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1.
Artigo em Inglês | MEDLINE | ID: mdl-38865692

RESUMO

ABSTRACT: Nerve conduction studies (NCS) are a commonly performed procedure and a core competency for Physical Medicine and Rehabilitation (PM&R) residents. Nerve conduction studies are complex to learn and no standardized training protocols exist across PM&R programs. The aim of this study is to standardize training and assessment of resident proficiency in NCS skills and to evaluate the impact of an educational intervention on skills development. This was a repeated measures design wherein 36 PM&R residents underwent a pretest, followed by a mastery-learning-based intervention, including deliberate practice. Residents were then expected to meet or exceed a minimum passing score at post-test. Performance improved from a median score of 4.5/66 on the pretest to a median score of 63/66 on the posttest. 33/36 residents achieved the minimum passing score on the first attempt; three residents required additional deliberate practice and met the minimum passing score on the second attempt. A curriculum featuring deliberate practice dramatically increased checklist scores of residents performing NCS. This mastery learning program shows a reliable and reproducible method to achieve procedural competency within a PM&R residency program and can shift the curve to allow residents to immediately start performing NCS at the start of their clinical experience.

3.
Clin Transplant ; 38(1): e15182, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37922201

RESUMO

Heart transplantation is considered definitive treatment for patients with end-stage heart failure. Unfortunately, medical and functional complications are common after heart transplantation for a variety of reasons, and these may impact the patients' functional recovery. Rehabilitation is often needed post-operatively to improve functional outcomes. This review article aims to discuss the transplanted heart exercise physiology that may affect the rehabilitation process and provide an overview of the functional benefits of inpatient rehabilitation for cardiac and surgical specialties who may be less familiar with post-acute care rehabilitation options for their patients.


Assuntos
Transplante de Coração , Especialidades Cirúrgicas , Humanos , Pacientes Internados , Recuperação de Função Fisiológica , Terapia por Exercício , Resultado do Tratamento
4.
PM R ; 15(10): 1351-1360, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-36565450

RESUMO

Heart transplantation is a definitive treatment option for patients with end-stage heart failure. Medical and functional complications are common after this procedure, and rehabilitation is often needed postoperatively. Physiatrists caring for persons who have received a donor heart must appreciate the surgical background, the physiologic changes expected, as well as the potential medical complications for which they are at risk after heart transplantation. This review summarizes various topics in heart transplantation including the history of the procedure, exercise physiology and functional outcomes, postoperative medical therapy, medical complications, and special considerations for inpatient rehabilitation in this patient population.


Assuntos
Transplante de Coração , Medicina , Humanos , Transplante de Coração/reabilitação , Pacientes Internados , Doadores de Tecidos
7.
Arch Dermatol ; 143(5): 606-12, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17515510

RESUMO

OBJECTIVE: To evaluate the effectiveness of topical retinol (vitamin A) in improving the clinical signs of naturally aged skin. DESIGN: Randomized, double-blind, vehicle-controlled, left and right arm comparison study. SETTING: Academic referral center. PATIENTS: The study population comprised 36 elderly subjects (mean age, 87 years), residing in 2 senior citizen facilities. INTERVENTION: Topical 0.4% retinol lotion or its vehicle was applied at each visit by study personnel to either the right or the left arm, up to 3 times a week for 24 weeks. MAIN OUTCOME MEASURES: Clinical assessment using a semiquantitative scale (0, none; 9, most severe) and biochemical measurements from skin biopsy specimens obtained from treated areas. RESULTS: After 24 weeks, an intent-to-treat analysis using the last-observation-carried-forward method revealed that there were significant differences between retinol-treated and vehicle-treated skin for changes in fine wrinkling scores (-1.64 [95% CI, -2.06 to -1.22] vs -0.08 [95% CI, -0.17 to 0.01]; P<.001). As measured in a subgroup, retinol treatment significantly increased glycosaminoglycan expression (P = .02 [n = 6]) and procollagen I immunostaining (P = .049 [n = 4]) compared with vehicle. CONCLUSIONS: Topical retinol improves fine wrinkles associated with natural aging. Significant induction of glycosaminoglycan, which is known to retain substantial water, and increased collagen production are most likely responsible for wrinkle effacement. With greater skin matrix synthesis, retinol-treated aged skin is more likely to withstand skin injury and ulcer formation along with improved appearance.


