Rehabilitation therapy self-efficacy and functional recovery after hip fracture

Little is known about the role of psychological factors in the functional recovery process of hip fracture patients. This study employed a prospective cohort design to test the hypothesis that hospitalized hip fracture patients with greater reported self-efficacy for conducting rehabilitation therapy would have a greater likelihood of recovering to a pre-fracture level of locomotion function six months after the fracture. This hypothesis was tested controlling for pre-fracture level of function and depressive symptoms reported during hospitalization for surgical repair. An original measure of rehabilitation therapy self-efficacy was evaluated prior to hypothesis testing. Study patients were recruited from two hospitals, interviewed during hospitalization and followed up six months later. Patients included in hypothesis test analyses (n = 24) were mostly women (82%) with a mean age of 79 years. Results showed that patients with higher self-efficacy scores had a greater likelihood of locomotion recovery, controlling for pre-fracture locomotion function level (adjusted odds ratio (AOR) = 1.21; 95% confidence interval (CI) = 1.00-1.45; P= 0.05). This positive association between rehabilitation therapy self-efficacy and likelihood of locomotion recovery persisted after adding depressive symptoms (the Center for Epidemiological Studies-depression (CES-D) score) to this logistic regression model (AOR for self-efficacy = 1.18; 95% CI = 0.99-1.42; P= 0.07). It is concluded that rehabilitation therapy self-efficacy is a potentially important psychological factor in helping hip fracture patients recover locomotion functioning.     

A multi-feature and multi-channel univariate selection process for seizure prediction.

OBJECTIVE: To develop a prospective method for optimizing seizure prediction, given an array of implanted electrodes and a set of candidate quantitative features computed at each contact location. METHODS: The method employs a genetic-based selection process, and then tunes a probabilistic neural network classifier to predict seizures within a 10 min prediction horizon. Initial seizure and interictal data were used for training, and the remaining IEEG data were used for testing. The method continues to train and learn over time. RESULTS: Validation of these results over two workshop patients demonstrated a sensitivity of 100%, and 1.1 false positives per hour for Patient E, using a 2.4s block predictor, and a failure of the method on Patient B. CONCLUSIONS: This study demonstrates a prospective, exploratory implementation of a seizure prediction method designed to adapt to individual patients with a wide variety of pre-ictal patterns, implanted electrodes and seizure types. Its current performance is limited likely by the small number of input channels and quantitative features employed in this study, and segmentation of the data set into training and testing sets rather than using all continuous data available. SIGNIFICANCE: This technique theoretically has the potential to address the challenge presented by the heterogeneity of EEG patterns seen in medication-resistant epilepsy. A more comprehensive implementation utilizing all electrode sites, a broader feature library, and automated multi-feature fusion will be required to fully judge the method's potential for predicting seizures.     

Errors in health care management: what do they cost?

BACKGROUND: Iatrogenic injuries are relatively common and a potentially avoidable source of morbidity. The economic evaluation of this area has been limited by the lack of good quality national data to provide an estimate of incidence, associated disability, and preventability of iatrogenic injuries. Two recent surveys, the Quality in Australian Health Care Study (QAHCS) and the Utah Colorado Study (UTCOS), have now made this feasible. AIMS: To determine the direct costs associated with iatrogenic injuries occurring in a hospital setting. METHODS: The QAHCS was used as a representative national source of information on the incidence, disability, and preventability of iatrogenic injuries. Costs were calculated using information from Australian disease related groups (AN-DRGs) relative to the injury categories. RESULTS: The cost of just 12 preventable iatrogenic injuries is significant (0.25 million US dollars) and accounts for 2-3% of the annual budget of a typical Australian community based hospital of 120 beds. Costing data provide additional useful information for policy and decision makers. CONCLUSION: Costing iatrogenic injuries is an important component of the impact of these events. An ongoing national database of iatrogenic injuries is necessary to assist in identifying the incidence of these injuries, monitoring trends, and providing data for cost estimates and economic evaluations.     

Modulation of the age at onset of Parkinson's disease by apolipoprotein E genotypes

Parkinson's disease (PD) patients often develop dementia, and Alzheimer's disease (AD) patients frequently develop parkinsonian signs. The apolipoprotein E σ4 allele is associated with increased risk and earlier onset of AD. We studied 137 unrelated white PD patients. Those with σ4 had the earliest onset (52.7 · 9.8 years), σ3/σ3 patients had an intermediate onset (56.1 · 11.1 years), and those with σ2 had the latest onset (59.1 · 13.4 years). The age at onset distribution for σ4/σ – was significantly earlier than for σ3/σ3 and σ2/σ3. These preliminary results suggest that apolipoprotein E genotypes modulate the age at onset of PD.     

