Evaluation of a single session with cooling garment for persons with multiple sclerosis – a randomized trial

Purpose. This research investigates the objective and subjective effects of wearing the Rehband® cooling garment.

Method. A multi-centre, randomized crossover study was conducted regarding 43 heat-sensitive persons with multiple sclerosis (MS), comparing active treatment with placebo. Subjects were tested immediately before and after intervention. Ten- (10TW) and 30-metre timed walk (30TW), oral temperature, spasticity, standing balance and timed up and go (TUG) and nine-hole peg test (NHPT) performance were measured. A study-specific questionnaire was used to evaluate subjective experiences.

Results. Active treatment produced statistically significant objective improvement in 10TW, 30TW, one-legged stance, tandem stance (right) and TUG; statistically significant subjective improvement was also found in fatigue, spasticity, weakness, balance, gait, transfers, ability to think clearly and time to recover. The coherence between the objective and subjective results indicates clinical relevance from the subjects' perspective. There were no statistically significant differences between treatments in terms of oral temperature, spasticity (measured by the modified Ashworth scale), tandem stance (left), step test or NHPT, or subjective signs such as difficulty in dressing, dysarthria or pain.

Conclusions. Active cooling with a Rehband® vest is likely to have a positive effect on everyday life in heat-sensitive persons with MS.     

The intention to exercise and the execution of exercise among persons with multiple sclerosis – a qualitative metasynthesis

Purpose: This review was designed as a qualitative metasynthesis aiming to identify factors influencing the intention to exercise and the execution of exercise among persons with multiple sclerosis (PwMS). Method: Based on principles laid out by Sandelowski and Barroso, this qualitative metasynthesis started with a systematic literature search for studies of PwMS’s experiences relating to exercise in the following databases: CINAHL, Rehabilitation and Sports Medicine Source, PubMed, Web of Science and Psychology & Behavioral Science. The metasynthesis procedure also included critical appraisal using the Consolidated Criteria for Reporting Qualitative Research checklist, and integrating synthesis of the articles’ findings. Results: The metasynthesis included nine articles. Factors identified as influencing intention to exercise and the execution of exercise included social support, professional support and outcome expectations. Strong relationships between these three themes were detected for the intention to exercise, the execution of exercise or both among PwMS. Conclusions: The present metasynthesis offers a comprehensive understanding of factors influencing the intention to exercise and the execution of exercise among PwMS. Our findings reveal that health professionals influence the part of the process where PwMS enter the exercise setting, as well as the PwMS’s intention to exercise.

• Implications for Rehabilitation

• Social support, professional support and outcome expectations are potential facilitators and barriers for the intention to exercise and the execution of exercise among PwMS.

• Health professionals specializing in MS rehabilitation can influence the intention and the execution of physical exercise among PwMS when there exists a personal and supportive patient–professional relationship.

• Outcome expectations may impact the motivational and volitional phases of physical exercise.

     

The Resolution Integral – a tool for characterising the performance of diagnostic ultrasound scanners

In this paper, we describe how the resolution integral can be used as a tool for characterising the grey-scale imaging of diagnostic ultrasound scanners. The definitions of resolution integral, characteristic resolution and depth of field are discussed in relation to grey-scale imaging performance, together with a method of measuring these parameters using the Edinburgh Pipe Phantom. We show how the characteristic resolution and depth of field can be used to quantify the differences between transducers designed for different applications and how they are useful in identifying and quantifying changes in the performance of individual transducers.     

Efficacy of a neuropsychological training programme for patients with multiple sclerosis – a randomised controlled trial

BACKGROUND: One aim of this project was to investigate the efficacy of a specific training programme for MS patients which also contained compensation strategies and relaxation exercises relevant to everyday life. The other aim was to check the programme's relevance to everyday life. METHOD: 19 patients, randomised into two groups, took part in the study. The participants in the treated group completed a specific neurological training programme which began immediately after the basic testing (visit 1) and lasted 4 weeks, with a total of 12 sessions. The monitoring test was done immediately after the training programme (at visit 2) and the follow-up was 3 months later (visit 3). Both study groups were fully comparable as regards clinical and socio-demographic data and baseline intelligence level. RESULTS: The results of the cognitive training programme were especially evident in the significant improvements in executive functions (CKV) and spatial-constructional abilities (HAWIE-R). Comparison between the treated and the control group showed no significant difference in the fatigue values (MFIS). However, when the treated group was examined over the three times of measurements, the symptoms of fatigue had diminished significantly. Regarding memory, comparison of the groups showed no changes; within the treated group; however, the verbal (VLT) and nonverbal learning and memory (NVLT) improved significantly. The results for sustained attention improved in both groups over time. It must be assumed that a learning effect had occurred here. The depression values (BDI) also improved in both study groups. The follow-up questionnaire showed that 60% (6) attributed an average to above-average benefit to the training. CONCLUSION: To summarise, it is apparent that MS patients with mild to moderate cognitive impairment are able to profit from even a fairly brief neuropsychological training programme and to integrate much of it into their everyday lives. In view of this, it would seem appropriate to offer such a programme as standard, associated with medication.     

