Assessing pulmonary function in ALS using electrical impedance tomography.

Objective: We sought to determine whether thoracic electrical impedance tomography (EIT) could characterize pulmonary function in amyotrophic lateral sclerosis (ALS) patients, including those with facial weakness. Thoracic EIT is a noninvasive, technology in which a multi-electrode belt is placed across the chest, producing real-time impedance imaging of the chest during breathing. Methods: We enrolled 32 ALS patients and 32 age- and sex-matched healthy controls (HCs) without underlying lung disease. All participants had EIT measurements performed simultaneously with standard pulmonary function tests (PFTs), including slow and forced vital capacity (SVC and FVC) in upright and supine positions and maximal inspiratory and expiratory pressures (MIPs and MEPs, respectively). Intraclass correlation coefficients (ICCs) were calculated to assess the immediate reproducibility of EIT measurements and Pearson's correlations were used to explore the relationships between EIT and PFT values. Results: Data from 30 ALS patients and 27 HCs were analyzed. Immediate upright SVC reproducibility was very high (ICC 0.98). Correlations were generally strongest between EIT and spirometry measures, with R values ranging from 0.64 to 0.82 (p < 0.001) in the ALS cohort. There were less robust correlations between EIT values and both MIPs and MEPs in the ALS patients, with R values ranging from 0.33 to 0.44. There was no significant difference for patients with and without facial weakness. There were no reported adverse events. Conclusion: EIT-based pulmonary measures hold the promise of providing an alternative approach for lung function assessment in ALS patients. Based on these early results, further development and study of this technology are warranted.

Electrical Impedance Myography in Dogs With Degenerative Myelopathy.

Canine degenerative myelopathy (DM) leads to disuse and neurogenic muscle atrophy. Currently there is a lack of non-invasive quantitative measures of muscle health in dogs with DM. Muscle pathology has been previously quantified in other disorders using the technique of electrical impedance myography (EIM) but it has not been reported for DM. The objective of this study was to compare EIM between DM-affected and similar aged healthy dogs as well as assess EIM changes over time in DM-affected dogs. Multifrequency EIM was performed on DM affected dogs at baseline and during disease progression and on age-matched healthy dogs. Muscles evaluated in the pelvic limbs included the craniotibialis, gastrocnemius, gracilis, sartorius, and biceps femoris. The 100 kHz phase angle was extracted from the full frequency set for analysis. Phase values were lower in DM dogs as compared to healthy controls. Specifically, phase of the gastrocnemius was lower on the left (θ = 7.69, 13.06; p =0.002) and right (θ= 6.11, 11.72; p = 0.001) in DM vs. control dogs, respectively. The mean phase value of all measured muscles was also lower on the left (θ = 9.24, 11.62; p = 0.012) and right (θ = 9.18, 11.72; p = 0.021). Other individual muscles measured did not reach statistical significance, although values were consistently lower in DM-affected dogs. With disease progression, downward trends in phase values were detected in DM-affected dogs when monitored serially over time. This study demonstrates that EIM 100 kHz phase values are sensitive to muscle pathology in DM and that phase values are decreased in dogs with DM. Measurements from the gastrocnemius muscle show the greatest differences from similar aged healthy dogs suggesting it may be the preferred muscle for future EIM studies.

Electrical impedance myography in healthy dogs: Normative values, repeatability, and the impact of age.

Convenient tools to assess canine skeletal muscle health would be useful for a variety of applications, including standard veterinary assessments of dog fitness, as well as studies of muscle deterioration due to age or disease. One technology that can be applied conveniently to awake dogs with minimal restraint is electrical impedance myography (EIM). In EIM, a weak electrical current is applied via surface electrodes to a muscle of interest and consequent impedance characteristics of the muscle are obtained, providing insight into muscle condition and composition. In this study, we assessed a total of 73 dogs (42 males and 31 females), of varied neutering status and breed, ages 0.6 to 13.5 years. We identified age-dependent reference values for the 100 kHz phase value in three pelvic limb muscles, caudal sartorius, cranial tibial, and gastrocnemius. While phase values were generally higher in males than females, the difference did not reach significance. In general, values declined on average with age at about 0.5 degrees/year, but with the decline being most substantial in the oldest dogs. Limited reproducibility assessment of the technique suggested good repeatability with variation in values between measurements being under 5%. These results show that EIM has the potential for the assessment of canine muscle health and may find value in aging muscle research.

