Abstract WP412: Low Concordance Rates of Dysphagia Screening in Stroke Patients Evaluated by Neuroscience Nurses and Speech-Language Pathologists

Background: While there is recognition about the importance of dysphagia screens in stroke patients, there is limited data on the concordance rates of dysphagia screens performed by neuroscience-trained nurses and speech language pathologist (SLPs). Hypothesis: Neuroscience nurses and SLPs will have high concordance rates when assessing stroke patients with dysphagia screens. Methods: From March 1, 2016 through May 31, 2016 a random sample of stroke patients underwent a dysphagia screening by neuroscience nurses and subsequently by SLPs within 24 hours using the same tool, a 2-part screen assessing for contraindications and using the 3-ounse water swallow test. Results of the dysphagia screens were retrospectively collected to identify concordance rates. Results: During the study period, 98% of stroke patients underwent dysphagia screening prior to oral intake. Of 50 stroke patients evaluated by neuroscience nurses and SLPs, only 26 patients (52%) demonstrated concordance with pass or fail results. Of 33 patients who were administered the water test and passed the dysphagia screen based on the neuroscience nursing assessment, 20 patients (61%) were determined by SLPs evaluation to have dysphagia and 11 (33%) of these patients had had overt aspiration. Conclusions: Current metrics on dysphagia screening do not identify the efficacy of dysphagia screening among stroke patients. Stroke centers who utilize bedside nurses to perform initial dysphagia screens should evaluate concordance rates with SLPs. A multidisciplinary team including Clinical Nurse Specialists, SLPs, and Nursing IT specialists have implemented measures (hospital wide re-education of nursing staff and optimizing the electronic dysphagia screening form) to improve concordance rates among nurses and SLPs. A post-intervention follow-up study of concordance rates among neurosciences and SLPs is underway.

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Sensorimotor vs. Motor Upper Limb Therapy for Patients With Motor and Somatosensory Deficits: A Randomized Controlled Trial in the Early Rehabilitation Phase After Stroke

Frontiers in Neurology ◽

10.3389/fneur.2020.597666 ◽

2020 ◽

Vol 11 ◽

Author(s):

Nele De Bruyn ◽

Leen Saenen ◽

Liselot Thijs ◽

Annick Van Gils ◽

Eva Ceulemans ◽

...

Keyword(s):

Upper Limb ◽

Controlled Trial ◽

Motor Impairment ◽

Early Rehabilitation ◽

Stroke Patients ◽

Post Intervention ◽

Clinical Trial Registration ◽

Additional Therapy ◽

Somatosensory Function

Background: Somatosensory function plays an important role in motor learning. More than half of the stroke patients have somatosensory impairments in the upper limb, which could hamper recovery.Question: Is sensorimotor upper limb (UL) therapy of more benefit for motor and somatosensory outcome than motor therapy?Design: Randomized assessor- blinded multicenter controlled trial with block randomization stratified for neglect, severity of motor impairment, and type of stroke.Participants: 40 first-ever stroke patients with UL sensorimotor impairments admitted to the rehabilitation center.Intervention: Both groups received 16 h of additional therapy over 4 weeks consisting of sensorimotor (N = 22) or motor (N = 18) UL therapy.Outcome measures: Action Research Arm test (ARAT) as primary outcome, and other motor and somatosensory measures were assessed at baseline, post-intervention and after 4 weeks follow-up.Results: No significant between-group differences were found for change scores in ARAT or any somatosensory measure between the three time points. For UL impairment (Fugl-Meyer assessment), a significant greater improvement was found for the motor group compared to the sensorimotor group from baseline to post-intervention [mean (SD) improvement 14.65 (2.19) vs. 5.99 (2.06); p = 0.01] and from baseline to follow-up [17.38 (2.37) vs. 6.75 (2.29); p = 0.003].Conclusion: UL motor therapy may improve motor impairment more than UL sensorimotor therapy in patients with sensorimotor impairments in the early rehabilitation phase post stroke. For these patients, integrated sensorimotor therapy may not improve somatosensory function and may be less effective for motor recovery.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03236376.

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Standard early rehabilitation and lower limb transcutaneous nerve or neuromuscular electrical stimulation in acute stroke patients: a randomized controlled pilot study

Clinical Rehabilitation ◽

10.1177/0269215519841420 ◽

2019 ◽

Vol 33 (8) ◽

pp. 1344-1354 ◽

Cited By ~ 1

Author(s):

Hsiao-Ching Yen ◽

Wen-Shiang Chen ◽

Jiann-Shing Jeng ◽

Jer-Junn Luh ◽

Ya-Yun Lee ◽

...

