Can Older Adults Accurately Report Their Use of Physical Rehabilitation Services?

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Vicki A. Freedman, Judith D. Kasper, Alan Jette

Abstract

Objective

To explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home).

Design

Longitudinal observational study.

Setting

Participants' homes.

Participants

Community-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview.

Interventions

Not applicable.

Main Outcome Measures

Respondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service.

Results

Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (approaching 95%). However, in adjusted models, sensitivity was lower for black enrollees, the very old, and those with lower education levels.

Conclusions

Survey-based measures of rehabilitation accurately captured use over the past year, but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans.

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Archives of Physical Medicine and Rehabilitation Supplements

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s):

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Correction

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s):

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Correction

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s):

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Neuromuscular Electrical Stimulation for Lower Limb in Chronic Stroke

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Mohammad Etoom, Yazan Khraiwesh

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Response to Letter “Prediction of Falls in Subjects Suffering From Parkinson Disease, Multiple Sclerosis, and Stroke: Methodologic Issues”

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Davide Cattaneo, Elisa Gervasoni, Elisabetta Pupillo, Elisa Bianchi, Michela Agostini, Marco Rovaris, Irene Aprile, Angelo Montesano, Ettore Beghi

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Prediction of Falls in Subjects Suffering From Parkinson Disease, Multiple Sclerosis, and Stroke: Methodologic Issues

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Siamak Sabour

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Optimizing the Management of Spasticity in People With Spinal Cord Damage: A Clinical Care Pathway for Assessment and Treatment Decision Making From the Ability Network, an International Initiative

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Indira S. Lanig, Peter W. New, Anthony S. Burns, Gerald Bilsky, Jesus Benito-Penalva, Djamel Bensmail, Michael Yochelson

Abstract

The recognition, evaluation, and management of disabling spasticity in persons with spinal cord damage (SCD) is a challenge for health care professionals, institutions, health systems, and patients. To guide the assessment and management of disabling spasticity in individuals with SCD, the Ability Network, an international panel of clinical experts, developed a clinical care pathway. The aim of this pathway is to facilitate treatment decisions that take into account the effect of disabling spasticity on health status, individual preferences and treatment goals, tolerance for adverse events, and burden on caregivers. The pathway emphasizes a patient-centered, individualized approach and the need for interdisciplinary coordination of care, patient involvement in goal setting, and the use of assessment and outcome measures that lend themselves to practical application in the clinic. The clinical care pathway is intended for use by health care professionals who provide care for persons with SCD and disabling spasticity in various settings. Barriers to optimal spasticity management in these people are also discussed. There is an urgent need for the clinical community to clarify and overcome barriers (knowledge-based, organizational, health system) to optimizing the management of spasticity in people with SCD.

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Effectiveness of Surgical and Postsurgical Interventions for Carpal Tunnel Syndrome—A Systematic Review

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Bionka M. Huisstede, Janneke van den Brink, Manon S. Randsdorp, Sven J. Geelen, Bart W. Koes

Abstract

Objective

To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions for carpal tunnel syndrome (CTS).

Data Sources

The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016.

Study Selection

Two reviewers independently applied the inclusion criteria to select potential studies.

Data Extraction

Two reviewers independently extracted the data and assessed the methodologic quality.

Data Synthesis

A best-evidence synthesis was performed to summarize the results. Four systematic reviews and 33 RCTs were included. Surgery versus nonsurgical interventions, timing of surgery, and various surgical techniques and postoperative interventions were studied. Corticosteroid injection was more effective than surgery (strong evidence, short-term). Surgery was more effective than splinting or anti-inflammatory drugs plus hand therapy (moderate evidence, midterm and long-term). Manual therapy was more effective than surgical treatment (moderate evidence, short-term and midterm). Within surgery, corticosteroid irrigation of the median nerve before skin closure as additive to CTS release or the direct vision plus tunneling technique was more effective than standard open CTS release (moderate evidence, short-term). Furthermore, short was more effective than long bulky dressings, and a sensory retraining program was more effective than no program after surgery (moderate evidence, short-term). For all other interventions only conflicting, limited, or no evidence was found.

Conclusions

Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the short-term, midterm, and/or long-term to treat CTS. However there is strong evidence that a local corticosteroid injection is more effective than surgery in the short-term, and moderate evidence that manual therapy is more effective than surgery in the short-term and midterm. There is no unequivocal evidence that suggests one surgical treatment is more effective than the other. Postsurgical, a short- (2-3 days) favored a long-duration (9-14 days) bulky dressing and a sensory retraining program seems to be more effective than no program in short-term. More research regarding the optimal timing of surgery for CTS is needed.

