Use Of Assist Devices Research Articles

Evaluation of Depression and Cognitive Status in Geriatric Patients Undergoing Orthopedic Surgery.

Cognitive disorders are common in geriatric surgical patients We conducted a study to evaluate depression and cognitive behavior in geriatric patients undergoing orthopedic surgery. This descriptive cross-sectional study was conducted at a university hospital in Turkey, involving 262 elderly patients who underwent orthopedic surgeries. Data were collected using The Patient Information Form, Standardized Mini-Mental Test, and Geriatric Depression Scale. The mean score of the Standardized Mini-Mental Test scale of the patients after surgery was 17.97±4.99, mean score of the Geriatric Depression Scale was 6.20±2.78. The study revealed that 85.1% (n=223) of the participants had cognitive impairment and 69.1% (n=181) depressive symptoms. Additionally, cognitive impairment and depressive symptoms increased as age, pain scores, and length of hospital stay increased. Our research also showed that individuals with a history of falls, visual/hearing impairment, malnutrition, use of assistive devices, dependence on others for daily activities, non-educated or single, individuals are more likely to experience geriatric depression and have a higher of cognitive impairment. Additionally, patients who have had hip arthroplasty, have low hemoglobin levels, or have high ASA scores are more prone to cognitive impairment. Cognitive impairment was more common in patients with higher depression scores. Considering these findings, it is crucial to identify the cognitive disorders and depressive symptoms during their initial hospitalization to prevent or treat them in geriatric patients. Regular monitoring of geriatric patients in orthopedic clinics for symptoms of cognitive status and depression is recommended, and caregivers should be made aware of this issue. geriatric patients, orthopedic procedures, cognitive status, depression.

Motor function outcomes in children with open prenatal repair of Spina Bifida Aperta at 36-month follow-up: The Zurich cohort.

This study aimed to describe outcomes of motor function with a special focus on ambulation ability at 36 months among children with open prenatal repair of spina bifida aperta (SB). A prospective cohort study was conducted including 87 patients with open prenatal repair of SB at the investigating center born between 2010 and 2018. Anatomic lesion level and motor function level in the neonatal period, as well as motor function level, ambulation status, and use of orthotics and assistive devices at 36 months were assessed. At 36 months, ambulation was assessed in 86 children; of those, 86% (n = 74) were ambulating. Independent of ambulation, orthotics were worn in 81.6% (71/87) and assistive devices in 47.1% (41/87). Children with a lower lumbar or sacral motor function level were the first to reach independent ambulation and were more likely to ambulate at 36 months than children with higher motor function levels (p = < .001). The anatomic lesion level determined on the neonatal MRI correlated with ambulation status at 36 months (p = < 0.001). At 36 months, most children with open prenatal repair for SB showed favourable ambulation status. However, most still used assistive devices or orthotics. Anatomic lesion level on neonatal MRI, motor function level during the neonatal period, and motor function level at 36 months were associated with ambulation status at 36 months.

An exploration of status of chronic diseases and its influencing factors of older people in Chinese home care and long-term care facilities: a cross-sectional study.

