Compensatory Treatments Research Articles

The Prescribing Patterns of Diuretics in Intensive Care Retrospective Study About 64 Cases

Diuretics are commonly recommended in medical practice, utilized for both chronic management and emergency interventions in intensive care units., due to their powerful pharmacological effect. However, their use in the intensive care setting is sometimes inappropriate and excessive, leading to errors in indication and significantly increased iatrogenic harm. Our study aims to evaluate the use of diuretics in intensive care units by examining the indications for prescription as well as their clinical and biological impacts, in order to elucidate practical guidelines for optimal use ensuring relevant and safe employment while eliminating harmful practices that could have serious consequences for the health of intensive care patients. To achieve this, we conducted a retrospective descriptive case series study involving patients hospitalized in the medical intensive care unit of CHU Ibn Rochd in Casablanca from January 1, 2022, to December 31, 2022. Demographic, clinical, paraclinical, therapeutic, and evolutionary data were collected. Out of the 292 patients hospitalized in the medical intensive care unit during the year 2022, 64 cases of diuretic use were collected, with an incidence of 21.91%. The most frequent indications for diuretic use in our series were acute renal failure and inadequate diuresis, followed by acute respiratory distress syndrome and heart failure. Furosemide was the only diuretic prescribed in our series. Following diuretic administration, hemodynamic, metabolic, and organic complications were observed. The most frequently encountered complications were arterial hypotension requiring the use of vasoactive drugs in some cases, hypokalemia, and impaired renal function. Mortality was high in our series, with death occurring in 77% of our patients. The indications for diuretics in intensive care have changed over the last decade. They are no longer recommended in cases of acute renal failure to maintain diuresis or to preserve renal function, nor in hepatorenal syndrome as this can worsen renal perfusion and acute renal injury. However, as part of fluid balance regulation by the intensivist, diuretic administration may be considered in organ congestion, particularly pulmonary, and in various situations such as ventilatory weaning, acute heart failure, and acute respiratory distress syndrome, provided that this use is carefully evaluated and associated with precise administration modalities, in addition to appropriate compensatory treatments to prevent their adverse effects.

Qualifications, professional roles and service practices of nurses, occupational therapists and speech-language pathologists in the management of adults with oropharyngeal dysphagia: a Nordic survey

Purpose To identify the qualifications, professional roles and service practices of nurses, occupational therapists (OTs) and speech-language pathologists (SLPs) in the management of adults with oropharyngeal dysphagia (OD) in the Nordic countries. Methods A web-based survey was developed that consisted of 50 questions on respondent demographics, education, experience, roles and service practices provided for adults with OD. The survey was distributed to practicing nurses, OTs, and SLPs in five Nordic countries via professional associations, social media, online networks and snowballing. Results Data from 396 nurses, OTs and SLPs whom provided services for adults with OD revealed that the majority of respondents worked in acute care and inpatient rehabilitation facilities. Most respondents had minimal undergraduate education and practical clinical training in OD. Notable variances in roles and service practices in OD between professions and countries were found. OTs were the primary service provider for OD management in Denmark, while SLPs had this role in the other Nordic countries. Nurses were mainly involved in screening and some compensatory treatments in most Nordic countries. Limited use of evidence-based screening, non-instrumental or instrumental clinical assessments and rehabilitative therapeutic methods was evident. Conclusions Study results highlight challenges in education and training of professionals responsible for the management of adults with OD in the Nordic countries. Increased use of evidence-based assessment and exercise-based treatments to improve swallowing are warranted. Adherence to European and international clinical practice guidelines for the management of adults with OD is recommended.

Disorders of higher visual processing in patients with acquired brain injury.

Disorders of higher visual processing often impact patients with acquired brain injury. Even with treatment, these vision conditions can cause chronic challenges for patients. Understanding these conditions and their management can help improve functional independence and quality of life. To discuss the various disorders of higher visual processing that result from acquired brain injury. Discussion to include classification, evaluation, and treatment techniques available to clinicians. Peer reviewed journal articles were searched, primarily through PubMed. Articles spanning several decades were included in the review for historical context of these conditions, however an emphasis was placed on more recent publications for purposes of a discussion regarding clinical management of these conditions. Peer-reviewed articles and clinical trials from across several disciplines were included to frame a discussion of this varied group of conditions. Visual processing disorders have debilitating impacts on both the rehabilitation process as well as functional independence. Varied approaches are utilized in the treatment of these conditions with limited success. Understanding the benefits and limitations of both restorative and compensatory treatments will better help clinicians manage patients with these conditions.