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Do Patients With Carpal Tunnel Syndrome Benefit From Low-Level Laser Therapy? A Systematic Review of Randomized Controlled Trials

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Thierry P. Franke, Bart W. Koes, Sven J. Geelen, Bionka M. Huisstede

Abstract

Objective

To systematically review the literature on the effectiveness of low-level laser therapy for patients with carpal tunnel syndrome.

Data Sources

The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs) up to April 8, 2016.

Study Selection

Two reviewers independently applied the inclusion criteria to select potential studies.

Data Extraction

Two reviewers independently extracted the data and assessed the methodologic quality.

Data Synthesis

A best-evidence synthesis was performed to summarize the results of the 2 systematic reviews and 17 RCTs that were included. Strong evidence was found for the effectiveness of low-level laser therapy compared with placebo treatment in the very short term (0 to ≤5wk). After 5 weeks, the positive effects of low-level laser therapy on pain, function, or recovery diminished over time (moderate and conflicting evidence were found at 7- and 12-wk follow-up, respectively).

Conclusions

In the very short term, low-level laser therapy is more effective as a single intervention than placebo low-level laser therapy in patients with carpal tunnel syndrome, after which the positive effects of low-level laser therapy tend to subside. Evidence in the midterm and long term is sparse.

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Effectiveness of Conservative, Surgical, and Postsurgical Interventions for Trigger Finger, Dupuytren Disease, and De Quervain Disease: A Systematic Review

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Bionka M. Huisstede, Saskia Gladdines, Manon S. Randsdorp, Bart W. Koes

Abstract

Objectives

To provide an evidence-based overview of the effectiveness of conservative and (post)surgical interventions for trigger finger, Dupuytren disease, and De Quervain disease.

Data Sources

Cochrane Library, Physiotherapy Evidence Database, PubMed, Embase, and CINAHL were searched to identify relevant systematic reviews and randomized controlled trials (RCTs).

Data Selection

Two reviewers independently applied the inclusion criteria to select potential studies.

Data Extraction

Two reviewers independently extracted the data and assessed the methodologic quality.

Data Synthesis

A best-evidence synthesis was performed to summarize the results. Two reviews (trigger finger and De Quervain disease) and 37 randomized controlled trials (RCTs) (trigger finger: n=8; Dupuytren disease: n=14, and De Quervain disease: n=15) were included. The trials reported on oral medication (Dupuytren disease), physiotherapy (De Quervain disease), injections and surgical treatment (trigger finger, Dupuytren disease, and De Quervain disease), and other conservative (De Qervain disease) and postsurgical treatment (Dupuytren disease). Moderate evidence was found for the effect of corticosteroid injection on the very short term for trigger finger, De Quervain disease, and for injections with collagenase (30d) when looking at all joints, and no evidence was found when looking at the PIP joint for Dupuytren disease. A thumb splint as additive to a corticosteroid injection seems to be effective (moderate evidence) for De Quervain disease (short term and midterm). For Dupuytren disease, use of a corticosteroid injection within a percutaneous needle aponeurotomy in the midterm and tamoxifen versus a placebo before or after a fasciectomy seems to promising (moderate evidence). We also found moderate evidence for splinting after Dupuytren surgery in the short term.

Conclusions

In recent years, more and more RCTs have been conducted to study treatment of the aforementioned hand disorders. However, more high-quality RCTs are still needed to further stimulate evidence-based practice for patients with trigger finger, Dupuytren disease, and De Quervain disease.

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Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Bionka M. Huisstede, Peter Hoogvliet, Thierry P. Franke, Manon S. Randsdorp, Bart W. Koes

Abstract

Objective

To review scientific literature studying the effectiveness of physical therapy and electrophysical modalities for carpal tunnel syndrome (CTS).

Data Sources

The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database.

Study Selection

Two reviewers independently applied the inclusion criteria to select potential eligible studies.

Data Extraction

Two reviewers independently extracted the data and assessed the methodologic quality using the Cochrane Risk of Bias Tool.

Data Synthesis

A best-evidence synthesis was performed to summarize the results of the included studies (2 reviews and 22 randomized controlled trials [RCTs]). For physical therapy, moderate evidence was found for myofascial massage therapy versus ischemic compression on latent, or active, trigger points or low-level laser therapy in the short term. For several electrophysical modalities, moderate evidence was found in the short term (ultrasound vs placebo, ultrasound as single intervention vs other nonsurgical interventions, ultrasound vs corticosteroid injection plus a neutral wrist splint, local microwave hyperthermia vs placebo, iontophoresis vs phonophoresis, pulsed radiofrequency added to wrist splint, continuous vs pulsed vs placebo shortwave diathermy, and interferential current vs transcutaneous electrical nerve stimulation vs a night-only wrist splint). In the midterm, moderate evidence was found in favor of radial extracorporeal shockwave therapy (ESWT) added to a neutral wrist splint, in favor of ESWT versus ultrasound, or cryo-ultrasound, and in favor of ultrasound versus placebo. For all other interventions studied, only limited, conflicting, or no evidence was found. No RCTs investigating the long-term effects of physical therapy and electrophysical modalities were found. Because of heterogeneity in the treatment parameters used in the included RCTs, optimal treatment parameters could not be identified.

