Acute pancreatitis induced by "herbs of Provence".
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Acute Disease↗
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Medical procedures, complications, and outcomes for patients with spinal cord injury: A multicenter investigation comparing African Americans and whites.
OBJECTIVE: To examine the role of race on rehabilitation outcomes for a matched sample of patients with spinal cord injury (SCI). DESIGN: African Americans and whites with SCI were matched based on age group, level and completeness of injury, and sponsor of care to retrospectively analyze the impact of race. SETTING: Eighteen medical centers in the federally sponsored Model Spinal Cord Injury Systems project. PARTICIPANTS: A total of 628 adults with SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Medical procedures and complications; American Spinal Injury Association motor index, and FIMT instrument scores at admission and discharge; and discharge dispositions. RESULTS: Analysis revealed race-related differences in spinal surgeries, laparotomies, traction during acute care, and method of bladder management at discharge. In most cases, these were explained by cause of injury rather than direct affects of race. No differences were found with regard to medical complications functional outcomes, or discharge disposition. CONCLUSIONS: Although differences exist in the medical procedures given to African Americans and whites with SCI, they are generally accounted for by cause of injury rather than the direct affects of race.
Adolescent↗
Sitting and standing tolerance in patients with chronic back pain: comparison between physician prediction and covert observation.
OBJECTIVES: To measure covertly observed continuous sitting and standing tolerance in patients with chronic back pain and to compare observations to physician predictions. DESIGN: Blinded, prospective, cohort study. SETTING: Ambulatory referral centers, both public and private, at 5 major medical centers in the eastern United States. PARTICIPANTS: All volunteers (N=154; 64.0% women, mean age, 48.7y; 16.8% had active lawsuits) with diagnosis codes of the International Classification of Diseases, 9th Revision consistent with thoracic and/or lumbosacral back pain were selected from a cohort of 651 outpatients with chronic pain enrolled in the Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Continuous sitting and standing tolerance was measured by (1). covert observation of subjects during the MMPAP trial and (2). blinded expert physician prediction based on complete history and physical examination. RESULTS: Most (124/154, 80.5%) subjects stood for 30 minutes or more and most (124/154, 80.5%) sat for 60 minutes or more. Overall, physicians underpredicted the ability to sit 60 minutes or more and to stand 30 minutes or more. Physician prediction showed poor correlation to covert observation for sitting tolerance (kappa=-.061, P=.221) and standing tolerance (kappa=-.021, P=.727). CONCLUSIONS: The majority of this sample demonstrated the ability to sit continuously 60 minutes or more and to stand continuously 30 minutes or more while being covertly observed. Expert physician prediction showed poor correlation to covertly observed sitting and standing tolerances, raising doubt about the validity of using physician evaluation to establish work restrictions in patients with chronic back pain. These findings are preliminary, follow only a brief period of covert observation, and indicate the need for further research in this area.
Back Pain↗
Relationship between strength, balance, and swallowing deficits and outcome after traumatic brain injury: a multicenter analysis.
OBJECTIVE: To examine the relation among strength, balance, and swallowing deficits, as measured on rehabilitation admission, and functional outcome at discharge and 1 year after traumatic brain injury (TBI). DESIGN: Multicenter analysis of consecutive admissions to designated Traumatic Brain Injury Model Systems (TBIMS) facilities. SETTING: Seventeen TBIMS centers. PARTICIPANTS: Adults and children older than 16 years of age with TBI (N=2363) enrolled in the national database from January 1989 to November 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Transfers, locomotion, stairs, lower-body dressing, grooming, bathing, upper-body dressing, toileting, and eating as measured by the FIM instrument at acute rehabilitation discharge and at 1 year after TBI. RESULTS: Lower-extremity strength less than 3/5 on admission to acute rehabilitation was associated with increased need for assistance in locomotion, transfers, and lower-body dressing and less than 3/5 upper-extremity strength was associated with the need for assistance in self-care at rehabilitation discharge and at 1 year postinjury. Similar relations were found between impaired swallowing and assistance with eating, grossly impaired dynamic sitting, or standing balance and assistance with locomotion, transfers, eating, and self-care at rehabilitation discharge and at 1 year after TBI. CONCLUSIONS: Assessments of physical strength, swallowing ability, and dynamic balance on acute rehabilitation admission are helpful as screening tests in predicting the need for assistance of another person for mobility and self-care at rehabilitation discharge. This association remains strong at 1 year after TBI. By using this information, clinicians should initiate therapeutic interventions that optimize rehabilitation of the identified impairments and should make necessary arrangement for the patient's anticipated postdischarge needs. Further studies are necessary to delineate the amount of unique variance that these early physical examination findings contribute to outcome prediction.
