Mathematical Modelling of Different Types of Body Support Surface for Pressure Ulcer Prevention

Pressure ulcer is a common problem for today’s healthcare industry. It occurs due to external load applied to the skin. Also when the subject is immobile for a longer period of time and there is continuous load applied to a particular area of human body, blood flow gets reduced and as a result pressure ulcer develops. Body support surface has a significant role in preventing ulceration so it is important to know the characteristics of support surface under loading conditions. In this paper we have presented mathematical models of different types of viscoelastic materials and also we have shown the validation of our simulation results with experiments

A Review on Pressure Ulcer: Aetiology, Cost, Detection and Prevention Systems

Pressure ulcer (also known as pressure sore, bedsore, ischemia, decubitus ulcer) is a global challenge for today’s healthcare society. Found in several locations in the human body such as the sacrum, heel, back of the head, shoulder, knee caps, it occurs when soft tissues are under continuous loading and a subject’s mobility is restricted (bedbound/chair bound). Blood flow in soft tissues becomes insufficient leading to tissue necrosis (cell death) and pressure ulcer. The subject’s physiological parameters (age, body mass index) and types of body support surface materials (mattress) are also factors in the formation of pressure ulcer. The economic impacts of these are huge, and the subject’s quality of life is reduced in many ways. There are several methods of detecting and preventing ulceration in human body. Detection depends on assessing local pressure on tissue and prevention on scales of risk used to assess a subject prior to admission. There are also various types of mattresses (air cushioned/liquid filled/foam) available to prevent ulceration. But, despite this work, pressure ulcers remain common.This article reviews the aetiology, cost, detection and prevention of these ulcers

A Population-Based Study Comparing Child (0-4) and Adult (55-74) Mortality, GDP-Expenditure on-Health and Relative Poverty in the UK and Developed Countries 1989-2014. Some Challenging Outcomes

Purpose: To compare the UK Child (0-4) and Adult (55-74) Mortality with twenty developed countries 1989-2014 to explore whether the UK has lower priorities for children? Design: WHO data on Child and Adult mortality examined within context of World Bank %GDPExpenditure-on-Health (%GDPEH) data and Income Inequality i.e Relative poverty. Settings: 21 developed countries. Patients: National populations. Outcome Measures: Child and Adult mortality rates per million (pm) population between 1989-2014. Confi dence Intervals compares UK with other developed countries (ODC); odds ratios of average European to UK mortality calculated. Correlations explore links between mortalities, %GDPEH and Income Inequality. Important Results: Highest average 1980-2014 %GDPEH is USA 12.6%, the lowest UK 7.0%. European average 8.5% a UK to European odds ratio 1:1.21. Widest Income Inequality was USA 15.9 times, UK 13.8 was third, European average 8.5times. Child Mortality fell in every country but eleven signifi cantly better than Britain. Highest was USA 1383pm the UK fourth at 967pm. European average 728pm yielded a European to UK odds ratio of 1:1.33. Income Inequality and CRM signifi cantly correlated (RHO=+0.6188 p<0.001) and lowest Private: Public %GDP ratio and highest CMR (Rho=+0.3805 p<0.05). Adult Mortality fell substantially in every country but UK signifi cantly greater reductions than Seventeen counties. European average 9545pm to UK 10,754pm gave a European to UK odds ratio of 1:1.13. Conclusion: Implications; Britain’s results suggest a higher priority is given to adult health than children. The socio-economic context in which UK Child health operates appears to disadvantage UK children, indicating the need to address income inequalities and at least match European average health funding

A Smart Device To Substitute The Neurothesiometer

This paper presents a patented smart point-of-care testing (POCT) system for the diagnosis and grading of peripheral neuropathy at the patient’s home or care center. The device aims to detect changes or worsening of a patient’s neuropathy. Our system utilizes the vibration motor within a smart-phone, applied through a 3D printed probe attachment to detect sensation loss in vibration sensitivity threshold (VST). A smartphone app displays several neuropathy questionnaires to the user to identify and monitor changes in their condition. This paper presents results from comparison between the new smart device and the gold standard Neurothesiometer. Results suggest that the new device performs closely to the gold standard in terms of the frequency and amplitude of vibration

A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder.

