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  • 1.

    【2hr】Calciphylaxis as A Rare Cause of A Chronic Wound in An 83-Year-Old Woman

    包量

    机译 钙减少是一名83岁女性慢性伤口的罕见原因
    摘要：Chronic wounds are common in elderly patients, and the majority of them are caused by vascular diseases, such as peripheral arterial occlusive disease (PAD) or chronic venous insufficiency. Because of typical signs, these diseases can be usually easily differentiated. However, 10% of chronic wounds are caused by specific rare diseases, such as vasculitis, specific infections, skin cancer, or calciphylaxis. Calciphylaxis is a rare cause of chronic wounds, and it is usually found in patients with end-stage renal disease. In this paper, we describe the case of an 83-year-old woman with a chronic ulcer of the lower leg caused by calciphylaxis.
  • 2.

    【2hr】Giving Them a Voice: Challenges to Narrative Agency in People with Dementia

    包量

    机译 发出声音：痴呆症患者叙事能力的挑战
    摘要：In this paper, we argue that the capacity for narrative agency is significantly compromised in individuals with dementia due to at least three factors: (a) Dementia itself, which causes increasing difficulties in constructing and articulating coherent and meaningful stories, and sharing them with others; (b) cultural narratives about dementia, which promote an extremely negative and pessimistic view of those with the disease; and (c) the convergence of these two last factors, which can lead to caregiving interactions that do not support storytelling and can even stop people with dementia from telling stories. We highlight the importance of narrative care, which involves interventions that focus on the person and their unique life narrative. In narrative care, people with dementia are treated not as impaired patients defined by the disease, but as human beings. In doing so, people with dementia can have their own voices back, which is silenced and discredited so many times.
  • 3.

    【2hr】The Occupational Therapy Approach to Addressing Food Insecurity among Older Adults with Chronic Disease

    包量

    机译 解决老年人慢性病食物不安全问题的职业疗法
    摘要：The older adult population is one of the fastest growing age groups in the United States. Various components influence productive aging, and current research has identified nutrition and healthy eating as key factors that impact older adults’ overall health status. While consumption of nutritious meals can help minimize the risk of health decline, the growing rate of food insecurity inhibits older adults’ abilities to access healthy food regularly. Additionally, the high prevalence of chronic disease and disability in older adults can also limit independent participation in food-related activities, such as shopping, self-feeding, and meal preparation. A lack of food access and difficulties engaging in food-related activities place older adults with chronic disease at an increased risk of malnutrition, disability, and losing independence, thereby threatening social participation, healthy aging, and quality of life. Due to their expertise in promoting health and independent living, occupational therapy practitioners may be uniquely positioned to enhance older adults’ healthy eating behaviors through the use of client-centered interventions tailored to food-related activities. This position paper reviews the scope of the occupational therapy profession, the consequences of food insecurity among older adults with chronic conditions, and strategies to enhance food-related activity participation in later life.
  • 4.

    【2hr】Psychological Wellbeing and Healthy Aging: Focus on Telomeres

    包量

    机译 心理健康与健康老龄化：关注端粒
    摘要：Stress and depression are known to modulate the aging process, and might also affect telomere biology. In fact, exposure to some biochemical pathways involved in stress-related depression may contribute to an ‘‘accelerated aging” phenotype, as well as the incidence of age-related diseases, including metabolic disorders and dementia. Basic studies support the notion that the telomere and telomerase system plays a pivotal role in the aging process and disease promotion. Interestingly, short and dysfunctional telomeres are associated with reduced lifespan, as shown in animal models. In this context, telomeres are very sensitive to stress, mindset, and lifestyle, and their rescue may be sufficient to restore cell and organism viability. This mini-review discusses conceptual models of healthy and active aging and their relationship with telomere biology and mental health.
  • 5.

