The Effects of Exercise Interventions for Patients with Venous Lower Limb Ulcers: A Systematic Review

The Effects of Exercise Interventions for Patients with Venous Lower Limb Ulcers: A Systematic Review Student Researchers: Christian San Pedro, SPT Jordan Hoffman, SPT Sabrina Mendez, SPT Mentored by: Kristen Karnish, PT, MPH, DEd, GCS, CEEAA Background: Approximately 30 million Americans are affected by vascular disease with greater numbers world wide. Chronic wound care is costly, as seen by the 1.5 billion dollars Medicare spent treating wounds in 2014. Vascular disease can predispose individuals to lower limb ulcers, chronic wounds, necrosis, and amputation. In patients with chronic wounds, exercise has been hypothesized to decrease healing times by triggering cortisol release and increasing blood flow to the tissue. The purpose of this study was to evaluate the effects of exercise on wound healing, functional status and quality of life for patients with lower limb venous wounds. Methods: An article search was conducted between August 2020 and September 2020 and again in February 2021. Databases, PEDRO, Medline, and PubMed, were searched using the terms “Venous Ulcer” or “Venous Leg Ulcer” and “physical therapy” or “physiotherapy” or “rehabilitation” or “exercise” and “lower leg”. Articles were also obtained from forward search of included articles. Inclusion criteria included: peer reviewed articles, publication between 2015-2020, randomized controlled trials, and PEDro score ≥ 4/10. Nine articles were included based on the inclusion criteria. Articles addressed the effects of exercise on wound healing, functional outcomes, and quality of life. Results: Wound healing measures included healing rates, wound size, and PUSH scores. Wound healing rates and PUSH scores of the exercise groups showed significant improvement when compared to control groups, however ulcer size measurements between exercise and control groups were not significantly different. Functional outcome measures included: ankle ROM, strength, and gait outcome measures. Ankle ROM measurements between control and exercise groups were not significantly different overall with some outliers, while strength measurements between control and exercise groups were not significantly different. Gait measures between control and exercise groups were not significantly different at final assessment. Quality of life measures included pain scales and quality of life questionnaires. Quality of life questionnaires showed no significant differences and no trends between exercise and control groups, however pain scores showed significant improvement within intervention groups and significant difference when comparing exercise and control groups. Conclusions: Exercise is an effective adjunct intervention when treating patients with venous leg ulcers. Physical activity can aid in speeding up the healing process and can lead to better functional and quality of life outcomes. Even modest movement and activity was beneficial to aid in the rehabilitation and healing of those with venous leg ulcers, however further research is required to determine the most effective interventions to be provided by physical therapists.https://digitalcommons.misericordia.edu/research_posters2021/1009/thumbnail.jp

La formación gerencial de las pymes

El tema general de esta investigación es El Fortalecimiento Institucional de las Pymes en Nicaragua desarrollándose como sub – tema La Formación Gerencial de las mismas siendo este de gran relevancia para la subsistencia, desarrollo y éxito de la empresa. En nuestra investigación se aborda el grado de preparación académica que poseen los gerentes de las Pymes encontrándonos con bajos niveles de formación técnica y profesional lo que limita el fortalecimiento y desarrollo de las mismas. Actualmente existen programas y proyectos de desarrollo empresarial implementados por el gobierno con ayuda de organismos gubernamentales y no gubernamentales dirigidos a las Pymes con el fin de promover y motivar la correcta aplicación de herramientas y técnicas de tal forma que se integren al mercado de trabajo mejor preparado, obteniendo mayores resultados. En cuanto al comportamiento gerencial de las Pymes en el municipio de Matagalpa se investigó el sector alimenticio como pequeña empresa La Fábrica de Alimentos La Matagalpa y mediana empresa La Compañía de Productos Lácteos S.A. (PROLACSA) donde se determinó una adecuada formación de parte de sus dirigentes lo que les a permitido sobresalir como empresa, sirviendo como motivación a las demás Pymes en vías de desarrollo. Con nuestra investigación se pudo identificar fortalezas y oportunidades que se presenta así como debilidades y amenazas que enfrentan los gerentes de las Pymes y que obstaculizan su desarrollo. Nos hemos planteado estrategias para el fortalecimiento gerencial de forma que contribuyan a la implementación de mayores propuestas de desarrollo en este secto

