A clinical training model for students: intensive treatment of stuttering using prolonged speech

ABSTRACT Purpose This study describes a practical model for improving the quality of Speech-Language Pathology (SLP) education on a clinical setting in a Bulgarian University. During this study, adults who stutter (AWS) received intensive treatment (IT) to increase fluent speech. The intensive treatment was delivered by students trained in the SLP Master's degree program "Logopedics Management in Fluency and Voice Disorders". Methods The La Trobe University intensive program of prolonged speech was implemented. SLP students were trained and delivered the IT for AWS, under supervision in all stages. The treatment followed a clinical modeling pattern. Results The primary outcomes were measured according to (i) percent of syllables stuttered (%SS) within and outside the stuttering research center of the university; (ii) self-reported inventory scores; and (iii) speech naturalness score evaluations from pre-treatment, immediately following treatment, 11 months post-treatment, and 18 months after the intensive treatment using stutter-free speech samples. The outcomes were reported for the overall IT program delivered by the SLP Master students. Conclusion The treatment delivered by students can ensure objective speech outcomes. The evidence-based practice model allowed students to develop and master specific clinical skills in establishing fluent speech by applying a prolonged speech technique. During the IT experience, students began to incorporate elements of evidence-based practice (EBP), clinical expertise, and consider values held by AWS. After four outcome-sessions, the AWS developed self-consciousness about the quality of their prolonged speech during controlled fluent patterns. The participants produced objective speech fluency data and statistically significant differences before and immediately after the IT regarding %SS and overall speech naturalness.

Evidence-based guides in tracheostomy use in critical patients

Objetivos: Proporcionar guías de traqueostomía para el paciente crítico, basadas en la evidencia científica disponible, y facilitar la identificación de áreas en las cuales se requieren mayores estudios. Métodos: Un grupo de trabajo formado con representantes de 10 países pertenecientes a la Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva y a la Latin American Critical Care Trial Investigators Network(LACCTIN) desarrollaron estas recomendaciones basadas en el sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: El grupo identificó 23 preguntas relevantes entre las 87 preguntas planteadas inicialmente. En la búsqueda inicial de la literatura se identificaron 333 estudios, de los cuales se escogieron un total de 226. El equipo de trabajo generó un total de 19 recomendaciones: 10 positivas (1B = 3, 2C = 3, 2D = 4) y 9 negativas (1B = 8, 2C = 1). En 6 ocasiones no se pudieron establecer recomendaciones. Conclusión: La traqueostomía percutánea se asocia a menor riesgo de infecciones en comparación con la traqueostomía quirúrgica. La traqueostomía precoz solo parece reducir la duración de la ventilación mecánica pero no la incidencia de neumonía, la duración de la estancia hospitalaria o la mortalidad a largo plazo. La evidencia no apoya el uso de broncoscopia de forma rutinaria ni el uso de máscara laríngea durante el procedimiento. Finalmente, el entrenamiento adecuado previo es tanto o más importante que la técnica utilizada para disminuir las complicaciones.(AU)

OBJECTIVES: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION: Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.(AU)

Microvascular complications in elderly patients with diabetes mellitus / 中华内分泌代谢杂志

The specific features of diabetic microangiopathy include thickening of basement membrane with deposition of a transparent material.Diabetic retinopathy,neuropathy,cardiomyopathy,as well as diabetic foot are the main complications.It remains controversial whether intensive treatment may reduce the clinical renal end point events significantly,while evidence-based medicine confirmed that intensive treatment can reduce the trace and heavy proteinuria,neuropathy,and retinopathy.It will benefit the patients if comprehensive,and standard and,persistent treatments,are started as early as possible,and it consider the features of elderly patients.Managing Older People with Type 2 Diabetes Global Guidelines (IDF) and Chinese Elderly Diabetes Expert Consensus on Diagnosis and Treatment Measures point out that microvascular complications in elderly patients with diabetes closely related to the quality of life,to which we should pay great attention.Early prevention,early diagnosis,early treatment,reach the standard in early stage will be of important clinical significance for the prevention and treatment of senile diabetic microvascular lesion.

