Vestibular semicircular canal function as detected by video Head Impulse Test (vHIT) is essentially unchanged in people with Parkinson's disease compared to healthy controls.

BACKGROUND: Parkinson's disease (PD) is a common multi-system neurodegenerative disorder with possible vestibular system dysfunction, but prior vestibular function test findings are equivocal. OBJECTIVE: To report and compare vestibulo-ocular reflex (VOR) gain as measured by the video head impulse test (vHIT) in participants with PD, including tremor dominant and postural instability/gait dysfunction phenotypes, with healthy controls (HC). METHODS: Forty participants with PD and 40 age- and gender-matched HC had their vestibular function assessed. Lateral and vertical semicircular canal VOR gains were measured with vHIT. VOR canal gains between PD participants and HC were compared with independent samples t-tests. Two distinct PD phenotypes were compared to HC using Tukey's ANOVA. The relationship of VOR gain with PD duration, phenotype, severity and age were investigated using logistic regression. RESULTS: There were no significant differences between groups in vHIT VOR gain for lateral or vertical canals. There was no evidence of an effect of PD severity, phenotype or age on VOR gains in the PD group. CONCLUSION: The impulsive angular VOR pathways are not significantly affected by the pathophysiological changes associated with mild to moderate PD.

Using virtual reality to assess vestibulo-visual interaction in people with Parkinson's disease compared to healthy controls.

People with Parkinson's disease (PD) have increased visual dependency for balance and suspected vestibular dysfunction. Immersive virtual reality (VR) allows graded manipulation of visual sensory inputs during balance tasks, and hence VR coupled with portable force platforms have emerged as feasible, affordable, and validated tools for assessing sensory-motor integration of balance. This study aims to determine (i) how people with PD perform on a VR-based visual perturbation standing balance task compared to healthy controls (HC), and (ii) whether balance performance is influenced by vestibular function, when other known factors are controlled for. This prospective observational study compared the balance performance under varying sensory conditions in 40 people with mild to moderate PD with 40 age-matched HC. Vestibular function was assessed via Head Impulse Test (HIMP), cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) and subjective visual vertical (SVV). Regression analyses were used to determine associations between VR balance performance on firm and foam surfaces with age, group, vestibular function, and lower limb proprioception. PD failed at significantly lower levels of visual perturbation than HC on both surfaces. In PD, greater disease severity was significantly associated with lower fall thresholds on both surfaces. Multiple PD participants failed prior to visual perturbation on foam. On firm, PD had a greater visual dependency. Increasing age, impaired proprioception, impaired SVV, abnormal HIMP and cVEMP scores were associated with worse balance performance. The multivariate model containing these factors explained 29% of the variability in balance performance on both surfaces. Quantitative VR-based balance assessment is safe and feasible in PD. Balance performance on both surfaces was associated with age, HIMP abnormality and proprioception.

Suppression head impulse test paradigm (SHIMP) characteristics in people with Parkinson's disease compared to healthy controls.

The suppression head impulse test paradigm (SHIMP) is a newly described indicator of vestibular function which yields two measures: vestibulo-ocular reflex (VOR) gain and a saccadic response. It is an alternative and complementary test to the head impulse test paradigm (HIMP). Parkinson's disease (PD) has known saccadic and central vestibular pathway dysfunction. This paper is the first description of SHIMP VOR gain and saccade characteristic in this population. This prospective observational study measured the SHIMP VOR gain and saccade characteristics in 39 participants with idiopathic PD and compared this to 40 healthy controls (HC). The effect of group, demographic variables and SHIMP characteristics were evaluated. SHIMP VOR gains were not significantly different between groups (p = 0.10). Compared to HC, the PD group mean SHIMP peak saccade velocity was significantly reduced by an average of 77.07°/sec (p < 0.001), and SHIMP saccade response latency was longer, with an average delay of 23.5 ms (p = 0.003). SHIMP saccade peak velocity was also associated with both head impulse velocity (p = 0.002) and SHIMP VOR gain (p = 0.004) variables, but there was no significant influence of these variables when SHIMP saccade peak velocity was considered as a predictor of PD (p = 0.52-0.91). VOR gains were unaffected by PD. PD-specific saccadic dysfunction, namely reduced peak saccade velocities and prolonged response latencies, were observed in the SHIMP-induced saccade responses. VOR gain using slow phase eye velocity is preferred as the indicator of vestibular function in the SHIMPs paradigm as non-vestibular factors affected saccade peak velocity.

Static and dynamic otolith reflex function in people with Parkinson's disease.

