29 June 2013
USA(Miami): Dr. Augusto SARMIENTO: FUNCTIONAL FRACTURE BRACING (FFB)
Dr.Sarmiento: FFB is a system of nonsurgical care for certain long- bone fractures based on the proposition that immobilization of joints above and below a fracture is not essential for healing, and that the resulting physiologically induced motion at the fracture site is conducive to the formation of a stronger callus.
Body Cast Editor: How has functional fracture bracing evolved from its inception?
Dr. Sarmiento: Experiences with the PTB prosthesis for the below-the-knee amputee developed in the early 1960s,
which successfully eliminated the traditional thigh corset, prompted me to suspect that a below-the-knee cast molded
like the prosthesis could be successfully used in the treatment of tibial diaphyseal fractures, where the proximal fragment would be the equivalent of the stump and shortening would be prevented. The initial results were encouraging, but soon I realized that neither the indented patellar tendon nor the molded tibial condyles were major weight-bearing
contributors. The soft tissues surrounding the fractured bones were the structures that prevented shortening above
the one present at the initial injury. A degree of shortening that does not increase with the introduction of graduated
weight-bearing ambulation.
Therefore, the name PTB commonly used to describe the cast is wrong. Further experiences with the short-leg functional cast led to the construction of a brace that gave freedom of motion of the ankle joint, as well.
Following subsequent clinical and laboratory investigations, the concept was extended to other bones, such as the humerus, forearm, isolated fractures of the ulna, the femoral shaft, tibial nonunions, and Colles' fractures. The results were mixed, so much that the use of the system was discontinued for fractures of both bones of the forearm, open tibial fractures and the femur. Advances in the surgical treatment of these fractures fully justified their dismissal. Similarly, the intramedullary nailing of fractures has made this approach a successful one in the management of many tibial fractures, particularly in those with unacceptable initial shortening or uncorrectable angulation.
UK: NURSING MEDICATION ERRORS in NHS HOSPITALS
From UK DAILY MAIL
Saturday, Jun 29 2013 12PM 16°C 3PM 20°C 5-Day Forecast
One in three diabetes patients 'are given the wrong medication while in hospital'
A third of patients in England and Wales experienced a 'medication error' during a five week audit
The audit found that 61 patients had developed life threatening ketoacidosis during a hospital stay
Charity Diabetes UK says it is 'appalling' that anybody should develop the preventable condition
By Daily Mail Reporter
PUBLISHED: 00:49 GMT, 27 June 2013 | UPDATED: 07:52 GMT, 27 June 2013
Worrying: A third of patients in hospitals in England and Wales experienced a 'medication error' during the five-day National Diabetes Inpatient Audit (file picture)
Worrying: A third of patients in hospitals in England and Wales experienced a 'medication error' during the five-day National Diabetes Inpatient Audit (file picture)
One in every three diabetic patients are given the wrong medication while in hospital, a new report suggests.
A third of patients in hospitals in England and Wales experienced a 'medication error' during the five-day National Diabetes Inpatient Audit.
The audit, conducted last September, also found that 61 patients developed a life-threatening but preventable complication due to poor care.
Charity Diabetes UK said it is 'appalling' that any patients should develop diabetic ketoacidosis during a hospital stay.
The audit, which examined data from 13,400 patients, also found that a fifth of patients suffered from hypoglycaemia while in hospital.
Bridget Turner, director of policy and care improvement at Diabetes UK, said: 'It is appalling that some people with diabetes are being so poorly looked after in hospitals that they are being put at risk of dying of an entirely preventable life-threatening condition.
'Even a single case of diabetic ketoacidosis developing in hospital is unacceptable because it suggests that insulin has been withheld from that person for some time.
'The fact that this is regularly happening raises serious questions about the ability of hospitals to provide even the most basic level of diabetes care.
'In every aspect of hospital diabetes care that this report shines a light on, the picture that emerges is profoundly disturbing.