Personalization of Restorative and Compensatory Treatments for People With Aphasia

Speech–language pathologists serving individuals with aphasia must make many decisions regarding assessment and intervention practices to support comprehension and expression of language. Each of these decisions can influence the effectiveness of therapy and long-term functional outcomes for individuals with aphasia. One factor that must be considered is the impact of personalizing therapy techniques to match the unique strengths and challenges of a client as well as incorporating personally relevant stimuli and methodologies into therapy. Research indicates that treatment customization can have a positive impact on service provision quality and can potentially lead to positive outcomes in therapy. The purpose of this article is to provide a broad overview of how personalization can be achieved across a variety of interventions. Furthermore, we explore factors (e.g., client motivation, cognitive resources) that influence therapeutic outcomes and discuss the benefits, challenges, and rationale for therapy customization.

Oropharyngeal dysphagia and malnutrition in patients with Covid-19 at the Consorci Sanitari Del Maresme, Catalonia, Spain: Prevalence and needs of compensatory treatment

Rationale: COVID-19 may manifest with a wide range of symptoms and its degree of severity may be from mild to severe. Our aim was to assess the prevalence and pathophysiology of oropharyngeal dysphagia (OD), malnutrition (MN), nutritional risk, and the needs of compensatory treatments in patients admitted due to COVID-19 at the Consorci Sanitari del Marseme (CSdM), Catalonia, Spain. Methods: Prospective observational study with clinical assessment of OD (clinical symptoms, clinical observation and Volume-Viscotisy Swallowing Test) and nutritional screening with NRS2002 and GLIM criteria in consecutive COVID-19 patients admitted at the Hospital de Mataró (CSdM) during 2020 Covid-19 pandemics. Patient’s clinical characteristics and their needs of compensatory treatments for OD and MN were assessed at baseline and will be followed up at 3 and 6 months. Here we present the baseline data. Results: We included 268 hospitalized patients, 52.2% men, with a mean age of 70.2±17.0 yr, severity of disease was moderate-severe in 34%. At hospital admission prevalence of OD was 52.4% (49.4% had impaired efficacy and 44.9% impaired safety of swallow). Pathophysiology of OD includes ICU and post-extubating factors (16%), neurological factors (32%), respiratory insufficiency (42%) and interstitial pneumonia (74%). Up to 43.7% of patients needed thickeners to be safely hydrated (38.7% with 250mPa·s and 5.2% with 800mPa·s of Xanthan Gum thickeners) and 54.5% had mastication impairments needing texture-modified diets (27.7% easy mastication and 28.8% puree). 74.2% of patients presented a NRS2002>3 and were at risk of MN, 46% had MN and 73.8% of patients received ONS. Conclusion: Prevalence of OD, nutritional risk and MN in patients with COVID-19 at admission in a General Hospital is very high. Pathophysiology is multifactorial and not limited to ICU factors. Early treatment includes fluid thickening, texture modified foods and nutritional support.

ESSD Commentary on Dysphagia Management During COVID Pandemia.

Since the World Health Organization declared the COVID-19 pandemic a Global Public Health Emergency, experts in swallowing are seeking guidance on service delivery and clinical procedures. The European Society for Swallowing Disorders provides considerations to support experts in swallowing disorders in clinical practice. During the COVID-19 pandemic, assessment and treatment of patients with oropharyngeal dysphagia should be provided, while at the same time balancing risk of oropharyngeal complications with that of infection of patients and healthcare professionals involved in their management. Elective, non-urgent assessment may be temporarily postponed and patients are triaged to decide whether dysphagia assessment is necessary; instrumental assessment of swallowing is performed only if processing of the instruments can be guaranteed and clinical assessment has not provided enough diagnostic information for treatment prescription. Assessment and management of oropharyngeal dysphagia is a high-risk situation as it must be considered an aerosol-generating procedure. Personal protective equipment (PPE) should be used. Telepractice is encouraged and compensatory treatments are recommended.