As the population ages, the proportion of chronic diseases becomes more prevalent. This study aimed to investigate the current status of chronic diseases among the older people in home care (HC) and long-term care facilities (LTCFs) in China and to analyze its influencing factors. This cross-sectional study was conducted between 2021 and 2022. A multi-stage stratified random sampling and census sampling approach was used in this survey of the health of 389 older people in HC and 202 older people in LTCFs from Western Hunan, respectively. The following instruments were included in the survey "International Resident Assessment Instrument for Home Care (interRAI-HC)" and the "International Resident Assessment Instrument for Long-Term Care Facilities (interRAI-LTCF)." Univariate analysis was used to examine the prevalence of chronic diseases among older people with different characteristics. Data were analyzed by IBM SPSS version 25.0 software. A p-value of <0.05 was considered statistically significant. The survey results showed that the prevalence of chronic diseases among older people in HC was 73.26% (95% CI, 68.85-77.68), and the top five chronic diseases were hypertension (26.36%), bone and joint disease (23.36%), gastrointestinal and gallbladder disease (11.78%), heart disease (11.21%), and diabetes (8.97%). The prevalence of chronic diseases among older people in LTCFs was 77.23% (95% CI, 77.23-83.06), and the top five chronic diseases were hypertension (33.11%), bone and joint disease (13.25%), cerebrovascular disease (12.91%), diabetes (11.26%), and heart disease (10.26%). The results showed that long time spent alone, having sleep disorders, and self-rated health status significantly increased HC in older people with the prevalence of chronic diseases (p < 0.05). Having marital status, non-healthy BMI, having sleep disorder, walking with the use of assistive devices, and self-rated health status significantly increased older people in LTCFs with the prevalence of chronic diseases (p < 0.05). There are differences in the prevalence and distribution of chronic diseases among older people in two different aged care models in China, and there are various risk factors for chronic diseases. Therefore, chronic disease healthcare strategies should be tailored to two different aged care models for older people. Further summary found that older people in HC spend a lot of time alone and suffer from loneliness, which ultimately causes psychological disorders. Thus, psychological adaptation interventions are needed for older people in HC. Besides, older people in LTCFs lack social support from their families (divorced/widowed) and have activity disorders (walking with the use of assistive devices). Thus, social adaptation interventions are needed for older people in LTCFs. This study provides a theoretical basis for the distribution of healthcare and the prevention and treatment of chronic diseases in Chinese older people.

발달장애학생의 학습과 학교생활 긍정적 변화를 위한 특수교사의 교육용 보조기기 적용 경험의 의미 탐색

Objectives The purpose of this study is to examine the application experiences of assistive devices for the pos-itive change of learning and school life of students with developmental disabilities in special schools, and to ex-plore the significance of these experiences. Based on this, we aim to derive measures to activate the use of edu-cational assistive devices.&#x0D; Methods To achieve this, in-depth interviews were conducted with six special education teachers who have ex-perience applying assistive devices to students with developmental disabilities. The meaning of these experi-ences was analyzed following a comprehensive analytical procedure for qualitative data, and based on the ana-lyzed meaning of the experiences, measures for activation were also derived.&#x0D; Results The results of this study are as follows. First, for future participation in digital educational activities and communication, it is essential to utilize educational assistive devices for students with developmental disabilities. There's a need not just for support centered on special education teachers but for structural support at the school level. In particular, to address the issues revealed in remote learning due to COVID-19, there's a need to expand support for educational assistive devices, provide guides, develop curriculum content based on universal learning design, and increase home support through measures like digital tutors. Second, to enhance the usability of edu-cational assistive devices in school settings, it's necessary to conduct assistive technology assessments for stu-dents with disabilities based on their life stages. For systematic support of educational assistive devices at the national level, there's a need to establish structures like an “Educational Assistive Device Center.”&#x0D; Conclusions To apply educational assistive devices for students with developmental disabilities, there's a need to reframe not just as simply providing the devices but as offering individual-centered tailored service support. There's also a necessity to place assistive device experts within special education support centers or similar in-stitutions to ensure comprehensive and continuous assistive technology assessments and post-management at the local level.

Factors Predicting Discharge Disposition Following Head and Neck Free Flap Reconstruction.

Patients undergoing head and neck free flap reconstruction (HNFFR) may have significant change to their baseline functional status requiring inpatient rehabilitation (IPR) after discharge. We sought to identify patient/procedure characteristics predictive of discharge destination. Patients undergoing elective HNFFR between July 2017 and July 2022 were reviewed for discharge destination. Those discharged to IPR versus home were compared across patient/procedure characteristics and physical/occupational therapy metrics. Significance was assessed via bivariate and multivariable analyses. Of the 531 patients, 102 (19.2%) required IPR postoperatively. Patients discharged to IPR versus home were significantly older (70.1 [11.6] vs. 64.1 [13.1] years; p < 0.001) and more likely to lack family assistance (26.5% vs. 8.6%; p < 0.001), require baseline assistance for activities of daily living (ADLs) (31.4% vs. 9.8%; p < 0.001), have baseline cognitive dysfunction (15.7% vs. 6.1%; p = 0.001), were more likely to have neoplasm as the surgical indication for HNFFR (89.2% vs. 80.0%; p = 0.033) and more likely to have a tracheostomy postop (62.7% vs. 51.7%), and had a significantly longer length of stay (11.2 [8.0] vs. 6.8 [8.3] days; p < 0.001). There was no significant difference in gender, donor site, use of tube feeds, and use of assistive devices between the two groups. Following logistic regression, the strongest predictors of discharge to IPR include lack of family assistance (OR = 3.8; p < 0.001) and baseline assistance for ADLs (OR = 4.0, p < 0.001). Certain patient factors predict the need for discharge to rehab after HNFFR. Perioperative identification of these factors may facilitate patient counseling and discharge planning with potential to reduce hospital length of stay and further optimize patient care. III Laryngoscope, 134:2721-2725, 2024.

