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1. Patient Versus Clinician Proxy Reliability of the AM-PAC '6-Clicks' Basic Mobility and Daily Activity Short Forms

Author

Johnson, Joshua K., Lapin, Brittany, Bethoux, Francois, Skolaris, Alexis, Katzan, Irene, and Stilphen, Mary

Subjects
Therapeutics, Physiological -- Evaluation, Physical therapy -- Evaluation, Proxy -- Evaluation, Medical care -- Quality management, Health
Abstract

Objective. The purpose of this study was to test the reliability of the Activity Measure for Post-Acute Care (AM-PAC) '6-Clicks' mobility and activity short forms between patients and therapist proxies. As a secondary aim, reliability was examined when patients completed their self-report before versus after the therapist evaluation. Methods. Patients being seen for an initial physical therapist (N =70) or occupational therapist (N =71) evaluation in the acute care hospital completed the '6-Clicks' mobility short form (if a physical therapist evaluation) or activity short form (if an occupational therapist evaluation). Whether patients completed their self-assessment before or after the evaluation was randomized. Patient- and therapist-rated '6-Clicks' raw scores were converted to AM-PAC T-scores for comparison. Reliability was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, and agreement was assessed with weighted kappa values. Results. The ICCs for the '6-Clicks' mobility and daily activity short forms were 0.57 (95% CI = 0.42-0.69) and 0.45 (95% CI =0.28-0.59), respectively. For both short forms, reliability was higher when the patient completed the self-assessment after versus before the therapist evaluation (ICC =0.67, 95% CI = 0.47-0.80 vs ICC=0.50, 95% CI = 0.26-0.67 for the mobility short form; and ICC = 0.52, 95% CI =0.29-0.70 vs ICC= 0.34, 95% CI = 0.06-0.56 for the activity short form). Conclusion. Reliability of the '6-Clicks' total scores was moderate for both the mobility and activity short forms, though higher for the mobility short form and when patients' self-report occurred after the therapist evaluation. Impact. Reliability of the AM-PAC '6-Clicks' short forms is moderate when comparing scores from patients with those of therapists responding as proxies. The short forms are useful for measuring participants' function in the acute care hospital; however, it is critical to recognize limitations in reliability between clinician- and patient-reported AM-PAC scores when evaluating longitudinal change and recovery. Keywords: Activities of Daily Living, Acute Care, Measurement: Basic Theory and Science, Mobility, Introduction Many individuals in acute care hospitals experience new or worsening deficits in physical function and their ability to participate in daily activities. (1,2) Individual's functional status in the hospital [...]

Published
2022
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2. Engaging patients as partners in a multicentre trial of spinal versus general anaesthesia for older adults