Tooth loss in patients under periodontal maintenance in a private practice : a retrospective study

The aim of the present study was to evaluate the incidence and causes of tooth loss in periodontal subjects from a private practice in Brazil. Two trained examiners extracted data from the records of subjects who sought periodontal treatment from 1980 to 2013. Only records of patients who completed the non-surgical periodontal treatment and had at least one visit for maintenance were included. Data were analyzed by chi-square test, Student’s t-test, Kaplan-Meier survival curve and Cox regression. A total of 3,319 records were reviewed and 737 records included (58.6% women, mean age of 46.6±13.0 years at the beginning of the treatment). Maintenance period ranged from 1 to 33 years (7.4±6 years). During this period, 202 individuals (27.4%) lost 360 teeth, 47.5% of losses within the first five years (n=171). Non-compliers lost more teeth than compliers (p<0.001), respectively 211 and 149 teeth. Regarding reasons of tooth loss, 84 individuals lost 38% of the teeth from periodontal disease progression (n=137). Survival analysis showed that most patients lost only one tooth from periodontal disease, and differences in the survival rates between compliers and non-compliers were observed following the second tooth loss. Approximately one-third of tooth losses was related to periodontal disease progression, and there was stability in time of the proportion of losses from disease progression and other reasons. Therefore, it is possible to conclude that compliant patients in a private practice lose fewer teeth than do non-compliers. Among compliers, periodontal disease progression was not the main cause of tooth loss

Asylum seeker trauma in a student-run clinic: reducing barriers to forensic medical evaluations

Introduction: The number of forcibly displaced immigrants entering the United States continues to rapidly increase. Movement&nbsp;from Latin America across the southern border of the United States&nbsp;was the third-largest migration worldwide in 2017; the U.S. now serves as home to one-fifth of the world’s migrants (Budiman, 2020; Leyva-Flores et al., 2019).&nbsp;Reporting on&nbsp;the first two years of&nbsp;clients receiving forensic medical evaluations (FMEs) conducted by clinicians trained at University of California, San Francisco (UCSF), this&nbsp;descriptive study&nbsp;demonstrates the multiple layers and types of trauma&nbsp;in asylum seekers presenting to a student-run asylum clinic (SRAC) at an academic medical center. &nbsp; Methods: A retrospective review of the first 102 asylum seekers presenting to a university-affiliated SRAC for forensic medical and psychological evaluations is summarized. Demographics, immigration history, medical and mental health histories, descriptions of extensive trauma and referral patterns are reported. Multivariate statistics were employed to investigate the relationship between past trauma and current mental health status. &nbsp; Results: Clients reported extensive trauma histories, with an average of 4.4 different types of ill-treatment per person, including physical, psychological, and sexual violence. The current mental health burden was extensive with 86.9 percent of clients reporting symptoms of PTSD and/or depression. Clients were evaluated within a clinic structure&nbsp;that&nbsp;intentionally&nbsp;aligns&nbsp;with SAMHSA’s&nbsp;implementation&nbsp;domains of trauma-informed care&nbsp;using a continuous improvement model to reduce barriers to FMEs and promote longitudinal follow-up and referral access. &nbsp; Discussion: This&nbsp;study demonstrates the profound trauma exposure reported by asylum seekers, as well as the adaptation of a SRAC to better respond to complex trauma through intentional structural and leadership decisions. The HRC experience provides a blueprint for other asylum clinics to implement systematic trauma-centered services

Ovarían morphology andfolliculogenesis in Gymnotus carapo (Linnaeus, 1758)

