Poor Dexterity Research Articles

DOES MOTOR PROFICIENCY INFLUENCE SLEEP, PHYSICAL ACTIVITY AND MENTAL WELLBEING IN AUSTRALIAN CHILDREN?

INTRODUCTION Motor impairments such as poor timing, balance, sequencing, and dexterity often impact on the child’s quality of life, both physically and emotionally. Sleep and physical activity are modifiable behaviours that have a bi-directional association with mental health outcomes. However, there is very limited research on sleep in children with motor difficulties. The aim of this study is to examine if level of motor proficiency influences physical activity, sleep behaviour, and mental well-being. METHODS Children aged between 6 and 12 years attended one ∼90-minute testing session where they completed the Movement Assessment Battery for Children (MABC; 2nd edition), the Test of Gross Motor Development (TGMD; 3rd edition), and a brief physical activity assessment. Questionnaire were completed by the children and parents (Adolescents Motor Competence Questionnaire (AMCQ), Short Moods and Feelings, Kids Screen, Strength and Difficulties Questionnaire, Children’s Sleep Habits Questionnaire (CSHQ). RESULTS Currently, 15 children (9 males, mean age 9.2 ± 1.97 yrs) have completed the study. Preliminary results show a mean TGMD index of 104.93 ±1.97, suggesting motor skills performed to an average level. The MABC percentile rank was 56.93 ±27.05, one participant below 5th percentile (motor impairment). AMCQ mean 87.00±8.9, however four participants had perceived low motor competence. Interestingly mean sleep score suggests high sleep disturbance among the sample (CSHQ mean 42.33 ± 9.73) with 9 out of 15 participants identifying with a paediatric sleep disorder (three low motor competence and six high motor competence has a paediatric sleep disorder). CONCLUSION Results indicate some interesting findings with both high and low motor competence children demonstrating a sleep disorder. Further analysis looking at actigraph sleep data, sleep diary and physical activity collected over 7 days will be presented during the conference.

Assessment and Management of Existing Direct Restorations with a Minimal Invasive Approach in Older Population

We have an increasing older population with a reduced number of edentulism. This has led to an increased number of patients with complex restorations. Any failing restoration will require assessment and management, whilst considering their health conditions. The minimal intervention dentistry and operative procedures will help a general dental practitioner to provide ethical and least-invasive dentistry to the older population. It helps to avoid unnecessary tooth destruction and damage to dentine–pulp complex. It prevents iatrogenic damage to adjacent teeth and soft tissues. Minimal intervention dentistry reduces costs for the older population. Clinical Relevance: The growing older population along with the rising restorative challenges of heavily restored dentition, occlusion, salivary dysfunction, disruptive behaviours, poor dexterity, poor compliance, high plaque levels, and financial constraints, if inevitable the operative procedure needs to be minimal to preserve tooth structure.

Changes in Brain Activation Patterns During Working Memory Tasks in People With Post-COVID Condition and Persistent Neuropsychiatric Symptoms.

