Mean Follow-up Scores Research Articles

Assessment of Handover Communication among Neurology Residents: Utilization of a Handover OSCE and a Standardized Curriculum To Improve Transitions of Care (P07.237)

Objective: Our purpose was to assess changes in handover communication among PGY-2 neurology residents after completing a standardized handover curriculum. Background Handovers between housestaff during transitions of inpatient care are typically unstructured. Handover frequency has increased as a consequence of changes in resident duty hour standards. Omission of key handover information can adversely affect patient safety and outcomes. Formal handover training has not been widely adopted into resident education despite an ACGME mandate that programs ensure and monitor effective, structured handover procedures. Providing formal training in handover procedures achieves the core competencies of enhanced patient care, interpersonal communication, and systems based practice. Design/Methods: A two-part objective structured clinical examination (OSCE) was used to assess handover communication. In Part I, the resident received a verbal handover lacking critical clinical information and was given the opportunity to request additional information from the examiner. In Part II, the resident provided a verbal handover after reading a patient vignette containing both core elements and superfluous information. For each part, a total score of 15 was possible with one point awarded for each of pre-specified15 core elements incorporated by the resident during the simulated handover communication. Following the initial OSCE, residents completed a structured handover curriculum and were re-assessed at 3 months. Results were compared using a paired t -test (GraphPad Software, Inc). Results: Four PGY-2 neurology residents completed the initial and follow-up OSCE. For Part I, the mean initial score was 7.75 and the mean follow-up score was 11.75 (4 point improvement; 95% confidence interval 2.16-5.84, p=0.0062). For Part II, the mean score was 13.25 on both initial and 3-month follow-up assessment. Conclusions: This study suggests that a standardized handover OSCE is sensitive to performance changes after completion of a structured handover curriculum. Standardized education with ongoing resident-to-resident feedback is effective in improving handover competency. Disclosure: Dr. Chiota has nothing to disclose. Dr. McCollum has nothing to disclose. Dr. Mauricio has nothing to disclose. Dr. Ditrapani has nothing to disclose. Dr. Capobianco has nothing to disclose. Dr. Barrett has nothing to disclose.

Midterm Outcome of Modified Kidner Procedure

The results of modified Kidner procedures have generally been satisfactory at short-term followup. The objective of this study was to evaluate the midterm followup results including medial longitudinal arch height. Forty-one patients (50 feet) with a symptomatic accessory navicular who underwent the modified Kidner procedure between July 1999 and February 2004 were evaluated. A midfoot AOFAS score, VAS score, and satisfaction rate were recorded. The talo-first metatarsal (T-MT1), talo-calcaneal (TC), and calcaneal pitch (CP) angles were measured on plain radiographs. Average clinical and radiological followup periods were 88.4 ±17.0 months and 85.7 ±15.0 months, respectively. The mean preoperative and followup AOFAS scores were 40.8 ±7.1 (range, 32 to 57), and 88.4 ±7.9 (range, 72 to 100), respectively (p < 0.01). The mean preoperative and followup VAS scores were 7.1 ±1.0 (range, 4 to 9) and 1.8 ±1.0 (range, 0 to 5), respectively (p < 0.01). At last followup , the satisfaction rate was 82.0%. There were no significant differences between preoperative and followup T-MT1 (p = 1.00), TC (p = 0.84), and CP (p = 0.08) angles. Increased medial longitudinal arch was found in four of 16 feet in patients 15 years of age or younger with followup radiographs. We found the modified Kidner procedure could result in symptomatic relief and high satisfaction rate without a loss of arch height in any patient.

