Presentation at Otto Bock Scandinavia - focusing on the diabetic foot and covering screening, biomechanics and orthotic management for ulcer prevention and treatment
Diabetes is a global public health problem. In particular, type 2 diabetes is imposing a growing burden on health care systems as the number of people affected continues to grow. The economic and human costs are high. We see, for example, that foot problems due to diabetes account for more hospital inpatient days than any other diabetes related complication. Prevention of ulceration is a key aspect of care but it isnʼt always easy to achieve. Diabetic foot problems can develop extremely quickly, with tissue breakdown often complicated by infection. Everything possible must be done to prevent tissue breakdown though good medicine and effective therapeutic footwear prescribed according to the personʼs individual level of risk. An individualʼs risk of ulceration determines the strategy for prevention or treatment and also influences the nature and extent of the resources that must be committed.
Preserving and protecting the diabetic foot has been described as a mechanical challenge - a problem of mechanics as much as medicine - and in this presentation we discuss why this is so. We examine the terms used to describe this complex mechanical environment.
However, everything I will tell you is “a lie” - but hopefully a useful lie. The reason for this comes down to how biomechanics - that is - engineering applied to gain an understanding of body systems - must rely on “models” of reality. These models are imperfect - they are simplifications that we can hold to be true for a while or just for certain specific situations. When we use terms like force, pressure, stress and strain we should do so acknowledging the inherent limitations of our viewpoint.
There is a lot of confusion on the topic of shoes for persons with diabetic foot disease. We seem to lack clarity about exactly how shoes for diabetic patients should be designed, manufactured and prescribed.
The principles of biomechanics imply that it is nonsense to suggest that there is such a thing as a “diabetic shoe” or that what is needed is footwear that is “soft and roomy.” In the minds of many, especially administrators and budget holders, there is a belief that prescription shoes can't be all that complicated. Health care systems strive to treat things often as a commodity so that they can be bought at the lowest cost. As in many aspects of life the subject is much more complex than we might like.
In the UK, and perhaps many other countries professionals in our field have a responsibility to educate budget holders on the true complexity of foot care for persons with diabetes and establish approaches that recognise the natural limitations of biomechanics
This presentation discusses the design and development of medicated footwear for diabetic patients. It outlines 10 objectives for the project, including learning about materials used, safety features incorporated, and foot troubles related to diabetes. The document then provides details on the pathophysiology of diabetic foot complications and how specially designed shoes can help reduce risks. Design aspects of the proposed diabetic footwear are presented, along with testing methods for shoe insoles. Challenges in diabetic footwear such as lack of awareness and economic limitations are also examined.
This document systematically reviews literature on footwear prescription for ulcer prevention and reduction in diabetic patients. It found 6 randomized controlled trials examining footwear and insole interventions to offload the diabetic foot. Factors influencing plantar pressures included footwear/insole design and compliance. In-shoe pressure analysis was effective for selecting target regions for offloading and modifying footwear. Further high-quality clinical trials are needed to inform how footwear design aspects affect diabetic populations.
Dina Mekhail is an accomplished technical writer with experience in FDA regulated manufacturing operations. She has expertise reengineering batch records and procedures to improve product quality and yields. Her skills include knowledge of FDA regulations, Lean Manufacturing, Six Sigma, and technical writing. She has held contract roles as a Technical Writer and Process Improvement Specialist for Ortho Clinical Diagnostics, where she standardized documents, qualified equipment, and led projects. She aims to provide innovative solutions to meet operational goals.
Gary D. Lowery has over 15 years of experience as a shop foreman at Aggreko, LLC in Pearland, TX. He has extensive training and certifications in electrical systems, refrigeration, HVAC equipment, diesel and electric power generation, and safety. His education includes an associate's degree in electrical/electronics and certification in PLC programming.
Delta Socks Ltd produces various types of socks including diabetic socks and socks with nano technology. The document provides details on 11 different sock styles including composition, sizing, weight, and price. It also describes the benefits of nano diabetic socks such as odor management, moisture wicking, and promotion of healthy circulation.
The document discusses COSECSA's efforts to address the shortage of surgeons in East, Central and Southern Africa. It notes that over 5 billion people lack access to safe and affordable surgery. COSECSA has worked to enhance surgical training programs, increase the number of examinations, and build infrastructure like the East and Central African Journal of Surgery. Through partnerships with organizations like RCSI, it has helped train over 1,600 surgeons who have an 84% retention rate in Africa. COSECSA aims to continue developing sustainable indigenous training initiatives to address the large unmet need for surgical services in the region.
