Falls Predict Acute Hospitalization in Parkinson's Disease

xloma.fota13 shared this article with you from Inoreader Falls Predict Acute Hospitalization in Parkinson's Disease Via pubmed: dysphagia J Parkinsons Dis. 2021 Apr 7. doi: 10.3233/JPD-212539. Online ahead of print. ABSTRACT BACKGROUND: There is a need for identifying risk factors for hospitalization in Parkinson's disease (PD) and also interventions to reduce acute hospital admission. OBJECTIVE: To analyze the frequency, causes, and predictors of acute hospitalization (AH) in PD patients from a Spanish cohort. METHODS: PD patients recruited from 35 centers of Spain from the COPPADIS-2015 (COhort of Patients with PArkinson's DIsease in Spain, 2015) cohort from January 2016 to November 2017, were included in the study. In order to identify predictors of AH, Kaplan-Meier estimates of factors considered as potential predictors were obtained and Cox regression performed on time to hospital encounter 1-year after the baseline visit. RESULTS: Thirty-five out of 605 (5.8%) PD patients (62.5±8.9 years old; 59.8% males) presented an AH during the 1-year follow-up afte r the baseline visit. Traumatic falls represented the most frequent cause of admission, being 23.7% of all acute hospitalizations. To suffer from motor fluctuations (HR [hazard ratio] 2.461; 95% CI, 1.065-5.678; p = 0.035), a very severe non-motor symptoms burden (HR [hazard ratio] 2.828; 95% CI, 1.319-6.063; p = 0.008), falls (HR 3.966; 95% CI 1.757-8.470; p = 0.001), and dysphagia (HR 2.356; 95% CI 1.124-4.941; p = 0.023) was associated with AH after adjustment to age, gender, disease duration, levodopa equivalent daily dose, total number of non-antiparkinsonian drugs, and UPDRS-IIIOFF. Of the previous variables, only falls (HR 2.998; 95% CI 1.080-8.322; p = 0.035) was an independent predictor of AH. CONCLUSION: Falls is an independent predictor of AH in PD patients. PMID:33843696 | DOI:10.3233/JPD-212539 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcomes after cervical vertebral interbody fusion using an interbody fusion device and polyaxial pedicle screw and rod construct in 10 horses (2015-2019)

xloma.fota13 shared this article with you from Inoreader Outcomes after cervical vertebral interbody fusion using an interbody fusion device and polyaxial pedicle screw and rod construct in 10 horses (2015-2019) Via pubmed: dysphagia Equine Vet J. 2021 Apr 12. doi: 10.1111/evj.13449. Online ahead of print. ABSTRACT BACKGROUND: Further development of surgical techniques for equine cervical stabilisation is necessary to make the procedure less technically demanding, reduce complications, and improve outcomes. OBJECTIVE: To describe clinical outcomes and owner reports in horses undergoing placement of an interbody fusion device and polyaxial pedicle screw and rod construct for cervical vertebral fusion in horses with cervical vertebral compressive myelopathy. STUDY DESIGN: Retrospective case series. METHODS: Data were retrieved from medical records of 10 horses undergoing cervical vertebral fusion (2015-2019). Records were evaluated for signalment, duration of clinical signs, number and location of compression sites, grade of ataxia, duration of hospitalisation, and complications. Long-term follow-up was obtained through clinical re-evaluation, postoperativ e radiographs, and owner contact. RESULTS: Breeds were mixed. Median age was 24 (range 12-168) months. There were 2/10 mares, 4/10 geldings, and 4/10 stallions. Preoperative grade of ataxia ranged from 1-3/5. Fusion was performed at one (n=3) or two (n=7) sites. Two horses were euthanised within the first year. In 6 out of 8 horses with ≥1-year follow-up, ataxia improved by 1 - 3 grades, with an average improvement of 1.25 grades. In four horses, ataxia improved to grade 0-1. In two horses the gait was unaffected, but neck comfort improved. Complications included seroma formation (n=9), pain (n=5), fever (n=4), upper respiratory tract obstruction (n=2), azotemia (n=2), screw breakage (n=2), progression of neurological signs (n=1), Horner's Syndrome (n=1), dysphagia (n=1), hives (n=1), implant infection (n=1), and nondisplaced fracture (n=1). MAIN LIMITATIONS: Small case series, heterogeneous patient population. CONCLUSIONS: This technique resulted in ≥1 grade g ait improvement in 6/10 cases operated and 6/8 cases for which ≥1-year follow-up was available, similar to other methods. Fatal complications related to implant placement did not occur. This technique may represent a safer alternative to current techniques of ventral interbody fusion with similar outcomes. PMID:33844334 | DOI:10.1111/evj.13449 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lingual Exercise