Expanding clinical profiles and prognostic markers in stiff person syndrome spectrum disorders

ObjectiveTo describe the clinical features of a cohort of individuals with stiff person syndrome spectrum disorders (SPSD) and identify potential early predictors of future disability.BackgroundThere is a need to better understand the full spectrum of clinical and paraclinical features and long-term impact of SPSD.Design/MethodsObservational study from 1997 to 2022 at Johns Hopkins. Clinical phenotypes included classic SPS, partial SPS (limb or trunk limited), SPS-plus (classic features plus cerebellar/brainstem involvement), and progressive encephalomyelitis with rigidity and myoclonus (PERM). Outcome measures were modified Rankin scale (mRS) and use of assistive device for ambulation. Multivariate logistic regression was used to assess significant predictors of outcomes.ResultsCohort included 227 individuals with SPSD with mean follow-up of 10 years; 154 classic, 48 SPS-plus, 16 PERM, and 9 partial. Mean age at symptom onset was 42.9 ± 14.1 years, majority were white (69.2%) and female (75.8%). Median time to diagnosis was 36.2 months (longest for SPS-plus and PERM) and 61.2% were initially misdiagnosed. Most had systemic co-morbidities and required assistive devices for ambulation. Female sex (OR 2.08; CI 1.06–4.11) and initial brainstem/cerebellar involvement (OR 4.41; CI 1.63–14.33) predicted worse outcome by mRS. Older age at symptom onset (OR 1.04; CI 1.01–1.06), female sex (OR 1.99; CI 1.01–4.01), Black race (OR 4.14; CI 1.79–10.63), and initial brainstem/cerebellar involvement (OR 2.44; CI 1.04–7.19) predicted worse outcome by use of assistive device. Early implementation of immunotherapy was associated with better outcomes by either mRS (OR 0.45; CI 0.22–0.92) or use of assistive device (OR 0.79; CI 0.66–0.94).ConclusionsWe present the expanding phenotypic variability of this rare spectrum of disorders and highlight potential predictors of future disability.

An Osteopathic Approach to Urinary Incontinence Including Biopsychosocial Aspects and Multiple Modalities for a Holistic Approach to Optimize Ongoing Care

Urinary incontinence is a nuanced and stigmatized condition that causes significant challenges for a large number of people in the United States and imposes a large financial and community burden. We provide an overview of major categorizations of incontinence by type as well as potential etiologies. We discuss how this condition impairs self-image, interferes with socialization, and can lead to depression and isolation; these elements inter-relate with access to care and implementation of the therapeutic options, further exacerbating patient suffering. We recognize the key components of patient evaluation regarding history and physical examination. Medicinal, surgical, and assistive device use are reviewed. Osteopathic manipulative treatments addressing the structures of the pelvis are also reviewed in detail. We illustrate how these techniques can be used to optimize outcomes. Utilizing a holistic approach to mitigate the multiple challenges that this condition presents can lead to greater success, reduced distress, and improved patient satisfaction.

Musculoskeletal and Psychological Rehabilitation.

