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1.
BMC Health Serv Res ; 22(1): 1218, 2022 Sep 30.
Article in English | MEDLINE | ID: mdl-36180905

ABSTRACT

INTRODUCTION: Following the COVID-19 directive to cease non-essential services, a rapid shift was made in the delivery of Speech Language Pathology (SLP) dysphagia management in the 3-arm, randomized PRO-ACTIVE trial. To inform future programs, this study explored patients' experiences with telehealth when the planned in-person SLP intervention was moved to a telehealth modality. METHODS: A theory-guided qualitative descriptive approach was used. Willing participants who had received at least one telehealth swallowing therapy session participated in a one-time semi-structured interview. Interview transcripts were subjected to a standard qualitative content/theme analysis. Researchers reviewed all transcripts and used a multi-step analysis process to build a coding framework through consensus discussion. Summaries and key messages were generated for each code. RESULTS: Eleven participants recounted their telehealth experiences and reported feeling satisfied, comfortable and confident with the session(s). They identified that previous experience with teleconferencing, access to optimal technical equipment, clinician skill, and caregiver assistance facilitated their telehealth participation. Participants highlighted that telehealth was beneficial as it reduced commuting time, COVID-19 exposure and fatigue from travel; and also allowed caregiver participation particularly during COVID. In comparing their in-person SLP sessions to telehealth sessions, limitations were also identified, including: lack of previous experience with and/or poor access to technology, and less opportunity for personalization. Participants indicated that use of phone alone was less preferred than an audio/video platform. DISCUSSION: Patients reported that overall, telehealth sessions did not compromise their learning experience when compared to in-person sessions. Patients benefited from use of telehealth in several ways despite some limitations of the use of technology. Patient feedback about telehealth provides an important perspective that may be critical to inform best practices for care delivery.


Subject(s)
COVID-19 , Deglutition Disorders , Head and Neck Neoplasms , Telemedicine , COVID-19/epidemiology , Delivery of Health Care , Humans , Patient Outcome Assessment
3.
Am J Transplant ; 14(2): 305-18, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24410845

ABSTRACT

Allostimulation with concurrent costimulatory blockade induces alloantigen-specific hyporesponsiveness in responder T cells ("alloanergization"). Alloanergized responder cells also acquire alloantigen-specific suppressive activity, suggesting this strategy induces active immune tolerance. While this acquired suppressive activity is mediated primarily by CD4(+) FOXP3(+) cells, other cells, most notably CD8(+) suppressor cells, have also been shown to ameliorate human alloresponses. To determine whether alloanergization expands CD8(+) cells with allosuppressive phenotype and function, we used mixed lymphocyte cultures in which costimulatory blockade was provided by belatacept, an FDA-approved, second-generation CTLA-4-immunoglobulin fusion protein that blocks CD28-mediated costimulation, as an in vitro model of HLA-mismatched transplantation. This strategy resulted in an eightfold expansion of CD8(+) CD28(-) T cells which potently and specifically suppressed alloresponses of both CD4(+) and CD8(+) T cells without reducing the frequency of a range of functional pathogen-specific T cells. This CD8-mediated allosuppression primarily required cell-cell contact. In addition, we observed expansion of CD8(+) CD28(-) T cells in vivo in patients undergoing alloanergized HLA-mismatched bone marrow transplantation. Use of costimulatory blockade-mediated alloanergization to expand allospecific CD8(+) CD28(-) suppressor cells merits exploration as an approach to inducing or supporting immune tolerance to alloantigens after allogeneic transplantation.


Subject(s)
CD28 Antigens/immunology , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , Clonal Anergy/immunology , Immune Tolerance/immunology , Isoantigens/immunology , Leukocytes, Mononuclear/immunology , CD28 Antigens/metabolism , CD4-Positive T-Lymphocytes/metabolism , CD8-Positive T-Lymphocytes/metabolism , Cells, Cultured , Flow Cytometry , Humans , Lymphocyte Activation , Transplantation, Homologous
4.
Orthop Nurs ; 8(6): 61-9, 1989.
Article in English | MEDLINE | ID: mdl-2601999

ABSTRACT

Altered clotting encompasses a wide spectrum of clinical conditions ranging from bleeding disorders to abnormal clot formation. DIC is an abnormal overstimulation of the normal coagulation process resulting from several clinical conditions that illustrate these extremes. In orthopaedic patients, DIC can develop following trauma (crush injuries), tissue necrosis, fat embolism, gram-negative or gram-positive sepsis, and venous stasis (bedrest). Because of its occurrence as a secondary process and its subtle development, DIC can elude early recognition, diagnosis, and treatment.


Subject(s)
Disseminated Intravascular Coagulation/nursing , Patient Care Planning , Adult , Disseminated Intravascular Coagulation/physiopathology , Disseminated Intravascular Coagulation/therapy , Humans , Male
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