1,230 research outputs found

    An investigation of the NHS Service provision of prosthetic limbs

    Get PDF
    This thesis explores the NHS Service provision of prosthetic limbs from a patient centred perspective. Amputation is the removal of a limb either for medical reasons or through trauma. The amputated limb can be replaced with a manufactured device to help the patient regain movement and as much function as possible. This device is known as a prosthesis and is given to the patient by the NHS at a Disablement Services Centre (DSC). There has been increasing negative media coverage of the NHS and the service it provides with specific reference to the Postcode lottery which has allegedly become apparent. This research aims to ascertain whether the service being provided at DSCs across the UK is satisfactory to patients and how this service can be improved. The literature surrounding amputation rehabilitation and care pathways is reviewed (Chapter 2). Research philosophies and approaches are discussed (Chapter 3). A countrywide study of NHS Disablement Services Centres was conducted to ascertain how the centres functioned and the differences in service between centres (Chapter 4). The data collected from this study were used to create a questionnaire for amputees to ascertain their opinions on the service they received at their centre (Chapter 5). The data revealed that patients had many problems with the service they received, very few of which could readily be acted upon due to budget restrictions. An investigation into patient s opinions on information provision was conducted as information provision was a problem highlighted by patients that could be influenced by further research (Chapter 6). Data gathered from all three studies were used to produce a proposed clinical pathway for Disablement Services Centres to follow with a new patient (Chapter 7). The proposed pathway was critically evaluated by prosthetists at a clinical conference and improvements to the proposed pathway were made using their suggestions (Chapter 7). The benefits, drawbacks and threats to the use of the proposed pathway were discussed both from the patient and clinical perspective (Chapter 8). The work was completed by overall conclusions and a discussion of further work (Chapter 9)

    The development of an adaptive and reactive interface system for lower limb prosthetic application

    Get PDF
    Deep tissue injury (DTI) is a known problem correlating to the use of a prosthetic by a transtibial amputee (TTA), causing ulcer-like wounds on the residual limb caused by stress-induced cell necrosis. The magnitude of these stresses at the bone tissue interface has been identified computationally, far exceeding those measured at the skin's surface. Limited technology is available to directly target and reduce such cellular loading and actively reduce the risk of DTI from below-knee use. The primary aim of this project was to identify whether a bespoke prosthetic socket system could actively stiffen the tissues of the lower limb. Stabilising the residual tibia during ambulation and reducing stress concentrations on the cells. To achieve this, a proof-of-concept device was designed and manufactured, a system that allowed the change in displacement of a magnet to be responded to by counterbalancing load. The device was evaluated through experimentation on an able-bodied subject wearing an orthotic device designed to replicate the environment of a prosthetic socket. The chosen sensor effector system was validated against vector data generated by the Motek Medical Computer Assisted Rehabilitation Environment (CAREN.) The project explored a new concept of reactive loading of a below-knee prosthesis to reduce tibial/socket oscillation. The evaluation of the device indicated that external loading of the residual limb in such a manner could reduce the magnitude of rotation about the tibia and therefore minimise the conditions by which DTIs are known to occur. Efforts were made to move the design to the next iteration, focusing on implementing the target demographic.Deep tissue injury (DTI) is a known problem correlating to the use of a prosthetic by a transtibial amputee (TTA), causing ulcer-like wounds on the residual limb caused by stress-induced cell necrosis. The magnitude of these stresses at the bone tissue interface has been identified computationally, far exceeding those measured at the skin's surface. Limited technology is available to directly target and reduce such cellular loading and actively reduce the risk of DTI from below-knee use. The primary aim of this project was to identify whether a bespoke prosthetic socket system could actively stiffen the tissues of the lower limb. Stabilising the residual tibia during ambulation and reducing stress concentrations on the cells. To achieve this, a proof-of-concept device was designed and manufactured, a system that allowed the change in displacement of a magnet to be responded to by counterbalancing load. The device was evaluated through experimentation on an able-bodied subject wearing an orthotic device designed to replicate the environment of a prosthetic socket. The chosen sensor effector system was validated against vector data generated by the Motek Medical Computer Assisted Rehabilitation Environment (CAREN.) The project explored a new concept of reactive loading of a below-knee prosthesis to reduce tibial/socket oscillation. The evaluation of the device indicated that external loading of the residual limb in such a manner could reduce the magnitude of rotation about the tibia and therefore minimise the conditions by which DTIs are known to occur. Efforts were made to move the design to the next iteration, focusing on implementing the target demographic