Keyword(s):

Electrical Stimulation ◽

Acute Stroke ◽

Nerve Stimulation ◽

Neuromuscular Electrical Stimulation ◽

Early Rehabilitation ◽

Stroke Patients ◽

Post Intervention ◽

Transcutaneous Nerve Stimulation ◽

Stroke Center

Objective:We investigated adding lower limb transcutaneous nerve stimulation or neuromuscular electrical stimulation to standard early rehabilitation in acute stroke patients.Design:An assessor-blinded, randomized controlled pilot study.Setting:A medical stroke center.Subjects:First-stroke patients aged 20–80 years admitted to the stroke center within 24 hours post stroke.Interventions:A total of 42 participants were randomly assigned to groups: transcutaneous nerve stimulation + standard early rehabilitation, neuromuscular electrical stimulation + standard early rehabilitation, or standard early rehabilitation-only. Transcutaneous nerve or neuromuscular electrical stimulation was delivered to the affected tibialis anterior and quadriceps muscles for 30 minutes a day, five days per week for two weeks.Main measures:The Postural Assessment Scale for Stroke Patients, the Functional Independence Measure, and three mobility milestones, namely, sitting for >five minutes, standing for >one minute, and walking ⩾50 m, were evaluated, respectively, at baseline, at the two-week post-intervention, and at two-week follow-up.Results:Significant differences existed in the Postural Assessment Scale for Stroke Patients scores between the transcutaneous nerve stimulation and standard early rehabilitation-only groups measured at two-weeks post-intervention (mean (SD) = 31.38 (5.39) and 18.00 (8.65), respectively) and at the two-week follow-up (34.08 (2.69) and 26.14 (7.77), respectively). A higher proportion of participants could walk ⩾50 m independently in the transcutaneous nerve stimulation group than in the standard early rehabilitation-only group at the two-week post-intervention ( P = 0.013) and two-week follow-up ( P = 0.01) marks.Conclusion:Two weeks of transcutaneous nerve stimulation added to standard early rehabilitation improved postural stability and walking in acute stroke patients.

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Effect of Respiratory Muscle Training on Dysphagia in Stroke Patients - A Retrospective Pilot Study

10.1101/2020.02.08.20021303 ◽

2020 ◽

Author(s):

Robert J. Arnold ◽

Nina Bausek

Keyword(s):

Respiratory Muscle ◽

Intervention Group ◽

Oral Intake ◽

Respiratory Muscle Training ◽

Control Group ◽

Muscle Training ◽

Stroke Patients ◽

Post Intervention ◽

Swallowing Function ◽

Expiratory Muscle

AbstractBackgroundDysphagia is prevalent with cerebrovascular accidents and contributes to the burden of disease and mortality. Strengthening of the dysfunctional swallow muscles through respiratory muscle training (RMT) has proven effective in improving swallow effectiveness and safety. However, approaches to strengthen only the expiratory muscle groups (EMST) dominate the clinical study literature, with variable outcomes. This study investigated the effect of a simultaneous inspiratory and expiratory muscle strengthening strategy to improve swallowing function in stroke patients.MethodsTwenty post-stroke patients were randomly assigned to either intervention group (IG) or control group (CG). The intervention group was treated with three 5-minute sessions of resistive respiratory muscle training every day for 28 days, while the control group received no RMT. Respiratory and swallow outcomes were assessed pre- and post-intervention and included Mann Assessment of Swallowing Ability (MASA), Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with Penetration/Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), patient visual analogue scale (VAS), and peak expiratory flow (PEF).ResultsAfter 28 days, the intervention group demonstrated greater improvements (pVal < 0.05) in PEF (IG: 168.03% vs CG: 17.47%), VAS (IG: 103.85% vs CG: 27.54%), MASA (IG: 37.28% vs CG: 6.92%), PAS (IG: 69.84% vs CG: 12.12%), and FOIS (IG: 93.75% vs CG: 21.21%).ConclusionCombined resistive inspiratory and expiratory muscle training is a feasible and effective method to improve signs and symptoms of dysphagia in stroke patients.

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Association between multimodality measures of aortic stenosis severity and quality-of-life improvement outcomes after transcatheter aortic valve replacement

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcab017 ◽

2021 ◽

Author(s):

Michael A Catalano ◽

Shahryar G Saba ◽

Bruce Rutkin ◽

Greg Maurer ◽

Jacinda Berg ◽

...

