Assessing dysphagia via telerehabilitation: patient perceptions and satisfaction

To gain insight into factors which may influence future acceptance of dysphagia management via telerehabilitation, patients' perceptions were examined before and after a telerehabilitation assessment session. Forty adult patients with dysphagia (M =66 years, SD =16.25) completed pre- and post-session questionnaires which consisted of 14 matched questions worded to suit pre- and post-conditions. Questions explored comfort with the use of telerehabilitation, satisfaction with audio and video quality, benefits of telerehabilitation assessments and patients' preferred assessment modality. Questions were rated on a 5-point scale (1 = strongly disagree, 3 = unsure, 5 = strongly agree). Patients' comfort with assessment via telerehabilitation was high in over 80% of the group both pre- and post-assessment. Pre-assessment, patients were unsure what to expect with the auditory and visual aspects of the videoconference, however there were significant positive changes reported post-experience. In relation to perceived benefits of telerehabilitation services in general, most patients believed in the value of telerehabilitation and post-assessment this increased to 90-100% agreement. Although 92% felt they would be comfortable receiving services via telerehabilitation, 45% of patients indicated ultimate preference for a traditional face-to-face assessment. The data highlight that patients are interested in and willing to receive services via telerehabilitation; however, any concerns should be addressed pre-assessment.

Use of ultrasound-guided autologous bone marrow transfer for treatment of suspensory ligament desmitis in 30 race horses (2003-2010)

OBJECTIVE

To evaluate the racing performance of horses that underwent ultrasound-guided intralesional injection of autologous bone marrow aspirate for treatment of selected forelimb suspensory ligament (body or branch) core lesions.

DESIGN

Retrospective cohort study of 13 Standardbred and 17 Thoroughbred race horses.

METHODS

Autologous bone marrow aspirated from the sternebrae was injected, under ultrasound guidance, into suspensory ligament core lesions (body or branch). Racing records were reviewed for a comparison of performance before and after surgery.

RESULTS

Of the 13 Standardbreds, 9 (69%) had one or more starts within the follow-up period and 9 (69%) had five or more starts. Of the 17 Thoroughbreds, 15 (88%) had one or more starts within the follow-up period and 12 (71%) had five or more starts. Eight Standardbred horses had at least one start both before and after surgery. Earnings per start did not differ significantly between the three starts immediately after surgery compared with the three starts immediately prior to surgery. Thirteen Thoroughbred horses had at least one start both before and after surgery. Earnings per start were less for the three starts immediately after surgery compared with the three starts immediately prior to surgery.

CONCLUSIONS AND CLINICAL RELEVANCE

A horse with a core lesion in the branch or body of the suspensory ligament has a good prognosis for return to racing after treatment with intralesional injection of bone marrow aspirate.

The feasibility and validity of a remote pulse oximetry system for pulmonary rehabilitation: a pilot study

Pulmonary rehabilitation is an effective treatment for people with chronic obstructive pulmonary disease. However, access to these services is limited especially in rural and remote areas. Telerehabilitation has the potential to deliver pulmonary rehabilitation programs to these communities. The aim of this study was threefold: to establish the technical feasibility of transmitting real-time pulse oximetry data, determine the validity of remote measurements compared to conventional face-to-face measures, and evaluate the participants' perception of the usability of the technology. Thirty-seven healthy individuals participated in a single remote pulmonary rehabilitation exercise session, conducted using the eHAB telerehabilitation system. Validity was assessed by comparing the participant's oxygen saturation and heart rate with the data set received at the therapist's remote location. There was an 80% exact agreement between participant and therapist data sets. The mean absolute difference and Bland and Altman's limits of agreement fell within the minimum clinically important difference for both oxygen saturation and heart rate values. Participants found the system easy to use and felt confident that they would be able to use it at home. Remote measurement of pulse oximetry data for a pulmonary rehabilitation exercise session was feasible and valid when compared to conventional face-to-face methods.

Clinical assessment, design and performance testing of mobile shower commodes for adults with spinal cord injury: an exploratory review

PURPOSE

The purpose of this article is to explore evidence concerning clinical assessment, design and performance testing of mobile shower commodes used by adults with spinal cord injury (SCI).

METHOD

Searches of electronic databases, conference proceedings and key journals were undertaken with no restriction on language or study design. Keywords included spinal cord injury, lesion, sanichair, sanitary chair, shower chair, bowel chair and commode.

RESULTS

A total of 20 publications were included in this review. Common approaches to clinical assessments were questionnaires and observational analysis to assess bowel care routines, function and skin integrity. Design features addressed access for bowel care, postural support, transfers, stability, use in wet environments and skin integrity. Objective performance measures addressed requirements for static stability, backward-sloping seat angles, arm supports and seat materials.

