Activity In Patients Research Articles

Factors Associated with Patient Activation in People with Heart Failure based on the Individual and Family Self-Management Theory: A Cross-sectional Study.

Patient activation (PA) is crucial for effective self-management of people with heart failure (HF). Clarifying factors associated with PA might be important to develop interventions to promote PA. This study aimed to explore Context factors associated with PA in people with HF. 268 patients were enrolled in a cross-sectional study (Median age=65 years). We surveyed variables based on Context factors of the Individual and Family Self-Management Theory (IFSMT), including demographic and disease factors, quality of chronic care, family function, and depression. Correlation analysis was conducted for data analysis, and path analysis was used to verify our hypothesis model about Context factors and PA. The median PA score was 51.10. Path analysis showed that age, educational level, living arrangement, device therapy, quality of chronic care, family function, and depression were directly or indirectly related to PA. The quality of chronic care mediated the associations between device therapy and educational level and PA. Age, educational level, living arrangement, and quality of chronic care affected family function and then affected activation. Depression mediated the relationships between the quality of chronic care, educational level, family function, and PA. This study increased the understanding of factors associated with PA in the HF population. When assessing PA in people with HF, those who are older, have a low educational level, living alone need more attention from healthcare professionals. Interventions focusing on improving the quality of chronic care, family function, and depression might help activate people to practice self-management.

Additional Scapular Spine Bone Grafting Combined with Bankart and Remplissage for Off-Track Hill-Sachs Lesions with Subcritical Glenoid Bone Loss: Provides Better Stability.

Arthroscopic Bankart repair combined with remplissage and autologous scapular spine bone grafting have been described as a treatment for off-track Hill-Sachs lesions with subcritical glenoid bone defects in the anterior shoulder instability. However, whether these two techniques can achieve satisfactory postoperative outcomes is unclear, and there are few comparative studies between them. Therefore, this study compared the postoperative efficacy of the two techniques for off-track Hill-Sachs lesions with subcritical glenoid bone loss. Between June 2017 and December 2020, 62 patients with shoulder instability due to Off-Track Hill-Sachs lesions with subcritical glenoid bone loss underwent surgical treatment and were included in this regression study. Thirty-two patients underwent arthroscopic Bankart repair combined with remplissage (B + R group), and 30 patients underwent additional autologous scapular glenoid bone grafting (additional bone grafting group). The general information of the patients was recorded. The patient's activity before and after surgery was recorded. The DASH score and Constant-Murley (CM) score were used to assess the patient's functional status; the Rowe score was used to evaluate the patient's shoulder stability. The shoulder function and stability before and after surgery were analyzed and compared between the two groups. The final DASH scores of the B + R group and the additional bone grafting group were significantly lower than those before surgery, with a statistically significant difference (9.76 ± 4.32 vs. 27.89 ± 6.63, 8.50 ± 3.32 vs. 28.0 ± 4.27, p = 0.000); the final CM scores of the two groups were significantly higher than those before surgery (88.71 ± 3.74 vs. 73.68 ± 3.74, 87.16 ± 2.29 vs. 71.37 ± 2.68, p = 0.000). There was no statistical difference in the final DASH score and final CM score between the two groups (p > 0.05). In terms of postoperative stability, the final Rowe scores of the two groups were significantly higher than those before surgery, with a statistically significant difference (89.06 ± 9.19 vs. 41.71 ± 4.13; 93.16 ± 4.99 vs. 42.33 ± 2.53, p = 0.000). Compared with the control group, the additional bone graft group achieved higher final Rowe scores (93.16 ± 4.99 vs. 89.06 ± 9.19, p = 0.032). For patients with anterior shoulder instability due to off-track Hill-Sachs lesions with subcritical glenoid bone loss, although Bankart and remplissage can achieve satisfactory clinical results, additional autogenous scapular spine bone grafting can provide better stability of the shoulder, especially for patients with high sports demands.

Navigating Laser Treatments for Scars: The Physical and Emotional Journey.