Post-COVID condition (PCC) is common and often involves neuropsychiatric symptoms. This study aimed to use blood oxygenation level-dependent fMRI (BOLD-fMRI) to assess whether participants with PCC had abnormal brain activation during working memory (WM) and whether the abnormal brain activation could predict cognitive performance, motor function, or psychiatric symptoms. The participants with PCC had documented coronavirus disease 2019 (COVID-19) at least 6 weeks before enrollment. Healthy control participants had no prior history of COVID-19 and negative tests for severe acute respiratory syndrome coronavirus 2. Participants were assessed using 3 NIH Toolbox (NIHTB) batteries for Cognition (NIHTB-CB), Emotion (NIHTB-EB), and Motor function (NIHTB-MB) and selected tests from the Patient-Reported Outcomes Measurement Information System (PROMIS). Each had BOLD-fMRI at 3T, during WM (N-back) tasks with increasing attentional/WM load. One hundred sixty-nine participants were screened; 50 fulfilled the study criteria and had complete and usable data sets for this cross-sectional cohort study. Twenty-nine participants with PCC were diagnosed with COVID-19 242 ± 156 days earlier; they had similar ages (42 ± 12 vs 41 ± 12 years), gender proportion (65% vs 57%), racial/ethnic distribution, handedness, education, and socioeconomic status, as the 21 uninfected healthy controls. Despite the high prevalence of memory (79%) and concentration (93%) complaints, the PCC group had similar performance on the NIHTB-CB as the controls. However, participants with PCC had greater brain activation than the controls across the network (false discovery rate-corrected p = 0.003, Tmax = 4.17), with greater activation in the right superior frontal gyrus (p = 0.009, Cohen d = 0.81, 95% CI 0.15-1.46) but lesser deactivation in the default mode regions (p = 0.001, d = 1.03, 95% CI 0.61-1.99). Compared with controls, participants with PCC also had poorer dexterity and endurance on the NIHTB-MB, higher T scores for negative affect and perceived stress, but lower T scores for psychological well-being on the NIHTB-EB, as well as more pain symptoms and poorer mental and physical health on measures from the PROMIS. Greater brain activation predicted poorer scores on measures that were abnormal on the NIHTB-EB. Participants with PCC and neuropsychiatric symptoms demonstrated compensatory neural processes with greater usage of alternate brain regions, and reorganized networks, to maintain normal performance during WM tasks. BOLD-fMRI was sensitive for detecting brain abnormalities that correlated with various quantitative neuropsychiatric symptoms.

Physical therapy and occupational therapy management of a person with bilateral transradial amputations: a case report

Objective This longitudinal case study describes the physical and occupational therapy interventions and recommendations for treatment of a person with bilateral transradial amputations during subacute rehabilitation, as there are currently few recommendations. Materials and methods A 53-year-old female with subacute bilateral transradial amputations received inpatient rehabilitation. Impairments include decreased balance, global weakness, and need for assistance with ADLs and transfers. Physical therapy, occupational therapy, nursing, a peer mentor, and a prosthetist collaborated. Interventions included task-specific and generalized strengthening, standing balance re-education, assistive device prescription, education using body-powered prostheses, home adaption recommendations, and activities of daily living practice. Results Patient progressed to independent functional mobility but required assist for activities of daily living and stairs negotiation due to limited caregiver support and poor prosthetic dexterity. She discharged to a skilled nursing facility. Conclusion Rehabilitation of a person with bilateral transradial amputations requires clinicians experienced with prostheses; excellent interdisciplinary coordination; early discernment of the available social support system; task-specific strengthening and coordination exercises to prepare the patient for prostheses; significant task-practice with prostheses; and a working knowledge of home modifications and adaptive equipment. This article describes recommendations, successful interventions, and lessons learned for future therapists when rehabilitating someone with bilateral transradial amputations. IMPLICATIONS FOR REHABILITATION Bilateral transradial amputations (BTAs) are a life-altering, but rare condition, meaning that literature surrounding this population is sparse and that guidelines for rehabilitation are unclear. This article provides recommendations so that clinicians can be better informed when treating BTA patients in the subacute phase and more quickly progress patients toward functional independence and discharge to the community.

Poorer dexterity is associated with underlying Alzheimer’s disease brain pathology

