IntroductionRegular physical activity (PA), especially aerobic exercise, may benefit cognitive fu... more IntroductionRegular physical activity (PA), especially aerobic exercise, may benefit cognitive function in middle‐aged and older adults, but promoting regular PA in individuals with traumatic brain injury (TBI) remains a challenge.ObjectiveTo characterize PA and perceived barriers to PA in younger (<45 years) and middle age and older (≥45 years) individuals ≥1 year after moderate‐to‐severe TBI.DesignMulticenter survey study.SettingCommunity.ParticipantsPersons who met the following criteria were included in the study: (1) 18 years and older; (2) English speaking; (3) History of moderate‐to‐severe TBI; (4) Followed in a TBI Model Systems Center for at least 1 year; and (5) Able to complete the survey independently.InterventionNot applicable.Main Outcome Measure(s)PA level measured by Rapid Assessment of Physical Activity questionnaire (RAPA) and self‐reported barriers to PA.ResultsA total of 472 participants completed the survey (response rate of 21%). More individuals in the younger group (<45 years old) met Centers for Disease Control and Prevention (CDC) recommended aerobic PA guidelines compared to the middle‐aged and older group (≥ 45 years old) (62% vs 36%, p < .001). Lack of motivation, lack of time, and fatigue were the most reported barriers. Perceived barriers to PA varied by age and PA level: the middle‐aged and older individuals (≥ 45 years old) were more likely to report no barriers and inactive individuals (RAPA ≤5) more likely to report lack of motivation and money, pain, and lack of resources.ConclusionParticipants ≥45 years of age were less likely to meet the CDC PA guidelines than younger individuals after moderate‐to‐severe TBI. Because perceived barriers to PA varied between age groups and PA levels, individualized approaches may be needed to promote PA in this population.
Changes in Gc‐globulin (Gc) and in alpha‐foetoprotein (AFP) have been shown to be related to outc... more Changes in Gc‐globulin (Gc) and in alpha‐foetoprotein (AFP) have been shown to be related to outcome in patients with acute liver failure (ALF). Gc is a serum protein that complexes with intravascular actin released during cellular necrosis. AFP, also made by hepatocytes, is associated with hepatocellular growth and regeneration. Previously, low absolute levels or decreases over time in either AFP or Gc portended to be a poor outcome.
Introduction: Emergency Departments utilizing telestroke technology are less likely to meet Ameri... more Introduction: Emergency Departments utilizing telestroke technology are less likely to meet American Heart Association/American Stroke Association’s recommended Door to Needle goal of less than 45 minutes. The Nursing Driven-Acute Stroke Care (NAS-Care) study tested effects of standardized stroke protocols on key workflow best practices. Methods: Seven non-academic stroke hospitals in the Lone Star Stroke Consortium’s network participated in this prospective, multi-site, baseline-controlled study from February 2015 - December 2018. After three months of blinded baseline data collection, the following interventions were implemented: NIHSS certification, nursing education including mock stroke codes, and a standardized flowsheet for code organization and documentation. The NAS-Care Run Sheet was also used to collect six months of post-intervention data. Results: Six hospitals completed the study. Study enrolment was halted after interim analysis of 447 patients, 180 in the pre-intervention control group and 267 in the post-intervention follow-up. The proportion of patients receiving alteplase was 18.9% (control) and 18.4% (intervention, NS). In the interim analysis, Door-to-ED Provider and Door-to-CT times were reduced after intervention while Door-to-Specialists and Door-to-Needle times were not significantly improved (table). Conclusion: Standardized nursing education and protocols improved staff-dependent initial stroke time metrics in Emergency Departments utilizing telestroke. Additional workflows for telestroke physicians may be required to optimize alteplase administration metrics. Final results of the NAS-Care study will be presented at the International Stroke Conference.
