A Pilot Study Evaluating Daily Physical Activity Before and After Cardiac Resynchronization Therapy.

A Pilot Study Evaluating Daily Physical Activity Before and After Cardiac Resynchronization Therapy.

Biol Res Nurs. 2013 Mar 28;
Sherry D, Knight BP, Casey C, Larson J, Hacker ED, Quinn LT, Wang E, Collins EG

Benefits of daily physical activity are well known, but there are limited data to describe physical activity in heart failure patients who receive cardiac resynchronization therapy devices. The purpose of this pilot study was to evaluate changes in physical activity (PA) levels before and 3 months after Cardiac Resynchronization Therapy (CRT) and determine relationships of PA to physical function and comorbidities, as well as describe changes in heart failure symptoms. This was a prospective pre-/post- design that included a convenience sample of 21 subjects using self- report questionnaires and 6-minute walk test (6MWT). In this sample, there was a 2.6 hour increase in high level PA (p = 0.024). 6MW distance improved 27% (p < .0001). Subjects experienced a 25% reduction in dyspnea (p = 0.015). Knowledge gained from this study adds to the understanding of the patient response to CRT. Further study is recommended to generalize findings and explore whether an intervention (cardiac rehabilitation) is indicated. HubMed – rehab

Development of a crosswalk for pain interference measured by the BPI and PROMIS pain interference short form.

Qual Life Res. 2013 Mar 29;
Askew RL, Kim J, Chung H, Cook KF, Johnson KL, Amtmann D

INTRODUCTION: To help researchers in multiple sclerosis (MS) take advantage of the measurement properties of the PROMIS Pain Interference instrument while maintaining continuity with previous research, we developed and tested a crosswalk table to transform Brief Pain Inventory pain interference scale (BPI-PI) scores to PROMIS-PI short form (PROMIS-PI SF) scores. METHODS: The BPI-PI and the PROMIS-PI SF were administered in two studies that included persons with MS. One sample of 369 participants served as a developmental calibration sample, and a separate sample of 360 served as a validation sample. The crosswalk development included dimensionality assessment, item-level parameter estimation, and assessment of accuracy. BPI-PI and PROMIS-PI T scores were obtained from participants’ item responses, and using the crosswalk table, PROMIS-PI T scores were derived from responses to the BPI-PI items. Differences between observed and crosswalked T scores were compared in both samples. RESULTS: For BPI-PI summary scores ranging from 0 to 10, corresponding T scores ranged from 38.6 to 81.2. The mean difference between observed and crosswalked T scores was 0.51 (SD = 3.9) in the calibration sample and -1.47 (SD = 4.2) in the validation sample. Approximately 80 % of crosswalked scores in the calibration sample were within four score points of the observed PROMIS-PI SF scores, and 70 % were within four points in the validation sample. In both samples, the largest differences were at lower levels of the pain interference continuum. CONCLUSIONS: Crosswalked pain interference scores adequately approximated observed PROMIS-PI SF scores in both the calibration and validation samples. MS researchers and clinicians interested in adopting the PROMIS instruments can use this table to transform BPI-PI scores to enable comparisons with other studies and to maintain continuity with previous research. HubMed – rehab

The challenge of home discharge with a total artificial heart: the La Pitie Salpetriere experience.

Eur J Cardiothorac Surg. 2013 Mar 28;
Demondion P, Fournel L, Niculescu M, Pavie A, Leprince P

