The objective of this study was to investigate the relationship between cutaneous vasodilatory function and nonlinear complexity of blood flow oscillations (BFO) in older people. A non-painful fast local heating protocol was applied to the sacral skin in 20 older subjects with various vasodilatory functions. Laser Doppler flowmetry was used to measure skin blood oscillations. The complexity of the characteristic frequencies (i.e., metabolic (0.0095–0.02 Hz), neurogenic (0.02–0.05 Hz), myogenic (0.05–0.15 Hz), respiratory (0.15–0.4 Hz), and cardiac (0.4–2 Hz)) of BFO was quantified using the multifractal detrended fluctuation analysis. Compared with the 65–75 years group, the complexity of metabolic BFO in the 75–85 years group was significantly lower at the baseline (P < 0.05) and the second peak (P < 0.001). Compared with baseline BFO, subjects in the 65–75 years group had a significant increase in the complexity of metabolic BFO (P < 0.01) in response to local heating; while subjects in the 75–85 years group did not. Our findings support the use of multifractal analysis to assess aging-related microvascular dysfunction.
This article examines evidence-based practice (EBP) and emphasizes how the case manager can find and use research about best practices. EBP should be a mainstay of care but fear about accessing and lack of time to purse EBP material may deter many case managers from integrating best practices into their everyday care coordination. EBP can be made approachable and understandable for case managers at both the basic and advanced levels of practice. Case managers will find that many sources of EBP are very understandable and user-friendly if they comprehend a few basic concepts.
Case management service provision based on the established evidence base creates a more legally and ethically sound practice. A change in practice to EBP will increase individual case managers' leadership abilities, thus establishing a stronger and more satisfied employee base. Utilization of a well-planned approach to incorporate evidence into practice results in higher levels of success and improves patient and organizational outcomes.
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