Prevalence, Risk Factors, and Complications of Oropharyngeal Dysphagia in Older Patients with Dementia.

The prevalence of older patients with dementia and oropharyngeal dysphagia (OD) is rising and management is poor. Our aim was to assess the prevalence, risk factors, and long-term nutritional and respiratory complications during follow-up of OD in older demented patients. We designed a prospective longitudinal quasi-experimental study with 255 patients with dementia. OD was assessed with the Volume-Viscosity Swallowing Test and a geriatric evaluation was performed. OD patients received compensatory treatments based on fluid viscosity and texture modified foods and oral hygiene, and were followed up for 18 months after discharge. Mean age was 83.5 ± 8.0 years and Alzheimer’s disease was the main cause of dementia (52.9%). The prevalence of OD was 85.9%. Up to 82.7% patients with OD required fluid thickening and 93.6% texture modification, with poor compliance. OD patients were older (p < 0.007), had worse functionality (p < 0.0001), poorer nutritional status (p = 0.014), and higher severity of dementia (p < 0.001) than those without OD and showed higher rates of respiratory infections (p = 0.011) and mortality (p = 0.0002) after 18 months follow-up. These results show that OD is very prevalent among patients with dementia and is associated with impaired functionality, malnutrition, respiratory infections, and increased mortality. New nutritional strategies should be developed to increase the compliance and therapeutic effects for this growing population of dysphagic patients.

Post-stroke dysphagia: novel treatment approaches

The paper presents the results of examination and treatment in patients in the early recovery period of ischemic stroke. It considers the concurrent use of drug and speech therapies to improve the rehabilitation of patients with post-stroke speech and swallowing disorders. Objective : to identify the role of speech-language therapy and neuropsychology sessions in the treatment of speech and swallowing disorders in the early recovery period of ischemic hemispheric stroke. Patients and methods . A total of 45 patients (32 (71%) men and 13 (29%) women) with a 2–3-month history of ischemic hemispheric stroke were examined. The follow-up period was 2 months. The patients were divided in two groups. Group 1 (a study group) included 30 patients who received combination therapy (drug treatment; sessions with a speech-language pathologist; and compensatory treatments for restoring swallowing function). All the patients had moderate dysphagia accompanied by speech disorders. Moderate sensorimotor aphasia was observed in 15 patients; moderate dysarthria was also seen in 15 patients. Vinpocetine (Cavinton®) and its dispersible tablets (Cavinton® Comfort) were chosen as an agent for vasoactive therapy. Group 2 (a comparison group) consisted of 15 patients with dysphagia who had only standard therapy and speech therapy sessions. There was sensorimotor aphasia in 2 (4%) patients and dysarthria in 13 (29%). A complex psychological and logopedic examination was carried out using the Mann Assessment of Swallowing Ability (MASA), dysarthria assessment, and the scale designed by L.I. Vasserman for estimating the degree of speech disorders in patients with local brain injuries. Results and discussion . Posttreatment swallowing function improved in all the 45 patients; however, more pronounced positive changes were recorded in the patients of Group 1 (p< 0.05). Survey data, possible diet modification, better patient communications, improved quality of life in the patients, and the opinions of their relatives and medical staff served as criteria for the effectiveness of the model used to recover swallowing function. A subjective improvement showed itself as an increased ability to initialize the pharyngeal phase of swallowing in 25 (56%) patients and none mild delays (up to 5 sec) in the movement of a food bolus in the oral cavity in 10 (22%) patients and in the intake of the food of different consistency in 10 (22%). After a treatment cycle in Group 1, the number of patients with mild dysphagia increased up to 30%; moderate swallowing disorders were present in 63% of patients, which required that medical and speech correction should be continued. A significant improvement in swallowing function was noted in 10% of Group 1 patients with medium-sized cortical and cortical-subcortical lesions; a moderate improvement was seen in 67% with medium and small cerebral foci at the same location. At the same time, in Group 2 there were insignificant positive changes only in 20% of patients, most of whom had dysarthria. Conclusion. The high incidence of post-stroke makes it reasonable to use speech therapy methods in a set of multidisciplinary specialized types of care. This care should be personalized; prescribing easy-to-swallow dispersible drugs plays an important role in this case. This will improve quality of life in the patient and protect him from unwanted complications.

