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Hoffman Estates, IL, United States

Rubayi S.,Amigos y Amigos
Plastic and Reconstructive Surgery | Year: 2011

Learning Objectives: After reading this article, the participant should be able to: 1. Describe the principles of wound closure, torso reconstruction, and pressure sore reconstruction. 2. Outline standard options to treat defects of the chest, abdomen, and back and pressure ulcers in all anatomical areas. 3. Manage and prevent pressure ulcers. Chest wall reconstruction is indicated following tumor resection, radiation wound breakdown, or intrathoracic sepsis. Principles of wound closure and chest wall stabilization, where indicated, are discussed. Principles of abdominal wall reconstruction continue to evolve with the introduction of newer bioprosthetics and the application of functional concepts for wound closure. The authors illustrate these principles using commonly encountered clinical scenarios and guidelines to achieve predictable results. Pressure ulcers continue to be devastating complications to patients health and a functional hazard when they occur in the bedridden, in patients with spinal cord injuries, and in patients with neuromuscular disease. Management of pressure ulcers is also very expensive. The authors describe standard options to treat defects of the chest, abdomen, and back and pressure ulcers in all anatomical areas. A comprehensive understanding of principles and techniques will allow practitioners to approach difficult issues of torso reconstruction and pressure sores with a rational confidence and an expectation of generally satisfactory outcomes. With pressure ulcers, prevention remains the primary goal. Patient education and compliance coupled with a multidisciplinary team approach can reduce their occurrence significantly. Surgical management includes appropriate patient selection, adequate débridement, soft-tissue coverage, and use of flaps that will not limit future reconstructions if needed. Postoperatively, a strict protocol should be adapted to ensure the success of the flap procedure. Several myocutaneous flaps commonly used for the surgical management of pressure are discussed. Commonly used flaps in chest and abdominal wall reconstruction are discussed and these should be useful for the practicing plastic surgeon. © 2011 by the American Society of Plastic Surgeons.

Pascua L.A.M.,University of Nevada, Las Vegas | Wulf G.,University of Nevada, Las Vegas | Lewthwaite R.,Amigos y Amigos
Journal of Sports Sciences | Year: 2015

The authors examined the individual and combined influences of 2 factors that have been shown to benefit motor learning: an external focus of attention and enhanced performance expectancies. Another purpose of this study was to gain further insight into the mechanisms underlying these variables. In a factorial design, participants learning a novel motor skill (i.e., throwing with the non-dominant arm) were or were not given external focus instructions, and were or were not provided bogus positive social-comparative feedback to enhance their expectancies. This resulted in 4 groups: external focus, enhanced expectancy, external focus/enhanced expectancy and control. External focus instructions and enhanced expectancies had additive benefits for learning: the external focus/enhanced expectancy group demonstrated the greatest throwing accuracy on both retention and transfer tests, while the accuracy scores of the external focus and enhanced expectancy groups were lower, but higher than those of the control group. Furthermore, self-efficacy was increased by both external focus and enhanced expectancy, and predicted retention and transfer performance. Positive affect was heightened in the enhanced expectancy and external focus/enhanced expectancy groups after practice and predicted transfer performance. The findings suggest that the learning benefits of an external focus and enhanced expectancies mediate learning through partially different mechanisms. © 2014 Taylor & Francis.

Towfighi A.,University of Southern California | Towfighi A.,Amigos y Amigos | Markovic D.,University of California at Los Angeles | Ovbiagele B.,Medical University of South Carolina
Stroke | Year: 2014

BACKGROUND AND PURPOSE-: Blood pressure (BP) reduction lowers vascular risk after stroke; however, little is known about the relationship between consistency of BP control and risk of subsequent vascular events. METHODS-: In this post hoc analysis of the Vitamin Intervention for Stroke Prevention trial (n=3680), individuals with recent (<120 days) stroke, followed up for 2 years, were divided according to proportion of visits in which BP was controlled (<140/90 mm Hg): <25%, 25% to 49%, 50% to 74%, and ?75%. Multivariable models adjusting for demographic and clinical variables determined the association between consistency of BP control versus primary (stroke) and secondary (stroke, myocardial infarction, or vascular death) outcomes. RESULTS-: Only 30% of participants had BP controlled ?75% of the time. Consistency of BP control affected outcomes in individuals with baseline systolic BP >132 mm Hg. Among individuals with baseline systolic BP >75th percentile (>153 mm Hg), risks of primary and secondary outcomes were lower in those with BP controlled ?75% versus <25% of visits (adjusted hazard ratio, 0.46; 95% confidence interval, 0.26-0.84 and adjusted hazard ratio, 0.51; 95% confidence interval, 0.32-0.82). Individuals with mean follow-up BP <140/90 mm Hg had lower risk of primary and secondary outcomes than those with BP ?140/90 mm Hg (adjusted hazard ratio, 0.76; 95% confidence interval, 0.59-0.98 and adjusted hazard ratio, 0.76; 95% confidence interval, 0.62-0.92). CONCLUSIONS-: In this rigorous clinical trial, fewer than one third of patients with stroke had BP controlled ?75% of the time for 2 years. Furthermore, consistency of BP control among those with elevated baseline systolic BP was linked to reduction in risk of recurrent stroke and stroke, myocardial infarction, and vascular death. © 2014 American Heart Association, Inc.

Sun G.H.,Amigos y Amigos
Otolaryngology - Head and Neck Surgery (United States) | Year: 2015

Variation in medicine and surgery is a critical contemporary health policy issue. Recent research demonstrates that variation in Medicare payments to otolaryngologists in a single metropolitan area was attributable to differences in health care resource utilization among physicians and that the hospital with the highest Medicare payments per physician had a higher proportion of office endoscopy-related relative value units than that of other providers, relying less on evaluation and management office visits for revenue. This study is the latest in a line of fascinating case records of variation in otolaryngology and other surgical specialties dating back to the work of J. Alison Glover in 1938. © 2015 American Academy of Otolaryngology - Head and Neck Surgery Foundation.

Towfighi A.,University of Southern California | Towfighi A.,Amigos y Amigos | Saver J.L.,University of California at Los Angeles
Stroke | Year: 2011

Background and Purpose-Stroke recently declined from the third to the fourth leading cause of death in the United States, its first rank transition among sources of American mortality in nearly 75 years. Methods-This is a narrative review supplemented by new analyses of Centers for Disease Control and Prevention National Vital Statistics Reports from 1931 to 2008. Results-Historically, stroke transitioned from the second to the third leading cause of death in the United States in 1937, but stroke death rates were essentially stable from 1930 to 1960. Then a long, great decline began, moderate in the 1960s, precipitous in the 1970s and 1980s, and moderate again in the 1990s and 2000s. By 2008, age-adjusted annual death rates from stroke were three fourths less than the historic 1931 to 1960 norm (40.6 versus 175.0 per 100 000). Total actual stroke deaths in the United States declined from a high of 214 000 in 1973 to 134 000 in 2008. Improved stroke prevention, through control of hypertension, hyperlipidemia, and tobacco, contributed most greatly to the mortality decline with a lesser but still substantial contribution of improved acute stroke care. Persisting challenges include race-ethnicity, sex, and geographic disparities in stroke mortality; the burden of stroke disability; the expanding obesity epidemic and aging of the US population; and the epidemic of cerebrovascular disease in low-and middle-income countries worldwide. Conclusions-The recent rank decline of stroke among leading causes of American death is testament to a half century of societal progress in cerebrovascular disease prevention and acute care. Renewed commitments are needed to preserve and broaden this historic achievement. © 2011 American Heart Association, Inc.

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