scholarly journals The Monitoring Efficacy of Neurogenic Bowel Dysfunction Treatment on Response (MENTOR) in a Non-Hospital Setting

2021 ◽  
Vol 10 (2) ◽  
pp. 263
Author(s):  
Sofie Dagmar Studsgaard Slot ◽  
Simon Mark Dahl Baunwall ◽  
Anton Emmanuel ◽  
Peter Christensen ◽  
Klaus Krogh
Keyword(s):  
Clinical Decision Making ◽  
Unmet Need ◽  
Hospital Setting ◽  
Clinical Decision ◽  
Bowel Dysfunction ◽  
Social Activities ◽  
Ability To Work ◽  
Treatment Algorithms ◽  
Cord Injury ◽  
Neurogenic Bowel

Background: Most patients with a spinal cord injury (SCI) suffer from neurogenic bowel dysfunction (NBD). In spite of well-established treatment algorithms, NBD is often insufficiently managed. The Monitoring Efficacy of Neurogenic bowel dysfunction Treatment On Response (MENTOR) has been validated in a hospital setting as a tool to support clinical decision making in individual patients. The objective of the present study was to describe clinical decisions recommended by the MENTOR (either “monitor”, “discuss” or “act”) and the use of the tool to monitor NBD in a non-hospital setting. Methods: A questionnaire describing background data, the MENTOR, ability to work and participation in various social activities was sent by mail to all members of The Danish Paraplegic Association. Results: Among 1316 members, 716 (54%) responded, 429 men (61%) and 278 women (39%), aged 18 to 92 (median 61) years. Based on MENTOR, the recommended clinical decision is to monitor treatment of NBD in 281 (44%), discuss change in treatment in 175 (27%) and act/change treatment in 181 (28%). A recommendation to discuss or change treatment was associated with increasing age of the respondent (p = 0.016) and with impaired ability to work or participate in social activities (p < 0.0001). Conclusion: A surprisingly high proportion of persons with SCI have an unmet need for improved bowel care. The MENTOR holds promise as a tool for evaluation of treatment of NBD in a non-hospital setting.

scholarly journals A day in the life: a qualitative study of clinical decision-making and uptake of neurorehabilitation technology

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Courtney Celian ◽  
Veronica Swanson ◽  
Maahi Shah ◽  
Caitlin Newman ◽  
Bridget Fowler-King ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Decision ◽  
Relative Advantage ◽  
Personal Attributes ◽  
Design Work ◽  
Cognitive Limitations ◽  
Knowledge And Beliefs ◽  
Cord Injury

Abstract Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Our aim is to improve understanding of rehabilitation therapists’ real-time decision-making processes on the use of rehabilitation technology (RT) in clinical treatment. Methods We used a phenomenological qualitative approach, in which three OTs and two PTs employed at a major, technology-encouraging rehabilitation hospital wrote vignettes from a written prompt describing their RT use decisions during treatment sessions with nine patients (4 with stroke, 2 traumatic brain injury, 1 spinal cord injury, 1 with multiple sclerosis). We then coded the vignettes using deductive qualitative analysis from 17 constructs derived from the RT literature and the Consolidated Framework for Implementation Research (CFIR). Data were synthesized using summative content analysis. Results Of the constructs recorded, the five most prominent are from CFIR determinants of: (i) relative advantage, (ii) personal attributes of the patients, (iii) clinician knowledge and beliefs of the device/intervention, (iv) complexity of the devices including time and setup, and (v) organizational readiness to implement. Therapists characterized candidate RT as having a relative disadvantage compared to conventional treatment due to lack of relevance to functional training. RT design also often failed to consider the multi-faceted personal attributes of the patients, including diagnoses, goals, and physical and cognitive limitations. Clinicians’ comfort with RT was increased by their previous training but was decreased by the perceived complexity of RT. Finally, therapists have limited time to gather, setup, and use RT. Conclusions Despite decades of design work aimed at creating clinically useful RT, many lack compatibility with clinical translation needs in inpatient neurologic rehabilitation. New RT continue to impede the immediacy, versatility, and functionality of hands-on therapy mediated treatment with simple everyday objects.

scholarly journals Efficacy of functional magnetic stimulation in neurogenic bowel dysfunction after spinal cord injury

2009 ◽  
Vol 41 (1) ◽  
pp. 41-47 ◽  
Author(s):  
PY Tsai ◽  
CP Wang ◽  
FY Chiu ◽  
YA Tsai ◽  
YC Chang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Magnetic Stimulation ◽  
Bowel Dysfunction ◽  
Cord Injury ◽  
Neurogenic Bowel

scholarly journals Decoding Clinical Biomarker Space of COVID-19: Exploring Matrix Factorization-based Feature Selection Methods