AbstractBackgroundThere has been increasing recognition for the decline of motor function in Alzheimer’s disease (AD) progression and its substantial role in disease morbidity. However, less is known about regional pathology burden—including amyloid‐β and tau protein deposition and cortical trophy—and its relationship to motor performance. Here investigate this relationship using standardized motor function assessment tools.MethodParticipants along a control‐to‐impaired continuum were enrolled in the Alzheimer’s Disease Connectome Project and underwent T1‐weighted MRI (N=206), with a subset undergoing [C‐11]PiB (N=61) and [F‐18 ]Flortaucipir PET (N=58) (Table 1) imaging for amyloid and tau pathology, respectively. T1‐weighted scans were processed using Freesurfer to estimate regional cortical thickness. [C‐11]PiB distribution volume ratios (DVR; cerebellar GM reference region) and [F‐18] Flortaucipir standardized uptake value ratios (SUVr; inferior cerebellar GM reference region) were assessed. Regions of interest (ROI) for analysis included the parahippocampal, entorhinal, motor, and frontal regions. Motor function was assessed utilizing NIH toolbox tests including the 2‐minute walking, 9‐hole pegboard dexterity, and dynamometer grip strength assessments. Motor performance was analyzed using participants uncorrected standardized scores. Scores were collected from participant‐reported dominant hand assessments. Multiple linear regression models tested relationships between AD biomarker burden and motor performance while controlling for age and sex of participants.ResultIncreased amyloid‐β (β‐0.42, p‐value: <0.05) and tau (β: ‐0.53, p‐value: <0.05) burden in primary motor cortices were associated with worse dexterity scores independent of age and sex. Grip strength did not show a significant correlation to cortical amyloid‐β (β: ‐0.14, p‐value 0.33) or tau burden (β: 0.23, p‐value: 0.36). Higher cortical thickness in primary motor regions were associated with higher dexterity (β: 0.21, p‐value <0.0001) and 2‐minute walking scores (β: 0.24, p‐value <0.001). When controlling for age and sex, grip strength predicted decreasing cortical thickness (β: 0.01, p‐value: <0.001) (Table 2).ConclusionLower dexterity performance may be driven by elevated AD pathological burden and cortical thinning in cortical motor regions. Further research into motor performance and clinical disease manifestation is needed to determine the diagnostic utility of fine motor assessment as a predictor of motor decline in individuals with Alzheimer’s disease pathology.

Hand dexterity, daily functioning and health-related quality of life in kidney transplant recipients

Impaired interplay between sensory and motor function may be an important, often overlooked cause of the decreased daily functioning and impaired health-related quality of life (HRQoL) of kidney transplant recipients (KTR). We assessed this interplay using a hand dexterity test, and investigated its potential associations with daily functioning and HRQoL among KTR enrolled at the TransplantLines Biobank and Cohort Study. A total of 309 KTR (58% male, mean age 56 ± 13 years) at median 4 [IQR: 1–11] years after transplantation were included. Impaired hand dexterity, as defined by a test performance slower than the 95th percentile of an age- and sex-specific reference population, was observed in 71 (23%) KTR. Worse hand dexterity was independently associated with worse performance on almost all measures of physical capacity, activities of daily living and societal participation. Finally, hand dexterity was independently associated with physical HRQoL (standardized beta − 0.22, 95%CI − 0.34 to − 0.09, P < 0.001). In conclusion, impaired interplay between sensory and motor function, as assessed by hand dexterity, is prevalent among KTR. In addition, poor hand dexterity was associated with impaired daily functioning and limited physical HRQoL. Impaired interplay between sensory and motor function may be therefore an important, hitherto overlooked, phenomenon in KTR.

Biomaterial-targeted precision nanoparticle delivery to the injured spinal cord

Drug delivery requires precision in timing, location, and dosage to achieve therapeutic benefits. Challenges in addressing all three of these critical criteria result in poor temporal dexterity, widespread accumulation and off-target effects, and high doses with the potential for toxicity. To address these challenges, we have developed the BiomatErial Accumulating Carriers for On-demand Nanotherapy (BEACON) platform that utilizes an implantable biomaterial to serve as a target for systemically delivered nanoparticles (NPs). With the BEACON system, administered NPs are conjugated with a ligand that has high affinity for a receptor in the implanted biomaterial. To test BEACON, an in vivo spinal cord injury (SCI) model was used as it provides an injury model where the three identified criteria can be tested as it is a dynamic and complicated injury model with no currently approved therapies. Through our work, we have demonstrated temporal dexterity in NP administration by injecting 6 days post-SCI, decreased off-target accumulation with a significant drop in liver accumulation, and retention of our NPs in the target biomaterial. The BEACON system can be applied broadly, beyond the nervous system, to improve systemically delivered NP accumulation at an implanted biomaterial target. Statement of significanceTargeted drug delivery approaches have the potential to improve therapeutic regimens for patients on a case-by-case basis. Improved localization of a therapeutic to site of interest can result in increased efficacy and limit the need for repeat dosing. Unfortunately, targeted strategies can fall short when receptors on cells or tissues are too widespread or change over the course of disease or injury progression. The BEACON system developed herein eliminates the need to target a cell or tissue receptor by targeting an implantable biomaterial with location-controllable accumulation and sustained presentation over time. The targeting paradigm presented by BEACON is widely applicable throughout tissue engineering and regenerative medicine without the need to retool for each new application.

