13 results on '"Vela, SA"'
Search Results
2. Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations. A comparison of treatments.
- Author
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Lavery LA, Vela SA, Lavery DC, Quebedeaux TL, Lavery, L A, Vela, S A, Lavery, D C, and Quebedeaux, T L
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- 1996
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3. A Crisis in Scope: Recruitment and Retention Challenges Reported by VA Gastroenterology Section Chiefs.
- Author
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von Rosenvinge EC, Vela SA, Paine ER, Chang MF, Hanson BJ, Taddei T, Smalley WE, Dunbar KB, Khan NH, Kahng LS, Anwar J, Zing R, Gawron A, Dominitz JA, and Baffy G
- Abstract
Background: Having a sufficient number of gastroenterologists is important for protecting the digestive health of veterans. However, gastroenterology is among the most difficult medical specialties for recruitment at the US Department of Veterans Affairs (VA)., Methods: We surveyed VA gastroenterology section chiefs to learn about current barriers to recruitment and retention and to identify opportunities for improvement., Results: Of 131 VA gastroenterology section chiefs at VA medical centers who received the survey, 55 responded (42%). Thirty-six respondents (65%) reported current vacancies at their facilities (range, 1-4). Low salary and human resources challenges were the most frequently reported barriers to recruitment. Low salary and administrative burden, including lack of sufficient support staff, were the most frequently reported barriers to retention., Conclusions: While salary is the most frequently reported barrier to recruitment and retention, human resources challenges represent the second-most frequently reported barrier to recruitment. Administrative burden linked to suboptimal staffing support is the second most frequently reported barrier to retention. Efforts to raise salaries (higher than the current $400,000 ceiling), streamline human resources processes, and reduce administrative burden are needed to ensure a thriving VA gastroenterology workforce., Competing Interests: Author disclosures: Brian Hanson served as a consultant for Motus GI. The other authors have no conflicts to disclose., (Copyright © 2024 Frontline Medical Communications Inc., Parsippany, NJ, USA.)
- Published
- 2024
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4. Pain Assessment in Mechanically Ventilated, Noncommunicative Severe Trauma Patients.
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López-López C, Pérez-Pérez T, Beneit-Montesinos JV, García-Klepzig JL, Martinez-Ureta MV, Murillo-Pérez MDA, Torrente-Vela SA, and García-Iglesias M
- Subjects
- Adult, Aged, Communication Disorders nursing, Emergency Service, Hospital, Female, Humans, Intensive Care Units, Male, Middle Aged, Registries, Risk Assessment, Spain, Treatment Outcome, Wounds and Injuries diagnosis, Critical Illness nursing, Pain Management methods, Pain Measurement, Respiration, Artificial, Wounds and Injuries complications
- Abstract
The aim of this study was to measure pain levels in noncommunicative patients with severe trauma who required tracheal suctioning and mobilization and to determine the utility of the Behavioral Indicators of Pain Scale (ESCID) in these cases. The pain scores for the procedures were recorded on Days 1, 3, and 6 of the patients' stay in the intensive care unit. These assessments were performed at 3 moments: before, during, and after the application of the procedures. Because of the longitudinal character of the study, data were fitted into a multivariate model using the Generalized Estimating Equations method. The sample of 124 patients comprised 77.4% males and 22.6% females with an average age of 45.93 (SD = 16.43) years. A significant increase (p < .01) in the ESCID score was observed during the application of the procedures that produced similar pain levels. Kappa coefficient value obtained for interobserver agreement of ESCID scale scores during the application of care procedures at the intervals being evaluated was greater than 0.84, which should be interpreted as almost perfect. The ESCID scores increased during 2 care procedures that are frequently carried out in intensive care units and indicated that they produced similar pain levels.
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- 2018
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5. Endoscopic ultrasound-guided fine-needle aspiration with on-site cytopathology versus core biopsy: a comparison of both techniques performed at the same endoscopic session.