CONCLUSIONS

Evidence reviewed was of low methodological quality and lacking in validated instruments to guide clinical practice. Further high-quality research is needed to identify bathing, showering and personal hygiene tasks affecting mobile shower commodes use and to develop validated clinical assessment tools. Performance testing to published standards is also needed.

Training the allied health assistant for the telerehabilitation assessment of dysphagia

We examined the effect of knowledge and task specific training provided to an allied health assistant (AHA), prior to her involvement in facilitating assessments of dysphagia (swallowing disorders) via telerehabilitation. The AHA received four hours of training, which included basic theoretical information regarding dysphagia as well as hands-on training with simulated patients. A written test examining swallowing function and its evaluation was completed pre- and then immediately post-training, and then again after the 15th and 30th of 31 consecutive patient assessments. In addition, after each set of 5 clinical dysphagia assessments completed with patients following the training, two speech pathologists rated the AHA's competence in relation to performing the tasks and activities required of her during the telerehabilitation swallowing assessment. The AHA also self-rated the perceived level of confidence at these times. Before training, the assistant's knowledge of dysphagia theory was at 40%. Following training, all tests were above the 80% level. The AHA's performance was rated as competent on each evaluation post-training. The AHA also expressed overall satisfaction with the initial training provided and reported feeling confident after the initial sessions with patients. Thus for an AHA with previous clinical experience, competence and perceived comfort in providing assistance in the sessions was achieved with only a few hours of task specific training.

Ecstacy-induced delayed rhabdomyolysis and neuroleptic malignant syndrome in a patient with a novel variant in the ryanodine receptor type 1 gene

We present the case of a 20-year-old woman who developed rhabdomyolysis, disseminated intravascular coagulopathy and multi-organ failure induced by ecstasy. Following initial improvement, she developed delayed rhabdomyolysis then haloperidol-induced neuroleptic malignant syndrome, which was treated with a total of 50 mg.kg(-1) dantrolene. Subsequent genetic testing revealed a novel potentially pathogenic variant in the ryanodine receptor type 1 gene. However, caffeine-halothane contracture testing of the patient's mother who carried the same gene variant was negative for malignant hyperthermia.

First Report of Leaf Spot Caused by Alternaria alternata on Switchgrass in Tennessee

Field-grown seedlings of 'Alamo' switchgrass (Panicum virgatum L.) from Vonore, TN exhibited light brown-to-dark brown leaf spots and general chlorosis in June 2009. Symptomatic leaf tissue was surface sterilized (95% ethanol for 1 min, 20% commercial bleach for 3 min, and 95% ethanol for 1 min), air dried on sterile filter paper, and plated on 2% water agar amended with 10 mg/liter rifampicin (Sigma-Aldrich, St. Louis, MO) and 5 μl/liter miticide (2.4 EC Danitol, Valent Chemical, Walnut Creek, CA). Plates were incubated at 26°C for 4 days in darkness. An asexual, dematiaceous mitosporic fungus was isolated and transferred to potato dextrose agar. Cultures were transferred to Alternaria sporulation medium (3) to induce conidial production. Club-shaped conidia were produced in chains with branching of chains present. Conidia were 27 to 50 × 10 to 15 μm, with an average of 42.5 × 12.5 μm. Morphological features and growth on dichloran rose bengal yeast extract sucrose agar were consistent with characteristics described previously for Alternaria alternata (1). Pathogenicity studies were conducted with 5-week-old 'Alamo' switchgrass plants grown from surface-sterilized seed. Nine pots with approximately 20 plants each were prepared. Plants were wounded by trimming the tops. Eight replicate pots were sprayed with a conidial spore suspension of 5.0 × 10⁶ spores/ml sterile water and subjected to high humidity by enclosure in a plastic bag for 7 days. One pot was sprayed with sterile water and subjected to the same conditions to serve as a control. Plants were maintained in a growth chamber at 25/20°C with a 12-h photoperiod. Foliar leaf spot symptoms appeared 5 to 10 days postinoculation for all replicate pots inoculated with A. alternata. Symptoms of A. alternata infection were not observed on the control. Lesions were excised, surface sterilized, plated on water agar, and identified in the same manner as previously described. The internal transcribed spacer (ITS) region of ribosomal DNA and the mitochondrial small sub-unit region (SSU) from the original isolate and the reisolate recovered from the pathogenicity assay were amplified with PCR, with primer pairs ITS4 and ITS5 and NMS1 and NMS2, respectively. Resultant DNA fragments were sequenced and submitted to GenBank (Accession Nos. HQ130485.1 and HQ130486.1). A BLAST search (BLASTn, NCBI) was run against GenBank isolates. The ITS region sequences were 537 bp and matched 100% max identity with eight A. alternata isolates, including GenBank Accession No. AB470838. The SSU sequences were 551 bp and matched 100% max identity with seven A. alternata isolates, including GenBank Accession No. AF229648. A. alternata has been reported from switchgrass in Iowa and Oklahoma (2); however, this is the first report of A. alternata causing leaf spot on switchgrass in Tennessee. Switchgrass is being studied in several countries as a potentially important biofuel source, but understanding of the scope of its key diseases is limited. References: (1) B. Andersen et al. Mycol. Res. 105:291, 2001. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Mycology and Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , September 22, 2011. (3) E. A. Shahin and J. F. Shepard. Phytopathology 69:618, 1979.

