scholarly journals Study on the correlation between the impact dose of extracorporeal shockwave and the curative effect on stage IV pressure sore based on pressure ulcer area

2018 ◽  
Vol 61 ◽  
pp. e384-e385
Author(s):  
H. Duan ◽  
N. Li ◽  
Z. Li
Keyword(s):  
Pressure Ulcer ◽  
Stage Iv ◽  
Pressure Sore ◽  
Curative Effect ◽  
Ulcer Area ◽  
Extracorporeal Shockwave ◽  
The Impact

Role of topical insulin therapy as an adjunct in the management of pressure ulcer

2020 ◽  
Vol 2 (3) ◽  
pp. 01-03
Author(s):  
Ravi Chittoria
Keyword(s):  
Wound Healing ◽  
Insulin Therapy ◽  
Pressure Ulcer ◽  
Healing Rate ◽  
Pressure Sore ◽  
Pressure Sores ◽  
Established Method ◽  
Wound Bed Preparation ◽  
Wound Healing Rate

Pressure ulcer or pressure sore is one of the complications seen in bedridden patients. Management of these ulcers is often challenging. But there is no well-established method that accelerates the wound healing rate. Various adjunctive methods are used for wound bed preparation before definitive reconstruction plan is made. Here we describe our experience in the role of insulin therapy as an adjunct in the management of pressure sores.

scholarly journals The halo model as a versatile tool to predict intrinsic alignments

2020 ◽  
Author(s):  
Maria Cristina Fortuna ◽  
Henk Hoekstra ◽  
Benjamin Joachimi ◽  
Harry Johnston ◽  
Nora Elisa Chisari ◽  
...  
Keyword(s):  
Degrees Of Freedom ◽  
Power Spectra ◽  
Stage Iv ◽  
Stage Iii ◽  
Radial Dependence ◽  
Additional Parameter ◽  
Small Scales ◽  
Cosmic Shear ◽  
Galaxy Populations ◽  
The Impact

Abstract Intrinsic alignments (IAs) of galaxies are an important contaminant for cosmic shear studies, but the modelling is complicated by the dependence of the signal on the source galaxy sample. In this paper, we use the halo model formalism to capture this diversity and examine its implications for Stage-III and Stage-IV cosmic shear surveys. We account for the different IA signatures at large and small scales, as well for the different contributions from central/satellite and red/blue galaxies, and we use realistic mocks to account for the characteristics of the galaxy populations as a function of redshift. We inform our model using the most recent observational findings: we include a luminosity dependence at both large and small scales and a radial dependence of the signal within the halo. We predict the impact of the total IA signal on the lensing angular power spectra, including the current uncertainties from the IA best-fits to illustrate the range of possible impact on the lensing signal: the lack of constraints for fainter galaxies is the main source of uncertainty for our predictions of the IA signal. We investigate how well effective models with limited degrees of freedom can account for the complexity of the IA signal. Although these lead to negligible biases for Stage-III surveys, we find that, for Stage-IV surveys, it is essential to at least include an additional parameter to capture the redshift dependence.

Impact of Medicaid expansion on two-year mortality among stage IV breast cancer (BC) patients according to race.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6525-6525
Author(s):  
Catalina Malinowski ◽  
Xiudong Lei ◽  
Hui Zhao ◽  
Sharon H. Giordano ◽  
Mariana Chavez Mac Gregor
Keyword(s):  
Breast Cancer ◽  
Low Income ◽  
Stage Iv ◽  
Medicaid Expansion ◽  
Risk Of Death ◽  
Stage Iv Breast Cancer ◽  
Increased Risk ◽  
The Impact ◽  
Expansion Period ◽  
White Patients

