Simplified form of tinnitus retraining therapy in adults: a retrospective study

Background

To evaluate the long-term surgical outcome(s) in patients who have undergone canal-wall-down operation with mastoid and epitympanic obliteration using autologous cortical bone chips, bone pate and meatally-based musculoperiosteal flap technique.

Method

Retrospective evaluation of seventy patients operated during 1986–1991 due to a cholesteatoma. An otomicroscopy was performed to evaluate the postoperative outer ear canal configuration with a modified Likert scale (1 – 4). The outer ear canal physical volume was assessed by tympanometry. The hearing outcome and a patient-filled questionnaire were also analyzed.

Results

The posterior wall results were 1.8 (± 0.9 SD) and the attic region 1.8 (± 0.9 SD) (ns., p > 0.05). These values show either no cavity formation or minor formation of a cavity, with a good functional result. The mean volume of the operated ear canal was 1.7 (± 0.5 SD) ml. The volume of the contralateral ear canal was 1.2 (± 0.3 SD) ml (*** p < 0.0001). A comparison of the current mean ABG to the preoperative mean ABG and to the ABG at one-year postoperatively, 5-years postoperatively or 10-years postoperatively showed no statistical significance (p > 0.05).

Conclusion

ABG does not significantly change in the long-term. The configuration of the cavity tends to change, however, the obliteration material is stable in the long-term and clinically significant cavitation rarely occurs.     

A novel video game--based device for measuring stepping performance and fall risk in older people

Schoene D, Lord SR, Verhoef P, Smith ST. A novel video game–based device for measuring stepping performance and fall risk in older people.

Objective

To determine whether a dance mat test of choice stepping reaction time (CSRT) is reliable and can detect differences in fall risk in older adults.

Design

Randomized order, crossover comparison.

Setting

Balance laboratory, medical research institute, and retirement village.

Participants

Older (mean age, 78.87±5.90y; range, 65–90y) independent-living people (N=47) able to walk in place without assistance.

Interventions

Not applicable.

Main Outcome Measures

Reaction (RT), movement, and response times of dance pad–based stepping tests, Physiological Profile Assessment (PPA) score, Digit Symbol Substitution Test (DSST) score, time to complete the Trail Making Test (TMT) A+B, Fall Efficacy Scale International (FES-I) score, Activities-specific Balance Confidence (ABC) Scale score, and Incidental and Planned Exercise Questionnaire (IPEQ) incidental IPEQ activity subscore.

Results

Test-retest reliability of the dance mat CSRT response time was high (intraclass correlation coefficient model 3,k=.90; 95% confidence interval [CI], .82–.94; P<.001) and correlated highly with the existing laboratory-based measure (r=.86; 95% CI, .75–.92; P<.001). Concurrent validity was shown by significant correlations between response time and measures of fall risk (PPA: r=.42; 95% CI, .15–.63; P<.01; TMT A: r=.61; 95% CI, .39–.77; TMT B: r=.55; 95% CI, .31–.72; DSST: r=−.53; 95% CI, −.71 to −.28; P<.001; FES-I: Spearman ρ=.50; 95% CI, .25–.69; ABC Scale: Spearman ρ=−.58; 95% CI, −.74 to −.35; P<.01). Participants with moderate/high fall-risk scores (PPA score >1) had significantly slower response times than people with low/mild fall-risk scores (PPA score <1) at 1146±182 and 1010±132ms, respectively (P=.005), and multiple fallers and single/nonfallers showed significant differences in RT (883±137 vs 770±100ms; P=.009) and response time (1180±195 vs 1031±145ms; P=0.017).

Conclusions

The new dance mat device is a valid and reliable tool for assessing stepping ability and fall risk in older community-dwelling people. Because it is highly portable, it can be used in clinic settings and the homes of older people as both an assessment and training device.     

Community Ambulation in Older Adults: Which Internal Characteristics Are Important?

Lord SE, Weatherall M, Rochester L. Community ambulation in older adults: which internal characteristics are important?

Objective

To examine the internal characteristics of older adults independent in community ambulation to gain further understanding of the skills required for its successful execution.

Design

Exploratory factor analysis.

Setting

General community.

Participants

Healthy, community dwelling older adults (N=113) who were cognitively intact and walked outdoors independently.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal gait parameters derived from accelerometry over 6 minutes walking outdoors and a battery of measures for motor, cognitive, executive, and behavioral characteristics.

