Intensive rehabilitation programme for patients with subacute stroke in an inpatient rehabilitation facility: describing a protocol of a prospective cohort study

Accident cerebrovascular; Rehabilitació; Estudi prospectiuAccidente cerebrovascular; Rehabilitación; Estudio prospectivoRehabilitation; Stroke; Prospective StudiesRehabilitation is recognised as a cornerstone of multidisciplinary stroke care. Intensity of therapy is related to functional recovery although there is high variability on the amount of time and techniques applied in therapy sessions. There is a need to better describe stroke rehabilitation protocols to develop a better understanding of current practice increasing the internal validity and generalisation of clinical trial results. The aim of this study is to describe an intensive rehabilitation programme for patients with stroke in an inpatient rehabilitation facility, measuring the amount and type of therapies (physical, occupational and speech therapy) provided and reporting functional outcomes. Methods and analysis: This will be a prospective observational cohort study of patients with subacute stroke admitted to our inpatient rehabilitation facility during 2 years. A therapy recording tool was developed in order to describe the rehabilitation interventions performed in our unit. This tool was designed using the Delphi method, literature search and collaboration with senior clinicians. Therapists will record the time spent on different activities available in our unit during specific therapy sessions. Afterwards, the total time spent in each activity, and the total rehabilitation time for all activities, will be averaged for all patients. Outcome variables were divided into three different domains: body structure and function outcomes, activity outcomes and participation outcomes and will be assessed at baseline (admission at the rehabilitation unit), at discharge from the rehabilitation unit and at 3 and 6 months after stroke. Ethics and dissemination: This study was approved by the Medical Research Committee at Hospital del Mar Research Institute (Project ID: 34/C/2017). The results of this study will be presented at national and international congress and submitted for publication in peer-reviewed journals.This Project is funded by Fundació La Marató TV

Malnutrition According to GLIM Criteria Is Associated with Mortality and Hospitalizations in Rehabilitation Patients with Stable Chronic Obstructive Pulmonary Disease

Malnutrition has a negative impact on patients with chronic pulmonary obstructive disease (COPD). The purpose of this study was to assess the prevalence of malnutrition, defined by the Global Leadership Initiative for Malnutrition (GLIM), in stable COPD patients referred to pulmonary rehabilitation, and to explore potential associations of malnutrition according to GLIM, and its components, with increased risk of mortality and hospitalizations in 2 years. In a post-hoc analysis of a prospective cohort of 200 rehabilitation patients with stable COPD, main outcome variables were hospital admissions, length of stay, and mortality during a 2-year follow-up. Covariates were malnutrition according to GLIM and its phenotypic criteria: unintentional weight loss, low body mass index (BMI), and low fat-free mass (FFM). Univariate and multivariate analysis were performed using logistic and proportional hazard Cox regression. Malnutrition according to GLIM showed 45% prevalence and was associated with increased mortality risk. Low age-related BMI and FFM were independently associated with mortality, which persisted after adjustment for age and lung function. Malnutrition and low BMI were also associated with increased risk of hospitalization. Malnutrition according to GLIM criteria was highly prevalent in rehabilitation patients with COPD and was associated with nearly 3 times greater mortality and hospitalization risk

Llibre Blanc de la mediació a Catalunya

Projectes científics associats: IDT SGR2009-688; ONTOMEDIA CSO-2008-05536-SOCI, TSI-20501-2008-131; GCC SGR2009-221; GREL SGR2009-357; SGR2009-1328; AT CSD2007-0022; AT COST IC0801Altres ajuts: TSI-20501-2008-131Altres ajuts: COST-IC0801L'estudi que es presenta ara és fruit de gairebé dos anys de treball. Una cartografia completa de les experiències en mediació en tots els àmbits socials, de les escoles als hospitals, de les empreses als nuclis familiars, de la mediació comunitària als conflictes de consum o laborals, de la mediació penal a la mediambiental. També s'hi ha incorporat una anàlisi dels costos de la mediació i de la seva configuració jurídica. La conjunció de les fotografies en relleu i dels estudis més teòrics han fet possible la reflexió ulterior, les interpretacions crítiques i, en darrer terme, les conclusions i les recomanacions, que ens ajudaran a progressar. La mediació permet detenir l'escalada dels conflictes i sostreure'ls de la resolució judicial, per implicar les parts i fer-les protagonistes actives de les solucions a què arribin. Des del Departament de Justícia, ens interessa superar l'excessiva judicialització dels conflictes -insatisfactòria per a tothom- i promoure instruments que facilitin, de manera àgil però amb totes les garanties, la intel·ligència dels problemes i, a partir d'aquí, la fixació de les millors solucions per a les parts implicades, que elles mateixes hauran construït

