Diabetic Neuropathy

2019 ◽  
Vol 39 (05) ◽  
pp. 560-569 ◽  
Author(s):  
Elina Zakin ◽  
Rory Abrams ◽  
David M. Simpson
Keyword(s):  
Quality Of Life ◽  
Diabetic Neuropathy ◽  
Tricyclic Antidepressants ◽  
Health Care Systems ◽  
Sense Making ◽  
Sensory Disturbances ◽  
Care Systems ◽  
Charcot Osteoarthropathy ◽  
Severe Deterioration

AbstractDiabetes mellitus is becoming increasingly common worldwide. As this occurs, there will be an increase in the prevalence of known comorbidities from this disorder of glucose metabolism. One of the most disabling adverse comorbidities is diabetic neuropathy. The most common neuropathic manifestation is distal symmetric polyneuropathy, which can lead to sensory disturbances, including diminished protective sense, making patients prone to foot injuries. However, focal, multifocal, and autonomic neuropathies are also common. Diabetic nerve pain and Charcot osteoarthropathy are advanced neuropathic conditions that portend a severe deterioration in quality of life. To combat these symptoms, along with glycemic control and establishment of health care systems to educate and support patients with the complexities of diabetes, there are pharmacologic remedies to ameliorate the neurologic symptoms. Several guidelines and review boards generally recommend the use of tricyclic antidepressants, serotonin/norepinephrine-reuptake inhibitors, α-2-delta ligands, and anticonvulsants as medications to improve painful diabetic neuropathy and quality of life.

Social Care and Life Quality of Frail or Dependent Elderly

2016 ◽  
Vol 4 (1) ◽  
pp. 12-22 ◽  
Author(s):  
Cristina Albuquerque
Keyword(s):  
Quality Of Life ◽  
Social Care ◽  
Health Care Systems ◽  
Life Quality ◽  
Use Of Technology ◽  
Care Systems ◽  
Alternative Responses ◽  
Privacy And Confidentiality ◽  
Dependent Elderly

In this article the author underlines the potentialities of technological achievements and ICT applications in social and health care systems to best accomplish the goals of autonomy, social participation and quality of life of frail or dependent elderly. Additionally some critical questions concerning the use of technological devises to promote alternative responses to dependency and isolation of elderly are also discussed, namely associated with inequalities in the access and use of technology and with ethical questions of privacy and confidentiality.

scholarly journals Microbiome Imbalances: An Overlooked Potential Mechanism in Chronic Nonhealing Wounds

2019 ◽  
Vol 18 (1) ◽  
pp. 31-41
Author(s):  
Mengru Pang ◽  
Meishu Zhu ◽  
Xiaoxuan Lei ◽  
Pengcheng Xu ◽  
Biao Cheng
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Care Costs ◽  
Chronic Wounds ◽  
Health Care Systems ◽  
Potential Mechanism ◽  
Care Systems ◽  
Hospital Stays ◽  
Care Costs

Chronic nonhealing wounds are a severe burden to health care systems worldwide, causing millions of patients to have lengthy hospital stays, high health care costs, periods of unemployment, and reduced quality of life. Moreover, treating chronic nonhealing wounds effectively and reasonably in countries with limited medical resources can be extremely challenging. With many outstanding questions surrounding chronic nonhealing wounds, in this review, we offer changes to the microbiome as a potentially ignored mechanism important in the formation and treatment of chronic wounds. Our analysis helps bring a whole new understanding to wound formation and healing and provides a potential breakthrough in the treatment of chronic nonhealing wounds in the future.

scholarly journals Quality of life domains affected in women with breast cancer

2015 ◽  
Vol 36 (2) ◽  
pp. 89-96 ◽  
Author(s):  
Sabrina Nunes Garcia ◽  
Michele Jacowski ◽  
Gisele Cordeiro Castro ◽  
Carila Galdino ◽  
Paulo Ricardo Bittencourt Guimarães ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Health Care ◽  
Body Image ◽  
Health Care Systems ◽  
Life Questionnaire ◽  
Private Health Care ◽  
Cancer Data ◽  
Care Systems

OBJECTIVE: This study aimed to investigate the quality of life of women suffering from breast cancer undergoing chemotherapy in public and private health care systems. METHOD: It is an observational, prospective study with 64 women suffering from breast cancer. Data was collected with two instruments: Quality of Life Questionnaire C30 and Breast Cancer Module BR23. By applying Mann Whitney and Friedman's statistical tests, p values < 0.05 were considered statistically significant. RESULTS: The significant results in public health care systems were: physical functions, pain symptom, body image, systemic effects and outlook for the future. In private health care systems, the results were sexual, social functions and body image. Women's quality of life was harmed by chemotherapy in both institutions. CONCLUSION: The quality of life of women has been harmed as a result of the chemotherapy treatment in both institutions, but in different domains, indicating the type of nursing care that should be provided according to the characteristics of each group.