The effect of interferon-β on black holes in patients with multiple sclerosis

Multiple sclerosis (MS) is an immunological disorder of the CNS. Linked to an initial transient inflammation as the result of blood–brain barrier leakage, the disease progresses into a neurodegenerative phase. MRI is the most powerful paraclinical tool for diagnosing and monitoring MS. Although contrast enhancing lesions are the visible events of blood–brain barrier breakdown, accumulation of hypointense lesions, namely black holes, are recognised as irreversible axonal loss. IFN-β is administered as a first-line drug in MS patients. However, whether the effect of IFN-β extends beyond just prevention of blood–brain barrier leakage and further prevents the formation of black holes or promotes their recovery once formed, is not yet understood.     

Safety and feasibility of transcranial direct current stimulation in amyotrophic lateral sclerosis – a pilot study with a single subject experimental design

Introduction: Transcranial direct current stimulation (tDCS) has been explored as a neuromodulatory tool to prime motor function in several neurological disorders. Studies using tDCS in amyotrophic lateral sclerosis (ALS) are limited. We investigated the safety, feasibility and effects of long-term tDCS in an individual with ALS. Methods: A 36-year-old male diagnosed with clinically definite ALS received 12 sessions each of anodal, sham, and cathodal tDCS. Outcome measures included disease progression (revised ALS functional rating scale (ALSFRS-R)), clinical measures of endurance and mobility, and corticomotor excitability. Results: No adverse events or change in disease progression were noticed during the study. Small improvement in gait speed (15% increase) was noticed with anodal tDCS only. Conclusions: This case study demonstrates the safety and feasibility of long-term facilitatory and inhibitory tDCS on a single participant with ALS. This study serves as a guideline for implementing tDCS in future ALS trials.     

The effect of dual-task functional exercises on postural balance in adolescents with intellectual disability – a preliminary report

Abstract

Purpose: The study aimed to assess the effectiveness of an original intervention programme of unstable surface dual-task functional exercises on postural stability in adolescents with intellectual disability (ID). Methods: A total of 34 adolescents with ID, aged 14–16 years, were engaged in our study. A 17-person experimental group (E) took part in a 12-week intervention programme which consisted of unstable surface functional exercises, designed after activities of daily living (ADLs). Another group of 17 youngsters constituted a control group (C). Within a span of 12 weeks, the postural stability assessment was conducted twice in both groups, employing a stabilometric platform ALFA AC International East. Results: After taking part in the intervention programme, the experimental group (E) improved all their scores (p?<?0.05). The path length of the COG and the time in which the dynamic test was performed were shorter in the experimental group (E), while the control group (C) scored worse in comparison with their initial results. Conclusions: A distinctly positive effect of unstable-surface dual-task functional exercises on postural stability in individuals with ID was also revealed in our tests.

• Implications for Rehabilitation

• Rehabilitation of intellectually disabled persons should be carried out individually and contain ADL-based exercises.

• The use of unstable surfaces, making the above training more difficult, naturally stimulates the trainee to focus more closely on the task being performed.

• Implementation of dual-task exercises, consisting in compiling functional tasks with balance training, in the intervention programme for adolescents with ID is likely to improve efficiency of their everyday living and the quality of their lives.

     

The impact of self-efficacy on physical activity maintenance in patients with hip osteoarthritis – a mixed methods study

Purpose: Understanding motivational factors related to physical activity (PA) maintenance is essential in promoting long-term exercise benefits. This study explored the impact of self-efficacy (SE) on post-intervention PA maintenance in patients with hip osteoarthritis. Method: An SE-theory based mixed-methods sub-study of a trial investigating the effects of 4 months supervised exercise in patients with hip osteoarthritis. Questionnaire data (n?=?52; baseline and 12 months) on PA and SE (Arthritis Self-Efficacy Scale, ASES, score-range 10–100) were analysed (Mann–Whitney test) for differences in characteristics of maintainers and non-maintainers. Semi-structured individual interviews (n?=?15; at 12-months follow-up) were analysed using directed content analysis. Results: Compared to non-maintainers (n?=?9; 17%) maintainers (n?=?31; 60%) had improved (p?Conclusion: SE contributes to understanding of post-intervention PA maintenance in patients with hip osteoarthritis. However, disease-related factors and clinical trial participation appears significant too.

• Implications for Rehabilitation

• Patients’ perceived self-efficacy for physical activity contributes to the understanding of post-intervention physical activity maintenance in patients with hip osteoarthritis.

• Practitioners may benefit from incorporating the self-efficacy theory in the planning and execution of exercise interventions to promote post-intervention physical activity maintenance and long term health benefits.

• Post-intervention physical activity maintenance may be increased by focussing on the patients’ exercise self-efficacy through verbal persuasion and support, disease-specific information and information on normal physiological responses to exercise combined with an individualised training progression to support experiences of success and achievement of desired outcomes.

