Publications by authors named "Allison Foster"

30 Publications

  • Page 1 of 1

Mechanisms for the Clinical Utility of Low-Frequency Stimulation in Neuromodulation of the Dorsal Root Ganglion.

Neuromodulation 2020 Nov 25. Epub 2020 Nov 25.

Spine & Pain Institute of New York, New York City, NY, USA.

Background: Dorsal root ganglion stimulation (DRG-S) involves the electrical modulation of the somata of afferent neural fibers to treat chronic pain. DRG-S has demonstrated clinical efficacy at frequencies lower than typically used with spinal cord stimulation (SCS). In a clinical study, we found that the frequency of DRG-S can be tapered to a frequency as low as 4 Hz with no loss of efficacy. This review discusses possible mechanisms of action underlying effective pain relief with very low-frequency DRG-S.

Materials And Methods: We performed a literature review to explore the role of frequency in neural transmission and the corresponding relevance of frequency settings with neuromodulation.

Findings: Sensory neural transmission is a frequency-modulated system, with signal frequency determining which mechanisms are activated in the dorsal horn. In the dorsal horn, low-frequency signaling (<20 Hz) activates inhibitory processes while higher frequencies (>25 Hz) are excitatory. Physiologically, low-threshold mechanoreceptors (LTMRs) fibers transmit or modulate innocuous mechanical touch at frequencies as low as 0.5-5 Hz, while nociceptive fibers transmit pain at high frequencies. We postulate that very low-frequency DRG-S, at least partially, harnesses LTMRs and the native endogenous opioid system. Utilizing lower stimulation frequency decreases the total energy delivery used for DRG-S, extends battery life, and facilitates the development of devices with smaller generators.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ner.13323DOI Listing
November 2020

It's complicated: A case report on a COVID-19-positive HIV patient presenting with rhabdomyolysis and acute kidney injury.

SAGE Open Med Case Rep 2020 15;8:2050313X20965423. Epub 2020 Oct 15.

Chief of Critical Care and Clinical Medicine, Richmond University Medical Center, Staten Island, NY, USA.

The SARS-Cov-2/COVID-19 pandemic in early 2020 has had a devastating impact on health systems around the world. While viral pneumonia remains the most common complication, reports are surfacing of cases with neurological, cardiac, and renal involvement. Even less is known about the implications in special high-risk populations. In this report, we discuss a unique case of an HIV-positive patient in New York City who presented with a 2-week history of worsening fatigue, cough, dyspnea, and myalgias and was found to have COVID-19 pneumonia and acute kidney injury. He was managed for severe uremic metabolic acidosis and electrolyte abnormalities with emergent hemodialysis and supportive therapy with subsequent improvement. Direct involvement of SARS-CoV-2 and pneumonia-induced rhabdomyolysis were identified as the precipitating factors of his acute kidney injury. The pathophysiologic mechanisms of acute kidney injury, SARS-CoV-2 renal tropism, and the impact of highly active antiretroviral therapy on COVID-19 pneumonia are discussed. We highlight the importance of clinician awareness of this potentially fatal complication of COVID-19 pneumonia, particularly in the HIV-positive population as early recognition and management can have favorable outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2050313X20965423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7570771PMC
October 2020

What are we missing? Three cases of severe COVID-19 pneumonia with negative testing.

SAGE Open Med Case Rep 2020 15;8:2050313X20965410. Epub 2020 Oct 15.

Richmond University Medical Center, Staten Island, NY, USA.

The COVID-19 pandemic has drastically affected health care systems globally. Reverse transcriptase-polymerase chain reaction is currently the preferred method of detecting COVID-19; however, sensitivity of this test remains questionable. Incidental transmission and potential harm to infected individuals are some consequences of the failure to identify high-risk patients. We report three cases of symptomatic patients that required intensive care management with labs and imaging consistent with COVID-19 with initial false-negative reverse transcriptase-polymerase chain reaction testing. Improper sampling, viral load, and manufacturer variances of tests all contribute to reduced sensitivity. A clinical diagnosis should supplant such cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2050313X20965410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7570767PMC
October 2020

COVID-19-Induced Diabetic Ketoacidosis and Acute Respiratory Distress Syndrome in an Obese 24-Year-Old Type I Diabetic.

Am J Case Rep 2020 Oct 26;21:e925586. Epub 2020 Oct 26.

Department of Critical Care and Clinical Medicine, Richmond University Medical Center, Staten Island, NY, USA.