Paramagnetic rim lesions are associated with pathogenic CSF profiles and worse clinical status in multiple sclerosis: A retrospective cross-sectional study

Background: Paramagnetic rims have been observed as a feature of some multiple sclerosis (MS) lesions on susceptibility-sensitive magnetic resonance imaging (MRI) and indicate compartmentalized inflammation. Objective: To investigate clinical, MRI, and intrathecal (cerebrospinal fluid, CSF) associations of paramagnetic rim lesions (PRLs) using 3T MRI in MS. Methods: This is a retrospective, cross-sectional analysis. All patients underwent 3T MRI using a T2*-weighted sequence with susceptibility postprocessing (susceptibility-weighted angiography (SWAN) protocol, GE). SWAN-derived filtered-phase maps and corresponding T2-FLAIR images were manually reviewed to determine PRL. Descriptive statistics, t-tests, and regression determined demographic, clinical, MRI, and CSF associations with PRL. Results: A total of 147 MS patients were included; 79 of whom had available CSF. Forty-three percent had at least one PRL. PRL status (presence/absence) did not vary by sex or Expanded Disability Status Scale (EDSS) but was associated with younger age, shorter disease duration, worse disease severity, high-efficacy therapy use, and poorer dexterity, as well as lower age-adjusted brain volumes and cognitive processing speeds. PRL status was moreover associated with blood–brain barrier disruption as determined by pathologically elevated albumin quotient. Sensitivity analyses remained supportive of these findings. Conclusion: PRLs, an emerging noninvasive biomarker of chronic neuroinflammation, are confirmed to be associated with greater disease severity and newly shown to be preliminarily associated with blood–brain barrier disruption.

Not a bag for life… a bag for living

Stoma products often look and feel medical and can prevent ostomates from living life to the full. They are not designed to address common problems experienced by patients; they can be bulky and visible, allow flatus to escape, need frequent changing (often disrupting sleep) and are uncomfortable. Pelican Healthcare's ModaVi range of ostomy pouches were designed using insight from intestinal ostomates. The company considered their unmet needs and designed products intended to improve patients' quality of life, allowing them to lead the lives they want. ModaVi pouches have innovative features, including being made of a soft fabric that is comfortable and water resistant, and come in black and neutral colours. The pouches are made in different sizes, which can be altered to meet patients' lifestyles and fit in clothing. In addition, they are adapted for people with poor sight or dexterity, and the simple outlet and viewing window make them easier to use. New and established ostomates have evaluated them positively.

Impaired Hand Function and Its Association With Self-Perceived Hand Functional Ability and Quality of Life in Parkinson Disease.

Comprehensive hand function in people with Parkinson disease (PD) has been underevaluated. The objectives were to compare self-perceived and objective hand functions of PD and controls, compare outcomes between more and less affected hand subgroups, and evaluate relationship between self-perceived and objective outcomes in subgroups. A total of 165 PD and 82 healthy participants completed the Jebsen-Taylor Hand Function Test, Purdue Pegboard Test, grip strength test, and Manual Ability Measure-16 in a cross-sectional study. PD participants completed the Parkinson Disease Questionnaire-39. Associations between objective and self-perceived/quality of life outcomes in PD groups were analyzed, and nondominant and dominant more affected subgroups performance was compared. PD participants had significantly worse performance in most Jebsen-Taylor Hand Function Test and all Purdue Pegboard Test items, lower Manual Ability Measure-16 scores, and poorer handgrip strength. Weak associations were found between dexterity, but not grip strength, and self-perceived functional hand ability and Parkinson Disease Questionnaire-39 scores in PD subgroups. For nondominant more affected subgroup, poorer dexterity was associated with better Parkinson Disease Questionnaire-39 Activity of Daily Living domain scores. People with mild to moderate PD were shown to have poorer manual dexterity, reduced grip strength, and lower self-perceived functional hand ability than controls. Associations between dexterity and self-perceived outcomes highlight the importance of unimanual and bimanual training.