Activities of Daily Living↗
Geriatric rehabilitation. 1. Social and economic implications of aging.
UNLABELLED: This self-directed learning module highlights the social and economic implications of aging. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation and geriatric medicine. This article specifically focuses on the epidemiology of aging, the economics of aging, informal and formal social support systems, ageism and societal issues, and care and treatment settings. OVERALL ARTICLE OBJECTIVE: To summarize the social and economic implications of aging in the context of physical medicine and rehabilitation.
Aged↗
Geriatric rehabilitation. 2. Physiatric approach to the older adult.
UNLABELLED: This self-directed learning module highlights the physiatric approach to the older adult. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation (PM and R) and geriatric medicine. This article specifically focuses on the advantages of the physiatric approach, PM and R training in geriatric rehabilitation, metrics in geriatric assessment, prevention, symptom management, medical management, falls, pain, and pharmacology. OVERALL ARTICLE OBJECTIVE: To summarize the physiatric approach to the older adult.
Accidental Falls↗
Geriatric rehabilitation. 3. Physical medicine and rehabilitation interventions for common disabling disorders.
UNLABELLED: This self-directed learning module highlights physical medicine and rehabilitation (PM and R) interventions for common disorders that cause disability in older adults. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in PM and R and geriatric medicine. This article specifically focuses on PM and R interventions for arthritides, fractures, cardiovascular disorders, peripheral vascular disease, amputations, pulmonary disorders, cancer, stroke, traumatic brain injury, Parkinson's disease, spinal cord injury, peripheral neuropathies, and diabetic complications. OVERALL ARTICLE OBJECTIVE: To summarize the physical medicine and rehabilitation interventions for commonly disabling conditions of older adults.
Aged↗
Geriatric rehabilitation. 4. Physical medicine and rehabilitation interventions for common age-related disorders and geriatric syndromes.
UNLABELLED: This self-directed learning module highlights physical medicine and rehabilitation (PM and R) interventions for age-related physiologic changes. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in PM and R and geriatric medicine. This article specifically focuses on PM and R interventions (including exercise) for mobility alterations, activities of daily living alterations, osteoporosis, cognitive and behavioral changes, bladder changes, and bowel changes. OVERALL ARTICLE OBJECTIVE: To summarize the physical medicine and rehabilitation interventions for age-related physiologic changes.
Aged↗
Geriatric rehabilitation. 5. The societal aspects of disability in the older adult.
UNLABELLED: This self-directed learning module highlights the societal aspects of disability and the older adult. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation and geriatric medicine. This article specifically focuses on ethical issues, including capacity, psychodynamics, sexuality, community integration, work, leisure skills, and the issue of driving a motor vehicle. OVERALL ARTICLE OBJECTIVE: To summarize the societal aspects of disability and the older adult.
Aged↗
Validating the Berg Balance Scale for patients with Parkinson's disease: a key to rehabilitation evaluation.