PURPOSE: Parkinson's disease (PD) is a neurodegenerative disorder with possible vestibular system dysfunction. This study reports the transient and sustained functions of the otoliths and their reflex pathways in PD compared to healthy controls (HC) and determines if otolith function relates to previous fall history. METHODS: Forty participants with PD and 40 HC had their otolith function assessed. Transient saccular and utricular-mediated reflexes were assessed by cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs, respectively) elicited by air-conducted stimulus (clicks) and bone-conducted vibration (light tendon hammer taps). Static otolith function was assessed by the Curator Subjective Visual Vertical (SVV) test. RESULTS: Compared to HC, the PD group had significantly more absent cVEMP responses to both clicks (47.5% vs. 30%, respectively, p = 0.03) and taps (21.8% vs. 5%, respectively, p = 0.002). Only the PD group had bilaterally absent tap cVEMPs, this was related to previous falls history (p < 0. 001). In both groups, click oVEMPs were predominantly absent, and tap oVEMPs were predominantly present. The PD group had smaller tap oVEMP amplitudes (p = 0.03) and recorded more abnormal SVV responses (p = 0.01) and greater error on SVV compared to HC, p < 0.001. SVV had no relationship with VEMP responses (p = 0.14). CONCLUSIONS: PD impacts on cVEMP reflex pathways but not tap oVEMP reflex pathways. Bone-conducted otolith stimuli (taps) are more robust than air-conducted sound stimuli (clicks) for both o and cVEMPs. A lack of association between SVV and VEMP responses suggest that static and dynamic otolith functions are differentially affected in PD.

Development and Assessment of an Interprofessional Education Simulation to Promote Collaborative Learning and Practice.

BACKGROUND: We designed an interprofessional education (IPE) clinical simulation that paired nurse practitioner and pharmacy students. The objective was to evaluate the effect on attitudes of interprofessional collaborative learning and practice. METHOD: Perceptions were assessed using the Student Perceptions of Interprofessional Clinical Education-Revised instrument and reflection questions that assessed the simulation's effectiveness in requiring team knowledge and experience from each profession whether the experience improved individual student clinical performance, and how this team approach influenced patient outcomes. RESULTS: Students believed that working with another health profession was educationally beneficial and should be a required experience; they also believed that this collaboration improved patient outcomes and satisfaction. Responses also indicated student ambiguity about their role in interprofessional care, and that clinical rotations were not the ideal setting for first professional interactions with others. CONCLUSION: Students expressed satisfaction and increased awareness of the importance of collaboration to ensure patient safety. Increasing interprofessional education experiences prior to clinical rotations should be considered. [J Nurs Educ. 2018;57(7):426-429.].

The development of an instrument to evaluate interprofessional student team competency.

Healthcare institutions, accreditation agencies for higher learning, and organizations such as the National Academy of Medicine in the United States, support interprofessional education (IPE) opportunities. However, incorporating IPE opportunities into academic settings remains difficult. One challenge is assessing IPE learning and practice outcomes, especially at the level of student performance to ensure graduates are "collaboration-ready". The Creighton-Interprofessional Collaborative Evaluation (C-ICE) instrument was developed to address the need for a measurement tool for interprofessional student team performance. Four interprofessional competency domains provide the framework for the C-ICE instrument. Twenty-six items were identified as essential to include in the C-ICE instrument. This instrument was found to be both a reliable and a valid instrument to measure interprofessional interactions of student teams. Inter-rater reliability as measured by Krippendorff's nominal alpha (nKALPHA) ranged from .558 to .887; with four of the five independent assessments achieving nKALPHA greater than or equal to 0.796. The findings indicated that the instrument is understandable (Gwet's alpha coefficient (gAC) 0.63), comprehensive (gAC = 0.62), useful and applicable (gAC = 0.54) in a variety of educational settings. The C-ICE instrument provides educators a comprehensive evaluation tool for assessing student team behaviors, skills, and performance.

The Experience of Feeling Disrespected: A Humanbecoming Perspective.

The concept of feeling disrespected was explored using the Parse research method. Ten women living with embodied largeness were asked, "What is the experience of feeling disrespected?" The structure of the living experience was feeling disrespected is mortifying disheartenment arising with disquieting irreverence, as distancing affiliations surface while enduring hardship. The findings provided new knowledge of living quality, advanced nursing practice, and presented future direction for research.

Feeling disrespected: an exploration of the extant literature.

In this article, a comprehensive exploration of the literature on feeling disrespected is presented. Literature is reviewed from philosophy, sociology, psychology, education, business, and nursing. Four over-arching themes concerning feeling disrespected are identified.

Characterization of an avirulent FCV strain with a broad serum cross-neutralization profile and protection against challenge of a highly virulent vs feline calicivirus.