The physical and emotional burden that scars impose on people's lives has been the concern of dermatological research for quite some time. Usually, the available literature on the topic draws a grim image containing solely dry medical facts. The present study deviates from this approach by reflecting a solution-centered study which has also touched on the quotidian life of an average person. The overall intention of the present experiment was to inspect how a holistic approach to scars in dermatology can be crucial for the patient's quality of life. This pilot study compiles data collected through the Patient and Observer Scar Assessment Scale (POSAS) and the Dermatology Life Quality Index (DLQI) from the same set of patients within the span of a year. Sixty patients with diverse scar profiles were asked to rate POSAS and DLQI in every session. A combination of EBDs was used based on the scar examination. Student's t-test was run to validate the data. The evaluations by POSAS and DLQI indicate significant improvement in the physical aspect of the scar as well as the patient quality of life a year after the first treatment. According to mean values collected from POSAS, there is a direct correlation between average patient evaluations and physician assessments. Thus, EBDs prove to be efficient in improving the QoL of scar patient. The 20 patients who had reported mild side effects after treatments recovered fully within a few days after the sessions. No patient reported severe side effects. Apart from the physical indications that scars bring about into patients' lives, the psychological repercussions caused by scars have a major effect on the QoL of the patients. These repercussions can be divided into individual and social. At the individual level, scars have a profoundly negative effect on the image of the self which leads to several different psychological complications by time. At the social level, scars affect the radius of physical movement besides the quality of the patient's activities. Therefore, EBDs as effective treatment methods can improve itchiness, pain, and so forth, of the patient, and can also improve the psychological aspect. All in all, the present study aims to produce a more panoramic perspective on the concern of scars in the field of dermatology, centering around EBDs as a solution for improving scar patient QoL. With a focus on the efficacy of EBDs in the scar treatment, and with reference to studies on the topic, it is safe to assume that the earlier the scar treatment initiates, the better the outcomes. Departing from this point, in the future of cosmetic dermatology, prepping the skin by EBD treatments before surgery is imaginable.

Pectoralis Major Muscle Tear – Effectiveness Orthobiologic Nonoperative Treatment with Platet-Rich Plasma (PRP) Injections

Introduction Pectoralis major muscle ruptures, once considered rare, are now more common, especially in young male athletes and weightlifters involved in high-intensity sports. This injury can significantly impair upper limb function, leading to pain, weakness, and potential disability. Exploring and understanding available treatment options, particularly the promising role of orthobiologic therapies like PRP, is essential for optimizing recovery and achieving the best outcomes. Purpose The purpose of this review is to evaluate the effectiveness and the role of orthobiologic treatments such as PRP in enhancing healing and functional recovery for pectoralis major muscle ruptures. Conslusions The treatment of pectoralis major muscle ruptures requires a tailored approach that considers the injury's severity, the patient's activity level, and their goals. Nonoperative treatment can be effective for partial tendinous tears, muscle belly tears, muscle origin tears, and complete tendinous tears in sedentary individuals or when surgery is not feasible. Surgical intervention generally provides superior functional outcomes, particularly for athletes and those with complete ruptures. Orthobiologic treatments, such as ultrasound-guided PRP injections, provide a promising complement to conservative management, with potential benefits in pain reduction and accelerated functional recovery. Studies indicate that PRP-treated patients report higher satisfaction and better outcomes compared to those without PRP treatment. Nevertheless, many questions remain regarding the optimal formulation, dosage, and rehabilitation protocols for PRP. To fully understand PRP's effectiveness and refine its applications in sports medicine, more rigorous and long-term studies are needed. Additionally, further research is required to improve nonoperative treatment and rehabilitation protocols, ensuring optimal outcomes for all patients.

One type of graft for reconstruction of the ACL does not suit all patients based on their characteristics and sports: a scoping review.