Although it has long been believed that stress has a detrimental effect on health and the risk of disease, little research has been done on the precise mechanisms by which this happens. The literature produced by past workers suggests many possibly intersecting mechanistic pathways that might be useful for future fundamental and clinical study. Exercise has been thoroughly researched as a non-pharmacologic strategy to increase bone mass. Many evidence-based treatment recommendations for patients suffering from osteoporosis-related fractures, potential courses of care, and rehabilitation concur that multidisciplinary therapy would be the most beneficial. Older and recent articles about musculoskeletal and psychological rehabilitation in the management of osteoporosis published in prominent and reputed journals are reviewed. Important and interesting information from some of the cross-references is also included. Opinions and impressions from the experience of treating osteoporosis are added while describing various aspects of psychological and physical rehabilitation. The recent evidence, reviewed here, also indicates the possibility of cross-effects between osteoporosis and psychological issues. A multi-factorial and personalised strategy should be explored for improved outcomes in patients under psychological stress, particularly those at increased risk of osteoporosis development. Reviewing current publications, the objectives of rehabilitation are evolving based on the disease's stage. For example, during the initial stage of a vertebral body collapse, the patient is treated with bracing, physical therapy, education, local and systemic analgesics, and a brief period of bed rest. The need to mobilise the patient carefully and safely along with a mix of medical care, dietary supplements, rehabilitation, and instructions to facilitate daily living activities, are endorsed to manage post-fracture osteoporosis. This chapter is not to make treatment advice, but rather to outline potential connections between psychological stress and low bone density and to emphasise potential multi-system consequences of pharmaceutical therapies. The goal is to enhance activities of daily living, which will increase safety, minimise falls, and maintain bone mass. Osteoporosis and fragility fractures can be prevented and managed with regular medical check-ups, daily exercise and yoga, a healthy diet, fall prevention measures,recreational groupactivities, supportive medications, control ofcomorbidities, use of assistivedevices, and customised rehabilitation programmes.

The reality of occupational harm incurred by Japanese home health care nurses, the hazardous situations they face, and protective measures: a cross-sectional study.

Objectives: To gain a comprehensive understanding of the occupational hazards encountered by home health care nurses in Japan and to elucidate the reality of harm they incur, the hazardous situations, and the protective measures taken Methods:A questionnaire survey of managers of home health care nursing agencies in Japan was conducted, and 355 valid responses were obtained. The survey questions concerned the occupational hazards experienced by home health care nursing staff. The occupational hazards were classified into 6 categories, and responses were obtained regarding harm, hazardous situations, and protective measures in each category Results: The types of harm that occurred at highest rates during the previous 3 years were emotional abuse by the patient or their family members, lower back pain resulting from improper posture while providing care, sexual harassment by the patients and their family members, automobile accidents while traveling to home care sites, and allergic reactions to the environment at home care sites. Some hazardous situations were caused by the unique environments of home care sites Conclusions: In order to prevent the occurrence of harm, the development of risk assessment tools, educational initiatives to increase awareness of occupational hazards, and consideration of the financial and technical support that will enable the use of assistive devices in the practice of nursing techniques were considered necessary. The development of effective guidelines and manuals specific to the occupational hazards encountered by home health care nurses is an important challenge

Cost consequence analysis of transcutaneous tibial nerve stimulation (TTNS) for urinary incontinence in care home residents alongside a randomised controlled trial

