An adapted walking intervention for a child with Pitt Hopkins syndrome*

Purpose: To investigate the effects of a community-based adapted walking intervention on a child with Pitt Hopkins syndrome (PTHS).

Methods: A four-year old boy with PTHS participated in a 12-week intervention comprising five one-hour long walking sessions per week at a local daycare. Walking sessions used the Upsee mobility device (Firefly by Leckey Ltd., Ireland). Outcome measures included Goal Attainment Scaling and the Mobility Ability Participation Assessment.

Results: Parental and caregiver goals for social interaction, physical activity and physical health surpassed expectations by post-testing. Gains were not sustained at three months follow-up. The participant’s ability and mobility may have increased following the intervention.

Conclusions: Participants with PTHS may benefit from regular physical activity and early intervention. The Upsee mobility device is a feasible and fun way to promote inclusive community-based physical activity and social engagement in a young child with PTHS. Further research into the health benefits of physical activity and the Upsee for children with PTHS may be warranted.

• Implications for Rehabilitation

• Physical activity may be beneficial for a child with Pitt Hopkins syndrome, a rare genetic disorder.

• New design, implementation of mobility intervention for a child with neurodevelopmental disabilities.

• The Upsee mobility device may offer physical benefits for a child with a neurodevelopmental disability.

• The Upsee mobility device may offer social benefits for a child with a neurodevelopmental disability.

     

Re‐endothelialization of rat lung scaffolds through passive,gravity‐driven seeding of segment‐specific pulmonary endothelial cells

Effective re‐endothelialization is critical for the use of decellularized scaffolds for ex vivo lung engineering. Current approaches yield insufficiently re‐endothelialized scaffolds that haemorrhage and become thrombogenic upon implantation. Herein, gravity‐driven seeding coupled with bioreactor culture facilitated widespread distribution and engraftment of endothelial cells throughout rat lung scaffolds. Initially, human umbilical vein endothelial cells were seeded into the pulmonary artery by either gravity‐driven, variable flow perfusion seeding or pump‐driven, pulsatile flow perfusion seeding. Gravity seeding evenly distributed cells and supported cell survival and re‐lining of the vascular walls while perfusion pump‐driven seeding led to increased cell fragmentation and death. Using gravity seeding, rat pulmonary artery endothelial cells and rat pulmonary vein endothelial cells attached in intermediate and large vessels, while rat pulmonary microvascular endothelial cells deposited mostly in microvessels. Combination seeding of these cells led to positive vascular endothelial cadherin staining. In addition, combination seeding improved barrier function as assessed by serum albumin extravasation; however, leakage was observed in the distal portions of the re‐endothelialized tissue suggesting that recellularization of the alveoli is necessary to complete barrier function of the capillary–alveolar network. Overall, these data indicate that vascular recellularization of rat lung scaffolds is achieved through gravity seeding. Copyright © 2016 John Wiley & Sons, Ltd.     

Efficacy of Injected Corticosteroid Type,Dose, and Volume for Pain in Large Joints: A Narrative Review

Corticosteroid injections are commonly used in the treatment of disorders of the large joints. This review assimilates the available literature on corticosteroid injections into the glenohumeral joint, subacromial space, hip joint, and knee joint. A systematic method to review available literature revealed 84 articles that fit the inclusion criteria. For each injection location, four items were examined: overall efficacy of injection, superior type of steroid, superior dose of steroid, and superior volume of injectate. Most research demonstrates positive short-term outcomes in pain and function for corticosteroid injections of the large joints. Methylprednisolone and triamcinolone seem similar in efficacy, with minor differences seen in specific studies. Larger doses may last longer, but need to be balanced with the systemic effects from higher doses. Volume has not been studied extensively. Due to heterogeneity in study types, subject populations, and outcomes, it is not possible to identify a single defining trend for a superior type, dose, or volume of steroid. Future prospective studies examining these factors may better reveal the optimum regimen for each injection location.

Implementation and Preliminary Clinical Outcomes of a Pharmacist‐managed Venous Thromboembolism Clinic for Patients Treated With Rivaroxaban Post Emergency Department Discharge

Objective

The objective was to describe the implementation, work flow, and differences in outcomes between a pharmacist‐managed clinic for the outpatient treatment of venous thromboembolism (VTE) using a non‐vitamin K oral anticoagulant versus care by a primary care provider (PCP).

Methods

Patients in the studied health system that are diagnosed with low‐risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with a non‐vitamin K oral anticoagulant and follow‐up either in a pharmacist‐managed VTE clinic or with their PCP. Pharmacists in the VTE clinic work independently under a collaborative practice agreement (CPA). An evaluation of 34 patients, 17 in each treatment arm, was conducted to compare the differences in treatment‐related outcomes of rivaroxaban when managed by a pharmacist versus a PCP.

Results

The primary endpoint was a 6‐month composite of anticoagulation treatment‐related complications that included a diagnosis of major bleeding, recurrent thromboembolism, or fatality due to either major bleeding or recurrent thromboembolism. Secondary endpoints included number of hospitalizations, adverse events, and medication adherence. There was no difference in the primary endpoint between groups with one occurrence of the composite endpoint in each treatment arm (p = 1.000), both of which were recurrent thromboembolic events. Medication adherence assessment was formally performed in eight patients in the pharmacist group versus no patients in the control group. No differences were seen among other secondary endpoints.

Conclusions

The pharmacist‐managed clinic is a novel expansion of clinical pharmacy services that treats patients with low‐risk VTEs with rivaroxaban in the outpatient setting. The evaluation of outcomes provides support that pharmacist‐managed care utilizing standardized protocols under a CPA may be as safe as care by a PCP.