92. A Pilot Intervention to Improve Sexually Transmitted Infection Testing for Urban Adolescents

Methods: Eligibility criteria for the study included HIV serostatus, 12 to 29 years of age, use of personal cell phone, English-speaking, and currently on ART regimen, but with poor adherence. Participants agreed to a 24-week (6-month) enrollment period and provided their own cell phone for receipt of messages. Assessments were scheduled for 6, 12, 18, and24-week follow-upperiods. Descriptive anddistributional analyses were performed to describe the sample and evaluate outcomes of interest. For assessment of pre-post changes in adherence levels, scores were compared using a t test for aired samples, with a significance level set at p .05. esults: The participants (n 25) were mean age 23 (range 12-29), 92% male, 60% Black and 84% reported acquiring HIV through unprotected sex. Mean adherence scores on the VAS significantly increased at 12 and 24 weeks in comparison to baseline (0-12 weeks: mean baseline 74.7, mean ollow-up 93.3; p .01; 0-24-weeks: mean follow-up score 93.1; p .01; n 22). Mean CD4 counts increased andmean iral loads decreased from 0-12 and 0-24 weeks. Particiants were very satisfied with the invervention, 80% (n 0) of participants. reported that the text messages helped hem very much, to avoid missed doses of medication; 56% n 14) reported that the reminders help them very much ithmedication refills; and 60% (n 15) said it helped them very much to remember follow-up medical appointments. In addition, 64% (n 16) reported that they prefer to receive the text reminders as part of their care in comparison to regular care with no text messages and 68% (n 17) said they would like to continue to receive text messages after the end of study. With regard to feasibility, 21 of 25 participants (84%) were retained and completed all assessments with no paid staff to provide retention services. At 24-week follow-up, 68% participants (n 17) reported that they received all daily text message reminders and 80% (n 20) indicated that they always, or often read their text message reminders. Only 16% (n 4) of participants found the mesages to be always or sometimes bothersome and 80% (n 0) reported that the messages respected their privacy very uch. onclusions: This pilot study demonstrates that daily text essaging is a feasible and acceptable way to remind HIVositive youth with poor adherence to ART to take their edications and there was a significant increase in adhernce rates post-intervention. Larger studies including a conrol group and youth who are newly starting ART will be eeded to show the potential effect of this intervention to mprove adherence. ources of Support: None.

Health-related quality of life for pediatric emergency department febrile illnesses: an Evaluation of the Pediatric Quality of Life Inventory™ 4.0 generic core scales

ObjectiveWe sought to assess the validity and short-term responsiveness of the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales (PedsQL™) for febrile illnesses evaluated in the pediatric emergency department (ED).DesignProspective cohort study of children 2–18 years discharged after ED evaluation for fever (≥ 38°C). Self-administered, parent-report of health-related quality of life (HRQOL) was assessed using the PedsQL™ Acute Version, a validated HRQOL instrument. HRQOL was measured on ED presentation and at 7–10 day follow-up. At follow-up, duration of fever, child functional impairment, missed daycare/school, and disrupted family unit functioning, were assessed.ResultsOf 160 subjects enrolled, 97 (61%) completed the study; mean follow-up was 8.7 days. Mean total HRQOL score on ED presentation was 76.4; mean follow-up score was 86.3. Compared to subjects that returned to baseline, statistically significant differences in HRQOL were noted for those with prolonged fever, child functional impairment, and relapse. Significant correlation was observed between HRQOL at follow-up and days of daycare/school missed (r = -0.35, p = .003) and days of family disruption (r = -0.43, p < .001). Mean change in HRQOL within subjects, from ED visit to follow-up, was +9.8 (95% CI: 5.6–14.6). Effect size was 0.53, indicating moderate responsiveness.ConclusionThe PedsQL™ appears to be a valid and responsive indicator of HRQOL for short-term febrile illnesses evaluated in the ED.

Short‐ and Long‐Term Effects of Training on Dental Hygiene Faculty Members’ Capacity to Write SOAP Notes