Screening, Assessment and Prescription in Diabetic Foot DiseaseDerek Jones
Presentation at the BAPO Conference in Telford 2013. Starts by describing the screening and assessment process for the diabetic foot and the important differences between them. It describes the importance of risk stratification of the individual as this will determine the essential characteristics of the protective footwear for the individual. The key to effective management is to make sure that individuals are treated according to their risk of ulceration. Keeping those at the lowest risk from progressing is vital for cost efffective management. The presentation also describes the nature of the orthotic prescription and how this should relate to the patients risk level.
Diabetes is a global public health problem. In particular, type 2 diabetes is imposing a growing burden on health care systems as the number of people affected continues to grow. The economic and human costs are high. We see, for example, that foot problems due to diabetes account for more hospital inpatient days than any other diabetes related complication. Prevention of ulceration is a key aspect of care but it isnʼt always easy to achieve. Diabetic foot problems can develop extremely quickly, with tissue breakdown often complicated by infection. Everything possible must be done to prevent tissue breakdown though good medicine and effective therapeutic footwear prescribed according to the personʼs individual level of risk. An individualʼs risk of ulceration determines the strategy for prevention or treatment and also influences the nature and extent of the resources that must be committed.
Preserving and protecting the diabetic foot has been described as a mechanical challenge - a problem of mechanics as much as medicine - and in this presentation we discuss why this is so. We examine the terms used to describe this complex mechanical environment.
However, everything I will tell you is “a lie” - but hopefully a useful lie. The reason for this comes down to how biomechanics - that is - engineering applied to gain an understanding of body systems - must rely on “models” of reality. These models are imperfect - they are simplifications that we can hold to be true for a while or just for certain specific situations. When we use terms like force, pressure, stress and strain we should do so acknowledging the inherent limitations of our viewpoint.
There is a lot of confusion on the topic of shoes for persons with diabetic foot disease. We seem to lack clarity about exactly how shoes for diabetic patients should be designed, manufactured and prescribed.
The principles of biomechanics imply that it is nonsense to suggest that there is such a thing as a “diabetic shoe” or that what is needed is footwear that is “soft and roomy.” In the minds of many, especially administrators and budget holders, there is a belief that prescription shoes can't be all that complicated. Health care systems strive to treat things often as a commodity so that they can be bought at the lowest cost. As in many aspects of life the subject is much more complex than we might like.
In the UK, and perhaps many other countries professionals in our field have a responsibility to educate budget holders on the true complexity of foot care for persons with diabetes and establish approaches that recognise the natural limitations of biomechanics
This presentation discusses the design and development of medicated footwear for diabetic patients. It outlines 10 objectives for the project, including learning about materials used, safety features incorporated, and foot troubles related to diabetes. The document then provides details on the pathophysiology of diabetic foot complications and how specially designed shoes can help reduce risks. Design aspects of the proposed diabetic footwear are presented, along with testing methods for shoe insoles. Challenges in diabetic footwear such as lack of awareness and economic limitations are also examined.
This document systematically reviews literature on footwear prescription for ulcer prevention and reduction in diabetic patients. It found 6 randomized controlled trials examining footwear and insole interventions to offload the diabetic foot. Factors influencing plantar pressures included footwear/insole design and compliance. In-shoe pressure analysis was effective for selecting target regions for offloading and modifying footwear. Further high-quality clinical trials are needed to inform how footwear design aspects affect diabetic populations.
Dina Mekhail is an accomplished technical writer with experience in FDA regulated manufacturing operations. She has expertise reengineering batch records and procedures to improve product quality and yields. Her skills include knowledge of FDA regulations, Lean Manufacturing, Six Sigma, and technical writing. She has held contract roles as a Technical Writer and Process Improvement Specialist for Ortho Clinical Diagnostics, where she standardized documents, qualified equipment, and led projects. She aims to provide innovative solutions to meet operational goals.
Gary D. Lowery has over 15 years of experience as a shop foreman at Aggreko, LLC in Pearland, TX. He has extensive training and certifications in electrical systems, refrigeration, HVAC equipment, diesel and electric power generation, and safety. His education includes an associate's degree in electrical/electronics and certification in PLC programming.
Delta Socks Ltd produces various types of socks including diabetic socks and socks with nano technology. The document provides details on 11 different sock styles including composition, sizing, weight, and price. It also describes the benefits of nano diabetic socks such as odor management, moisture wicking, and promotion of healthy circulation.