BackgroundUrinary incontinence (UI) is prevalent in more than half of residents of nursing and residential care homes and can have a detrimental impact on dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. We examined the costs and consequences of delivering TTNS to care home residents in comparison to sham (inactive) electrical stimulation.MethodsA cost consequence analysis approach was used to assemble and present the resource use and outcome data for the ELECTRIC trial which randomised 406 residents with UI from 37 care homes in the United Kingdom to receive 12 sessions of 30 min of either TTNS or sham (inactive) TTNS. TTNS was administered by care home staff over 6 weeks. Health state utility was measured using DEMQOL-U and DEMQOL-PROXY-U at baseline, 6 weeks and 18 weeks follow-up. Staff completed a resource use questionnaire at baseline, 6 weeks and 18 weeks follow-up, which also assessed use of absorbent pads.ResultsHRQoL did not change significantly in either randomised group. Delivery of TTNS was estimated to cost £81.20 per participant, plus training and support costs of £121.03 per staff member. 85% of participants needed toilet assistance as routine, on average requiring one or two staff members to be involved 4 or 5 times in each 24 h. Daily use of mobility aids and other assistive devices to use the toilet were reported. The value of staff time to assist residents to use the toilet (assuming an average of 5 min per resident per visit) was estimated as £19.17 (SD 13.22) for TTNS and £17.30 (SD 13.33) for sham (per resident in a 24-hour period).ConclusionsUse of TTNS to treat UI in care home residents did not lead to changes in resource use, particularly any reduction in the use of absorbent pads and no cost benefits for TTNS were shown. Managing continence in care homes is labour intensive, requiring both high levels of staff time and use of equipment aids.Trial registrationISRCTN98415244, registered 25/04/2018. NCT03248362 (Clinical trial.gov number), registered 14/08//2017.

Effectiveness of Safe Patient Handling Equipment and Techniques: A Review of Biomechanical Studies.

This review aimed to evaluate all studies that have evaluated the biomechanical effects when using assistive devices. The physical demands of patient handling activities are well known. One safety strategy for the reduction of the physical risks is use of assistive devices. The search process identified articles published in English-speaking journals through Google Scholar, Medline, and ISI Web of Science. The included 56 studies contained a biomechanical assessment of a patient handling activity with assistive devices. The biomechanical effects included four groups: changes in body posture (spinal, other joints), subjective assessment (force, effort, discomfort), measured force (hand force, ground reaction force, spine force, joint torque), and physiological measures. The evidence showed caregivers benefited from using lift hoists, air-assisted devices, and to a lesser extent friction reducing devices for lateral transfers and repositioning, while floor and ceiling lifts were most effective for patient transfers. Some gaps were noted in the evidence and other handling tasks such as sit-to-stand, turning patient in bed, limb lifting, and repositioning and some more high hazard activities like supporting people with limited balance and those that fall need to be investigated with respect to biomechanical outcomes. There is a growing level of biomechanical evidence to support the use of assistive devices for many patient-handling tasks, but the benefits of equipment use in some transfers remain uninvestigated. Evidence indicates the best way to lift patients safely is with floor or ceiling lifts, and air-assisted devices for lateral and repositioning tasks.

Abstract 16289: Functional Status Improves Following Heart Transplantation for Most Patients and Functional Status at One Year Predicts Five-Year Survival

Introduction: Heart transplantation is a critical treatment for end-stage heart disease, with the goal of improving both length and quality of life. We investigated predictors of functional status improvement following transplant and the impact of functional status at 1 year on survival. Methods: We used data from the Scientific Registry of Transplant Recipients on 34,649 U.S. adults who received a heart transplant from Jan. 2006 - Jul. 2020. Functional status was measured using the Karnofsky Performance Scale (KPS; 0-100%). Linear regression with stepwise selection was used to identify predictors of change in KPS from listing to transplant, and from transplant to 1 and 5 years post-transplant. Kaplan Meier curves with log-rank testing was used to compare 5-year survival between patients with poor (≤50%) versus non-poor (&gt;50%) KPS at 1 year. Results: Mean KPS was low at listing (47.9%, SD 22.4%) and discharge following transplant (45.6%, SD 24.1%). At 1-year post-transplant, the mean KPS increased to 85.8% (SD 17.7%), which was stable at 5 years (Figure). There was a small difference in KPS at 1 and 5 years based upon KPS at listing (p&lt;0.0001). After adjusting for KPS at transplant and transplant center, predictors of the magnitude of KPS change from transplant to 1 year included insurance type, diabetes, hypertension, prior cardiac surgery, smoking, “1A” waitlist priority, and hospitalization status. Predictors of KPS change from transplant to 5 years included insurance type, diabetes, ventricular assist device use, prior cardiac surgery, sex, and age. Only 5.5% of patients had poor KPS (≤50%) at 1 year. Of these patients, 5-year survival was significantly lower at 72.9% compared to 88.3% among patients with KPS&gt;50% at 1 year (p&lt;0.0001). Conclusions: Functional status is an important outcome following heart transplant and impacts survival. Most patients alive at 1 year have excellent KPS but clinical and social interventions may help optimize KPS among at-risk patients.

