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Case Reports in Neurological Medicine 2024Focal muscle vibration (FMV) is increasingly being recognized as a rehabilitative therapy for enhancing motor function in central nervous system (CNS) diseases,...
Focal muscle vibration (FMV) is increasingly being recognized as a rehabilitative therapy for enhancing motor function in central nervous system (CNS) diseases, particularly in patients with fine motor control deficits stemming from CNS damage. Brain lesions from these diseases disrupt the motor networks, necessitating novel rehabilitation strategies. By applying vibrations to muscles, FMV stimulates sensory fibers to induce cortical activity and kinesthetic illusions. While initial studies have highlighted FMV's role in reducing spasticity, recent evidence points to its potential in treating motor paralysis. However, prior research has been limited by the lack of acute-phase studies and a focus on patients with minimal muscle contraction capability. This report aimed to explore FMV's efficacy on upper limb motor function in patients with flaccid motor paralysis immediately after acute CNS diseases. We report the case of a septuagenarian male with a brain abscess in the right parietal lobe, leading to flaccid motor paralysis. Rehabilitation included 28 sessions of occupational and physical therapy that incorporated FMV. Significant improvements were observed in upper extremity function, with moderate to very large effect sizes, while lower limb function showed lesser improvement without adverse effects. This case suggests the utility of FMV in enhancing upper-limb motor function after acute CNS injuries, potentially serving as a supplementary therapy for spontaneous recovery. This report contributes to emerging evidence on FMV's benefits in acute flaccid motor paralysis, expanding the documented therapeutic scope.
PubMed: 38957779
DOI: 10.1155/2024/2469074 -
Frontiers in Aging Neuroscience 2024Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Program (GAP) with Hispanic/Latino individuals living with memory challenges and...
PURPOSE
Utilizing a participatory approach, we sought to co-design a 12-week Green Activity Program (GAP) with Hispanic/Latino individuals living with memory challenges and their care partners, local outdoor professionals, and healthcare providers.
METHODS
Participants were recruited via convenience and snowball sampling in the Bronx, New York with Hispanic/Latino persons living with memory challenges and care partners, outdoor activity professionals, and interdisciplinary healthcare providers/dementia experts. Co-design occurred iteratively with 5 focus groups and 4 individual interviews lasting 30-90 min and focused on program and research design. Sessions were recorded and transcribed. Utilizing directed content analysis data was coded using a priori codes program design and research design.
RESULTS
21 participants completed co-design activities: ( = 8 outdoor activity professionals, = 6 Hispanic/Latino persons living with memory challenges and care partners, and = 7 interdisciplinary healthcare providers/dementia experts). Participant preferences for program design were captured by subcodes (30-90 min), (4-8 sessions), and (in-person and phone). Participants' preferred nature activities included group exercise and outdoor crafts [crocheting], outcomes of social participation, connectedness to nature, decreased loneliness, and stewardship were identified. Preferred language for recruiting and describing the program were "memory challenges," "Hispanic/Latino," and "wellbeing." were identified including community-based organizations and primary care.
CONCLUSION
Co-design was a successful form of engagement for people living with memory challenges that enabled participants to help design key elements of the GAP and research design. Our processes, findings, and recommendations for tailoring co-design to engage Hispanic/Latino people living with memory challenges can inform the development of other programs for this population.
PubMed: 38957542
DOI: 10.3389/fnagi.2024.1401255 -
MedEdPORTAL : the Journal of Teaching... 2024The influence of implicit biases in virtual interviews must be addressed to ensure equity within the admissions process. ABATE is a mnemonic framework of five specific...
INTRODUCTION
The influence of implicit biases in virtual interviews must be addressed to ensure equity within the admissions process. ABATE is a mnemonic framework of five specific categories of implicit bias (affinity-based, backdrop-based, appearance-based, technology and media-based, and enunciation-based biases) that should be anticipated and mitigated for faculty, staff, health professionals, and medical students who conduct virtual interviews at medical schools.
METHODS
A 60-minute workshop was developed to educate medical school admissions interviewers about the ABATE model and strategies to mitigate implicit bias during virtual interviews. Four workshops were held over 1 year totaling 217 individual attendees. The workshops were evaluated using a single-group, pre-post questionnaire designed with the Kirkpatrick evaluation model.