El objetivo del presente trabajo fue el estudio de la morfología ovárica y la foliculogénesis de Gymnotus carapo, a fin de aportar información sobre su biología reproductiva, y que ésta sea de utilidad en el manejo de dicha especie como recurso pesquero. Se recolectaron 40 ejemplares hembras durante el periodo de febrero a diciembre del 2019 en ambientes naturales próximos a la Ciudad de Corrientes. Posteriormente a la captura fueron anestesiados con solución de lidocaína al 2% y sacrificados por sección medular. Los ovarios fueron aislados y fijados en formol al 10%; posteriormente fueron procesados para la técnica histológica convencional y coloreados con hematoxilina-eosina (H-E), tricrómica de Gomori y reacción histoquímica de PAS. Los preparados histológicos fueron analizados a través del microscopio óptico. Se pudo observar que la foliculogénesis en G. carapo es similar a la descrita para otros peces. El ovario y los ovocitos de G. carapo experimentan diferentes etapas de desarrollo: crecimiento primario, secundario, vitelogénesis y maduración durante el ciclo reproductivo, información que sienta base para estudios futuros sobre biología reproductiva. La información brindada en el presente trabajo es importante dado que aporta un estudio histológico detallado que describe la morfología ovárica y foliculogénesis en G. carapo y contribuye a la gestión y planificación de conservación de especies de importancia para el recurso pesquero.The objective of this work is to study the ovarian morphology and folliculogenesis of Gymnotus carapo, in order to provide information on its reproductive biology, and that this is useful in the management of this species as a fishing resource. 40 female specimens were collected during the period from February to December 2019 from natural environments near the City of Corrientes. After capture, they were anesthetized with 2% lidocaine solution and sacrificed by spinal section. The ovaries were isolated and fixed in 10% formalin; Later they were processed for the conventional histological technique and stained with hematoxylin-eosin (H-E), Gómori trichrome and PAS histochemical reaction. The histological preparations were analyzed through the light microscope. It was observed that the folliculogenesis in G. carapo is similar to that described for other fish. The ovary and oocytes of G. carapo undergo different stages of development: primary and secondary growth, vitellogenesis and maturation during the reproductive cycle, information that provides the basis for future studies on reproductive biology. The information provided in this work is important since it provides a detailed histological study that describes the ovarian morphology and folliculogenesis in G. carapo and contributes to the management and conservation planning of species that are of importance to the fishing resource.Fil: Perez, Dante David. Universidad Nacional del Nordeste. Facultad de Cs.veterinarias. Departamento de Cs.basicas. Cátedra de Histología y Embriologia; ArgentinaFil: Olea, Gabriela Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas, Naturales y Agrimensura. Departamento de Biología; Argentina. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Universidad Nacional del Chaco Austral; ArgentinaFil: Mendez Galarza, Sabrina. Universidad Nacional del Nordeste. Facultad de Cs.veterinarias. Departamento de Cs.basicas. Cátedra de Histología y Embriologia; ArgentinaFil: Blanco Cohene, Tania Katherina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Universidad Nacional del Nordeste. Facultad de Cs.veterinarias. Departamento de Cs.basicas. Cátedra de Histología y Embriologia; ArgentinaFil: Flores Quintana, Carolina Isabel. Universidad Nacional del Nordeste. Facultad de Cs.veterinarias. Departamento de Cs.basicas. Cátedra de Histología y Embriologia; Argentina. Universidad Nacional del Chaco Austral; Argentin

Ovarían morphology andfolliculogenesis in Gymnotus carapo (Linnaeus, 1758)