Parental Perspective on Impact of Hearing Assistive Devices on Children with Hearing Impairment

Being a common disability in Pakistan, hearing impairment causes the problem in the language development of the child. This cause delay in their speech and language development and need of using hearing assistive devices to fulfill their communicational needs. Parental perceptions regarding their children’s auditory behaviors by using these hearing assistive devices is essential. Objective: To evaluate the Parental perception of impact of hearing assistive devices of children with hearing impairment using PEACH questionnaire. Methods: This cross-sectional Study was conducted from Nov-2018 to Oct-2019 at Isra Institute of Rehabilitation Sciences, Isra University, Islamabad. Sample recruited N=100 parents of children with mild to profound hearing loss using hearing aids and cochlear implants using convenience sampling. Sample included both genders and 1 to 15 years of age. Basic demographic sheet and PEACH (Parents’ Evaluation of Aural/Oral Performance of Children) Questionnaire was used for data collection. The data were analyzed by SPSS version-22. Results: Results revealed a significant (p&lt;0.05) association of Peech Category with type of hearing assistive device use with higher number of children with typical performance noted in cochlear implant 38(62.3%) group compared to hearing aid users17(43.6%) in quite environment. In noisy environment too, significantly (p=0.001) more cases 47(77.0%) revealed typical performance compared to hearing aid users. 18(46.2%). Children with higher hearing age and those who received speech therapy revealed better performance on PEACH questionnaire (p&lt;0.001). Conclusions: Children using cochlear implants have better listening in everyday life conditions compared to hearing aid. It provides comprehension and understanding of language than hearing aid.

Left Ventricular Assist Device Use in Minorities: An Analysis of the National Inpatient Sample.

Minorities are less likely to receive a left ventricular assist device (LVAD). This, however, is based on total implant data. By examining rates of LVAD implant among patients admitted with heart failure complicated by cardiogenic shock, we sought to further elucidate LVAD utilization rates and racial disparities. Utilizing the National Inpatient Sample from 2013 to 2019, all patients admitted with a primary diagnosis of heart failure complicated by cardiogenic shock were included for analysis. Those who then received an LVAD during that hospitalization defined the LVAD utilization which was examined for any racial disparities. Left ventricular assist device utilization was low across all racial groups with no significant difference noted in univariate analysis. Non-Hispanic Blacks had the highest length of stay (LOS), the highest proportion of discharge to home (71.52%), and the lowest inpatient mortality (6.33%). Multivariable modeling confirmed the relationship between race and LOS; however, no differences were noted in mortality. Non-Hispanic Blacks were found to be less likely to receive an LVAD; however, when controlling for payer, median household income, and comorbidities, this relationship was no longer seen. Left ventricular assist devices remain an underutilized therapy in cardiogenic shock. When using a multivariable model, race does not appear to affect LVAD utilization.

Early Outcomes of Operative Versus Nonoperative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries.

To compare the early outcomes of patients with stress-positive minimally displaced lateral compression type 1 (LC1b) pelvic ring injuries managed with or without operative fixation. Retrospective comparison study. Level 1 trauma center. Forty-three patients with LC1b injuries. Operative versus nonoperative. Discharge to subacute rehabilitation (SAR); 2- and 6-week pain visual analog score, opioid use, assistive device use, percentage of normal single assessment numerical evaluation, SAR status; fracture displacement; and complications. The operative group did not differ in age, gender, body mass index, high-energy mechanism, dynamic displacement stress radiographs, complete sacral fractures, Denis sacral fracture classification, Nakatani rami fracture classification, follow-up length, or American Society of Anesthesiologists classification. The operative group was less likely to be using an assistive device at 6 weeks [observed difference (OD) -53.9%, 95% confidence interval (CI) -74.3% to -20.6%, OD/CI 1.00, P = 0.0005], less likely to remain in an SAR at 2 weeks (OD -27.5%, CI, -50.0% to -2.7%, OD/CI 0.58, P = 0.02), and had less fracture displacement at follow-up radiographs (OD -5.0 mm, CI, -9.2 to -1.0 mm, OD/CI 0.61, P = 0.02). There were no other differences in outcomes between treatment groups. Complications occurred in 29.6% (n = 8/27) of the operative group compared with 25.0% (n = 4/16) of the nonoperative group resulting in 7 and 1 additional procedures, respectively. Operative treatment was associated with early benefits over nonoperative management, including shorter time using assistive devices, less SAR use, and less fracture displacement at follow-up. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Achilles tendon pathologies