Read more: http://www.dailymail.co.uk/health/article-2349313/One-diabetes-patients-given-wrong-medication-hospital.html#ixzz2XbmK7OG7
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26 June 2013
PERSONALIZED (PRIVATE) vs GUIDELINE (STATE) MEDICINE
ONLINE FIRST
Personalized Medicine vs Guideline-Based Medicine
Published online
May 27, 2013
Two
philosophical approaches to the implementation of optimal health care
are emerging—the use of evidence-based guidelines and the application of
personalized (or “precision”) medicine. Even though both approaches
have important merits, they both also can present conflicting priorities
that must be reconciled before they can be best leveraged.
Evidence-based
guidelines are generated based on the body of clinical data available
for a particular question. The highest level of evidence assigned in a
guideline is based on multiple randomized controlled clinical trials. In
general, randomized clinical trials have specific inclusion and
exclusion criteria designed to represent a population broad enough and
sufficiently enriched to attain a requisite number of end points and
demonstrate a statistically and clinically significant difference in
outcome. Subgroup analyses (both those that are prespecified and other
post hoc analyses) are often performed to identify characteristics
within the study population that are associated with greater benefit
from the intervention, with no benefit, or even with harm. Yet these
analyses are accompanied by warnings that findings should be cautiously
interpreted.1
24 June 2013
UK AVITA MEDICAL : RECELL spray-on skin
About ReCell
ReCell is a stand-alone, rapid, autologous cell harvesting,
processing and delivery technology that enables surgeons and clinicians
to treat skin defects using the patient's own cells in a regenerative
process.Developed as an 'off the shelf' kit, ReCell enables a thin split thickness biopsy, taken at the time of the procedure, to be processed into an immediate cell population for delivery onto the surface of the treatment area using a highly efficient, easy-to-use proprietary 'spray-on' application process. Tissue collection, cell segregation and preparation of the cell suspension takes approximately 20-30 minutes in total during which time the treatment area is prepared. Once processed, the cell suspension is available for immediate use and can cover a treatment area up to 80 times the area of the donor biopsy.
ReCell enables the delivery of keratinocytes, melanocytes, fibroblasts and Langerhans cells harvested from the epidermal-dermal junction for application onto a wound surface in order to promote rapid and effective healing.
ReCell has been clinically demonstrated to accelerate healing, minimize scar formation, eliminate tissue rejection and reintroduce pigmentation into hypopigmented areas.
ReCell has been designed for use in a wide variety of wound, plastic, reconstructive, burn and cosmetic procedures including burns and scalds, donor sites, glabrous injuries, mild to moderate scars, hypopigmentation (hypopigmented scars, iatrogenic hypopigmentation and Vitiligo) and in aesthetic rejuvenation procedures.
As the ReCell technology enables cell processing at the site of treatment without the use of specialised laboratory staff, the process is both cost and time efficient.
Advantages include:
· Minimisation of donor site size and depth with concomitant reduction in complications, morbidity and healing time.
· Improved wound healing time and scar quality.
· Repopulation of melanocytes to reduce hypopigmentation.
· On-site processing for immediate application.
· Increased viability through immediate harvest and application.
· Ability to be processed by clinician and not require specialised laboratory staff.
REPORTED IN UK DAILY MAIL
23 June 2013
19 June 2013
UK ROYAL BIRTHING HOSPITAL
Paddington St.Mary's Teaching Hospital.The Lindo Wing prices
(Does not include Medical fees)
Antenatal careDay case accommodation: Up to one hour £75, up to three hours £200, over three hours £400
Antenatal care overnight: £900
Parent education (five classes): £350
Consultant-led care packages
Cost of additional night – per room
First 24 hours normal delivery package £4,965
(Cost of additional night £900 for superior package, £1,050 for deluxe package, and suite prices and information available on request and subject to availability)
First 24 hours instrumental delivery £ 5,500
(Cost of additional night £900 for superior package, £1,050 for deluxe package, and suite prices and information available on request and subject to availability)
First 24 hours caesarean section (emergency or planned) £ 6,420
(Cost of additional night £900 for superior package, £1,050 for deluxe package, and suite prices and information available on request and subject to availability)
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