BACKGROUND In early 2020, severe acute respiratory syndrome-corona virus 2 caused an outbreak of a viral pneumonia that rapidly progressed to a global pandemic. Most cases presented with mild respiratory symptoms and required only supportive care with instructions to self-quarantine at home. Others had more severe symptoms that became complicated by acute respiratory distress syndrome (ARDS) and required hospitalization. CASE REPORT In this report, we present the case of a young patient in New York City who presented to our hospital with coronavirus disease 2019-induced diabetic ketoacidosis (DKA) that progressed to ARDS and subsequent death. The patient was managed for DKA on presentation with insulin protocol and acidosis management. However, it became evident that he had underlying respiratory complications, which later presented as ARDS requiring mechanical ventilation and antibiotics. CONCLUSIONS We recommend that clinicians be aware of this potentially fatal complication in all patients with pre-existing diabetes. Simultaneously, a low threshold for intubation should be advocated for patients with concurrent COVID-19 and type I diabetes mellitus since the potential for poor clinical outcomes from respiratory demise may be lessened by early respiratory intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12659/AJCR.925586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598147PMC
October 2020

More than Just Pneumonia: Acute Pulmonary Embolism in Two Middle-Aged Patients with COVID-19.

Case Rep Med 2020 30;2020:4812036. Epub 2020 Jul 30.

Department of Radiology, Richmond University Medical Center, New York, NY, USA.

Background: Although severe pneumonia and respiratory compromise have remained the predominant complications of coronavirus disease 19, we are now learning this virus is much more varied in its presentation. In particular, there are increasingly reported cases of thromboembolic events occurring in infected patients. . In this report, we present two patients, both under the age of 40 with known risk factors for venous thromboembolism, who presented with respiratory distress. Both patients were diagnosed with SARS-CoV-2 pneumonia and pulmonary embolism requiring management with anticoagulation. Both patients were discharged after a short course in the hospital.

Conclusion: The discussion of a hypercoagulable state induced by coronavirus disease 19 has been well documented; however, the exact mechanisms remain unknown. We suspect that a prothrombotic inflammatory response provoked by coronavirus disease could be the culprit, acting as an additive effect on middle-aged patients with known risk factors for venous thromboembolism. We recommend clinicians closely monitor those with known risk factors for pulmonary embolism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2020/4812036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396098PMC
July 2020

Attention and Communication Following TBI: Making the Connection through a Meta-Narrative Systematic Review.

Neuropsychol Rev 2020 09 25;30(3):345-361. Epub 2020 Jul 25.

ABI Rehabilitation, NZ, Ltd., Auckland, New Zealand.

Background And Aim: Communication difficulties are one of the hallmark characteristics of adults following traumatic brain injury (TBI), a difficulty that incorporates multiple aspects of cognition and language. One aspect of cognition that impacts communication is attention. This review explores both attention and communication following moderate to severe TBI and aims to connect them through a narrative analysis of the discourse surrounding the terms and how they have evolved over time. This includes exploring and reviewing theories and specific constructs of these two aspects of cognition.

Method: A meta-narrative systematic literature review was completed according to RAMESES methodology.

Results: A total of 37 articles were included in the review. The disciplines that populated the articles included, but were not limited to, speech language pathology (SLP) 36.5%, psychology 23.8%, and a collaboration of neuropsychology and SLP 7.9%. Of the papers that were included, 10% explored and supported theories of attention related to executive function affecting communication. Specific levels of attention were mapped onto specific communication skills with the corresponding year and authors to create a timeline and narrative of these concepts.

Conclusions: The main communication behaviours that are related to attention in the context of post-TBI cognition include discourse, tangential communication, social communication, auditory comprehension, verbal reasoning, topic maintenance, interpretation of social cues and emotions, verbal expression, reading comprehension, verbal response speed, and subvocal rehearsal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11065-020-09445-5DOI Listing
September 2020

Serious outcomes of medically attended, laboratory-confirmed influenza illness among school-aged children with and without asthma, 2007-2018.

Influenza Other Respir Viruses 2020 03 14;14(2):173-181. Epub 2020 Jan 14.

Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA.

Background: Asthma was associated with influenza hospitalizations in children during the 2009 pandemic, but it is unclear if asthma is associated with serious illness during seasonal epidemics. Little is known regarding the effect of vaccination on influenza severity in children with asthma.

Methods: Children aged 5-17 years in a community cohort presenting with acute respiratory illness were prospectively enrolled and tested for influenza from 2007-08 through 2017-18 (excluding the 2009-10 pandemic season). Data from the electronic health record were extracted to determine asthma status and serious outcomes associated with influenza infection. A serious outcome was defined as hospitalization, emergency department visit, and/or pneumonia diagnosis within 30 days of symptom onset. Multivariable logistic regression models were used to assess asthma status and effect of vaccination on odds of a serious outcome.

Results: One thousand seven hundred and sixty four medically-attended influenza infections among school-aged children were included. Asthma was confirmed in 287 (16%) children. A serious influenza-associated outcome occurred in 104 (6%) children. The odds of a serious outcome did not differ between those with confirmed asthma and those without asthma [adjusted odds ratio (aOR): 1.35, 95% confidence interval (CI): (0.77-2.35), P = .3]. The effect of vaccination on serious outcomes was not modified by asthma status [aOR for children without asthma: 0.55 (95% CI: 0.28-1.07), children with asthma: 1.39 (95% CI: 0.53-3.69); interaction P-value = .12].