Highly virulent, systemic strains of Feline calicivirus (vs FCV) have been described in recent years. These vs FCV isolates cause severe edema, cutaneous ulcers, lameness and other upper respiratory and oral clinical signs typically associated with FCV infection in cats. Vs FCV isolates can cause high mortality even in cats vaccinated with currently available commercial vaccines. This study reports identification and characterization of an avirulent FCV strain (FCV 21). This strain offers a broader serum cross-neutralization profile in comparison with the commonly used vaccine strain (FCV F9), as tested with two separate viral panels of FCV isolates. The first viral panel consists of 45 FCV strains isolated around 1993. The second viral panel consists of 26 FCV strains with most isolated around 2003. The potential of using this strain as a vaccine, in a 3-way (FCV+FHV+FPV) or 4-way (FCV+FHV+FPV+FCp) format, was tested by using a highly virulent vs FCV strain (FCV-33585) as a challenge virus. The mortality induced by this vs FCV in unvaccinated control cats was 78% (7 out of 9 cats). The mortality decreased to 44% (4 out of 9 cats) in cats vaccinated with a 4-way vaccine containing FCV F9. However, when this novel FCV vaccine strain (FCV 21) was used, either in combination with FCV F9 or by itself, the mortality decreased to 0% (0 out of 10 cats). The 3-way vaccine (FCV+FHV+FPV) that contained both FCV 21 and FCV F9 also had mortality of 0% (0 out of 10 cats). The clinical scores, as calculated taking into consideration the frequency and severity of various clinical signs, correlated with mortality data. The results suggested this FCV vaccine has the potential to be broadly protective against newly emergent FCV isolates, including complete protection against challenge with a highly virulent vs FCV 33585.

Treatment of chronic hepatitis C in a Canadian Aboriginal population: results from the PRAIRIE study.

BACKGROUND: The Aboriginal population of Canada is at increased risk of exposure to the hepatitis C virus (HCV). Previous data indicate that spontaneous clearance of HCV occurs more often in Aboriginals than Caucasians. Whether this enhanced response extends to antiviral therapy for chronic HCV remains to be determined. OBJECTIVES: To document and compare the biochemical and virological responses to antiviral therapy in HCV-infected Canadian Aboriginals and Caucasians. METHODS: A total of 101 treatment-naive adult patients (46 Aboriginal, 55 Caucasian) with chronic HCV genotype 1 infections were prospectively treated with pegylated-interferon and ribavirin and followed as per national guidelines. RESULTS: Aboriginals had higher HCV-RNA loads at baseline (6.42log(10) versus 5.98log(10); P<0.03). Although normalization of serum aminotransferase levels, decreases in viral loads, and rapid, early and end-of-treatment virological responses were similar in the two cohorts, sustained virological responses were significantly lower in Aboriginals (35% versus 55%; P=0.047). Premature discontinuation of treatment and/or loss of patients to follow-up was common (Aboriginals 37%, Caucasians 27%). Treatment-related side effects were similar in the two cohorts. CONCLUSION: Despite higher rates of spontaneous HCV clearance, the response to antiviral therapy was similar, if not lower, in Aboriginals compared with Caucasians with chronic HCV genotype 1 infections. Compliance with treatment is an issue that needs to be addressed in the management of these patients.

Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients.

BACKGROUND: The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. METHODS: HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis). DISCUSSION: The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients' beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above the effects of the behaviour-specific thinking and ii) the relationship between adherence to exercise and to medical treatment is stronger among those with more favourable views about the goal. Results from this study should identify the key contributing factors to inform subsequent adherence research and afford a more streamlined assessment matrix. The project also aims to inform patient care practices. UK CLINICAL RESEARCH NETWORK REGISTRATION NUMBER: UKCRN 7842.

The potential influence of KIR cluster profiles on disease patterns of Canadian Aboriginals and other indigenous peoples of the Americas.