Nitrous oxide and epinephrine-induced arrhythmias

We asked whether the sympathomimetic effect of nitrous oxide (N2O) predisposed patients receiving N2O to arrhythmias in response to epinephrine administration. We also asked whether aging contributed to the development of arrhythmias, with or without N2O. One hundred patients having transsphenoidal hypophysectomy were randomly assigned to receive anesthesia including (n = 49) or excluding (n = 51) N2O. All patients were given an injection of epinephrine 1:200,000, with 0.5% lidocaine to produce hemostasis. Using intermittent 12-lead and continuous lead II electrocardiography, we determined the incidence of premature ventricular contraction, isorhythmic atrioventricular (AV) dissociation, and changes in T-wave morphology. Patients given N2O had a significantly higher incidence of isorhythmic AV dissociation (61.2% vs 41.2%). A trend toward a higher incidence of multiple premature ventricular contractions (16.3% vs 7.8%) was not statistically significant. Both anesthetic groups had a high incidence of postoperative changes in T-wave morphology (46.9% in the N2O group vs 50.9% in the group not given N2O). Aging alone did not affect the incidence of ventricular ectopic beats, isorhythmic AV dissociation, or changes in electrocardiographic morphology, but correlated with the development of ventricular ectopy during N2O anesthesia. We conclude that the use of N2O correlated with a higher incidence of isorhythmic AV dissociation in response to injection of epinephrine with lidocaine.     

Diffuse supravalvular aortic stenosis: comprehensive imaging with ECG-gated CT angiography

Congenital supravalvular aortic stenosis (SVAS) is a rare cause of congenital left ventricular outflow obstruction and pressure overload, with a diffuse form that often extends into the aortic arch, and can be associated with stenoses in other vascular territories. Knowledge of the extent of disease involvement can be complementary to medical management or critically important prior to surgical intervention. We report a case of diffuse SVAS and demonstrate the utility of ECG-gated multidetector computed tomography (CT) as a comprehensive diagnostic tool in evaluating such patients.     

Using portfolios to evaluate achievement of population-based public health nursing competencies in baccalaureate nursing students

Public health nurses from 13 local public health agencies and nurse educators from five schools of nursing developed population-based public health nursing competencies for new graduates and novice public health nurses. Educators in one nursing program used a portfolio assignment to measure achievement of the competencies by traditional and RN to BSN students in a community health nursing course. Data were collected from surveys and focus groups to determine students' responses to the portfolio and their use of population-based public health nursing concepts. The assignment enhanced students' critical thinking skills; however, concerns about the structure and evaluation of the portfolio decreased student satisfaction. Recommendations are made for improving the portfolio format, increasing students' valuing of the portfolio, managing the tension between assessment and learning, and orienting clinical agency staff and nursing instructors.     

B lymphoblastoid cell lines with normal and defective O-glycosylation established from an individual with blood group Tn

Individuals with the Tn blood group contain terminal serine/threonine- linked N-acetylgalactosamine residues in their blood cells. This is due to lack of UDP-D-galactose: D-N-acetyl galactosamine beta-D-galactosyl transferase from part of their red cells and probably from their leukocytes. We have established B lymphoblastoid cell lines from such an individual by in vitro infection of his lymphocytes with Epstein- Barr virus. The original line contained a mixture of cells reactive and nonreactive with Helix pomatia lectin (Hp). These cells were subcloned after staining with fluorescent Hp by a fluorescence-activated cell sorter (FACS) into homogeneous, phenotypically stable lines of Hp- positive (Hp+) and Hp-negative (Hp-) cells. The molecular differences between the membrane glycoproteins were characterized by carbohydrate- specific surface labeling techniques, Hp affinity chromatography, polyacrylamide slab gel electrophoresis and glycopeptide/oligosaccharide analysis. The major O-glycosidic membrane glycoprotein (GP105) was retained on Hp-Sepharose columns only from Hp+ cells, whereas the common leukocyte antigen (GP160-200) was partially retained on Hp columns from both lines. These proteins were isolated by immune precipitation with monoclonal antibodies and characterized. The results show that the GP105 glycoprotein from Hp+ cells contains terminal N-acetylgalactosamine residues but also more complex oligosaccharides. The common leukocyte antigen showed different electrophoretic mobilities in Hp+ and Hp- cells. UDP-galactose D-N- acetyl galactosamine beta-galactosyl transferase was almost absent in the Hp+ cells. These cell lines are useful for studies on the functional role and regulation of the biosynthesis of O-glycosidic carbohydrates.