The selection of graft type for anterior cruciate ligament reconstruction remains a topic of debate, taking into consideration patient characteristics, as well as the type and level of sports involvement. The aim of this scoping review was to investigate patient characteristics that might influence the selection of graft type for anterior cruciate ligament reconstruction. PubMed and Scopus were searched to identify articles for inclusion. All included studies focused on one or more patient characteristics involved in the decision-making process regarding anterior cruciate ligament reconstruction autograft, including the hamstrings tendon (HT), patellar tendon (BPTB) and quadriceps tendon (QT). Out of the 1,977 initial studies, 27 studies were included in this review. The BPTB graft seems to be the preferred choice in young patients, females, and athletes-especially those engaged in pivoting sports. The HT graft seems to be the preferred choice in less active and older patients, along with those involved in sports where knee extensors are vital. The HT graft is not preferable in patients with a small body height and graft diameter. Moreover, surgeon preferences were also of importance for graft selection. The success of a specific graft type in anterior cruciate ligament reconstruction is highly dependent on the patient's characteristics and type of sport. Patient characteristics such as age, gender, body height, graft diameter, and the patient's activity level should all be considered when choosing the appropriate graft type.

Physical exercise to promote regeneration after peripheral nerve injury in animal models: A systematic review.

Peripheral nerve injuries are common injuries that often have a drastic effect on patient's activities of daily living and physical function. While techniques for the surgical repair of these injuries have improved over time, rehabilitation methods following these repairs have been non-standardized and under researched. Electronic searches were conducted in Ovid/Medline and SCOPUS to identify articles that discuss rehabilitation and exercise following peripheral nerve injury in animal models and its effects on peripheral nerve regeneration and recovery of function. Thirty-eight articles met inclusion criteria; all were prospective studies in animal models. This systematic review suggests that exercise is a useful tool in returning autonomy to the individual and has beneficial effects in the recovery from peripheral nerve injury. It is beneficial to use rehabilitation exercises following the repair of peripheral nerve injuries to promote regeneration, and timing of that exercise may be just as important as the exercise prescribed. However, further studies with standardized models and outcome measures need to be conducted before translation to clinical trials.

Validation of the patient reported experiences and outcomes of safety in primary care compact Form Brazil.

To analyze the psychometric properties of the cross-culturally adapted version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) Compact Form Brazil. A methodological study was conducted with 281 adult Primary Health Care users. Data collection took place online. Confirmatory Factor Analysis (CFA) was used to evaluate the psychometric properties of the PREOS-PC after the process of cross-cultural adaptation to the Brazilian context. Internal consistency was evaluated through Cronbach's alpha coefficient (α) and McDonald's omega coefficient (ω). The sample consisted of 73.3% women. The mean age was 36.1 years (SD = 12.2). Of the 23 items of the PREOS-PC that were eligible for CFA, a model with four correlated domains and 16 items presented satisfactory fit indexes. The domains were Practice Activation (PrA) (four items), Patient Activation (PaA) (two items), Experiences of patient safety events (EPaS) (five items) and Outcomes of patient safety (OPaS) (six items). One domain (GPeS) presented one question with a 0 to 10 response scale and two open questions, which cannot be inserted in the CPA due to the nature of the items, but can be included in the application of the scale, being evaluated individually. In this factorial model, five items (EPaS2, EPaS3, EPaS4, EPaS5, EPaS6 and EPaS8) presented factor loadings ≤ 0.30. The α and ω values demonstrated good internal consistency for all domains of the PREOS-PC. The Brazilian version of the PREOS-PC Compact Form Brazil composed of four domains (PrA, PA, EPaS and OPaS) and 16 items presented evidence of validation of its psychometric properties and can be used to evaluate the experiences and results of patient safety in Primary Health Care in the Brazilian context.

Fitness to Work in a Hansen's Disease Worker With a Disability: A Case Report.

Hansen's disease not only causes problems for patients in the workplace, but also increases the possibility of transmission to other workers. This case report discusses the fitness-to-work assessment for a Hansen's disease patient with a disability. A 19-year-old female, who worked as an online shop warehouse staff, presented at our hospital with a wound on her left hand accompanied by numbness. The patient's activity indicated mild limitations with a SALSA score of 25. A seven-step process for evaluating fitness to work was conducted. These steps involved assessing the patient's medical condition, disability, job demands, risks, and tolerance to determine the appropriate work status. This patient was declared fit to work with a note as online shop warehouse staff. She must take care of herself by maintaining good personal hygiene and consulting a doctor regularly, in addition to educating other workers about her condition and avoiding stigma. Routine examinations are also an important part of treating leprosy in the workplace.