Genetic differences in immune regulators influence disease resistance and susceptibility patterns. There are major health discrepancies in immune-mediated diseases between Caucasians and Canadian Aboriginal people, as well as with other indigenous people of the Americas. Environmental factors offer a limited explanation as Aboriginal people also demonstrate a rare resistance to chronic hepatitis C virus infection. Killer immunoglobulin-like receptors (KIRs) are known modulators of viral responses and autoimmune diseases. The possibility that variation in KIR cluster profiles contribute to the health outcomes of Aboriginal people was evaluated with Canadian Caucasian (n=93, population controls) and Aboriginal (n=86) individuals. Relative to Caucasians, the Aboriginal KIR cluster displayed a greater immune activating phenotype associated with genes of the B haplotype situated within the telomeric region. In conjunction, there was a decrease in the genes of the B haplotype from the centromeric region. Caucasian and Aboriginal cohorts further demonstrated distinct genotype and haplotype relationships enforcing the disconnect between the B haplotype centromeric and telomeric regions within the Aboriginal population. Moreover, Caucasian KIR cluster patterns reflected studies of Caucasians globally, as well as Asians. In contrast, the unique pattern of the Canadian Aboriginal cohort mirrored the phenotype of other indigenous peoples of the Americas, but not that of Caucasians or Asians. Taken together, these data suggest that historically indigenous peoples of the Americas were subject to immune selection processes that could be influencing the current disease resistance and susceptibility patterns of their descendents.

Reliability and internal consistency findings from the C-SEI.

Human patient simulation (HPS) is increasingly being used as both a teaching and an evaluation strategy in nursing education. To meaningfully evaluate student performance in HPS activities, nurse educators must be equipped with valid and reliable instruments for measuring student performance. This study used a novel method, including leveled, video-archived simulation scenarios, a virtual classroom, and webinar and e-mail communication, to assess the reliability and internal consistency of data produced using the Creighton Simulation Evaluation Instrument. The interrater reliability, calculated using intraclass correlation (2,1) and 95% confidence interval, was 0.952 (0.697, 0.993). The intrarater reliability, calculated using intraclass correlation (3,1) and 95% confidence interval, was 0.883 (-0.001, 0.992), and the internal consistency, calculated using Cronbach's alpha, was α = 0.979. This article includes a sample of the instrument and provides valuable resources and reliability data for nurse educators and researchers interested in measuring student performance in HPS activities.

HIV Patient Characteristics that Affect Adherence to Exercise Programmes: An Observational Study.

BACKGROUND: Benefits of exercise for HIV-infected persons have been documented, although in clinical practice, diminished adherence to exercise limits the effectiveness of this auxiliary treatment. Exercise intervention studies carry the caveat that the results are limited to volunteers with good compliance and completion profiles. OBJECTIVES: This study aimed to identify characteristics contributing to adherence vs non-adherence to prescribed supervised 10-week 75-minute aerobic and progressive resistance exercise programme in a clinical setting that requires twice-weekly attendance at the physiotherapy gym. STUDY DESIGN: This observational study was comprised of 11 males and 11 females, physician-assessed, HIV seropositive patients referred to exercise programmes in a tertiary multi-disciplinary outpatient service for HIV patients at an urban Teaching Hospital in London (UK). Measurements taken prior to the exercise programme were used as dependent variables and include CD4 count, fitness level, flexibility and perceived physical-, emotional-, functional- and psychological- well-being. Attendance records were categorised into a dichotomous independent variable of adherence based on a natural break that occurred at 8/20 attended sessions. RESULTS: Prior-to-treatment differences in perceived physical, functional and psychological well-being exist between adherent and non-adherent patients, but no differences were found in age, CD4 count or fitness level. Perceived well-being explained 55.7% of the variances in attendance. Gender and reason for referral appear to be independent of adherence, whereas ethnicity may play an influential role. CONCLUSION: Perceived well-being appears to differentiate between adherent and non-adherent patients. Further studies are required to investigate other psychological characteristics and barriers to maintaining exercise.

The development of a quantitative evaluation tool for simulations in nursing education.

In a complex healthcare environment, educating nursing students to safely care for clients is a challenging endeavor. As the use of high fidelity simulations increases, the ability to evaluate students is essential. A review of the literature identified a lack of tested simulation evaluation instruments to accurately measure student performance. A simulation evaluation tool was developed and tested with senior nursing students. Content validity was established from the literature and from the review of the tool by an expert panel. Reliability was established using sixteen simulation sessions, with two trained evaluators at each session. Percent agreement by evaluators ranged from 84.4% to 89.1%. Additional research needs to verify these results with different evaluators, varying levels of students, and additional scenarios. A valid, reliable tool to evaluate simulation experiences improves student assessment skills and ultimately clinical performance.

A unique simulation teaching method.

Simulation is an excellent venue for students to learn experientially and provides opportunities for students to practice problem solving and psychomotor skills in a safe, controlled environment. Through the use of a specifically designed format, faculty at Creighton University School of Nursing have developed a unique method of implementing high-fidelity simulation that allows a more comprehensive learning experience. This innovative teaching strategy incorporates not just skill acquisition, but also care management concepts into the scenario, while requiring only one faculty member. Students simultaneously take one of two paths through the components of this method to achieve the same learning outcomes.