Theory of Mind as a potential trait marker of schizophrenia: a family study

INTRODUCTION

Although there is some evidence that Theory of Mind (ToM) deficits may be trait markers of schizophrenia it is not clear yet if ToM deficits are primary deficits, that is, to be independent of deficits in general intellectual abilities and executive function. The aim was to examine if ToM deficits may be trait markers of the illness and the effect of cognitive inhibition, general intellectual abilities and depression on ToM abilities of patients with schizophrenia and their unaffected parents.

METHODS

We assessed ToM abilities (first-order and second-order ToM stories, The Revised Eyes Test), cognitive inhibition (Stroop Task), general intellectual ability (Standard Progressive Matrices Test Plus) in patients with schizophrenia (N=21) and their unaffected fathers (N=21) and mothers (N=21) in comparison with healthy control families (healthy control males, N=21, healthy control fathers, N=21, healthy control mothers, N=21)

RESULTS

Patients showed deficits in first-order ToM tasks but some of these deficits were mediated by general intellectual abilities. Impairments in cognitive inhibition mediated only patients' performance in The Revised Eyes Test. Patients showed deficits in second-order ToM stories independently of deficits in general intellectual abilities and cognitive inhibition. Unaffected parents did not show deficits in first-order ToM tasks, whereas they showed deficits in second-order ToM stories. However, the deficits that unaffected parents showed in second-order ToM stories were mediated by their deficits in general intellectual abilities, and there was an effect of remitted depression on the unaffected mothers' performance.

CONCLUSIONS

The results suggest that intact neurocognitive and general intellectual abilities are necessary in order patients and their unaffected parents to pass successfully ToM tasks. Patients and their unaffected parents show ToM deficits but these deficits are not similar. Patients show ToM deficits but these deficits seem to be a component of the pathophysiology of the illness (e.g., deficits in executive function, general intellectual abilities).

Telehealth for nursing homes: the utilization of specialist services for residential care

Specialist care consultations were identified by two research nurses using documentation in patient records, appointment diaries, electronic billing services and on-site observations at a 441-bed long term care facility. Over a six-month period there were 3333 consultations (a rate of 1511 consultations per year per 100 beds). Most consultations were for general practice (n = 2589, 78%); these consultations were mainly on site (99%), with only 27 taking place off site. There were 744 consultations for specialities other than general practice. A total of 146 events related to an emergency or unplanned hospital admission. The remaining medical consultations (n = 598, 18%) related to 23 medical specialities. The largest number of consultations were for surgery (n = 106), podiatry (n = 100), nursing services including wound care (n = 74), imaging (n = 41) and ophthalmology (n = 40). Many services which are currently being provided on site to metropolitan long-term care facilities could be provided by telehealth in both urban and rural facilities.

Measurement of forces applied during Macintosh direct laryngoscopy compared with GlideScope® videolaryngoscopy

Laryngoscopy can induce stress responses that may be harmful in susceptible patients. We directly measured the force applied to the base of the tongue as a surrogate for the stress response. Force measurements were obtained using three FlexiForce Sensors(®) (Tekscan Inc, Boston, MA, USA) attached along the concave surface of each laryngoscope blade. Twenty-four 24 adult patients of ASA physical status 1-2 were studied. After induction of anaesthesia and neuromuscular blockade, laryngoscopy and tracheal intubation was performed using either a Macintosh or a GlideScope(®) (Verathon, Bothell, WA, USA) laryngoscope. Complete data were available for 23 patients. Compared with the Macintosh, we observed lower median (IQR [range]) peak force (9 (5-13 [3-25]) N vs 20 (14-28 [4-41]) N; p = 0.0001), average force (5 (3-7 [2-19]) N vs 11 (6-16 [1-24]) N; p = 0.0003) and impulse force (98 (42-151 [26-444]) Ns vs 150 (93-207 [17-509]) Ns; p = 0.017) with the GlideScope. Our study shows that the peak lifting force on the base of the tongue during laryngoscopy is less with the GlideScope videolaryngoscope compared with the Macintosh laryngoscope.