     

The importance of a daily rhythm in a supportive environment – promoting ability in activities in everyday life among older women living alone with chronic pain

Abstract

Purpose: The aim of this study was to explore how older women living alone with chronic musculoskeletal pain, describe their ability in performing activities in everyday life and what could promote their ability in activities in everyday life as well as their perceived meaning of a changed ability to perform activities in everyday life. Method: Qualitative interviews were conducted with 12 women, and an inductive content analysis was used. Results: The results showed the importance of a daily rhythm of activities. Activities included in the daily rhythm were socializing with family and friends, physical activities, doing own activities as well as activities supported by relatives and the community. The activities described by the women also promoted their ability in activities in everyday life. Other findings were the women’s perceived meaning of being independent and maintaining that independency, along with the meaning of accepting and adapting to a changed life situation. Conclusion: This paper concludes that it is important to be sensitive of individual needs regarding the daily rhythm of activities when health-care professionals intervene in the activities in everyday life of older women living alone, promote the women’s independency, and enable them to participate in the community.

• Implications for Rehabilitation

• A daily rhythm of activities is important for older women who live alone with chronic musculoskeletal pain.

• The importance of health-care professionals being sensitive to individual needs to promote ability in activities in everyday life and to encourage the everyday activities into a daily rhythm.

• Facilitate the women’s desire and will of independency, despite their needs of help from their environment to manage their everyday life.

     

The cost of running a practice – Part 2

ABSTRACT:

This article continues an introduction into the costs of running a veterinary practice, detailing specific hidden costs and owner-specific costs. It introduces the concept of ‘leakage’ and steps that individual nurses can take to help ensure costs are kept proportionate.     

Can a b value of 500 be substituted for a b value of 1000 in the characterization of focal liver lesions?

Purpose

Comparison of two different b values in diffusion-weighted magnetic resonance imaging (DWI) for characterization of focal liver lesions.

Methods

A total of 174 focal liver lesions from 100 patients were analyzed using two different b values (500 and 1000 s/mm²). The DWI with b values of 500 s/mm² (DWI500) and 1000 s/mm² (DWI1000) were analyzed using the Mann–Whitney test, kappa statistic, and paired t test with respect to image quality. The statistically significant differences between DWI500 and DWI1000 in the characterization of the lesions with respect to the cutoff ADC values were evaluated via χ ² test.

Results

DWI500 had the highest mean score in the qualitative evaluation of image quality (p < 0.0001) and the highest signal-to-noise ratio (8.7 ± 2.1; p < 0.0001). The sensitivity, specificity, and AUC for discriminating malignant from benign focal lesions on DWI500 and DWI1000 using cutoff ADC values of 1.54 × 10^?3 and 1.38 × 10^?3 s/mm² were 95.8%, 92.3%, 0.98, and 93.8%, 92.3%, 0.97, respectively. There was no statistically significant difference in sensitivity, specificity, and AUC values between DWI500 and DWI1000 with respect to the cutoff ADC values (p > 0.05).

Conclusions

The image quality of DWI500 was better than that of DWI1000, and there was no significant difference between DWI500 and DWI1000 in the characterization of the lesions with respect to the cutoff ADC values. The b value of 500 s/mm² can be substituted for the b value of 1000 s/mm² in the characterization of focal liver lesions.     

The value of ultrasonic examination in the diagnosis of carotid atheromatous plaque in brain infarction

１Subjectsandmethods１．１Subjects１２０PatientswithCTorMRIprovedbraininfarctionincluding７０malesand５０maleswererecruited．６０casesagedfrom５０～６５years，and６０agedfrom６６～８０years．Allpatientsexhibitedlimbsdysfunctionofhistoryoftransientcerebralhemorrhage．１．２MethodUsingultrasonicdiagnosticapparatusLOGIQ４００with７．５MHzofprobingheadfrequency，weexaminedbilateralcommoncarotidartery（CCA），externalcarotidartery（ECA），initiatingpartofinternalcarotidartery（ICA），carot…     

Osteopontin – a fibrosis-related marker – in dilated cardiomyopathy in patients with Emery-Dreifuss muscular dystrophy

Abstract

Background: As osteopontin (OPN) may be assumed to have diagnostic/prognostic value in heart diseases, it is worth assessing whether it is also involved in the pathogenesis and can be applied in the diagnosis of the dilated cardiomyopathy (DCM) in Emery-Dreifuss muscular dystrophy (EDMD). Methods: Serum levels of osteopontin were quantified by means of sandwich immunoassay in 25 EDMD patients (10 laminopathies AD-EDMD and 15 emerinopathies – X-EDMD), eight carriers of X-EDMD, nine disease controls (patients with dystrophinopathy) and 20 age-matched healthy controls. Results: The levels of circulating OPN were elevated in all AD-EDMD and X-linked EDMD patients, as well as in X-EDMD carriers and patients suffering progressive muscular dystrophy. There was no correlation between the osteopontin level and different cardiac parameters, including left-ventricular end-diastolic diameter, left atrial diameter, the left ventricular ejection fraction and the CK-MB level. There was a slight negative correlation with the ages of the patients. Conclusions: The presented results indicate that assessments of circulating OPN levels may help to identify EDMD patients at risk of dilated cardiomyopathy and might be therefore included among the set of biomarkers referred to with a view to appropriate early cardiologic diagnosis and therapy being commenced with in time.