Conclusions: Asthma was not a risk factor for serious illness among children with influenza. Additional studies are needed to better understand the role of influenza vaccination in preventing serious outcomes among children with asthma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/irv.12710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040974PMC
March 2020

Strengthening and Institutionalizing the Leadership and Management Role of Frontline Nurses to Advance Universal Health Coverage in Zambia.

Glob Health Sci Pract 2018 12 27;6(4):736-746. Epub 2018 Dec 27.

IntraHealth International, Chapel Hill, NC, USA.

In Zambia, nurses and nurse-midwives lead more than half of rural facilities and guide primary health care delivery. Based on a formative assessment, the Ministry of Health (MOH) determined that improved leadership capacity and management skills of facility heads would help maximize the potential of Zambia's community-level investments. In support of these efforts, the Primary Health Care to Communities (PHC2C) initiative designed and tested a 12-month blended learning program for a certificate in leadership and management practice (CLMP) to build leadership and management competencies of rural facility heads, including increasing their ability to lead frontline teams and strengthening their skills and confidence in technology use. The CLMP was created with leadership from the MOH, technical guidance from the University of Zambia, and expertise from PHC2C partners IntraHealth International, Johnson & Johnson, and mPowering Frontline Health Workers. In total, 20 nurse facility heads and 5 district nurse supervisors in 20 rural facilities across 5 districts were selected to test the course content and delivery approach. A mixed-methods approach, including evaluation of facility heads' presentations on community health improvement projects, focus group discussions with community members, and key informant interviews with nurses, clinical officers, and other stakeholders, was used to assess the results. Findings suggested that the facility heads had successfully strengthened their leadership and management competencies, increased their ability to lead frontline teams, and strengthened their skills and confidence in use of technology, including using a WhatsApp community of practice for support and consultation with other colleagues, with demonstrated improvements in the quality and accessibility of services. Based on assessment results and lessons from the test intervention, the Zambian government has committed to institutionalize CLMP as a national continuing professional development program, required for nurses posted to lead rural facilities. The planning, design, and implementation of this program offer an example to other countries and global actors of how nurses empowered with competence and confidence can play a significant role in coordinating the maze of community actors and navigating the complexities of community health systems to advance primary health care and universal health coverage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.9745/GHSP-D-18-00067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370361PMC
December 2018

Making sense of recovery after traumatic brain injury through a peer mentoring intervention: a qualitative exploration.

BMJ Open 2018 10 10;8(10):e020672. Epub 2018 Oct 10.

Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.

Objective: To explore the acceptability of peer mentoring for people with a traumatic brain injury (TBI) in New Zealand.

Design: This is a qualitative descriptive study exploring the experiences reported by mentees and mentors taking part in a feasibility study of peer mentoring. Interviews with five mentees and six mentors were carried out. Data were analysed using conventional content analysis.

Setting: The first mentoring session took place predischarge from the rehabilitation unit. The remaining five sessions took place in mentees' homes or community as preferred.

Participants: Twelve people with TBI took part: six mentees (with moderate to severe TBI; aged 18-46) paired with six mentors (moderate to severe TBI >12 months previously; aged 21-59). Pairing occurred before mentee discharge from postacute inpatient brain injury rehabilitation. Mentors had been discharged from rehabilitation following a TBI between 1 and 5 years previously.

Intervention: The peer mentoring programme consisted of up to six face-to-face sessions between a mentee and a mentor over a 6-month period. The sessions focused on building rapport, exploring hopes for and supporting participation after discharge through further meetings and supported community activities.

Results: Data were synthesised into one overarching theme: making sense of recovery. This occurred through the sharing of experiences and stories; was pivotal to the mentoring relationship; and appeared to benefit both mentees and mentors. Mentors were perceived as valued experts because of their personal experience of injury and recovery, and could provide support in ways that were different from that provided by clinicians or family members. Mentors required support to manage the uncertainties inherent in the role.

Conclusions: The insight mentors developed through their own lived experience established them as a trusted and credible source of hope and support for people re-engaging in the community post-TBI. These findings indicate the potential for mentoring to result in positive outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2017-020672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252636PMC
October 2018

Are Public Health Academia, Professional Certification, and Public Health Practice on the Same Page?

J Public Health Manag Pract 2018 May/Jun;24 Suppl 3:S47-S50

National Board of Public Health Examiners (NBPHE), Washington, District of Columbia (Ms Foster); Council on Education for Public Health (CEPH), Silver Spring, Maryland (Ms King); and Public Health Accreditation Board (PHAB), Alexandria, Virginia (Dr Bender).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PHH.0000000000000746DOI Listing
November 2019

A Formative Assessment of Nurses' Leadership Role in Zambia's Community Health System.

World Health Popul 2017 ;17(3):55-68

Dalhousie University, WHO/PAHO Collaborating Center for Health Workforce Planning and Research, Halifax, NS.

Background: Despite its achievements in decreasing HIV prevalence and under-five mortality, Zambia still faces high maternal and neonatal mortality, particularly in the rural and remote areas where almost 60% of the population resides. After significant investments in developing its community health system, the Zambian Ministry of Health was interested to understand how to leverage the role of nurses to sustain achievements made and further improve the quality of care in rural communities. The Ministry joined research partners in an assessment into the role and leadership capacity of nurses heading rural health facilities.