Comparison of two different insulin intensive therapy plan on treating type-2 diabetes mellitus patients / 中国综合临床

Objective To compare the effect of insulin pump continuous subcutaneous insulin (CSII) and multiple subcutaneous insulin (short-acting insulin before meals + glargine,MSII) for the short duration of type 2 diabetes mellitus (T2DM) patients.Methods Fifty-two newly diagnosed T2DM patients were randomly divided into CSII(n =29) and MSII(n =23) group.Patients in CSII group were given insulin pump continuous subcutaneous plus metformin.And patients in MSII group were given insulin by multiple subcutaneous insulin injection plus metformin.The treating periods was 2 weeks and followed up one month.Results The periods from point of insulin injection to blood glucose back to normal level in CSII group was (4.70 ±2.01) d,shorter than that in MSII group(6.90 ± 1.50) d,and the difference was significant(t =2.056,P ＜0.05).The levels of C peptide in two hours postprandial before and after treatment in CSII group were (4.24 ± 0.25) ng/L,(6.29 ± 0.56) ng/L,and (3.20 ±0.11) ng/L and (7.33 ±0.41) ng/L respectively in MSII group.The levels of C peptide in two hours postprandial after treatment were higher than that of before treatment in two groups (t =2.018,2.436 respectively,P ＜0.05),but there were no significant differences between two groups(t =0.985,P ＞ 0.05).Nineteen cases (65.5％) in CSII group were off insulin treatment in one month,and 9 cases (39.1％) in MSII group.There were significant differences in two groups(x2 =5.11,P ＜0.05).Conclusion The two treatment plans can make the improvement in terms of glucose control.However,CSII plan showed more effective than MSII.

Strengthening control of blood glucose, blood pressure, and blood lipids in type 2 diabetes mellitus patients: Influence on obestatin level and relation with lipid metabolism / 第二军医大学学报

Objective To observe the influence of intensive control of blood glucose, blood pressure and blood lipid on fasting plasma obestatin level in type 2 diabetes mellitus (T2DM) patients and its correlation with lipid metabolism. Methods Seventy-two T2DM patients were assigned to four groups according to different treatments. Group A(n=25) received blood glucose (BG) and blood pressure(BP)controlling; group B(n=12) received BG, BP and blood lipid (BL) controlling; group C(n=20) received BG,BP, and BL controlling plus vitamin E administration; and group D(n=15) received BG,BP,BL controlling and compound Danshen dripping pill administration. Results Fasting obestatin level of group A was significantly lower than those in the other three groups (P<0.01). Fasting obestatin level was negatively correlated with body mass index (BMI), HbAlc, waist to hip ratio (WHR),total cholesterol(TC), low-density lipoprotein cholesterol (LDL-C), fasting insulin (FIN) and hemeostasis model assessment of insulin resistance (HOMA-IR) (P<0.05), and was positively correlated with high-density lipoprotein cholesterol (HDL-C) (P<0.05). After adjusting age, sex, BMI, WHR, blood glucose, and blood pressure, high level fasting obestatin was correlated with intensified control of blood lipid (P<0.01). Conclusion The fasting obestatin level is increased in T2DM patients receiving BL control compared with those do not receive, and obestatin level might be associated with lipid metabolism.

Perfil de idosos admitidos em unidades de terapia intensiva gerais em Rio Grande, RS: resultados de um estudo de demanda / Profile of the elderly admitted into general intensive care units in Rio Grande, Southern Brazil: results of a cross-sectional survey

Este estudo teve por objetivo conhecer o perfil do paciente com 60 anos ou mais de idade internado nas duas unidades de terapia intensiva (UTI) do município de Rio Grande, RS. Utilizando-se de delineamento transversal, entre abril/2007 e março/2008, entrevistadores previamente treinados aplicaram questionário padrão investigando sobre suas características demográficas, socioeconômicas e ambientais, utilização prévia de serviços de saúde e condições clínicas, que em 90 por cento dos casos foram respondidos por familiares. Os 213 idosos hospitalizados neste período provinham, em sua maioria, do próprio município, eram casados, tinham mais de 70 anos, cinco anos de escolaridade, dois ou mais salários mínimos de renda familiar mensal, viviam em casa própria com outras duas pessoas e não possuíam plano de saúde; 88 por cento foram à consulta médica nos últimos seis meses e 56 por cento foram hospitalizados nos últimos 12 meses; metade deles chegaram à UTI inconscientes, por problemas clínicos oriundos da enfermaria do próprio hospital, onde 147 foram submetidos a ventilação mecânica, e 45 por cento do grupo total evoluiu para óbito, em média, no oitavo dia. Estes dados mostram que é possível identificar idosos com maior potencial de internação em UTI também a partir de suas condições socioeconômicas e ambientais.

