Relationship Between Pulse Wave Velocity and Serum YKL-40 Level in Patients With Early Rheumatoid Arthritis.

Relationship between pulse wave velocity and serum YKL-40 level in patients with early rheumatoid arthritis.

Rheumatol Int. 2013 Jun 25;
Turkyilmaz AK, Devrimsel G, Kirbas A, Cicek Y, Karkucak M, Capkin E, Gokmen F

Subclinical atherosclerosis has been demonstrated in patients with early rheumatoid arthritis (ERA) without any signs of cardiovascular disease (CVD). The aim of this study was to investigate the relationship between serum YKL-40 level and arterial stiffness in patients with ERA. Forty two patients with ERA and 35 healthy controls with no history or current sign of CVD were included in the study. ERA patients with active disease, defined as DAS28 ?3.2, and symptoms onset <12 months were recruited. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (CF-PWV), and the intima-media thickness carotid (IMT-C) was measured by carotid ultrasonography. Serum YKL-40 levels were measured by an enzyme-linked immunoassay method. The mean age was 43.1 ± 5.8 years in ERA patients and 41.0 ± 5.9 years in control group. The CF-PWV and IMT-C of the ERA patients were determined significantly higher than the control group (P = .001, P < .001, respectively). YKL-40 levels were significantly elevated in ERA patients than controls (P = .008). The serum levels of YKL-40 in the ERA patients showed a strong correlation with CF-PWV (r = .711, P < .001) and IMT-C (r = .733, P < .001). Multiple linear regression analysis revealed that CF-PWV could be explained by serum YKL-40 levels (adjusted R² = .493, P < .001). We have shown that patients with ERA had increased CF-PWV and serum YKL-40 levels. In addition, there was an association between CF-PWV values and serum YKL-40 levels in patients with ERA. As a result, we believe that serum YKL-40 level and CF-PWV might reflect early atherosclerosis in patients with ERA. HubMed – rehab


Barriers to, and facilitators for, referral to pulmonary rehabilitation in COPD patients from the perspective of Australian general practitioners: a qualitative study.

Prim Care Respir J. 2013 Jun 24;
Johnston KN, Young M, Grimmer KA, Antic R, Frith PA

Pulmonary rehabilitation (PR) is recommended in the management of people with chronic obstructive pulmonary disease (COPD), but referral to this service is low.To identify barriers to, and facilitators for, referral to PR programmes from the perspective of Australian general practitioners.Semi-structured interviews were conducted with general practitioners involved in the care of people with COPD. Interview questions were informed by a validated behavioural framework and asked about participants’ experience of referring people with COPD for PR, and barriers to, or facilitators of, this behaviour. Interviews were audiotaped, transcribed verbatim, and analysed using content analysis.Twelve general practitioners participated in this study, 10 of whom had never referred a patient to a PR programme. Four major categories relating to barriers to referral were identified: low knowledge of PR for COPD; low knowledge of how to refer; actual or anticipated access difficulties for patients; and questioning the need to do more to promote exercise behaviour change. Awareness of benefit was the only current facilitator. Three major categories of potential facilitators were identified: making PR part of standard COPD care through financial incentive; improving information flow with regard to referrals and services; and informing patients and public.Significant barriers to referral exist, but opportunities to change the organisation of practice and information management were identified. Behaviour change strategies which directly target these barriers and incorporate facilitators should make up the key components of interventions to improve referral to PR by general practitioners who care for people with COPD. HubMed – rehab


Bihemispheric repetitive transcranial magnetic stimulation combined with intensive occupational therapy for upper limb hemiparesis after stroke: a preliminary study.

