Development and evaluation of the Communication over Language Barriers questionnaire (CoLB-q) in paediatric healthcare

Objective

To develop a valid and reliable questionnaire addressing the experiences of healthcare personnel of communicating over language barriers and using interpreters in paediatric healthcare.

Alterations in the motor neuron–renshaw cell circuit in the Sod1G93A mouse model

Motor neurons become hyperexcitable during progression of amyotrophic lateral sclerosis (ALS). This abnormal firing behavior has been explained by changes in their membrane properties, but more recently it has been suggested that changes in premotor circuits may also contribute to this abnormal activity. The specific circuits that may be altered during development of ALS have not been investigated. Here we examined the Renshaw cell recurrent circuit that exerts inhibitory feedback control on motor neuron firing. Using two markers for Renshaw cells (calbindin and cholinergic nicotinic receptor subunit alpha2 [Chrna2]), two general markers for motor neurons (NeuN and vesicular acethylcholine transporter [VAChT]), and two markers for fast motor neurons (Chondrolectin and calcitonin‐related polypeptide alpha [Calca]), we analyzed the survival and connectivity of these cells during disease progression in the Sod1^G93A mouse model. Most calbindin‐immunoreactive (IR) Renshaw cells survive to end stage but downregulate postsynaptic Chrna2 in presymptomatic animals. In motor neurons, some markers are downregulated early (NeuN, VAChT, Chondrolectin) and others at end stage (Calca). Early downregulation of presynaptic VAChT and Chrna2 was correlated with disconnection from Renshaw cells as well as major structural abnormalities of motor axon synapses inside the spinal cord. Renshaw cell synapses on motor neurons underwent more complex changes, including transitional sprouting preferentially over remaining NeuN‐IR motor neurons. We conclude that the loss of presynaptic motor axon input on Renshaw cells occurs at early stages of ALS and disconnects the recurrent inhibitory circuit, presumably resulting in diminished control of motor neuron firing. J. Comp. Neurol. 521:1449–1469, 2013. © 2012 Wiley Periodicals, Inc.     

TracheobronchiaI Clearance in Twins

Tracheobronchial clearance was studied with a lest aerosol of 6μ-7μ monodisperse fluorinated ethylene propylene (Teflon 120) particles tagged with technetium 99m (half-life, 6.0 hours) and external measurements of the radioactivity in the lungs. Nine pairs of monozygotic and nine pairs of dizygotic twins were studied. The clearance patterns in the monozygotic pairs were highly similar. In the dizygotic pairs there was a tendency to similarity. Among the pairs there was a remarkable difference in the clearance patterns, Consequently the result indicates that tracheobronchial clearance to a great extent is constitutionally determined. The medical implications of this are discussed.     

Live/Real Time Three‐Dimensional Transesophageal Echocardiographic Assessment of Ventricular Septal Volume and Mass before and after Myectomy in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most common genetically transmitted cardiomyopathy. In patients resistant to medical management, myectomy is the surgical procedure of choice to reduce the symptoms of left ventricular outflow obstruction. Two‐dimensional transesophageal echocardiography (2DTEE) has become part of the operative procedure by decreasing the incidence of postoperative complications. However, because of the three‐dimensional geometry of left ventricular outflow tract, it is unable to comprehensively assess the location and severity of the obstruction and to provide accurate guidance during myectomy. In this study, 10 patients with HCM underwent live/real time three‐dimensional transesophageal echocardiography (3DTEE) intra‐operatively to measure the volume of the resected septum. This volume correlated well with the volume of the resected septal muscle directly obtained using a graduating cylinder containing water (r = 0.9, P < 0.000). 3DTEE may be potentially used as an adjunct to guide the surgeon in performing an adequate myectomy with a lower incidence of residual obstruction and complications such as an iatrogenic ventricular septal defect.     

Item development for a questionnaire investigating patient self reported perception,satisfaction and outcomes of a single osteopathy in the cranial field (OCF) treatment

BackgroundOsteopathy in the Cranial Field (OCF) is a treatment approach used by osteopaths in the management of a wide variety of complaints. OCF is based on the premise that the bones of the skull are mobile and that changes in the flow of cerebrospinal fluid can affect the function of the body. There are only a few studies assessing the effectiveness of OCF and there is no published research investigating patients' perception of what happens during and post an OCF treatment.ObjectiveTo develop items for a patient self-reported questionnaire that assesses patients' own perceptions of one OCF treatment.DesignSystematic literature search, item development and face validity testing.MethodsA systematic search of the literature was undertaken to identify a measure or measures that may be suitable to assess patient perceptions of OCF. No measure of patient perception of OCF was located. Measures of patient ratings of satisfaction, efficacy and outcomes of physical therapy treatment were located and reviewed. From these published measures, items that were appropriate for a measure of OCF were identified and considered as possible items to include in a new measure of patient perception of OCF. Items were developed and face validity was investigated.ParticipantsSix osteopaths who were familiar with or use OCF as part of their treatment approach, 2 patients who had previously been treated by osteopaths who used OCF exclusively, and 2 patients who had not previously received any OCF treatment as part of their osteopathic treatment.ResultsA systematic literature search was conducted. Appropriate items were extracted from 7 articles in the ‘osteopathy’ search and 4 additional articles from the ‘manual therapy’ search. Items were reworded, where appropriate, to ensure they reflected the OCF approach. Consideration of face validity identified a number of changes that were required to some of the items.ConclusionsThe Patient Perception Measure of Osteopathy in the Cranial Field (PPM-OCF) was developed to assess patient perceptions of the OCF treatment approach. Six domains of patient perception of treatment were identified and 37 items were developed within these 6 domains. Further psychometric testing of the PPM-OCF is required prior to its application in the clinical and research settings.     

Orofacial esthetics and dental anxiety: Associations with oral and psychological health

Objective. Severe dental anxiety (DA) is associated with both oral health and psychosocial consequences in what has been described as a vicious circle of DA. The aim of this study was to investigate self-rated orofacial esthetics in patients with DA and its relationship to psychological and oral health. Materials and methods. A consecutive sample of 152 adult patients who were referred or self-referred to a specialized dental anxiety clinic filled out the Orofacial Esthetic Scale (OES) as well as measurements on DA, self-rated oral health and general anxiety and depression. Clinical measures of dental status were also obtained. Results. Compared with the general population, patients with DA had lower ratings of satisfaction on all aspects of their orofacial esthetics, which included the teeth, gingiva, mouth and face, as well as a global orofacial assessment. Furthermore, the perception of the orofacial appearance was related both to dental status and self-rated oral health, as well as to general anxiety and depression. The level of dissatisfaction with the orofacial appearance was similar for both genders, but women reported more regular dental care and better dental status. Conclusions. The results of this study clearly show less satisfaction with dental and facial appearance in patients with DA, and that the self-rating of orofacial esthetics is related to both oral and psychological health. The OES can be used to assess orofacial esthetics in patients with DA.