xloma.fota13 shared this article with you from Inoreader Lingual Exercise in Older Veterans With Dysphagia: A Pilot Investigation of Patient Adherence Via pubmed: dysphagia J Speech Lang Hear Res. 2021 Apr 12:1-13. doi: 10.1044/2021_JSLHR-20-00461. Online ahead of print. ABSTRACT Purpose Adherence is a concern in dysphagia management. Poor adherence with recommendations can negatively affect treatment efficacy and patient outcomes. For exercise-based therapies, low adherence can alter the dose of exercise delivered to the muscle, which can diminish impact of exercise. It has been established that low adherence is a problem in dysphagia treatments; however, relationships among levels of adherence and outcomes from exercise-based interventions have not been explored. Method In this retrospective pilot study, data were collected from a multicenter clinical demonstration program in the Veterans Affairs hospital system to examine the relationships between patient adherence with a device-facilitated lingual exercise regimen. Outcomes were compared pre- and posttreatment using a paired t test or Wilcoxon matched -pairs signed-ranks test, and relationships among adherence and outcome measures were evaluated using Pearson or Spearman rank correlation coefficients, as appropriate. Results Patient adherence was evenly distributed across participants: Adherence at the front sensor was 59.3% (SD = 28.2), ranging from 5.5% to 95.8%; the back sensor adherence was 55.9% (SD = 29.8), ranging from 1.1% to 97.2%. Maximum isometric pressure (MIP) generation, at both the front and back sensors, was increased from pre- to posttreatment (p < .0001, front; p = .008, back). Functional Oral Intake Scale (FOIS) scores were also significantly improved at the posttreatment time point as compared to baseline (p = .005). However, there were no significant correlations among adherence and outcome measures (front sensor adherence vs. ΔMIP, r = -.161, p = .342; back sensor adherence vs. ΔMIP, r = .002, p = .991; front sensor adherence vs. ΔFOIS, r = -.183, p = .279; back sensor adherence vs. ΔFOIS, r = -.160, p = .399). Conclusions These findings suggest that patient adherence with this lingual exercise program was not related to the increases in lingual pressure generation or improvement in functional oral intake observed in this cohort. These preliminary findings suggest the need for future, prospective, controlled, and randomized clinical trials to further investigate patient adherence with a lingual exercise program and related impacts of adherence on exercise dose and swallowing-related outcomes. PMID:33844587 | DOI:10.1044/2021_JSLHR-20-00461 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Προσευχή Εφφαθά , Θεραπεία του κωφάλαλου