Int J Rehabil Res. 2013 Jun 20;
Yamada N, Kakuda W, Kondo T, Shimizu M, Mitani S, Abo M

We investigated the safety, feasibility, and efficacy of the combination of bihemispheric repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) for upper limb hemiparesis in poststroke patients. The study participants were eight poststroke patients with upper limb hemiparesis (age at intervention: 62.8±4.9 years, time after stroke: 84.3±87.2 months, mean±SD). During 15 days of hospitalization, each patient received 10 sessions of 40-min bihemispheric rTMS and 240-min intensive OT (120-min one-to-one training and 120-min self-training). One session of bihemispheric rTMS comprised the application of both 1 and 10 Hz rTMS (2000 stimuli for each hemisphere). The Fugl-Meyer Assessment, Wolf Motor Function Test, and the Modified Ashworth Scale were administered on the day of admission and at discharge. All patients completed the treatment without any adverse effects. Motor function of the affected upper limb improved significantly, on the basis of changes in Fugl-Meyer Assessment and Wolf Motor Function Test (P<0.05, each). A significant decrease in the Modified Ashworth Scale score was noted in the elbow, wrist, and finger flexors of the affected upper limb (P<0.05, each). The combination of bihemispheric rTMS and intensive OT was safe and feasible therapy for poststroke hemiparetic patients, and improved motor function of the hemiparetic upper limb in poststroke patients. The findings provide a new avenue for the treatment of patients with poststroke hemiparesis.Wir untersuchten die Sicherheit, Durchführbarkeit und Wirksamkeit der Kombination aus bihemisphärischer repetitiver transkranieller Magnetstimulation (rTMS) und intensiver Ergotherapie bei Patienten mit Hemiparese der oberen Extremitäten nach Schlaganfall. Die Studienteilnehmer waren acht Patienten mit Hemiparese der oberen Extremitäten nach Schlaganfall (Alter zum Zeitpunkt der Intervention: 62.8±4.9 Jahre, Zeit nach Schlaganfall: 84.3±87.2 Monate, mittlere±Sta). Im Laufe des 15-tägigen Krankenhausaufenthalts erhielt jeder Patient insgesamt 10 Anwendungen à 40 Minuten bihemisphärischer rTMS und 240 Minuten intensive Ergotherapie (120 Minuten Einzeltraining und 120 Min. Eigentraining). Eine Anwendung bihemisphärischer rTMS bestand aus der Anwendung von 1 und 10 Hz rTMS (2000 Stimuli pro Hemisphäre). Der Fugl-Meyer-Score, der motorische Funktionstest nach Wolf und die modifizierte Ashworth-Skala wurden am Tag der Aufnahme und Entlassung angewendet. Alle Patienten schlossen die Behandlung ohne unerwünschte Ereignisse ab. Die motorische Funktion der betroffenen oberen Extremität wies ausgehend von den Veränderungen beim Fugl-Meyer-Score und beim motorischen Funktionstest nach Wolf (je P<0.05) eine signifikante Verbesserung auf. Eine signifikante Abnahme des Scores bei der modifizierten Ashworth-Skala wurde bei den Ellbogen-, Handgelenks- und Fingerbeugern in der betroffenen oberen Extremität beobachtet (je P<0.05). Die Kombination bihemisphärischer rTMS und intensiver Ergotherapie war eine sichere und durchführbare Therapie bei hemiparetischen Patienten nach Schlaganfall, die die motorische Funktion der hemiparetischen oberen Extremität verbesserte. Die Ergebnisse eröffnen neue Wege für die Behandlung von hemiparetischen Patienten nach Schlaganfall.En este estudio se ha investigado la seguridad, la viabilidad y la eficacia de la combinación de estimulación magnética transcraneal repetitiva (EMTr) bihemisférica con una terapia ocupacional intensiva (TO) para el tratamiento de hemiparesia del miembro superior en pacientes con ictus. En el estudio participaron ocho sujetos con ictus y hemiparesia del miembro superior (edad en el momento de la intervención: 62.8±4.9 años, tiempo transcurrido tras el ictus: 84.3±87.2 meses, media±DE). A lo largo de 15 días de hospitalización, cada uno de los pacientes recibió 10 sesiones de EMTr bihemisférica de 40 minutos y TO de 240 minutos (120 minutos de terapia individual y 120 minutos de autoterapia). En una sesión de EMTr bihemisférica se aplicaba una EMTr de 1 y 10 Hz (2000 estímulos para cada hemisferio). La puntuación Fugl-Meyer, la prueba de función motora de Wolf y la Escala modificada de Ashworth fueron llevadas a cabo en el día de la admisión y en el momento del alta. Todos los pacientes finalizaron el tratamiento sin presentar ningún efecto adverso. Se observó una mejora significativa de la función motora del miembro superior afectado, de acuerdo con la puntuación Fugl-Meyer y la prueba de función motora de Wolf (P<0.05, respectivamente). Asimismo, se observó una disminución significativa de la puntuación de la Escala modificada de Ashworth en el codo, la muñeca y los flexores de los dedos del miembro superior afectado (P<0.05, respectivamente). Se concluyó que la combinación de EMTr bihemisférica y TO intensiva es un método de tratamiento seguro y viable para pacientes hemiparéticos, además de mejorar la función motora del miembro superior hemiparético en individuos con ictus. Dichos hallazgos ofrecen un nuevo método de tratamiento de pacientes con hemiparesia postictus.Nous avons étudié l'innocuité, la faisabilité et l'efficacité de la combinaison de stimulation magnétique transcrânienne répétitive bihémispherique (SMTr) et d'ergothérapie intensive (EI) pour une hémiparésie du membre supérieur chez les patients post-AVC. Les participants à l'étude étaient huit patients post-AVC souffrant d'hémiparésie du membre supérieur (âge au moment de l'intervention: 62.8 ± 4.9 ans, délai après l'accident vasculaire cérébral : 84.3 ± 87.2 mois, moyenne ± écart-type). Pendant 15 jours d'hospitalisation, chaque patient a reçu 10 séances de 40 min de SMTr bihémispherique et 240 min d'EI (120 min avec formateur en individuel et 120 min en traitement autonome). Une séance de SMTr bihémispherique comprend l'application de stimuli de rTMS de 1 et 10 Hz (2000 stimuli pour chaque hémisphère). L'évaluation de Fugl-Meyer, le test de la fonction motrice de Wolf et l'échelle d'Ashworth modifiée ont été administrés le jour de l'admission et celui de la sortie. Tous les patients ont suivi le traitement sans effets indésirables. La fonction motrice du membre supérieur atteint s'est améliorée de façon significative, sur la base des changements observés dans l'évaluation de Fugl-Meyer et le test de la fonction motrice de Wolf (P <0.05, chacun). Une diminution significative du score sur l'échelle d'Ashworth modifiée a été notée au niveau du coude, du poignet et fléchisseurs des doigts du membre supérieur atteint (P <0.05, chacun). La combinaison de SMTr bihémispherique et d'ergothérapie intensive constitue une thérapie sûre et pratique pour des patients hémiplégiques, pour l'amélioration de la fonction motrice du membre supérieur hémiplégique chez les patients post-AVC. Ces résultats fournissent une nouvelle voie de traitement pour les patients atteints d'hémiparésie post-AVC. HubMed – rehab