Mobile health (mHealth) usage, barriers, and technological considerations in persons with multiple sclerosis: a literature review.

ObjectivesPersons with multiple sclerosis (MS) can face a number of potential healthcare-related barriers, for which mobile health (mHealth) technology can be potentially beneficial. This review aimed to understand the frequency, current uses, and potential barriers with mHealth usage among persons with MS.MethodsA query string was used to identify articles on PubMed, MEDLINE, CINAHL, and IEEE Xplore that were published in English between January 2010 and December 2019. s were reviewed and selected based on a priori inclusion and exclusion criteria. Fifty-nine peer-reviewed research studies related to the study questions are summarized.ResultsThe majority of persons with MS were reported as using smartphones, although rates of mHealth utilization varied widely. mHealth usage was grouped into 3 broad categories: (1) disability and symptom measurement; (2) interventions and symptom management; and (3) tracking and promoting adherence. While there have been an increasing number of mHealth options, certain limitations associated with MS (eg, poor dexterity, memory problems) may affect usage, although including persons with MS in the design process can address some of these issues.DiscussionGiven the increased attention to mHealth in this population and the current need for telehealth and at home devices, it is important that persons with MS and healthcare providers are involved in the development of new mHealth tools to ensure that the end product meets their needs. Considerations for addressing the potential mHealth use barriers in persons with MS are discussed.

Severe Cubital Tunnel Syndrome: Considerations for Nerve Transfer Surgery.

Cubital tunnel syndrome is the second most common compressive neuropathy, next to only carpal tunnel syndrome in its incidence. Severe states of disease do not respond to nonoperative management. Likewise, functional outcomes of cubital tunnel surgery decline as the disease becomes more severe. The relatively long distance from site of nerve compression at the elbow to the hand intrinsic muscles distally makes it a race between reinnervation of the muscle and irreversible motor endplate degeneration with muscle atrophy. Loss of intrinsic function can lead to severe functional impairment with poor dexterity and clawing of the hand. While decompressing the nerve at the site of compression is important to prevent further axonal injury, until recently, the only option to restore intrinsic function was tendon transfers. Tendon transfers aim to restore thumb side pinch and control clawing with addition surgery. They also require the sacrifice of wrist extensors or finger flexors. In the past decade, nerve transfers to the distal portion of the ulnar nerve innervating these intrinsic muscles, originally described for proximal ulnar nerve injury or transections, have become increasingly popular as an adjunct procedure in severe cubital tunnel syndrome. Physicians treating severe ulnar neuropathy must be aware of these nerve transfers, as well as their indications and expected outcomes. The so-called supercharged anterior interosseous nerve (AIN)-to-ulnar motor nerve transfer has become a mainstay for distal nerve transfers for ulnar neuropathy and/or injury. Ideal patients to undergo such a procedure demonstrate severe ulnar neuropathy on nerve conduction and electromyography studies, with reduced compound muscle action potential (CMAP) amplitude and fibrillations at rest. Recent studies demonstrate nerve transfers to be superior in intrinsic muscle reinnervation compared with nerve graft in the setting of large segmental nerve defects. Likewise, compared with decompression alone, patients undergoing the supercharge procedure are more likely to regain intrinsic function and less likely to need secondary tendon transfer surgeries. Finally, initial results for sensory nerve transfer to recover sensation in the ulnar-sided digits in severe cubital tunnel are more advantageous than for decompression alone. Distal nerve transfers offer a reliable, reproducible treatment option for the restoration of intrinsic hand function and protective sensation in the setting of severe cubital tunnel syndrome.

Cleansing efficacy of an auto-cleaning electronic toothbrushing device: a randomized-controlled crossover pilot study