OBJECTIVES: The total artificial heart (TAH) helps to counteract the current decrease in heart donors and is likely to bridge patients to transplant under favourable conditions. Today’s mobile consoles facilitate home discharge. The aim of this study was to report on the La Pitie Hospital experience with CardioWest™ TAH recipients, and more particularly, on generally successful outpatient’ management. METHODS: A retrospective analysis was performed on clinical and biological data from patients implanted with a TAH between December 2006 and July 2010 in a single institution. Morbi-mortality during hospital stay, number and causes of rehospitalizations, quality of life during home discharge, bridge to transplant results and survival have all been analysed. RESULTS: Twenty-seven patients were implanted with the CardioWest™. Fifteen patients (55.5%) died during support. Prior to home discharge, the most frequent cause of death was multi-organ failure (46.6%). Twelve patients were discharged home from hospital within a median of 88 days [range 35-152, interquartile range 57] postimplantation. Mean rehospitalization rate was 1.2 by patient, on account of device infection (n = 7), technical problems with the console (n = 3) and other causes (n = 4). Between discharge and transplant, patients spent 87% of their support time out of hospital. All patients who returned home with the TAH were subsequently transplanted, and 1 died in post-transplant. CONCLUSION: Despite the morbidity and mortality occurring during the postimplantation period, home discharge with a TAH is possible. Portables drivers allow for a safe return home. Aside from some remaining weak points such as infectious complications or noise, CardioWest™ TAH allows for successful rehabilitation of graft candidates, and assures highly satisfactory transplant results. HubMed – rehab

Early Structured Surgical Management Plan for Neonates with Short Bowel Syndrome May Improve Outcomes.

World J Surg. 2013 Mar 29;
Wood SJ, Khalil B, Fusaro F, Folaranmi SE, Sparks SA, Morabito A

BACKGROUND: In children with short bowel syndrome, maximal adaptation of the bowel after extensive resection is thought to occur during the first 2 years of life. The aim of the present study was to review children with short bowel syndrome from two intestinal rehabilitation centers, comparing those undergoing lengthening procedures <365 days of age (early) versus those whose lengthening procedure was carried out >365 days of age (late). METHODS: Retrospective data collection was performed from January 2004 to December 2010 in Manchester, UK, and from December 2006 to December 2010 in Brussels, Belgium. Both medical centers follow a similar intestinal rehabilitation program (IRP). Data collected included population demographics, bowel length preoperatively and postoperatively, age at operation, parenteral nutrition (PN), central access, and complications. RESULTS: Complete data were available for eight children who underwent lengthening surgery at <365 days of age, and six who underwent the procedure at >365 days of age. Diagnoses were similar. Groups were matched for gestation and birthweight, with no statistical difference in preoperative and postoperative bowel lengths. The mean duration of PN postoperatively was 378 days in the early cohort and 589 days in the late cohort. This trended toward statistical significance (p = 0.071). Full enteral autonomy was achieved at 17 months (early) and 59 months (late) (p = 0.01). Patients in the early group required fewer central lines than those operated on later (p = 0.035). CONCLUSIONS: Enrolling children into an IRP involving early (<365 days of age) lengthening surgery allows a shorter postoperative time to allow weaning to full enteral nutrition, as well as fewer central lines. Both outcomes provide benefits for the child and family, allowing an earlier return to normal life. HubMed – rehab

Electrodiagnostically Confirmed Posttraumatic Neuropathy and Associated Clinical Exam Findings With Lisfranc Injury.

Foot Ankle Int. 2013 Mar 28;
Pourcho AM, Liu YH, Milshteyn MA

BACKGROUND: Patients with a Lisfranc injury often complain of persistent pain radiating from the Lisfranc joint up or down the first dorsal web space, accompanied by decreased sensation. We hypothesized that these symptoms were related to a posttraumatic neuropathy of the terminal medial branch of deep fibular (peroneal) nerve (MBDFN) and that by recognizing this symptom an earlier diagnosis of Lisfranc injury may be possible. METHODS: Twelve patients with diagnosis of subtle unilateral Lisfranc injury, confirmed by standing X-ray, CT, or bone scan, were enrolled. Standardized antidromic sensory nerve conduction studies of MBDFN were performed bilaterally within 2 months postinjury and prior to surgical intervention. The contralateral, normal side was used as a control. All patients were tested for decreased 2-point discrimination in the first dorsal web space on both lower extremities. RESULTS: Sensory nerve action potential of the MBDFN was absent, with decreased 2-point discrimination on the injured side in all patients. CONCLUSION: Lisfranc injuries were associated with a posttraumatic neuropathy of the MBDFN and decreased 2-point discrimination in the first dorsal web space. The finding of altered sensation in the first dorsal web space may help the practitioner to earlier diagnosis of a Lisfranc injury. LEVEL OF EVIDENCE: Level III, case control study. HubMed – rehab