RESULTS
Attendees reported that they found the ABATE workshop useful and relevant to improving their ability to minimize implicit bias during virtual interviews. Significant improvements were found in attendee reactions to the utility of implicit bias training ( pre = 2.6, post = 3.1, = .002). Significant changes were also reported in attendees' attitudes about interviewing confidence ( pre = 3.0, post = 3.2, = .04), bias awareness ( pre = 3.0, post = 3.4, = .002), and identifying and applying bias mitigation solutions ( pre = 2.5, post = 3.0, = .003). Knowledge specific to backdrop-based biases also significantly increased ( pre = 3.2, post = 3.4, = .04).
DISCUSSION
The ABATE workshop demonstrates promise in mitigating implicit bias in virtual medical school interviews.
Topics: Humans; Schools, Medical; Interviews as Topic; Surveys and Questionnaires; School Admission Criteria; Students, Medical; Bias; Education; Male; Female
PubMed: 38957531
DOI: 10.15766/mep_2374-8265.11416 -
Cureus Jul 2024Chronic pain is a complex condition that often poses diagnostic and management challenges due to its multifactorial etiology. This case report describes a 49-year-old...
A Novel Ultrasound-Guided Bilateral Vagal Nerve Hydrodissection With 5% Dextrose Without Local Anesthetic for Recalcitrant Chronic Multisite Pain and Autonomic Dysfunction.
Chronic pain is a complex condition that often poses diagnostic and management challenges due to its multifactorial etiology. This case report describes a 49-year-old pastor who presented with a three-year history of chronic pain affecting multiple sites, including the neck, bilateral shoulders, thoracic region, lower back, and bilateral knees. Additionally, he experienced shortness of breath on mild exertion, which adversely affected his ability to converse and speak publicly. The patient had a rapid resting heart rate of 100-120 beats per minute, occasional palpitations, and a 24-hour electrocardiogram that confirmed 15% premature ventricular complexes with bigeminy and trigeminy. He complained of limited appetite with early satiety, intermittent nausea, and regurgitation. Despite consultations with multiple specialists, no underlying causes were identified in the cardiac, respiratory, gastrointestinal, or psychological domains. Ultrasound-guided bilateral vagus nerve hydrodissection using 5% dextrose without local anesthetics was administered three times at monthly intervals, resulting in remarkable pain relief within three months and the effects persisted at the nine-month follow-up. Tachycardia was no longer perceived, resting heart rate slowed to 70-80 beats per minute, shortness of breath improved, and public speaking ability was restored. The patient's early satiety, nausea, and reflux complaints were resolved. This case report highlights the potential effectiveness of this novel intervention for chronic pain. Further research is warranted to validate these findings and explore the mechanism of action.
PubMed: 38957517
DOI: 10.7759/cureus.63609 -
ATS Scholar Jun 2024A lack of high-quality provider education hinders the delivery of standard-of-care delirium detection and prevention practices in the intensive care unit (ICU). To fill...
BACKGROUND
A lack of high-quality provider education hinders the delivery of standard-of-care delirium detection and prevention practices in the intensive care unit (ICU). To fill this gap, we developed and validated an e-learning ICU Delirium Playbook consisting of eight videos and a 44-question knowledge assessment quiz. Given the increasing Spanish-speaking population worldwide, we translated and cross-culturally adapted the playbook from English into Spanish.
OBJECTIVE
To translate and culturally adapt the ICU Delirium Playbook into Spanish, the second most common native language worldwide.
METHODS
The translation and cross-cultural adaptation process included double forward and back translations and harmonization by a 14-person interdisciplinary team of ICU nurses and physicians, delirium experts, methodologists, medical interpreters, and bilingual professionals representing many Spanish-speaking global regions. After a preeducation quiz, a nurse focus group completed the playbook videos and posteducation quiz, followed by a semistructured interview.
RESULTS
The ICU Delirium Playbook: Spanish Version maintained conceptual equivalence to the English version. Focus group participants posted mean (standard deviation) pre- and post-playbook scores of 63% (10%) and 78% (12%), with a 15% (11%) pre-post improvement ( = 0.01). Participants reported improved perceived competency in performing the Confusion Assessment Method for the ICU and provided positive feedback regarding the playbook.
CONCLUSION
After translation and cultural adaptation, the ICU Delirium Playbook: Spanish Version yielded significant knowledge assessment improvements and positive feedback. The Spanish playbook is now available for public dissemination.
PubMed: 38957494
DOI: 10.34197/ats-scholar.2023-0114OC -
Journal of Rehabilitation Medicine.... 2024To assess pain outcomes, stress levels and body awareness among patients with chronic pain and explore potential associations between these variables.