The document discusses COSECSA's efforts to address the shortage of surgeons in East, Central and Southern Africa. It notes that over 5 billion people lack access to safe and affordable surgery. COSECSA has worked to enhance surgical training programs, increase the number of examinations, and build infrastructure like the East and Central African Journal of Surgery. Through partnerships with organizations like RCSI, it has helped train over 1,600 surgeons who have an 84% retention rate in Africa. COSECSA aims to continue developing sustainable indigenous training initiatives to address the large unmet need for surgical services in the region.
Screening, Assessment and Prescription in Diabetic Foot DiseaseDerek Jones
Presentation at the BAPO Conference in Telford 2013. Starts by describing the screening and assessment process for the diabetic foot and the important differences between them. It describes the importance of risk stratification of the individual as this will determine the essential characteristics of the protective footwear for the individual. The key to effective management is to make sure that individuals are treated according to their risk of ulceration. Keeping those at the lowest risk from progressing is vital for cost efffective management. The presentation also describes the nature of the orthotic prescription and how this should relate to the patients risk level.
Screening, Assessment and Footwear Prescription in Diabetic Foot DiseaseDerek Jones
This is our presentation for the British Association for Prosthetists and Orthotists meeting to be held in Telford, March 22/23rd 2013. We cover foot screening, assessment and footwear prescription in diabetic foot disease. Footwear in diabetes is much misunderstood. It is important that footwear is prescribed with an understanding of the individual patient's risk level. We describe a rational process for doing this. All footwear for persons with diabetic foot disease may have some consistent features - but there is no such thing as "diabetic footwear" in the sense of one design being good for everyone.
This document discusses updates in the diagnosis and treatment of osteoporosis. It defines osteoporosis as a disease characterized by low bone mass and deterioration of bone structure. Osteoporosis increases the risk of fractures, with vertebral fractures being the most common. It can lead to pain, disability, and increased mortality. An estimated 8 million women and 2.5 million men in the US have osteoporosis, and these numbers are expected to increase by 40% by 2020. Osteoporosis poses a significant economic burden and reduces quality of life. Advances have been made in assessing fracture risk levels based on 10-year probability in addition to bone mineral density scores. Treatment involves lifestyle changes and medications
Stop the Line – Empowering Clinicians to Recognize and Act on Impending Adver...marcus evans Network
Sara Atwell, RN, MHA, Oakwood Healthcare System - Speaker at the marcus evans National Healthcare CNO Summit 2012, held in Hollywood, FL, April 26-27, 2012, delivered her presentation entitled Stop the Line – Empowering Clinicians to Recognize and Act on Impending Adverse Events
The document discusses mandibular fractures, including the most common site being the parasymphysis. It covers surgical anatomy, classification systems, diagnosis, treatment approaches like closed or open reduction, and complications. Treatment involves reestablishing occlusion through methods like intermaxillary fixation or rigid fixation for displaced fractures. Infection is the most common complication, ranging from 5-10%, and treatment approach, fixation technique, and surgeon experience can impact complication rates.
This document discusses the management of open fractures. It defines an open fracture as one where the skin and soft tissue is broken, communicating with the fracture site. Initial management involves assessing injuries, covering wounds, antibiotics, and debridement to remove dead tissue. Fractures are then stabilized, either externally or internally. Wounds are closed primarily if possible or allowed to heal secondarily. Complications can include early issues like infection or late problems like nonunion. Grading and scoring systems help determine prognosis and need for amputation. The goal is always limb salvage when possible.
Incident Severity Ratios Inevitability Or OpportunityGavin_Bruwer
This document discusses Bird's triangle, which shows the relationship between minor incidents and more serious outcomes. It argues that organizations should focus on investigating minor incidents to uncover contributing factors and develop controls, rather than just reacting after serious incidents. The triangle can be used proactively by defining exposure units, reporting fields, leading indicators, and continuously improving controls for contributing factors identified. This will help reduce inherent risks and prevent potential for more serious incidents.
Fracture Lecture 2/4 (General Notes)
(Human anatomy)
by DR RAI M. AMMAR
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www.twitter.com/drraiammar
www.instagram.com/drraiammar
www.linkedin.com/in/drraiammar
www.themedicall.com/blog/auther/drraiammar/
For Any Book or Notes Visit Our Website:
www.allmedicaldata.wordpress.com
www.drraiammar.blogspot.com
YOUTUBE CHANNEL :
https://www.youtube.com/channel/UCu-oR9V3OdFNTJW5yqXWXxA
ANY QUESTION ??
