Improvement in psychological well-being of people with aphasia and their families: Evaluation of a community-based programme

Abstract

The York-Durham Aphasia Centre comprises a community-based programme for people with aphasia and their families. It offers long-term support and service at any time post-stroke or head injury. This evaluation focused on improvement in psychosocial well-being in the clients and their family members as a measure of programme effectiveness. Trained programme volunteers administered Ryff's Psychological Well-being Scale to 35 clients twice, at 6 months apart. Twelve family members also self-administered the scale twice. Voluuteers handled the administration well, and aphasic clients were able to complete the scale with little difficulty. Both clients and family members showed positive change in five of six dimensions of psychological well-being. This improvement in both groups may be related to the direct attention the programmes give to psychosocial well-being and communication, the overall environment of the centre, and the test administration itself. The positive change in these aphasic clients of varying ages and time post-stroke means that imporovement in psychological well-being is possible regardless of time post-stroke and age. There are important implications for health and social service system planning, and more specifically for programme planning for people with aphasia and their families.     

Supplementation with vitamin D and insulin homeostasis in healthy overweight and obese adults: A randomized clinical trial

IntroductionHypovitaminosis D which is a frequent problem in overweight and obese individuals, seems to interfere with cells responsible for control of glycemic status. Therefore, the current research intended to study the impact of supplementation with vitamin D on insulin homeostasis among healthy obese and overweight individuals.MethodsThe current study was conducted among obese or overweight individuals who had hypovitaminosis D. After separation of participants into two groups, one group received vitamin D pearls (50,000 IU/weekly) for eight weeks, whereas another group received a placebo over the same period. Next, the level of vitamin D, fasting blood sugar (FBS), fasting insulin, Homeostasis Model Assessment 2 for Insulin Resistance (HOMA2-IR), Function of β-cell (HOMA2-β), and Insulin Sensitivity (HOMA2-S) and lipid profile of participants were evaluated.ResultsOverall, 67.2% of the participants were female. No considerable difference was observed concerning biochemical parameters among the study groups at baseline. After eight weeks, the mean (SD) level of vitamin D was significantly lower in the placebo group than those in the vitamin D group. (38.6 ± 8.1 vs. 14.9 ± 6.4; P < 0.001). The patients who received vitamin D had significant lower levels of FBS (P < 0.001), fasting insulin (P < 0.001), HOMA2-IR (P < 0.001), and HOMA2-β (P = 0.03), than the placebo group. The HOMA2-S was significantly enhanced in vitamin D group, while it reduced in another group (P < 0.001). However, no considerable decrease was found in triglyceride, cholesterol, high-density lipoprotein or low-density lipoprotein.ConclusionSupplementation with vitamin D improved sensitivity to insulin and pancreatic function of β cells of healthy overweight and obese adults.     

Interventions promoting employee “speaking-up” within healthcare workplaces: A systematic narrative review of the international literature

BackgroundHealthcare systems worldwide increasingly value the contribution of employee voice in ensuring the quality of patient care. Although employees’ concerns are often dealt with satisfactorily, considerable evidence suggests that some employees may feel unable to speak-up, and even when they do their concerns may be ignored. As a result, in addition to trans-national and national policies, workplace interventions that support employees to speak-up about their concerns have recently increased.MethodsA systematic narrative review, informed by complex systems perspectives addresses the question: “What workplace strategies and/or interventions have been implemented to promote speaking-up by employees”?ResultsThirty-four studies were included in the review. Most studies reported inconclusive results. Researchers explanations for the successful implementation, or otherwise, of speak-up interventions were synthesised into two narrative themes (Braithwaite et al., 2018 (a)) hierarchical, interdisciplinary and cultural relationships and (Francis, 2015 (b)) psychological safety.ConclusionsWe strengthen the existing evidence base by providing an in-depth critique of the complex system factors influencing the implementation of speak-up interventions within the healthcare workforce. Although many of the studies were locally unique, there were international similarities in workplace cultures and norms that created contexts inimical to speaking-up interventions. Changing communication behaviours and creating a climate that supports speaking-up is immensely challenging. Interventions can be usurped in practice by complex, emergent and contextual issues, such as pre-existing socio-cultural relationships and workplace hierarchies.     