OBJECTIVE
To assess pain outcomes, stress levels and body awareness among patients with chronic pain and explore potential associations between these variables.
DESIGN
An explorative study.
METHODS
Patients with chronic pain in primary and specialist care were assessed regarding pain intensity using the Numerical Rating Scale (NRS; 0-10 point scale) and stress levels using the Stress and Crisis Inventory (SCI-93; 0-140). To assess body awareness, multidimensional assessment of interoceptive awareness (MAIA; 0-5), a widely used self-report measure of interoceptive bodily awareness was used.
RESULTS
Participants ( = 42) reported an average NRS of 4.4, elevated stress levels and low body awareness. Stress levels were moderately correlated with pain intensity ( = 0.53; < 0.001; 95% confidence interval [CI] 0.25-0.72) and number of pain sites ( = 0.58; < 0.001; 95% CI 0.32-0.76). The regression analysis showed that pain outcomes predicted stress level scores and explained almost 50% of variance ( = 0.47, < 0.001). Moreover, shorter pain duration predicted a higher body awareness ( = 0.04).
CONCLUSION
In patients with chronic pain, high pain intensity and multiple painful sites seem to be associated with impaired stress regulation. The patients had low body awareness, which was negatively influenced by pain duration.
PubMed: 38957475
DOI: 10.2340/jrmcc.v7.13374 -
Frontiers in Endocrinology 2024Diabetic gastroparesis is a common complication in patient with diabetes. Dietary intervention has been widely used in the treatment of diabetic gastroparesis. The aim... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Diabetic gastroparesis is a common complication in patient with diabetes. Dietary intervention has been widely used in the treatment of diabetic gastroparesis. The aim of this study is to evaluate the role of diet in the treatment of diabetic gastroparesis.
METHODS
This systematic review was conducted a comprehensive search of randomized controlled trials using dietary interventions for the treatment of diabetic gastroparesis up to 9 November 2023. The primary outcomes were gastric emptying time and clinical effect, while fasting blood glucose, 2-hour postprandial blood glucose and glycosylated hemoglobin were secondary outcomes. Data analysis was performed using RevMan 5.4 software, and publication bias test was performed using Stata 15.1 software.
RESULTS
A total of 15 randomized controlled trials involving 1106 participants were included in this review. The results showed that patients with diabetic gastroparesis benefit from dietary interventions (whether personalized dietary care alone or personalized dietary care+routine dietary care). Compared with routine dietary care, personalized dietary care and personalized dietary care+routine dietary care can shorten the gastric emptying time, improve clinical efficacy, and reduce the level of fasting blood glucose, 2-hour postprandial blood glucose and glycosylated hemoglobin.
CONCLUSIONS
Limited evidence suggests that dietary intervention can promote gastric emptying and stabilize blood glucose control in patients with diabetic gastroparesis. Dietary intervention has unique potential in the treatment of diabetic gastroparesis, and more high-quality randomized controlled trials are needed to further validate our research results.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42023481621.
Topics: Humans; Gastroparesis; Gastric Emptying; Blood Glucose; Diabetes Complications; Randomized Controlled Trials as Topic; Treatment Outcome; Diabetes Mellitus
PubMed: 38957444
DOI: 10.3389/fendo.2024.1379398 -
Frontiers in Neurology 2024Post-stroke depression (PSD) is a frequent complication following a stroke, characterized by prolonged feelings of sadness and loss of interest, which can significantly...
BACKGROUND
Post-stroke depression (PSD) is a frequent complication following a stroke, characterized by prolonged feelings of sadness and loss of interest, which can significantly impede stroke rehabilitation, increase disability, and raise mortality rates. Traditional antidepressants often have significant side effects and poor patient adherence, necessitating the exploration of more suitable treatments for PSD. Previous researchers and our research team have discovered that Botulinum Toxin A (BoNT-A) exhibits antidepressant effects. Therefore, our objective was to assess the efficacy and side effects of BoNT-A treatment in patients with PSD.
METHODS
A total of 71 stroke patients meeting the inclusion criteria were allocated to the two group. 2 cases were excluded due to severe neurological dysfunction that prevented cooperation and 4 cases were lost follow-up. Ultimately, number of participants in the BoNT-A group ( = 32) and Sertraline group ( = 33). Treatment efficacy was evaluated 1, 2, 4, 8 and 12 weeks post-treatment.
