Implementation of pressure injury prevention best practices across six Canadian rehabilitation sites: results from the Spinal Cord Injury Knowledge Mobilization Network

Publication date: Available online 9 November 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Carol Y. Scovil, Jude J. Delparte, Saagar Walia, Heather M. Flett, Stacey D. Guy, Michelle Wallace, Anthony S. Burns, Dalton L. Wolfe, SCI KMN Group

Abstract

Objective

To utilize the theoretical frameworks of implementation science to implement pressure injury (PI) prevention best practices in spinal cord injury (SCI) rehabilitation.

Design

Quality Improvement

Setting

Six Canadian SCI rehabilitation centers

Participants

Inpatients admitted 2011-2015

Interventions

The SCI Knowledge Mobilization Network (SCI KMN) selected and implemented two PI prevention best practices at six Canadian SCI rehabilitation centers: (1) completing a comprehensive PI risk assessment comprised of a structured risk assessment instrument followed by an individualized, interprofessional risk factor determination and prevention plan; and (2) providing structured and individualized PI prevention patient education. Active Implementation Frameworks provided a systematic approach to best practice implementation.

Outcome Measures

Implementation indicators (completion rates) and patient outcomes (PI incidence; patient education survey).

Results

Following implementation, risk assessment completion rates improved from 46% to 82% (p<0.05). Between initial (2012-13) and full (2014-15) implementation stages, completion rates improved for both interprofessional risk factor determination (67% to 96%) and prevention plans (67% to 94%). Documentation of patient education also increased to 86% (71% pre-implementation). The incidence of PIs at rehabilitation admission was 22%, with 14% of individuals developing new PIs during rehabilitation. The overall PI prevalence was 30%. Considering only PIs of stage 2 or greater, prevalence was 21% and incidence 7%. There were no statistically significant differences in PI incidence between pre- and post-implementation. Patient education surveys indicated that PI education improved patients' knowledge of prevention strategies.

Conclusions

Active Implementation Frameworks supported successful implementation of PI prevention best practices across the six participating SCI KMN sites. Achieving a reduction in PI incidence will require additional measures, and there is an ongoing need to strengthen the evidence base underpinning PI prevention guidelines.

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Improvement of upper limb motor control and function after competitive and non-competitive volleyball exercises in chronic stroke survivors: A randomized clinical trial

Publication date: Available online 9 November 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Mahbubeh Mandehgary Najafabadi, Akram Azad, Hajar Mehdizadeh, Saeed Behzadipour, Maliheh Fakhar, Parvaneh Taghavi Azar Sharabiani, Mohamad Parnianpour, Ghorban Taghizadeh, Kinda Khalaf

Abstract

Objectives

To investigate the effects of competitive and non-competitive volleyball exercises on the functional performance and motor control of the upper limbs in chronic stroke survivors.

Design

Randomized clinical trial.

Setting

Outpatient rehabilitation center.

Participants

Forty-eight chronic stroke survivors.

Interventions

Participants were randomly assigned to competitive (n=16) or non-competitive (n=16) volleyball exercise groups (60 min/day volleyball exercise + 30 min/day traditional rehabilitation, 3 day/week for 7 weeks) and control group (n=16).

Main outcome measures

Reach and grasp motor control measures were evaluated through kinematic analysis. Functional outcomes were assessed via Motor Activity Log, Wolf Motor Function Test, Box and Block Test, as well as, Wrist Position Sense Test.

Results

Significant improvement of functional performance was observed in both competitive (P <0.0001) and non-competitive volleyball exercise groups (P <0.01), but not in the control group (P >0.05), with the exception of Wolf Motor Function Test score. Volleyball training, in general, resulted in more efficient spatiotemporal control of reach and grasp functions, as well as less dependence on feedback control as compared to the control group. Moreover, the competitive volleyball exercise group exhibited greater improvement in both functional performance and motor control levels.

Conclusions

Volleyball team exercises, especially in a competitive format, resulted in enhancing the efficacy of the pre-programming and execution of reach and grasp movements, as well as a shift from feedback to feedforward control of the affected upper limb in chronic stroke survivors. This may well be a potential underlying mechanism for improving functional performance.

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RNA sequencing-based transcriptomic profiles of embryonic lens development for cataract gene discovery

Abstract

Isolated or syndromic congenital cataracts are heterogeneous developmental defects, making the identification of the associated genes challenging. In the past, mouse lens expression microarrays have been successfully applied in bioinformatics tools (e.g., iSyTE) to facilitate human cataract-associated gene discovery. To develop a new resource for geneticists, we report high-throughput RNA sequencing (RNA-seq) profiles of mouse lens at key embryonic stages (E)10.5 (lens pit), E12.5 (primary fiber cell differentiation), E14.5 and E16.5 (secondary fiber cell differentiation). These stages capture important events as the lens develops from an invaginating placode into a transparent tissue. Previously, in silico whole-embryo body (WB)-subtraction-based "lens-enriched" expression has been effective in prioritizing cataract-linked genes. To apply an analogous approach, we generated new mouse WB RNA-seq datasets and show that in silico WB subtraction of lens RNA-seq datasets successfully identifies key genes based on lens-enriched expression. At ≥2 counts-per-million expression, ≥1.5 log₂ fold-enrichment (p < 0.05) cutoff, E10.5 lens exhibits 1401 enriched genes (17% lens-expressed genes), E12.5 lens exhibits 1937 enriched genes (22% lens-expressed genes), E14.5 lens exhibits 2514 enriched genes (31% lens-expressed genes), and E16.5 lens exhibits 2745 enriched genes (34% lens-expressed genes). Biological pathway analysis identified genes associated with lens development, transcription regulation and signaling pathways, among other functional groups. Furthermore, these new RNA-seq data confirmed high expression of established cataract-linked genes and identified new potential regulators in the lens. Finally, we developed new lens stage-specific UCSC Genome Brower annotation tracks and made these publicly accessible through iSyTE (https://research.bioinformatics.udel.edu/iSyTE/) for user-friendly visualization of lens gene expression/enrichment to prioritize genes from high-throughput data from cataract cases.