ObjectivesTo compare the cleansing efficacy of a representative “ten seconds” auto-cleaning device with that of uninstructed manual toothbrushing in a pilot study.Materials and methodsTwenty periodontally healthy probands refrained from oral hygiene for 3 days. Baseline full-mouth plaque scores (Rustogi Modified Navy Plaque Index, RMNPI) were assessed. After randomization, probands cleaned their teeth either with the auto-cleaning test device according to the manufacturer’s protocol or with a manual toothbrush. Plaque reduction was assessed by two aligned blinded investigators. After a 2-week recovery, the clinical investigation was repeated in a crossover design. The brushing pattern of the auto-cleaning device was analyzed in probands’ casts.ResultsFull-mouth plaque reduction was 11.37 ± 3.70% for the auto-cleaning device and 31.39 ± 5.27% for manual toothbrushing (p < 0.0001). The investigation of the auto-cleaning device’s brushing pattern in dental casts revealed a positive relationship of bristle rows in contact with tooth surfaces and the cleansing efficacy in the respective areas. A maximum of 2/4 bristle rows were in contact with the tooth surfaces; in some areas, the bristles had no contact to the teeth.ConclusionsUninstructed manual toothbrushing is superior to auto-cleaning. The alignment and density of the auto-cleaning device’s bristle rows need to be improved, and assorted sizes would be necessary to cover different jaw shapes.Clinical relevanceThe auto-cleaning device has been developed to accommodate individuals with poor dexterity or compliance. To date, it is unable to provide sufficient plaque reduction due to an inappropriate bristle alignment and poor fit with diverse dental arches.

Handheld Active Add-On Control Unit for a Cable-Driven Flexible Endoscope.

The instruments currently used by surgeons for in utero treatment of the twin-to-twin transfusion syndrome (TTTS) are rigid or semi-rigid. Their poor dexterity makes this surgical intervention risky and the surgeon's work very complex. This paper proposes the design, assembly and quantitative evaluation of an add-on system intended to be placed on a commercialized cable-driven flexible endoscope. The add-on system is lightweight and easily exchangeable thanks to the McKibben muscle actuators embedded in its system. The combination of the flexible endoscope and the new add-on unit results in an easy controllable flexible instrument with great potential use in TTTS treatment, and especially for regions that are hard to reach with conventional instruments. The fetoscope has a precision of 7.4% over its entire bending range and allows to decrease the maximum planar force on the body wall of 6.15% compared to the original endoscope. The add-on control system also allows a more stable and precise actuation of the endoscope flexible tip.

Patient-Centered Counseling for Older Adults

Patient-Centered Counseling for Older Adults

The ability of people with intellectual disability to use inhalers – an exploratory mixed methods study

Objective: This aim of this study was to assess inhaler technique of people with intellectual disability (ID), and evaluate the effectiveness of teaching with respect to their individual ability to adopt correct technique. Methods: Seventeen people with ID were recruited through existing networks of general practitioners and disability support organisations. Inhaler technique was assessed using validated checklists and placebo devices, followed by provision of individualised training. The educational interaction between participant and researcher was captured via video recording and analysed qualitatively. Results: Seventeen people with ID participated; females comprised 65%. At baseline, no participants correctly used any device. Pressurised metered dose inhalers, with or without accessory devices, were the most poorly used devices. Inhalation steps were poorly performed across all devices. Following training, the proportions of assessed participants that were able to master inhaler technique were 100% of Accuhaler users, 40% of Turbuhaler users, 25% of pressurised metered dose inhaler users and 0% of Handihaler users. Barriers identified included poor comprehension of breathing processes, the lack of attentiveness and poor dexterity. Facilitators for educator delivery of inhaler technique education included the use of analogies and being patient. Conclusions: This is the first study to examine inhaler technique mastery in people with ID. Results show that with education that addresses the unique patient barriers inherent in this group, some individuals can be trained to mastery. Structured modules of inhaler technique training tailored for people with ID, but which can be individualised, are recommended.

Precise digit use increases the expression of handedness in Colombian spider monkeys (Ateles fusciceps rufiventris).