scholarly journals Quality of Life in Danish Patients with Multiple Myeloma during the COVID-19 Pandemic

COVID ◽  
2021 ◽  
Vol 1 (1) ◽  
pp. 303-314
Author(s):  
Louise Redder ◽  
Sören Möller ◽  
Anna Thit Johnsen ◽  
Mary Jarden ◽  
Christen Lykkegaard Andersen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Health Care Systems ◽  
Viral Spread ◽  
Health Authorities ◽  
Increased Risk ◽  
Care Systems ◽  
Fatal Course ◽  
The Impact

In general, governments and health authorities have taken precautions during the COVID-19 pandemic to reduce the viral spread and protect vulnerable citizens. Patients with multiple myeloma (MM) have an increased risk of being infected with COVID-19 and developing a fatal course due to the related immunodeficiency. We investigated how Danish patients with MM reported their quality of life (QoL) pre-COVID and during COVID, in an ongoing longitudinal QoL survey. The responses given during the first and second wave of the COVID-19 pandemic were pooled, analyzed and compared to the same period the year before. We hypothesized that locking down the society would have caused deteriorated QoL and that patients living alone and those under the age of 65 would be particularly affected by the situation. Surprisingly, our study showed the opposite. Statistically significant and clinically relevant differences were primarily found during the first lock down and represented reduced fatigue, improved role functioning, decreased insomnia and improved physical health summaries in patients below 65 years of age. These results indicate that Danish patients with MM might have felt protected and safe by COVID restrictions. Otherwise, the questionaries used in QoL-MM survey may not have been able to capture the impact of the COVID-19 pandemic. Importantly, this indicates that QoL survey data obtained in clinical studies, in countries with highly developed health-care systems using standard questionnaires during the pandemic, allow room for interpretation without being adjusted for the impacts of the pandemic.

Abstract 6225: Cost of Improvement of Angina-Related Health Status by Health Care System: A Secondary Analysis from the COURAGE Trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Zugui Zhang ◽  
Paul Kolm ◽  
Ron Goeree ◽  
Claudine Jurkovitz ◽  
Koon Teo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Status ◽  
Health Care Systems ◽  
Net Benefit ◽  
Physical Limitation ◽  
Angina Frequency ◽  
Care Systems ◽  
The Cost

Background: COURAGE compared percutaneous coronary intervention (PCI) plus intensive pharmacologic and lifestyle intervention (optimal medical therapy, OMT) to OMT alone in reducing the risk of cardiovascular events in patients with stable coronary disease. In this post hoc study, we assessed the cost of treating angina across the three health care systems from which patients were enrolled: Canada, US non-Veterans Affairs (VA) and U.S. VA. Methods: A total of 2,287 patients were enrolled and followed for a median of 4.6 years. Angina-related health status was assessed with the Seattle Angina Questionnaire (SAQ) and RAND-36. The cost of resource use was evaluated by DRG for hospitalizations and CPT for outpatient visits and tests. Analyses were conducted using the U.S. non-VA costing system in 2004 U.S. dollars. Clinically significant differences in the Physical Limitation, Angina Frequency, and Quality of Life domains of the SAQ were defined as scores ≥8, ≥20, and ≥16 respectively. Absolute net benefit, number of patients needed to treat (NNT) to achieve one patient with clinically significant angina improvement, and the cost of improvement in angina-related health status were estimated. Results: Added cost of PCI per patient and results for Angina Frequency are presented in the table . Results for Quality of Life were similar. Physical Limitation results varied more widely among health care systems with net benefit ranging from <1% (U.S. non-VA) to 18% (Canada), and cost per patient in angina improvement from $55,700 (Canada) to over $1,000,000 (U.S. non-VA). Conclusions: The improvement of angina-related health status and corresponding costs were relatively similar across health care systems and among SAQ Angina Frequency and Quality of Life domains, but varied widely for the Physical Limitation Domain. Adding PCI to OMT improved angina-related health status, but at a cost generally considered to be prohibitive as a routine initial management strategy. Cost of Improvement of Angina-Related Health Status by Health Care System

Hallucinogenic/psychedelic 5HT2A receptor agonists as rapid antidepressant therapeutics: Evidence and mechanisms of action

2021 ◽  
pp. 026988112098642
Author(s):  
Rafael Guimarães dos Santos ◽  
Jaime EC Hallak ◽  
Glen Baker ◽  
Serdar Dursun
Keyword(s):  
Health Care Systems ◽  
Treatment Compliance ◽  
Therapeutic Effects ◽  
Beneficial Effects ◽  
Antidepressant Effects ◽  
Care Systems ◽  
Drug Treatments ◽  
Fast Acting