    Doctor of Philosophy

    Get PDF
    dissertationThe purpose of this constructivist grounded theory study was to identify and examine challenges and strategies used by people with parkinsonism to maintain identity. These concerns were explored within the context of daily life, vital relationships, and familiar roles. The setting was three Midwestern states during historic winter weather conditions (2013-2014). Illness descriptions were obtained through medication logs and two scales: Hoehn and Yahr staging and activities of daily living. Qualitative data consisted of 62 in-depth interviews, photos, videos, fieldnotes, and memos. Twenty-five volunteers (10 female/15 male; ages 40-95) with self-reported Parkinson disease participated. Range of disease duration was 3 months to 30 years. Disease staging: I (n = 0), II (n = 0), III (n = 14), IV (n = 8), and V (n = 3). Stage III participants completed daily living activities at an independence level of 60 to 80%, while stage V participants ranged from 20 to 30%. Twenty-one participants used carbidopa-levodopa. Analytic coding procedures generated the theory of Preserving self. This clinically logical 5-staged theory represents social and psychological processes for maintaining identity while living with a life-limiting illness. The stages and transitions are: (1) Making sense of symptoms describes noticing and taking action prediagnosis. Transition: Finding out the diagnosis was shocking, but time-limited. (2) Turning points confronted abilities with demanding tasks and strong emotions. Transition: Unsettling reminders of losses were perpetual. (3) Dilemmas of identity are the difficulties relinquishing comfortable self-attributes. Transition: Sifting and sorting is a time of grieving, letting go, and considering new self-identities. (4) Reconnecting the self synthesizes former and current identities. Transition: Balancing risks and rewards compares a lost past with possible futures. (5) Envisioning a future demonstrates planning pragmatically with tunnel vision. iv Creative methods were developed for maintaining independence; abilities were frequently overestimated. An interesting finding was the use of self-adjusted carbidopa-levodopa beginning during Sifting and sorting continuing through Reconnecting the self. Medication was used as a social prosthesis to function normally, maintain valued relationships, and roles. People with parkinsonisim desperately seek normalcy. Recommendations include medication instruction to bridge wearing-off effects and sensory integrative activities as a self-reconnecting technique

    Pharmacokinetics of Oxycodone and Paracetamol in the Elderly. Clinical Pharmacokinetic Study on Orthopaedic Surgical Patients and Healthy Volunteers