Effect of three intensive insulin treatments on newly diagnosed type 2 diabetes in different insulin resistant status / 中国综合临床

Objective To investigate the effects on the improvement of the function of islet β cell by three intensive insulin treatments on newly diagnosed type 2 diabetes(T2D) in different insulin resistant status.Methods Ninety-eight patients of newly diagnosed T2D were divided into two groups:group with overt insulin resistant status ( IR group) ( HOMA-IR ≥ 5 ); group without overt insulin resistant status ( Non-IR group) ( HOMA-IR ＜ 5).According to the condition of patient,there were six subgroups:IR-CSⅡ group ( n = 20 ); IR-glar group ( n = 22 );IR-aspart 30 group (n=23); Non-IR-CSⅡ group (n= 10); Non-IR-glar group (n=12); Non-IR-aspart 30 group (n = 11 ).Subgroups were treated with continuous subcutaneous insulin injection (CSⅡ group),insulin aspart plus insulin glargine ( glar group),and insulin aspart 30 injection ( aspart 30 group) for two weeks,respectively.The levels of fasting plasma glucose (FPG) ,fasting C-peptide(C-P) ,2 h plasma glucose (2 hPG) were measured and homeostasis model assessments of beta cell (HOMA-β) and homeostasis model assessments of insulin resistance ( HOMA-IR) were calculated using fasting C-P.Results The time of blood glucose recover,insulin dosage and the incidence of hypoglycemia of CSⅡ group were lower than those of the glar group and aspart 30 group( P ＜ 0.05 and P ＜0.01 ,respectively).However,there were no significant difference between the glar-group and aspart 30 group ( P ＞ 0.05 ).The insulin dosage of Non-IR-subgroups was significantly lower than the IR-subgroups ( P ＜ 0.01 ).The △HOMA-IR(C-P) of Non-IR-subgroups was lower than the IR-subgroups ( P ＜ 0.05 ).The △HOMA-islet(C-P) of the Non-IR-subgroups was higher than the IR-subgroups ( P ＜ 0.05 ).The △HOMA-IR(C-P) ( 1.79 ± 0.15 and 1.51 ±0.09 in IR and non-IR group,respectively) and △HOMA-islet(C-P) (4.01 ±0.21 and 4.35 ±0.23 in IR and Non-IR group,respectively) of the CSⅡ group were higher than those of the glar group (1.63 ± 0.21 and 1.40 ±0.19 of △HOMA-IR (C-P) and 3.86 ± 0.12 and 4.03 ± 0.18 of △HOMA-islet(C-P) in IR and Non-IR group,respectively) and aspart 30 group ( 1.61 ± 0.13 and 1.42 ± 0.1 1 ) △HOMA-islet (C-P) and 3.88 ± 0.32 and 4.01 ±0.14of△HOMA-islet(C-P)inIRandNon-IRgroup,respeetively)(P＜0.05).Conclusions Thethree intensive insulin treatments for newly diagnosed T2D accompanied with high blood glucose may improve the function of β cell and alleviate insulin resistance,especially the CSⅡ.However,the efficacy on T2D with overt insulin resistant status is limited.

Analysis of the insulin dosage and impact factors of intensive insulin treatment of type 2 diabetic patients / 中国糖尿病杂志

Objective To investigate the insulin dosage and analyze the dosage-impacting factors of intensive insulin treatment in Chinese type 2 diabetic patients.Methods Totally 1025 patients with intensive insulin treatment were included,the insulin dosage and clinical characteristics were taken down and analyzed.Results The mean insulin dosage was 39.30U/day,the insulin dosage per kg of body weight was 0.61U/Kg,among which the dosage of intermediate-acting insulin was 9.79 U/day,occupying 25.24%,while the pre-meal one was 29.51 U/day,occupying 74.76%.According to the insulin dosage per kg of body weight,patients were divided into low dosage group and high dosage one.The result showed significant difference in period of diabetes,BMI,HbA1c,and the highest weight level between the two groups.Correlation analysis showed that the average insulin dosage per kg of body weight was positively correlated with period of diabetes,HbA1c,fasting glucose level and LDL-C,while negatively correlated with BMI,fasting and postprandial C-peptide,the highest body weight level and HDL-C.Conclusions The average insulin dosage for type 2 diabetic patients is 39.30U/day,among which the dosage of intermediate-acting insulin occupies 25% while the pre-meal one occupies 75%.The insulin dosage is positively correlated with period of diabetes and HbA1c,while negatively correlated with BMI and the highest body weight level

