Targeting Lifestyle Behavior Change in Adults with NAFLD During a 20-min Consultation: Summary of the Dietary and Exercise Literature

Non-alcoholic fatty liver disease (NAFLD) is largely linked to poor diet, lack of physical activity/exercise, and being overweight. In the absence of approved pharmaceutical agents, lifestyle modification, encompassing dietary change and increased physical activity/exercise to initiate weight loss, is the recommended therapy for NAFLD. Despite this, the use of lifestyle therapy within clinical settings is lacking with limited guidance available about what it should involve, how it should be delivered, and whether it can be feasibly delivered as part of standard care. This paper highlights the evidence for the use of lifestyle modification in NAFLD. While there is evidence to support use of behavioral strategies to support lifestyle behavior change in other clinical populations, these are yet to be assessed in people with NAFLD. However, there is sufficient evidence to suggest that behavioral intervention targeting diet and physical activity to promote weight loss in general is effective and a number of practical strategies are presented on how this could be achieved.     

Targeting the “Cytokine Storm” for Therapeutic Benefit

Inflammation is the body''s first line of defense against infection or injury, responding to challenges by activating innate and adaptive responses. Microbes have evolved a diverse range of strategies to avoid triggering inflammatory responses. However, some pathogens, such as the influenza virus and the Gram-negative bacterium Francisella tularensis, do trigger life-threatening “cytokine storms” in the host which can result in significant pathology and ultimately death. For these diseases, it has been proposed that downregulating inflammatory immune responses may improve outcome. We review some of the current candidates for treatment of cytokine storms which may prove useful in the clinic in the future and compare them to more traditional therapeutic candidates that target the pathogen rather than the host response.     

Delusions Demand Attention

We used a variant of the Stroop paradigm to investigate attention bias in a young woman (JK) with delusional beliefs that she had died and that members of her family had changed. JK was shown sets of words printed in different colours of ink, and was asked to name the colour of each word. Sets of words were chosen which related to her delusions, and to possible contributory moods. The times taken by JK to colour-name words in these lists were compared with her times to colour-name sets of neutral words. There were three separate testing sessions which took place over a two-year period. In comparison to her times to name the colours of words in the neutral lists, JK was significantly slower to colour-name test lists containing words related to her delusional beliefs. When she was no longer experiencing these delusions, however, she was no slower to colour-name any of the test word lists. The results indicate that the Stroop paradigm can be useful in investigating individual cases of delusions and in monitoring changes in attentional bias over time.     

Integration of a palliative care specialist in an amyotrophic lateral sclerosis clinic: Observations from one center

Palliative care specialists can aid in the care of patients with amyotrophic lateral sclerosis (ALS). In this article, we describe our 1-year experience incorporating a palliative care specialist into the ALS multidisciplinary team. We describe our integration model, patient selection, and visit content. Of 500 total clinic patients, 74 (14.8%) were seen by the palliative care specialist in 1 year. Referral was most often triggered by advance care planning needs (91%). In the initial visit with the palliative care specialist, topics most frequently covered included goals of care (84%), anxiety/depression (35%), and medical decision-making about feeding tubes (27%) or tracheostomy (31%). Symptom management comprised a relatively small number of the visits, and duration of visits was limited by patient fatigue. Patients with complex goals of care may benefit from the input of a palliative care specialist, and unique integration models may help to facilitate care delivery. Muscle Nerve 60 : 137–140, 2019     

Radiation Exposure Time during MBSS: Influence of Swallowing Impairment Severity, Medical Diagnosis, Clinician Experience, and Standardized Protocol Use

Guidelines and preventive measures have been established to limit radiation exposure time during modified barium swallow studies (MBSS) but multiple variables may influence the duration of the exam. This study examined the influence of clinician experience, medical diagnosis category, swallowing impairment severity, and use of a standardized protocol on fluoroscopy time. A retrospective review of 739 MBSSs performed on 612 patients (342 males/270 females; age range = 18–96 years) completed in 1 year at the Medical University of South Carolina was performed with IRB approval. All studies were completed by speech-language pathologists trained in the data collection protocol, interpretation, and scoring of the MBSImP?^©. Medical diagnosis category, swallowing impairment severity (MBSImP?^© score), clinician experience, and fluoroscopy time were the variables recorded for analysis. Fluoroscopy time was not significantly associated with medical diagnosis category (p = 0.10). The severity of the MBSImP?^© Oral Total and Pharyngeal Total resulted in statistically significant increases in fluoroscopy time (p < 0.05). Studies by novice clinicians had longer exposure times when compared to those of experienced clinicians (p = 0.037). Average radiation exposure time using the MBSImP?^© approach was 2.9 min, with a 95 % confidence interval of 2.8–3.0 min, which was well within the range of exposure times reported in the literature. This study provides preliminary information regarding the impact of medical diagnosis category, swallowing impairment severity, and clinician experience on fluoroscopy time. These findings also suggest that a thorough, standardized protocol for MBSSs did not cause unnecessary radiation exposure time during the MBSS.     

Measuring Recovery Related Outcomes: A Psychometric Investigation of the Recovery Markers Inventory

The concept of recovery can be operationalized from either the point of view of the consumer or from the perspective of the provider of services. The Recovery Markers Inventory (RMI) was created to assess recovery-related factors (i.e., actions/events associated with consumer’s recovery) from the provider’s perspective. Evidence, which established the psychometric properties of the RMI, was obtained through the use of: (a) construct validity (i.e., confirmatory factor analysis and Rasch principal components analysis of residuals); (b) concurrent validity (i.e., the calculation of Pearson correlations between the RMI and other recovery-oriented instruments); and (c) reliability (i.e., Rasch Partial Credit models). Evidence presented in this article shows that the RMI scale is unidimensional, has an adequate level of correlation, and acceptable reliability. The current analysis provides evidence to support the RMI as a valid, reliable measure of recovery-related factors, which can complement consumer based instruments in the assessment of changes in recovery.