Calibration among faculty is challenging to achieve and maintain. In this study, calibration refers to the training process by which standardization of chart documentation in a SOAP note format was achieved. In the SOAP format, chart entries by health care providers are written in the following categories: Subjective data, Objective data, Assessment, and Plans. The primary training "effect" or outcome that was measured in this study was the capacity of faculty members to write a SOAP note that adhered to prescribed standards for chart documentation. This study was conducted to assess the short-term effects of training and determine whether faculty members' capacity to write appropriately constructed SOAP notes could be sustained for one year. Eight dental hygiene faculty members at the University of Minnesota participated in a pre-training assessment in which they prepared a SOAP note based on a patient case, completed a training session on writing SOAP notes, and completed a post-training test shortly after training that also consisted of writing a SOAP note based on a patient's case. One year later, a follow-up test, similar to the pre- and post-tests, was conducted. Each component of the SOAP note was compared and scored against a gold standard benchmark score of 29 that represented the number of items that should have been included in an ideal SOAP note in the estimation of the investigators, based on chart documentation guidelines of the University of Minnesota Dental Hygiene Division. The mean score for the pre-test was 18.25 (SD=2.82), which represented 63 percent of the benchmark gold standard score of 29. The post-test mean score immediately after training was 24.63 (SD=2.13; 84.9 percent of the benchmark score), and the one-year follow-up mean score was 22.75 (SD=1.83; 78.4 percent of the gold standard benchmark). From the pre-test to the post-test administered in close approximation to the SOAP note training, faculty members' approximation of the gold standard benchmark increased by 35 percent, or 6.28 points, and from the post-test to the follow-up test one year subsequently, approximation of the benchmark score decreased by approximately 1 percent or 1.88 points. Friedman's test indicated that the differences in mean scores for the pre-test, post-test, and follow-up test were significant. The Sign test was used for post hoc tests; alpha was adjusted using Bonferroni's procedure. Conclusions support a hypothesis that faculty capacity to write a SOAP note that adheres to standards can be increased through training and that the effects can be maintained over a period of approximately one year.

Assessing the impact of training on mental health nurses’ therapeutic attitudes and knowledge about co-morbidity: A randomised controlled trial

Background Substance misuse can trigger or be causally associated with mental health problems. Therapeutic attitude is important in predicting effective engagement with people with alcohol and drug problems but health professionals’ attitudes towards this client group are often negative. Education regarding substance misuse has often been neglected and nurses may lack knowledge to provide appropriate care. Objectives To test the impact of training for staff who work with people who have co-existing mental health and substance use problems. Design A randomised controlled trial. Setting An NHS Primary Care Division in the West of Scotland. Participants Forty-nine mental health nurses. Methods Intervention. A four-day training programme. Measurements: (a) therapeutic attitudes measured by the co-morbidity problems perceptions questionnaire; (b) knowledge of alcohol, drugs and co-morbidity measured by a structured questionnaire. Results Significant effects for group ( F = 30.42 , p < 0.001 ) were found in therapeutic attitude scores and also over time ( F = 10.66 , p < 0.001 ). A significant interaction was also found ( p < 0.001 ). Post-hoc testing revealed that the mean pre-training attitude score was significantly different from post-training ( p = 0.001 ; 95% CI 5.53, 25.38) and from six-months follow-up ( p < 0.001 ; 95% CI 11.26, 32.49) but that post-training and follow-up mean scores were not significantly different ( p = 0.358 ; 95% CI −4.71, 17.55). For knowledge, a significant group effect was found ( F = 10.32 , p = 0.002 ), and also a significant time effect ( F = 3.35 , p = 0.039 ) but no significant interaction effect was present ( p = 0.169 ). The post-hoc testing revealed that only a pre-training to six-month follow-up time effect was statistically significant ( p = 0.005 ; 95% CI 1.37, 9.29). Conclusions The training programme was effective in improving the therapeutic attitudes of participants to working with clients who have co-existing mental health and substance use problems, both immediately after the training was delivered, and at six-months follow-up. It was also effective in improving participants’ overall knowledge of alcohol, drugs and co-morbidity.

