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Age-Friendly Care and Mobility in Hospitalized Older Adults With Cognitive Impairment: A Feasibility Quality Improvement Initiative
Get PDFBACKGROUND: Hospitalized older adults with cognitive impairment (CI) have an increased risk for adverse outcomes. Acute Care for Elders (ACE) Units were developed to reduce functional decline in hospitalized older adults. INTERVENTION: We developed a quality improvement (QI) initiative to disseminate ACE care processes to non-ACE units, converting them into Virtual ACE units. The aim of this evaluation is to examine the impact of this intervention on the mobilization of patients with CI. POPULATION: Older adults with CI admitted to a study unit (ACE Unit or seven Virtual ACE units). METHODS: We conducted a pre/post-intervention evaluation of the proportion of informed respondents answering yes to the Acute Care Mobility Assessment (ACMA) interview item: In the past 24 hours did the patient move from the bed to the chair, walk in the room, walk in the hallway? RESULTS: There were no significant differences in patient demographics, baseline activities of daily living (ADL) performance, history of falls, or consults to physical or occupational therapy between the total pre- (n = 56) versus post- (n = 135) intervention cohorts. The ACE Unit patients were significantly older (82.9 ± 7.5 vs. 75.5 ± 7.7 years, p \u3c 0.05) and significantly more impaired in baseline ADL performance based on Katz Index scores (6.4 ± 4.4 vs. 8.5 ± 4.4, p \u3c 0.05) compared to patients on Virtual ACE units. The proportion of patients with CI reported on ACMA interview to have mobilized from bed to chair (29% vs. 51%, p \u3c 0.05) and ambulated into the hallway (13% vs. 27%, p \u3c 0.05) in the prior 24 hours significantly increased post-intervention. Similar benefits were seen in the ACE and Virtual ACE patients evaluated separately. CONCLUSION: This QI intervention demonstrated that disseminating ACE care processes to non-ACE units was associated with increased mobilization of hospitalized older adults with CI. Studies with larger sample sizes are needed to confirm findings
The Acute Care Mobility Assessment is a promising tool for evaluating day-to-day mobility in clinical settings: linguistic and convergent-validity in Danish geriatric patients
Get PDFObjective: Low in-hospital mobility is highly prevalent and can cause hospital-associated-disability. In both research and clinical care, valid and reliable outcome measures of in-hospital mobility are necessary. The Acute Care Mobility Assessment (ACMA) provides a single measure of hospital out-of-bed mobility and may be a promising tool. The purpose of this study was to perform a cross-cultural validation to facilitate international uptake. Methods: We performed a linguistic validation (translation, cognitive interviewing, cultural adaptation) of the ACMA in Denmark and investigated the convergent-validity of the Danish version (ACMA-DK) in older hospitalized (+65) Danish adults by evaluating the correlation between the ACMA-DK and 24-hour mobility assessed as number of steps, time spent walking, and upright time by SENS motion® activity monitors. Results: The linguistic validation showed ACMA-DK to be well understood and accepted by the respondents. We found a moderate positive correlation between the ACMA-DK and both steps and time spent walking (r \u3e 0.5). Linear regression analyses suggested that for every 1-point increase in the ACMA-DK, steps increased by 363 and time spent walking by 0.14 hours. Conclusion: The ACMA-DK was cross-culturally adapted and was positively associated with out-of-bed mobility (steps taken and time spent walking). The ACMA is a potential tool for evaluating day-to-day out-of-bed mobility in clinical settings
Bypassing Blood-Brain Barrier and Glucose Dependency of Anti-Glioblastoma Drug Candidates Targeting Mitochondrial Respiration
No full textWe attempt to address two key therapeutic obstacles affecting glioblastoma patients: low ability of anticancer drugs to penetrate the blood-brain barrier (BBB), and temozolomide (TMZ) resistance, by targeting mitochondrial respiration of glioblastoma cells. We designed and tested over 100 new compounds based on the chemical structure of fenofibrate (FF), which in its prodrug form is cytotoxic to cancer cells by causing severe impairment of mitochondrial respiration. The compounds were designed using two key predictive tools: central nervous system–multiparameter optimization (CNS-MPO) and BBB_SCORE. These algorithms assess how effectively compounds can penetrate the BBB. We initially selected PP1 as a lead compound by testing its BBB penetration, metabolic performance, and antitumoral efficacy. PP1 accumulated in brain tumors and triggered glioblastoma cell death. However, PP1-induced inhibition of mitochondrial respiration was followed by an immediate glycolytic response, which attenuated PP1 toxicity in a glucose-dependent manner. To bypass this limitation, we tested two strategies: (1) the use of PP1 in combination with glycolysis inhibitors; and (2) introduction of a new compound, PP211, which inhibited mitochondrial respiration in the absence of a concomitant increase of glycolysis. Although the combination of PP1 with glycolysis inhibitors was very effective in vitro, this drug combination demonstrated elevated toxicity in mice. PP211, instead, attenuated TMZ-resistant tumor growth and prolonged mouse survival with only minimal general animal toxicity. In summary, we developed and tested a novel mitochondria-targeting drug candidate, PP211, which effectively crosses the BBB, overcomes TMZ resistance, and induces tumor cell death independently of glucose levels—while exhibiting minimal systemic toxicity in preclinical models. These findings support further development of PP211 for glioblastoma therapy
Hurricane Katrina Archive: Faculty Publications Bibliography 2010-2014
Get PDFThis bibliography includes 45 articles about Hurricane Katrina written by authors affiliated with LSU Health – New Orleans between January 2010 and December 2014.https://digitalscholar.lsuhsc.edu/biblio/1001/thumbnail.jp
Nasal Venous Malformation with Intracranial Communication: Presentation, Management, and Review of the Literature