Major depressive disorder (MDD) is among the most prevalent mental health disorders worldwide, and it is associated with a reduced quality of life and enormous costs to health care systems. Available drug treatments show low-to-moderate response in most patients, with almost a third of patients being non-responders (treatment-resistant). Furthermore, most currently available medications need several weeks to achieve therapeutic effects, and the long-term use of these drugs is often associated with significant unwanted side effects and resultant reductions in treatment compliance. Therefore, more effective, safer, and faster-acting antidepressants with enduring effects are needed. Together with ketamine, psychedelics (or classic or serotoninergic hallucinogens) such as lysergic acid diethylamide (LSD), psilocybin, and ayahuasca are among the few compounds with recent human evidence of fast-acting antidepressant effects. Several studies in the 1950s to 1970s reported antidepressive and anxiolytic effects of these drugs, which are being confirmed by modern trials (LSD, one trial; psilocybin, five trials; ayahuasca, two trials). The effects of these drugs appear to be produced primarily by their agonism at serotonin (5-hydroxytryptamine, 5-HT) receptors, especially the 5-HT2A receptor. Considering the overall burden of MDD and the necessity of new therapeutic options, the promising (but currently limited) evidence of safety and efficacy of psychedelics has encouraged the scientific community to explore more fully their beneficial effects in MDD.

Temperature as a Causative Factor in Diabetic Foot Ulcers: A Call to Revisit Ulceration Pathomechanics

2018 ◽  
Vol 109 (5) ◽  
pp. 345-350 ◽  
Author(s):  
Metin Yavuz ◽  
Ali Ersen ◽  
Jessica Hartos ◽  
Lawrence A. Lavery ◽  
Dane K. Wukich ◽  
...  
Keyword(s):  
Diabetic Neuropathy ◽  
Diabetic Foot ◽  
Linear Models ◽  
Health Care Systems ◽  
Predictive Biomarkers ◽  
Causative Factor ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Care Systems ◽  
Mean Differences

Background: Diabetic foot ulcers (DFUs) are a major burden to patients and to the health-care systems of many countries. To prevent or treat ulcers more effectively, predictive biomarkers are needed. We examined temperature as a biomarker and as a causative factor in ulcer development. Methods: Thirty-seven individuals with diabetes were enrolled in this observational case-control study: nine with diabetic neuropathy and ulcer history (DFU), 14 with diabetic neuropathy (DN), and 14 nonneuropathic control participants (DC). Resting barefoot plantar temperatures were recorded using an infrared thermal camera. Mean temperatures were determined in four anatomical regions—hallux and medial, central, and lateral forefoot—and separate linear models with specified contrasts among the DFU, DN, and DC groups were set to reveal mean differences for each foot region while controlling for group characteristics. Results: The mean temperature reading in each foot region was higher than 30.0°C in the DFU and DN groups and lower than 30.0°C in the DC group. Mean differences were greatest between the DFU and DC groups, ranging from 3.2°C in the medial forefoot to 4.9°C in the hallux. Conclusions: Increased plantar temperatures in individuals with a history of ulcers may include acute temperature increases from plantar stresses, chronic inflammation from prolonged stresses, and impairment in temperature regulation from autonomic neuropathy. Diabetic foot temperatures, particularly in patients with previous ulcers, may easily reach hazard thresholds indicated by previous pressure ulcer studies. The results necessitate further exploration of temperature in the diabetic foot and how it may contribute to ulceration.

scholarly journals Risk factors associated with peripheral neuropathy among diabetic individuals: a case control study

2021 ◽  
Vol 8 (2) ◽  
pp. 768
Author(s):  
Christa Kingston ◽  
Aravindan J. ◽  
Srikumar Walsalam
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Diabetic Neuropathy ◽  
Case Control Study ◽  
Case Control ◽  
Diabetic Patients ◽  
Factors Associated ◽  
History Of ◽  
Control Study

Background: Diabetic neuropathy is one among the most common complication in diabetes mellitus. Diabetic peripheral neuropathy hinders the quality of life causing morbidity and mortality. The purpose of this study was to find the risk factors associated with diabetic neuropathy.Methods: This case control study involved 100 diabetic patients attending the Dohnavur fellowship hospital, Dohnavur from October 2019 to March 2020. Sociodemographic profile and diabetic characteristics of the study group were obtained and analysed. Diagnosis of Diabetic Neuropathy was done by using the diagnostic method proposed by American Diabetic Association.Results: Of the total study population with mean age 59.43 years, 63% had family history of diabetes. Almost 70% had poor diabetic control. Statistically significant relationships were found between neuropathy and duration of diabetes, glycaemic control, history of hypertension, monofilament test and pinprick sensation.Conclusions: In this study, glycemic control, dyslipidemia and hypertension were modifiable risk factors for diabetic neuropathy. Early interventional programs to sensitize diabetics on these factors could improve the quality of life of Diabetic patients. 

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