Objectives/HypothesisTo determine if (1) the likelihood of presenting with phonotraumatic lesions... more Objectives/HypothesisTo determine if (1) the likelihood of presenting with phonotraumatic lesions differs by singing genre in treatment‐seeking singers and (2) if the distribution of phonotraumatic lesion types differs by singing genre.Study TypeRetrospective.MethodsRecords of singers who presented with a voice complaint over the course of 2.5 years (June 2017–December 2019) were reviewed to determine the proportion of those with phonotraumatic lesions as a function of genre (Study 1). Separately, the lesion types and genres of singers diagnosed with phonotraumatic lesions over a 9‐year period (July 2011–March 2020) were determined (Study 2).ResultsIn Study 1, 191 of 712 (26.8%) dysphonic singers were diagnosed with phonotraumatic lesions. Country/folk, gospel/jazz, and musical theater singers were more likely to present with phonotraumatic lesions. In Study 2, in 443 singers with phonotraumatic lesions, polyps and pseudocysts, but not nodules, were found to be distributed unequally across genres (χ2 p = 0.006, p < 0.0001, p = 0.064, respectively). Praise/worship singers had significantly higher proportions of polyps compared to choral singers (OR 4.8 [95% CI 1.9–12.5]) or compared to musical theater singers (OR 7.2 [95% CI 2.5–20.8]). Opera singers had significantly higher proportions of pseudocysts than choral singers (OR 3.1 [95% CI 1.5–6.1]) or musical theater singers (OR 3.7 [95% CI 1.8–7.6]).ConclusionsThe higher incidence of polyps in praise/worship singers likely reflects the more emphatic nature of singing and the tendency for acute injury. The higher incidence of pseudocysts in opera singers may reflect a more chronic nature of injury.Level of Evidence4 Laryngoscope, 133:1683–1689, 2023
Introduction: In today's healthcare environment, it is critical that allied health professionals ... more Introduction: In today's healthcare environment, it is critical that allied health professionals maintain and grow the requisite knowledge and skills that defined their competence upon entering the field. Despite a strong emphasis on the attribute of lifelong learning in the physical therapy profession, no psychometrically sound instrument has been developed to assess it. Methods: The Jefferson Scale of Physical Therapist Lifelong Learning (JSPTLL) was adapted from the Jefferson Scale of Physician Lifelong Learning. A national survey of physical therapists was conducted using mailing lists from state licensure boards from a geographically diverse sample. Results: Out of 7,654 survey invitations sent, 540 complete surveys were returned. The mean score of the JSPTLL was 55.13 (SD 7.4), ranging from 19 to 68. Commitment to lifelong learning had a large correlation to the JSPTLL score (rs=0.51, p<0.0001). A medium correlation exists between the JSPTLL and the level of career satisfaction (rs=0.32, p<0.0001). A small correlation exists between commitment to lifelong learning and levels of career satisfaction (r=0.27). Conclusion: The JSPTLL provides a means to objectify the aptitude and beliefs of the physical therapist lifelong learner. Applicability to other health professions can be established with further research.
IntroductionRegular physical activity (PA), especially aerobic exercise, may benefit cognitive fu... more IntroductionRegular physical activity (PA), especially aerobic exercise, may benefit cognitive function in middle‐aged and older adults, but promoting regular PA in individuals with traumatic brain injury (TBI) remains a challenge.ObjectiveTo characterize PA and perceived barriers to PA in younger (&lt;45 years) and middle age and older (≥45 years) individuals ≥1 year after moderate‐to‐severe TBI.DesignMulticenter survey study.SettingCommunity.ParticipantsPersons who met the following criteria were included in the study: (1) 18 years and older; (2) English speaking; (3) History of moderate‐to‐severe TBI; (4) Followed in a TBI Model Systems Center for at least 1 year; and (5) Able to complete the survey independently.InterventionNot applicable.Main Outcome Measure(s)PA level measured by Rapid Assessment of Physical Activity questionnaire (RAPA) and self‐reported barriers to PA.ResultsA total of 472 participants completed the survey (response rate of 21%). More individuals in the younger group (&lt;45 years old) met Centers for Disease Control and Prevention (CDC) recommended aerobic PA guidelines compared to the middle‐aged and older group (≥ 45 years old) (62% vs 36%, p &lt; .001). Lack of motivation, lack of time, and fatigue were the most reported barriers. Perceived barriers to PA varied by age and PA level: the middle‐aged and older individuals (≥ 45 years old) were more likely to report no barriers and inactive individuals (RAPA ≤5) more likely to report lack of motivation and money, pain, and lack of resources.ConclusionParticipants ≥45 years of age were less likely to meet the CDC PA guidelines than younger individuals after moderate‐to‐severe TBI. Because perceived barriers to PA varied between age groups and PA levels, individualized approaches may be needed to promote PA in this population.
Changes in Gc‐globulin (Gc) and in alpha‐foetoprotein (AFP) have been shown to be related to outc... more Changes in Gc‐globulin (Gc) and in alpha‐foetoprotein (AFP) have been shown to be related to outcome in patients with acute liver failure (ALF). Gc is a serum protein that complexes with intravascular actin released during cellular necrosis. AFP, also made by hepatocytes, is associated with hepatocellular growth and regeneration. Previously, low absolute levels or decreases over time in either AFP or Gc portended to be a poor outcome.