Achilles tendon pathologies are afrequent problem in the clinical practice. Adistinction must be made between insertional and noninsertional tendinopathies. In addition to intrinsic risk factors, such as diabetes mellitus, there are also extrinsic risk factors, such as overuse and running. Sonography, X‑ray imaging and magnetic resonance imaging (MRI) are established imaging methods, depending on the question. The primary treatment includes aconservative approach. First-line treatment includes administration of nonsteroidal anti-inflammatory drugs (NSAID), physical rest and the use of assistive devices. Established conservative treatment procedures include eccentric stretching, shockwave therapy and infiltration with, e.g., platelet-rich plasma. There are numerous other conservative treatment options. After exhausting the conservative treatment options, asurgical approach can be considered. The surgical procedure depends on the clinical symptoms and findings. Established procedures are minimally invasive or endoscopic procedures or even open debridement.

Social Determinants of Hip Fractures in Elderly Patients–A Case-Control Study

Aim: Hip fractures are common orthopedic traumas and are known as a problem in terms of public health, particularly among the elderly. Preventing fractures and determining risk factors are critical in reducing morbidity, mortality, and social and economic burden. The purpose of this study was to examine the social determinants affecting hip fractures. &#x0D; Material and Methods: This case-control study was conducted with a case group of 108 (36.1%) patients and a control group of 191 (63.9%). Hip fracture status was selected as the dependent variable in the study. The independent variables were marital status, place of residence, single-story or multi-story residence, use of stairs, use of assistive devices, cohabitants, working status, chronic disease status, education status, fixed income status, health insurance, family history of hip fractures, fractures in the last five years, getting help in daily work, smoking, fear of falling, and perception of general health status.&#x0D; Results: Marital status, cohabitants, chronic disease status, having a fixed income, having health insurance, fear of falling, and perception of general health differed to a significant extent between the case and control groups. Nonetheless, no statistically significant difference was found between the groups regarding their places of residence, living in whether single-story or multi-story residences, the use of stairs, assistive device usage, active employment status, education status, family history of hip fractures, fractures in the last five years, getting help in daily work, and smoking.&#x0D; Conclusion: Social factors affect the risk of hip fracture. Clinicians should be alert to the importance of this issue and raise the awareness of elderly patients.

The incidence of deep venous thrombosis in Parkinson’s disease

ABSTRACT Introduction Venous thromboembolism is one of the causes of sudden death in Parkinson’s Disease (PD). Few studies have investigated the correlation between PD and deep venous thrombosis (DVT). This study aimed to investigate the frequency of DVT in PD patients prospectively. Material and Method Demographic characteristics of 37 PD patients without known risk factors for DVT, disease duration, Hoehn-Yahr (H – Y) stage, oxygen saturation (SpO2) and heart rate values with pulse oximetry, use of assistive devices, waist and knee circumference measurements, and modified Medical Research Council (mMRC) dyspnea score was recorded. Both legs were evaluated for thrombus by Doppler venous ultrasound (US). Results With the H-Y stage of the disease duration, a positive correlation was determined between the H-Y stage and mMRC. Disease duration was negatively correlated with BMI and positively correlated with the need for assistance. Assistive device use was positively associated with age and mMRC. DVT was detected in only one patient. When our patients’ files were reviewed after 1.5 years, one patient was hospitalized with the diagnosis of submassive pulmonary embolism. Conclusion Attention should be paid to the development of DVT in elderly patients with advanced stages of PD, progression in the H-Y stage, use of assistive devices, and progression in dyspnea scoring. There is also a need for studies on the benefit of DVT prophylaxis in PD patients with a high risk of venous thromboembolism.