Methods: A seven-member research team conducted 30 in-depth interviews and 10 focus group discussions in four provinces with four categories of respondents: national decision-makers, provincial and district managers, rural facility staff and community respondents (neighborhood health committee members and volunteers). An initial scoping visit and literature review informed the development of specific interview guides for each category of respondent. After audio-recording and transcription, research team members identified and reached consensus on key themes, and presented and validated the findings at a national stakeholder workshop.

Results: Zambia's front-line health teams are a complex mixture of professional facility staff, community providers, community-based volunteers and neighborhood health committees. Nurses and nurse-midwives head over half the rural facilities in Zambia, where they are expected to lead the delivery of safe, high-quality care with staff and volunteers who often operate beyond their level of training. Nurses and midwives who are assigned to head rural facilities are not adequately prepared or recognized for the leadership responsibilities they are expected to fulfill.

Conclusions: This paper highlights opportunities to support rural facility heads in effectively leading front-line health teams to deliver primary healthcare to rural communities. Front-line teams require a leader to coordinate and motivate seamless and sustainable quality services that are accessible to all. Zambia has the potential to support integrated, responsive quality care and advance toward universal health coverage if nurses are adequately prepared and recognized with job descriptions that reflect their responsibilities and opportunities for career advancement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12927/whp.2017.25305DOI Listing
July 2019

Facing a Paradigm Shift in the Sustainable Development Goal Era.

World Health Popul 2017 ;17(3):4-10

Professor, Faculty of Health Sciences, University of Victoria, Victoria, BC.

The Sustainable Development Goals challenge us to step beyond traditional development approaches and to consider strategies that are evidence informed and innovative. The concepts are familiar; themes aligned with Harmonization, Primary Healthcare, Leadership, Public Private Partnerships, Community Engagement, and Integrated Technologies. However, to optimize resources and overcome today's challenge with sustainable solutions, we must capture lessons learned and apply evidence developed to inform and expand the thinking to shape and inform new paradigms. The tools, the experience, and the evidence are at our finger-tips. We must hold ourselves accountable to turn that rudder and hold the line so that the ship can advance toward universal health coverage that ensures healthy lives and promotes wellbeing for all at all ages. Health is where economic well-being, labour opportunities, educational advancement, gender equity and access to food, water, clean air come together to advance the wellbeing of all. This juncture is most significant at community level, where health systems intertwine with the social and cultural fabric and health workers stand at the interface between the health system and the people it serves. In these manuscripts, thought leaders in the health sector share evidence and experience to help us consider how we will use this intersection to push all nations to achieve all the SDGs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12927/whp.2017.25310DOI Listing
July 2019

Advancing the Certified in Public Health Examination: A Job Task Analysis.

Public Health Rep 2017 Jul/Aug;132(4):518-523. Epub 2017 Jun 22.

6 Center for Education Testing and Evaluation, University of Kansas, Kansas City, KS, USA.

Objectives: In 2014, the National Board of Public Health Examiners performed a job task analysis (JTA) to revise the Certified in Public Health (CPH) examination. The objectives of this study were to describe the development, administration, and results of the JTA survey; to present an analysis of the survey results; and to review the implications of this first-ever public health JTA.

Methods: An advisory committee of public health professionals developed a list of 200 public health job tasks categorized into 10 work domains. The list of tasks was incorporated into a web-based survey, and a snowball sample of public health professionals provided 4850 usable responses. Respondents rated job tasks as essential (4), very important (3), important (2), not very important (1), and never performed (0).

Results: The mean task importance ratings ranged from 2.61 to 3.01 (important to very important). The highest mean ratings were for tasks in the ethics domain (mean rating, 3.01). Respondents ranked 10 of the 200 tasks as the most important, with mean task rankings ranging from 2.98 to 3.39. We found subtle differences between male and female respondents and between master of public health and doctor of public health respondents in their rankings.

Conclusion: The JTA established a set of job tasks in 10 public health work domains, and the results provided a foundation for refining the CPH examination. Additional steps are needed to further modify the content outline of the examination. An empirical assessment of public health job tasks, using methods such as principal components analysis, may provide additional insight.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0033354917710015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507425PMC
July 2017

In Memoriam.

Public Health Rep 2017 Jan/Feb;132(1):11-13

2 Independent Consultant, New York, NY, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0033354916683680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298512PMC
January 2018

ANI Emerging Leader Project: Enhancing the Role of Nurses in Zambia Through mHealth.

Comput Inform Nurs 2016 Jan;34(1):6-7

ICF International, Fairfax, VA (Dr Vélez) and Intrahealth International, Chapel Hill, NC (Foster).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CIN.0000000000000211DOI Listing
January 2016

Prevalence of ear disease in dogs undergoing multidetector thin-slice computed tomography of the head.

