MORECare Research Methods Guidance Development: Recommendations for Ethical Issues in Palliative and End-of-Life Care Research.

MORECare research methods guidance development: Recommendations for ethical issues in palliative and end-of-life care research.

Palliat Med. 2013 May 21;
Gysels M, Evans CJ, Lewis P, Speck P, Benalia H, Preston NJ, Grande GE, Short V, Owen-Jones E, Todd CJ, Higginson IJ

Background:There is little guidance on the particular ethical concerns that research raises with a palliative care population.Aim:To present the process and outcomes of a workshop and consensus exercise on agreed best practice to accommodate ethical issues in research on palliative care.Design:Consultation workshop using the MORECare Transparent Expert Consultation approach. Prior to workshops, participants were sent overviews of ethical issues in palliative care. Following the workshop, nominal group techniques were used to produce candidate recommendations. These were rated online by participating experts. Descriptive statistics were used to analyse agreement and consensus. Narrative comments were collated.Setting/participants:Experts in ethical issues and palliative care research were invited to the Cicely Saunders Institute in London. They included senior researchers, service providers, commissioners, researchers, members of ethics committees and policy makers.Results:The workshop comprised 28 participants. A total of 16 recommendations were developed. There was high agreement on the issue of research participation and high to moderate agreement on applications to research ethics committees. The recommendations on obtaining and maintaining consent from patients and families were the most contentious. Nine recommendations were refined on the basis of the comments from the online consultation.Conclusions:The culture surrounding palliative care research needs to change by fostering collaborative approaches between all those involved in the research process. Changes to the legal framework governing the research process are required to enhance the ethical conduct of research in palliative care. The recommendations are relevant to all areas of research involving vulnerable adults. HubMed – rehab


Combined information from resting-state functional connectivity and passive movements with functional magnetic resonance imaging differentiates fast late-onset motor recovery from progressive recovery in hemiplegic stroke patients: A pilot study.

J Rehabil Med. 2013 May 17;
Jung TD, Kim JY, Seo JH, Jin SU, Lee HJ, Lee SH, Lee YS, Chang Y

Objective: To investigate the value of combining information from resting-state functional connectivity and passive movements, measured with functional magnetic resonance imaging (fMRI), in acute stroke patients with severe motor impairment. Subjects: Eight patients with severe left upper limb motor impairment underwent a passive movement task with fMRI and resting-state fMRI, 3 weeks following stroke onset. According to the patterns of motor recovery, patients were divided into groups with, respectively, good or poor motor recovery. Patients with good recovery were further divided into two subgroups: progressive and fast late-onset motor recovery. Method: Activation and deactivation maps from a passive movement task with fMRI were obtained. Interhemispheric connectivity analysis was conducted using resting-state fMRI. Results: Interhemispheric connectivity score in patients with progressive motor recovery was much greater than the scores in patients with fast late-onset and poor motor recovery. For passive movement, patients with progressive recovery exhibited activation in the ipsilesional sensorimotor area and no deactivation in the contralesional sensorimotor area. Patients with fast late-onset motor recovery showed strong deactivation in both sensorimotor areas. Patients with poor recovery showed no activation or deactivation in either of the sensorimotor areas. Conclusion: Interhemispheric connectivity alone is not enough to predict delayed motor recovery. HubMed – rehab


Medical Emergency Team: Transitioning From an External Response Team to an Internal Response Team.

Rehabil Nurs. 2013 May 21;
Dipietro EA, Prestwich S, Swearingen T

PURPOSE: To outline the process and thoroughly discuss the methods used to transition from an external rapid response team to an internal rapid response team. METHODS: The medical complexities of the patient population at Kennedy Krieger Institute, coupled with a retrospective data review of past “code calls,” revealed a rapid response team was essential. The anticipated loss of the current external rapid response team indicated that an alternative solution would need to be designed. Over a 2-year period, an internal medical response team was developed and implemented to address the potential medical emergency needs of our acute care rehabilitation patients. RESULTS: The outcome from all “code calls” since the implementation of the internal rapid response team has been markedly positive. DISCUSSION: Comprehensive planning involving many team members, detailed communication with external resources, and extensive education resulted in a seamless transition from an external rapid response team to an internal response team. CLINICAL RELEVANCE: Freestanding rehabilitation centers do not have the in-house rapid response team resources that an acute care hospital utilizes to address potential medical emergencies. The development and implementation of an internal rapid response team can meet these needs. HubMed – rehab


Wheelchair exercise capacity in spinal cord injury up to five years after discharge from inpatient rehabilitation.

J Rehabil Med. 2013 May 17;
van Koppenhagen CF, de Groot S, Post MW, van Asbeck FW, Spijkerman D, Faber WX, Lindeman E, van der Woude LH

Objective: To elucidate the course and determinants of wheelchair exercise capacity in spinal cord injury up to 5 years after discharge from inpatient rehabilitation, and to describe loss to follow-up. Design: Prospective cohort study, with measurements at the start and discharge from inpatient rehabilitation, 1 and 5 years after discharge. Subjects: A total of 225 wheelchair-dependent persons with spinal cord injury. Methods: Random coefficient analysis of the course and determinants of peak aerobic power output (POpeak) and peak oxygen uptake (VO2peak). Results: A total of 162 participants attended 1 or more peak exercise tests and were analysed. Significant changes were found for both VO2peak and POpeak between start and 5 years after discharge, and discharge and 5 years after discharge. No significant changes were found for VO2peak and POpeak between 1 year and 5 years after discharge. Age, gender, level and completeness of lesion were determinants for level of VO2peak and age, gender, and level of lesion for level of POpeak. No significant determinants were found for the course of wheelchair exercise capacity. The 63 participants who were not analysed were older, and showed more persons with a tetraplegia. Conclusion: Wheelchair exercise capacity of persons with spinal cord injury stabilizes at between 1 and 5 years after discharge. The participants appear to be a positive selection of the total study group. HubMed – rehab