Conclusions

Moderate evidence was found for several physical therapy and electrophysical modalities for CTS in the short term and midterm. Future studies should concentrate on long-term effects and which treatment parameters of physical therapy and electrophysical modalities are most effective for CTS.

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Effectiveness of Oral Pain Medication and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Bionka M. Huisstede, Manon S. Randsdorp, Janneke van den Brink, Thierry P.C. Franke, Bart W. Koes, Peter Hoogvliet

Abstract

Objective

To present an evidence-based overview of the effectiveness of oral pain medication and corticosteroid injections to treat carpal tunnel syndrome (CTS).

Data Sources

The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database were searched for relevant systematic reviews and randomized controlled trials (RCTs).

Study Selection

Two reviewers independently applied the inclusion criteria to select potential studies.

Data Extraction

Two reviewers independently extracted the data on pain (visual analog scale), function or recovery, and assessed the methodologic quality.

Data Synthesis

A best-evidence synthesis was performed to summarize the results of the included studies. Four reviews and 9 RCTs were included. For oral pain medication, strong and moderate evidence was found for the effectiveness of oral steroids versus placebo in the short term. Moderate evidence was found in favor of oral steroids versus splinting in the short term. No evidence was found for the effectiveness of oral steroids in the long term. For corticosteroid injections, strong evidence was found in favor of a corticosteroid injection versus a placebo injection and moderate evidence was found in favor of corticosteroid injection versus oral steroids in the short term. Also, in the short term, moderate evidence was found in favor of a local versus a systematic corticosteroid injection. Higher doses of corticosteroid injections seem to be more effective in the midterm; however, the benefits of corticosteroid injections were not maintained in the long term.

Conclusions

The reviewed evidence supports that oral steroids and corticosteroid injections benefit patient with CTS particularly in the short term. Although a higher dose of steroid injections seems to be more effective in the midterm, the benefits of oral pain medication and corticosteroid injections were not maintained in the long term.

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Quality of Life and Adaptation in People With Spinal Cord Injury: Response Shift Effects From 1 to 5 Years Postinjury

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Carolyn E. Schwartz, Brian Stucky, Carly S. Rivers, Vanessa K. Noonan, Joel A. Finkelstein, RHSCIR Network

Abstract

Objective

To investigate response shift effects in spinal cord injury (SCI) over 5 years postinjury.

Design

Prospective cohort study observed at 1, 2, and 5 years post-SCI.

Setting

Specialized SCI centers.

Participants

Sample included 1125, 760, and 219 participants at 1, 2, and 5 years post-SCI (N = 2104). The study sample was 79% men; 39% were motor/sensory complete (mean age, 44.6±18.3y).

Interventions

Not applicable.

Main Outcome Measures

Patient-reported outcomes included the Medical Outcomes Study 36-Item Short-Form Health Survey version 2 and the Life Satisfaction-11 Questionnaire. Participant latent variable scores were adjusted for (1) potential attrition bias and (2) propensity scores reflecting risk of worse outcomes. The Oort structural equation modeling approach for detecting and accounting for response shift effects was used to test the hypothesis that people with SCI would undergo response shifts over follow-up.

Results

The study data comprised the time after FIM scores, an objective measure of motor and cognitive function, had improved and stabilized. Three latent variables (Physical, Mental, and Symptoms) were modeled over time. The response shift model indicated uniform recalibration and reconceptualization response shift effects over time. When adjusted for these response shift effects, Physical showed small true change improvements at 2- and 5-year follow-up, despite FIM stability.

Conclusions

We detected recalibration and reconceptualization response shift effects in 1- to 5-year follow-up of people with SCI. Despite stable motor and cognitive function, people with SCI are adapting to their condition. This adaptation reflects a progressive disconnection between symptoms and physical or mental health, and a real improvement in the Physical latent variable.

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Gait Training in Acute Spinal Cord Injury Rehabilitation—Utilization and Outcomes Among Nonambulatory Individuals: Findings From the SCIRehab Project

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Stephanie Rigot, Lynn Worobey, Michael L. Boninger

Abstract

Objectives

To investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI).

Design

Prospective observational study using the SCIRehab database.

Setting

Six IPR facilities.

Participants

Patients with new SCI (N=1376) receiving initial rehabilitation.