Decades of research on the hand use patterns of nonhuman primates can be aptly summarized by the following phrase: measurement matters. There is a general consensus that simple reaching is a poor indicator of handedness in most species, while tasks that constrain how the hands are used elicit individual, and in some cases, population-level biases. The TUBE task has become a popular measure of handedness, although there is variability in its administration across studies. The goal of this study was to investigate whether TUBE performance is affected by tube diameter, with the hypothesis that decreasing tube diameter would increase task complexity, and therefore the expression of handedness. We predicted that hand preference strength, but not direction, would be affected by tube diameter. We administered the TUBE task using a 1.3 cm tube to Colombian spider monkeys, and compared their performance to a previous study using a larger 2.5 cm diameter tube. Hand preference strength increased significantly on the smaller diameter tube. Hand preference direction was not affected. Notably, spider monkeys performed the TUBE task using a single digit, despite the longstanding view that this species has poor dexterity. We encourage investigators who use the TUBE task to carefully consider the diameter of the tube used in testing, and to report digit use consistently across studies. In addition, we recommend that researchers who cannot use the TUBE task try to incorporate the key features from this task into their own species appropriate measures: bimanual coordination and precise digit use.

PD9-05 ATTITUDES TOWARD THE USE OF CONTINENT URINARY DIVERSIONS IN PATIENTS UNDERGOING CYSTECTOMY: A SURVEY OF THE SOCIETY OF UROLOGIC ONCOLOGY

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion I1 Apr 2015PD9-05 ATTITUDES TOWARD THE USE OF CONTINENT URINARY DIVERSIONS IN PATIENTS UNDERGOING CYSTECTOMY: A SURVEY OF THE SOCIETY OF UROLOGIC ONCOLOGY Adam Mellis, Michael Cookson, and Joel Slaton Adam MellisAdam Mellis More articles by this author , Michael CooksonMichael Cookson More articles by this author , and Joel SlatonJoel Slaton More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.932AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Our institution recently reported that despite tremendous enthusiasm towards the introduction of continent urinary diversions (CUD) 20 years ago, surprisingly few patients (only 15–19%) end up undergoing a CUD in the contemporary era. Our study goal was to survey members of the Society of Urologic Oncology (SUO) for attitudes towards the use of CUD. METHODS In conjunction with the SUO, our institution performed an electronic survey of physicians in the organization during the fall of 2014. Data collected included patient factors influencing decision making for use of CUD (gender, age, comorbidities, obesity, previous radiation or surgeries, hydronephrosis and renal dysfunction), intraoperative factors and surgical factors and stratified results by provider demographics and education. RESULTS Among the 93 responders to the survey. 88% were fellowship-trained and 82% were academically-based. Among the responders, 52% perform less than 20 cystectomies per year. 56% of responders created a neobladder in less than 20% of patients with providers of less than 10 years of experience less willing to perform a neobladder than more experienced providers. Physicians' choice of ileal neobladder was Studer (54%) over Hautmann (26%). A robotic cystectomy was a strong consideration among 36% of younger physicians compared to 18% of older physicians. Providers found female gender to be a negative influence compared to male gender in deciding to create a neobladder. A history of an myocardial infarction, poor dexterity, morbid obesity, a creatinine of greater than 2.0 mg/dl were all negative influences toward use of CUD. While nearly every provider utilizes ureteral stents, younger providers were more likely to use a suprapubic tube into the neobladder (62% vs 55%) and less likely to use a nasogastric tube (24% vs 34%) and to perform a mechanical bowel prep (29% vs 56%). CONCLUSIONS Most providers report performing CUD at a rate (20–30%) slightly above that reported in our previous study (15–19); this difference may reflect the SUO providers' strong association with academic institutions. As expect a number of factors tend to sway providers away shy away from use of CUD, including significant comorbidities and manual dexterity though remains a disparity in attitudes between use of neobladders in women vs men. The attitudes of younger providers toward specifics techniques (less use of bowel prep and nasogastric tubes) reflect adoption of evolving attitudes in the management of bowel during surgical resections. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e196 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Mellis More articles by this author Michael Cookson More articles by this author Joel Slaton More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Six-DOF parallel manipulators with maximal singularity-free joint space or workspace

SUMMARYSingularity-free workspace is a very important criterion for the design of manipulators, especially for parallel manipulators which are well known for their limited workspace and complex singularities. This paper studies geometric parameters and dexterity measures that affect the size of a singularity-free joint space and proposes methods for the development of 6-DOF Stewart–Gough parallel manipulators that have better singularity-free joint space. With a local dexterity measure as the objective function, a systematic method is employed to search for the design with a maximal singularity-free joint space. The related workspaces are also investigated. It is shown that the workspace is not proportional to the size of the joint space and that manipulators with a larger singularity-free workspace usually have relatively poor dexterity.