Objective Systematic reviews highlight a broad range of cancer-related post-traumatic stress disorder (CR-PTSD) prevalence estimates in cancer survivors. This meta-analysis was conducted to provide a prevalence estimate of significant CR-PTSD symptoms and full diagnoses to facilitate the psychological aftercare of cancer survivors. Methods A systematic literature search was conducted for studies using samples of cancer survivors by using validated clinical interviews and questionnaires to assess the prevalence of CR-PTSD (k = 25, n = 4189). Prevalence estimates were calculated for each assessment method using random-effects meta-analysis. Mixed-effects meta-regression and categorical analyses were used to investigate study-level moderator effects. Results Studies using the PTSD Checklist—Civilian Version yielded lower event rates using cut-off [7.3%, 95% confidence intervals (CI) = 4.5–11.7, k = 10] than symptom cluster (11.2%, 95% CI = 8.7–14.4, k = 9). Studies using the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition (SCID), yielded low rates for lifetime (15.3%, 95% CI = 9.1–25, k = 5) and current CR-PTSD (5.1%, 95% CI = 2.8–8.9, k = 9). Between-study heterogeneity was substantial (I2 = 54–87%). Studies with advanced-stage samples yielded significantly higher rates with PTSD Checklist—Civilian Version cluster scoring (p = 0.05), and when assessing current CR-PTSD on the SCID (p = 0.05). The effect of mean age on current PTSD prevalence met significance on the SCID (p = 0.05). SCID lifetime prevalence rates decreased with time post-treatment (R2 = 0.56, p < 0.05). Discussion The cancer experience is sufficiently traumatic to induce PTSD in a minority of cancer survivors. Post-hoc analyses suggest that those who are younger, are diagnosed with more advanced disease and recently completed treatment may be at greater risk of PTSD. More research is needed to investigate vulnerability factors for PTSD in cancer survivors

Gemcitabine-induced haemolytic uremic syndrome, although infrequent, can it be prevented: A case report and review of literatureN

Gemcitabine is an antineoplastic used to treat several malignancies including pancreatic cancer. Its toxicity profile is well known with myelotoxicity, increased vascular permeability and peripheral oedema as most frequent adverse events. However, several cases of acute renal failure have been reported and haemolytic uremic syndrome (HUS) seems to be the underlying process. The cause of HUS remains unknown but its consequences can be lethal. Therefore, a high grade of suspicion is crucial to diagnose it and promptly treat it. This hopefully will reduce its morbidity. HUS is characterized by progressive renal failure associated with microangiopathic haemolytic anaemia and thrombocytopenia. The primary event is damage to endothelial cells and thrombotic microangiopathy (TMA) is the histopathological lesion. TMA affects mainly renal microvasculature. However, some cases evolve with central nervous or cardiovascular systems involvement. We present here a case of gemcitabine-induced HUS, with renal and cardiovascular system affected at the time of diagnosis which to our knowledge this is the first time of such case to be reported

Comparing Total Neoplasms, Breast & Prostate Cancer Mortality Rates of the UK and 20 Major Developed Countries 1989-91 v 2013- 15 - Identifying Progress

Introduction: Britain’s cancer survival results have been criticised as being significantly higher than twenty Major Developed Countries (MDC). Hence this comparison of current UK Total Age-StandardisedDeath-Rates (ASDR), female Breast and Prostate cancer mortality rates with twenty (MDC) between1989 to 2015 to determine any significant change. Method: WHO data ASDR per million (pm) for Total, Breast and Prostate cancer mortality rates examined for the years 1989-91 to 2013-15. Confidence Intervals (+/- 95%) are used to determine any significant differences between the UK and other country’s outcomes over the period. Chi square tests for each nation’s Breast and Prostate mortality. Results: Every country’s Total ASDR, Breast and Prostate cancer mortality fell except Greece and Japan. Total ASDR Male cancer mortality rates ranged from Portugal 1653pm to Sweden 1232pm. UK at 1475pm were 10th but had been 6th highest. Total ASDR Female rates went from Denmark’s 1176pm to Japan’s 740pm, the UK 1092pm now 5th but previously had been second highest. No country’s Total rates fell significantly more than Britain’s who had significantly bigger reductions than four other countries for both sexes. Breast mortality ranged from Ireland’s 206pm to Japan’s 99pm, UK rates fell significantly more than five countries. Whilst Breast mortality fell in every country Norway and UK had significantly bigger reductions in Breast than Prostate deaths, conversely France’s Prostate rates fell more than Breast mortality. Prostate mortality went from Norway 213pm Japan’s 60pm, the UK 167pm and five countries had greater reductions than Britain. Conclusions: Results reflect well on UK services for Total and Breast cancers, showing the NHS achieving more with proportionately less as Britain spends less on health than most MDC. The need how to improve UK prostate results are briefly discussed, such as a public information campaign to match the successful Breast cancer aware programme of the 1990’s