The Paradox of the Nested Pediatric Emergency Department

Objectives: Nested pediatric emergency departments (nPEDs) are defined as dedicated treatment areas operating during peak pediatric hours within general emergency departments (EDs). This study examined three staffing models for nPEDs and their impact on pediatric encounters. Methods: Three models were applied to children younger than 37 months presenting to the ED of an urban community hospital over one year. In the nPED, physicians cared only for nPED patients. In the restricted (rPED) model, physicians cared only for pediatric patients presenting outside nPED hours. In the total ED (tED) model, physicians treated all pediatric patients regardless of time. Full-time equivalent pediatric encounters, potential neonatal lumbar punctures, and illness severity were determined for all models. Statistical analysis was performed by analysis of variance and chi-square test. Results: For the 3,389 eligible ED visits, the number of annual patient encounters per full-time equivalent was 1,236 for the nPED, 805 for the tED, and 336 for the rPED (p < 0.001). Physicians practicing only in the nPED treated 3.7 times the number of children younger than 37 months than did physicians in the rPED model and 1.5 times the number than did physicians in the tED model. Spending 10% of total practice hours in the nPED would increase pediatric encounters 26% for rPED physicians, while practicing 25% of time in the nPED would increase pediatric encounters 67% and equate to 45% of nPED encounters. An nPED physician could expect to perform 17 neonatal lumbar punctures, compared with ten for a tED physician and four for an rPED physician (p < 0.001). There was no significant difference in severity of illness for the three models. Conclusions: Physicians practicing in facilities that include an nPED must dedicate some portion of their practice to the nPED to maintain equivalent pediatric encounters.     

The calcimimetic AMG 073 reduces parathyroid hormone and calcium x phosphorus in secondary hyperparathyroidism

BACKGROUND: A need exists for a therapy that lowers parathyroid hormone (PTH) without increasing calcium x phosphorus in patients with secondary hyperparathyroidism. The calcimimetic AMG 073 increases the sensitivity of the parathyroid calcium-sensing receptor to extracellular calcium, thereby reducing PTH secretion. Consequently, AMG 073 may provide a novel therapy for secondary hyperparathyroidism. METHODS: Seventy-eight hemodialysis patients with secondary hyperparathyroidism were enrolled into this 18-week, double-blind, randomized, placebo-controlled, dose titration study. Daily oral AMG 073 doses were administered to determine the effect on PTH, serum calcium, phosphorus, and calcium x phosphorus. RESULTS: The mean baseline PTH was similar in patients administered AMG 073 or placebo (632 +/- 280.1 pg/mL vs. 637 +/- 455.9 pg/mL, respectively). PTH decreased by 26.0% in the AMG 073-treated group, compared with an increase of 22.0% in the placebo group (P < 0.001). A greater proportion in the AMG 073 group (38%) had a decrease in PTH >or=30%, compared with the placebo group (8%) (P = 0.001). Decreases in PTH were independent of baseline vitamin D usage. Patients receiving AMG 073 had an 11.9% decrease in calcium x phosphorus compared with a 10.9% increase in the placebo group (P < 0.001). Use of vitamin D sterols, as well as both calcium and noncalcium-containing phosphate binders. were similar between treatment groups. Administration of AMG 073 was safe and well tolerated in this 18-week study. CONCLUSIONS: The calcimimetic AMG 073 decreases both PTH and calcium x phosphorus levels in hemodialysis patients with secondary hyperparathyroidism.     

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Abundant data are available for direct anterior/posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre- and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups. This work is dedicated to the memory of Grace and Julia Hanson.     

Real-time quantitative RT-PCR of cyclin D1 mRNA in mantle cell lymphoma: comparison with FISH and immunohistochemistry

Presence of the balanced translocation t(11;14)(q13;q32) and the consequent overexpression of cyclin D1 found in mantle cell lymphoma (MCL) has been shown to be of important diagnostic value. Although many molecular and immunohistochemical approaches have been applied to analyze cyclin D1 status, correlative studies to compare different methods for the diagnosis of MCL are lacking. In this study, we examined 39 archived paraffin specimens from patients diagnosed with a variety of lymphoproliferative diseases including nine cases meeting morphologic and immunophenotypic criteria for MCL by: (1) real-time quantitative RT-PCR to evaluate cyclin D1 mRNA expression; (2) dual fluorescence in situ hybridization (FISH) to evaluate the t(11;14) translocation in interphase nuclei; and (3) tissue array immunohistochemistry to evaluate the cyclin D1 protein level. Among the nine cases of possible MCL, seven cases showed overexpression of cyclin D1 mRNA (cyclin D1 positive MCL) and two cases showed no cyclin D1 mRNA increase (cyclin D1 negative "MCL-like"). In six of seven cyclin D1 positive cases, the t(11;14) translocation was demonstrated by FISH analysis; in one case FISH was unsuccessful. Six of the seven cyclin D1 mRNA overexpressing cases showed increased cyclin D1 protein on tissue array immunohistochemistry; one was technically suboptimal. Among the two cyclin D1 negative MCL-like cases, FISH confirmed the absence of the t(11;14) translocation in both cases. All other lymphoproliferative diseases studied were found to have low or no cyclin D1 mRNA expression and were easily distinguishable from the cyclin D1 overexpressing MCLs by all three techniques. In addition, to confirming the need to assess cyclin D1 status, as well as, morphology and immunophenotyping to establish the diagnosis of MCL, this study demonstrates good correlation and comparability between measure of cyclin D1 mRNA, the 11;14 translocation and cyclin D1 protein.