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Lin M, Hair CD, Green LK, Vela SA, Patel KK, Qureshi WA, and Shaib YH
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Background: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) with bedside cytopathology is the gold standard for assessment of pancreatic, subepithelial, and other lesions in close proximity to the gastrointestinal tract, but it is time-consuming, has certain diagnostic limitations, and bedside cytopathology is not widely available., Aims: The goal of this study is to compare the diagnostic yield of EUS-guided FNA with on-site cytopathology and EUS-guided core biopsy., Methods: Twenty-six patients with gastrointestinal mass lesions requiring biopsy at a tertiary medical center were included in this retrospective analysis of a prospective cohort. Two core biopsies were taken using a 22 gauge needle followed by FNA guided by a bedside cytopathologist at the same endoscopic session. The diagnostic yield and test characteristics of EUS core biopsy and EUS FNA with bedside cytopathology were examined., Results: The mean number of passes was 3.2 for FNA, and the mean procedure time was 39.4 minutes. The final diagnosis was malignant in 92.3 %. Sensitivity and specificity were 83 % and 100 %, respectively, for FNA, and 91.7 % and 100 %, respectively, for core biopsy. Diagnostic accuracy was 92.3 % for FNA and 84.6 % for core biopsy. The two approaches were in agreement in 88.4 % with a kappa statistic of 0.66 (95 % confidence interval 0.33 - 0.99)., Conclusions: An approach using two passes with a core biopsy needle is comparable to the current gold standard of FNA with bedside cytopathology. The performance of two core biopsies is time-efficient and could represent a good alternative to FNA with bedside cytopathology.
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- 2014
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6. Multicenter comparison of the interobserver agreement of standard EUS scoring and Rosemont classification scoring for diagnosis of chronic pancreatitis.
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Stevens T, Lopez R, Adler DG, Al-Haddad MA, Conway J, Dewitt JM, Forsmark CE, Kahaleh M, Lee LS, Levy MJ, Mishra G, Piraka CR, Papachristou GI, Shah RJ, Topazian MD, Vargo JJ, and Vela SA
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- Humans, Observer Variation, Pancreas pathology, Pancreatitis, Chronic pathology, Video Recording, Endosonography, Pancreatitis, Chronic classification, Pancreatitis, Chronic diagnosis
- Abstract
Background: EUS has less than optimal interobserver agreement for the diagnosis of chronic pancreatitis. The newly developed Rosemont consensus scoring system includes weighted criteria and stricter definitions for individual features., Objective: The primary aim was to compare the interobserver agreement of standard and Rosemont scoring., Setting: Multiple tertiary-care institutions., Intervention: Fifty EUS videos were interpreted by 14 experts. Each expert interpreted the videos on two occasions: First, the videos were read by using standard scoring (9 criteria). Second, after viewing a presentation of the Rosemont classification, the same experts re-read the videos by using Rosemont scoring., Main Outcome Measurements: Fleiss' kappa (K) statistics are reported with 95% confidence intervals (CI)., Results: The interobserver agreement was "substantial" (K = 0.65 [95% CI, 0.52-0.77]) for Rosemont scoring and "moderate" (K = 0.54 [95% CI, 0.44-0.66]) for standard scoring; however, the difference was not statistically significant (P = 0.12)., Limitations: The sample size does not allow detection of differences in K of <0.25., Conclusion: Use of the Rosemont classification did not significantly increase interobserver agreement for EUS diagnosis of chronic pancreatitis compared with standard scoring., (2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)
- Published
- 2010
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7. The effect of increased weight on peak pressures: implications for obesity and diabetic foot pathology.
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Vela SA, Lavery LA, Armstrong DG, and Anaim AA
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- Adult, Body Mass Index, Diabetic Foot prevention & control, Female, Humans, Male, Pressure, Weight Loss, Body Weight, Diabetic Foot physiopathology, Foot physiopathology, Obesity physiopathology
- Abstract
The purpose of this study was to determine if increased weight contributes to increased mean peak plantar foot pressures when foot function, deformity, and structure are controlled. Ten male and nine female volunteers without sensory neuropathy or other systemic disease were evaluated in the study. Using a repeated measures design, peak plantar foot pressures were compared using the Novel Pedar in-shoe pressure measurement system under three conditions. Baseline measurements were made while volunteers wore the standard test footwear, a thin-soled rubber oxford sneaker. The second and third test conditions involved pressure measurements with an additional 9.1 kg (20 lb) and 18.2 kg (40 lb), respectively, of weight evenly distributed in pockets on the front and back of a workout vest. There was a significant increase in mean peak plantar foot pressures under the metatarsal heads, heel, and midfoot for each incremental increase of weight (baseline vs. 9.1 kg, p < .05; 9.1 kg vs. 18.2 kg, p < .05). The authors conclude that increases in weight increased plantar foot pressures for the first metatarsal, lesser metatarsal, midfoot, and heel regions in both men and women.
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- 1998
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8. Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration.