Alzheimer's Patient Support System Based on IoT and ML

Alzheimer's disease poses significant challenges as it progressively erodes memory and identity, severely impacting daily functioning. Patients often experience disorientation, wandering, and are at risk of falls, leading to heightened concerns for caregivers. These difficulties can result in a loss of independence and increased caregiver burden. In response to these challenges, this study introduces an innovative assistive system designed to enhance the safety and quality of life for Alzheimer's patients. The system comprises of two main components: a smart arm band and a facial recognition system. The smart arm band is equipped with a suite of sensors including GPS, accelerometer, and heart rate sensor. These sensors enable real-time monitoring of the patient's location, movement, and physiological parameters. By leveraging these data streams, caregivers can track the patient's activities, detect falls or emergencies, and provide timely assistance when needed. The facial recognition system employs state-of-the-art machine learning techniques, specifically the CAFFE and Local Binary Patterns Histograms (LBPH), to recognize familiar faces in the patient's environment. This capability promotes social interaction and enhances the patient's sense of familiarity and security. Through rigorous testing, the facial recognition system achieves an impressive accuracy of 97% with a low error rate of 3%, validating its effectiveness in real-world scenarios. Overall, the integrative assistive system presented in this study offers a promising solution to address the multifaceted challenges associated with Alzheimer's disease. This system provides caregivers with invaluable support in ensuring the safety and well-being of Alzheimer's patients while fostering social engagement and autonomy.

Patient activation and health literacy in Dutch patients with multiple involved specialties

Abstract Aim To examine the association between having a higher number of involved specialties, patient activation (PA), and health literacy (HL) in patients visiting a general hospital. Subject and methods Patients ≥ 18 years of age who had an appointment with the medical specialist or physician assistant were asked to participate in this study. Patients completed the Patient Activation Measure-13 (PAM) questionnaire and the European Health Literacy Survey Questionnaire (HLS-EU-Q). They were stratified into having < 3 or ≥ 3 involved medical specialties in the past 12 months. Two association models were built to examine the association. Results This study included 200 patients with 52% males (n = 104), a median age of 65 years, and low levels of education (67%). Patients with ≥ 3 involved medical specialties (58%) had lower total PAM scores (p = 0.03) and had lower HLS-EU-Q index scores (p = 0.23). The multivariable regression analysis showed that having ≥ 3 involved medical specialties was not associated with low PAM scores (OR = 1.59, p = 0.13) when adjusted for low education, low HLS-EU-Q scores, and higher age (> 65 years). In addition, having ≥ 3 involved medical specialties was not associated with low HLS-EU-Q scores (OR = 1.10, p = 0.76) when adjusted for low PAM scores and low education. Conclusion Patients with ≥ 3 involved medical specialties visiting the internal medicine department of a general (non-academic) hospital had variable levels of PA and HL. Moreover, having ≥ 3 involved medical specialties was not significantly associated with lower PA and HL. Importantly, the number of involved specialties may not be a proxy for recognizing low PA and HL. Organizations aiming to improve PA and HL could measure these constructs directly.

P104 Exploring patient activation and self-management experiences in adults with fibromyalgia: A qualitative evidence synthesis

