Palliative Care for Chronic Illness – A Different Paradigm for the Advance Practice Nurse in the Nursing Home

Today, 51% of all Nursing Home (NH) residents are 85 years old and above, 6 years older than the life expectancy for both men and women in the United States (US). Most NH facilities provide care using a medical model of care focused on cure and acute illness, yet many older adults experience dying as a gradual process from chronic disease and/or serious illness. In the US, the need to consider innovative approaches to gradual death and chronic illness is necessary. For those who are actively dying, hospice provides a framework of care focusing on pain relief and comfort. However, neither the current medical model of “cure” nor hospice are adequate to provide care to those of advanced age who are nearing the end of life, but for whom death is not imminent. In contrast, concurrent palliative care (PC), as opposed to palliative care synonymous with hospice (hospice), does provide a framework of comfort, caring, and quality for older adults with chronic disease or serious illness. The purpose of this project is to introduce an evidence-based recommendation for concurrent palliative care (PC) to be used by the Advanced Practice Nurse in the nursing home

The alchemy of tendon repair: A primer for the (S)mad scientist

During vertebrate development, mesenchymal progenitors capable of forming bone, cartilage, muscle, fat, or tendon arise from either neural crest or somitic mesoderm. Transcriptional programs that specify mesenchymal cell fates are initiated and modified by paracrine cues provided by TGF-β superfamily members and mediated in part via the regulated assembly of Smad-containing multiprotein transcription factor complexes. In this issue of the JCI, Hoffmann and colleagues have identified that Smad8 activation drives tendon formation from C3H10T1/2 cells, a murine cell line that recapitulates many features of normal multipotent mesenchymal cells (see the related article beginning on page 940). Cells programmed to the tenocyte cell fate in vitro formed tenogenic grafts in vivo. These results add to the accumulating evidence that proliferating, multipotent mesenchymal progenitor cells can be programmed to yield multiple cell types — e.g., osteoblasts, myocytes, chondrocytes, and tenocytes — that may be useful in cell-based therapeutic approaches to musculoskeletal diseases

Common Treatments and Procedures Used for Fractures of the Distal Radius and Scaphoid: A Review

The distal radius and the scaphoid are the most commonly injured carpal bones among both active adults and the osteoporotic elderly. The purpose of surgical treatment is to restore form and function to the wrist. Depending on the nature of the fracture, either topical procedures or invasive surgery can be applied. This article critiques the treatments currently used for fixation of wrist fractures in order to drive the development of new materials to improve patient outcomes

Materials and Techniques Used in Cranioplasty Fixation: A Review

Cranioplasty is the surgical repair of a deficiency or deformity of the skull. The purpose of cranioplasty is to provide protection for the brain following cranial surgery, and to offer relief to psychological disadvantages while increasing social performance. There are several materials that had been used for cranioplasty, but an ideal product has yet to be developed, hence the ongoing research into biologic and non-biologic alternatives to the existing materials. This article critiques the products currently used for cranioplasty in order to facilitate the development of new materials, which can improve patient outcomes

Biofilm Inhibitory Coatings Formulated from Glass Polyalkenoate Cement Chemistry: An Evaluation of their Adhesive Nature

Researchers evaluated the adhesive nature of the biofilm inhibitory coatings formulated from glass polyalkenoate cement (GPC) chemistry with the aim to establish the novel testing modality by modifying the conventional T-peel tests. Special consideration was given to determine the resistance of a bonded assembly of two adherents having at least one adherent flexible to quantify the bond between tape and a surgical metal substrate bonded by a luting GPC. The delaminated tape surface was examined by scanning electron microscopy (SEM) with an accelerating voltage of 20 K V to determine whether failure of the bond was adhesive of cohesive in nature. Researchers have also evaluated the cements against Ti6A14V, as they are designed as surgical coatings. The load testing evaluation in excess of 5500 Pa, showed the failure of the novel GPC adhered to rigid and flexible substrates

Gallium Containing Glass Polyalkenoate Bone Cements: Ion Release and E. Coli Inhibition

The Glass Polyalkenoate Cement (GPC) series (LCon., LGa-1 and LGa-2) containing gallium (Ga) and a 50 wt% addition of E11 polyacrylic acid (PAA), previously developed, was evaluated for ion release, specifically Si, Ca, Zn and Ga, and E. coli inhibition. The maximum inhibition was observed in the t = 0 samples and was 0.35 mm for LCon. and 0.65 mm for LGa-1 and LGa-2. © 2013 IEEE

Silver Coated Bioactive Glass Particles for Wound Healing Applications

Hench and colleagues discovered that bone could bond chemically to certain glass compositions in 1969 [1]. This group of glasses is known as bioactive glasses [1]. Some special compositions of bioactive glasses will bond to soft tissues as well as bone [1]. One of the important characteristics of bioactive glasses is their ability to release beneficial ions such as Ca2+, Na+, Zn2+, Sr2+, and PO 43- in the body, which promote self-healing [2]. Bioactive glasses generally contain much less glass former (e.g., SiO2, B2O3 etc.) than conventional glasses [3]. Network modifiers encourage the formation of Non-Bridging Oxygens (NBO) groups. These NBO groups decrease aqueous durability and increase bioactivity [4]. © 2012 IEEE

Silver Coated Bioactive Glass Particles for Wound Healing Applications

Bioactive glass particles (0.42SiO2-0.15CaO-0.23Na 2O-0.20ZnO) of varying size (\u3c90 \u3eμm and 425-850 μm) were synthesized and coated with silver (Ag) to produce Ag coated particles (PAg). These were compared against the uncoated analogous particles (Pcon.). Surface area analysis determined that Ag coating of the glass particles resulted in increased the surface area from 2.90 to 9.12 m2/g (90 μm) and 1.09-7.71 m2/g (425-850 μm). Scanning electron microscopy determined that the Ag coating remained at the surface and there was little diffusion through the bulk. Antibacterial (Escherichia coli - 13 mm and Staphylococcus epidermidis - 12 mm) and antifungal testing (Candida albicans - 7.7 mm) determined that small Ag-coated glass particles exhibited the largest inhibition zones compared to uncoated particles. pH analysis determined an overall higher pH consider in the smaller particles, where after 24 h the large uncoated and Ag coated particles were 8.27 and 8.74 respectively, while the smaller uncoated and Ag coated particles attained pH values of 9.63 and 9.35 respectively. © Springer Science+Business Media, LLC 2012

Gallium Containing Glass Polyalkenoate Bone Cements: Glass Characterization and Physical Properties

Gallium (Ga) glasses were developed to formulate a Glass Polyalkenoate Cement (GPC) series with both E9 and E11 polyacrylic acid (PAA) at 50, 55 and 60wt% additions. Working times (T w), setting times (T s), compression (σ c), and biaxial flexural (σ f) strength testing were evaluated to determine the GPCs potential use in orthopedics. © 2012 IEEE