- Author
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Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, and Fleischli JG
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- Adult, Case-Control Studies, Diabetic Foot etiology, Diabetic Neuropathies complications, Female, Humans, Male, Middle Aged, Prospective Studies, ROC Curve, Risk, Sensitivity and Specificity, Surveys and Questionnaires, Touch, Vibration, Diabetic Foot epidemiology, Mass Screening methods
- Abstract
Objective: To evaluate the sensitivity and specificity of 3 sensory perception testing instruments to screen for risk of diabetic foot ulceration., Methods: This case-control study prospectively measured the degree of peripheral sensory neuropathy in diabetic patients with and without foot ulcers. We enrolled 115 age-matched diabetic patients (40% male) with a case-control ratio of approximately 1:3 (30 cases and 85 controls) from a tertiary care diabetic foot specialty clinic. Cases were defined as individuals who had an existing foot ulceration or a history of a recently (< 4 weeks) healed foot ulceration. Controls were defined as subjects with no foot ulceration history. Using receiver operating characteristic analysis, we evaluated the sensitivity and specificity of 2 commonly used nephropathy assessment tools (vibration perception threshold testing and the Semmes-Weinstein 10-g monofilament wire system) and a 4-question verbal neuropathy score to evaluate for presence of foot ulceration., Results: A vibration perception threshold testing using 25 V and lack of perception at 4 or more sites using the Semmes-Weinstein 10-g monofilament wire system had a significantly higher specificity than neuropathy score used. The neuropathy score was most sensitive when 1 or more answers were affirmative. When modalities were combined, particularly the monofilament wire system plus vibration perception threshold testing and the neuropathy score plus the monofilament wire system, there was a substantial increase in specificity with little or no diminution in sensitivity., Conclusions: The early detection of peripheral neuropathy or loss of "protective sensation" is paramount to instituting a structured treatment plan to prevent lower extremity amputation. The results of our study suggest that all 3 sensory perception testing instruments are sensitive in identifying patients at risk for ulceration. Combining modalities appears to increase specificity with very little or no diminution in sensitivity.
- Published
- 1998
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9. Practical criteria for screening patients at high risk for diabetic foot ulceration.
- Author
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Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, and Fleischli JG
- Subjects
- Adult, Aged, Case-Control Studies, Female, Humans, Logistic Models, Male, Middle Aged, Risk, Risk Factors, Diabetic Foot prevention & control, Mass Screening standards
- Abstract
Background: A comprehensive understanding of clinical risk factors for developing foot ulcerations would help clinicians to categorize patients by their risk status and schedule intervention resources accordingly to prevent amputation., Objective: To evaluate risk factors for foot ulcerations among persons with diabetes mellitus., Method: We enrolled 225 age-matched patients, 46.7% male, with a ratio of approximately 1:2 cases: controls (76 case-patients and 149 control subjects). Case-patients were defined as subjects who met the enrollment criteria and who had an existing foot ulceration or a recent history of a foot ulceration. Control subjects were defined as subjects with no history of foot ulceration. A stepwise logistic regression model was used for analysis., Results: An elevated plantar pressure (> 65 N/cm2), history of amputation, lengthy duration of diabetes (> 10 years), foot deformities (hallux rigidus or hammer toes), male sex, poor diabetes control (glycosylated hemoglobin > 9%), 1 or more subjective symptoms of neuropathy, and an elevated vibration perception threshold (> 25 V) were significantly associated with foot ulceration. In addition, 59 patients (78%) with ulceration had a rigid deformity directly associated with the site of ulceration. No significant associations were noted between vascular disease, level of formal education, nephropathy, retinopathy, impaired vision, or obesity and foot ulceration on multivariate analysis., Conclusions: Neuropathy, foot deformity, high plantar pressures, and a history of amputation are significantly associated with the presence of foot ulceration. Although vascular and renal disease may result in delayed wound healing and subsequent amputation, they are not significant risk factors for the development of diabetic foot ulceration.
- Published
- 1998
- Full Text
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10. Is postural instability exacerbated by off-loading devices in high risk diabetics with foot ulcers?
- Author
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Lavery LA, Fleishli JG, Laughlin TJ, Vela SA, Lavery DC, and Armstrong DG
- Subjects
- Adult, Aged, Diabetic Foot etiology, Humans, Middle Aged, Pressure, Casts, Surgical standards, Diabetic Foot prevention & control, Posture, Shoes standards
- Abstract
Pressure reduction is of pivotal importance in any treatment plan designed to heal diabetic foot ulcers. However, to our knowledge, no work has evaluated the effect of ambulatory pressure reducing devices on postural stability (PS) in high risk diabetics. Therefore, the purpose of this study was to compare PS associated with 5 off-loading strategies: total contact casts with cast boot, total contact casts with heel, removable cast walker, half-shoes, and canvas shoes using a repeat measure design. Twenty-six diabetic patients with foot ulcers were enrolled in the study. Using a digital pressure platform, the degree of sway was measured as total deviation of center of force. Three 30 second trials were evaluated using Turkey's studentized range test for multiple comparisons (alpha = 0.05). Sway was significantly greater with total contact casts with heel compared to other devices. While total contact casting remains the gold standard with which to treat neuropathic ulcers, care should be taken when placing patients in any devices that may exacerbate postural instability. The results suggest that total contact casts with an incorporated rubber heel may indeed accentuate sway. It is therefore recommended that the rubber heel be eliminated in lieu of a protective cast boot when using this modality.