Keyword(s):

Quality Of Life ◽

Computed Tomography ◽

Aortic Valve ◽

Transcatheter Aortic Valve Replacement ◽

Multivariable Analysis ◽

Calcium Score ◽

Post Intervention ◽

Transcatheter Aortic Valve

Abstract Aims Up to 40% of patients with aortic stenosis (AS) present with discordant grading of AS severity based on common transthoracic echocardiography (TTE) measures. Our aim was to evaluate the utility of TTE and multi-detector computed tomography (MDCT) measures in predicting symptomatic improvement in patients with AS undergoing transcatheter aortic valve replacement (TAVR). Methods and results A retrospective review of 201 TAVR patients from January 2017 to November 2018 was performed. Pre- and post-intervention quality-of-life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Pre-intervention measures including dimensionless index (DI), stroke volume index (SVI), mean transaortic gradient, peak transaortic velocity, indexed aortic valve area (AVA), aortic valve calcium score, and AVA based on hybrid MDCT-Doppler calculations were obtained and correlated with change in KCCQ-12 at 30-day follow-up. Among the 201 patients studied, median KCCQ-12 improved from 54.2 pre-intervention to 85.9 post-intervention. In multivariable analysis, patients with a mean gradient >40 mmHg experienced significantly greater improvement in KCCQ-12 at follow-up than those with mean gradient ≤40 mmHg (28.1 vs. 16.4, P = 0.015). Patients with MDCT-Doppler-calculated AVA of ≤1.2 cm2 had greater improvements in KCCQ-12 scores than those with computed tomography-measured AVA of >1.2 cm2 (23.4 vs. 14.1, P = 0.049) on univariate but not multivariable analysis. No association was detected between DI, SVI, peak velocity, calcium score, or AVA index and change in KCCQ-12. Conclusion Mean transaortic gradient is predictive of improvement in quality-of-life after TAVR. This measure of AS severity may warrant greater relative consideration when selecting the appropriateness of patients for TAVR.

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Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

Palliative & Supportive Care ◽

10.1017/s1478951521000626 ◽

2021 ◽

pp. 1-11

Author(s):

Wendy G. Lichtenthal ◽

Martin Viola ◽

Madeline Rogers ◽

Kailey E. Roberts ◽

Lindsay Lief ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Experiential Avoidance ◽

Decision Makers ◽

Post Intervention ◽

Prolonged Grief ◽

Surrogate Decision Makers ◽

Surrogate Decision ◽

Peritraumatic Distress

Abstract Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

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986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1172 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S521-S522

Author(s):

Jennifer R Silva-Nash ◽

Stacie Bordelon ◽

Ryan K Dare ◽

Sherrie Searcy

Keyword(s):

Emergency Department ◽

Sexual Assault ◽

Hiv Transmission ◽

Post Exposure Prophylaxis ◽

Intervention Period ◽

Post Intervention ◽

Post Exposure ◽

Assault Victims ◽

Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

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Efficacy of Manual Therapy and Transcutaneous Electrical Nerve Stimulation in Cervical Mobility and Endurance in Subacute and Chronic Neck Pain: A Randomized Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm10153245 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3245

Author(s):

Belén Díaz-Pulido ◽

Yolanda Pérez-Martín ◽

Daniel Pecos-Martín ◽

Isabel Rodríguez-Costa ◽

Milagros Pérez-Muñoz ◽

...

Keyword(s):

Primary Care ◽

Neck Pain ◽

Manual Therapy ◽

Nerve Stimulation ◽

Transcutaneous Electrical Nerve Stimulation ◽

Sagittal Plane ◽

Chronic Neck Pain ◽

Post Intervention ◽

Electrical Nerve Stimulation

Neck pain is a frequent health problem. Manual therapy (MT) and transcutaneous electrical nerve stimulation (TENS) are recommended techniques for treatment of mechanical neck disorders (MND) in Spanish Public Primary Care Physiotherapy Services. The aim of this study was to compare the efficacy of MT versus TENS in active mobility and endurance in cervical subacute or chronic neck pain. Ninety patients with MND were randomly allocated to receive ten 30-min sessions of either MT or TENS, in a multi-centered study through 12 Primary Care Physiotherapy Units in the Madrid community. Active cervical range of motion (CD-ROM) and endurance (Palmer and Epler test) were evaluated pre- and post-intervention and at 6-month follow-up. A generalized linear model of repeated measures was constructed for the analysis of differences. Post-intervention MT yielded a significant improvement in active mobility and endurance in patients with subacute or chronic MND, and at 6-month follow-up the differences were only significant in endurance and in sagittal plane active mobility. In the TENS group, no significant improvement was detected. With regard to other variables, MT improved mobility and endurance more effectively than TENS at post-intervention and at 6-month follow-up in the sagittal plane. Only MT generated significant improvements in cervical mobility and endurance in the three movement planes.