Εἰς τό ὄνομα τοῦ Πατρός καί τοῦ Υἱοῦ καί τοῦ Ἁγίου Πνεύματος. Ἀμήν
Δόξα σοί ο Θεός ημών, δόξα σοί.
Βασιλεύ ουράνιε, παράκλητε, το Πνεύμα της αληθείας, ο πανταχού παρών και τα πάντα πληρών, ο θησαυρός των αγαθών και ζωής χορηγός, ελθέ και σκήνωσον εν ημίν, και καθάρισον ημάς από πάσης κηλίδος, και σώσον, Αγαθέ, τας ψυχάς ημών.
Ἅγιος ὁ Θεός, Ἅγιος Ἰσχυρός, Ἅγιος Ἀθάνατος ἐλέησον ἠμᾶς. (3 φορές)
Παναγία τριάς, ἐλέησον ἠμᾶς. Κύριε ἰλάσθητι ταῖς ἁμαρτίαις ἠμῶν. Δέσποτα, συγχώρισον τάς ἀνομίας ἠμίν. Ἅγιε, ἐπισκεψε καί ἴασαι τάς ἀσθενείας ἠμῶν, ἕνεκεν τοῦ ὀνόματός σου.
Κύριε ἐλέησον, Κύριε ἐλέησον, Κύριε ἐλέησον.
Πάτερ ἠμῶν, ὁ ἐν τοῖς οὐρανοῖς, ἁγιασθήτω τό ὄνομά Σου, ἐλθέτω ἡ βασιλεία Σου, γεννηθήτω τό θέλημά Σου ὡς ἐν οὐρανό καί ἐπί τῆς γής. Τόν ἄρτον ἠμῶν τόν ἐπιούσιον δός ἠμίν σήμερον, καί ἅφες ἠμίν τά ὀφειλήματα ἠμῶν, ὡς καί ἠμεῖς ἀφίεμεν τοῖς ὀφειλέταις ἠμῶν, καί μή εἰσενέγκης ἠμᾶς εἰς πειρασμόν ἀλλά ρύσαι ἠμᾶς ἀπό τοῦ πονηροῦ.
Θεοτόκε Παρθένε, χαῖρε κεχαριτωμένη Μαρία, ὁ Κύριος μετά Σου. Εὐλογημένη Σύ ἐν γυναιξί, καί εὐλογημένος ὁ καρπός τῆς κοιλίας Σου, ὅτι Σωτήρα ἔτεκες, τῶν ψυχῶν ἠμῶν.
Βαπτιστά τοῦ Χριστοῦ, πάντων ἠμῶν μνήσθητι, ἴνα ρυσθῶμεν τῶν ἀνομιῶν ἠμῶν, σοί γάρ ἐδόθη χάρις, πρεσβεύειν ὑπέρ ἠμῶν.
Δεῦτε προσκυνήσομεν καί προσπέσωμεν τῷ Βασιλεῖ ἠμῶν Θεῶ.
Δεῦτε προσκυνήσομεν καί προσπέσωμεν Χριστό τῷ Βασιλεῖ ἠμῶν Θεῶ.
Δεῦτε προσκυνήσομεν καί προσπέσωμεν Αὐτῶ Χριστῷ τῷ Βασιλεῖ καί Θεῶ ἠμῶν.
ΚΥΡΙΕ, μὴ τῷ θυμῷ σου ἐλέγξῃς με, μηδὲ τῇ ὀργῇ σου παιδεύσῃς με.  ἐλέησόν με, Κύριε, ὅτι ἀσθενής εἰμι· ἴασαί με, Κύριε, ὅτι ἐταράχθη τὰ ὀστᾶ μου,  καὶ ἡ ψυχή μου ἐταράχθη σφόδρα· καὶ σύ, Κύριε, ἕως πότε;  ἐπίστρεψον, Κύριε, ρῦσαι τὴν ψυχήν μου, σῶσόν με ἕνεκεν τοῦ ἐλέους σου.  ὅτι οὐκ ἔστιν ἐν τῷ θανάτῳ ὁ μνημονεύων σου· ἐν δὲ τῷ ῞ᾼδῃ τίς ἐξομολογήσεταί σοι;  ἐκοπίασα ἐν τῷ στεναγμῷ μου, λούσω καθ᾿ ἑκάστην νύκτα τὴν κλίνην μου, ἐν δάκρυσί μου τὴν στρωμνήν μου βρέξω.  ἐταράχθη ἀπὸ θυμοῦ ὁ ὀφθαλμός μου, ἐπαλαιώθην ἐν πᾶσι τοῖς ἐχθροῖς μου.  ἀπόστητε ἀπ᾿ ἐμοῦ πάντες οἱ ἐργαζόμενοι τὴν ἀνομίαν, ὅτι εἰσήκουσε Κύριος τῆς φωνῆς τοῦ κλαυθμοῦ μου·  ἤκουσε Κύριος τῆς δεήσεώς μου, Κύριος τὴν προσευχήν μου προσεδέξατο.  αἰσχυνθείησαν καὶ ταραχθείησαν σφόδρα πάντες οἱ ἐχθροί μου, ἀποστραφείησαν καὶ καταισχυνθείησαν σφόδρα διὰ τάχους.
Επιστολή Αποστόλου Παύλου – Προς Εβραίους,
Πεπείσμεθα δὲ περὶ ὑμῶν, ἀγαπητοί, τὰ κρείττονα καὶ ἐχόμενα σωτηρίας, εἰ καὶ οὕτω λαλοῦμεν.οὐ γὰρ ἄδικος ὁ Θεὸς ἐπιλαθέσθαι τοῦ ἔργου ὑμῶν καὶ τοῦ κόπου τῆς ἀγάπης ἧς ἐνεδείξασθε εἰς τὸ ὄνομα αὐτοῦ, διακονήσαντες τοῖς ἁγίοις καὶ διακονοῦντες.ἐπιθυμοῦμεν δὲ ἕκαστον ὑμῶν τὴν αὐτὴν ἐνδείκνυσθαι σπουδὴν πρὸς τὴν πληροφορίαν τῆς ἐλπίδος ἄχρι τέλους,ἵνα μὴ νωθροὶ γένησθε, μιμηταὶ δὲ τῶν διὰ πίστεως καὶ μακροθυμίας κληρονομούντων τὰς ἐπαγγελίας.
Κατά Μάρκο
Καὶ πάλιν ἐξελθὼν ἐκ τῶν ὁρίων Τύρου καὶ Σιδῶνος ἦλθε πρὸς τὴν θάλασσαν τῆς Γαλιλαίας ἀνὰ μέσον τῶν ὁρίων Δεκαπόλεως.καὶ φέρουσιν αὐτῷ κωφὸν μογιλάλον καὶ παρακαλοῦσιν αὐτὸν ἵνα ἐπιθῇ αὐτῷ τὴν χεῖρα.καὶ ἀπολαβόμενος αὐτὸν ἀπὸ τοῦ ὄχλου κατ᾿ ἰδίαν ἔβαλε τοὺς δακτύλους αὐτοῦ εἰς τὰ ὦτα αὐτοῦ, καὶ πτύσας ἥψατο τῆς γλώσσης αὐτοῦ,καὶ ἀναβλέψας εἰς τὸν οὐρανὸν ἐστέναξε καὶ λέγει αὐτῷ· ἐφφαθά, ὅ ἐστι διανοίχθητι.καὶ εὐθέως διηνοίχθησαν αὐτοῦ αἱ ἀκοαὶ καὶ ἐλύθη ὁ δεσμὸς τῆς γλώσσης αὐτοῦ, καὶ ἐλάλει ὀρθῶς.καὶ διεστείλατο αὐτοῖς ἵνα μηδενὶ εἴπωσιν· ὅσον δὲ αὐτὸς αὐτοῖς διεστέλλετο, μᾶλλον περισσότερον ἐκήρυσσον.καὶ ὑπερπερισσῶς ἐξεπλήσσοντο λέγοντες· καλῶς πάντα πεποίηκε· καὶ τοὺς κωφοὺς ποιεῖ ἀκούειν καὶ τοὺς ἀλάλους λαλεῖν.
Δί' ευχών των αγίων Πατέρων ημών, Κύριε Ιησού Χριστέ ο Θεός ημών, ελέησον ημάς. Αμήν.