- Published
- 1998
11. Total contact casts: pressure reduction at ulcer sites and the effect on the contralateral foot.
- Author
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Lavery LA, Vela SA, Lavery DC, and Quebedeaux TL
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- Adult, Aged, Diabetes Mellitus, Type 2 rehabilitation, Equipment Design, Female, Humans, Male, Middle Aged, Pressure, Shoes, Casts, Surgical, Diabetic Foot rehabilitation
- Abstract
Objective: To compare the effectiveness of total contact casts with a cast boot (TCCB), total contact casts with a cast heel (TCCH), and therapeutic XtraDepth shoes (XDS) to reduce ulcer site pressures and to determine if total contact casts increase contralateral pressures., Design: Repeat measure design with 40 replications nested within each treatment for each patient., Methods: Peak contralateral foot pressures and ulcer site pressures under the 1st metatarsal (1MET; n = 10), 2nd to 5th metatarsals (2-5MET; n = 10), and great toe (GT; n = 5) were compared using the Novel-Pedar system and three treatments: TCCB, TCCH, and XDS. Baseline pressures were established using canvas oxfords., Results: There was no difference in pressure reduction with TCCH vs. TCCB for 1MET or GT ulcers, but TCCH reduced pressure better for 2-5MET ulcers (p < .001). Contralateral pressures were not elevated in either TCC group., Conclusions: TCCH were superior to TCCB in reducing 2-5MET ulcer pressures and equivalent to TCCB for 1MET and GT ulcers. Contralateral pressures are not increased by TCC use.
- Published
- 1997
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12. 1997 William J. Stickel Bronze Award. Comparison of strategies for reducing pressure at the site of neuropathic ulcers.
- Author
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Fleischli JG, Lavery LA, Vela SA, Ashry H, and Lavery DC
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- Adult, Aged, Bandages standards, Diabetic Foot prevention & control, Evaluation Studies as Topic, Female, History, 20th Century, Humans, Male, Middle Aged, Pressure, United States, Walking, Awards and Prizes, Casts, Surgical standards, Diabetic Foot physiopathology, Diabetic Foot therapy, Foot physiopathology, Podiatry history, Shoes standards
- Abstract
Few scientific data are available on the effectiveness of commonly used modalities for reducing pressure at the site of neuropathic ulcers in persons with diabetes mellitus. The authors' aim was to compare the effectiveness of total contact casts, half-shoes, rigid-soled postoperative shoes, accommodative dressings made of felt and polyethylene foam, and removable walking casts in reducing peak plantar foot pressures at the site of neuropathic ulcerations in diabetics. Using an in-shoe pressure-measurement system, data from 32 midgait steps were collected for each treatment. There was a consistent pattern in the devices' effectiveness in reducing foot pressures at ulcer sites under the great toe and ball of the foot. Removable walking casts were as effective as or more effective than total contact casts. Half-shoes were consistently the third most effective modality, followed by accommodative dressings and rigid-soled postoperative shoes.
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- 1997
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13. Novel methodology to obtain salient biomechanical characteristics of insole materials.
- Author
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Lavery LA, Vela SA, Ashry HR, Lanctot DR, and Athanasiou KA
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- Biomechanical Phenomena, Humans, Time Factors, Diabetic Foot prevention & control, Foot physiology, Shoes
- Abstract
Viscoelastic inserts are commonly used as artificial shock absorbers to prevent neuropathic foot ulcerations by decreasing pressure on the sole of the foot. Unfortunately, there is little scientific information available to guide physicians in the selection of appropriate insole materials. Therefore, a novel methodology was developed to form a rational platform for biomechanical characterizations of insole material durability, which consisted of in vivo gait analysis and in vitro bioengineering measurements. Results show significant differences in the compressive stiffness of the tested insoles and the rate of change over time in both compressive stiffness and peak pressures measured. Good correlations were found between pressure-time integral and Young's modulus (r2 = 0.93), and total energy applied and Young's modulus (r2 = 0.87).
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- 1997
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