    Get PDF
    The proportion of elderly people over 65 years of age in Finland is expected to grow to over 25% by the 2025. It has been estimated that elderly people today consume nearly 40% of all drugs. Age brings about number of physiological changes that may affect the disposition, metabolism and excretion of drugs. The function of heart, lungs, liver and kidneys decreases even in healthy people, as they get older. The proportion of total body water decreases and the relative fat percentage increases. Also several other factors such as concurrent diseases, concomitant medication and nutritional factors have an effect on drug therapy in elderly. Age increases the risk of adverse drug reactions, which most often are dose-dependent. Despite all this there are not enough studies involving the elderly people and the elderly are most often excluded from clinical trials. Oxycodone is a strong opioid analgesic, which is used to treat moderate or severe pain. Paracetamol is a widely used nonopioid analgesic, which has become popular in the treatment of pain in many patient groups. In this series of studies the pharmacokinetics of oral and intravenous oxicodone as well as intravenous paracetamol in the elderly and young adult patients were investigated. Also a study investigating the interaction of oral antibiotic clarityhromycin, a known cytochrome P450 (CYP) 3A4 inhibitor, with oxycodone pharmacokinetics and pharmacodynamics in elderly and young healthy volunteers was carried out. The pharmacokinetics of oxycodone showed a clear age depency. Patients over 70 years had 50-80% higher mean exposure to oral oxycodone and a twofold greater plasma concentration than young adults 12 h after ingestion of the drug. Elderly patients had 40-80% greater exposure to intravenous oxycodone and patients over 80 years had over twofold greater plasma concentrations 8 h post dose than the young adults. The elderly patients had also greater exposure to intra venous paracetamol compared to young adults. Clarithromycin increased the exposure to oral oxycodone in both young and elderly volunteers. The elderly had marked interindividual variation in the pharmacokinetics and pharmacodynamics when clarithromycin was given concomitantly with oxycodone. Because the pharmacokinetics of oxycodone and intravenous paracetamol depend on the age of the subject, it is important to titrate the analgesic dose individually in the elderly.Oksikodonin ja parasetamolin farmakokinetiikka vanhuksilla. Kliininen farmkokineettinen tutkimus ortopedisilla leikkauspotilailla ja terveillä vapaaehtoisilla koehenkilöillä Yli 65-vuotiaiden vanhusten osuus Suomessa on arvioitu kasvavan yli 25%:in vuoteen 2025 mennessä. Nykypäivänä vanhukset kuluttavat 40% kaikista lääkkeistä. Ikääntyessä elimistön fysiologia muuttuu, mikä saattaa vaikuttaa lääkeaineiden imeytymiseen, jakautumiseen, aineenvaihduntaan ja eritykseen elimistöstä. Sydämen, keuhkojen, maksan ja munuaisten toiminta heikkenee iän myötä myös terveilläkin ihmisillä. Veden määrä elimistössä laskee ja rasvan suhteellinen osuus lisääntyy. Myös muut tekijät kuten sairaudet, mahdollinen muu lääkitys ja ravitsemukselliset tekijät vaikuttavat ikäihmisten lääkehoitoon. Suurin osa lääkkeiden aiheuttamista haittavaikutuksista on lääkkeen annostuksesta riippuvaisia. Korkea ikä nostaa lääkkeiden haittavaikutusten riskiä. Tästä huolimatta vanhuksia ei ole riittävästi tutkittu ja usein ikäihmiset suljetaan pois kliinisistä tutkimuksista. Oksikodoni on vahva opiaatti-kipulääke, jota käytetään keskivaikean ja kovan kivun hoitoon. Parasetamoli on yleisesti käytetty kipulääke kaikissa ikäryhmissä. Tässä tutkimuksessa selvitettiin sekä suun kautta annetun että suonensisäisesti annetun oksikodonin ja suonensisäisesti annetun parasetamolin farmakokinetiikkaa nuorilla aikuisilla ja vanhuksilla. Lisäksi selvitettiin sytokromi P450 (CYP) 3A:ta estävän antibiootin, suun kautta annostellun klaritromysiinin vaikutusta oksikodonin farmakokinetiikkaan ja farmakodynamiikkaan sekä iäkkäillä, että nuorilla vapaaehtoisilla. Tutkimuksessa ikä vaikutti selvästi oksikodonin farmakokinetiikkaan. Yli 70-vuotiailla altistuminen suun kautta annetulle oksikodonille oli 50-80% suurempaa ja heillä oli yli kaksinkertainen oksikodonin plasmapitoisuus nuoriin aikuisiin verrattuna 12 tuntia lääkkeen ottamisesta. Iäkkäillä altistuminen suonensisäisesti annostellulle oksikodonille oli 40- 80%suurempaa ja oksikodonin plasmapitoisuus oli yli kaksinketainen 8 tuntia lääkkeen antamisesta nuoriin aikuisiin verrattuna. Myös suonensisäisesti annostellulle parasetamolille altistuminen oli suurempaa iäkkäillä potilailla. Klaritromysiini lisäsi altistumista oksikodonille sekä nuorilla että iäkkäillä vapaaehtoisilla. Iäkkäillä yksilöiden väliset erot olivat suuria oksikodonin farmakokinetiikassa ja farmakodynamiikassa samanaikaisen klaritromysiinikuurin yhteydessä. Koska potilaan ikä vaikuttaa oksikodonin ja suonensisäisesti annostellun parasetamolin farmakokinetiikkaan ja farmakodynamiikkaan, tulee näidnen lääkkeiden annos arvioida aina yksilöllisesti iäkkäillä potilailla.Siirretty Doriast

    Direct Nerve Stimulation for Induction of Sensation and Treatment of Phantom Limb Pain

    Get PDF

    Autologous stem cells as a promising therapeutic approach for augmentation of alveolar bone