Results

Mean participant age ± SD was 75.8±7.3 years, with almost a third of the sample over 80 years. Four factors emerged from the Factor Analysis of 23 variables: motor control, self-efficacy, executive function, and cognitive-motor interference, which together explained 61.4% of common variance. Eight variables loaded onto motor control, accounting for 34.5% of common variance; 7 items loaded onto self-efficacy, which explained 12.4% of common variance; 5 variables loaded onto executive function, accounting for 8.4% of common variance; and 3 variables loaded onto cognitive-motor interference, explaining 6% of the variance.

Conclusions

Results of this study indicate that factors beyond motor control contribute to independent community ambulation in older adults, reflecting the multidimensional, complex nature of the task. Self-efficacy was shown to be more relevant than executive function to gait performance, suggesting the need for a broader approach to assessment and intervention strategies.     

骨龄评估及其与运动的相关性

目的:对骨龄的评价方法,运动对骨龄的作用及影响进行综述。资料来源:应用计算机检索维普资讯、CNKI数据库及手工检索1989-01/2007-02期间的相关文献。中文检索词包括"骨龄","运动","体育锻炼","青少年";英文检索词有"skeletal age","movement","physical training","bone age"。资料选择:共收集到相关文献397篇,阅读全部文章的文题和大部分文章的摘要。选择文献所述内容与运动对骨龄的作用及影响相关的文献。排除重复性研究。资料提炼:共得到符合纳入条件的文献129篇,排除268篇。选择其中32篇进行分析,英文17篇,中文15篇。资料综合:目前,国际上普遍采用G-P图谱法和TW2计分法评价骨龄,但这两种方法都不完全适合中国儿童青少年。在20世纪90年代,国家体委在TW2法的基础上提出了一套中国人的骨发育等级标准——CHN计分法。2006年,张绍岩等参照TW3方法,以百分位数法分别制订了TW3-C RUS、TW3-C腕骨、RUS-CHN骨龄标准,称为《中国人手腕骨发育标准-中华05》,在这种评价法中,虽然考虑到一些因素的影响,但其调查对象均为城市汉族正常青少儿,然而,诸多因素如种族、遗传、性别、疾病、营养、体育锻炼、情绪波动、生活习惯等,均可影响全身发育和内分泌器官机能,从而影响骨骼发育。此外,地理环境不同,居民饮食结构、质量及生活习惯等亦不同,进而会引起各地区人群发育的差异。结论:由于骨的发育会受到多因素的影响,有些因素还互相影响、互相干扰,因此,在实际工作中,应充分考虑到诸多因素对骨龄评价的影响;同时,由于骨龄标准的时限性,一般认为骨龄标准最好每10～15年修正一次;并制定本地区、本民族人群的骨龄标准。     

Effects of protein kinase C modulation by PEP005, a novel ingenol angelate, on mitogen-activated protein kinase and phosphatidylinositol 3-kinase signaling in cancer cells

PEP005 (ingenol-3-angelate) is a novel anticancer agent extracted from Euphorbia peplus that was previously shown to modulate protein kinase C (PKC), resulting in antiproliferative and proapoptotic effects in several human cancer cell lines. In Colo205 colon cancer cells, exposure to PEP005 induced a time- and concentration-dependent decrease of cells in S phase of cell cycle and apoptosis. In Colo205 cells exposed to PEP005, a variety of signaling pathways were activated as shown by increased phosphorylation of PKCdelta, Raf1, extracellular signal-regulated kinase 1/2 mitogen-activated protein kinase (MAPK), c-Jun NH(2)-terminal kinase, p38 MAPK, and PTEN. PEP005-induced activation of PKCdelta was associated with its translocation from the cytosol to the nucleus and other cellular membranes. Interestingly, PEP005 treatment also resulted in reduced expression of PKCalpha and reduced levels of phosphorylated active form of AKT/protein kinase B. These data suggest that PEP005-induced activation of PKCdelta and reduced expression of PKCalpha resulted in apoptosis by mechanisms mediated by activation of Ras/Raf/MAPK and inhibition of the phosphatidylinositol 3-kinase/AKT signaling pathways. This study supports ongoing efforts targeting PKC isoforms in cancer therapy with PEP005 alone and in combination with other cytotoxic agents.     