Vet Radiol Ultrasound 2015 Jan-Feb;56(1):18-24. Epub 2014 Jul 21.

Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, 2407 River Drive, Rm C247 Veterinary Teaching Hospital, Knoxville, TN, 37996.

Previous reports describing the prevalence of ear diseases in dogs have primarily been based on dogs presenting with clinical signs of disease. The prevalence of subclinical ear disease remains unknown. The purpose of this cross-sectional retrospective study was to describe the prevalence of lesions consistent with middle and external ear disease in dogs presented for multidetector computed tomography (CT) of the head and/or cranial cervical spine at our hospital during the period of July 2011 and August 2013. For each included dog, data recorded were signalment, CT findings, diagnosis, and treatment. A total of 199 dogs met inclusion criteria. Nineteen dogs (9.5%) were referred for evaluation of suspected ear disease and 27 dogs (13.5%) had histories or physical examination findings consistent with otitis externa. A total of 163 dogs (81.9%) had CT lesions consistent with external ear disease (i.e. ear canal mineralization, external canal thickening, and/or narrowing of the external canal). Thirty-nine dogs (19.5%) had CT lesions consistent with middle ear disease (i.e. soft tissue attenuating/fluid material in the tympanic bullae, bulla wall thickening or lysis, and/or periosteal proliferation of the temporal bone). Findings from this study indicated that the prevalence of external and middle ear disease in dogs could be higher than that previously reported.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vru.12180DOI Listing
April 2016

Exploring participant experiences of research after traumatic brain injury.

Brain Inj 2014 21;28(7):995-1002. Epub 2014 Mar 21.

Person Centred Research Centre, School of Rehabilitation and Occupation Studies, Auckland University of Technology , Auckland , New Zealand .

Objective: To explore peoples' perceptions and experiences of taking part in research following a traumatic brain injury (TBI) and identify the factors that influence research participation.

Methods: A total of 30 people (15 who had participated in research following a TBI and 15 who had previously declined or not been offered the opportunity to take part), were asked about their perceptions and experiences of research in a semi-structured qualitative interview. Audio recordings of the interviews were transcribed verbatim and analysed using the qualitative description approach.

Results: Participants perceptions and experiences of research were strongly influenced by the researcher, the practicalities of taking part, including the timing and relevance of research, and perceived end results, such as access to a new treatment or reimbursement for their time.

Conclusion: People want to be empowered to make their own decisions about research participation following a TBI. The findings have implications for research procedures and researchers working in the field of brain injury and recommendations to enhance the research experience are proposed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/02699052.2014.888767DOI Listing
February 2015

Encouraging family engagement in the rehabilitation process: a rehabilitation provider's development of support strategies for family members of people with traumatic brain injury.

Disabil Rehabil 2012 10;34(22):1855-62. Epub 2012 Apr 10.

ABI Rehabilitation New Zealand, Ltd., New Zealand.

Purpose: After a moderate to severe traumatic brain injury, it is widely recommended that family members be actively engaged in the client's rehabilitation journey because evidence suggests that this is associated with better outcomes. The ability of family members to fully engage in rehabilitation may be hindered by the barriers (logistical and psychological) they encounter. However, rehabilitation services can facilitate family engagement through a person-centred approach that provides support to remove barriers. Limited published guidance exists regarding practical and effective methods for delivering such support. This paper describes how one rehabilitation service has developed an eight-tiered approach.

Key Messages And Implications: Family support is provided by explicit structuring of services to include (i) early engagement, (ii) meeting cultural needs, (iii) keeping families together, (iv) actively listening, (v) active involvement, (vi) education, (vii) skills training, and (viii) support for community re-integration. Implementation of these support strategies are individualised based on the expressed needs of each family. Families report a high level of satisfaction with the service.

Conclusion: A practice-based quality improvement model identified challenges, implemented changes, and observed/evaluated the results to successfully develop a multifaceted strategy for supporting families, thereby encouraging their engagement in rehabilitation. Ongoing refinements and evaluation are planned.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09638288.2012.670028DOI Listing
December 2012

Neuroprotective effect of testosterone treatment on motoneuron recruitment following the death of nearby motoneurons.

Dev Neurobiol 2009 Oct;69(12):825-35

Research and Development Service, Edward Hines, Jr. VA Hospital, Hines, Illinois 60141, USA.