Impact of tumour histological subtype on chemotherapy outcome in advanced oesophageal cancer.

AIM: To investigate the impact of histology on outcome in advanced oesophageal cancer treated with first-line fluoropyrimidine-based chemotherapy. METHODS: Individual patient data were pooled from three randomised phase III trials of fluoropyrimidine-based chemotherapy ± platinum/anthracycline in patients with advanced, untreated gastroesophageal adenocarcinoma or squamous cell carcinoma (SCC) randomised between 1994 and 2005. The primary endpoint was overall survival of oesophageal cancer patients according to histology. Secondary endpoints were response rates and a toxicity composite endpoint. RESULTS: Of the total 1836 randomised patients, 973 patients (53%) were eligible (707 patients with gastric cancer were excluded), 841 (86%) had adenocarcinoma and 132 (14%) had SCC. There was no significant difference in survival between patients with adenocarcinoma and SCC, with median overall survivals of 9.5 mo vs 7.6 mo (HR = 0.85, 95%CI: 0.70-1.03, P = 0.09) and one-year survivals of 38.8% vs 28.2% respectively. The overall response rate to chemotherapy was 44% for adenocarcinoma vs 33% for SCC (P = 0.01). There was no difference in the frequency of the toxicity composite endpoint between the two groups. CONCLUSION: There was no significant difference in survival between adenocarcinoma and SCC in patients with advanced oesophageal cancer treated with fluoropyrimidine-based chemotherapy despite a trend for worse survival and less chemo-sensitivity in SCC. Tolerance to treatment was similar in both groups. This analysis highlights the unmet need for SCC-specific studies in advanced oesophageal cancer and will aid in the design of future trials of targeted agents

Increased DNA Methylation of ABCB1, CYP2D6, and OPRM1 Genes in Newborn Infants of Methadone-Maintained Opioid-Dependent Mothers.

OBJECTIVE: To investigate whether in utero opioid exposure, which has been linked to adverse neurodevelopmental and social outcomes, is associated with altered DNA methylation of opioid-related genes at birth. STUDY DESIGN: Observational cohort study of 21 healthy methadone-maintained opioid-dependent mother-infant dyads consecutively delivered at >36 weeks of gestation, and 2 comparator groups: smoking, "deprived" opioid-naïve mother-infant dyads (n = 17) and nonsmoking, "affluent" opioid-naïve mother-infant dyads (n = 15). DNA methylation of ABCB1, CYP2D6, and OPRM1 genes for mothers and babies was determined from buccal swabs. Plasma methadone concentrations were additionally measured for methadone-maintained opioid-dependent mothers. RESULTS: DNA methylation for ABCB1 and CYP2D6 was similar in opioid-naïve infants compared with their mothers, but was less for OPRM1 (3 ± 1.6% vs 8 ± 1%, P < .0005). Opioid-exposed newborns had similar DNA methylation to their mothers for all genes studied and greater methylation of ABCB1 (18 ± 4.8% vs 3 ± 0.5%), CYP2D6 (92 ± 1.2% vs 89 ± 2.4%), and OPRM1 (8 ± 0.3% vs 3 ± 1.6%) compared with opioid-naïve newborns (P < .0005 for all 3 genes). Infant DNA methylation was not related to birth weight, length of hospital stay, maternal smoking, dose or plasma concentration of methadone at delivery, or postcode of residence. CONCLUSIONS: In utero exposure to opioids is associated with increased methylation of opioid-related genes in the newborn infant. It is not clear whether these findings are due to opioid exposure per se or other associated lifestyle factors