No full textThis manuscript reports the rare case of a pediatric patient with a nasal venous malformation (VM) with intracranial communication and bilateral internal jugular vein (IJV) occlusion. Due to the IJV occlusion, the nasal VM provided collateral circulation for blood drainage from the patient\u27s brain. Spontaneous recanalization of the IJVs was reported in the patient, potentially allowing for new treatment modalities, as the nasal VM would be responsible for less collateral venous outflow. A literature review was conducted to identify the incidence of spontaneous recanalization of the jugular venous system. Through 3 databases, 413 peer-reviewed journal articles were obtained for the systematic review. After eliminating duplicate articles and screening titles, abstracts, and full texts, 4 articles were included in the final literature review. The level of evidence from the literature review was relatively low. All 4 articles identified in the literature review were case reports of spontaneous recanalization of thrombotic events. In our patient, spontaneous recanalization of IJV occlusion allowed for consideration of treatment options (ie, surgical excision) of a nasal VM, which otherwise provided critical venous drainage for the patient\u27s brain. If flow through the IJVs is not sufficient, balloon angioplasty, patch angioplasty, or possible reconstruction of the IJVs may be necessary to allow for treatment of the nasal VM. If these surgical interventions prove to be too high-risk for the patient, conservative therapy may be the best option
An Analysis of Face Validity for the Mobile-App Scenario and Biomimetic Simulator in the Burns for Providers Program (BP2)
No full textINTRODUCTION: The military funded a novel burn educational program called the Burns for Providers Program (BP2) which teaches cognitive skills via a scenario-based mobile app and psychomotor skills via biomimetic tabletop simulators. We sought to establish face validity for these prototypes. METHODS: Instruments have face validity if subject matter experts (SMEs) feel they have verisimilitude for whatever they purport to represent. Booths were purchased at the 2024 American Burn Association (ABA) and Southern Region Burn meetings. Interested SMEs (defined as completion of a burn fellowship or \u3e3 years in a practice consisting of \u3e25% burns) engaged with prototypes depicting a patient presenting to a Role 2 or civilian emergency department (ED) with a femur fracture and a 44% burn. SMEs completed a 17-item survey consisting of positive statements about the prototypes which they rated from 1= Strongly disagree to 5= Strongly agree. These procedures were repeated for SMEs at the United States Army\u27s Institute of Surgical Research. RESULTS: 77 SMEs with 12.4 + 10.1 years\u27 experience made up the study cohort (89% civilian, 11% military). The majority were nurses (43%), burn surgeons (26%), or advanced practice providers (APPs) (9%). Overall, 88% of SMEs answered 17/17 positively-phrased statements interrogating the software and model\u27s importance, verisimilitude, and effectiveness with strongly agree or somewhat agree; 8% had at least 1 neutral response with the remainder being agreement; 4% registered at least one disagree response to the 17 positively-phrased statements. CONCLUSIONS: The resources, environment, and injuries portrayed in the prototype BP2 mobile app scenario and tabletop simulator appear to have high face validity
Three-Level Anterior Cervical Discectomy and Fusion With or Without an Investigational Posterior Stabilization System Assessed Through 24 Months: A Multicenter Randomized Controlled Trial
No full textStudy design: Prospective randomized controlled trial. Objective: This trial was designed to understand safety and effectiveness outcomes in subjects with three-level cervical degenerative disc disease treated with anterior cervical discectomy and fusion (ACDF) alone or supplemented with a posterior cervical fusion (PCF) performed using an investigational posterior cervical stabilization system (PCSS). Background: ACDF remains the most common surgical treatment for cervical disc disease. Long-segment (3+ disc levels) procedures are associated with increased risk of complications including symptomatic nonunion. Supplementing ACDF with PCF to form a circumferential cervical fusion (CCF) improves biomechanical stability but increases the surgical burden for the patient. Materials and methods: This multicenter study compared outcomes in participants with three-level symptomatic cervical disc degeneration treated with either ACDF or CCF. The CCF procedure incorporated PCF with PCSS. The primary endpoint was 12-month fusion success, defined by bridging bone across the interbody and range of motion \u3c 2° across all treated disc levels. The 24-month secondary endpoint was a composite of fusion success, neck disability index (NDI) improvement, neurological status success, and freedom from surgical revision. Results: This protocol-defined interim analysis included 202 participants with 12-month outcomes and 116 participants with 24-month outcomes. Twelve-month fusion success was higher for CCF (61/100, 61%) compared with ACDF (17/102, 17%) ( P \u3c 0.001). The 24-month secondary endpoint was also improved with CCF compared with ACDF [51% (30/59) vs. 23% (13/57); P =0.002]. Revision rates were lower for CCF (1/59, 2%) compared with ACDF (13/57, 23%) ( P \u3c 0.001), with 11 of 13 ACDF revisions addressing symptomatic nonunion. Adding supplemental PCF with PCSS did not increase the rates of adverse events (ACDF=65%, CCF=46%, P =0.005). Conclusions: This study represents the first randomized controlled trial assessing treatment of three-level cervical disc disease. Long-segment ACDF demonstrated low fusion rates and high rates of revision. Adding supplemental PCF with PCSS improved fusion without increasing the risk of surgical complications. Keywords: anterior cervical discectomy and fusion; cervical spine; circumferential cervical fusion; degenerative disease; fusion; multilevel; nonunion; posterior cervical fusion; pseudarthrosis; randomized controlled trial
Parham, Frederick William
No full textPlaque reads: Frederick William Parham / 1856-1927 / Interne Charity Hospital 1876-78 / Asst House Surgeon 1885-87 / Surgical Staff 1878-1927 / Surgeon Teacher Administrator Friendhttps://digitalscholar.lsuhsc.edu/cac/1094/thumbnail.jp