6525 Background: Inadequate access to healthcare services is associated with worse outcomes. Disparities in access to cancer care are more frequently seen among racial/ethnic minorities, uninsured patients, and those with low socioeconomic status. A provision in the Affordable Care Act called for expansion of Medicaid eligibility in order to cover more low-income Americans. In this study, we evaluate the impact of Medicaid expansion in 2-year mortality among metastatic BC patients according to race. Methods: Women (aged 40-64) diagnosed with metastatic BC (stage IV de novo) between 01/01/2010 and 12/31/2015 and residing in states that underwent Medicaid expansion in 01/2014 were identified in the National Cancer Database. For comparison purposes, 2010-2013 was considered the pre-expansion period and 2014-2015 the post-expansion period. We calculated 2-year mortality difference-in-difference (DID) estimates between White and non-White patients using multivariable linear regression models. Results are presented as adjusted differences (in % points) between groups in the pre- and post-expansion periods and as adjusted DID with 95%CI. Covariates included age, comorbidity, BC subtype, insurance type, transfer of care, distance to hospital, region, residence area, education, income quartile, facility type and facility volume. In addition, overall survival (OS) was evaluated in pre- and post-expansion periods via Kaplan-Meier method and Cox proportional hazards models; results are presented as 2-year OS estimates, hazard ratios (HRs), and 95% CIs. Results: Among 7,675 patients included, 4,942 were diagnosed in the pre- and 2,733 in the post-expansion period. We observed a reduction in 2-year mortality rates in both groups according to Medicaid expansion. Among Whites 2-year mortality decreased from 42.5% to 38.7% and among non-Whites from 45.4% to 36.4%, resulting in an adjusted DID of -5.2% (95%CI -9.8 to -0.6, p = 0.027). A greater reduction in 2-year mortality was observed among non-Whites in a sub-analysis of patients who resided in the poorest quartile (n = 1372), with an adjusted DID of -14.6% (95%CI -24.8 to -4.4, p = 0.005). In the multivariable Cox model, during the pre-expansion period there was an increased risk of death for non-Whites compared to Whites (HR 1.14, 95% CI 1.03 to 1.26, P = 0.04), however no differences were seen in the post-expansion period between the two groups (HR 0.93, 95% CI 0.80 to 1.07, P = 0.31). Conclusions: Medicaid expansion reduced racial disparities by decreasing the 2-year mortality of non-White patients with metastatic breast cancer and reducing the gap when compared to Whites. These results highlight the positive impact of policies aimed at improving equity and increasing access to health care.

The impact of the COVID-19 pandemic on stage at diagnosis of breast and colorectal cancers.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6501-6501
Author(s):  
Jade Zhou ◽  
Shelly Kane ◽  
Celia Ramsey ◽  
Melody Ann Akhondzadeh ◽  
Ananya Banerjee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Cancer Screening ◽  
Late Stage ◽  
Stage Iv ◽  
Stage I ◽  
Screening Programs ◽  
Stage Distribution ◽  
Number Of Patients ◽  
The Impact

6501 Background: Effective cancer screening leads to a substantial increase in the detection of earlier stages of cancer, while decreasing the incidence of later stage cancer diagnoses. Timely screening programs are critical in reducing cancer-related mortality in both breast and colorectal cancer by detecting tumors at an early, curable stage. The COVID-19 pandemic resulted in the postponement or cancellation of many screening procedures, due to both patient fears of exposures within the healthcare system as well as the cancellation of some elective procedures. We sought to identify how the COVID-19 pandemic has impacted the incidence of early and late stage breast and colorectal cancer diagnoses at our institution. Methods: We examined staging for all patients presenting to UCSD at first presentation for a new diagnosis of malignancy or second opinion in 2019 and 2020. Treating clinicians determined the stage at presentation for all patients using an AJCC staging module (8th edition) in the electronic medical record (Epic). We compared stage distribution at presentation in 2019 vs 2020, both for cancers overall and for colorectal and breast cancer, because these cancers are frequently detected by screening. Results: Total numbers of new patient visits for malignancy were similar in 2019 and 2020 (1894 vs 1915 pts), and stage distribution for all cancer patients was similar (stage I 32% in 2019 vs 29% in 2020; stage IV 26% in both 2019 and 2020). For patients with breast cancer, we saw a lower number of patients presenting with stage I disease (64% in 2019 vs 51% in 2020) and a higher number presenting with stage IV (2% vs 6%). Similar findings were seen in colorectal cancer (stage I: 22% vs 16%; stage IV: 6% vs 18%). Conclusions: Since the COVID-19 pandemic, there has been an increase in incidence of late stage presentation of colorectal and breast cancer, corresponding with a decrease in early stage presentation of these cancers at our institution. Cancer screening is integral to cancer prevention and control, specifically in colorectal and breast cancers which are often detected by screening, and the disruption of screening services has had a significant impact on our patients. We plan to continue following these numbers closely, and will present data from the first half of 2021 as it becomes available.