Author

Looke, Thomas, Bent, Sandra, Franco-Mora, Ariana, Hedrick, Pamela, Newbern, Matthew, Tadros, Rafik, Pealer, Karen, Marcantonio, Edward, Vlassakov, Kamen, Buckley, Carolyn, Gorbatov, Svetlana, Gosnell, James, Steen, Talora, Vafai, Avery, Zeballos, Jose, Cardenas, Louis, Berry, Ashley, Getchell, John, Quercetti, Nicholas, Sessler, Daniel I., Ayad, Sabry, Hassan, Manal, Ali, Assad, Bajracharya, Gauasan, Billow, Damien, Bloomfield, Michael, Elliott, Kavita, Hampton, Robert, He, Linda, Honar, Hooman, Khoshknabi, Dilara, Kim, Daniel, Minko, Paul, Morris, Adam, Niazi, Azfar, Nutcharoen, Tara, Roberts, Jeffrey, Saha, Partha, Salih, Ahmed, Skolaris, Alexis, Stang, Taylor, Strimbu, Victor, Templeton, Jesse, Volio, Andrew, Wang, Jiayi, Bolkus, Kelly, DeAngelis, Matthew, Dodson, Gregory, Gerritsen, Jeffrey, McEniry, Brian, Mitrev, Ludmil, Kwofie, Kwesi, Bonazza, Flynn, Lloyd, Vera, Panek, Izabela, Dabiri, Jared, Chavez, Chris, Craig, Jason, Davidson, Todd, Dietrichs, Chad, Fleetwood, Cheryl, Foley, Mike, Getto, Chris, Hailes, Susie, Hermes, Sarah, Hooper, Andy, Koener, Greg, Kohls, Kate, Law, Leslie, Lipp, Adam, Losey, Allison, Nelson, William, Nieto, Mario, Rogers, Pam, Rutman, Steve, Scales, Garrett, Sebastian, Barbara, Stanciu, Tom, Lobel, Gregg, Giampiccolo, Michelle, Herman, Dara, Kaufman, Margit, Murphy, Bryan, Pau, Clara, Puzio, Thomas, Veselsky, Marlene, Stone, Trevor, Apostle, Kelly, Boyer, Dory, Fan, Brenda Chen, Lee, Susan, Lemke, Mike, Merchant, Richard, Moola, Farhad, Payne, Kyrsten, Perey, Bertrand, Viskontas, Darius, Poler, Mark, D'Antonio, Patricia, Sheppard, Richard, Abdullah, Amer, Fish-Fuhrmann, Jamie, Giska, Mark, Fidkowski, Christina, Guthrie, Trent, Hakeos, William, Hayes, Lillian, Hoegler, Joseph, Nowak, Katherine, Hymes, Robert, Beck, Jeffery, Cuff, Jaslynn, Gaski, Greg, Haaser, Sharon, Holzman, Michael, Malekzadeh, A. Stephen, Ramsey, Lolita, Schulman, Jeff, Schwartzbach, Cary, Sieber, Frederick, Azefor, Tangwan, Brown, Charles, Davani, Arman, Jaberi, Mahmood, Masear, Courtney, Sharma, Balram, Haider, Syed Basit, Chungu, Carolyn, Ebrahimi, Ali, Fikry, Karim, Gannon, Kerri, Marcantonio, Andrew, Pace, Meredith, Sanders, David, Clarke, Collin, Lawendy, Abdel, Schwartz, Gary, Garg, Mohit, Kim, Joseph, Marshall, Mitchell, Caurci, Juan, Commeh, Ekow, Cuevas, Randy, Cuff, Germaine, Franco, Lola, Furguiele, David, Giuca, Matthew, Allman, Melissa, Barzideh, Omid, Cossaro, James, D'Arduini, Armando, Farhi, Anita, Gould, Jason, Kafel, John, Patel, Anuj, Peller, Abraham, Reshef, Hadas, Safur, Mohammed, Toscano, Fiore, Tedore, Tiffany, Akerman, Michael, Brumberger, Eric, Clark, Sunday, Friedlander, Rachel, Jegarl, Anita, Lane, Joseph, Lyden, John P., Mehta, Nili, Murrell, Matthew T., Painter, Nathan, Ricci, William, Sbrollini, Kaitlyn, Sharma, Rahul, Steel, Peter A.D., Steinkamp, Michele, Weinberg, Roniel, Wellman, David Stephenson, Nader, Antoun, Fitzgerald, Paul, Ritz, Michaela, Papp, Steven, Bryson, Greg, Craig, Alexandra, Farhat, Cassandra, Gammon, Braden, Gofton, Wade, Harris, Nicole, Lalonde, Karl, Liew, Allan, Meulenkamp, Bradley, Sonnenburg, Kendra, Wai, Eugene, Wilkin, Geoffrey, Donegan, Derek, Dinh, Cassandra, Elkassabany, Nabil, Horan, Annamarie, Mehta, Samir, Troxell, Karen, Alderfer, Mary