Electrical brain stimulation in different variants of primary progressive aphasia: A randomized clinical trial

IntroductionTranscranial direct current stimulation (tDCS) has been recently shown to improve language outcomes in primary progressive aphasia (PPA) but most studies are small and the influence of PPA variant is unknown. MethodsThirty-six patients with PPA participated in a randomized, sham-controlled, double-blind, within-subject crossover design for 15 daily sessions of stimulation coupled with written naming/spelling therapy. Outcome measures were letter accuracy of treated and untreated words immediately after and at 2 weeks and 2 months posttreatment. ResultstDCS treatment was more effective than sham: gains for treated words were maintained 2 months posttreatment; gains from tDCS also generalized to untreated words and were sustained 2 months posttreatment. Different effects were obtained for each PPA variant, with no tDCS advantage for semantic variant PPA. DiscussionThe study supports using tDCS as an adjunct to written language interventions in individuals with logopenic or nonfluent/agrammatic PPA seeking compensatory treatments in clinical settings.

Prognostic Value of EEG Microstates in Acute Stroke.

Given the importance of neuronal plasticity in recovery from a stroke and the huge variability of recovery abilities in patients, we investigated neuronal activity in the acute phase to enhance information about the prognosis of recovery in the stabilized phase. We investigated the microstates in 47 patients who suffered a first-ever mono-lesional ischemic stroke in the middle cerebral artery territory and in 20 healthy control volunteers. Electroencephalographic (EEG) activity at rest with eyes closed was acquired between 2 and 10days (T0) after ischemic attack. Objective criteria allowed for the selection of an optimal number of microstates. Clinical condition was quantified by the National Institute of Health Stroke Scale (NIHSS) both in acute (T0) and stabilized (T1, 5.4 ± 1.7 months) phases and Effective Recovery (ER) was calculated as (NIHSS(T1)-NIHSS(T0))/NIHSS(T0). The microstates A, B, C and D emerged as the most stable. In patients with a left lesion inducing a language impairment, microstate C topography differed from controls. Microstate D topography was different in patients with a right lesion inducing neglect symptoms. In patients, the C vs D microstate duration differed after both a left and a right lesion with respect to controls (C lower than D in left and D lower than C in right lesion). A preserved microstate B in acute phase correlated with a better effective recovery. A regression model indicated that the microstate B duration explained the 11% of ER variance. This first ever study of EEG microstates in acute stroke opens an interesting path to identify neuronal impairments with prognostic relevance, to develop enriched compensatory treatments to drive a better individual recovery.

Comparison of dysphagia outcomes between rostral and caudal lateral medullary infarct patients

ABSTRACTObjective: A detailed knowledge of dysphagia outcomes in lateral medullary infarct (LMI) patients would enable proper establishment of swallowing therapy goals and strategies. However, little is known about the impact of infarct location on dysphagia outcomes in patients with LMI. Methods: Twenty patients with rostral LMI (rostral group) and 20 patients with caudal LMI (caudal group) participated in the study. All patients underwent swallowing therapy, which included compensatory treatments and strengthening exercises, for >3 months. Dysphagia evaluation was performed twice (during the subacute stage and six months after stroke onset) using videofluoroscopic swallowing studies. Dysphagia degree was assessed using the functional dysphagia scale (FDS), the penetration–aspiration scale (PAS) and the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale. Results: In the subacute stage, the rostral group had significantly higher FDS and PAS scores and a significantly lower ASHA NOMS score than the caudal group. Patients from both groups showed significant improvement from the initial evaluation to the six-month evaluation. There were no significant differences in these scale scores between the two groups at the six-month evaluation. Conclusion: In the subacute stage, patients in the rostral group had more severe dysphagia than those in the caudal group. Dysphagia improved in both groups after 3–6 months of swallowing therapy. At six months after onset, there were no significant differences in dysphagia severity between the two groups. Recovery from dysphagia after LMI was observed regardless of the infarct location.