OBJECTIVE: To assess the criterion-related validity of the Berg Balance Scale (BBS) in subjects with Parkinson's disease (PD). DESIGN: Prospective, correlational analysis between the BBS and accepted measures of PD motor and functional impairment. SETTING: The federally funded PD research center, an interdisciplinary center of excellence for people with PD within a Veterans Affairs medical center. PARTICIPANTS: Thirty-eight men (average +/- standard deviation, 71.1+/-10.5 y) with confirmed PD. Their initial diagnosis had been made on average 5.8+/-3.6 years earlier. All could stand or walk unassisted and had mild to moderate disability. Patients who could not ambulate without assistive devices were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Correlational analyses between the BBS and the Unified Parkinson's Disease Rating Scale (UPDRS) motor scale, Modified Hoehn and Yahr Staging (Hoehn and Yahr) Scale, and the Modified Schwab and England Capacity for Daily Living Scale (S&E ADL Scale). RESULTS: BBS score showed significant correlations with indicators of motor functioning, stage of disease, and daily living capacity. BBS score was inversely associated with the UPDRS motor score (-.58, P <.005), Hoehn and Yahr Scale staging (-.45, P <.005), and S&E ADL Scale rating (.55, P <.005). In all 3 correlations, lower scores on the BBS (indicating greater balance deficits) correlated with higher UPDRS scores (indicating greater motoric or functional impairment). CONCLUSIONS: Results support the criterion-related validity of the BBS. Its utility in other balance conditions of older adults has been established. Rehabilitation interventions have been shown to improve the balance deficits associated with PD. Early referral and periodic reassessment is vital to achieving and maintaining improvements. Our research results agree with other published research in suggesting that the BBS may be used as a screening tool and ongoing assessment tool for patients with PD.
Activities of Daily Living↗
A follow-up study of older adults with traumatic brain injury: taking into account decreasing length of stay.
OBJECTIVE: To examine age-related differences in rehabilitation outcomes following traumatic brain injury (TBI). DESIGN: Retrospective collaborative study. SETTING: Patients received acute neurotrauma and inpatient rehabilitation services at 1 of the 17 National Institute on Disability and Rehabilitation Research-designated Traumatic Brain Injury Model Systems (TBIMS) centers. PARTICIPANTS: A sample of 273 older patients (> or =55y) admitted for TBI were taken from the TBIMS National Database. Older patients were matched with subjects 44 years of age or younger, based on severity of injury (Glasgow Coma Scale score, length of coma, intracranial pressure elevations). Due to decreasing length of stay (LOS), only patients admitted from 1996 through 2002 were included. INTERVENTION: Inpatient interdisciplinary brain injury rehabilitation. MAIN OUTCOME MEASURES: Acute care LOS, inpatient rehabilitation LOS, admission and discharge FIM instrument and Disability Rating Scale (DRS) scores, FIM and DRS efficiency, acute and rehabilitative charges, and discharge disposition. RESULTS: One-way analyses of variance demonstrated a statistically significant difference between older and younger patients with respect to LOS in rehabilitation but not for acute care. Total rehabilitative charges, and admission and discharge DRS and FIM scores also showed statistically significant differences between groups. Older patients progressed with significantly less efficiency on both the DRS and FIM scales. Significantly more charges were generated per unit for older patients to improve on the DRS scale, but not the FIM scale. Using chi-square analysis, a statistically significant difference in rate of discharge to home was identified between older (80.5%) and younger (94.4%) patients. CONCLUSIONS: Results in this study are similar to those in earlier studies with smaller sample sizes. Major differences observed include significantly slower and more costly progress in inpatient rehabilitation for older patients with TBI, as well as a significantly lower rate of discharge to community for older patients. However, even with decreasing LOS in both settings, community discharge rate is still encouraging for older patients with TBI.
Age Factors↗
Functional outcomes from inpatient rehabilitation after traumatic brain injury: how do Hispanics fare?