Assuntos
Envelhecimento da Pele/efeitos dos fármacos , Vitamina A/administração & dosagem , Vitaminas/administração & dosagem , Administração Cutânea , Idoso de 80 Anos ou mais , Atrofia/tratamento farmacológico , Atrofia/metabolismo , Atrofia/patologia , Colágeno Tipo I/genética , Colágeno Tipo I/metabolismo , Método Duplo-Cego , Feminino , Glicosaminoglicanos/genética , Glicosaminoglicanos/metabolismo , Humanos , Masculino , RNA Mensageiro/metabolismo , Receptores do Ácido Retinoico/genética , Receptores do Ácido Retinoico/metabolismo , Envelhecimento da Pele/patologia , Envelhecimento da Pele/fisiologia , Resultado do Tratamento
8.
J Med Entomol ; 41(1): 69-73, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14989348

RESUMO

We performed a series of experiments to determine if human peripheral blood mononuclear cells (PBMCs) from a healthy donor and dendritic cells (NHDCs) derived from these PBMCs reacted to molecules in a scabies extract. PBMCs extravasate from the circulatory system and enter tissues such as scabietic lesions, where monocytes become macrophages. Cells were cultured in medium alone or medium containing 50 microg/ml of Sarcoptes scabiei (SS) extract, 50 ng/ml E. coli lipopolysaccharide (LPS), or SS + LPS together. Supernatants were collected and assayed by enzyme-linked immunosorbent assay (ELISA) for specific cytokines. PBMCs stimulated with SS or LPS exhibited moderately upregulated production of interleukin (IL)-1beta and huge increases in secretions of IL-6, IL-8 and TNF-alpha. Cells co-stimulated with both SS and LPS generally secreted more of these cytokines than cells stimulated with either SS or LPS alone. LPS induced a small amount of IL-1alpha secretion, whereas SS did not, and neither additive resulted in the production of IL-10. NHDCs did not produce IL-1alpha, IL-1beta, IL-6, IL-8, or IL-10 in response to stimulation with SS. These cells did produce IL-6, IL-8, and tumor necrosis factor (TNF)-alpha in response to LPS. When cells were co-stimulated with both LPS and SS, the production of IL-6 and IL-8 was significantly reduced compared with the levels secreted after LPS stimulation alone. These studies show that molecules in a whole body extract of S. scabiei modulate the function of PBMCs (probably monocytes) and dendritic cells.


Assuntos
Citocinas/genética , Células Dendríticas/imunologia , Linfócitos/imunologia , Sarcoptes scabiei/química , Extratos de Tecidos/farmacologia , Animais , Células Dendríticas/efeitos dos fármacos , Sinergismo Farmacológico , Escherichia coli/imunologia , Regulação da Expressão Gênica/imunologia , Humanos , Técnicas In Vitro , Interleucinas/genética , Lipopolissacarídeos/farmacologia , Linfócitos/efeitos dos fármacos
9.
Am J Trop Med Hyg ; 69(6): 652-6, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14740884

RESUMO

Sarcoptes scabiei lives in the stratum corneum of its mammalian host. Keratinocytes and fibroblasts are among the first cells to encounter the burrowing mite and its products. The aim of this study was to determine if molecules in an extract of S. scabiei modulate the expression of cytokines by keratinocytes and fibroblasts. Human keratinocytes and fibroblasts were exposed to an extract of S. scabiei var. canis in the absence or presence of Escherichia coli lipopolysaccharide. Cytokine expression was measured by an enzyme-linked immunosorbent assay. Components in the S. scabiei extract induced marked increases in secretion of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) and slight increases in production of granulocyte-colony-stimulating factor (G-CSF) by keratinocytes. The scabies extract down-regulated keratinocyte secretion of IL-1 receptor antagonist, but did not influence the production of IL-1alpha or IL-1beta. In comparison, components in the scabies extract induced marked increases in the elaboration of IL-6, IL-8, G-CSF, and VEGF by fibroblasts. Neither cell type produced eotaxin, stem cell factor, or tumor necrosis factor-alpha under any of the conditions tested. This study demonstrates that components in an extract of the mite S. scabiei are able to influence cytokine expression by human keratinocytes and fibroblasts.