Get in touch with us at Any of the Above Social Media or Email at
drraiammar@gmail.com
allmedicaldata@gmail.com
The document discusses oncology nursing and cancer treatment modalities. It defines the 7 cardinal signs of cancer and differentiates between benign and malignant tumors. The goals of cancer therapy are described as curative, control, or palliative. The major cancer treatment modalities - surgery, radiation therapy, and chemotherapy - are explained along with associated nursing interventions. Toxic effects of treatment are outlined and nursing management of side effects is discussed.
This document provides guidance on basic wound assessment and management. It defines different types of wounds and stages of healing. It emphasizes the importance of thorough assessment of wounds including location, size, depth, presence of infection. The goals of wound care are to debride, manage infection, pack dead space lightly, absorb excess exudate, maintain a moist wound surface, protect the healing area. Selection of appropriate dressings depends on wound characteristics.
The document discusses key concepts in economic entomology, including injury, damage, economic levels, economic thresholds, and economic injury levels. It defines injury as physical harm to a commodity caused by a pest, while damage refers to the monetary value lost due to injury. The economic level is the pest population level at which control actions must be taken to prevent quality or yield loss. The economic threshold is the pest density at which management should occur to prevent populations reaching the economic injury level, which is the lowest pest population that causes economic damage and justifies the cost of control.
Introduction to child health and disaster risk reductionkatiev007
Short Introductory overview of the concepts of Disaster Risk Reduction and impacts on Child Health. From DRR and Child Health Workshop Hyderabad India May 2012. First in a series of presentations that outline how to mainstream DRR into Child Health Programmes
This document discusses fractures in pediatric patients. It notes that fractures account for 15% of pediatric injuries and have unique features compared to adult fractures due to differences in bone structure, growth plates, and remodeling potential in children. Key points include descriptions of common fracture types like buckle/torus fractures and greenstick fractures. The Salter-Harris classification of physeal injuries is presented, along with factors that influence remodeling. Management principles and fixation methods are outlined. Complications are rarely seen in pediatric fractures due to children's natural healing abilities.
This document summarizes information about ensuring the safety of organs, tissues, and cells for transplantation. It notes that while they are generally considered safe, there are still risks of infection or disease transmission that require ongoing monitoring. Key points discussed include:
- The increasing volume of musculoskeletal allografts distributed each year, but unknown prevalence of infection.
- Potential risks at various stages from donation to implantation, including during the "window period" before tests can detect infections.
- Lessons learned from previous transmission cases where neither surgeons nor tissue banks recognized the graft as the infection source.
- The importance of competent authorities, adverse event reporting and investigation, and international collaboration through projects like EUSTITE to continuously
This document provides guidance on slip, trip, and fall prevention for healthcare workers. It identifies the top 10 slip, trip, and fall hazards specific to healthcare facilities, such as contaminants on floors, poor drainage, and tripping hazards. For each hazard, it explains how the hazard can cause slips, trips and falls, where the hazard is likely to occur, and provides recommendations to reduce or eliminate the hazard. The goal is to help healthcare facilities recognize common slip, trip and fall hazards and protect employees by implementing prevention strategies. The intended audience includes safety and health professionals responsible for safety in healthcare settings.
clavical fractures are most controversial in case of treatment modalities in orthopaedics. it is one of the common fracture of all ages. so we are explaining our point what to do or not?
https://userupload.net/ucq2c1km5pb7
Preventive dentistry aims to stop the progression of dental caries by promoting daily habits and clinical therapies that either promote the remineralization of the tooth surface or prevent the formation of the oral biofilm responsible for lowering the oral pH levels in an attempt to prevent cavity formation.
Here is an overall glance on some recent concepts/advances in preventive dentistry with a detail note on pit and fissure sealants
1) Falls are common among older adults, especially those over 80 years old, and can threaten their independence and quality of life. They often result from deficiencies in multiple domains like senses, muscle strength, cognition, chronic conditions, and medications.
2) Epidemiological studies show that 30-40% of older adults fall each year in the community, with higher rates in long-term care facilities. Injurious falls can result in fractures, hospitalization, admission to long-term care, and even death in some cases.
3) Risk factor assessment, physical and cognitive evaluation, and targeted interventions including exercise, medication review, and fall prevention programs can help reduce falls among older adults.
Pressure ulcers are frequently seen, expensive to treat and distressing for all concerned. The medical risk factors for ulceration are well recognised and when these are combined with undesirable mechanical effects - namely pressure and shear pressure ulcers arise. Pressure and shear effects can and should be managed just as diligently as the medical risk factors. In this presentation we look at heel pressure ulcers and how the PRAFO range can eliminate pressure and shear at the heels of at risk persons - whether recumbent or ambulant
RehaCom software for cognitive rehabilitation Derek Jones
RehaCom is a clinical proven software tool to support cognitive training and rehabilitation following a brain injury. Best results rely on restitution as well as compensation strategies and RehaCom's evidence based approach is effective across the main application domains.