Ellen, Brannen, Jason, Cupitt, Christopher, Gerhart, Stacy, McLin, Renee, Sheidy, Julie, Yurick, Katherine, Carson, Jeffrey, Chen, Fei, Dragert, Karen, Kiss, Geza, Malveaux, Halina, McCloskey, Deborah, Mellender, Scott, Mungekar, Sagar S., Noveck, Helaine, Sagebien, Carlos, Perlman, Barry, Biby, Luat, McKelvy, Gail, Richards, Anna, Azim, Syed, Abola, Ramon, Ayala, Brittney, Halper, Darcy, Mavarez, Ana, Choi, Stephen, Awad, Imad, Flynn, Brendan, Henry, Patrick, Jenkinson, Richard, Kaustov, Lilia, Lappin, Elizabeth, McHardy, Paul, Singh, Amara, Hauck, Ellen, Donnelly, Joanne, Gonzalez, Meera, Haydel, Christopher, Livelsberger, Jon, Pazionis, Theresa, Slattery, Bridget, Vazquez-Trejo, Maritza, Schwenk, Eric, Baratta, Jaime, Deiling, Brittany, Deschamps, Laura, Glick, Michael, Katz, Daniel, Krieg, James, Lessin, Jennifer, Torjman, Marc, Chin, Ki Jinn, Jin, Rongyu, Salpeter, Mary Jane, Powell, Mark, Simmons, Jeffrey, Lawson, Prentiss, Kukreja, Promil, Graves, Shanna, Sturdivant, Adam, Bryant, Ayesha, Crump, Sandra Joyce, Dillane, Derek, Taylor, Michael, Verrier, Michelle, Applegate, Richard, Arias, Ana, Pineiro, Natasha, Uppington, Jeffrey, Wolinsky, Phillip, Sappenfield, Joshua, Gunnett, Amy, Hagen, Jennifer, Harris, Sara, Hollen, Kevin, Holloway, Brian, Horodyski, Mary Beth, Pogue, Trevor, Ramani, Ramachandran, Smith, Cameron, Woods, Anna, Warrick, Matthew, Flynn, Kelly, Mongan, Paul, Ranganath, Yatish, Fernholz, Sean, Ingersoll-Weng, Esperanza, Marian, Anil, Seering, Melinda, Sibenaller, Zita, Stout, Lori, Wagner, Allison, Walter, Alicia, Wong, Cynthia, Magaziner, Jay, Orwig, Denise, Brown, Trina, Dattilo, Jim, Ellenberg, Susan, Feng, Rui, Fleisher, Lee, Gaskins, Lakisha, Goud, Maithri, Helker, Chris, Mezenghie, Lydia, Montgomery, Brittany, Preston, Peter, Stephens, Alisa, Schwartz, J. Sanford, Tierney, Ann, Weber, Ramona, Chelly, Jacques, Goel, Shiv, Goncz, Wende, Kawabe, Touichi, Khetarpal, Sharad, King, Kevin, Kunkel, Frank, Luke, Charles, Monroe, Amy, Shick, Vladislav, Silipo, Anthony, Stehle, Caroline, Szabo, Katherine, Yennam, Sudhakar, Hoeft, Mark, Breidenstein, Max, Dominick, Timothy, Friend, Alexander, Mathews, Donald, Lennertz, Richard, Akere, Helen, Balweg, Tyler, Bo, Amber, Doro, Christopher, Goodspeed, David, Lang, Gerald, Parker, Maggie, Rettammel, Amy, Roth, Mary, Sanders, Robert, White, Marissa, Whiting, Paul, Allen, Brian, Baker, Tracie, Craven, Debra, McEvoy, Matt, Turnbo, Teresa, Kates, Stephen, Morgan, Melanie, Willoughby, Teresa, Weigel, Wade, Auyong, David, Fox, Ellie, Welsh, Tina, Jaffe, J. Douglas, Cusson, Bruce, Dobson, Sean, Edwards, Christopher, Harris, Lynette, Henshaw, Daryl, Johnson, Kathleen, McKinney, Glen, Miller, Scott, Reynolds, Jon, Turner, Jimmy, VanEenenaam, David, Weller, Robert, Akhtar, Shamsuddin, Blessing, Marcelle, Johnson, Chanel, Kampp, Michael, Kunze, Kimberly, Li, Jinlei, O'Connor, Mary, Treggiari, Miriam, Hruslinski, Jennifer, Menio, Diane A., Hymes, Robert A., Langlois, Christine, Gaskins, Lakisha J., and Neuman, Mark D.