[Documenting occupation in the medical chart of a public hospital system: 2006-2010.]

Arch Prev Riesgos Labor. 2012 Jul to Sep; 15(3): 124-128
Aguilar-Rodríguez AA, Ramada JM, Delclòs J

To describe the frequency of recording of a patient’s occupation and/or employment status in the medical charts of a Barcelona hospital system by age, sex, department and type of medical record.We reviewed the medical records of a random sample of 495 patients age 18 years and older, admitted between 2006 and 2010 in nine hospital departments (dermatology, pulmonary diseases, ophthalmology, oncology, otolaryngology, radiation therapy, rehabilitation, traumatology and urology). For each department and each year, 11 hard copy and 11 different electronic records were reviewed. In all cases we collected information on recording of occupation and/or employment status, age, sex and recording year.57% of reviewed records were from male patients, 40% of the charts were hard copy and 60% were electronic. Overall, information on the patient’s occupation and/or employment status was found in 32% of cases, more often for male patients and in the hard copy records. The rehabilitation department exhibited the highest completion rate (47%), whereas the ophthalmology department exhibited the lowest (16%).Information on a hospitalized patient’s occupation and/or employment status is low, being present in less than one-third of cases, which is consistent with previous studies conducted in Spain and elsewhere. Specific initiatives are needed to improve this important shortcoming. HubMed – rehab