Glucan Supplementation Regulates Secretory Immunity and Stress

Sixty-six children were supplemented with beta glucan and dietary nucleotides, another 63 children served as negative control. We evaluated the effects of these supplements on several aspects of secretory immunity such as levels of secretory IgA (SIgA), albumin and SIgA/albumin ratio. In addition, in order to monitor effects of physical challenges and compensatory treatments on stress and reparation of immunity, we measured levels of salivary cortisol. We found significant effects of supplementation with beta glucan on secretory IgA in children with increased physical challenge. To fully explain these findings, we will need to add additional indicators of stress and salivary immunity.

Neuro-visual rehabilitation.

Despite the fact that almost one-third of patients suffer from visual deficits following brain damage; neuro-visual rehabilitation to compensate for visual field deficits is relatively neglected in the clinical setting. This is in contrast to physio and speech therapies, which are the bread and butter of rehabilitative programs. Likewise, programs that address coping with dementia usually concentrate on language, memory and cognitive skills, but often fail to address the deficits experienced by the subset of patients suffering from progressive cortico-visual dysfunction. Herein, we will review the different approaches to neuro-visual rehabilitation, mainly concentrating on restorative and compensatory treatments. While the first claims to restore vision in the blind visual field, the latter attempts to improve the use of the remaining intact field. These approaches differ in their premise regarding the ability of the adult human brain to adapt following damage, reflecting different attitudes toward the presumed treatment target organ. While restorative therapies claim to reactivate inactive neurons within or around the damaged cortices, compensatory approaches aim to improve voluntary eye movements to compensate the visual loss. We will also briefly discuss the use of optical devices for bypassing the visual deficit as well as the use of the blind-sight phenomena to convert non-conscious visual abilities in the blind visual field into awareness. The various therapeutic approaches will be discussed in the context of patients suffering from hemianopsia and in patients suffering from posterior cortical atrophy. We will argue that of all, the compensatory strategies have shown the most promising results.

Bracket/wire play: what to expect from tipping prescription on pre-adjusted appliances

INTRODUCTION: The opinion on the 'straight-wire' concept has been evolving since its origin, characterized by faithful followers or absolute skepticism. Currently, it seems reasonable to state that most professionals have a more realistic and critical viewpoint, with an attitude that reveals Orthodontics' maturity and greater knowledge on the technique. The most relevant criticisms refer to the impossibility of the both the Straight-Wire and the Standard systems to completely express the characteristics related to the brackets due to mechanical deficiencies, such as bracket/wire play. OBJECTIVES: A critical analysis of this relationship, which is unclear due to lack of studies, was the scope of this paper. METHODS: The compensatory treatment of two patients, using Capelozza's individualized brackets, works as the scenery for cephalometric evaluation of changes in incisor inclination produced by different dimensions of leveling archwires. RESULTS: The evaluation of these cases showed that, while the introduction of a 0.019 x 0.025-in stainless steel archwire in a 0.022 x 0.030-in slot did not produce significant changes in incisor inclination, the 0.021 x 0.025-in archwire was capable of changing it, mainly in mandibular incisors, and in the opposite direction to the compensation. CONCLUSION: Considering compensatory treatments, even when using an individualized prescription according to the malocclusion, the bracket/wire play seems to be a positive factor for malocclusion correction, without undesirable movements. Therefore, it seems reasonable to admit that, until a bracket system can have absolute individualization, the use of rectangular wires that still have a certain play with the bracket slot is advisable.

The Neurobiology of Language Recovery in Aphasia

The Neurobiology of Language Recovery in Aphasia

Does nutrition cause intelligence? A reanalysis of the Cali experiment

Recent literature has suggested there is a causal link between malnutrition and impaired cognitive development. From a selective review of this literature it is concluded that owing to methodological imperfections in many of these studies the presence or absence of such a link cannot be established, even if randomized experiments were to be carried out. It is argued that compensatory experiments, even though they are not as logically compelling as experiments where proper nutrition is withheld, are ethically justifiable and more useful strategically since they may suggest ways of improving the cognitive development of currently affected children, especially if a variety of compensatory treatments is implemented. A reanalysis of such an experiment was conducted to determine whether the nutritional or educational component of the treatment was responsible for the observed gains in cognitive development. The reanalysis indicated that after four years of treatment there was no association between cognitive and nutritional status. The results were discussed in relation to previous research. Some of the social implications of the results were also discussed.