Interventions

Patients were divided into groups consisting of those who did and did not receive GT. Patients were further subdivided based on their primary mode of mobility as measured by the FIM.

Main Outcome Measures

Pain rating scales, Patient Health Questionnaire Mood Subscale, Satisfaction With Life Scale, and Craig Handicap Assessment and Reporting Technique (CHART).

Results

Nearly 58% of all patients received GT, including 33.3% of patients who were primarily using a wheelchair 1 year after discharge from IPR. Those who used a wheelchair and received GT, received significantly less transfer and wheeled mobility training (P<.001). CHART physical independence (P=.002), mobility (P=.024), and occupation (P=.003) scores were significantly worse in patients who used a wheelchair at 1 year and received GT, compared with those who used a wheelchair and did not receive GT in IPR. Older age was also a significant predictor of worse participation as measured by the CHART.

Conclusions

A significant percentage of individuals who are not likely to become functional ambulators are spending portions of their IPR stays performing GT, which is associated with less time allotted for other functional interventions. GT in IPR was also associated with participation deficits at 1 year for those who used a wheelchair, implying the potential consequences of opportunity costs, pain, and psychological difficulties of receiving unsuccessful GT. Clinicians should consider these data when deciding to implement GT during initial IPR.

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Cannabis Use in Individuals With Spinal Cord Injury or Moderate to Severe Traumatic Brain Injury in Colorado

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Lenore A. Hawley, Jessica M. Ketchum, Clare Morey, Kathleen Collins, Susan Charlifue

Abstract

Objectives

To describe the prevalence of cannabis use in an adult sample with spinal cord injury (SCI) or traumatic brain injury (TBI) in Colorado, and to describe the self-reported reasons and side effects of cannabis use in this sample.

Design

Mixed-methods observational study, using focus group data and telephone survey.

Setting

Community.

Participants

Colorado adults who sustained SCI or moderate to severe TBI and received services through Craig Hospital.

Interventions

None.

Main Outcome Measures

Survey.

Results

Focus group participants identified issues that were then included in the survey development. Seventy percent of the 116 participants surveyed reported cannabis use before their injury (67% SCI, 74% TBI) and 48% reported use after their injury (53% SCI, 45% TBI). Overall, the most common reason for use was recreational (67%), followed by reducing stress/anxiety (62.5%) and improving sleep (59%). Among the respondents with SCI, the most common reasons for use were to reduce spasticity (70%), recreation (63%), and to improve sleep (63%). Among those with TBI, reasons endorsed were recreational (72%), reducing stress/anxiety (62%), and improving sleep (55%). Smoking was the most common method of use.

Conclusions

A majority of this sample reported using cannabis before injury, and approximately half reported using cannabis after injury. Both groups reported recreational use, whereas the group with SCI also highly endorsed using cannabis to address chronic medical conditions. Clinicians should be aware of the high prevalence of cannabis use in these populations and the impact such use may have on the individual's medical management. Further research in this area is needed.

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Association of Posttraumatic Stress Symptom Severity With Health-Related Quality of Life and Self-Reported Functioning Across 12 Months After Severe Traumatic Brain Injury

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Colin M. Bosma, Nashwa Mansoor, Chiara S. Haller

Abstract

Objective

To investigate the relation between posttraumatic stress (PTS) symptom severity and health-related quality of life (HRQoL) after severe traumatic brain injury (TBI).

Design

Longitudinal prospective multicenter, cohort study on severe TBI in Switzerland (2007–2011).

Setting

Hospital, rehabilitation unit, and/or patient's living facility.

Participants

Patients with severe TBI (N=109) were included in the analyses. Injury severity was determined using the Abbreviated Injury Score of the head region after clinical assessment and initial computed tomography scan.

Interventions

Not applicable.

Main Outcome Measures

HRQoL (Medical Outcomes Study 12-Item Short-Form Health Survey Physical and Mental Component Summaries) and self-reported emotional, cognitive, and interpersonal functioning (Patient Competency Rating Scale for Neurorehabilitation).

Results

Multilevel models for patients >50 and ≤50 years of age revealed significant negative associations between PTS symptom severity and interpersonal functioning (P<.001 and P=.002), respectively. Among patients ≤50 years of age, PTS symptom severity was significantly associated with total functioning (P=.001) and emotional functioning (P<.001). Among all patients, PTS symptom severity was significantly associated with cognitive functioning (P<.001) and mental HRQoL (P=.01).

Conclusions

Findings indicate that PTS symptoms after severe TBI are negatively associated with HRQoL and emotional, cognitive, and interpersonal functioning.