El objetivo del presente trabajo fue el estudio de la morfología ovárica y la foliculogénesis de Gymnotus carapo, a fin de aportar información sobre su biología reproductiva, y que ésta sea de utilidad en el manejo de dicha especie como recurso pesquero. Se recolectaron 40 ejemplares hembras durante el periodo de febrero a diciembre del 2019 en ambientes naturales próximos a la Ciudad de Corrientes. Posteriormente a la captura fueron anestesiados con solución de lidocaína al 2% y sacrificados por sección medular. Los ovarios fueron aislados y fijados en formol al 10%; posteriormente fueron procesados para la técnica histológica convencional y coloreados con hematoxilina-eosina (H-E), tricrómica de Gomori y reacción histoquímica de PAS. Los preparados histológicos fueron analizados a través del microscopio óptico. Se pudo observar que la foliculogénesis en G. carapo es similar a la descrita para otros peces. El ovario y los ovocitos de G. carapo experimentan diferentes etapas de desarrollo: crecimiento primario, secundario, vitelogénesis y maduración durante el ciclo reproductivo, información que sienta base para estudios futuros sobre biología reproductiva. La información brindada en el presente trabajo es importante dado que aporta un estudio histológico detallado que describe la morfología ovárica y foliculogénesis en G. carapo y contribuye a la gestión y planificación de conservación de especies de importancia para el recurso pesquero.The objective of this work is to study the ovarian morphology and folliculogenesis of Gymnotus carapo, in order to provide information on its reproductive biology, and that this is useful in the management of this species as a fishing resource. 40 female specimens were collected during the period from February to December 2019 from natural environments near the City of Corrientes. After capture, they were anesthetized with 2% lidocaine solution and sacrificed by spinal section. The ovaries were isolated and fixed in 10% formalin; Later they were processed for the conventional histological technique and stained with hematoxylin-eosin (H-E), Gómori trichrome and PAS histochemical reaction. The histological preparations were analyzed through the light microscope. It was observed that the folliculogenesis in G. carapo is similar to that described for other fish. The ovary and oocytes of G. carapo undergo different stages of development: primary and secondary growth, vitellogenesis and maturation during the reproductive cycle, information that provides the basis for future studies on reproductive biology. The information provided in this work is important since it provides a detailed histological study that describes the ovarian morphology and folliculogenesis in G. carapo and contributes to the management and conservation planning of species that are of importance to the fishing resource.Fil: Perez, Dante David. Universidad Nacional del Nordeste. Facultad de Cs.veterinarias. Departamento de Cs.basicas. Cátedra de Histología y Embriologia; ArgentinaFil: Olea, Gabriela Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas, Naturales y Agrimensura. Departamento de Biología; Argentina. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Universidad Nacional del Chaco Austral; ArgentinaFil: Mendez Galarza, Sabrina. Universidad Nacional del Nordeste. Facultad de Cs.veterinarias. Departamento de Cs.basicas. Cátedra de Histología y Embriologia; ArgentinaFil: Blanco Cohene, Tania Katherina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Universidad Nacional del Nordeste. Facultad de Cs.veterinarias. Departamento de Cs.basicas. Cátedra de Histología y Embriologia; ArgentinaFil: Flores Quintana, Carolina Isabel. Universidad Nacional del Nordeste. Facultad de Cs.veterinarias. Departamento de Cs.basicas. Cátedra de Histología y Embriologia; Argentina. Universidad Nacional del Chaco Austral; Argentin

Understanding the context of balanced scorecard implementation: a hospital-based case study in pakistan

Background: As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Methods: Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipp\u27s context (why), process (how) and content (what) framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire) and qualitative approaches including key informant interviews and participant observation.Results: Method triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if they are built on existing infrastructures and data networks. Conclusion: Variable levels of the BSC implementation were observed in this study. Those intending to apply the BSC in other hospital settings need to ensure a participatory culture, clear institutional mandate, appropriate leadership support, proper reward and recognition system, and sensitization to BSC benefits

The Boston Puerto Rican Health Study, a longitudinal cohort study on health disparities in Puerto Rican adults: challenges and opportunities

BACKGROUND: The Boston Puerto Rican Health Study is an ongoing longitudinal cohort study designed to examine the role of psychosocial stress on presence and development of allostatic load and health outcomes in Puerto Ricans, and potential modification by nutritional status, genetic variation, and social support. METHODS: Self-identified Puerto Ricans, aged 45-75 years and residing in the Boston, MA metro area, were recruited through door-to-door enumeration and community approaches. Participants completed a comprehensive set of questionnaires and tests. Blood, urine and salivary samples were extracted for biomarker and genetic analysis. Measurements are repeated at a two-year follow-up. RESULTS: A total of 1500 eligible participants completed baseline measurements, with nearly 80% two-year follow-up retention. The majority of the cohort is female (70%), and many have less than 8th grade education (48%), and fall below the poverty level (59%). Baseline prevalence of health conditions is high for this age range: considerable physical (26%) and cognitive (7%) impairment, obesity (57%), type 2 diabetes (40%), hypertension (69%), arthritis (50%) and depressive symptomatology (60%). CONCLUSIONS: The enrollment of minority groups presents unique challenges. This report highlights approaches to working with difficult to reach populations, and describes some of the health issues and needs of Puerto Rican older adults. These results may inform future studies and interventions aiming to improve the health of this and similar communities