    【2hr】ACE Model for Older Adults in ED

    包量

    机译 ED中老年人的ACE模型
    摘要：The emergency department (ED) is uniquely positioned to improve care for older adults and affect patient outcome trajectories. The Mount Sinai Hospital ED cares for 15,000+ patients >65 years old annually. From 2012 to 2015, emergency care in a dedicated Geriatric Emergency Department (GED) replicated an Acute Care for Elderly (ACE) model, with focused assessments on common geriatric syndromes and daily comprehensive interdisciplinary team (IDT) meetings for high-risk patients. The IDT, comprised of an emergency physician, geriatrician, transitional care nurse (TCN) or geriatric nurse practitioner (NP), ED nurse, social worker (SW), pharmacist (RX), and physical therapist (PT), developed comprehensive care plans for vulnerable older adults at high risk for morbidity, ED revisit, functional decline, or potentially avoidable hospital admission. Patients were identified using the Identification of Seniors at Risk (ISAR) screen, followed by geriatric assessments to assist in the evaluation of elders in the ED. On average, 38 patients per day were evaluated by the IDT with approximately 30% of these patients formally discussed during IDT rounds. Input from the IDT about functional and cognitive, psychosocial, home safety, and pharmacological assessments influenced decisions on hospital admission, care transitions, access to community based resources, and medication management. This paper describes the role of a Geriatric Emergency Medicine interdisciplinary team as an innovative ACE model of care for older adults who present to the ED.
  • 6.

    【2hr】Rehabilitative Support for Persons with Dementia and Their Families to Acquire Self-Management Attitude and Improve Social Cognition and Sense of Cognitive Empathy

    包量

    机译 为痴呆症患者及其家人提供的康复支持，以帮助他们养成自我管理的态度，并提高其社会认知能力和认知移情能力
    摘要：People with dementia are often inevitably confronted with various difficulties with social interaction and communication, which is a core problem that can be improved with rehabilitative support, thus improving their quality of life. The authors propose rehabilitative support using communication via activities; co-beneficial relationship-based rehabilitation, which emphasizes the following 3 points: support for people with dementia to improve social reserves, which is the ability to overcome the decline in social cognition; support for family members for improving cognitive empathy, which is the ability to analyze the background of others’ behaviors and speech; and the involvement of the practitioner to supervise and empower them. The process of intervention is as follows: (1) selecting activities for collaboration; (2) sharing information on their current situation including declined abilities; (3) enhancing cognitive empathy through dementia education; (4) designing the intervention measures together; and (5) practice and feedback. Living with dementia involves a continuous process of coping with various challenges in daily living, however, the process of effectively managing these challenges is one of the ways to improve the quality of life of people with dementia and their family members.
  • 7.

    【2hr】Neuromuscular Electrical Stimulation Plus Rehabilitative Exercise as a Treatment for Dysphagia in Stroke and Non-Stroke Patients in an NHS Setting: Feasibility and Outcomes

    包量

    机译 神经肌肉电刺激加康复锻炼作为NHS卒中和非卒中患者吞咽困难的治疗方法：可行性和结果
    摘要：Dysphagia is a debilitating condition with significant consequences in terms of physical and mental health. This study demonstrates that it is feasible to provide an intensive therapy program combining neuromuscular electrical stimulation (NMES) with exercise against resistance in the treatment of dysphagia in a public healthcare setting. Thirty-one patients (17 stroke, 14 non-stroke) who experienced dysphagia with reduced laryngeal elevation completed the therapy program. After checking the data sets for comparability, it was deemed appropriate for the outcome data from these patients to be combined with that of 12 stroke patients previously reported to enable statistical analysis on a larger data set (n = 43). A repeated-measures ANOVA revealed a statistically significant increase in amount and variety of food a patient was able to take orally (FOIS) following completion of treatment ( < 0.001). There was no significant between-subject effect of stroke status ( = 0.43), or interaction between treatment and stroke status ( = 0.68). There was a significant improvement in secondary outcome measures of swallow safety with fluids (PAS) ( < 0.001) and swallow-related quality of life (Swal-Qol ( < 0.001). These findings indicate that the therapy program may be associated with reduced impairment in a subset of patients with dysphagia resulting from stroke and non-stroke atiologies, and the data will inform the design of future research to address unanswered questions.
  • 8.

    【2hr】Comparing Inpatient Complication Rates between Octogenarians and Nonagenarians Following Primary and Revision Total Hip Arthroplasty in a Nationally Representative Sample 2010–2014