Retrospective Analysis of the Postoperative Patients Admitted to General Surgical-Medical Intensive Care Unit / 대한구급학회지

BACKGROUND: The present study was designed to examine the purpose of intensive care unit (ICU) admission and the prevalence of disease in postoperative patients admitted to general surgical-medical ICU. METHODS: Between 1 January 2007 and 31 December 2007, 646 cases of 612 patients admitted to a general postoperative patients admitted to general surgical-medical ICU were examined. The patients were classified into two groups, ICU treatment and ICU monitoring groups according to Knaus' suggestion which defines the kinds of treatment done exclusively in ICU. Patients' demographics, preoperative American Society of Anesthesiologists physical status classification (ASA) grade, prevalence of disease and emergent operation rate were analyzed. RESULTS: 255 patients (39.5%) were included in the ICU treatment group and 391 cases (60.5%) in the ICU monitoring group. The prevalence of respiratory, gastrointestinal, and central nervous diseases was higher significantly in the ICU treatment group. In addition, the average of ASA grade and the duration of operation were higher significantly in the ICU treatment group. CONCLUSION: Admission rate only for monitoring was higher than one for intensive treatment. An alternative strategy should be considered to care for postoperative patients who need just close monitoring.

The Effects of Transient Intensive Insulin Treatment on Beta-cell Function in Newly Diagnosed Type II Diabetic Patients / 昆明医科大学学报

11.1 mmol/L were treated by 2 weeks CSII.An intravenous glucose tolerance test(IVGTT) was performed before and after CSII.The levels of fasting plasma glucose(FPG),2 hours postprandial glucose(2hPG),glycosylated hemoglobin A1c(HbA1c),first-phase secretion of insulin,the mean area under the curve(AUC) of insulin,insulin sensitivity index(ISI),insulin resistance index(Homa IR) and insulin secretion index(Homa ?) were compared.Results The excellent control of FPG and 2hPG in 20 out of 21 patients were achieved stably in 2.8?1.6 days and 7.8?1.9 days by CSII.After the treatment,FPG,2h PG and HbA1c were significantly decreased(P

Clinical Research of Integrated TCM into Intensive Insulin Treatment in Newly Diagnosed Type 2 Diabetic Patients / 中国中医药信息杂志

Objective To investigate the remission rate of the therapy of integrated TCM into intensive insulin treatment, and the relationship between each factor and the remission rate. The effect of TCM on improving ?-cell fimction and remission rate was also studied. Methods Forty-seven newly diagnosed type 2 diabetic patients were shortly treated with both continuous subcutaneous insulin infusion (CSII) and Chinese medicine. The remission rate was observed. The relationship between each factor and remission was analyzed by logistic regression. The ?-cell function of patients in remission group were evluated at the end of the treatment and during the period of follow-up. Results After treatment of (11.8?2.5)d, BMI and the ratio of the days of blood glucose reaching the standard and the total treatment days were the mainly factors affecting the remission. The remission rate at the end of treatment, one month after treatment and follow-up period (about six month) was 46.8%, 55.3%, 53.3% respectively. In following up, the remission rate in the Chinese medicine group and the control group was 66.7%, 44.4% respectively. Conclusions About half of newly diagnosed type 2 diabetic patients obtain clinical remission after the short-term intensive treatment of integrated insulin and Chinese medicine. Chinese medicine may have positive impaction on remission and extending honeymoon period.