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This is our presentation for the British Association for Prosthetists and Orthotists meeting to be held in Telford, March 22/23rd 2013. We cover foot screening, assessment and footwear prescription in diabetic foot disease. Footwear in diabetes is much misunderstood. It is important that footwear is prescribed with an understanding of the individual patient's risk level. We describe a rational process for doing this. All footwear for persons with diabetic foot disease may have some consistent features - but there is no such thing as "diabetic footwear" in the sense of one design being good for everyone.
This document discusses updates in the diagnosis and treatment of osteoporosis. It defines osteoporosis as a disease characterized by low bone mass and deterioration of bone structure. Osteoporosis increases the risk of fractures, with vertebral fractures being the most common. It can lead to pain, disability, and increased mortality. An estimated 8 million women and 2.5 million men in the US have osteoporosis, and these numbers are expected to increase by 40% by 2020. Osteoporosis poses a significant economic burden and reduces quality of life. Advances have been made in assessing fracture risk levels based on 10-year probability in addition to bone mineral density scores. Treatment involves lifestyle changes and medications
Stop the Line – Empowering Clinicians to Recognize and Act on Impending Adver...marcus evans Network
Sara Atwell, RN, MHA, Oakwood Healthcare System - Speaker at the marcus evans National Healthcare CNO Summit 2012, held in Hollywood, FL, April 26-27, 2012, delivered her presentation entitled Stop the Line – Empowering Clinicians to Recognize and Act on Impending Adverse Events
The document discusses mandibular fractures, including the most common site being the parasymphysis. It covers surgical anatomy, classification systems, diagnosis, treatment approaches like closed or open reduction, and complications. Treatment involves reestablishing occlusion through methods like intermaxillary fixation or rigid fixation for displaced fractures. Infection is the most common complication, ranging from 5-10%, and treatment approach, fixation technique, and surgeon experience can impact complication rates.
This document discusses the management of open fractures. It defines an open fracture as one where the skin and soft tissue is broken, communicating with the fracture site. Initial management involves assessing injuries, covering wounds, antibiotics, and debridement to remove dead tissue. Fractures are then stabilized, either externally or internally. Wounds are closed primarily if possible or allowed to heal secondarily. Complications can include early issues like infection or late problems like nonunion. Grading and scoring systems help determine prognosis and need for amputation. The goal is always limb salvage when possible.
Incident Severity Ratios Inevitability Or OpportunityGavin_Bruwer
This document discusses Bird's triangle, which shows the relationship between minor incidents and more serious outcomes. It argues that organizations should focus on investigating minor incidents to uncover contributing factors and develop controls, rather than just reacting after serious incidents. The triangle can be used proactively by defining exposure units, reporting fields, leading indicators, and continuously improving controls for contributing factors identified. This will help reduce inherent risks and prevent potential for more serious incidents.
Fracture Lecture 2/4 (General Notes)
(Human anatomy)
by DR RAI M. AMMAR
www.facebook.com/drraiammar
www.twitter.com/drraiammar
www.instagram.com/drraiammar
www.linkedin.com/in/drraiammar
www.themedicall.com/blog/auther/drraiammar/
For Any Book or Notes Visit Our Website:
www.allmedicaldata.wordpress.com
www.drraiammar.blogspot.com
YOUTUBE CHANNEL :
https://www.youtube.com/channel/UCu-oR9V3OdFNTJW5yqXWXxA
ANY QUESTION ??
Get in touch with us at Any of the Above Social Media or Email at
drraiammar@gmail.com
allmedicaldata@gmail.com
The document discusses oncology nursing and cancer treatment modalities. It defines the 7 cardinal signs of cancer and differentiates between benign and malignant tumors. The goals of cancer therapy are described as curative, control, or palliative. The major cancer treatment modalities - surgery, radiation therapy, and chemotherapy - are explained along with associated nursing interventions. Toxic effects of treatment are outlined and nursing management of side effects is discussed.
This document provides guidance on basic wound assessment and management. It defines different types of wounds and stages of healing. It emphasizes the importance of thorough assessment of wounds including location, size, depth, presence of infection. The goals of wound care are to debride, manage infection, pack dead space lightly, absorb excess exudate, maintain a moist wound surface, protect the healing area. Selection of appropriate dressings depends on wound characteristics.