    包量

    机译 在2010-2014年全国代表性样本中，比较初次和修订全髋关节置换术后八头肌和非agenararians患者的住院并发症发生率
    摘要：We compared inpatient postoperative complication rates between octogenarians and nonagenarians undergoing primary and revision total hip arthroplasty (THA). We used inpatient admission data from 2010–2014 from the Nationwide Inpatient Sample (NIS). We compared the rates at which nonagenarians and octogenarians developed each complication in the inpatient setting following both primary THA (PTHA) and revision THA (RTHA). A total of 40,944 inpatient admissions were included in our study which extrapolates to a national estimate of 199,793 patients. A total of 185,799 (93%) were octogenarians and 13,994 (7%) were nonagenarians. PTHA was performed on 155,669 (78%) and RTHA was performed on 44,124 (22%) of the patients. Nonagenarians undergoing PTHA required transfusions significantly more frequently (33.13% v. 24.0%, < 0.001) and developed urinary tract infection (5.14% v. 3.92%, = 0.012) and acute kidney injury (5.50% v. 3.57%, < 0.001) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA required transfusions significantly more frequently (51.43% v. 41.46%, < 0.001) and developed urinary tract infection (19.66% v. 11.73%, < 0.001), acute kidney injury (13.8% v. 9.66%, < 0.001), pulmonary embolism (1.24% v. 0.67%, = 0.031), postoperative infection (1.89% v. 1.11%, = 0.023), sepsis (3.59% v. 2.43%, = 0.021) and other postoperative shock (1.76% v. 1.06%, = 0.036) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA also had a significantly higher inpatient mortality rate (3.28% v. 1.43%, < 0.001) than octogenarians. Orthopedic surgeons and primary care providers can use these findings to help counsel both their octogenarian and nonagenarian patients preoperatively when considering THA. Our analysis can help these patients better understand expected inpatient complication rates and assist them in deciding whether to pursue surgical intervention when applicable.
  • 9.

    【2hr】The Prevalence of Delirium in An Older Acute Surgical Population and Its Effect on Outcome

    包量

    机译 老年急性手术人群中Deli妄的发生率及其对结局的影响
    摘要：Background: With an ageing population, an increasing number of older adults are admitted for assessment to acute surgical units. Older adults have specific factors that may influence outcomes, one of which is delirium (acute cognitive impairment). Objectives: To establish the prevalence of delirium on admission in an older acute surgical population and its effect on mortality. Secondary outcomes investigated include hospital readmission and length of hospital stay. Method: This observational multi-centre study investigated consecutive patients, ≥65 years, admitted to the acute surgical units of five UK hospitals during an eight-week period. On admission the Confusion Assessment Method (CAM) score was performed to detect delirium. The effect of delirium on important clinical outcomes was investigated using tests of association and logistic regression models. Results: The cohort consisted of 411 patients with a mean age of 77.3 years (SD 8.1). The prevalence of admission delirium was 8.8% (95% CI 6.2–11.9%) and cognitive impairment was 70.3% (95% CI 65.6–74.7%). The delirious group were not more likely to die at 30 or 90 days (OR 1.1, 95% CI 0.2 to 5.1, = 0.67; OR 1.4, 95% CI 0.4 to 4.1. = 0.82) or to be readmitted within 30 days of discharge (OR 0.9, 95% CI 0.4 to 2.2, = 0.89). Length of hospital stay was significantly longer in the delirious group (median 8 vs. 5 days respectively, = 0.009). Conclusion: Admission delirium occurs in just under 10% of older people admitted to acute surgical units, resulting in significantly longer hospital stays.
  • 10.

    【2hr】PT Achievement in Public Hospitals and Its Effect on Outcomes

    包量

    机译 公立医院的PT成就及其对结果的影响
    摘要：The demand for TKA continues to rise within the United States, while increasing quality measures and cost containment became the basis of reimbursement for hospital systems. Length of stay is a major driver in the cost of TKA. Early mobilization with physical therapy has been shown to increase range of motion and decrease complications, but with mixed results in regards to length of stay. We postulate that initiating physical therapy on post-operative day zero will decrease length of stay in an urban public hospital. Retrospective chart review was performed at a large, urban, public academic medical center to identify patients who have had a primary TKA over the course of a 3-year period. Groups who underwent post-operative day zero therapy were compared with those who initiated physical therapy on post-operative day one. Length of stay was the primary outcome. Patient demographic characteristics and discharge disposition were also collected. There were 98 patients in the post-operative day-one physical therapy cohort and 58 in the post-operative day zero physical therapy group. Hospital length of stay was significantly decreased in the post-operative day zero physical therapy group. ( < 0.01) There was no difference in discharge disposition between the two groups.
  • 11.