OBJECTIVE: To examine the relation between Hispanic ethnicity and rehabilitation outcome in traumatic brain injury (TBI) survivors. DESIGN: Retrospective study. SETTING: Longitudinal dataset of the Traumatic Brain Injury Model Systems national database. PARTICIPANTS: Persons (N=3056; 2745 whites vs 311 Hispanics) with moderate to severe TBI hospitalized between 1989 and 2003. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcomes at discharge and 1-year follow-up (Disability Rating Scale [DRS], FIM instrument). Glasgow Outcome Scale-Extended (GOS-E), and the Community Integration Questionnaire (CIQ) were measured at follow-up only. RESULTS: At admission, Hispanics were less educated (P</=.001), earned less money (P</=.05), and were younger (P</=.001) than whites. Hispanics had lower GOS-E scores (P</=.01) at acute hospital admission compared with whites. Despite similar functional status at inpatient rehabilitation discharge, Hispanic ethnicity was associated with poorer functional outcomes at 1 year postinjury (DRS, FIM, CIQ), after controlling for age, length of posttraumatic amnesia, injury severity, DRS score at admission, FIM score at admission, and preinjury educational level (P<.05). CONCLUSIONS: Hispanics showed significantly reduced long-term functional outcome after rehabilitation relative to whites. Rehabilitation professionals should recognize the possible impact of individual differences and diverse sociodemographic, injury, and rehabilitation characteristics so that differential health outcomes among TBI survivors can be reduced or eliminated.
Activities of Daily Living↗
Cell cycle molecules define a pathway required for neuron death in development and disease.
We review here evidence defining a molecular pathway that includes cell cycle-related molecules and that appears to play a required role in neuron death during normal development as well as in disease and trauma. The pathway starts with inappropriate activation of cyclin dependent kinase 4 (Cdk4) in neurons which leads to hyper-phosphorylation of the pRb family member p130. This in turn results in dissociation of p130 and its associated chromatin modifiers Suv39H1 and HDAC1 from the transcription factor E2F4. Dissociation of this complex results in de-repression of genes with E2F binding sites including those encoding the transcription factors B- and C-Myb. Once elevated in neurons, B- and C-Myb proteins bind to the promoter for the pro-apoptotic BH3-only protein Bim and promote its induction. Bim then interacts with the core cellular apoptotic machinery, leading to caspase activation and apoptotic death. This pathway is supported by a variety of observations and experimental findings that implicate it as a required element for neuron loss in development and in many nervous system traumas and disorders. The components of this pathway appear to represent potential therapeutic targets for prevention of disease-associated neuron death.
Animals↗
P4 cap modified tetrapeptidyl alpha-ketoamides as potent HCV NS3 protease inhibitors.
We describe herein the design, syntheses, and biological evaluation of new series of P4 tetrazole and adipic acid, ester, amide capped tetrapeptidyl alpha-ketoamide based HCV protease inhibitors.
Amides↗
Management of new-onset mitral regurgitation with intraoperative angiography and intraoperative percutaneous coronary intervention.
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Aged↗
The relationship between therapy intensity and rehabilitative outcomes after traumatic brain injury: a multicenter analysis.
OBJECTIVES: To identify factors relating to the intensity of rehabilitation services received and to ascertain the relation between injury outcomes, demographics, types of therapy, and the intensity of rehabilitation services provided. DESIGN: A multicenter, prospective, nonrandomized study with inpatient rehabilitation data collected between 1989 and 1996. SETTING: Three medical centers in the federally sponsored Traumatic Brain Injury Model Systems. In each setting, the continuum of care includes emergency medical services, intensive and acute medical care, and inpatient rehabilitation. PARTICIPANTS: A total of 491 consecutively enrolled patients with a mean age +/- standard deviation of 34.3+/-15.88 years recruited from 3 medical centers. To be included in the study, patients must have been at least 16 years of age, have presented to the emergency department within 24 hours of injury, and have received acute care and inpatient rehabilitation. INTERVENTIONS: Patients received comprehensive medical care along with a combination of rehabilitative therapies, including physical, occupational, psychologic, and speech therapy. MAIN OUTCOME MEASURES: Therapy intensity; levels of functional independence, cognitive function, functional gain, and treatment efficiency, as indicated by the FIM instrument; rehabilitation length of stay (LOS); and charges. RESULTS: Age predicted the intensity of both psychologic (P<.001) and total therapy (P<.01) services. Acute care LOS was also a significant predictor of psychologic services (P<.01). Only admission motor FIM was relevant in predicting speech services intensity (P<.01). Therapy intensity was predictive of motor functioning at discharge (P<.001). However, therapy intensity did not predict cognitive gain (P<.05). CONCLUSIONS: This study is among the first multicenter efforts to examine the potential benefits of individual therapy services. Findings support assertions that increased therapy intensity, particularly physical and psychologic therapies, enhances functional outcomes.