Nuevos esquemas de tratamiento con insulina en niños y dolescentes con Diabetes Mellitus tipo 1 (DM1) en un Hospital Público / New schemes of insulin treatment in children and adolescents with type 1 diabetes mellitus attending a Public Hospital

En la última década se ha demostrado la importancia del control glicémico en la prevención de las complicaciones microvasculares de la DM1. Para lograr este objetivo se ha propiciado el uso de esquemas terapéuticos de insulina intensificados. Objetivo: Comunicar los nuevos esquemas terapéuticos que se utilizan en niños y adolescentes con DM1 y sus resultados en el control metabólico. Método: Se evaluaron los esquemas insulínicos utilizados por todos los pacientes < 19 años en control durante 2003, clasificándolos en tratamiento intensificado (doble o triple dosis de NPH o Glargina) o convencional (< 2 dosis/día). Se consignaron las dosis utilizadas, la HbA1c promedio, el resultado del programa educativo (conocimiento de cantidad de hidratos de carbono, intercambio de alimentos, cambio de dosis según ingesta de hidratos de carbono (HdC) y proporción Insulina/ HdC) y se compararon los resultados obtenidos con las distintas modalidades de tratamiento. Resultados: Se estudiaron 69 pacientes con DM1 (36 mujeres), de 12,0 ± 3,7 años (2-19 años), 59,7% púberes. Todos utilizaban una insulina basal (69,2% de la dosis diaria) y otra prandial; 87% de los pacientes requirieron tres o más dosis diarias de insulina y 13% utilizaba esquema convencional de dos dosis de NPH. Los pacientes en tratamiento intensificado recibían tres o cuatro dosis diarias de insulina prandial, con los siguientes esquemas de insulina basal: dos dosis diarias de NPH (28%), glargina (10%) y tres dosis diarias de NPH (49%). 88,4% de los pacientes modificaba la dosis de insulina rápida según la glicemia y 46,4% consideraba la ingesta de HC; 27% conocía la relación HdC/insulina y 79,7% se colocaba refuerzos adicionales de insulina al comer fuera de sus horarios. La HbA1C del grupo fue de 8,6 ± 1,4%; 30,4% de los pacientes logró el objetivo de HbA1c establecido en el programa, sin diferencias respecto al esquema de insulinoterapia basal utilizado. Por análisis de ...

Introduction: During the last decade the importance of glycaemic control in the prevention of microvascular complications of type 1 diabetes mellitus (DM1) has been demostrated. To achieve this goal, different modalities of intensive therapy have been recommended. Objective: To communicate a novel therapeutic modality employed in paedriatric patients and the metabolic control achieved. Methods: All DM patients < 19 years were included. Insulin treatment was consigned and classified as intensive (at least 3 daily doses, 2 or 3 NPH daily doses, or glargin) or conventional (2 or less doses). Number of doses, mean HbA1c during 2003, results of educative programmes were evaluated and compared. Results: 69 patients (36 females) were studied, 59,7% were pubertal, with a mean age of 12,0 ± 3,7 years. All patients used a basal insulin (69,2% daily dose) and a prandial insulin. Intensive therapy was used by 87% of children. Patients with multiple daily doses received 3 or 4 inyections of a short or rapid acting insulin. Basal insulin was glargine in 10%, twice daily NPH in 28% and thrice daily in 49%. Patients modified dose according to glucose level occured in 88,4%, and 46,4% considered carbohydrate intake. 27% knew the carbohydrate/insulin ratio and 79,7% used additional insulin when eating extra carbohydrates. The BbA1c was 8,6 ± 1,4% without differences in terms of insulin modality used. 30,4% achieved the proposed goals of HbA1c. The total and basal insulin usage correlated with the HbA1c. Conclusions: Multiple modalities of insulin therapy are available, no difference in metabolic control between the modalities was detected. We have achieved very good control in 30% of the patients, only insulin daily dose and basal dose correlated significatively with HbA1c.

Randomized Controlled Study on the Effects of Intensive Cyclophosphamide Therapy Plus Corticosteroids and Corticosteroids-alone Treatment for Lupus Nephritis / 药物流行病学杂志

To investigate the short and long-term effects of intensive cyclophosphamide therapy plus corticosteroids on lupus mephritis, 27 patients with severe lupus nephritis were divided into two groups. Patients in group 1 received prednisone alone and patients in group 2 were given intensive cyclophosphamide therapy plus corticosteroids. The treatment course lasted for 1.5 years and the patients were followed up for 4 years. At the end of the treatment, the differences in indicators, single or comprehensive, of effieacy were statistically signifieant(P＜0.05) between the two groups. A four-year follow-up showed that the difference in relapse was significant(P＜0.05). It is concluded that the intensive cyclophosphamide therapy plus corticosteroids on lupus nephritis was better than that of predinison-alone treatment in our series in terms of short-term and long-term effects on lupus nephritis.