BS3-2: Mammary Stroma as an NSAID Target; Implications for Pregnancy-Associated Breast Cancer

Utilizing a young women's breast cancer cohort from the University of Colorado Cancer Center, we show that women diagnosed as late as five-ten years postpartum have worse prognosis than nulliparous women or women diagnosed during pregnancy, and represent ∼50% of all young women's breast cancer patients. We propose that breast involution following pregnancy accounts for this poor prognosis. Characterization of involution identifies tissue remodeling programs that share similarities with microenvironments known to promote metastasis. Using SHG imaging, we find fibrillar collagen bundles with radially-aligned fibers similar to those observed in invasive tumors deposited in the involuting gland. By immunohistochemistry and FACS we find macrophages with an M2-polarization-like profile similar to tumor-associated macrophages at abundant levels during involution. In three independent mouse models for postpartum breast cancer, we isolate postpartum mammary gland involution as a driving force for cancer progression. Mammary tumors arising in the mouse involuting microenvironment express COX-2 and isolated tumor cells are motile and invasive in a collagen-1/COX-2 dependent manner. Targeting involution-macrophages as likely mediators of tumor promotion was accomplished using a previously described mouse transgenic model. Macrophage depletion during involution had catastrophic effects on normal mammary gland involution. Conversely, inhibition of COX-2 with celecoxib, aspirin or ibuprofen did not interfere with postpartum lobular regression. COX-2 inhibition did decrease tumor growth, local tumor cell dispersion and lung metastasis. NSAID treatment also suppressed collagen and tenascin-C deposition in the involuting microenvironment, suggesting that modulation of extracellular matrix proteins may be a novel mechanism by which NSAIDs exhibit chemopreventive activity. Our studies indicate two distinct roles for COX-2 in the postpartum setting. COX-2 activity within the tumor cell is required for invasiveness and COX-2 activity in the host promotes collagen fibrillogenesis. Several correlative observations implicate the collagen/COX-2 pathway in postpartum breast cancer in women: involuting breast tissue has increased collagen with radially aligned fibers, analysis of 11 publically available microarray data sets shows high COL1A and COX-2 independently correlate with decreased relapse free-survival in young breast cancer patients, and COX-2 protein is observed in DCIS lesions in postpartum cases at higher levels than nulliparous cases.

In summary, our studies suggest further research into COX-2 inhibitor use might provide a novel strategy to improve the prognosis of young women should they be diagnosed with postpartum breast cancer. The question of whether an NSAID based intervention study could be aimed at recently pregnant women at high risk for breast cancer also remains to be determined, but is an extremely desirable objective given that the ∼ 6 million pregnancies in the US per year.

Supported by grants from DoD Synergistic Idea Awards BC060531 & BC10400/001, Komen Foundation KG090629, DoD Idea Award BC074970 to PJK, ACS New England Division Postdoctoral Fellowship Spin Odyssey PF-08-257-01-CSM to TRL and DoD Predoctoral Grants BC073482 to JO and BC100910 to HM.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr BS3-2.

A Comparison of the Forces Applied to a Manikin during Laryngoscopy with the Glidescope® and Macintosh Laryngoscopes

The force applied during laryngoscopy can cause local tissue trauma and can induce cardiovascular responses and cervical spine movement in susceptible patients. Previous studies have identified numerous operator and patient factors that influence the amount of force applied during intubation. There are few studies evaluating the effect of different laryngoscope blades and no study involving video laryngoscopes. In this study we measured the forces using two laryngoscopic techniques. Three FlexiForce Sensors® (A201-25, Tekscan, Boston, MA, USA) were attached to the concave blade surface of a Macintosh and a GlideScope® laryngoscope. Experienced anaesthetists performed Macintosh and GlideScope intubations on the Laerdal® Airway Management Trainer manikin. Compared to Macintosh intubations, the GlideScope intubations had equal or superior views of the glottis with 55%, 58% and 66% lower median peak, average and impulse forces applied to the tongue base. The distal sensor registered the most force in both devices and the force distribution pattern was similar between the devices. The findings suggest that the GlideScope requires less force for similar or better laryngoscopic views, at least in a manikin model.