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Rehabilitation Utilization for Falls Among Community-Dwelling Older Adults in the United States in the National Health and Aging Trends Study

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Briana L. Moreland, Laura L. Durbin, Judith D. Kasper, Thelma J. Mielenz

Abstract

Objective

To determine the characteristics of community-dwelling older adults receiving fall-related rehabilitation.

Design

Cross-sectional analysis of the fifth round (2015) of the National Health and Aging Trends Study (NHATS). Fall-related rehabilitation utilization was analyzed using weighted multinomial logistic regression with SEs adjusted for the sample design.

Setting

In-person interviews of a nationally representative sample of community-dwelling older adults.

Participants

Medicare beneficiaries from NHATS (N=7062).

Interventions

Not applicable.

Main Outcomes Measures

Rehabilitation utilization categorized into fall-related rehabilitation, other rehabilitation, or no rehabilitation.

Results

Fall status (single fall: odds ratio [OR]=2.96; 95% confidence interval [CI], 1.52–5.77; recurrent falls: OR=14.21; 95% CI, 7.45–27.10), fear of falling (OR=3.11; 95% CI, 1.90–5.08), poor Short Physical Performance Battery scores (score 0: OR=6.62; 95% CI, 3.31–13.24; score 1–4: OR=4.65; 95% CI, 2.23–9.68), and hip fracture (OR=3.24; 95% CI, 1.46–7.20) were all associated with receiving fall-related rehabilitation. Lower education level (less than high school diploma compared with 4-y college degree: OR=.21; 95% CI, .11–.40) and Hispanic ethnicity (OR=.37; 95% CI, .15–.87) were associated with not receiving fall-related rehabilitation.

Conclusions

Hispanic older adults and older adults who are less educated are less likely to receive fall-related rehabilitation. Recurrent fallers followed by those who fell once in the past year were more likely to receive fall-related rehabilitation than are older adults who have not had a fall in the past year.

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Impact of Regular Physical Activity on Adipocytokines and Cardiovascular Characteristics in Spinal Cord–Injured Subjects

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Roberto Schreiber, Cristiane M. Souza, Layde R. Paim, Guilherme de Rossi, José R. Matos-Souza, Anselmo de A. Costa e Silva, Fernando R. Faria, Eliza R. Azevedo, Karina C. Alonso, Andrei C. Sposito, Alberto Cliquet, José I. Gorla, Wilson Nadruz

Abstract

Objective

To investigate the relationship of carotid artery intima-media thickness (IMT) and cardiac structure and function with adipocytokines in sedentary (S-SCI) and physically active (PA-SCI) subjects with spinal cord injury (SCI).

Design

Cross-sectional observational study.

Setting

Academic medical center.

Participants

Men with chronic (>1y) SCI (N=41; 16 S-SCI, 25 PA-SCI) were evaluated. S-SCI subjects did not perform labor that required physical effort, recreational physical activity, or sports, while PA-SCI subjects included competing athletes who were regularly performing adapted sports.

Interventions

Not applicable.

Main Outcome Measures

Clinical, laboratory, carotid ultrasonography, and echocardiography analysis. Plasma leptin, adiponectin, and plasminogen activating inhibitor-1 (PAI-1) levels were determined.

Results

PA-SCI subjects had similar levels of adipocytokines, but lower carotid IMT and carotid IMT/diameter, and better left ventricular diastolic function than S-SCI participants. Bivariate analysis showed that adiponectin was inversely correlated with triglycerides (r=–.85, P<.001), low-density lipoprotein cholesterol (r=–.57, P<.05), and carotid IMT/diameter (r=–.56, P<.05) in S-SCI but not in PA-SCI participants. Additionally, the leptin-adiponectin ratio showed a direct correlation with triglycerides (r=.84, P<.001) and low-density lipoprotein cholesterol (r=.53, P<.05) in S-SCI but not in PA-SCI individuals. By contrast, the studied adipocytokines did not correlate with cardiac structure and function in PA-SCI and S-SCI participants.

Conclusions

Lower adiponectin levels and higher leptin-adiponectin ratio are related to adverse vascular and/or metabolic characteristics in individuals with SCI. This relationship, however, appears to be mitigated by regular physical activity.

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Seasonal Patterns of Community Participation and Mobility of Wheelchair Users Over an Entire Year

Publication date: August 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 8

Author(s): Jaimie F. Borisoff, Jacquie Ripat, Franco Chan

Abstract

Objective

To describe how people who use wheelchairs participate and move at home and in the community over an entire yearlong period, including during times of inclement weather conditions.

Design

Longitudinal mixed-methods research study.

Setting

Urban community in Canada.

Participants

People who use a wheelchair for home and community mobility (N=11).

Intervention

Not applicable.