    【2hr】Geriatric Resource Teams: Equipping Primary Care Practices to Meet the Complex Care Needs of Older Adults

    包量

    机译 老人资源小组：配备初级保健实践，以满足老年人的复杂护理需求
    摘要：Primary care practices lack the time, expertise, and resources to perform traditional comprehensive geriatric assessment. In particular, they need methods to improve their capacity to identify and care for older adults with complex care needs, such as cognitive impairment. As the US population ages, discovering strategies to address these complex care needs within primary care are urgently needed. This article describes the development of an innovative, team-based model to improve the diagnosis and care of older adults with cognitive impairment in primary care practices. This model was developed through a mentoring process from a team with expertise in geriatrics and quality improvement. Refinement of the existing assessment process performed during routine care allowed patients with cognitive impairment to be identified. The practice team then used a collaborative workflow to connect patients with appropriate community resources. Utilization of these processes led to reduced referrals to the geriatrics specialty clinic, fewer patients presenting in a crisis to the social worker, and greater collaboration and self-efficacy for care of those with cognitive impairment within the practice. Although the model was initially developed to address cognitive impairment, the impact has been applied more broadly to improve the care of older adults with multimorbidity.
  • 12.

    【2hr】Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study

    包量

    机译 急性卒中吞咽困难评估和处理的变化：一项访谈研究
    摘要：(1) Background: Patients with dysphagia are at increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed. The aim of this study is to explore staff opinions about current practice of dysphagia screening, assessment and clinical management in acute phase stroke. (2) Methods: Fifteen interviews were conducted in five English National Health Service hospitals. Hospitals were selected based on size and performance against national targets for dysphagia screening and assessment, and prevalence of stroke-associated pneumonia. Participants were purposefully recruited to reflect a range of healthcare professions. Data were analysed using a six-stage thematic process. (3) Results: Three meta themes were identified: delays in care, lack of standardisation and variability in resources. Patient, staff, and service factors that contribute to delays in dysphagia screening, assessment by a speech and language therapist, and delays in nasogastric tube feeding were identified. These included admission route, perceived lack of ownership for screening patients, prioritisation of assessments and staff resources. There was a lack of standardisation of dysphagia screening protocols and oral care. There was variability in staff competences and resources to assess patients, types of medical interventions, and care processes. (4) Conclusion: There is a lack of standardisation in the way patients are assessed for dysphagia and variation in practice relating to staff competences, resources and care processes between hospitals. A range of patient, staff and service factors have the potential to impact on stroke patients being assessed within the recommended national guidelines.
  • 13.

    【2hr】Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

    包量

    机译 马来西亚老年人使用抗生素的知识和期望：跨部门调查
    摘要：Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been noted. However, there is limited information about their knowledge and expectations for antibiotics. This study aimed to assess older adults’ knowledge of antibiotic use and resistance, their expectations for antibiotics and the relationship between knowledge, expectation and inappropriate practices related to antibiotic use. A cross-sectional survey involving respondents aged 60 years and above was conducted, using a validated questionnaire. A lack of knowledge about the role of antibiotics was observed, whereby more than half of the respondents incorrectly believed that antibiotics can treat viral infections (53.5%) and colds and coughs (53.7%). Also, 67.9% of respondents incorrectly believed that antibiotic resistance occurs when the body becomes resistant to antibiotics. Almost half of the respondents would expect antibiotics for symptoms of self-limiting viral infections. Respondents who answered correctly for the role of antibiotics in viral infections were more likely not to expect antibiotics for cold, flu and cough ( < 0.001). Respondents who answered correctly regarding the need to adhere to antibiotics were more likely to have completed their antibiotic course ( < 0.001). Future educational initiatives should provide key information on the role of antibiotics and the importance of complying with antibiotics in this population.
  • 14.

    【2hr】Effect of Yoga versus Light Exercise to Improve Well-Being and Promote Healthy Aging among Older Adults in Central India: A Study Protocol for a Randomized Controlled Trial