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Oropharyngeal dysphagia after stroke: assessment and treatment

Els transtorns de la deglució afecten un 29-67% dels pacients post-Ictus. L’aspiració silent, aspiració sense expressió clínica, afecta del 15-39% dels ictus aguts. La disfàgia pot comportar malnutrició, deshidratació, pneumònia broncoaspirativa i mort, i té impacte sobre els costos sanitaris. L’evidència científica suggereix que la detecció de la disfàgia en estadis precoços de l’ictus redueix el risc de broncoaspiració i és útil per determinar l’estratègia terapèutica. Aquesta tesi avalua la capacitat de dos tests clínics de cribatge, el Mètode d’exploració Clínica de Volum Viscositat (MECV-V) i Test de la tos amb àcid cítric (CCT), per la detecció de l’aspiració i l’aspiració silent, respectivament. El MECV-V consisteix en l’administració de líquid a diferents viscositats i volums sota control de pulsioximetria. Canvis en els signes de seguretat com són el to de veu, la tos durant o després del bolus administrat, la desaturació >3% de la saturació basal, és consideren com a test alterat i al pacient com a possible aspirador. EL CCT registra el número de pics de tos durant el minut d’ inhalació oral d’una solució nebulitzada d’àcid cítric a 1M. Es considera > 5 pics de tos normal, mentre que ≤4 es considera disminuït i al pacient com a baix responedor o possible aspirador silent. En compració ala Videofluoroscòpia (VFSS), el gold estàndard, el MECVV detecta aspiració amb una sensibilitat del 88.2% i una especificitat del 71.4% , mentre que el CCT, detecta aspiració silent amb una sensibilitat i especificitat del 19% i 71%, respectivament. En conclusió el MECVV és un test de baix cost i fàcilment aplicable que compleix els criteris de test de cribatge en població afecte d’ictus; mentre que el CCT, a concentració 1M, no sembla un test útil aplicat individualment per la detecció dels potencials aspiradors silents. S’aporten dades recents sobre un assaig clínic dissenyat per valorar l’efectivitat de dues noves tècniques terapèutiques, l’estimulació elèctrica neuromuscular (NMES) i l’entrenament de la musculatura respiratòria, inspiratòria i espiratòria (IEMT) . Els pacients van ser randomitzats a la logopèdia clàssica (SST) , a NMES i SST o al IEMT i SST. La disfàgia es va avaluar amb el MECV-V i la VFSS, i la força de la musculatura respiratòria també es va recollir. La combinació del NMES o IEMT al SST millora significament els resultats en força respiratòria i els signes de seguretat de la deglució al final de la intervenció. Aquest estudi aporta noves evidències sobre teràpies emergents en el tractament de la disfàgia.Swallowing disorders affect up to 29-67% of patients with stroke. Silent aspiration, aspiration without clinical signs expression, is present in 15-39% of acute stroke samples. Dysphagia can lead to malnutrition, dehydration, bronchoaspirative pneumonia and death, and have impact on health care costs. Available evidence suggests that screening dysphagia in the early stages of stroke onset reduces the risk of bronchoaspiration and is useful to determine the best therapeutic strategy. This thesis project is aimed to evaluate two different screening techniques, the Volume Viscosity Swallow Test (V-VST) and the Citric Cough Test (CCT), for detecting aspiration and silent aspiration, respectively. The V-VST consists of the administration of different liquid viscosities and food consistencies under pulse oximetry control. Changes in security signs as tone of voice, coughing during or after eating, or desaturation of more than 3% compared to baseline oxygen saturation, are considered as a failed test and classifies the patient as potential aspirator or no aspirator. The CCT records the number of cough peaks in the minute to the oral inhalation of a 1M mixture of saline and citric acid through an ultrasonic nebulizer. More than 5 cough peaks are considered as normal responders, whereas those with ≤4 are considered as reduced or absent responders. In comparison with the videofluoroscopic swallow study (VFSS), the gold standard, the V-VST detects aspiration with a sensitivity of 88.2% and specificity of 71.4%, whilst the CCT detects silent aspiration with sensitivity and specificity indexes of 19% and 71%, respectively. In conclusion, the V-VST is low in cost, easy to use and very sensitive, meeting the requirements of oropharyngeal dysphagia and aspiration screening test in subacute stroke; whilst the low sensitivity of the CCT using 1.0% (weight by volume) does not support its use as standalone tool to screen for silent aspiration in stroke patients. In addition, breaking results of a clinical trial aimed to determine effectiveness of two new therapeutic techniques, neuromuscular electrical stimulation (NMES) and inspiratory and expiratory muscle training (IEMT), are discussed. Patients were randomly assigned to standard swallow therapy (SST), IEMT and SST, NMES and SST. Dysphagia was assessed with the V-VST and VFSS, and respiratory muscle strength parameters were also recorded. The combination of IEMT or NMES to the SST was associated with significantly improved respiratory strength and better pharyngeal security. This study provides new evidences on emerging strategies to manage dysphagi