Published
2021
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4. Intensive Aerobic Cycling Is Feasible and Elicits Improvements in Gait Velocity in Individuals With Multiple Sclerosis: A Preliminary Study.

Author

Simmons, Sarah B., Skolaris, Alexis, Love, Ryan, Fricker, Tori, Penko, Amanda L., Yadi Li, Lapin, Brittany, Streicher, Matt, Bethoux, Francois, and Linder, Susan M.

Subjects
MULTIPLE sclerosis treatment, EXERCISE physiology, PATIENT compliance, STATISTICAL models, WORLD Wide Web, BIOMECHANICS, T-test (Statistics), RESEARCH funding, PILOT projects, STATISTICAL sampling, FUNCTIONAL assessment, TREATMENT effectiveness, GAIT in humans, RANDOMIZED controlled trials, EXERCISE intensity, DESCRIPTIVE statistics, DIAGNOSIS, WEARABLE technology, CYCLING, HEART beat, AEROBIC exercises, TREADMILLS, WALKING speed, APPLICATION software, BLOOD pressure, REGRESSION analysis
Abstract

BACKGROUND: Aerobic exercise (AEx) has many potential benefits; however, it is unknown whether individuals with multiple sclerosis (MS) can attain the optimal intensity and duration to harness its effects. Forced-rate exercise (FE) is a novel paradigm in which the voluntary pedaling rate during cycling is supplemented to achieve a higher exercise intensity. The aim of this pilot trial was to investigate the feasibility and initial efficacy of a 12-week FE or voluntary exercise (VE) cycling intervention for individuals with MS. METHODS: Twenty-two participants with MS (Expanded Disability Severity Scale [EDSS] 2.0-6.5) were randomly assigned to FE (n = 12) or VE (n = 10), each with twice weekly 45-minute sessions at a prescribed intensity of 60% to 80% of maximum heart rate (HR). RESULTS: Eighteen individuals (FE = 11; VE = 7) completed the intervention, however, adaptations were required in both groups to overcome barriers to cycling. Overall, participants exercised for an average of 42.2 ± 2.3 minutes at an aerobic intensity of 65% ± 7% of maximum HR and a pedaling cadence of 67.3 ± 13.3 RPM. Cycling led to improved treadmill walking speed (0.61 to 0.68 m/sec, P = .010), with somewhat greater improvement with FE compared to VE (increase of 0.09 vs 0.03 m/s, respectively, P = .17) post intervention. Notably, the participant with the highest disability level (EDSS 6.5) tolerated FE but not VE. CONCLUSIONS: Aerobic exercise is feasible for individuals with MS, although those with increased disability may require novel paradigms such as FE to achieve targeted intensity. Further trials are warranted to investigate the effects of FE across the MS disability spectrum. [ABSTRACT FROM AUTHOR]

Published
2024
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6. Trends in personal protective equipment use by clinicians performing airway procedures for patients with coronavirus disease 2019 in the USA from the intubateCOVID registry

Author

Gaulton, Timothy, Neuman, Mark, Lane-Fall, Meghan, Gaskins, Lakisha, Dattilo, James, El-Boghdadly, Kariem, Wong, Danny J.N., Ahmad, Imran, Johnstone, Craig, Gutstein, Howard B., Muehlschlegel, Jochen D., Hua, May, Fonseca, Laura, Mitrev, Ludmil, Low, Yinhui, Gupta, Dhanesh, Ayad, Sabry, Volio, Andrew, Salih, Ahmed, Kim, Daniel, Nutcharoen, Aratara, Skolaris, Alexis, Sherman, Marian, Giska, Mark, Nowak, Katherine, Chhina, Anoop, Guruswamy, Jayakar, Penning, Donald, Majewski, Michael, Nagrebetsky, Alexander, Houle, Timothy, Aziz, Michael F., Freed, Julie K., Lien, Cynthia A., Mihm, Fred, Desai, Pankaj M., Fahy, Brenda G., Davies, Laurie, Adair, Kelsey, Gunnett, Amy, Mhyre, Jill M., Sharawi, Nadir, Applegate, Richard, Brzenski, Alyssa, Lin, Michael Y., Olmos, Andrea, Chen, Catherine L., Gropper, Michael, Shochat, Guy, Hoefnagel, Amie, Ranganath, Yatish, Sibenellar, Zita, Colquhoun, Douglas A., Cloyd, Benjamin H., Healy, David W., Mathis, Michael R., Schechtman, Samuel A., Steadman, Joy, Stuart, Ami, Bott, Steven, Gerety, Lyle, Fisher, J. Matthew, Friend, Alexander F., Breidenstein, Max W., Domino, Karen B., Cervantes, Vanessa, Joffe, Aaron M., Dutton, Richard, Shanahan, Jessica, Leissner, Kay B., Jaffe, J. Doug, Strathman, Andrea, Khanna, Ashish K., Segal, B. Scott, Harris, Lynnette, Fowler, Jacob, Johnson, Kathleen, Hill, Shanna S., Murrell, Matthew T., Panzica, Peter, Mittnacht, Alexander, Abramowicz, Elizabeth, Wecksell, Matthew, Schonberger, Robert B., Li, Jinlei, Michel, Shannon, Treggiari, Miriam, Berstein, Steven, Dashevksy, Meir, Gaulton, Timothy G., and Neuman, Mark D.