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Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01795-6 ◽

2021 ◽

Author(s):

Bente Storm Mowatt Haugland ◽

Mari Hysing ◽

Asle Hoffart ◽

Åshild Tellefsen Haaland ◽

Jon Fauskanger Bjaastad ◽

...

Keyword(s):

Early Intervention ◽

Standard Length ◽

Sleep Problems ◽

Sleep Onset ◽

Cognitive Behavioral ◽

Control Group ◽

Sleep Onset Latency ◽

Post Intervention ◽

Clinical Trial Registration

AbstractThe potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p < 0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251, Date: 11.31. 2014

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Changes in the Semantic Construction of Compassion after the Cognitively-Based Compassion Training (CBCT®) in Women Breast Cancer Survivors

The Spanish Journal of Psychology ◽

10.1017/sjp.2021.31 ◽

2021 ◽

Vol 24 ◽

Author(s):

Edgar González-Hernández ◽

Daniel Campos ◽

Rebeca Diego-Pedro ◽

Rocío Romero ◽

Rosa Baños ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Semantic Differential ◽

Post Intervention ◽

Treatment As Usual ◽

Spanish Speaking ◽

Specific Culture ◽

Differential Categories

Abstract The growing body of research on compassion has demonstrated its benefits for healthcare and wellbeing. However, there is no clear agreement about a definition for compassion, given the novelty of the research on this construct and its religious roots. The aim of this study is to analyze the mental semantic construction of compassion in Spanish-speaking women breast cancer survivors, and the effects of the Cognitively-Based Compassion Training (CBCT®) on the modification of this definition, compared to treatment-as-usual (TAU), at baseline, post-intervention, and six-month follow-up. Participants were 56 women breast cancer survivors from a randomized clinical trial. The Osgood’s Semantic Differential categories (evaluative, potency, and activity scales) were adapted to assess the semantic construction of compassion. At baseline, participants had an undefined idea about compassion. The CBCT influenced subjects’ semantic construction of what it means to be compassionate. Findings could lead to future investigations and compassion programs that adapt to a specific culture or population.

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A Short Mindfulness Retreat for Students to Reduce Stress and Promote Self-Compassion: Pilot Randomised Controlled Trial Exploring Both an Indoor and a Natural Outdoor Retreat Setting

Healthcare ◽

10.3390/healthcare9070910 ◽

2021 ◽

Vol 9 (7) ◽

pp. 910

Author(s):

Dorthe Djernis ◽

Mia S. O’Toole ◽

Lone O. Fjorback ◽

Helle Svenningsen ◽

Mimi Y. Mehlsen ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Effect Sizes ◽

Medium Effect ◽

Control Group ◽

Post Intervention ◽

Pilot Randomised Controlled Trial ◽

Self Compassion ◽

Randomised Controlled

Here, we developed and examined a new way of disseminating mindfulness in nature to people without meditation experience, based on the finding that mindfulness conducted in natural settings may have added benefits. We evaluated a 5-day residential programme aiming to reduce stress and improve mental health outcomes. We compared an indoor and an outdoor version of the programme to a control group in a pilot randomised controlled trial (RCT). Sixty Danish university students experiencing moderate to high levels of stress were randomised into a residential mindfulness programme indoors (n = 20), in nature (n = 22), or a control group (n = 18). Participants completed the Perceived Stress Scale and the Self-Compassion Scale (primary outcomes) along with additional secondary outcome measures at the start and end of the program and 3 months after. Stress was decreased with small to medium effect sizes post-intervention, although not statistically significant. Self-compassion increased post-intervention, but effect sizes were small and not significant. At follow-up, changes in stress were not significant, however self-compassion increased for both interventions with medium-sized effects. For the intervention groups, medium- to large-sized positive effects on trait mindfulness after a behavioural task were found post-intervention, and small- to medium-sized effects in self-reported mindfulness were seen at follow-up. Connectedness to Nature was the only outcome measure with an incremental effect in nature, exceeding the control with a medium-sized effect at follow-up. All participants in the nature arm completed the intervention, and so did 97% of the participants in all three arms. Overall, the results encourage the conduct of a larger-scale RCT, but only after adjusting some elements of the programme to better fit and take advantage of the potential benefits of the natural environment.

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