Abstract Background/Aims Fibromyalgia Syndrome (FMS) is a chronic pain condition that impacts daily functioning, including self-care and household responsibilities. Effective self-management strategies are essential for managing FMS; however, success depends on an individual’s readiness and capacity to adopt health-promoting behaviours. This qualitative evidence synthesis explored the experiences of adults in their self-management, focusing on understanding the barriers and facilitators influencing patient activation (PA) and effective self-management in the context of FMS. Methods A qualitative evidence synthesis was undertaken. An electronic search was conducted across several databases, including AMED, PubMed, CINAHL, Science Direct, and PsycINFO. Eligibility criteria were applied to screen studies for relevance. Quality assessment was conducted using established tools, including the Critical Appraisal Skills Programme (CASP) questionnaire for qualitative studies and the Consolidated Criteria for Reporting Qualitative Research Checklist (COREC). Findings from the selected papers underwent a three-stage thematic synthesis process to identify common themes. Results Nine studies, comprising a total of 130 participants, were included in the synthesis. Four analytical themes were identified: legitimising FMS, the value of medical support, receiving peer and social support, and learning to self-manage. These themes highlight the multifaceted nature of self-management in FMS. The first theme of legitimising FMS shows how people living with FMS validate their condition, seeking acknowledgement and understanding from healthcare providers and their social support network. The second theme of the value of medical support was important in FMS management, with empathy, education, and personalised guidance from clinicians playing a crucial role in empowering patients to self-manage effectively. The third theme of receiving peer and social support shows that people with FMS found relief and empowerment through interactions with peers and social networks. This shared experience and communal support served as a catalyst for adopting health-promoting behaviours. Finally, the theme of learning to self-manage shows that active involvement in their health is a key component to living well with FMS. People living with FMS embark on a self-management journey, navigating various strategies and interventions to identify what works for them. Conclusion This qualitative synthesis shows that the self-management of FMS requires active involvement from people living with FMS. It illuminates the pivotal role of healthcare providers, peer support, and social networks in enabling individuals to navigate the challenges of FMS. The findings encourage a holistic approach to FMS care, emphasising the need for healthcare professionals to provide medical expertise, empathy, education, and personalised support. Disclosure K. Yung: None. D. Jadhav: None. C. Ma: None. S. Majgaonkar: None. E. Manai: None. J. Pearson: None.

Venous disorders as an occupational disease - a systematic review on epidemiology, pathophysiology, and modification strategies.

Forced postures are common in the workplace. Work in the primary economic sector is characterised by a high degree of physical activity and movement; however, activities in the secondary and tertiary sectors commonly require workers to stand or sit. An expansion of the tertiary sector in recent decades has meant that people in industrialised and emerging economies primarily sit or stand at work. The aim of the systematic review was to identify occupational factors relating to the presence of chronic venous disease (CVD), to place these in the context of developments in the workplace, and to determine whether measures are in place to prevent CVD. We performed a systematic literature review to analyse studies assessing work-related risk factors for CVD. We searched for publications in the PubMed database, the clinic library of BG Hospital Bergmannstrost Halle, and the registry of the German Statutory Accident Insurance. Using occupation-specific keyword combinations, we identified 27,522 publications. The publications underwent an automatic and manual filtering process according to the PRISMA guidelines and 81 publications qualified for the review. Ultimately 25 studies were included in the systematic review. All of the subjects of the studies worked in the secondary and tertiary sectors. No studies looked at the relationship between venous disorders and primary sector occupations. Standing at work for more than four hours a day, repeated heavy lifting, and cumulative time working in a sitting or standing position are risk factors for the development of CVD. Sitting is less of a risk factor than standing or walking. Occupational history and the patient's activity profile are important diagnostic tools which can help confirm a diagnosis and justify treatment when findings are inconsistent. Compression therapy is the primary form of secondary and tertiary prevention. There continues to be a lack of primary preventive measures related to workplace design.

Imaging of the anterior cruciate ligament and anterolateral rotational instability of the knee joint