Published
2021
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7. Reducing inpatient opioid consumption after caesarean delivery: effects of an opioid stewardship programme and racial impact in a community hospital.

Author

Kim DD, Chiang E, Volio A, Skolaris A, Nutcharoen A, Vogan E, Krivanek K, and Ayad SS

Subjects
Humans, Female, Retrospective Studies, Adult, Pregnancy, Pain Management methods, Pain Management statistics & numerical data, Pain Management standards, Inpatients statistics & numerical data, Cesarean Section adverse effects, Cesarean Section methods, Cesarean Section statistics & numerical data, Analgesics, Opioid therapeutic use, Pain, Postoperative drug therapy, Hospitals, Community statistics & numerical data
Abstract

Caesarean section is the most common inpatient surgery in the USA, with more than 1.1 million procedures in 2020. Similar to other surgical procedures, healthcare providers rely on opioids for postoperative pain management. However, current evidence shows that postpartum patients usually experience less pain due to pregnancy-related physiological changes. Owing to the current opioid crisis, public health agencies urge providers to provide rational opioid prescriptions. In addition, a personalised postoperative opioid prescription may benefit racial minorities since research shows that this population receives fewer opioids despite greater pain levels. Our project aimed to reduce inpatient opioid consumption after caesarean delivery within 6 months of the implementation of an opioid stewardship programme.A retrospective analysis of inpatient opioid consumption after caesarean delivery was conducted to determine the baseline, design the opioid stewardship programme and set goals. The plan-do-study-act method was used to implement the programme, and the results were analysed using a controlled interrupted time-series method.After implementing the opioid stewardship programme, we observed an average of 80% reduction (ratio of geometric means 0.2; 95% CI 0.2 to 0.3; p<0.001) in inpatient opioid consumption. The institution designated as control did not experience relevant changes in inpatient opioid prescriptions during the study period. In addition, the hospital where the programme was implemented was unable to reduce the difference in inpatient opioid demand between African Americans and Caucasians.Our project showed that an opioid stewardship programme for patients undergoing caesarean delivery can effectively reduce inpatient opioid use. PDSA, as a quality improvement method, is essential to address the problem, measure the results and adjust the programme to achieve goals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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8. Suspected Septic Sacroiliitis Following Recent Cesarean Section Under Spinal Anesthesia.

Author

Nutcharoen AA, Salih AA, Volio A, Skolaris A, and Ayad S

Abstract

Septic sacroiliitis is sacroiliac (SI) joint inflammation secondary to microbial invasion of the synovial space characterized by tenderness over the sacroiliac joint, difficulty walking, and lower back pain that can radiate to the buttocks. Clinicians can easily overlook septic sacroiliitis as a potential diagnosis due to its rare occurrence and non-specific symptoms. A 30-year-old female (G2P2A0) who presented acutely to the ED nine days after an uncomplicated Cesarean section performed under spinal anesthesia. The patient experienced progressive lancinating, electric-shock pain originating from the coccyx radiating to the right buttock and lower back with the inability to bear weight. MRI pelvis demonstrated edematous changes of the right SI joint, indicative of septic sacroiliitis. Patient's condition improved after empiric intravenous antibiotics and was discharged home on the continued intravenous course. Rapid empiric administration of intravenous antibiotics may have prevented the onset of severe complications of an infective SI joint., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Nutcharoen et al.)

Published
2020
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