    包量

    机译 瑜伽与轻度锻炼对改善印度中部老年人的健康和促进健康老龄化的影响：一项随机对照试验的研究方案
    摘要：Background: Aging is a natural process associated with many functional and structural changes. These changes may include impaired self-regulation, changes in tissues and organs. Aging also affects mood, physical status and social activity. There are adverse changes in cognitive behavior, perceived sensation and thinking processes. Regular physical activity can alleviate many health problems; yet, many older adults are inactive. Yoga is one of the scientific and popular lifestyle practice considered as the integration of mind, body and soul. Results of previous studies reported positive effects of yoga on multiple health outcomes in elderly. However, there is scarcity of scientific information where yoga’s effect is examined on over well-being and on multiple health outcomes simultaneously in elderly. This protocol describes methods for a 12-week yoga-based intervention exploring the effects of yoga on well-being in physically inactive elderly living in community. Methods and analysis: This two group parallel single blind randomized controlled trial that will be conducted at a designated facility of R.D. Gardi Medical College, Ujjain, Madhya Pradesh, Central India. A 12-week 60-min yoga intervention three times weekly is designed. Comparison group participants will undergo a 60-min program comprising light exercise focusing on conventional stretching to improve mobility. After screening, 144 participants aged 60–80 years will be recruited. The primary outcome is subjective well-being. Secondary outcomes include mobility, fall risk, cognition, anxiety and depression, mood and stress, sleep quality, pain, physical activity/sedentary behavior and cardio-metabolic risk factors. Assessments will be conducted at baseline (0 week), after the intervention (12+1 week) and at follow-up (36+1 week). Intention-to-treat analyses with mixed linear modeling will be applied. Discussion: Through this trial, we aim to determine whether elderly people in the intervention group practicing yoga show more favorable primary (well-being) and secondary outcomes than those in the light exercise focusing on conventional stretching group. We assume that yoga may be practiced to maintain health, reduce particular symptoms commonly associated with skeletal pain, assist in pain relief and enhance well-being. We anticipate that practicing yoga will improve well-being and mental health and may lead to significant improvement in depression, pain and sleep quality.Ethics and dissemination: This study is approved by the Institutional Ethics Committee of R.D. Gardi Medical College, Ujjain, IEC Ref No. 09/2018. All participants would be provided with written and verbal information about the purpose of the project and would be free to withdraw from the study at any time. Refusal to participate in the study would not have any negative consequences. Confidentiality of the information of each participant would be ensured. Knowledge obtained would be disseminated to stakeholders through workshops, meetings and relevant scientific conferences.Trial Registration: The trial is prospectively registered with the Indian Council of Medical Research Trial Registry CTRI/2018/07/015051.
  • 15.

    【2hr】Simultaneous Hip and Distal Radius Fractures—Does It Make a Difference with Respect to Rehabilitation?

    包量

    机译 髋部和远端Rad骨骨折同时发生-在康复方面是否有所作为？
    摘要：Introduction: A minority of patients with hip fractures sustain concomitant wrist fractures. Little is known about the rehabilitation outcome in this group of patients. Aim of study: Prospective investigation of functional outcome and survival in patients with combined hip and wrist fractures compared with patients who sustain an isolated hip fracture. Methods: 341 patients who presented with an acute hip fracture during a 12 month period were included in the study. Outcome at discharge and 4 months follow-up was compared between patients with isolated hip fractures and those patients who sustained simultaneous distal wrist fractures. Results: The actual incidence of concurrent hip and wrist fractures in our cohort was 4.7%. Patients who sustained a concurrent hip and wrist fracture showed no differences regarding short- and long-term functional outcome and survival. Conclusion: Our results imply that patients with simultaneous hip and wrist fractures have no difference in rehabilitative outcome. Future studies should further investigate the distinctive characteristics of this patient subgroup.
  • 16.

    【2hr】Experiences of Dysphagia after Stroke: An Interview Study of Stroke Survivors and Their Informal Caregivers

    包量

    机译 中风后吞咽困难的经验：中风幸存者及其非正式照护者的访谈研究
    摘要：(1) Background: Swallowing difficulties (dysphagia) after stroke are not uncommon and is a consistent risk factor for stroke-associated pneumonia. This interview study explores the perspectives of stroke survivors, who had their swallowing assessed in the first few days of admission to hospital, and their informal caregivers. (2) Methods: A participatory approach was used involving people affected by stroke in the interpretation and analysis of the interview data. Data was thematically analysed and six themes were identified. (3) Results: These themes included how past-future experiences may influence a person’s emotional response to events; understanding what is happening and adjustment; the impact of dysphagia; attitudes to care; communication to patients and procedural issues. (4) Conclusion: The findings highlight the importance of effective public health messages to improve people’s responsiveness to the signs of stroke, standardisation of assessment and management procedures, effective communication to patients about the consequences of dysphagia, and the impact of dysphagia on the person who had the stroke and their informal caregiver.
  • 17.