The anterior cruciate ligament (ACL) is essential for the stability of the knee joint and ACL tears are one of the most common sports injuries with ahigh incidence, especially in sports that require rotational movements and abrupt changes in direction. Injuries of the ACL are rarely isolated and are often accompanied by meniscal and other internal knee injuries, which increase the risk of osteoarthritis. The spectrum of ACL injuries includes strains, partial tears and complete tears. Magnetic resonance imaging (MRI) plays apivotal role in the diagnostics as it can accurately depict not only the ACL but also accompanying injuries. Proton density and T2-weighted sequences are particularly suitable for evaluating the ACL, which is usually well visible and assessable in all planes. In addition to depicting fiber disruption as adirect sign and central diagnostic indicator of an ACL tear, there are numerous other direct and indirect signs of an ACL injury in MRI. These include abnormal fiber orientations, signal increases and an anterior subluxation of the tibia relative to the femur. The bone marrow edema patterns often associated with ACL tears are indicative of the underlying injury mechanism. The treatment of ACL tears can be conservative or surgical depending on various factors, such as the patient's activity level and the presence of accompanying injuries. The precise and comprehensive description of ACL injuries by radiology is crucial for optimal treatment planning. Anterolateral rotational instability (ALRI) of the knee joint characterizes acondition of excessive lateral and rotational mobility of the tibia in relation to the femur in the anterolateral knee region. This instability is primarily caused by arupture of the ACL, with the anterolateral ligament (ALL) that was rediscovered about 10 years ago, also being attributed arole in stabilizing the knee. Although ALRI is primarily diagnosed through clinical examinations, MRI is indispensable for detecting injuries to the ACL, ALL, and other internal knee structures, which is essential for developing an optimal treatment strategy.

(338) Impact of Microsurgical Denervation of the Spermatic Cord Treatment of Chronic Scrotal Pain on Men's Sexual Function: A Follow-Up Study for 6 Months After Surgical

Abstract Introduction When chronic severe scrotum affects the patient's activities and life in many aspects. Hypothetical study investigating clinical, laboratory characteristics and the influence of Microsurgical Denervation of the Spermatic Cord on male sexual performance. Objective The aim of this study was to describe the impact of microsurgical denervation of the spermatic cord treatment of chronic scrotal pain on men's sexual function Methods Observation study design. All patients with severe chronic scrotal pain, after excluding other causes, were indicated for surgery at the department of andrology, Binh Dan hospital from January 1, 2022 to November 1, 2022. Results There were thirty-one patients with chronic scrotal pain who underwent surgery. Mean age 24.2 ± 4.3 years, duration of pain 2.3 ±1.6 years. Location of pain: scrotum (41.3%), testis-epididymis (47.8%), spermatic cord (24.6%), inguinal (15.1%). Causes of pain: epididymitis (45.3%) accounted for most cases. NRS pain score before surgery 6.8 ± 2.3. There are 13/31 patients with severe pain scale (NRS = 7-10). Quality of life (QOL) in patients with moderate pain (NRS pain scale 1-6) 4.6 ± 4.0 and 6.75 ± 1.1 in patients with severe pain (NRS 7-10). 6%) patients reported pain affecting daily work Patient had small testicle size 43.5%, Varicose veins on ultrasound: 3.4±1.2 mm 51.6% (16/31) patients felt scrotal pain affecting sexual activity Patients with severe scrotal pain with high pain scale (NRS 7-10 points) had an effect on erectile function compared with moderate pain group (NRS 0-6 points) (P<0.05) Indicators “Scrotal pain prevents sexual activity”, “IIEF”, “Decreased libido ADAM questionnaire”, “Stimulating sexual activity pain”, “painful ejaculation” all improved after surgery. Conclusions Chronic scrotal pain mostly occurs in young patients with relatively large pain scores. Chronic scrotal pain also contributes to testicular size and endocrine function affecting quality of life. Chronic scrotal pain can greatly affect sexual performance in men. Microsurgical Denervation of the Spermatic Cord improves many aspects of a patient's sexual performance. Disclosure No.

Penerapan Kompres Hangat Jahe Merah Pada Asuhan Keperawatan Gerontik Klien Gout Arthritis Dengan Masalah Keperawatan Nyeri Akut Di Puskesmas Wongsorejo

Gout Arthritis is joint inflammation caused by increased uric acid levels in the blood due to purine metabolism distribution (hyperuricemia) in the body, characterized by joint pain that can interfere with the patient's activities. One of the non--pharmacological treatments that can be used for Gout Arthritis is red ginger warm compresses, often used to treat joint inflammation. This scientific paper aims to determine the effect of warm red ginger compress on changes in the pain scale in Gout Arthritis patients in Wongsorejo village. The method was a case study of implementing nursing care and applying Evidence-Based Nursing (EBN). From the assessment, the main diagnosis was acute pain. Red Ginger Warm Compress was given once a day by giving 2 segments of ginger or 9 grams, placing it in the area experiencing joint pain for 10 minutes and then doing a pain assessment again with the Numerical Tw`ig Scale (NRS). The results of the case study in the two respondents after seven days was a decrease in the pain scale from 8 and 6 and after the treatment the pain can be reduced to scale 1 in pain. Red ginger warm compresses are an effective complementary therapy for reducing pain in Gout Arthritis patients. It is recommended that nurses can apply Red Ginger Warm compress to reduce pain in Gout Arthritis clients.