Etiology, treatment and long-term results of isolated midfoot fractures

Abstract Purpose Etiology, treatment and long-term results of patients with isolated midfoot fractures were evaluated to create a basis for treatment optimization. Method Injury cause, type and extent, treatment and long-term results (American Association of Foot and Ankle Surgery-Midfoot-Score (AOFAS-M), Hannover Scoring System (HSS), own Questionnaire (Q)) of isolated midfoot fractures (avulsions and Chopart/Lisfranc fracture dislocations excluded) were determined. Results Fifty-eight patients with isolated midfoot fractures were included. Injury causes were vehicular trauma ( n =40), falls ( n =13), contusions ( n =3) and others ( n =2). The fractures were located as follows: cuboid, n =28; naviculare, n =23; cuneiforme I, n =19; cuneiforme II, n =11; and cuneiforme III, n =9. 91.4% ( n =53) of cases were treated operatively, 15 times with closed and 38 times with open reduction. Five patients were treated conservatively. Forty-seven (81.0%) patients had follow-up after 9 (1–22) years. The mean follow-up scores of the entire group were AOFAS-M=66.7, HSS=62.8, and Q=62.2. No significant score differences were determined with regard to age, sex, and time or type of treatment. The highest scores were observed in non-displaced fractures or after early anatomic reduction. Conclusion Isolated midfoot fractures without Chopart's or Lisfranc's joint fracture dislocation are uncommon. The long-term results are mostly characterized by minimal functional restrictions. In cases with poor results, the initial restoration of anatomic conditions have been unsatisfactory. Therefore, we recommend the early reduction and internal fixation in all displaced fractures. The reduction should be open if the closed reduction does not achieve anatomic conditions.

Evaluation of ultrasound-guided Extracorporeal Shock Wave Therapy (ESWT) in the treatment of chronic plantar fasciitis

Thirty patients (39 heels) were evaluated to determine the success of ultrasound-guided ESWT for treatment of recalcitrant plantar fasciitis. All patients had been diagnosed and treated for plantar fasciitis for greater than 6 months and had failed at least 3 conservative treatment modalities. Each patient received 3800 shockwaves into the treated heel using the Dornier Epos Ultra ESWT machine. The average postoperative follow-up was 124 days (range, 33 to 255). Written subjective surveys evaluated pre- and posttreatment pain levels using a visual analog scoring system. The mean pretreatment score was 8.51 (range, 5 to 10), which improved to a mean follow-up score of 3.75 (range, 0 to 10). This represents an improvement in the mean VAS of 4.76, which is statistically significant ( P = .0002). Twenty-five of 30 patients reported some degree of improvement, with 5 experiencing no change. These early results indicate ultrasound-guided ESWT may be a useful tool in the treatment armamentarium for chronic plantar fasciitis.

Knowledge of sleep in Italian high school students: pilot-test of a school-based sleep educational program

Purpose To evaluate knowledge about sleep and the effect of a sleep educational program on a group of Italian adolescents. Methods The program consisted of a 2-hour interactive sleep educational course. To assess students' sleep patterns and habits, the School Sleep Habits Survey was completed by 540 students, aged 17 to 19 years, who were attending three secondary public schools. Students were randomly assigned to the control and intervention group. Only the latter participated in the educational program. A pre-test evaluated baseline knowledge about sleep, a post-test measured the gain in knowledge after the course, and a 3-month follow-up test evaluated long-term retention of information. Improvement in knowledge was measured by increase in correct answers and comparisons of means between baseline and follow-up mean scores. Control group completed only baseline and 3-month follow-up tests. Data were analyzed using repeated measures analysis of variance, Cochran Q, and McNemar tests. Results Paired data were available for 425 students. Results showed unhealthy sleeping habits in 34% of students associated with high level of subjective sleepiness, increased vulnerability to injuries, and poor daytime functioning. Pre-test score showed a value of 4.2, post-test of 8.6 and 3-month follow-up of 6.7. Low baseline knowledge about sleep, an increase in knowledge, with an average of 50% gain in the percentage of correct answers immediately after the course, with a good long-term retention of information were found for the students who received the intervention as compared with control group. Conclusion Sleep educational programs for secondary students are recommended to improve information about sleep.