Adult↗
Predicting long-term maintenance of physical activity in older adults.
BACKGROUND: Considerable research has established that self-efficacy is a consistent correlate of physical activity. Additional factors, such as exercise-induced affect, social support, and value judgments, have also been identified as having the potential to influence adherence to activity. This study examined the utility of such variables in predicting the long-term exercise behavior of older adults. METHOD: In the context of a 6-month randomized controlled trial with an 18-month follow-up, we tested the extent to which adherence during the trial, affective responses to exercise, exercise value, and social support from the exercise group had either a direct or indirect effect through the mediation of exercise self-efficacy on physical activity levels at 6- and 18-month follow-up in a sample (N=174) of older adults (M age, 66 years). Structural equation modeling tested several models of exercise prediction. RESULTS: The best fitting model indicated significant paths from social support, affect, and exercise frequency to efficacy at the end of the program. Efficacy, in turn, was related to physical activity at 6- and 18-month follow-up. The model accounted for 40% of the variance in 18-month activity levels. CONCLUSION: This prospective study provides support for the inclusion of social cognitive variables in models of exercise adherence and highlights the pivotal role of self-efficacy in long-term exercise behavior. Subsequent trials are called for to replicate and extend these findings.
Aged↗
DNAPL remediation with in situ chemical oxidation using potassium permanganate. Part I. Mineralogy of Mn oxide and its dissolution in organic acids.
Previous studies on in situ chemical oxidation of trichloroethylene (TCE) with potassium permanganate indicated that the solid reaction product, Mn oxide, could reduce the permeability of the porous medium and impact the success of dense non-aqueous phase liquid (DNAPL) removal. In order to address the issue of permeability reduction caused by precipitation, this study investigated the mineralogy of Mn oxides and the possibilities of removing the solid precipitates by dissolution. The solid reaction product from the oxidation of TCE by permanganate is semi-amorphous potassium-rich birnessite, which has a layered mineral structure with an interlayer spacing of 7.3 A. The chemical formula is K(0.854)Mn(1.786)O(4).1.55H(2)O. It has a relatively small specific surface area at 23.6+/-0.82 m(2)/g. Its point of zero charge (pzc) was measured as 3.7+/-0.4. This birnessite is a relatively active species and could participate in various reactions with existing organic and inorganic matter. The dissolution kinetics of Mn oxide was evaluated in batch experiments using solutions of citric acid, oxalic acid, and ethylenediaminetetraacetic acid (EDTA). Initial dissolution rates were determined to be 0.126 mM/m(2)/h for citric acid, 1.35 mM/m(2)/h for oxalic acid, and 5.176 mM/m(2)/h for EDTA. These rates compare with 0.0025 mM/m(2)/h for nitric acid at pH=2. Organic acids dissolve Mn oxide quickly. Reaction rates increase with acid concentration, as tested with citric acid. The dissolution mechanism likely involves proton and ligand-promoted dissolution and reductive dissolution. Citric and oxalic acid can induce ligand-promoted dissolution, while EDTA can induce ligand-promoted and reductive dissolutions. At low pH, proton-promoted dissolution seems to occur with all the acids tested, but this process is not dominant. Reductive dissolution appears to be the most effective process in dissolving the solid, followed by ligand-promoted dissolution. These experiments indicate the significant potential in using these organic acids to remove precipitates formed during the oxidation reaction.
Chemical Precipitation↗