Main Outcome Measures

Use of a global positioning system (GPS) tracker for movement in community (number of trips per day), use of accelerometer for bouts of wheeling mobility (number of bouts per day, speed, distance, and duration), prompted recall interviews to identify supports and barriers to mobility and participation.

Results

More trips per day were taken during the summer (P= .03) and on days with no snow and temperatures above 0°C. Participants reliant on public transportation demonstrated more weather-specific changes in their trip patterns. The number of daily bouts of mobility remained similar across seasons; total daily distance wheeled, duration, and speed were higher on summer days, days with no snow, and days with temperatures above 0°C. A higher proportion of outdoor wheeling bouts occurred in summer (P=.02) and with temperatures above 0°C (P=.03). Inaccessible public environments were the primary barrier to community mobility and participation; access to social supports and private transportation were the primary supports.

Conclusions

Objective support is provided for the influence of various seasonal weather conditions on community mobility and participation for people who use a wheelchair. Longitudinal data collection provided a detailed understanding of the patterns of, and influences on, wheelchair mobility and participation within wheelchair users' own homes and communities.

Graphical abstract

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Ezras Nashim: EMS by women, for women

Brooklyn EMS volunteers offer services tailored to their New York community

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Virologic control and severity of liver disease determine survival after radiofrequency ablation of hepatocellular carcinoma on cirrhosis

We aimed to identify the main determinants of long-term overall survival (OS), including virologic control, and recurrence after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) on cirrhosis

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Virologic control and severity of liver disease determine survival after radiofrequency ablation of hepatocellular carcinoma on cirrhosis

We aimed to identify the main determinants of long-term overall survival (OS), including virologic control, and recurrence after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) on cirrhosis

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Radioecology in CONFIDENCE: Dealing with uncertainties relevant for decision making

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 192

Author(s): Wolfgang Raskob, Talal Almahayni, Nicholas A. Beresford

Abstract

The CONFIDENCE project is performing research on uncertainties in emergency management and post-accident recovery. It concentrates on the early and transition phases of an emergency, but considers also longer-term decisions made during these phases. To ensure success, the project brings together expertise from four European Radiation Protection Research Platforms (NERIS, MELODI, ALLIANCE and EURADOS) and also from the area of social sciences and humanities.

This paper presents an overview of the CONFIDENCE project with a focus on CONFIDENCE's consideration of the radioecology required to support emergency management and post-accident recovery. For instance, operational decisions concerning land and foodchain management rely on radioecological models that are at present mostly based on simple, but highly uncertain, transfer ratios to predict contamination in foodstuffs. CONFIDENCE will investigate if process-based models are better suited to reducing uncertainties associated with empirical ratio based models. Model improvements and uncertainty reduction might be also possible by better evaluating past experience from Chernobyl and Fukushima.

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Spasticity in adults with cerebral palsy and multiple sclerosis measured by objective clinically applicable technique

Publication date: September 2018

Source: Clinical Neurophysiology, Volume 129, Issue 9

Author(s): Tomofumi Yamaguchi, Tue Hvass Petersen, Henrik Kirk, Christian Forman, Christian Svane, Mathilde Kofoed-Hansen, Finn Boesen, Jakob Lorentzen

Abstract

Objective

The present study evaluated ankle stiffness in adults with and without neurological disorders and investigated the accuracy and reproducibility of a clinically applicable method using a dynamometer.

Methods

Measurements were obtained from 8 healthy subjects (age 39.3), 9 subjects with spastic cerebral palsy (CP) (age 39.8) and 8 subjects with multiple sclerosis (MS) (age 49.9). Slow and fast dorsiflexion stretches of the ankle joint were performed to evaluate passive muscle-tendon-joint stiffness, reflex mediated stiffness and range of movement (ROM), respectively. Intra/inter-rater reliability for passive and reflex mediated ankle muscle stiffness was assessed for all groups.

Results

Subjects with CP and MS showed significantly larger values of passive stiffness in the triceps surae muscle tendon complex and smaller ROM compared to healthy individuals, while no significant difference in reflex mediated stiffness. Measurements of passive muscle-tendon-joint stiffness and reflex mediated stiffness showed good to excellent inter- and intra-rater reliability (ICC: 0.62–0.91) in all groups.

Conclusion

Increased stiffness was found in subjects with CP and MS with a clinically applicable method that provides valid and reproducible measurement of passive ankle muscle-tendon-joint stiffness and reflex mediated stiffness.

Significance

The present technique may provide important supplementary information for the clinician.

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Validity and Responsiveness of PROMIS in Adult Spinal Deformity: The Need for a Self-Image Domain

. Validity and responsiveness of the Patient Reported Outcomes Measurement Information System (PROMIS) have been investigated in several orthopaedic subspecialties. PROMIS has shorter completion time and greater research flexibility for the heterogeneous adult spinal deformity (ASD) population versus the Oswestry Disability Index (ODI) and Scoliosis Research Society 22-item questionnaire (SRS-22r).