Bone-preserving prosthesis with a single axis for treating osteonecrosis of the femoral head: midterm results for the thrust plate hip prosthesis

We studied 27 patients (31 joints) who underwent total hip arthroplasty (THA) using the thrust plate hip prosthesis (TPP) for osteonecrosis of the femoral head. The mean follow-up period was 56 months (range 38–72 months). Clinical evaluation by the Merle d’Aubigne and Postel system showed a significant improvement from a preoperative mean score of 8.1 to a final mean follow-up score of 16.6. Mechanical loosening developed about 1 year postoperatively in one joint with a bone defect. Grade 1 stress shielding was observed in four joints. Although indications for the TPP are restricted to certain cases, unlike the conventional intramedullary stem, much can be expected of TPP. It is an outstanding prosthesis for osteonecrosis of the femoral head of young patients in terms of bone preservation and physiological load transfer.

Poster 38: Follow-up outcomes and stroke severity

Objective: To examine functional outcomes by case-mix group (CMG) for patients with stroke at 3 months after discharge from acute inpatient rehabilitation programs. Design: Retrospective, using information from US facilities subscribing to the National Followup Service. Setting: Data from follow-up telephone interviews and assessments administered by registered nurses at approximately 90 days postdischarge from 94 facilities for the reporting period of October 1, 2002 to March 15, 2003, were examined. Participants: A total of 17,975 follow-up records were examined. Of those, CMG data were available for 9917 patients; 2055 (20.4%) were patients in Rehabilitation Impairment Category 1 or Stroke (mean age ± SD, 69.59±14.4y). The sample was comprised of 48.81% men and 48.66% women (2.53% missing data for gender) with an average length of stay (LOS) of 17.54±10.43 days. Patient characteristics were derived from associated inpatient records consisting of data from the Inpatient Rehabilitation Facility-Patient Assessment Instrument. Interventions: Not applicable. Main Outcome Measure: Patient/proxy report of follow-up functional status. Results: The mean admission, discharge, and follow-up scores for stroke patients were 61.71, 86.31, and 103.58, with a mean inpatient functional gain of 24.6 and a mean discharge to follow-up gain of 17.28 points. The overall gain from admission to follow-up was 41.87. Of 2055 stroke patients, the largest samples by CMG were: 0114 (19.6%), 0105 (14%), 0113 (13.7%), 0106 (12.2%), and 0105 (10.5%). The average LOS for 0101 was 6.67 days and the LOS for 0114 was 25.1 ( r=.985). Average discharge to follow-up functional gain ranged from 3.17 for CMG 0101 to 21.54 for 0114 ( r=.870). Conclusions: This study provides basic descriptive information regarding function across different stroke CMGs. In addition, we found that as the severity of stoke increased, follow-up functional gain increased. Further study regarding follow-up functional gain is indicated.

Evolution of symptom severity during residential treatment of females with eating disorders.

The overall objective of this study was to measure the evolution of symptom severity in a residential programme based on a multidimensional approach to treatment that includes cognitive-behavioural, interpersonal, experiential and family therapies. The specific aims of the study were: 1) to evaluate changes in symptom severity in bulimic and anorexic patients between admission and discharge; 2) to compare the severity of these symptoms with those of non-patient college females (control group); and 3) to monitor the progression of symptom changes six months after discharge. The evolution of symptom severity was measured by comparing the mean raw scores of the Eating Disorder Inventory (EDI original inventory, 1983 version), which was administered at the beginning and end of the residential treatment. A subgroup of patients was also administered the EDI six months after discharge. The study involved 99 females: 47 with bulimia and 52 with anorexia as diagnosed by means of a clinical interview using DSM-IV criteria. The mean raw EDI scores in the control group (FC1, female college students) were obtained from the EDI manual. The population means were compared using the t-test for paired data (Microsoft Excel, version 2000). The overall results for the population as a whole show that the eight subscales of the EDI improved significantly with treatment (<0.001). The subscales with the largest numerical improvements were drive for thinness, ineffectiveness and interoceptive awareness. When divided on the basis of diagnosis, the mean feelings of perfectionism score of the bulimic patients was less than that of the control female college sample; the symptoms of bulimia in the anorexic patients were similar to those found in the control group. The fact that the mean follow-up scores for a number of the ED1 subscales remained similar to those recorded at the time of discharge suggests that some of the improvements in symptoms remained for at least six months. The results of our study show that multidimensional residential treatment leads to statistically significant changes in the severity of the symptoms manifested by females with eating disorders.