The pilates method in the function of pelvic floor muscles: Systematic review and meta-analysis

BackgroundMany Pilates instructors believe that the method can produce significant improvement in the resistance of pelvic floor muscles, but it is known that about 49% of women who can contract this muscle do not perform an adequate contraction and cannot increase urethral closure pressure.ObjectivesTo evaluate the response of the Pilates method in the function of the pelvic floor muscles, compared to the control group, in healthy women.Search methodsThe following databases were searched from October to December 2016: PUBMED, SCIELO, LILACS, MEDLINE, WEB OF SCIENCE and CINAHL via PERIÓDICOS CAPES, without restriction of language and year of publication.Selection criteriaRandomized (RCTs), quasi-randomized, and non-randomized clinical trials assessing the effectiveness of the Pilates method for the fuction of pelvic floor muscles in healthy women were included.Data collection and analysisTwo reviewers independently selected the studies, assessed the risk of bias and performed the data extraction. Primary outcomes were the method of evaluation of strength, function, coordination, and symmetry of contraction of the pelvic floor muscles.Results4434 articles were identified and 2 articles were selected to compose this review and the meta-analysis. No between-group difference was demonstrated for the pelvic floor muscle function as measured by perineometry (p = 0.32).ConclusionsNo evidence showed a modification of the function of pelvic floor muscles in healthy women practicing the Pilates method.     

Masculinity and preventing falls: insights from the fall experiences of men aged 70 years and over

Purpose: To explore men’s fall experiences through the lens of masculine identities so as to assist health professionals better engage men in fall prevention programs.

Methods: Twenty-five men, aged 70–93 years who had experienced a recent fall, participated in a qualitative semi-structured interview. Men’s willingness to engage in fall prevention programs taking account of individual contexts and expressions of masculinity, were conceptualised using constant comparative methods.

Results: Men’s willingness to engage in fall prevention programs was related to their perceptions of the preventability of falls; personal relevance of falls; and age, health, and capability as well as problem-solving styles to prevent falls. Fall prevention advice was rarely given when men accessed the health system at the time of a fall.

Conclusions: Contrary to dominant expectations about masculine identity, many men acknowledged fall vulnerability indicating they would attend or consider attending, a fall prevention program. Health professionals can better engage men by providing consistent messages that falls can be prevented; tailoring advice, understanding men are at different stages in their awareness of fall risk and preferences for action; and by being aware of their own assumptions that can act as barriers to speaking with men about fall prevention.

• Implications for rehabilitation

• Men accessing the health system at the time of the fall, and during rehabilitation following a fall represent prime opportunities for health professionals to speak with men about preventing falls and make appropriate referrals to community programs.

• Tailored advice will take account of individual men’s perceptions of preventability; personal relevance; perceptions of age, health and capability; and problem-solving styles.

     

Teamwork and social cohesion are key: Nurses' perceptions and experiences of working in a new decentralised intensive care unit

BackgroundDecentralised nursing stations (DCNs) have gained popularity in new hospital designs owing to their positive impact on patient safety. However, the impact on the nurses' working environment and on continuity and quality of patient care is limited.ObjectivesThe objective of this study was to describe nurses' perceptions and experiences of the working environment and of patient care in a decentralised intensive care unit (ICU).MethodsTwelve months after the establishment of the new decentralised ICU in a tertiary teaching hospital in Sydney, Australia, a prospective cross-sectional survey of registered nurses working in the unit was undertaken. Nurses' perceptions and experiences of the working environment and patient care were evaluated using a 56-item questionnaire comprising nine domains and optional open-ended comments. Quantitative data were analysed using SPSS, version 25. Qualitative data were used to enhance the quantitative data.ResultsA total of 128 nurses responded to the questionnaire. The mean scores for overall job satisfaction, nursing teamwork, social cohesion, continuity of patient care, and quality of patient care were 3.02 (±0.91), 2.78 (±1.05), 2.68 (1.02), 2.60 (±1.01), and 3.48 (±0.88), respectively, for a maximum obtainable score of 5. Overall mean scores for teamwork, social cohesion, and continuity of patient care were explained by nurses to be a direct result of the physical layout of the new DCN ICU. Nurses believed this influenced their ability to interact with other staff and impacted teamwork and social cohesion and in turn reflected in their current job satisfaction.ConclusionsImplementation of a new model of nursing care, whereby staff members are rostered together in a pod for a period of time, along with team-building exercises, is recommended to improve the social cohesion and teamwork within the DCN ICU. Further research on nurses' experiences within a DCN ICU is required to produce robust evidence and generalisability.