Intelligent embedded system for physiological control of ventricular assist devices in health 4.0 Background

The use of Left Ventricular Assist Devices (LVADs) has proven to be an effective treatment option for Congestive Heart Failure (CHF) patients who are not eligible for heart transplantation. These devices can serve as a bridge to heart transplantation (BTT) or as destination therapy (DT). While LVADs operate at a constant flow, this can affect the patient's quality of life and survival rate. To address this issue, Health 4.0 (H4) has developed new technological resources to personalize control systems and integrate medical devices into treatment. In this effort, a Physiological Control of LVAD (PC-LVAD) system was implemented within the H4 platform, using an Intelligent Embedded System (IES). The IES was developed using the MyRIO® development platform and tools such as LabVIEW® FPGA and RT, Quartus II® EDA, and MATLAB®. To evaluate its performance, preliminary criteria were assessed in experimental tests, analyzing the Internet of Things (IoT) characterization and applying best practices for information security. The results of the experimental tests showed that the IES could store and transmitting data in real-time to a graphical interface, and the data were found to be consistent with external measuring instruments.

Impact of adherence to disease modifying therapies on long-term clinical and economic outcomes in multiple sclerosis: A claims analysis of real-world data.

Multiple sclerosis (MS) is a chronic neurodegenerative inflammatory disease that requires long-term commitment to treatment for optimal outcomes. A variety of disease-modifying therapies (DMTs) are now available that reduce relapses and delay disease progression in people with MS. However, adherence remains a significant issue, with a variety of mental, physical, and emotional factors contributing to non-adherence. In a large number of studies, non-adherence has been associated with worse clinical outcomes (relapses and disease severity), a higher economic burden, and loss of work productivity. However, many of these studies were short-term (1-2 years) or cross-sectional studies; thus, more data are needed on the long-term clinical and economic impacts of DMT non-adherence. The objective of this study was to determine the longer-term impact of adherence to DMTs on disease activity and healthcare resource utilization (HCRU) in people with MS. The study hypothesis was that non-adherence to DMTs would be associated long-term with worse clinical outcomes and a higher economic burden. A retrospective administrative claims analysis of the US MarketScan® Commercial database (2011-2017) in individuals (18-65 years) with MS (based on International Classification of Disease coding) was conducted. Adherence was classified by proportion of days covered (PDC) ≥0.8 and non-adherence by PDC <0.8; sensitivity analyses helped further categorize as moderately (PDC ≥0.6-<0.8) or highly (PDC <0.6) non-adherent. Cohorts were matched using propensity score matching. Time to first relapse, annualized relapse rate (ARR), time to use of assistive devices (cane/walker or wheelchair), and annual HCRU (inpatient, emergency room [ER], outpatient, and MRI visits and costs) were compared between cohorts. 10,248 MS cases were identified; 58% met adherence criteria, and 42% met non-adherence criteria. Mean follow-up from diagnosis or first DMT claim was 5.3 years. Adherent individuals had a longer time to first relapse (hazard ratio [HR] 0.83; 95% confidence interval [CI]: 0.77-0.90; p<0.0001), a lower ARR (0.13vs. 0.18, respectively; rate ratio [RR] 0.75 [95% CI: 0.71-0.79]; p<0.0001), and longer lag times to cane/walker use (HR 0.79 [95% CI: 0.66-0.94]; p=0.0067) and wheelchair use (HR 0.68 [95% CI: 0.55-0.83]; p=0.0002) than non-adherent individuals. Adherent individuals had fewer annual inpatient and ER visits and lower total costs than those who were non-adherent (p<0.0001). Sensitivity analyses showed that differences in disease activity and HCRU were generally more pronounced between matched adherent and highly non-adherent pairs than between matched adherent and moderately non-adherent pairs. Significant differences in MS disease activity and HCRU were observed based on adherence to DMTs. Our study underscores the negative impact of non-adherence to DMTs on long-term clinical and economic outcomes in MS.