Sarah Network of Rehabilitation Hospitals

This study aimed to evaluate the effectiveness of pharmacist-led medication reviews in reducing the anticholinergic burden of hospitalised patients with cardiovascular diseases (CVDs), to identify which anticholinergic medications were most frequently prescribed or discontinued during hospitalisation and to investigate factors associated with an elevated anticholinergic burden via secondary analysis of the INFAR study. An uncontrolled before-and-after design was used, and medication reviews were performed for all patients so that the anticholinergic burden of medications prescribed to older adults during their hospital stay could be examined. The mean age of the 319 patients was 68.9 years (±6.2), and upon hospital admission, 40.4% were classified as having a high anticholinergic burden, decreasing to 22.6% at discharge. Multivariate analysis at admission indicated that polypharmacy (PR = 2.00; 95% CI = 1.47-2.72) and potentially inappropriate medication (PR = 4.47; 95% CI = 2.10-9.53) were independently associated with a higher anticholinergic burden; however, only inappropriate medication was significantly associated with a high burden (PR = 2.39; 95% CI = 1.54-3.71) at discharge. The results indicate that a clinical pharmacist-led medication review may reduce the anticholinergic burden in older adults with CVD, highlighting the importance of such a review in promoting safer prescribing practices during hospitalisation.

BackgroundIndividuals with symptoms of long-term COVID-19 (coronavirus disease 2019) who presented mild infection without needing invasive ventilatory support require rehabilitation and performance and monitoring evaluations. The 1-minute sit-to-stand test (STS) is used to assess individuals with COVID-19 and might be an alternative for remote use in this population.ObjectiveThe current study aimed to validate the synchronous and asynchronous STS tele-assessment in individuals with post-COVID-19 condition to analyze the inter-evaluator reliability of the asynchronous STS, and identify the relationship between the participants’ self-reported asynchronous STS results and those of the evaluator.MethodsThirty-eight men and women with post-COVID syndrome who did not require invasive ventilator support were included in this study. The participants were assessed using STS in-person (STS-IP), synchronous (STS-S), and asynchronous (STS-A) tele-assessments. The participants also self-reported the total executed repetitions (STS-SR). The main outcomes were the number of repetitions performed in the STS-IP, STS-S, STS-A, and STS-SR. To verify STS-A reliability, the total repetitions registered between evaluators were compared.ResultsSTS-IP showed significant correlations and lower total repetitions compared to STS-S and STS-A. STS-A repetitions were significantly lower compared to STS-SR; however, a significant correlation was observed. The STS-S and STS-A showed minimal detectable change values of 6.6 and 10.5, respectively. In terms of reliability, there were no significant differences in total repetitions or errors found between evaluators’ assessments of STS-A.ConclusionThe study demonstrated good and moderate evidence of validity for synchronous and asynchronous remote STS assessments, respectively, highlighting the impact of the assessment protocol on STS performance interpretation. Asynchronous STS presented high reliability.

Background: High social support is easily assessed and associated with a healthier lifestyle, including vaccination adherence. Similarly, immunization is a widely available public health statistic associated with healthier behaviors. However, the link between the hepatitis immunization status and social support needs to be explored. Methods: We assessed the association between levels of social support and hepatitis immunization status using the National Health and Nutrition Examination Survey (NHANES), a cross-sectional multidisciplinary database publicly available for researchers. With 2005–2006 data, 2997 participants were included. Statistical analyses were conducted using STATA18.5v software, including the odds ratio of both univariable logistic regression and multivariable logistic regression. After adjusting for clinically relevant confounders, two distinct models were designed: 1) full immunization, and 2) incomplete immunization. Results: Multivariable analysis revealed significantly greater odds of high social support for participants fully or partially immunized against both hepatitis A and B: 3.15 (95% CI 1.03–9.66,p=0.04) and 3.35 (95% CI 1.15–9.75,p=0.03), respectively. Conclusion: Our findings show an association between vaccination and social support in both adjusted models. Individuals not vaccinated at all may behave differently from those willing to be, at least partially, immunized. It seems that a similar behavior that may lead to vaccination may also lead to increased social support. Therefore, our study suggests that hepatitis vaccination could perhaps be a surrogate marker for public-health-related outcomes.

Introduction: Spasticity in the pediatric population presents significant management challenges. The aim of this study was to review the current literature on the use of selective neurectomy for treating pediatric spasticity. It is important to analyze children as a distinct group, as the selection criteria differ from those used in adults, and the procedure affects not only spasticity but also the overall development of the child. Methods: After a PubMed database search and applying inclusion criteria, we identified 14 relevant studies for this review. The following parameters were analyzed: patient age, number of participants, follow-up duration, Modified Ashworth Scale (MAS) scores, goniometry/passive range of motion (PROM), and motor function. Results: There was considerable variability in the first three parameters (age, sample size, and follow-up period). All included studies reported improvements in spasticity, range of motion, and motor function when these outcomes were assessed. However, the methods used to evaluate these outcomes varied, limiting direct comparisons across studies. Conclusion: Although few studies on selective neurectomy for pediatric spasticity were found, all demonstrated significant improvements in parameters associated with enhanced quality of life. These findings highlight the need for further research focused specifically on this population.