The Tipping Point: Prolonged Hospital Course As a Result of Dental Infection in a Nonagenarian

To the Editor: Untreated dental disease can lead to poor quality of life and potentially life-threatening infections in the growing population of vulnerable elderly adults. National data from the U.S. Centers for Disease Control and Prevention (CDC) indicate that 7% of individuals aged 65 and older report having had tooth pain at least twice during the last 6 months and that one-third have untreated dental disease.1 Impaired mobility, poor dexterity, cognitive dysfunction, and lack of insurance coverage impede older adults' access to dental care. This is a report of a case of an independent nonagenarian hospitalized for management of a potentially preventable dental infection. This case highlights the dramatic implications of neglecting oral care on overall health and well-being of an older adult. A man in his early 90s, previously independent in all of his activities of daily living (ADLs) presented to the emergency department (ED) with a 2-week history of right facial swelling and pain, fever (103.4°F, white blood cell count 15,500/μL) and poor oral intake. His past medical history included diabetes mellitus (glycosylated hemoglobin (HbA1c) 8.0%), hypertension, benign prostatic hypertrophy, hypothyroidism, and hyperlipidemia. He had previously been seen in an outpatient clinic and was given a prescription for penicillin. In the ED, computerized tomography of his head and neck revealed a multiloculated area of gas and fluid throughout the right side of the neck (3.4 × 4.8 × 4.5 cm). An extraoral incision and drainage (I&D) was completed, and he was admitted to the surgical intensive care unit (SICU) for airway monitoring and intravenous antibiotic treatment. After 3 days, he was transitioned to oral antibiotics and transferred to the general medical floor, although he subsequently reported feeling worse, with more pain and facial swelling, and a second I&D was completed. An oral surgeon then saw him after oral imaging revealed a periapical abscess related to an odontogenic infection. The teeth involved were extracted, and the patient was returned to the floor. However, his right cheek swelling still did not improve, so he was taken to the operating room for transcervical drainage and returned to the SICU for mechanical ventilation and monitoring. He gradually improved, and on hospital Day 19 was admitted to long-term care for rehabilitation. His treatment included physical and occupational therapy, nutritional counseling (albumin 2.6 g/dL upon admission), and follow-up dental services. Further examination and imaging revealed poor remaining dentition and a second periapical abscess. His remaining teeth were extracted because of poor prognosis and risk of further infection. After extraction of the remaining teeth, he had an uneventful recovery. His strength and oral intake increased, and he was discharged home after 22 days in the long-term care setting. Follow-up at 6 months revealed an unremarkable head, ears, eyes, nose, and throat examination with improved diabetes control (HbA1c 6.8%) and a return to baseline functional status. Oral health is an important component of healthy aging.2 Poor oral health in vulnerable elderly adults can lead to compromised nutritional intake, pain, and possibly life-threatening infections. Oral disease can also affect an individual's general health and result in acute illness with prolonged recovery. The number of decayed teeth has been significantly related to the incidence of aspiration pneumonia.3 A 5-year retrospective study of individuals admitted for odontogenic maxillofacial infection reported a positive correlation between length of admission and age of the individual.4 As in the case presented, a longer hospital stay reflects a more-complicated course and treatment, such as the need for repeated I&D. Untreated dental disease in elderly adults can result in acute illness, which may result in prolonged recovery and affect quality of life. Several opportunities exist for improving oral care and reducing resultant morbidity in older adults. Improving access to dental care and stressing the importance of daily oral care to elderly adults and their caregivers should improve overall health and could even reduce the number and complexity of hospitalizations. Because aging comes with comorbid illness resulting in greater likelihood of seeing a physician rather than a dentist, further education of primary care physicians and geriatricians on common oral conditions is an important potential prevention strategy.5 This case demonstrates the effect of poor oral health in older adults on quality of life and healthcare use and the urgent need for new solutions to this growing problem. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Hamid Afshari: Assistance in the dental management and treatment. Eleanor McConnell and Lauren Patton: Revision of manuscript. Mitchell Heflin: Revision of manuscript and approval of final version. Sponsor's Role: None.