Missouri medicine最新文献

This paper provides a basic overview for the role of some lower extremity orthotic devices in the rehabilitation and support of the maximization of function for individuals with neuromusculoskeletal conditions. It provides a comprehensive overview of orthotic principles, designs, indications, and limitations, emphasizing the importance of thorough patient assessment in device prescription. Key terminology, including definitions of orthoses and the role of certified orthotists, is clarified. The paper discusses various types of orthotic devices, comparing custom-made to off-the-shelf options, and examines the materials used, such as leather, metal alloys, and thermoplastics, each with distinct characteristics. Additionally, this article highlights functional considerations, fitting protocols, and the need for ongoing follow-up care to prevent complications like pressure injuries. The conclusion underscores the necessity of individualized orthotic prescriptions, addressing specific patient needs to optimize rehabilitation outcomes and enhance mobility while acknowledging the trade-offs in energy expenditure and gait velocity associated with orthotic use.

Loneliness is a distressing feeling that accompanies the perception that one's social needs are not being met by the quantity or the quality of one's social relationships. It is a subjective experience of a perceived discrepancy between the preferred and actual level and quality of social interaction.1 In contrast, social isolation is an objective lack of meaningful and sustained social contacts, interactions, networks or belonging. Social isolation describes a paucity of social relationships, while loneliness depicts the lived experience and recognition of that absence.2 Although sometimes used interchangeably, loneliness and social isolation are unique conditions that share overlapping features, risk factors, and consequences. One may feel lonely with or without being socially isolated, just as one may or may not feel lonely despite being alone. These conditions do often coexist, as demonstrated in a study of older adults during the COVID-19 pandemic. In this study, both loneliness and social isolation were present in one-third of individuals; one-third of those who were lonely were also socially isolated, and 94% of those who were socially isolated were also lonely (Figure 1).3 Loneliness is neither a disease nor classified as a mental health disorder. Some have suggested that loneliness is a new geriatric syndrome: a health condition highly prevalent in older adults that is multifactorial in cause and contributes to adverse health outcomes. The COVID-19 pandemic unmasked and magnified the detrimental effects of social isolation and loneliness in older populations. We are learning more about the physical and psychological impacts of loneliness and ways to mitigate social isolation.

NREM (Non-Rapid Eye Movement) sleep is necessary for normal physical and intellectual performance and behavior. NREM parasomnias are defined as conditions where different symptomologies are associated with various behaviors happening during NREM sleep. Moreover, the underlying mechanism and proper treatment of the various conditions are yet to be explored in the realm of NREM parasomnias. In this review article, we summarize the fundamental mechanisms underlying the NREM sleep parasomnias as well as portray an algorithm to treat those conditions. We also briefly discuss important studies associated with NREM parasomnias and their related advancements in the treatment.

The era of evidence-based practice began in the 1990s with the hope patient outcomes would be improved by eliminating clinical bias and clinically unsound practices. Clinical guidelines which had been previously written by panels of experts were slowly replaced by careful analysis of existing clinical studies and more rigorous designs of new clinical studies based on sound scientific and statistical principles. This still leaves the practitioner with the responsibility of understanding what the evidence is showing them. This article reviews the statistical thinking that underlies the evidence-based literature. We will review some evolutionary changes to statistical analysis being advocated by statisticians and discuss some nuances related to the use of statistics describing diagnosis and treatment in clinical settings.