Foreign Body Reaction to Hydrophilic Polymer Following Mohs Micrographic Surgery

xloma.fota13 shared this article with you from Inoreader Foreign Body Reaction to Hydrophilic Polymer Following Mohs Micrographic Surgery Via Dermatologic Surgery - Current Issue No abstract available View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Postoperative Pain After Mohs Micrographic Surgery is Well Tolerated Regardless of Psychological and Pain-Related Comorbidities

xloma.fota13 shared this article with you from Inoreader Postoperative Pain After Mohs Micrographic Surgery is Well Tolerated Regardless of Psychological and Pain-Related Comorbidities Via Dermatologic Surgery - Current Issue BACKGROUND Preoperative patient screening has been evaluated in many surgical specialties as a way to improve the overall patient experience. Current data are limited regarding patient screening for dermatologic procedures. The goal of preoperative screening is to identify patients at risk for poor outcomes and tailor the treatment plan to ensure a greater overall patient experience. OBJECTIVE To investigate the association between psychological comorbidities and acute postoperative pain in patients treated with Mohs micrographic surgery (MMS). MATERIALS AND METHODS Subjects were recruited from a single center, single provider, uniformed service MMS practice, and asked to complete preoperative and postoperative questionnaires for scheduled MMS. Outcome variables included anticipated pain, actual pain after MMS, duration of pain, and medications used for pain. RESULTS Mohs micrographic surgery was well tolerated. There were no significant differences in anticipated or reported pain, or in medication use between cohorts. Significant differences in pain were noted with closure technique with complex surgical repairs generating the greatest pain across groups. CONCLUSION Mohs micrographic surgery is well tolerated by patients, both with and without psychological comorbidities. Our results show no statistically significant differences, suggesting a limited role for preoperative screening as a tool to guide pain management after MMS. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Histopathologic Scoring System for Perineural Invasion Correlates With Adverse Outcomes in Patients With Cutaneous Squamous Cell Carcinoma

xloma.fota13 shared this article with you from Inoreader A Histopathologic Scoring System for Perineural Invasion Correlates With Adverse Outcomes in Patients With Cutaneous Squamous Cell Carcinoma Via Dermatologic Surgery - Current Issue BACKGROUND Perineural invasion (PNI) is a known risk factor for recurrence, metastasis, and death in cutaneous squamous cell carcinoma (cSCC). Current staging systems include PNI, but none define its extent or severity. OBJECTIVE To identify histopathologic features of cSCC with PNI that may be associated with adverse outcomes. MATERIALS AND METHODS This is a retrospective cohort study that included 45 patients with cSCC and PNI treated with surgical excision. Histopathologic slides were analyzed for 5 features of PNI: largest affected nerve diameter, number of nerves affected, depth of nerve involvement, intra- versus extratumoral PNI, and focal versus circumferential PNI. RESULTS The median largest affected nerve diameter was 0.13 mm, and the median number of nerve structures involved was 4. After a median follow-up time of 24 months, 6 patients developed adverse outcomes, including 2 local recurrences, 4 metastases, and 2 tumor-related deaths. Univariate logistic regression analysis revealed that nerve diameter and number of affected nerves were significantly associated with adverse outcome. A composite PNI score, calculated from 5 histopathologic features, was the strongest predictor of adverse outcome (p = .020). CONCLUSION Histopathologic features of PNI can be quantified with a composite PNI score that is significantly associated with adverse outcomes in cSCC. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.