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Liver disease is an independent predictor of poor 30-day outcomes following surgery for degenerative disease of the cervical spine

The impact of underlying liver disease on surgical outcomes has been recognized in a wide variety of surgical disciplines. However, less empiric data is available about the importance of liver disease in spinal surgery.

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The Impact of Frailty and Sarcopenia on Postoperative Outcomes in Adult Spine Surgery. A Systematic Review of the Literature

Study Design: Systematic review.Objectives: To identify currently used measures of frailty and sarcopenia in the adult spine surgery literature. To assess their ability to predict postoperative outcomes including mortality, morbidity, in-hospital length of stay (LOS) and discharge disposition. To determine which is the best clinical measure of frailty and sarcopenia in predicting outcome after spine surgery.Summary of Background Data: Frailty and sarcopenia have been identified as predictors of mortality and adverse-events (AEs) in numerous non-surgical and non-spine populations.

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Koala genome insights

Koala genome insights

Koala genome insights, Published online: 24 July 2018; doi:10.1038/s41576-018-0039-5

A paper in Nature Genetics reports a high-quality reference genome for the koala, with insights into its specialized lifestyle, and potential applications in vaccine development and conservation strategies.

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GC content elevates mutation and recombination rates in the yeast Saccharomyces cerevisiae [Genetics]

The chromosomes of many eukaryotes have regions of high GC content interspersed with regions of low GC content. In the yeast Saccharomyces cerevisiae, high-GC regions are often associated with high levels of meiotic recombination. In this study, we constructed URA3 genes that differ substantially in their base composition [URA3-AT (31%...

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Integrative analysis of single-cell genomics data by coupled nonnegative matrix factorizations [Genetics]

When different types of functional genomics data are generated on single cells from different samples of cells from the same heterogeneous population, the clustering of cells in the different samples should be coupled. We formulate this "coupled clustering" problem as an optimization problem and propose the method of coupled nonnegative...

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Genome instability is a consequence of transcription deficiency in patients with bone marrow failure harboring biallelic ERCC6L2 variants [Genetics]

Biallelic variants in the ERCC excision repair 6 like 2 gene (ERCC6L2) are known to cause bone marrow failure (BMF) due to defects in DNA repair and mitochondrial function. Here, we report on eight cases of BMF from five families harboring biallelic variants in ERCC6L2, two of whom present with...

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Evaluation of the Effect of Resveratrol and Doxorubicin on 99mTc-MIBI Uptake in Breast Cancer Cell Xenografts in Mice

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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EMT-B - Friendly Care Medical Transport

FULL/PART Time Positions Available. $15+ All shifts available. Highland Park, NJ. Please call 732-448-0100 for more information. Competitive pay and benefits. Job Purpose: Provides emergency medical support by responding to emergencies; stabilizing and transporting patients. Duties: - Prepares to transport patients by completing operator vehicle inspections; inventorying supplies; correcting deficiencies ...

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Evaluation of the Effect of Resveratrol and Doxorubicin on 99mTc-MIBI Uptake in Breast Cancer Cell Xenografts in Mice

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Koala genome insights

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Returning to Work After Mild Stroke

Publication date: Available online 24 July 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Shannon Scott, Suzanne Perea Burns, Jaclyn Schwartz, Mark Kovic

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Nurse urges public to learn CPR after fatal vehicle crash

Lindsey Skebba said she stopped at the crash scene and noticed several bystanders had not started CPR on the victim, who later died

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Paramedic 12 HOUR SHIFT - Cabarrus County EMS

Hiring range for this position is $38,043.20 - 43,368.00. Initial placement for new employees is customarily at entry level through 25% percentile. Pay grade for this position is 14 Performs advanced technical work responding, rescuing, and transporting the sick and injured and administering emergency medical care at the paramedic level. Work is performed under the regular supervision of a Shift Supervisor ...

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Sarcopenia definition in patients with NAFLD

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The DrugPattern tool for drug set enrichment analysis and its prediction for beneficial effects of oxLDL on type 2 diabetes

Publication date: Available online 24 July 2018

Source: Journal of Genetics and Genomics

Author(s): Chuanbo Huang, Weili Yang, Junpei Wang, Yuan Zhou, Bin Geng, Georgios Kararigas, Jichun Yang, Qinghua Cui