Motoneuron loss is a significant medical problem, capable of causing severe movement disorders or even death. We have previously shown that motoneuron death induces marked dendritic atrophy in surviving nearby motoneurons. Additionally, in quadriceps motoneurons, this atrophy is accompanied by decreases in motor nerve activity. However, treatment with testosterone partially attenuates changes in both the morphology and activation of quadriceps motoneurons. Testosterone has an even larger neuroprotective effect on the morphology of motoneurons of the spinal nucleus of the bulbocavernosus (SNB), in which testosterone treatment can completely prevent dendritic atrophy. The present experiment was performed to determine whether the greater neuroprotective effect of testosterone on SNB motoneuron morphology was accompanied by a greater neuroprotective effect on motor activation. Right side SNB motoneurons were killed by intramuscular injection of cholera toxin-conjugated saporin in adult male Sprague-Dawley rats. Animals were either given Silastic testosterone implants or left untreated. Four weeks later, left side SNB motor activation was assessed with peripheral nerve recording. The death of right side SNB motoneurons resulted in several changes in the electrophysiological response properties of surviving left side SNB motoneurons, including decreased background activity, increased response latency, increased activity duration, and decreased motoneuron recruitment. Treatment with exogenous testosterone attenuated the increase in activity duration and completely prevented the decrease in motoneuron recruitment. These data provide a functional correlate to the known protective effects of testosterone treatment on the morphology of these motoneurons, and further support a role for testosterone as a therapeutic agent in the injured nervous system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/dneu.20743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747250PMC
October 2009

Spinal cord stimulation has comparable efficacy in common pain etiologies.

Neuromodulation 2008 Jul;11(3):171-81

Pacific Pain Treatment Center, San Francisco, CA, USA; Yellowstone Neurosurgical Associates, Billings, MT, USA; Boston Scientific Neuromodulation, Valencia, CA, USA; Stanford University Medical Center, Stanford, CA, USA; California Pain Medicine Centers, Los Angeles, CA, USA; Texas Back Institute, Plano, TX, USA; North Shore University Hospital, Syosset, NY, USA; and Dallas Neurosurgical Associates, Dallas, TX, USA.

Objectives.  The probability of success with spinal cord stimulation (SCS) depends largely on appropriate patient selection. Here, we have assessed the predictive value of pain etiology as it relates to pain relief with SCS as part of a prospective multicenter clinical trial. Methods.  Sixty-five subjects with chronic and intractable pain tested an epidural SCS system. Subjects reported pain ratings (visual analog scale) with stimulation off and stimulation on at scheduled follow-up visits for up to 18 months after activation of the system. Visual analog scale scores were averaged and stratified by dominant pain etiologies, comprising failed back surgery syndrome, complex regional pain syndrome, and a subgroup of subjects with miscellaneous other pain etiologies. Results.  More than 70% of subjects in each subgroup had successful outcomes during the temporary trial period and similar percentages of subjects from each etiology subgroup subsequently went on to permanent implantation. After permanent implantation, all subgroups reported more than 50% pain relief, on average, at each follow-up time point. No predictive value of pain etiology was observed. Conclusions.  Spinal cord stimulation is an effective therapy for neuropathic pain arising from a variety of causes. Failed back surgery syndrome, complex regional pain syndrome, and pain of other etiologies responded equally well to SCS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1525-1403.2008.00163.xDOI Listing
July 2008

Successful long-term outcomes of spinal cord stimulation despite limited pain relief during temporary trialing.

Neuromodulation 2008 Jan;11(1):66-73

Yellowstone Neurosurgical Associates, Billings, MT, USA; Pacific Pain Treatment Center, San Francisco, CA, USA; North Shore University Hospital, Syosset, NY, USA; and Boston Scientific Neuromodulation, Valencia, CA, USA.

Objectives.  In spinal cord stimulation (SCS) therapy, limited pain relief during the temporary trial period is generally considered to be predictive of poor long-term benefit. To validate or refute this perception, the long-term outcomes of subjects who reported less than 50% pain relief during a temporary SCS trial were examined. Materials and Methods.  Twelve subjects with intractable pain underwent implantation of trial SCS systems. After a trial period in which they reported less than 50% pain relief, they each received a permanent SCS implant. Pain ratings and complications were tracked for 6-18 months. Results.  At the end of the temporary trial period, the average pain relief was 21%; no subject reported 50% or better pain relief. More favorable outcomes were reported after activation of the permanent system, however. At all follow-up time points, at least a third of the subjects reported better than 50% pain relief, and the average pain relief varied over time between 44% and 83%. All complications were readily resolved and no subjects withdrew from the study. Conclusions.  Although SCS provided limited pain relief during the trial period, efficacy was more satisfactory after permanent implantation. Several subjects went on to experience nearly complete pain relief for up to 18 months (the maximum follow-up visit for study purposes), and no subject chose to discontinue SCS therapy. SCS appears to be a viable treatment option for patients who fail trials, raising some doubt as to the predictive sensitivity and specificity of the trial period. Thus, although outcome of a temporary trial period may be suggestive of later efficacy with SCS, it may not be the sole predictor of success. Alternatively, the arbitrary benchmark of 50% pain relief that is typically used to define the success of a temporary trial may be too stringent and unreliable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1525-1403.2007.00145.xDOI Listing
January 2008

Appetite suppression and weight loss incidental to spinal cord stimulation for pain relief.

Obes Surg 2007 Sep;17(9):1272-4

Belleville Memorial Hospital, Belleville, IL, USA.

