Day 2 :
University of Alaska Anchorage| USA
Time : 09:30-10:15
Michele Burdette-Taylor has completed her PhD at the University of San Diego in California. She is an assistant professor at the University of Alaska Anchorage. She teaches undergraduate and graduate courses in community health, foot care, and wound care for the college of health, school of nursing and physician assistant program. She has published numerous skin, wound, pressure ulcer and foot care articles. Her most recent publication was a chapter for the new Wound Ostomy Continence Nurses Core Curriculum for Wound Care for entitled Foot and Nail Care.
Health in the Arctic among the indigenous circumpolar Inuit population is a serious concern. The Inuit span across four nations. They were descendants from human migrations across the Beringia land bridge 5,000 years ago. There are 167,000 Inuit in Greenland, Denmark, Alaska, Canada and Russia. The research conducted in these regions among this population is unique and directly related to geographic and genetic factors. Geographic remoteness, limited gene pool, and underdeveloped human resources have impacted the health systems and practices.
Chronic diseases as heart disease and diabetes are called “diseases of modernization”. They tend to increase in traditional societies undergoing rapid changes in diet and physical activity. Diabetes, alcoholism, and frostbite are a few concerns of the World Health Organization in reference to global health in the Arctic. Neuropathy leads to foot ulcers, wounds, and amputations are increasing exponentially. Though diabetes is considered a new disease among the Inuit, over the last 2-3 decade glucose tolerance surveys among the Inuit have shown to increase in prevalence.
Global health initiatives have historically excluded indigenous circumpolar concerns. There is much to share from one another. The population of many nations genetically linked over 5,000 years is a priceless resource for learning.
Sarah Herzog Hospital | Israel
Keynote: The effect of pressure ulcers on the survival in patients with advanced dementia and comorbidities
Time : 10:15-11:00
Efraim Jaul is a specialist in Family Medicine and Geriatric Medicine. He is the Head of the Geriatric Skilled Nursing Department at the Sarah Herzog Hospital, Jerusalem, Israel. It is affiliated with the Hebrew University-Hadassah Medical School, Jerusalem. He is a Clinical Senior Lecturer in the Hebrew Medical School Faculty. He supervises clinical practice and mentors students. He developed and established a pioneering inpatient unit at the Herzog Hospital specifically for the treatment of pressure ulcers concerning the need for a special unit and the resulting benefits for the immobile elderly patients. This unit has elicited interest in serving as a model for geriatric treatment facilities around the world and has set the standard for developing specialized pressure ulcer units
Background: The mortality rates for many leading causes of death have declined over the past decade. Advanced dementia with comorbidities has steadily increased to become one of the leading causes of death in the elderly population. Therefore, we examined the effect of pressure ulcers on the survival time of patients with advanced dementia and comorbidities.
Method: Data was reviewed from all the files of 147 patients hospitalized over a period of three and a half years. 99 tube-fed patients suffering from advanced dementia were included; 72(66.5%) had pressure ulcers and 27(33.5%) were without pressure ulcers at admission. Logistic regression analysis was used to estimate the odds ratio and 95% confidence intervals for pressure ulcers group versus non-pressure ulcers group. Unadjusted Cox model and Cox proportional Hazards model were used to assess the hazard ratio for pressure ulcers and the association between pressure ulcers and survival time, respectively. Kaplan- Meier model was used to visually confirm the existence of proportional hazards of pressure ulcers on survival.
Results: The median survival of advanced dementia patients with pressure ulcers was significantly shorter, compared to those without pressure ulcers (96 days vs 863 days respectively (p=0.001, log rank test). The Hazard Ratio for the advanced dementia patients with pressure ulcers; was 2.81, 95% CI: 1.51-5.22, p<0.01. Significant lower hemoglobin and serum albumin levels were found in the patients with pressure ulcers; (10.46 vs 11.7 p= 0.001) and (26.2 vs 29.6 p=0.02).
Conclusion: Advance dementia and pressure ulcers in the same patient results in earlier mortality. Advanced dementia patients with pressure ulcers, had significantly lower survival expectancy in comparison to similar patients without pressure ulcers. Clinical and ethical implications are discussed
Networking and Refreshment 11:00-11:20 @ Foyer
Englewood Hospital and Medical Center | USA
Time : 11:20-12:05
Thomas Bernik is Chief of Vascular Surgery at Englewood Hospital and Medical Center in Englewood New Jersey. Bernik specializes in complex open surgery, minimally invasive surgery for aortic aneurysms, carotid disease, peripheral vascular disease and complex venous thrombosis. Most recently Bernik served as Associate Professor of Surgery and Chief of Vascular Surgery at Mount Sinai, Beth Israel, New York. Bernik received his medical degree from George Washington University School of medicine and completed his vascular fellowship at North Shore University as well as Strong Memorial Hospital
Critical limb ischemia comprised of rest pain and tissue loss is a well-known public health issue. The incidence is higher in smokers, diabetics and the elderly. Although there is no clear consensus or randomized trials that support minimal invasive intervention over open surgery, there has been a general trend toward an endovascular first philosophy. The aim of this presentation is to describe current vascular management and supportive data for the treatment of patients with critical limb threatening ischemia. The multiple and various endovascular techniques and approaches will be described as well as case presentations
Armed Forces Medical Services| India
Time : 12:05-12:50
Bipin Puri has completed his M Ch in Pediatric Surgery from the Post Graduate Institute of Medical Education & Research, Chandigarh, India in the year 1993. He further completed his Fellowship in Pediatric Urology from Birmingham Children's Hospital, UK in 1997 and is a Fellow of the Royal College of Surgeons (Edinburgh). He is currently the Senior Consultant Surgery for the Armed Forces Medical Services of India, the highest Chair in the faculty of Surgery in the Armed Forces in India. He has 35 publications, 04 International papers and 03 chapters in Medical Text books. He is an examiner for Post Graduate studies with the National Board of Examinations, New Delhi, India, the PGIMER, India, Delhi University and MUHS University, India
Burn injury is a dreaded scourge the world over and indeed is fairly commonly tackled by the military surgeon. While superficial burn wounds heal spontaneously, the deep ones need to be excised and appropriately covered, preferably with autogenous split thickness skin grafts. This result in increased survival, decreased infection rates, and decreased length of hospital stay. However, this standard of care is quite often not offered to the unfortunate patient in the developing world as also in India. We in the Indian Armed Forces have taken the initiative to mitigate the suffering of the soldier and his dependants by this technique and present our 10-year experience in two large burn centers across the country. 622 consecutive patients with deep burn wounds who underwent early excision were included in the study. Average percentage of burned area was 33.09% and average percentage of area excised early in the study group was 20.07%. Maximum area excised at a time in one patient was 45%, with 15 patients excised in excess of 30%. Hospital stay before the early excision was 2.85 days per percent of body surface area burns. After initiation of early burn wound excision, this decreased to 1 day per percent of body surface area burns.
It is indeed a tough challenge to treat patients with major and deep burn wounds. Early excision of burns is far superior to conservative treatment in tackling deep burns. This markedly reduces mortality and significant morbidity in the wounded soldier and the members of his family