A robust and novel electrical impedance metric of pulmonary function in ALS patients.

OBJECTIVE: Pulmonary function tests (PFTs) are important for assessing respiratory function in amyotrophic lateral sclerosis (ALS) patients. However, weakness of oral and glottal closure, due to concomitant bulbar dysfunction, may result in unreliable PFT values stemming from leakage of air around the breathing tube and through the glottis. In this study, we assessed whether standard thoracic electrical impedance tomography (EIT) could serve as a surrogate measure for PFTs. APPROACH: Thoracic EIT was performed simultaneously with standard PFTs on seven ALS patients without clinical bulbar weakness (six men and one woman, mean age of 63 years) and ten healthy volunteers (seven men and three women, mean age of 57 years). A raw impedance metric along with more standard EIT measures were computed and correlated with the normalized forced vital capacity (FVC). Additionally, test/re-test metrics and EIT images were analyzed. MAIN RESULTS: The impedance metric was found to be robust and sensitive to lung activity. We also identified qualitative EIT differences between healthy volunteers and ALS patients, with the ALS images showing greater heterogeneity. Significant correlations with FVC were found for both impedance and EIT metrics in ALS patients (r2 = 0.89) and for the impedance metric only in healthy volunteers (r2 = 0.49). SIGNIFICANCE: This suggests that EIT, using our novel impedance metric, has the potential to serve as an alternative technology to standard PFTs for assessing pulmonary function in patients with ALS, offering new metrics of disease status for those with bulbar weakness.

The Need for Cultural Inclusivity in Global Palliative Nursing: Caring for Selected Underserved Populations in the United States.

It is estimated that 11.1 million people in the United States are living with serious illness, and most people with serious illness need palliative care. Quality palliative care incorporates culturally sensitive care, and with the increasing diversity in the United States, it has become even more critical that nurses and health care professionals be prepared to meet the unique needs of those living within the diverse and underserved populations of this country. Advocating for access to palliative care for the seriously ill, culturally respectful care at the end of life, and honoring values, practices, and beliefs are essential roles of the nurse. This article presents 4 examples of individuals from diverse and potentially vulnerable US populations who face unique challenges as they deal with their life-limiting diseases and face end of life.

Palliative care education in U.S. adult neuro-oncology fellowship programs.

INTRODUCTION: Palliative care (PC) for patients with neuro-oncological diseases positively impacts morbidity and mortality. No studies have evaluated whether neuro-oncology fellows receive formal PC education during fellowship. The purpose of this study was to describe the PC education and identify education needs of US neuro-oncology fellowship programs. METHODS: Program directors (PDs) of US neuro-oncology fellowships were surveyed. The electronic survey included qualitative and quantitative questions. RESULTS: Of 26 programs with fellows, 17 completed surveys (65% response rate) of which 3 (18%) offered no formal PC education. The methods most utilized were formal didactics (seminars/conferences) and self-directed reading materials. One-third of programs have developed their own teaching materials. Communication was the domain identified as most important, the domain fellows were most well-trained in, and the domain PDs felt most comfortable providing for their own patients. Addressing spiritual distress and initiating life-prolonging therapies were the domains PDs identified as being least important, fellows were least well trained in, and PDs were least comfortable providing for their own patients. Most programs (83%) were satisfied with the PC education available at their program. Time for teaching and faculty availability were the most common barriers. CONCLUSIONS: Neuro-oncology PDs recognize the need for PC education, which is currently offered in some form by most programs, but the content and methods of delivery are heterogenous. Interdisciplinary educational teams and nationally-available PC educational material may improve implementation of PC education in neuro-oncology.