Spinal cord stimulation (SCS) uses electrical stimulation of the dorsal columns of the spinal cord to prevent the perception of intractable neuropathic pain signals, but its mechanisms and consequences of use are poorly understood. Two overweight female patients who were implanted with SCS systems (Precision; Advanced Bionics/Boston Scientific, Valencia, CA) reported better than 50% relief of their chronic back and leg pain. Unexpectedly, SCS stimulation was also associated with a tingling sensation in the viscera and a reduction in appetite. Both patients were thus able to reduce food intake at mealtimes and had lost about 9 kg in the first 4 months of SCS use, despite denying changes in exercise habits. The mechanism by which SCS can reduce the desire for food is unknown, but this and similar neuromodulation techniques may hold promise for weight loss in patients who fail other treatments or are not healthy enough for surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11695-007-9217-9DOI Listing
September 2007

The Partners in Information Access for the Public Health Workforce: a collaboration to improve and protect the public's health, 1995-2006.

J Med Libr Assoc 2007 Jul;95(3):301-9

National Library of Medicine, Bethesda, MD 20894, USA.

Objective: The paper provides a complete accounting of the Partners in Information Access for the Public Health Workforce (Partners) initiative since its inception in 1997, including antecedent activities since 1995.

Methods: A descriptive overview is provided that is based on a review of meeting summaries, published reports, Websites, project reports, databases, usage statistics, and personal experiences from offices in the National Library of Medicine (NLM), six organizations that collaborate formally with NLM on the Partners initiative, and one outside funding partner.

Results: With ten years of experience, the initiative is an effective and unique public-private collaboration that builds on the strengths and needs of the organizations that are involved and the constituencies that they serve. Partners-supported and sponsored projects include satellite broadcasts or Webcasts, training initiatives, Web resource development, a collection of historical literature, and strategies for workforce enumeration and expansion of public health systems research, which provide excellent examples of the benefits realized from collaboration between the public health community and health sciences libraries.

Conclusions: With continued funding, existing and new Partners-sponsored projects will be able to fulfill many public health information needs. This collaboration provides excellent opportunities to strengthen the partnership between library science and public health in the use of health information and tools for purposes of improving and protecting the public's health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3163/1536-5050.95.3.301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924938PMC
July 2007

A new spinal cord stimulation system effectively relieves chronic, intractable pain: a multicenter prospective clinical study.

Neuromodulation 2007 Jul;10(3):262-78

Yellowstone Neurosurgical Associates, Billings, MT, USA. Pacific Pain Treatment Center, San Francisco, CA, USA; California Pain Medicine Centers, Los Angeles, CA, USA; North Shore University Hospital, Syosset, NY, USA; Advanced Bionics/Boston Scientific, Valencia, CA, USA; Dallas Neurosurgical Associates, Dallas, TX, USA; Texas Back Institute, Plano, TX, USA; and Stanford Medical Center, Stanford, CA, USA.

Objectives.  A prospective, open label, multicenter clinical trial confirmed the functionality of a new spinal cord stimulation (SCS) system for the treatment of chronic, intractable pain of the trunk and/or limbs. Materials and Methods.  Sixty-five subjects tested a rechargeable 16-channel SCS system with individual current control of each contact on one or two percutaneous eight-contact epidural leads. After baseline measurements, subjects were tracked on pain ratings and complication rates for up to 18 months. Results.  After a trial period, 75% of subjects underwent permanent implantation of the entire SCS system. More than one-half the implanted subjects experienced 50% or greater relief of pain after permanent implantation; some subjects reported relief of 90% or more of their pain. The most common complications after permanent implantation were lead migration, uncomfortable stimulation, and component failure; most resolved after reprogramming or device replacement. Conclusions.  The new SCS system provided good pain relief to a majority of subjects, and the results confirm a favorable safety and efficacy profile for the SCS system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1525-1403.2007.00115.xDOI Listing
July 2007

[Critical challenges for human resources in health: a regional view].

Rev Lat Am Enfermagem 2006 Jan-Feb;14(1):7-16. Epub 2006 Mar 8.

Mestre em Saúde Pública, Organização Pan-Americana de Saúde.

This text presents the context and background, the methodology and some of the main results of the regional consultation on the critical challenges for human resources in health in the Americas. The Consultation, carried out in June and July 2005, was part of the strategy of the Pan American Health Organization (PAHO/WHO) for the organization of the VII Regional Meeting of the Observatories of Human Resources, held in Toronto (Canada). The main results and suggestions by the actors consulted with regard to the role of international cooperation in the countries of the Region are presented, so that the countries and international agencies can better formulate common strategies of development and strengthening of the work force in health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/s0104-11692006000100002DOI Listing
May 2006

Implementing the Institute of Medicine's recommended curriculum content in schools of public health: a baseline assessment.

Am J Public Health 2004 Oct;94(10):1671-4

Association of Schools of Public Health, 1101 15th St NW #910, Washington, DC 20005, USA.