Surgical management of hallux valgus deformity in children with cerebral palsy.

Twenty-six cases of hallux valgus deformity, in 16 children with cerebral palsy, were managed with great toe metatarsophalangeal (MTP) arthrodesis. Mean age at the time of surgery was 16 years (range, 10 years and 11 months to 21 years and 11 months), and mean follow-up was 4 years and 11 months (range, 2 years and 1 month to 10 years). Significant improvement in the hallux valgus angle (preoperative, 36.3 degrees; follow-up, 9.6 degrees; p < 0.05), the intermetatarsal angle (preoperative, 12.3 degrees; follow-up, 8.4 degrees; p < 0.05), and lateral metatarsophalangeal angle (preoperative, 4.8 degrees; follow-up, 25.8 degrees; p < 0.05), were achieved and maintained after MTP arthrodesis. Functional outcome was documented by significant improvement in the modified American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale (preoperative mean score, 46.2; follow-up mean score, 90.9; p < 0.05). Patient/ parent/caregiver satisfaction (as determined by a questionnaire), with improvements in cosmesis, footwear, hygiene, activity, and pain were high, ranging from 81% to 100%. Hallux valgus deformity in children with cerebral palsy is best managed by MTP arthrodesis, in conjunction with other surgical procedures that address segmental foot malalignment and dynamic gait deviations.

Application of a Quality of Life Measure, the Life Situation Survey (LSS), to Alcohol‐Dependent Subjects in Relapse and Remission

Recent studies have shown that quality of life (QOL) is improved significantly when subjects do not relapse to heavy drinking, and QOL deteriorates significantly on prolonged relapse. This article further investigates these relationships using a QOL index, the Life Situation Survey (LSS). Eighty-two DSM-IV alcohol-dependent subjects admitted for alcohol detoxification were studied at baseline and 12 week follow-up. Sociodemographic data were collected, and severity of alcohol dependence (SADQ) and General Health Questionnaire (GHQ-12) were baseline indices only. The main outcome measure, the LSS, was administered at both time points. Two subjects were lost to follow-up and one died during the study period. Thus, the relapse/ nonrelapse analysis related to 79 subjects. Fifty subjects (63%) had relapsed to heavy drinking at 3 months follow-up. There was a significant correlation between LSS and GHQ-12 scores. Significant changes occurred in total LSS scores as a result of relapse and nonrelapse. The improvement in LSS scores associated with nonrelapse was larger than the deterioration that accompanied relapse. In those subjects who did not relapse to heavy drinking, the mean follow-up score remained in the poor/borderline LSS range. Remission from heavy drinking was accompanied by significant improvements in appetite, sleep, and self-esteem. Relapse to heavy drinking coincided with a significant deterioration in mood/affect, public support, and work/life role scores. QOL as assessed by the LSS in recently detoxified alcoholics is impaired significantly. In the nonrelapse group, there was a significant improvement in LSS scores after 3 months. Relapse was accompanied by a smaller deterioration in LSS scores. The LSS can play an important role in monitoring the clinical care and progress of alcohol-dependent subjects.

Application of a Quality of Life Measure, the Life Situation Survey (LSS), to Alcohol-Dependent Subjects in Relapse and Remission