Stage at cancer diagnosis during the COVID-19 pandemic in western Washington state.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 145-145
Author(s):  
Catherine R. Fedorenko ◽  
Karma L. Kreizenbeck ◽  
Li Li ◽  
Laura Elizabeth Panattoni ◽  
Veena Shankaran ◽  
...  
Keyword(s):  
Medical Care ◽  
Early Stage ◽  
Stage Iv ◽  
Washington State ◽  
Stage I ◽  
Tumor Type ◽  
Stage At Diagnosis ◽  
Stage Iv Cancer ◽  
Using Data ◽  
The Impact

145 Background: The COVID-19 pandemic disrupted medical care, including routine cancer screening for breast, colorectal, lung and cervical cancers. We aimed to investigate the impact of the pandemic on stage at diagnosis for cancer patients. Methods: Using data from the Washington State SEER records we compared AJCC stage for patients diagnosed with cancer in 2017-2019 to 2020 for two time periods, March to June (initial pandemic months) and July to December (later pandemic months). Patients were included if they were age 18+, diagnosed with a solid tumor, and not diagnosed at autopsy. Results: In the early phase of the pandemic, March – June 2020, there was a shift to cancers being diagnosed at a later stage compared to the same time period in 2017-2019 (Stage III: 13.5% to 14.9%, Stage IV: 16.2% to 19.7%). There was also a decrease in cancer diagnoses for cancers that are often detected through routine screening. As a percentage of all cancer diagnoses, both melanoma (13.2% to 9.8%) and colon cancer diagnoses (7.2% to. 6.7%) decreased during the early pandemic. In the later phase of the pandemic, July to December 2020, the stage at diagnosis showed an indication of returning to pre-pandemic levels with an increase in the proportion of early stage cancers (In situ: 16.6% to 19.3%, Stage I: 38.8% to 41.1%). Stage at diagnosis trends varied by tumor type. For colorectal cancer, the overall number of diagnoses decreased during the initial pandemic months. Stage I diagnoses decreased and Stage IV cancer diagnoses increased in both early and late stages of the pandemic. Conclusions: In Washington State, the COVID-19 pandemic had an impact on stage at diagnosis potentially caused by delays or interruptions in medical care. Additional studies are needed to understand how this shift in stage at diagnosis impacted treatment and outcomes for patients.

scholarly journals Prevention and treatment of pressure sore following spinal cord injury

2020 ◽  
Vol 63 (10) ◽  
pp. 623-632
Author(s):  
Myeong Ok Kim
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcer ◽  
Wound Care ◽  
Pressure Sore ◽  
Therapeutic Interventions ◽  
Advisory Panel ◽  
Pressure Sores ◽  
Cord Injury ◽  
Pressure Injury

Pressure sores or pressure injury is a serious complication of a spinal cord injury (SCI), representing a challenging problem for patients, their caregivers, and their physicians. Persons with SCI are vulnerable to pressure sores throughout their life. Pressure sores can potentially interfere with the physical, psychosocial, and overall quality of life. Outcomes directly depend on education and prevention along with conservative and surgical management. Therefore, it is very important to understand everything about pressure sores following SCI. This review covers epidemiology, cost, pathophysiology, risk factors, staging, evaluation tools, prevention, education, conservative wound care methods, surgical treatment, and future trends in wound healing related to post-SCI pressure sores. A change in nomenclature was adopted by the National Pressure Ulcer Advisory Panel in 2016, replacing “pressure ulcer”with “pressure injury.” New concepts of pressure injury staging, such as suspected deep tissue injuries and unstageable pressure injuries, were also introduced. A systematic evidence-based review of the prevention of and therapeutic interventions for pressure sores was also discussed.