The document discusses key concepts in economic entomology, including injury, damage, economic levels, economic thresholds, and economic injury levels. It defines injury as physical harm to a commodity caused by a pest, while damage refers to the monetary value lost due to injury. The economic level is the pest population level at which control actions must be taken to prevent quality or yield loss. The economic threshold is the pest density at which management should occur to prevent populations reaching the economic injury level, which is the lowest pest population that causes economic damage and justifies the cost of control.
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Short Introductory overview of the concepts of Disaster Risk Reduction and impacts on Child Health. From DRR and Child Health Workshop Hyderabad India May 2012. First in a series of presentations that outline how to mainstream DRR into Child Health Programmes
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This document summarizes information about ensuring the safety of organs, tissues, and cells for transplantation. It notes that while they are generally considered safe, there are still risks of infection or disease transmission that require ongoing monitoring. Key points discussed include:
- The increasing volume of musculoskeletal allografts distributed each year, but unknown prevalence of infection.
- Potential risks at various stages from donation to implantation, including during the "window period" before tests can detect infections.
- Lessons learned from previous transmission cases where neither surgeons nor tissue banks recognized the graft as the infection source.
- The importance of competent authorities, adverse event reporting and investigation, and international collaboration through projects like EUSTITE to continuously
This document provides guidance on slip, trip, and fall prevention for healthcare workers. It identifies the top 10 slip, trip, and fall hazards specific to healthcare facilities, such as contaminants on floors, poor drainage, and tripping hazards. For each hazard, it explains how the hazard can cause slips, trips and falls, where the hazard is likely to occur, and provides recommendations to reduce or eliminate the hazard. The goal is to help healthcare facilities recognize common slip, trip and fall hazards and protect employees by implementing prevention strategies. The intended audience includes safety and health professionals responsible for safety in healthcare settings.
clavical fractures are most controversial in case of treatment modalities in orthopaedics. it is one of the common fracture of all ages. so we are explaining our point what to do or not?
https://userupload.net/ucq2c1km5pb7
Preventive dentistry aims to stop the progression of dental caries by promoting daily habits and clinical therapies that either promote the remineralization of the tooth surface or prevent the formation of the oral biofilm responsible for lowering the oral pH levels in an attempt to prevent cavity formation.
Here is an overall glance on some recent concepts/advances in preventive dentistry with a detail note on pit and fissure sealants
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2) Epidemiological studies show that 30-40% of older adults fall each year in the community, with higher rates in long-term care facilities. Injurious falls can result in fractures, hospitalization, admission to long-term care, and even death in some cases.
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This document discusses a study on the effects of glove rehabilitation therapy (Gloreha) for post-stroke patients. The study assessed effects on motor skills, visual-spatial exploration, attention, and spasticity. Ten rehabilitation sessions over two weeks were administered. Results showed improvements in visual-spatial tests for one patient, attention for all patients, manual dexterity and functional capacity for some, and reduced spasticity for one patient. The study concluded that Gloreha integration of motor and cognitive rehabilitation showed benefits.
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The challenge of taking advantage of the current digital revolution to produce custom footwear efficiently. The production of individually designed and fitted footwear is very important for persons with diabetes at high risk of ulceration.
Conservative Management of Severe OA Knees with the V-VAS OrthosisDerek Jones
This presentation won best paper award at BAPO (British Association of Prosthetics & Orthotics) Conference in 2008. The focus is on conservative management of severe OA knee pain and deformity using the V-VAS Knee orthosis from Anatomical Concepts
1) Biomimetics and orthotics aim to take inspiration from nature to develop new technologies for assisting human movement and correcting physical limitations.
2) Nature provides many examples of structures and mechanisms that control motion, position body segments, and redirect forces, which can serve as models for orthotic design.
3) The development of biomimetic orthotics involves identifying gaps in current technologies, researching equivalent biological solutions, and generating new product ideas that are unique, cost-effective and sustainable.
The challenge of commercialising medical devicesDerek Jones
A presentation delivered at the Scottish Centre for Innovation in Spinal Cord Injury, May 2011 by Derek Jones to an audience of clinicians, engineers and scientists
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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5. A drop in the ocean?
Diabetes Expenditure
•
10% million affected inaffected world
2.9 of the UK NHS BudgetBudget
285 million UK NHS UK
10% of the people the
£9 Billion per Year
wide - 6.4% of population
• £9£286 per per Year
Billion Second
Lifetime risk of foot ulceration - 25%
• £286 per Second
6. Cost Burden for
Patients
Varies with Country
Cost of treating diabetic foot ulcers in five different countries.