Background: Recent studies have shown that quality of life (QOL) is improved significantly when subjects do not relapse to heavy drinking, and QOL deteriorates significantly on prolonged relapse. This article further investigates these relationships using a QOL index, the Life Situation Survey (LSS). Methods: Eighty-two DSM-IV alcohol-dependent subjects admitted for alcohol detoxification were studied at baseline and 12 week follow-up. Sociodemographic data were collected, and severity of alcohol dependence (SADQ) and General Health Questionnaire (GHQ-12) were baseline indices only. The main outcome measure, the LSS, was administered at both time points. Results: Two subjects were lost to follow-up and one died during the study period. Thus, the relapse/nonrelapse analysis related to 79 subjects. Fifty subjects (63%) had relapsed to heavy drinking at 3 months follow-up. There was a significant correlation between LSS and GHQ-12 scores. Significant changes occurred in total LSS scores as a result of relapse and nonrelapse. The improvement in LSS scores associated with nonrelapse was larger than the deterioration that accompanied relapse. In those subjects who did not relapse to heavy drinking, the mean follow-up score remained in the poor/borderline LSS range. Remission from heavy drinking was accompanied by significant improvements in appetite, sleep, and self-esteem. Relapse to heavy drinking coincided with a significant deterioration in mood/affect, public support, and work/life role scores. Conclusion: QOL as assessed by the LSS in recently detoxified alcoholics is impaired significantly. In the nonrelapse group, there was a significant improvement in LSS scores after 3 months. Relapse was accompanied by a smaller deterioration in LSS scores. The LSS can play an important role in monitoring the clinical care and progress of alcohol-dependent subjects.

ROM Dance Program Effects on Frail Elderly Women in an Adult Day-Care Center

The purpose of this study was to determine if the Range of Motion (ROM) Dance Program, created by Harlowe and Yu (1984), when used as part of an occupational therapy treatment program, has an effect on chronically ill elderly patients' ROM, self-esteem, and participation in activities of daily living (ADL). Seventeen frail, elderly female individuals participated in this four-week study as either an experimental or control group member. Participants' age ranged from 64 to 85 and all had various impairments or conditions associated with aging. This research study compared the participant's pre-program scores to their post-program scores on ROM, self esteem, and ADL's participation. Analysis of the pre-program and initial post-program mean score variances failed to reveal any significant differences between experimental and control groups, in the ADL, self-esteem, or ROM variables. In addition, evaluation of one-month follow-up mean score variances also were not significantly different. These results appear...

Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy: Comparison with positron emission tomography

To assess the presence of viable myocardium salvaged by coronary artery reperfusion, 17 patients with acute anterior myocardial infarction were studied. Each received intravenous thrombolysis within the first 3 h of symptoms and underwent two-dimensional echocardiography before and during dobutamine infusion (10 μg/kg per min) 7 ± 4 days after admission and positron emission tomography 9 ± 5 days after admission. Echocardiography and positron emission tomography were again performed 9 ± 7 months later. Six comparable segments specific for the territory of the left anterior descending artery were selected for comparison of the two techniques. Wall thickening was evaluated by using an echocardiographic score index. Segmental perfusion and glucose uptake were measured and normalized to the peak activity. A ratio of glucose uptake to perfusion was calculated for each segment.Concordant interpretation of the two techniques was found in 79% of affected segments for both acute and follow-up studies. Positron emission tomography revealed the presence of viable myocardium in 11 patients (group 1); perfusion was within normal limits in 5 of these (group 1A). Myocardial thickening improved with dobutamine infusion in these five patients, the echocardiographic score index decreasing from 12 ± 2 at rest to 7.8 ± 1.3 during dobutamine infusion (p = 0.003). Functional recovery was demonstrated in all five patients (follow-up score index 7.4 ± 1.7). Six patients exhibited decreased perfusion but an abnormally high glucose to perfusion ratio (group 1B); their score index improved with dobutamine from 14.8 ± 2.2 to 12 ± 2.1 (p = 0.05), but late functional recovery was found in only one of the six patients (mean follow-up score index in group 1B 16 ± 1.7). In the six remaining patients in whom no viable myocardium was detected with positron emission tomography (group 2), the echocardiographic score index did not change with dobutamine (15 ± 0.9 to 14.7 ± 0.8, p = NS) and there was no functional recovery (follow-up score index 15.5 ± 1.0).Echocardiography during dobutamine infusion is a promising method to unmask viable myocardium in acute myocardial infarction. Early recovery of perfusion in the area at risk is associated with a good functional outcome, whereas a high glucose to perfusion ratio indicates jeopardized myocardium that frequently loses viability.