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Stuttering as a matter of delay in neural activation: a combined TMS/EEG study

Publication date: Available online 10 November 2018

Source: Clinical Neurophysiology

Author(s): Pierpaolo Busan, Giovanni Del Ben, Lucia Roberta Russo, Simona Bernardini, Giulia Natarelli, Giorgio Arcara, Paolo Manganotti, Piero Paolo Battaglini

Abstract

Objective

Brain dynamics in developmental stuttering (DS) are not well understood. The supplementary motor area (SMA) plays a crucial role, since it communicates with regions related to planning/execution of movements, and with sub-cortical regions involved in paced/voluntary acts (such as speech). We used TMS combined with EEG to shed light on connections in DS, stimulating the SMA.

Methods

TMS/EEG was recorded in adult DS and fluent speakers (FS), stimulating the SMA during rest. TMS-evoked potentials and source distribution were evaluated.

Results

Compared to FS, stutterers showed lower activity of neural sources in early time windows: 66-82 ms in SMA, and 91-102 ms in the left inferior frontal cortex and left inferior parietal lobule. Stutterers, however, showed higher activations in later time windows (i.e. from 260-460 ms), in temporal/premotor regions of the right hemisphere.

Conclusions

These findings represent the functional counterpart to known white matter and cortico-basal-thalamo-cortical abnormalities in DS. They also explain how white matter abnormalities and cortico-basal-thalamo-cortical dysfunctions may be associated in DS. Finally, a mechanism is proposed in which compensatory activity of the non-dominant (right) hemisphere is recruited.

Significance

DS may be a disorder of neural timing that appears to be delayed compared to FS; new mechanisms that support stuttering symptoms are inferred; the SMA may be a promising target for neuro-rehabilitation.

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New Alert Criteria for Intraoperative Somatosensory Evoked Potential Monitoring

Publication date: Available online 10 November 2018

Source: Clinical Neurophysiology

Author(s): Marc R. Nuwer

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Reduced delta-band modulation underlies the loss of P300 responses in disorders of consciousness

Publication date: Available online 9 November 2018

Source: Clinical Neurophysiology

Author(s): Gonzalo Rivera-Lillo, Daniel Rojas-Líbano, Pablo Burgos, Jose I. Egaña, Srivas Chennu, Pedro E. Maldonado

Abstract

Objective

The P300 component of a sensory event-related potential is one of the major electrophysiological markers used to explore remnants of cognitive function in patients with disorders of consciousness (DoC). However, measuring the P300 in patients is complicated by significant inter-trial variability commonly observed in levels of arousal and awareness. To overcome this limitation, we analyzed single-trial modulation of power in the delta and theta frequency bands, which underlie the P300.

Methods

In a preliminary cross-sectional study using a 24-channel EEG and a passive own-name oddball paradigm, we analyzed event-related synchronization (ERS) across trials in the delta and theta bands in a sample of 10 control and 12 DoC subjects.

Results

In comparison to controls, DoC subjects presented a low percentage of trials where delta ERS was observed. In particular, coordinated modulation between delta and theta in response to the stimulus was absent, with a high percentage of trials where only theta ERS was observed. Further, we found a positive correlation between the percentage of epochs with delta ERS and the strength of the P300.

Conclusions

Reduced modulation of spectral activity in the delta band in response to stimuli indicates a dissociation in the activity of the neural networks that oscillate in delta and theta ranges and contribute to the generation of the P300.

Significance

The reduction in spectral modulation observed in DoC provides a deeper understanding of neurophysiological dysfunction and the means to develop a more fine-grained marker of residual cognitive function in individual patients.

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The ftsA gene as a molecular marker for phylogenetic studies in Bradyrhizobium and identification of Bradyrhizobium japonicum

Abstract

The use of ftsA gene sequences for taxonomic studies of the genus Bradyrhizobium bacteria was assessed. The ftsA gene codes for an actin-like protein involved in prokaryotic cell division. Up to now, this gene has not been used as a phylogenetic marker for analysis of bacteria establishing root nodule symbiosis with Fabaceae plants. In this study, the ftsA gene sequences obtained for bradyrhizobia forming N₂ fixing symbiosis with four Genisteae tribe plants growing in Poland and most of the type strains of the genus Bradyrhizobium species were analyzed and evaluated as molecular markers for phylogenetic studies of these bacteria for the first time. The ftsA gene sequences of all bradyrhizobial strains with completely or partially sequenced genomes, available in the GenBank database, were also included into the analysis. The phylogeny of the ftsA gene was compared to the phylogenies of other chromosomal genes commonly used in the studies of Bradyrhizobium bacteria. The results showed that the phylogenies of ftsA and the core genes recA and glnII were congruent, making the ftsA gene useful as a phylogenetic marker. Analysis of the ftsA gene sequences revealed a single-nucleotide polymorphism unique to Bradyrhizobium japonicum strains, and the potential use of this SNP for identification of this species was discussed.

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