Cavanagh P, Attinger C, Abbas Z, Bal A, Rojas N, Xu ZR.
Diabetes Metab Res Rev. 2012 Feb;28 Suppl 1:107-11. doi: 10.1002/dmrr.2245.
11. Screening Is..
The Starting Point
for Effectiveness
Quick & Simple
Assess Patient’s
Risk Level
Not the Same as
Assessment
12. What Do We
Screen For?
Previous Amputation
Significant deformity
Significant callus
Active ulceration
Previous ulceration
Vascular insufficiency
Neurological insufficiency
Able to self care?
14. Risk Stratification 5 % Active Ulcers or
5 % Active Ulcers or
Infection --
Infection
revascularisation or
revascularisation or
amputation
amputation
Multidisciplinary
Multidisciplinary
management
management
15 % High Risk
15 % High Risk
Intensive foot
Intensive foot
protection
protection
Ulcerated
20 % Moderate
20 % Moderate
High Risk Risk
Risk
60% Low Risk
60% Low Risk Regular foot
Regular foot
Routine annual
Routine annual protection
protection
screening
screening
Moderate Risk
Low Risk
15. Match the Strategy & Activity to the
Individual’s Level of Risk
LOW RESULT is...
• Most Effective Use of
MEDIUM Resources
• Ulcer Prevention
HIGH • Keep the Individual at
Lowest Risk of
Ulceration
ACTIVE
21. Sho es
abe tic” and R oomy
“Di Soft
U ppers
Pressure Relief? Sto ck?
or
o ke
esp Rock
B er Sol
W e M us t S e?
ave Money
.. But Who Has the
Skills?
Relieve Pressure?
How
Complicated
Can Shoes Be..?
25. Prevent Ulceration
Strategy according to individual risk
Ulcerated
Improve
Extrinsic
Influences High Risk
Moderate Risk
Low Risk
26. Problem is one of
Mechanics
Paul Brand
"The whole problem is one of mechanics, not of medicine.
The biological responses of these denervated limbs are
qualitatively similar to those of normal limbs.
It is the permitted pattern of mechanical stress that is different"
28. Preventing Trauma Means
Controlling the Mechanical
“Environment”
sure
Pr es
on chan ics
. nsati e
s . Se y
a
h d e M natom
ot re su A
Fo lte d Tis al Friction
A e re
✓ Alt truct ur
✓ and S She
ar
✓ For
ce
29. Elevated Plantar Pressure
Causative Factor
in
Ulceration
and Ulceration is often
a
Precursor to
Amputation
30. High Pressure is Bad
Friction & Shear
are Very Bad
But do we understand
these terms?
Are we using them
correctly?
41. Mechano-transduction
Mechanisms by which cells convert mechanical stimulus
into physiological activity - anabolic and catabolic
A field holding the keys to progress?
46. • Shoe and Contact Surface
(footbed) Must Work Together
• Materials & Structures Chosen &
Positioned for BOTH Control
and Tissue Matching
• Shoes Need to act like the
“Skeleton” as well as the “Soft
Tissues” - Support as well as
protect
• “Soft” Uppers not Necessarily
Best - Match to the Ambulatory
Status and Load Expectations
Preserving and protecting the diabetic foot has been described as a mechanical challenge - a problem of mechanics as much as medicine - and in this presentation we touch upon why this is so. We are going to point out some of the complexity behind terms such as pressure, friction and shear stress and the implications for footwear design. We conclude by listing some of the principles to keep in mind when designing shoes for the diabetic foot.
Preserving and protecting the diabetic foot has been described as a mechanical challenge - a problem of mechanics as much as medicine - and in this presentation we touch upon why this is so. We are going to point out some of the complexity behind terms such as pressure, friction and shear stress and the implications for footwear design. We conclude by listing some of the principles to keep in mind when designing shoes for the diabetic foot.
There is certainly a lot of confusion on the topic of shoes for persons with diabetic foot disease. We seem to have a general lack of clarity about exactly how shoes for diabetic patients should be designed, manufactured and prescribed. There is certainly confusion - even an abuse of terminology. In the minds of many, there is a belief that prescription shoes can't be all that complicated. However this is a mistaken belief. As in many aspects of biomechanics, the subject is much more complex than we might like.