scholarly journals Analysis of epidemiological characteristics and surgical treatment of patients with pressure ulcer

2021 ◽  
pp. 93-93
Author(s):  
Dragana Petrovic-Popovic ◽  
Milan Stojicic ◽  
Maja Nikolic-Zivanovic
Keyword(s):  
Surgical Treatment ◽  
Pressure Ulcer ◽  
Traffic Accidents ◽  
Pressure Ulcers ◽  
Stage Iv ◽  
Clinical Center ◽  
Bony Prominence ◽  
The University ◽  
Epidemiological Characteristics ◽  
Reconstructive Methods

Introduction/Objective. A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. It appears as a result of pressure or combination of pressure and shear. Pressure ulcers can be identified within a wide variety of patient subpopulations and a major role in their treatment plays epidemiological and etiological aspects. Methods. A retrospective study of data analysis included 72 patients with pressure ulcers that were hospitalized and surgically treated during a five-year period at the Clinic for Burns, Plastic and Reconstructive Surgery of the University Clinical Center of Serbia in Belgrade. Main data features used in the analysis were: gender, age, principal diseases, comorbidities and biochemical indicators of malnutrition. The patients' data was obtained from the existing patients? records. Additionally, the study analyzed the method of treating pressure ulcers, types of reconstructive methods in surgical treatment, as well as the incidence rate of partial osteotomy. Results. A total of 72 patients with pressure ulcers were included into this study with 54.7 ? 16.1 mean age. Three times more patients injured in traffic accidents were male (75% vs. 25%), while the most of the patients with multiple sclerosis were female (85.7%). More than 95% of patients who had pressure ulcers of III or IV stage were treated surgically with a reconstructive method of transposition or rotation myocutaneous flap. The patient with pressure ulcer of stage IV was usually treated with partial osteotomy. Conclusion. A surgical reconstructive treatment with fasciocutaneous and myocutanaeous flaps represents a gold standard for treating patients with pressure ulcers. These procedures provide reconstruction with adequate flap coverage and obliteration of dead space with well-vascularized tissue but with necessity of further implementation of antidecubitus measures.

scholarly journals Influence of motor impairment on exercise capacity and quality of life in patients with Parkinson disease

2021 ◽  
Vol 17 (4) ◽  
pp. 241-246
Author(s):  
Hélcio Kanegusuku ◽  
Raphael M. Ritti-Dias ◽  
Pâmela Yuki Igarasi Barbosa ◽  
Erica Tardelli das Neves Guelfi ◽  
Erika Okamoto ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson Disease ◽  
Healthy Subject ◽  
Exercise Capacity ◽  
Motor Impairment ◽  
Stage Iv ◽  
Summary Index ◽  
The Impact ◽  
Disease Questionnaire

This study evaluated the impact of motor impairment (MI) on exercise capacity and quality of life in patients with Parkinson disease (PD). One hundred ninety-two patients (≥50 years old) were divided according to the Hoehn and Yahr stages in: mild (stage I), mild to moderate (stage II), moderate (stage III), and advanced MI (stage IV). Exercise capacity (6-min walk test [6MWT]) and quality of life (Parkinson’s Disease Questionnaire [PDQ-39]) were obtained. In this context, 6MWT was progressively worse with increasing the severity of MI (P<0.01). Patients with advanced MI achieved 39% of predicted 6MWT of healthy subject, while subjects with mild MI achieved 83% of healthy subject (P<0.01). In addition, patients with advanced MI presented higher (i.e., worse) PDQ-39 scores in summary index, cognition, mobility and activities of daily live domains compared to other groups (P<0.01). Patients with moderate MI also presented worse scores in PDQ-39 summary index, mobility and activities of daily live domains in comparison with mild MI patients (P<0.01). Higher MI was correlated with worse exercise capacity (6MWT: r=-0.46, P<0.01), with worse PDQ-39 summary index and the mobility and activities of daily live domains scores (r=0.38, r=0.46, and r=0.43, P<0.01). In conclusion, MI is related to lower exercise capacity and quality of life (i.e., PDQ-39 summary index and mobility and activities of daily live domains) in patients with PD.

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