BIOMECHANICS AND DESIGN OF INTRAMEDULLARY NAILS

Intramedullary nails (IMNs) are the current gold standard for treatment of long bone diaphyseal and selected metaphyseal fractures. Their design has undergone many revisions to improve fixation techniques, conform to the bone shape with appropriate anatomic fit, reduce operative time and radiation exposure, and extend the indication of the same implant for treatment of different fracture types with minimal soft tissue irritation.The IMNs are made or either titanium alloy or stainless steel and work as load-sharing internal splints along the long bone, usually accommodating locking elements – screws and blades, often featuring angular stability and offering different configurations for multiplanar fixation – to secure secondary fracture healing with callus formation in a relative-stability environment. Bone cement augmentation of the locking elements can modulate the construct stiffness, increase the surface area at the bone-implant interface, and prevent cut-through of the locking elements.The functional requirements of IMNs are related to maintaining fracture reduction in terms of length, alignment and rotation to enhance fracture healing. The load distribution during patient's activities is along the entire bone-nail interface, with nail length and anatomic fit being important factors to avoid stress risers.

The impact of patient activation on the effectiveness of digital health remote post-discharge follow-up and same-day-discharge after elective colorectal surgery.

Low patient activation (PA) is associated with worse postoperative outcomes, however, its impact on the effectiveness of digital health interventions is unknown. We sought to determine the impact of PA on the effectiveness of digital health application for remote post-discharge follow-up for patients undergoing elective colectomy. Data analysis included a control cohort (CC) of patients undergoing elective colorectal surgery from 10/2017 to 04/2018 without the digital health intervention and a digital application cohort (DAC) that received a smart phone application for remote post-discharge follow-up from 03/2021 to 08/2022, including a subset of same-day discharge (SDD) patients. PA was measured using the Patient Activation Measure (PAM; score 0-100) and categorized into low (< 55.1) and high (≥ 55.1). The PAM was administered 4-6weeks before surgery in the DAC group and on postoperative day (POD) 1 in the CC group. The main outcome measure was 30-day emergency department (ED) visits. A total of 164 patients were included (89DAC with 50 SDD, 75CC), with no differences in patient characteristics other than more stoma closures in the DAC group. Overall, 77% of patients had high PA level, with no difference between CC and DAC (77% vs. 81%, p = 0.25). There was no difference in ED visits between CC and DAC (19% vs. 18%, p = 0.90). Overall, low PA was associated more ED visits (29% vs 14%, p = 0.04). In the SDD subgroup, low PA patients had more ED visits (38% vs. 7%, p = 0.015). PA level did not affect app usage metrics. On multiple regression, only low PA remained independently associated with ED visits (OR 3.42, 95%CI 1.27, 9.24). Low PA remains an important predictor of surgical outcomes after elective colorectal surgery regardless of the use of a digital health application for remote post-discharge follow-up. This suggests that improving PA levels may improve postoperative outcomes.

Muscle quality improvement in subacute post-stroke patients after rehabilitation: Usefulness of segmental phase angle from bioelectrical impedance analysis