2021 ◽  
Author(s):  
Farshad Saberi-Movahed ◽  
Mahyar Mohammadifard ◽  
Adel Mehrpooya ◽  
Mohammad Rezaei-Ravari ◽  
Kamal Berahmand ◽  
...  
Keyword(s):  
Feature Selection ◽  
Poor Prognosis ◽  
Clinical Decision Making ◽  
Unmet Need ◽  
Clinical Decision ◽  
Clinical Indicators ◽  
Arterial Blood Gas ◽  
Clinical Biomarkers ◽  
Arterial Blood ◽  
Global Pandemic

One of the most critical challenges in managing complex diseases like COVID-19 is to establish an intelligent triage system that can optimize the clinical decision-making at the time of a global pandemic. The clinical presentation and patients' characteristics are usually utilized to identify those patients who need more critical care. However, the clinical evidence shows an unmet need to determine more accurate and optimal clinical biomarkers to triage patients under a condition like the COVID-19 crisis. Here we have presented a machine learning approach to find a group of clinical indicators from the blood tests of a set of COVID-19 patients that are predictive of poor prognosis and morbidity. Our approach consists of two interconnected schemes: Feature Selection and Prognosis Classification. The former is based on different Ma- trix Factorization (MF)-based methods, and the latter is performed using Random Forest algorithm. Our model reveals that Arterial Blood Gas (ABG) O2 Saturation and C-Reactive Protein (CRP) are the most important clinical biomarkers determining the poor prognosis in these patients. Our approach paves the path of building quantitative and optimized clinical management systems for COVID-19 and similar diseases.

scholarly journals Reliability, validity and sensitivity to change of neurogenic bowel dysfunction score in patients with spinal cord injury

Spinal Cord ◽  
2017 ◽  
Vol 55 (12) ◽  
pp. 1084-1087 ◽  
Author(s):  
D Erdem ◽  
D Hava ◽  
P Keskinoğlu ◽  
Ç Bircan ◽  
Ö Peker ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Bowel Dysfunction ◽  
Sensitivity To Change ◽  
Cord Injury ◽  
Neurogenic Bowel

scholarly journals An improved rapid sampling microdialysis system for human and porcine organ monitoring in a hospital setting

2018 ◽  
Vol 10 (44) ◽  
pp. 5273-5281 ◽  
Author(s):  
Sally A. N. Gowers ◽  
Karim Hamaoui ◽  
Natalie Vallant ◽  
George B. Hanna ◽  
Ara Darzi ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Hospital Setting ◽  
Clinical Decision ◽  
Critical Information ◽  
Rapid Sampling

Online organ monitoring can provide clinicians with critical information regarding organ health prior to transplantation and could aid clinical decision-making.

scholarly journals Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury

Spinal Cord ◽  
2010 ◽  
Vol 48 (7) ◽  
pp. 554-559 ◽  
Author(s):  
C-W Liu ◽  
C-C Huang ◽  
C-H Chen ◽  
Y-H Yang ◽  
T-W Chen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Bowel Dysfunction ◽  
Cord Injury ◽  
Neurogenic Bowel

scholarly journals Return to Play after Cervical Spine Injuries: A Consensus of Opinion

2016 ◽  
Vol 6 (8) ◽  
pp. 792-797 ◽  
Author(s):  
John C. France ◽  
Michael Karsy ◽  
James S. Harrop ◽  
Andrew T. Dailey
Keyword(s):  
Decision Making ◽  
Cervical Spine ◽  
Clinical Decision Making ◽  
Clinical Symptoms ◽  
Clinical Decision ◽  
Return To Play ◽  
Spine Injury ◽  
Cervical Cord ◽  
Clinical Scenarios ◽  
Cord Injury

Study Design Survey. Objective Sports-related spinal cord injury (SCI) represents a growing proportion of total SCIs but lacks evidence or guidelines to guide clinical decision-making on return to play (RTP). Our objective is to offer the treating physician a consensus analysis of expert opinion regarding RTP that can be incorporated with the unique factors of a case for clinical decision-making. Methods Ten common clinical scenarios involving neurapraxia and stenosis, atlantoaxial injury, subaxial injury, and general cervical spine injury were presented to 25 spine surgeons from level 1 trauma centers for whom spine trauma is a significant component of their practice. We evaluated responses to questions about patient RTP, level of contact, imaging required for a clinical decision, and time to return for each scenario. The chi-square test was used for statistical analysis, with p < 0.05 considered significant. Results Evaluation of the surgeons’ responses to these cases showed significant consensus regarding return to high-contact sports in cases of cervical cord neurapraxia without symptoms or stenosis, surgically repaired herniated disks, and nonoperatively healed C1 ring or C2 hangman's fractures. Greater variability was found in recommendations for patients showing persistent clinical symptomatology. Conclusion This survey suggests a consensus among surgeons for allowing patients with relatively normal imaging and resolution of symptoms to return to high-contact activities; however, patients with cervical stenosis or clinical symptoms continue to be a challenge for management. This survey may serve as a basis for future clinical trials and consensus guidelines.

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