Characterization of a highly virulent feline calicivirus and attenuation of this virus.

Feline calicivirus (FCV) is a common cause of upper respiratory and oral disease in cats. Highly virulent, systemic strains of FCV (vs FCV) have been recently described. These vs FCV isolates cause edema, cutaneous ulcers and high mortality in affected cats. This study reports a disease model with such a vs FCV isolate (FCV-33585). It also describes a full-length capsid gene sequence of this vs FCV isolate and the capsid sequence comparison of this strain with 35 other virulent and non-virulent FCV strains. In addition, sequence comparison of this strain with other 114 known sequences in the hyper-variable region of capsid gene was analyzed. Two amino acids were identified within the hyper-variable region as potentially unique signature for this vs FCV strain. This study also describes the attenuation of FCV-33585 by two methods: serial passaging at low temperature, and the generation of a temperature sensitive (ts) mutant by UV irridiation. Moreover, the potential use of attenuated vs FCV as vaccine was also explored. Monoclonal antibodies were also identified which could differentiate commonly used FCV vaccine strain from this vs strain (FCV-33585). And two monoclonal antibodies were found to react specifically the wild-type, not the attenuated FCV-33585.

Pressure relieving support surfaces (PRESSURE) trial: cost effectiveness analysis.

OBJECTIVE: To assess the cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital. DESIGN: Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial. SETTING: 11 hospitals in six UK NHS trusts. PARTICIPANTS: Intention to treat population comprising 1971 participants. MAIN OUTCOME MEASURES: Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital. RESULTS: Alternating pressure mattresses were associated with lower overall costs (283.6 pounds sterling per patient on average, 95% confidence interval--377.59 pounds sterling to 976.79 pounds sterling) mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average,--24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost effectiveness acceptability curve indicated that on average alternating pressure mattresses compared with alternating pressure overlays were associated with an 80% probability of being cost saving. CONCLUSION: Alternating pressure mattresses for the prevention of pressure ulcers are more likely to be cost effective and are more acceptable to patients than alternating pressure overlays.

Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers: PRESSURE (pressure relieving support surfaces) trial.

OBJECTIVE: To compare whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers, healing of existing pressure ulcers, and patient acceptability. DESIGN: Pragmatic, open, multicentre, randomised controlled trial. SETTING: 11 hospitals in six NHS trusts. PARTICIPANTS: 1972 people admitted to hospital as acute or elective patients. INTERVENTIONS: Participants were randomised to an alternating pressure mattress (n = 982) or an alternating pressure overlay (n = 990). MAIN OUTCOME MEASURES: The proportion of participants developing a new pressure ulcer of grade 2 or worse; time to development of new pressure ulcers; proportions of participants developing a new ulcer within 30 days; healing of existing pressure ulcers; and patient acceptability. RESULTS: Intention to treat analysis found no difference in the proportions of participants developing a new pressure ulcer of grade 2 or worse (10.7% overlay patients, 10.3% mattress patients; difference 0.4%, 95% confidence interval--2.3% to 3.1%, P = 0.75). More overlay patients requested change owing to dissatisfaction (23.3%) than mattress patients (18.9%, P = 0.02). CONCLUSION: No difference was found between alternating pressure mattresses and alternating pressure overlays in the proportion of people who develop a pressure ulcer. TRIAL REGISTRATION: ISRCTN 78646179.

Minimization--reducing predictability for multi-centre trials whilst retaining balance within centre.

Minimization is often used to assign patients to treatment groups to ensure good balance in patient numbers within centre and other prognostic factors. Balance within centre is preferable since large imbalances between treatment arms may have logistical implications for centres, such as cost and resource implications. However, recent concern over high predictability of treatment allocation by centres when using minimization has caused this method to be questioned. We used data from current clinical trials to assess predictability and summarize subsequent within-centre imbalances with the aim of finding the most effective minimization method for reducing predictability whilst still retaining sufficient balance within centre, when randomization is to one of two treatments. We compared prediction rates and imbalances for deterministic minimization, and minimization incorporating various random elements, p (p=0.95,0.90,0.80,0.75,0.70). We also compared prediction rates and imbalance when centre was and was not included as a stratification factor. Incorporating a random element proved successful in reducing prediction rates whilst minimizing the inevitable increase in within-centre imbalance, whereas excluding centre as a stratification factor incurred major within-centre imbalance. We therefore suggest that minimization can still be used, and that centre can be included as a stratification factor, but a random element has to be incorporated into the minimization algorithm. Minimization incorporating a random element of 0.80 is the most efficient method to use based upon the simulations undertaken in this study of real clinical trial data using different probabilities of allocation.