In September 2003, the Association of Schools of Public Health administered an online survey to representatives of all 33 accredited US schools of public health. The survey assessed the extent to which the schools were offering curriculum content in the 8 areas recommended by the Institute of Medicine: communication, community-based participatory research, cultural competence, ethics, genomics, global health, informatics, and law/policy. Findings indicated that, for the most part, schools of public health are offering content in these areas through many approaches and have incorporated various aspects of a broad-based ecological approach to public health education and training. The findings also suggested the possible need for greater content in genomics, informatics, community-based participatory research, and cultural competence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448512PMC
http://dx.doi.org/10.2105/ajph.94.10.1671DOI Listing
October 2004

Bilateral organization of unilaterally generated activity in lumbar spinal motoneurons of the rat.

Brain Res 2004 May;1009(1-2):98-109

Department of Psychology, Program in Neural Science, Indiana University, Bloomington, IN 47405, USA.

The spinal nucleus of the bulbocavernosus (SNB) is a medially located, bilaterally organized sexually dimorphic motor nucleus in the lumbar spinal cord of the male rat. To begin to assess the potential functional significance of this bilateral organization, we recorded ipsi- and contralateral SNB motor nerve activity following unilateral spinal stimulation and examined the timing, pattern, and recruitment of population motoneuron activity. A possible mechanism for bilateral communication, gap junctional intercellular communication, was also investigated because dye coupling experiments indicate an extensive syncytium in which SNB motoneurons are coupled with each other and neighboring interneurons. An in vivo peripheral nerve recording paradigm was used: a bipolar stimulating electrode was placed on dorsal root L6, and bipolar recording electrodes were placed bilaterally on the SNB motor nerves. All processes were severed distal to electrode placement to isolate the central preparation; recruitment curves of motoneuronal activity were then generated. Amplitude of peak to peak recruitment was greater in the contralateral motor nerve than in the ipsilateral nerve. Response latency, Fourier transform and spike counts showed no evidence of ipsi/contralateral asymmetry. Recruitment was attenuated both ipsi- and contralaterally after pharmacological gap junction blockade, but antidromic stimulation could not drive activity in contralateral motor axons. These results indicate that unilateral input to the SNB may be differentially modulated to produce functionally distinct output in the two separate halves of the nucleus. We also discuss the potential modulatory role of gap junctions in the activity of the SNB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.brainres.2004.02.047DOI Listing
May 2004

Hormone sensitivity of muscle activation in the sexually dimorphic SNB/BC neuromuscular system of the rat.

Neurosci Lett 2004 Apr;359(1-2):41-4

Program in Neural Science, Department of Psychology, Indiana University, Bloomington, IN 47405, USA.

Rat penile reflexes are mediated in part by motoneurons in the sexually dimorphic spinal nucleus of the bulbocavernosus (SNB) and a muscle it innervates, the bulbocavernosus (BC). Recruitment in the M-wave component of electromyographic recording in the SNB/BC neuromuscular circuit is sensitive to testosterone and estradiol. To localize the site of the hormonal effect, we recorded muscle activity in a reduced preparation that isolated the peripheral structures involved in generating an M-wave. Castration reduced recruitment amplitude and increased response latency, and treatment with estradiol or the non-aromatizable androgen dihydrotestosterone prevented these changes. Dihydrotestosterone, but not estradiol, maintained BC muscle mass. These results indicate that functional changes in the SNB/BC circuit can result in part from hormonal sensitivity in the neuromuscular periphery and are independent of muscle mass.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.neulet.2004.01.065DOI Listing
April 2004

Estrogen alters excitability but not morphology of a sexually dimorphic neuromuscular system in adult rats.

J Neurobiol 2003 Jul;56(1):66-77

Psychology Department, Indiana University, Bloomington, Indiana 47405, USA.

In rats, motoneurons of the spinal nucleus of the bulbocavernosus (SNB) innervate the bulbocavernosus (BC) muscle, which surrounds the base of the penis. The SNB/BC is a sexually dimorphic, steroid-sensitive neuromuscular system, which is critically important in male reproductive behavior. Androgens are necessary for the development, morphology, and function of the SNB/BC system. However, estradiol (E) is also necessary for the development of the SNB/BC system, and E is capable of maintaining BC EMG activity in adulthood. In this study, we used electrophysiological and anatomical methods to examine estrogenic effects on BC EMG activity. We used a modified H-reflex testing method to investigate polysynaptic reflex characteristics in intact males, castrates, and castrates treated short term with estradiol benzoate (EB). Measures of EMG activity, response latency, and spike count were altered in castrates, but maintained in EB-treated castrates to the levels of intact males. Furthermore, estrogenic effects were found in EMG activity that could be isolated to the periphery of the SNB/BC system. BC NMJ size and muscle fiber area have been demonstrated to be hormone sensitive, and we examined these for possible correlates of E's effects on BC EMG activity. BC muscles of intact males, castrates, and short-term EB-treated castrates were fixed and stained with zinc iodide and osmium tetroxide. NMJ size and muscle fiber area did not differ between groups. Together, these data suggest that E treatment results in changes in the neuromuscular periphery that maintain BC EMG activity, but this effect cannot be accounted for by changes in NMJ size or muscle fiber area.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/neu.10224DOI Listing
July 2003