RESULTS
There were no significant differences in baseline characteristics between the two groups ( > 0.05). Both groups exhibited comparable treatment efficacy, with fewer side effects observed in the BoNT-A group compared to the Sertraline group. BoNT-A therapy demonstrated significant effects as early as the first week ( < 0.05), and by the 12th week, there was a notable decrease in neuropsychological scores, significantly lower than the baseline level. The analysis revealed significant differences in measurements of the Hamilton Depression Scale (HAMD) ((770) = 12.547, = 0.000), Hamilton Anxiety Scale (HAMA) ((951) = 10.422, = 0.000), Self-Rating Depression Scale (SDS) ((1385) = 10.607, = 0.000), and Self-Rating Anxiety Scale (SAS) ((1482) = 11.491, = 0.000).
CONCLUSION
BoNT-A treatment effectively reduces depression symptoms in patients with PSD on a continuous basis.
PubMed: 38957350
DOI: 10.3389/fneur.2024.1372547 -
Frontiers in Neurology 2024Spasticity is the most common motor disorder in cerebral palsy (CP), and its management is complex, posing a significant challenge for the rehabilitation team. Radial...
BACKGROUND
Spasticity is the most common motor disorder in cerebral palsy (CP), and its management is complex, posing a significant challenge for the rehabilitation team. Radial extracorporeal shock wave therapy (rESWT) has emerged in recent years as an effective, non-invasive, and low-risk alternative for the management of spasticity in CP patients, with only minor side effects such as small bruises or discomfort during application. There is great variability in rESWT administration protocols, ranging from a single session up to the 12 sessions. The most extensively studied protocol involves 3 rESWT sessions with a one-week interval between session. According to current literature, the effect of rESWT has not been investigated by extending the time interval between sessions beyond 1 week to determine if therapeutic effects on spasticity can be prolonged over time.
METHODS
Following a power calculation using the minimal clinical important difference of our primary outcome (R2 of Modified Tardieu Scale), 72 patients will be included in the study. Enrolment is based upon inclusion/exclusion criteria outlined in the Methods section. Participants will be randomized in 3 groups. Each patient will receive 2000 impulses in the Triceps Sural muscle (distributed by all the plantar flexor muscles: soleus and gastrocnemius), at a 2.2 Bars pressure and a frequency of 8 Hz. The Control Group will receive 3 rESWT sessions with a time interval of 1 week between each session. The Experimental Group A will receive 3 rESTW sessions with a time interval of 2 weeks between each session and the Experimental Group B will receive 3 rESTW sessions with a time interval of 4 weeks between each session.
DISCUSSION
This study will provide further information regarding the effect of rESWT on spasticity in patients with CP. If an increase in the time interval between rESWT sessions allows for the prolongation of therapeutic benefits on spasticity, it will be clinically relevant fact. With the same treatment dosage, patients will be able to benefit from its effects for a longer period of time.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, identifier NCT05702606.
PubMed: 38957349
DOI: 10.3389/fneur.2024.1402452 -
The Journal of Advanced Prosthodontics Jun 2024The purpose of this diagnostic study was to assess the accuracy and time efficiency of a digital method to draw the denture foundation extension outline on preliminary...
PURPOSE
The purpose of this diagnostic study was to assess the accuracy and time efficiency of a digital method to draw the denture foundation extension outline on preliminary casts compared with the conventional technique.
MATERIALS AND METHODS
A total of 28 preliminary edentulous casts with no anatomical landmarks were digitized using a laboratory scanner. The outlining of the entire basal seat of the denture was performed on preliminary casts and digitized. Casts with no extension outline were digitized and outlines were drawn using software (DWOS, Straumann). The accuracy of the extension outlined between both techniques was evaluated in the software (GOM Inspect; GOM GmbH) by file superimposition. Specificity and sensitivity tests were applied to measure accuracy. The paired t-test (95% CI) was used to compare the mean total area and the working time.
RESULTS
The accuracy ranged from 0.57 to 0.92. The buccal and labial frenulum showed a lower value in the maxilla (0.57); while the area between the retromolar pad and buccal frenulum (0.64) showed a lower score in the mandible. The maxillary denture foundation and the working time for both arches were significantly longer for the digital method ( < .001).
CONCLUSION
The denture foundation extension outline exhibited a sufficiently excellent accuracy for the digital method, except for the maxillary anterior region. However, the digital method required a longer working time.
PubMed: 38957291
DOI: 10.4047/jap.2024.16.3.139