    Get PDF
    The current gold standard for reconstructive bone surgery is based on autologous bone grafts. However, the risk of complications at both the donor and recipient sites is considerable. There is therefore a need to explore alternative methods of bone regeneration which will restore a defect to full functionality and meet esthetic demands. Nowhere is this a greater challenge than in reconstruction of defects in the orofacial region. Preliminary data, from limited in vitro and in vivo studies, indicate that bone marrow-derived MSC have potential application in bone tissue regeneration. However, interpretation of these studies is complicated by lack of conformity with respect to cell type (expanded or native), culture medium, source of growth factors, expansion time, cell dose and other variables. Moreover, biopsies are required to confirm the osteogenic capacity of the implanted cells and this has not been done routinely. In most studies to date, follow-up has been limited to radiographs, which do not allow differentiation between bone tissue formed by the implanted cells and by the native cells from the border of the osseous defect. The question also remains as to whether the presence of any new bone should qualify as clinical success, or whether a successful outcome requires evidence of new bone formation at the center of the regenerated area. With respect to culture and expansion of MSC for bone tissue engineering, a further issue has arisen, namely the exclusion of animal-derived products from culture medium, requiring a human-derived source of growth factors to replace FBS. The work presented in this thesis was undertaken in order to develop and validate each step in a standardized protocol for expanding autologous MSC in vitro in a GMP-compliant facility (Study II). The expanded MSC produced by this protocol were then applied in a phase I/II clinical trial of restoration of the mandibular alveolar ridge in 11 patients. The surgery was carried out by one experienced oral surgeon (Study III). The same surgeon also undertook the post-operative follow-up, with standardized patient evaluations at each appointment. Bone regeneration was confirmed in all 11 patients, as evidenced by radiographs and biopsies taken at installation of all 21 dental implants. All the implants osseo-integrated. All patients considered the outcomes to be satisfactory, with minimum pain and no morbidity. In a retrospective study of 59 patients who had undergone advanced alveolar ridge reconstruction in accordance with the current gold standard procedure, using autologous bone grafts (Study I), patient satisfaction and OHRQoL among participants was favorable. Despite their overall satisfaction with the outcome, these patients reported significant pain and morbidity. Furthermore, procedures based on autologous grafts from the iliac crest require substantial resources including hospitalization and sick leave. The following conclusions are drawn from this series of studies. Firstly, a standard protocol has been established for GMP expansion of autologous human MSC, using PL as a source of growth factors instead of FBS. Secondly, fresh autologous MSC can be manufactured, expanded and applied in bone regeneration, despite considerable geographic distance between the cell production facility and the clinical center. Thirdly, this protocol was successfully applied for alveolar ridge bone regeneration in 11 patients, with clinical outcomes comparable to those achieved using grafted autologous bone, recovered surgically from a second site. Although patient satisfaction with the new protocol was no different from the standard approach, those treated according to the new protocol reported low pain and morbidity. The results of the comprehensive trial confirm that bone marrow mesenchymal stem cells can successfully promote bone regeneration, with no unexpected adverse events and minimal pain. Hence, this novel augmentation procedure warrants further investigation. It has the potential to form the basis of a new therapeutic approach which may challenge the current gold standard

    The experiences of women undergoing therapeutic and prophylactic mastectomy

    Get PDF
    It is well established mastectomy affects a woman’s sexual functioning. However, there is growing recognition that the intrapsychic effects of mastectomy, such as changes to one’s body-image and physical integrity can threaten embodied experiences and gendered identity. This is seen to alter how a woman appraises her sense of femininity; influencing her engagement in sexual activity and impacting upon intimate relationships. Accordingly, the aim of this review was to explore and elaborate the impact of mastectomy upon a woman’s sexuality through a synthesis of relevant qualitative literature. A systematic literature search of five databases (Academic Search Complete, CINAHL, PsychARTICLES, PsychINFO, and MEDLINE) was undertaken using terms for mastectomy, sexuality, and qualitative data. A meta-synthesis was conducted on the data from the twelve studies obtained. Three overarching themes were derived highlighting how mastectomy impacts upon a woman’s femininity, sense of personal attractiveness and desirability within intimate relationships, and the importance of an intimate partners support in enabling women to adjust to their altered bodies. Findings have important practice implications. Particularly, the need for clinicians to offer interventions that aim to maintain the relationship between a woman, her altered body, and partner after mastectomy
    corecore