    【2hr】Primary Healthcare Professionals Experience of Transfer and Meaning According to Screening for Dysphagia

    包量

    机译 初级卫生保健专业人员根据吞咽困难筛查的经验和迁移经验
    摘要：Transfer is a well-known theory about learning in practice contexts. This concept, combined with the need to implement screening for dysphagia in the nursing homes, has led to this project describing the experienced transfer effect and meaning among healthcare professionals after participation in a practice-orientated workshop focusing on implementing the Minimal Eating Observation Form-II (MEOF-II). Fifty-eight healthcare professionals participated in a 2.5-h facilitated practice-orientated workshop in the period from March to September, 2018. Before and after the workshop, they filled out a questionnaire that focused on the healthcare professional’s experience of skills related to dysphagia. The study documented that, after the workshop, more healthcare professionals felt competent to perform the MEOF-II to identify signs of dysphagia and know their role in screening for dysphagia. Nine months after the workshop, 80% of the residents in the nursing home had been screened for dysphagia by using the MEOF-II. This study documented that practice-orientated workshops and systematic follow-up encouraged the healthcare professionals to use the MEOF-II to contribute to the early detection of dysphagia in the nursing home. Workshops based on the transfer theory may also be relevant for implementation and application of other new skills in similar settings.
  • 18.

    【2hr】Rapid Cognitive Decline and Recurrent Falls in a 71 Year-Old Man due to Cerebral Amyloidangiopathy-Related Inflammation (CAA-RI)

    包量

    机译 一名71岁男子因脑淀粉样血管病相关炎症（CAA-RI）导致的快速认知下降和反复跌倒
    摘要：Cognitive decline and falls in the elderly are common and are often accepted as natural and inevitable by relatives and health care professionals, but frequently there are specific and treatable diseases that should be revealed. In our case, cerebral amyloid angiopathy-related inflammation (CAA-RI) was causative for neuro-psychiatric symptoms and worsening of gait in a 71 year-old man with recurrent falls and decline of gait and cognition. Cerebral amyloidangiopathy (CAA) is an important cause of cerebrovascular disorders in the elderly, characterized by leukoencephalopathy combined with lobar or small cortical hemorrhage due to amyloid deposition in cortical and leptomeningeal vessels. In several conditions, amyloid deposition can provoke inflammation or edema that lead to -normally reversible- encephalopathy. CAA-RI is then characterized by subacute neurobehavioral symptoms, headache, seizures or stroke-like signs. The first therapeutic option after confirming the diagnosis is treatment with glucocorticoids. Despite treatment with prednisolone, our patient could not regain his unrestricted mobility and self-help competence. Our report aims to sharpen awareness for CAA and its inflammatory form (CAA-RI) in healthcare professionals involved in medical care of the elderly and provide a short summary of this disease.
  • 19.

    【2hr】Malignant Transformation in Diabetic Foot Ulcers—Case Reports and Review of the Literature

    包量

    机译 糖尿病足溃疡的恶性转化—病例报告和文献复习
    摘要：An imbalance of regeneration and destruction of the extracellular matrix due to a plethora of chemo- and cytokines, elevated matrix metalloproteinases, bacterial contamination and repetitive painless tissue damage can lead the chronicity of a wound, especially in diabetic foot ulcers (DFU). Along general lines, wound healing and cancer development are similar. Therefore chronic wounds prepare a breeding ground for cancer development. Several characteristics such as increase in size, verrucous everted margins and contact bleeding are suspicious for malignant growth in a chronic wound. While previously the term Marjolin’s ulcer was attributed to a malignant tumor in (burn) scars, it is nowadays used for every malignant tumor in chronic wounds. Furthermore, chronic ulcers in diabetic feet are susceptible for malignant transformation. We describe two cases of squamous cell carcinoma in patients with DFU—a 71 year-old woman and a 67 year old man. Both received total tumor excision and split-skin grafts with good short-time results.
  • 20.

    【2hr】Semi-Autonomous Vehicles as a Cognitive Assistive Device for Older Adults

    包量

    机译 半自动车辆作为老年人的认知辅助装置
    摘要：Losing the capacity to drive due to age-related cognitive decline can have a detrimental impact on the daily life functioning of older adults living alone and in remote areas. Semi-autonomous vehicles (SAVs) could have the potential to preserve driving independence of this population with high health needs. This paper explores if SAVs could be used as a cognitive assistive device for older aging drivers with cognitive challenges. We illustrate the impact of age-related changes of cognitive functions on driving capacity. Furthermore, following an overview on the current state of SAVs, we propose a model for connecting cognitive health needs of older drivers to SAVs. The model demonstrates the connections between cognitive changes experienced by aging drivers, their impact on actual driving, car sensors’ features, and vehicle automation. Finally, we present challenges that should be considered when using the constantly changing smart vehicle technology, adapting it to aging drivers and vice versa. This paper sheds light on age-related cognitive characteristics that should be considered when developing future SAVs manufacturing policies which may potentially help decrease the impact of cognitive change on older adult drivers.
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