Despite the critical need for data to support public health policies in Brazil, there is a glaring lack of national epidemiological studies on neurogenic lower urinary tract dysfunction (NLUTD). This study aimed to illuminate the factors associated with the urological management of NLUTD among individuals with traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI). Employing a quantitative, cross-sectional, and descriptive design, this study analyzed electronic medical records of NLUTD and SCI patients monitored within the SARAH network from 2007 to 2017. Sociodemographic and clinical data were collected, including the ASIA Impairment Scale, and statistical analyses such as the Mann–Whitney and Pearson’s Chi-square tests were conducted. The findings revealed that out of 903 patients, 67% had TSCI and 33% had NTSCI. Clean intermittent catheterization (CIC) was the primary bladder emptying method, utilized by 66.11% of the participants. The average emptying frequency was 4.71 times a day, and urinary incontinence was reported in 58.4% of cases. A significantly higher rate of positive urinary colonization was found among TSCI patients. The study highlighted significant differences in NLUTD management between TSCI and NTSCI patients, with NTSCI patients more frequently achieving voluntary urination and using maneuvers to stimulate urination. These distinctions underscore the need for more individualized approaches and deeper understanding of each type of spinal cord injury, aiming to enhance bladder rehabilitation programs in Brazil.

Electrical stimulation of trigeminal nerve branches elicits early and late reflex responses in the cervical muscles, known as the trigeminocervical reflex (TCR). This study aimed to evaluate the neurophysiological aspects, stimulation patterns, and topographic distribution of short-latency TCR components in humans in the absence of voluntary muscle activation. This prospective observational study included 30 participants. Trigeminocervical reflex responses were simultaneously recorded from the bilateral sternocleidomastoid, trapezius, and splenius capitis muscles (without voluntary muscle activation), after electrical stimulation of the supraorbital and infraorbital nerves. Two different stimulation protocols were evaluated: a 3 Hz stimulation protocol (using averaging) and a single-pulse stimulation protocol. Using a 3 Hz stimulation protocol, short-latency TCR responses were recorded in the sternocleidomastoid, trapezius, and splenius capitis muscles, ipsilateral and/or contralateral, but with variable recordability depending on the recording site. The most reliable response was obtained in ipsilateral sternocleidomastoid muscle. To the best of our knowledge, this is the first study to demonstrate the elicitation of short-latency TCR components in the sternocleidomastoid muscle in the absence of voluntary muscle activation in humans without craniocervical junction disorders or lower brainstem abnormalities. The choice of an appropriate stimulation protocol is particularly relevant for recording short-latency TCR components, considering that the visualization of early or late responses seems to be facilitated by different stimulation methodologies.

Children with meningomyelocele may require continuous care. Consequently, there is a risk for caregiver burden and impact on family quality of life (QoL), including siblings' QoL. Some studies analysed caregivers' burden and family QoL separately. However, none of these studies evaluated siblings' QoL and the associations between these three dimensions. This study investigated the associations between caregivers' burden, family QoL and siblings' QoL in Brazilian families of children with meningomyelocele and its correlations with sociodemographic, functional and clinical variables. Siblings' QoL was specifically assessed using as a parameter the QoL of typically developed Brazilian children. One hundred and fifty families, 150 caregivers and 68 siblings completed the Family Quality of Life Scale, Burden Interview, KIDSCREEN-27 Child and Adolescent Version and Parents Version questionnaires. Most families and caregivers reported a high family QoL and a low caregiver burden. Family QoL was significantly lower as caregivers' burden increased. Caregiver's burden was significantly lower with increasing family QoL levels. Self-reported siblings' QoL was significantly worse than that of typically developed peers. There were no significant differences between self and parent-reported siblings' QoL. Self-reported siblings' QoL was significantly worse as their age increased and better with increasing family QoL levels. Parent-reported siblings' QoL was significantly worse with increasing levels of caregiver's burden and significantly better as family QoL increased. There were no significant associations with functional and clinical variables. Despite the cross-sectional nature of the available data precludes any statements of causality, our results reinforce the relevance of knowing the factors that influence the QoL of families and siblings of children and adolescents with meningomyelocele and the relevance of actions aimed at reducing caregivers' burden, improving family QoL and meeting siblings' individual needs. Future multicenter studies may validate the generalizability of our findings.

Introduction: Diabetic foot ulcer (DFU) is one of the most common lower extremity diabetes-related complications. New therapies have been developed to increase the likelihood of wound healing and reduce complications, including biological and/or synthetic grafts that allow a temporary or permanent occlusion of wounds. Although their efficacy has been demonstrated, novel skin substitutes have been available, and few studies have described the head-to-head comparative effectiveness of those products. Therefore, this mini-review aims to analyze the available randomized clinical trials studying the impact of different cellular skin products on the healing of DFUs. Methods: The databases PubMed, EMBASE, Scopus, Scielo, and Lilacs were assessed from inception to July 30th, 2023, to identify randomized clinical trials on the effects of cellular skin substitutes on ulcer healing in adult patients aged 18 years or older with DFUs restricted to the skin and subcutaneous tissue, compared to standard of care or other skin substitutes. Results: Based on eligibility criteria, 22 articles were selected. These studies showed the efficacy and safety of cell skin substitutes compared to standard treatments, as demonstrated by the reduction in the total area of the ulcer and rates of complete wound healing. We identified a few studies with head-to-head comparisons among those products. Discussion: Cellular skin substitutes have shown promising results in healing DFUs as complementary therapies to the standard of care. Their incorporation into standard-of-care treatments could be discussed. Future studies should focus on head-to-head comparisons, cost-effective analysis, and long-term efficacy and safety.