Guidelines for the treatment of diabetic ulcers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72913/1/j.1524-475X.2006.00176.x.pd

Guidelines for the prevention of diabetic ulcers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72321/1/j.1524-475X.2008.00357.x.pd

Monkey see, monkey do : establishing new real estate development frameworks for the land optioning and assembly process in Singapore

Thesis: M.C.P., Massachusetts Institute of Technology, Department of Urban Studies and Planning, 2014.Thesis: S.M. in Real Estate Development, Massachusetts Institute of Technology, Program in Real Estate Development in conjunction with the Center for Real Estate, 2014.Cataloged from PDF version of thesis.Includes bibliographical references (pages 118-122).Development projects ultimately create places in the built environment. As such, the developer should be concerned with the quality of spaces they create for those in the community to interact within. For this reason, a structural framework should be established to allow developers to understand the needs of the various communities in which they develop. The focus of this thesis is not upon traditional notions of community engagement, which is primarily focused on short-term decisions and development implications. Rather the structural framework proposed in this thesis takes a long-term approach to development and views community involvement as a win-win situation in which all parties involved are better off. In order for this framework to be implemented, a large-scale embrace of strategic planning that facilitates and guides development is needed. This requires that community engagement be addressed at the onset of the development process, more specifically, the land optioning and assembly process. This thesis combines parametric design theory and community engagement in the ideal state of Singapore, with the goal of establishing a stakeholder framework that could be applied to the land optioning and assembly process for the Eco-Town development of Punggol. The intent of this thesis is to establish a stakeholder framework that provides an opportunity for the land optioning and assembly process to be more systematically understood. Using parametric design thinking theoretically allows each stakeholder to have control over various aspects of the land optioning process. Realistically, the developer could observe the impacts that occur when different stakeholders engage in this process. Ultimately, this framework provides the developer with a better methodology to understand stakeholder engagement as a component of their development projects. The hope is to generate ideal development and planning process ideals that can allow individuals to have a greater impact in the communities in which they reside.by Lawrence Bernard Harkless, Jr.M.C.P.S.M. in Real Estate Developmen

The epidemiology, evaluation, and assessment of lateral ankle sprains in athletes

Approximately 30,000 ankle injuries occur every day in the United States. With the incidence estimated at more than 3 million a year and at a rate of 2.15/1,000 in the U.S. alone, medical specialists and other healthcare providers caring for the foot and ankle must take notice. Despite the millions of ankle injuries sustained annually, the true incidence may be underestimated, as fewer than half of individuals with ankle sprains seek medical attention from healthcare professionals. The economic burden associated with the evaluation, diagnosis, and treatment is close to $4 billion annually. Ankle sprains account for half of all sports injuries and remains a difficult diagnostic and therapeutic challenge in the athlete. Accurate diagnosis is critical as 40% of ankle sprains are misdiagnosed or poorly treated leading to chronic ankle pain and disability. Implementing evidence supported diagnostic and treatment strategies is the goal for ensuring safe and rapid return to play. The Lateral Ankle Sprain (LAS) is among the most common type of ankle sprains suffered during athletic activities. Up to 80% of LAS are of the inversion type, and 75% lead to recurrence and instability. Although most individuals experiencing a LAS return to activity within six weeks, many report continued pain, diminished function, and instability. The purpose of this review is to highlight the epidemiology, pathoetiology, pathoanatomy, and biomechanics of the LAS, enabling sports physicians to implement the best practice guidelines and protocols to manage this common enigma.&nbsp

Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary

Objective To update the 2011 American Academy of Neurology (AAN) guideline on the treatment of painful diabetic neuropathy (PDN) with a focus on topical and oral medications and medical class effects. Methods The authors systematically searched the literature from January 2008 to April 2020 using a structured review process to classify the evidence and develop practice recommendations using the AAN 2017 Clinical Practice Guideline Process Manual. Results Gabapentinoids (standardized mean difference [SMD] 0.44; 95% confidence interval [CI], 0.21–0.67), serotonin-norepinephrine reuptake inhibitors (SNRIs) (SMD 0.47; 95% CI, 0.34–0.60), sodium channel blockers (SMD 0.56; 95% CI, 0.25–0.87), and SNRI/opioid dual mechanism agents (SMD 0.62; 95% CI, 0.38–0.86) all have comparable effect sizes just above or just below our cutoff for a medium effect size (SMD 0.5). Tricyclic antidepressants (TCAs) (SMD 0.95; 95% CI, 0.15–1.8) have a large effect size, but this result is tempered by a low confidence in the estimate. Recommendations Summary Clinicians should assess patients with diabetes for PDN (Level B) and those with PDN for concurrent mood and sleep disorders (Level B). In patients with PDN, clinicians should offer TCAs, SNRIs, gabapentinoids, and/or sodium channel blockers to reduce pain (Level B) and consider factors other than efficacy (Level B). Clinicians should offer patients a trial of medication from a different effective class when they do not achieve meaningful improvement or experience significant adverse effects with the initial therapeutic class (Level B) and not use opioids for the treatment of PDN (Level B)