafael Higashi, médico neurologista, no departamento de tratamento da dor do Centro Médico da Universidade de Nova York, NYU, EUA.
www.estimulacaoneurologica.com.br
Anesthesiology And Intraoperative Neurophysiological Monitoring Anurag Tewari MD
Anesthesiologists play a central role in optimizing IONM.
Intraoperative neuromonitoring (IONM) offers a near-real-time assessment of the functional integrity of the neuronal pathways during surgery. Evoked Potential signals may thus be regarded as surrogate markers of neuronal function and can be thought of as a repeated but limited neurological examination under general anesthesia. Optimization of anesthetic management contributes to the successful integration of IONM into perioperative care
A guide to beginners helping writing thesis protocol.
Comparison between USG guided Suprascapular Nerve block and Interscalene Nerve Block post operative analgesia after arthroscopic shoulder surgery- a prospective randomized double blind study.
Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.
The term Spinal Cord Injury is used to refer to neurological damage of the spinal cord
Any lesion involving the spinal cord result a syndrome called a “myelopathy”
Spinal cord injuries are defined as complete or incomplete according to the International Standards for the Neurological Classifification of SCI and the American Spinal Injuries Association Impairment Scale (AIS)
Complete lesions are defifined as AIS A, and incomplete lesions are defifined as AIS B, AIS C, AIS D or AIS E (Harvey, 2016)
Inguinodynia: Chronic pain after inguinal hernia surgery by Dr. Avisak Bhatta...abhishak bhattacharjee
This is the presentation on Inguinodynia where a complete definition has been formulated. It was presented in conference of Asia Pacific Hernia Society 2017 in Kaohsiung, Taiwan.
Le degré de relâchement musculaire en chirurgie coelioscopique de la vésicule biliaire fait partie du quotidien des discussions entre anesthésistes et chirurgiens au bloc opératoire. Au fond tous sont convaincus de l'efficacité du curare : le chirurgien qui le demande et l'anesthésiste qui pense lui à sa décurarisation.
Cette étude teste curarisation profonde versus curarisation de routine dans la chirurgie coelioscopique de la vésicule biliaire. Avec comme première question "est-ce qu'une curarisation profonde permet de travaillert avec une pression abdominable moindre?", pression dont on sait qu'elle est pourvoyeuse de douleur post-opératoire.
La réponse est que le degré de curarisation participe de façon marginale au confort du chirurgien... et ne permet pas plus fréquemment de travailler à pression abdominale basse.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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5. Methods
Literature
search
•26 Mar 2021.
Databases
• Embase,
Medline,
Cochrane,
Web of
Science, and
Google
Scholar
The
PICOS
framework
Search
strategy
• (((neuroma*
OR
((neuropathic*
OR phantom*
OR stump*
OR nerve)
NEAR/2
PRISMA
guidelines
Selection
Data
Extraction
Synthesis
6. • undergoing amputation
Population
• Surgical management for neuroma
prevention in amputation
Intervention
• Standard nerve managemnet
Control
• Neuropathic pain
Outcome
• Clinical studies > 3
Study
design
7. Selection criteria
Inclusion:
• reported incidence or intensity of neuropathic
pain after surgical neuroma prevention
methods during primary amputation surgery.
Exclusion
• reporting non-surgical prevention techniques
• case reports
• case series with less than four patients
• non-human studies
• non-full articles, such as conference abstracts
• Non-English manuscripts.
8. Data extraction & quality scoring
•Oxford centre for Evidence-Based Medicine (CEBM)
•Data extracted
pain prevention technique
amputation level
incidence, and VAS scores for the pain
• primary outcome measure - incidence of RLP and PLP
• Due to significant heterogeneity, a random-effects model
was used (P < 0.001)
• meta-analysis is not possible
• qualitative evidence synthesis
20. Forest plot of both (A) residual limb pain (RLP) or (B) phantom limb pain (PLP) across
different interventions at finger amputations and major limb amputations. Due to significant
heterogeneity, a random-effects model was used. The red diamonds represent the pooled
prevalence for each group. The lowest diamond represents the overall effect for all groups.
The blue squared represent the prevalence for each individual population. The white line
within the squared represents the estimated variance of the prevalence
21. Implications
• Centro-central union - finger amputations
• All techniques demonstrated efficacy in the
prevention of neuropathic pain – major limb
amputations
oTargeted muscle reinnervation.
oTargeted nerve implantation
oConcomitant nerve coaptation, and
oRegenerative peripheral nerve implantation
• Pain medication ranged between 16% and 50%
22. Limitations
Different descriptions of pain and
outcomes.
Significant heterogeneity for a meta-
analysis.
Standardize outcomes measure -
objective and subjective LANSS pain
scale or Douleur Neuropathique 4