During stroke rehabilitation, the whole-body Phase Angle (PhA) from Bioelectrical Impedance Analysis (BIA) is measured to assess whole-body muscle quality, which reflects cellular integrity and function. The segmental BIA is a valuable method for assessing the body composition of specific body segments, such as the arms, legs, and hemisoma. After a stroke insult, patients frequently experience hemiparesis, and segmental PhA from segmental BIA appears to be an appropriate parameter for examining the muscle quality of affected and unaffected limbs separately. This study aims to investigate whether segmental PhA is more informative than whole-body PhA in (a) assessing the deterioration of muscle quality in post-stroke patients and (b) monitoring its recovery following rehabilitative treatment. This longitudinal study recruited subacute post-stroke patients who were admitted to our rehabilitation center. At admission, demographic, anamnestic, and clinical information, such as the presence of comorbidities, were recorded. BIA was used to evaluate the whole-body PhA and segmental PhA of the affected and unaffected hemisoma, arms, and legs at admission (T0) and after a six-week rehabilitation program (T1). The modified Barthel Index (mBI), Fugl-Meyer Assessment for the Upper Extremity (FMA-UE), and Motricity Index of the Upper (MI-UE) and Lower (MI-LE) Extremities were evaluated at T0 and T1 to determine the patient's Activity of Daily Living (ADL) performance, upper limb motor performance, and upper and lower limb muscle strength, respectively. We evaluated segmental and whole-body BIA in 70 subacute post-stroke patients (women n=34, ischemic n=56, mean age 70±11) at T0 and T1. Whole-body PhA values of the patients were below the normal range. Considering segmental data, the affected hemisoma, arm, and leg had considerably lower PhA values as compared to the unaffected body segments. Furthermore, at T1, the PhA values of all affected body segments improved, while those of the unaffected ones and whole-body PhA did not. At both T0 and T1, the segmental PhA values of the affected body segments showed to be related with all clinical outcome measures, while whole-body PhA correlated only with mBI. This study emphasizes the significance of measuring segmental PhA in hemiparetic subacute stroke patients undergoing rehabilitation treatment. Segmental PhA is a more accurate parameter to evaluate rehabilitation treatment in patients with hemiparesis because it can distinguish affected from unaffected body segments, hence facilitating accurate monitoring of muscle quality improvements resulting from a rehabilitation program.

Design and development of a fuzzy explainable expert system for a diagnostic robot of COVID-19

&lt;p&gt;&lt;span lang="EN-US"&gt;Expert systems have been widely used in medicine to diagnose different diseases. However, these rule-based systems only explain why and how their outcomes are reached. The rules leading to those outcomes are also expressed in a machine language and confronted with the familiar problems of coverage and specificity. This fact prevents procuring expert systems with fully human-understandable explanations. Furthermore, early diagnosis involves a high degree of uncertainty and vagueness which constitutes another challenge to overcome in this study. This paper aims to design and develop a fuzzy explainable expert system for coronavirus disease-2019 (COVID-19) diagnosis that could be incorporated into medical robots. The proposed medical robotic application deduces the likelihood level of contracting COVID-19 from the entered symptoms, the personal information, and the patient's activities. The proposal integrates fuzzy logic to deal with uncertainty and vagueness in diagnosis. Besides, it adopts a hybrid explainable artificial intelligence (XAI) technique to provide different explanation forms. In particular, the textual explanations are generated as rules expressed in a natural language while avoiding coverage and specificity problems. Therefore, the proposal could help overwhelmed hospitals during the epidemic propagation and avoid contamination using a solution with a high level of explicability.&lt;/span&gt;&lt;/p&gt;

Influence of Participation in a Medical-Themed Science Café on Patient Activation.

This study aims to investigate the impact of a Science Café (SC) dealing with medical topics on participants' patient activation (PA), a concept that refers to patients' involvement in managing their own health, working with their healthcare providers, and maintaining their health. Semi-structured interviews were conducted with patients who had participated in a medical SC (n = 10) to identify the medical SC-associated factors that influenced PA. Through a questionnaire of medical SC participants (n = 23), the impact on PA and correlations with relevant psychological measures were quantitatively assessed. The interviews revealed three factors: "Experience & acceptance of chronic conditions", "Features of medical SC" and "Changes as a result of participation." The questionnaire results showed a positive correlation between PA and resilience and a negative correlation with decision regret. Participation in a medical SC by people with illnesses can improve PA by improving knowledge and skills for self-management and increasing self-awareness of illness in a supportive environment. The study highlights the potential benefits of using medical SC as a strategy for healthcare providers to improve PA and health outcomes.