Introduction: Emergency Departments utilizing telestroke technology are less likely to meet Ameri... more Introduction: Emergency Departments utilizing telestroke technology are less likely to meet American Heart Association/American Stroke Association’s recommended Door to Needle goal of less than 45 minutes. The Nursing Driven-Acute Stroke Care (NAS-Care) study tested effects of standardized stroke protocols on key workflow best practices. Methods: Seven non-academic stroke hospitals in the Lone Star Stroke Consortium’s network participated in this prospective, multi-site, baseline-controlled study from February 2015 - December 2018. After three months of blinded baseline data collection, the following interventions were implemented: NIHSS certification, nursing education including mock stroke codes, and a standardized flowsheet for code organization and documentation. The NAS-Care Run Sheet was also used to collect six months of post-intervention data. Results: Six hospitals completed the study. Study enrolment was halted after interim analysis of 447 patients, 180 in the pre-intervention control group and 267 in the post-intervention follow-up. The proportion of patients receiving alteplase was 18.9% (control) and 18.4% (intervention, NS). In the interim analysis, Door-to-ED Provider and Door-to-CT times were reduced after intervention while Door-to-Specialists and Door-to-Needle times were not significantly improved (table). Conclusion: Standardized nursing education and protocols improved staff-dependent initial stroke time metrics in Emergency Departments utilizing telestroke. Additional workflows for telestroke physicians may be required to optimize alteplase administration metrics. Final results of the NAS-Care study will be presented at the International Stroke Conference.
Objectives/HypothesisTo determine if (1) the likelihood of presenting with phonotraumatic lesions... more Objectives/HypothesisTo determine if (1) the likelihood of presenting with phonotraumatic lesions differs by singing genre in treatment‐seeking singers and (2) if the distribution of phonotraumatic lesion types differs by singing genre.Study TypeRetrospective.MethodsRecords of singers who presented with a voice complaint over the course of 2.5 years (June 2017–December 2019) were reviewed to determine the proportion of those with phonotraumatic lesions as a function of genre (Study 1). Separately, the lesion types and genres of singers diagnosed with phonotraumatic lesions over a 9‐year period (July 2011–March 2020) were determined (Study 2).ResultsIn Study 1, 191 of 712 (26.8%) dysphonic singers were diagnosed with phonotraumatic lesions. Country/folk, gospel/jazz, and musical theater singers were more likely to present with phonotraumatic lesions. In Study 2, in 443 singers with phonotraumatic lesions, polyps and pseudocysts, but not nodules, were found to be distributed unequally across genres (χ2 p = 0.006, p &lt; 0.0001, p = 0.064, respectively). Praise/worship singers had significantly higher proportions of polyps compared to choral singers (OR 4.8 [95% CI 1.9–12.5]) or compared to musical theater singers (OR 7.2 [95% CI 2.5–20.8]). Opera singers had significantly higher proportions of pseudocysts than choral singers (OR 3.1 [95% CI 1.5–6.1]) or musical theater singers (OR 3.7 [95% CI 1.8–7.6]).ConclusionsThe higher incidence of polyps in praise/worship singers likely reflects the more emphatic nature of singing and the tendency for acute injury. The higher incidence of pseudocysts in opera singers may reflect a more chronic nature of injury.Level of Evidence4 Laryngoscope, 133:1683–1689, 2023
Introduction: In today's healthcare environment, it is critical that allied health professionals ... more Introduction: In today's healthcare environment, it is critical that allied health professionals maintain and grow the requisite knowledge and skills that defined their competence upon entering the field. Despite a strong emphasis on the attribute of lifelong learning in the physical therapy profession, no psychometrically sound instrument has been developed to assess it. Methods: The Jefferson Scale of Physical Therapist Lifelong Learning (JSPTLL) was adapted from the Jefferson Scale of Physician Lifelong Learning. A national survey of physical therapists was conducted using mailing lists from state licensure boards from a geographically diverse sample. Results: Out of 7,654 survey invitations sent, 540 complete surveys were returned. The mean score of the JSPTLL was 55.13 (SD 7.4), ranging from 19 to 68. Commitment to lifelong learning had a large correlation to the JSPTLL score (rs=0.51, p<0.0001). A medium correlation exists between the JSPTLL and the level of career satisfaction (rs=0.32, p<0.0001). A small correlation exists between commitment to lifelong learning and levels of career satisfaction (r=0.27). Conclusion: The JSPTLL provides a means to objectify the aptitude and beliefs of the physical therapist lifelong learner. Applicability to other health professions can be established with further research.
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