Abstract

Enrichment analysis methods, e.g., gene set enrichment analysis, represent one class of important bioinformatical resources for mining patterns in biomedical datasets. However, tools for inferring patterns and rules of a list of drugs are limited. In this study, we developed a web-based tool, DrugPattern, for drug set enrichment analysis. We first collected and curated 7019 drug sets, including indications, adverse reactions, targets, pathways, etc. from public databases. For a list of interested drugs, DrugPattern then evaluates the significance of the enrichment of these drugs in each of the 7019 drug sets. To validate DrugPattern, we employed it for the prediction of the effects of oxidized low-density lipoprotein (oxLDL), a factor expected to be deleterious. We predicted that oxLDL has beneficial effects on some diseases, most of which were supported by evidence in the literature. Because DrugPattern predicted the potential beneficial effects of oxLDL in type 2 diabetes (T2D), animal experiments were then performed to further verify this prediction. As a result, the experimental evidences validated the DrugPattern prediction that oxLDL indeed has beneficial effects on T2D in the case of energy restriction. These data confirmed the prediction accuracy of our approach and revealed unexpected protective roles for oxLDL in various diseases. This study provides a tool to infer patterns and rules in biomedical datasets based on drug set enrichment analysis. DrugPattern is available at http://www.cuilab.cn/drugpattern.

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Spotlight: 12 Lead Trainer features a wave generation algorithm that creates an EKG that simulates reality

12 Lead Trainer's goal is to drastically improve the training process, providing rhythms like those you'd see in the field.

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Paramedic/Emergency Medical Services Instructor - Ozarks Technical Community College

**Date Position Available: **September 17, 2018 **Department: **Allied Health **FLSA: **Exempt **Immediate Supervisor: **Paramedic/Emergency Medical Services Program Director **Schedule Details: **Full-time/11 month position/PSRS **Position Summary** The Instructor will be responsible for the instruction and management of assigned classes and will maintain professionalism within their specialized field ...

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Acute kidney injury in parturients with severe preeclampsia

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Reply to: Acute kidney injury in parturients with severe preeclampsia

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Risk of rheumatoid arthritis in patients with hepatitis C virus infection receiving interferon-based therapy: A retrospective cohort study using the Taiwanese national claims database

BMJ Open

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Non-alcoholic fatty liver disease is an independent risk factor for inflammation in obstructive sleep apnea syndrome in obese Asian Indians

Sleep and Breathing

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Recent Molecular Profiling Studies in Papillary and Follicular Thyroid Carcinoma Provide Clinical and Basic Insights

Clinical Thyroidology, Volume 30, Issue 7, Page 319-323, July 2018.


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A High Proportion of Serum rT3 Tests Are Ordered by a Relatively Small Number of Providers in a U.S.-Wide Sample

Clinical Thyroidology, Volume 30, Issue 7, Page 337-339, July 2018.


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Higher Preconception Maternal Iodine Intakes Are Associated with Higher Child IQ

Clinical Thyroidology, Volume 30, Issue 7, Page 302-304, July 2018.


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New Genomic Sequencing Classifier in Cytologically Indeterminate Thyroid Nodules Shows Improved Results

Clinical Thyroidology, Volume 30, Issue 7, Page 328-331, July 2018.


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Some Advanced Thyroid Cancer Patients Have a Prolonged Response to Lenvatinib

Clinical Thyroidology, Volume 30, Issue 7, Page 305-308, July 2018.


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Editorial: Will the EUGOGO Predictive Score for Graves’ Orbitopathy Be Useful for Management?

Clinical Thyroidology, Volume 30, Issue 7, Page 300-301, July 2018.


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Analysis of Clinical Factors 1 Year After Surgery for Thyroid Cancer Enables Prediction of Treatment-free Survival

Clinical Thyroidology, Volume 30, Issue 7, Page 309-311, July 2018.


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Residual Lymph Node Metastases after Initial Surgery—What Are the Implications for the Approach to Initial Surgery and Postoperative Therapy?

Clinical Thyroidology, Volume 30, Issue 7, Page 324-327, July 2018.


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Thyroglobulin Levels Do Not Predict Recurrence After Lobectomy for Low-Risk Papillary Thyroid Cancer

Clinical Thyroidology, Volume 30, Issue 7, Page 312-314, July 2018.


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Automated Analysis of Gray-Scale Ultrasound Images of Thyroid Nodules (“Radiomics”) May Outperform Image Interpretation by Less Experienced Thyroid Radiologists

Clinical Thyroidology, Volume 30, Issue 7, Page 332-336, July 2018.


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What Factors Contribute to the Development of Central Hypothyroidism When Adult Patients with GH Deficiency Are Treated with rhGH?

Clinical Thyroidology, Volume 30, Issue 7, Page 315-318, July 2018.


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Letter to the Editor: Molecular Analysis Should Be Incorporated Into the Definition of NIFTP

Clinical Thyroidology, Volume 30, Issue 7, Page 340-341, July 2018.


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