Assuntos
Citocinas/biossíntese , Fibroblastos/imunologia , Queratinócitos/imunologia , Sarcoptes scabiei/imunologia , Animais , Células Cultivadas , Ensaio de Imunoadsorção Enzimática , Fibroblastos/citologia , Fibroblastos/parasitologia , Fator Estimulador de Colônias de Granulócitos/biossíntese , Humanos , Interleucina-6/biossíntese , Queratinócitos/citologia , Queratinócitos/parasitologia , Sarcoptes scabiei/fisiologia , Regulação para Cima , Fator A de Crescimento do Endotélio Vascular/biossíntese
10.
Curr Allergy Asthma Rep ; 2(5): 401-11, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12165207

RESUMO

The most important allergy-causing mites found in homes worldwide are the house dust mites Dermatophagoides farinae, D. pteronyssinus, Euroglyphus maynei, and the storage mite Blomia tropicalis. Most homes contain multiple species. The most prevalent mite species and allergen in homes differ geographically, between homes within a geographical region, and among areas within a home. Therefore, it is important to know which mite species are present in a geographical area when performing diagnostic testing and prescribing immunotherapy. The key factor that influences mite survival and prevalence is relative humidity. Mites are present in homes in humid geographical areas and are rare or absent in drier climates unless humidity is artificially raised. Generally speaking, dust mite allergen levels are low in public buildings and transportation compared to levels in homes.


Assuntos
Alérgenos , Poeira , Ácaros/imunologia , Animais , Clima , Ecologia , Geografia , Habitação , Humanos , Meios de Transporte , Local de Trabalho
11.
Ann Allergy Asthma Immunol ; 88(4): 410-5, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11991559

RESUMO

BACKGROUND: Locations where there are no dust mites or pets present may contain allergens that pose a risk factor for sensitizing and inducing rhinitis and asthma. OBJECTIVE: The purpose of this study was to investigate the relationship among the prevalence of mites and mite, dog, and cat allergens in homes, on clothing, and on automobile seats. METHODS: Over a 2-year period (July 1998 to July 2000), dust mite and mite, dog, and cat allergen densities were determined in homes, associated automobiles, and on the clothing of the drivers. During this period 87 homes were sampled one to five times each. RESULTS: Low levels of live and dead mites were present in most dust samples obtained from automobile seats and in 16% from clothing. Seventy-two and 50% of the home samples had >2 microg and >10 microg Der l/g of dust, respectively, whereas 23% of automobiles seat samples had >2 microg Der l/g of dust with a mean of 1.3 microg/g. Mite and Der 1 densities were not different for homes with or without pets. However, homes with pets had significantly more Fel d 1 or Can f 1 allergen than homes without pets. Homes without cats and dogs had an average of 93 and 29 microg/g of Fel d 1 and Can f 1, respectively, which was well above threshold levels for sensitization and induction of allergic reactions. Although most clothing had detectable levels of pet allergen, the levels of these allergens were low. CONCLUSIONS: Der 1 densities in some automobiles were sufficiently high (>2 microg/g of dust) to be risk factors for sensitization and allergic reactions. However, most automobile seats had levels of dog and cat allergen that were well above the threshold levels considered to be risk factors for both sensitization and symptoms, regardless of the presence of a pet in the home. The presence of live and dead mites and mite, cat, and dog allergens in automobiles and on clothing suggests that both are vehicles in the dispersal of mites and mite and pet allergen.


Assuntos
Alérgenos/análise , Automóveis , Vestuário , Cães/imunologia , Poeira/análise , Glicoproteínas/análise , Habitação , Ácaros , Animais , Animais Domésticos , Antígenos de Dermatophagoides , Antígenos de Plantas , Exposição Ambiental , Utensílios Domésticos , Humanos , Hipersensibilidade Imediata/epidemiologia , Decoração de Interiores e Mobiliário , Ácaros/imunologia , Ohio , Fatores de Risco
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