With the diabetic foot, we understand that each affected individual may well have neuropathy, tissues of the foot that have mechanical characteristics that differ from "normal" ranges - and altered anatomical structures. These mechanical characteristics will vary from person to person, and are modified by the disease process and even will vary in one person over time. As we move through our environment the interaction - the points of contact - we have with our environment has mechanical and therefore biological consequences. The forces generated, for example, manifest as changing patterns of pressure, friction and shear force at the foot-shoe interface and deep within the tissues of the foot.
Well at a simpler level - what do we know for sure? We know that high pressure is bad and that friction and shear are potentially very bad. We also know that localised pressure, creating pressure gradients and localised tissue deformation generates damaging shear stresses. But that level of knowledge isn't sufficient to help us with the ideal shoe design. In order to influence design we need to delve deeper and this is where biomechanics can be useful.
Now I'd better start with a confession. Everything I will tell you is a lie - but hopefully a useful lie. The reason for this comes down to how biomechanics - that is - engineering applied to gain an understanding of body systems - must rely on models of reality. And these models are never perfect - they are simplifications that we can hold to be true for a while or for certain specific situations. The fact is, sooner or later a better model - and improved understanding - comes along. So when we use terms like force, pressure, stress and strain we should do so acknowledging the inherent limitations of our viewpoint.
Most of us believe we have a good grasp of the physical meaning of pressure. After all, its simple to imagine how pressure is created though the application of load over an area - but its difficult to accurately measure. And its not just a surface effect when we apply load to tissue. The skin, muscle and soft tissues deform and experience these mechanical loads in different ways. Many of the strategies that are applied in the creation of footbeds and footwear aim to spread applied loads over a greater area - thereby reducing the local pressure gradients.
Using a mixture of measurement and mathematics we can predict for example how different interface materials will influence the surface pressures and shear stress. These approaches are always simplifications because we have to make assumptions about the conditions that prevail. Of course we wish to manage the performance of the interface between foot and shoe - knowing that in use the parameters that we need to fine tune that performance vary from situation to situation and from person to person.
Two of the terms we frequently hear are "Friction" & "Shear". Actually, strictly speaking, there are a number of different types of friction and shear. Friction is the force that resists the relative motion of solid surfaces in contact. It is in practical terms very difficult to calculate a value for friction - it generally has to be determined empirically. Friction and Shear Stress occur together and this is why we try to minimise them in footwear for diabetics. Shear Stress results when a force acts coplanar to a surface with the result that the tissues deform. And when the tissue deforms and flexes to extremes we have part of the precursor for ulceration.
If we take a look at tissue closely we see that it is not homogenous. There are actually multiple layers of skin, fat, muscle, bone and other structures - each with different behaviours under load. An of course the foot and ankle is a dynamic jointed structure that is meant to be rigid at some phases of gait and flexible at others. Engineers have studied areas of the foot such the heel pad to understand how such tissue behaves under dynamic loading conditions such as those experienced during gait. As we try to model this type of situation we truly discover it's inherent complexity. Notice that the dynamic behaviour of the tissue might be modelled using forms well understood by engineers.
When we have to make choices about shoe design for diabetics we have to be mindful of the need for foot protection and control. Just as we saw with tissue, we potentially have multiple layers that have individual mechanical characteristics and shapes with the potential to harm or protect. During walking and other activities the shoe will flex and twist and thought must be given to how the shoe and tissues will interact. By all means have materials that behave like tissue in contact with the plantar surface and high load bearing areas of the foot. But we need to be mindful about how the whole shoe and footbed work together. If the thickness and weight of the upper is not matched to the flexibility of the sole unit, for example, the shoe is likely to distort under the loads generated during walking - the result will be undesirable pressure, friction and shear.
Here is a short list of principles that should guide us. First of all we need accurate, reliable measurements of the foot. At present we have a plethora of techniques and beliefs about how measurement should be done. Clearly if measurements cannot be taken consistently and reliably we are off to a bad start. Some areas of the foot are particularly sensitive to localised pressure gradients and therefore prone to ulceration. The insole and components of the shoe should be designed to work together. It is not good enough to put a soft "tissue like" insole inside a shoe and hope for the best. Materials chosen to behave like tissue should go close to tissue if we are to minimise stress. However, these insole materials need to interface with the structure of the shoe. Take a look at the human body that has layers of tissue for good reason. The skeleton, ligaments and tendons transmit force whilst the soft tissues absorb dynamic stresses and strains. The shoes we design should act like the skeleton too - not just like the soft tissues. They should allow safe transmission of dynamic load and should allow control and protection to be imposed. To think that shoes should always have "soft roomy uppers" is very inaccurate and mechanically flawed thinking. Of course we should choose the materials carefully and position them within a shoe so that they have the desired effect of control or tissue matching.