Oropharyngeal dysphagia after stroke: assessment and treatment

Els transtorns de la deglució afecten un 29-67% dels pacients post-Ictus. L'aspiració silent, aspiració sense expressió clínica, afecta del 15-39% dels ictus aguts. La disfàgia pot comportar malnutrició, deshidratació, pneumònia broncoaspirativa i mort, i té impacte sobre els costos sanitaris. L'evidència científica suggereix que la detecció de la disfàgia en estadis precoços de l'ictus redueix el risc de broncoaspiració i és útil per determinar l'estratègia terapèutica. Aquesta tesi avalua la capacitat de dos tests clínics de cribatge, el Mètode d'exploració Clínica de Volum Viscositat (MECV-V) i Test de la tos amb àcid cítric (CCT), per la detecció de l'aspiració i l'aspiració silent, respectivament. El MECV-V consisteix en l'administració de líquid a diferents viscositats i volums sota control de pulsioximetria. Canvis en els signes de seguretat com són el to de veu, la tos durant o després del bolus administrat, la desaturació >3% de la saturació basal, és consideren com a test alterat i al pacient com a possible aspirador. EL CCT registra el número de pics de tos durant el minut d' inhalació oral d'una solució nebulitzada d'àcid cítric a 1M. Es considera > 5 pics de tos normal, mentre que ≤4 es considera disminuït i al pacient com a baix responedor o possible aspirador silent. En compració ala Videofluoroscòpia (VFSS), el gold estàndard, el MECVV detecta aspiració amb una sensibilitat del 88.2% i una especificitat del 71.4% , mentre que el CCT, detecta aspiració silent amb una sensibilitat i especificitat del 19% i 71%, respectivament. En conclusió el MECVV és un test de baix cost i fàcilment aplicable que compleix els criteris de test de cribatge en població afecte d'ictus; mentre que el CCT, a concentració 1M, no sembla un test útil aplicat individualment per la detecció dels potencials aspiradors silents. S'aporten dades recents sobre un assaig clínic dissenyat per valorar l'efectivitat de dues noves tècniques terapèutiques, l'estimulació elèctrica neuromuscular (NMES) i l'entrenament de la musculatura respiratòria, inspiratòria i espiratòria (IEMT) . Els pacients van ser randomitzats a la logopèdia clàssica (SST) , a NMES i SST o al IEMT i SST. La disfàgia es va avaluar amb el MECV-V i la VFSS, i la força de la musculatura respiratòria també es va recollir. La combinació del NMES o IEMT al SST millora significament els resultats en força respiratòria i els signes de seguretat de la deglució al final de la intervenció. Aquest estudi aporta noves evidències sobre teràpies emergents en el tractament de la disfàgia.Swallowing disorders affect up to 29-67% of patients with stroke. Silent aspiration, aspiration without clinical signs expression, is present in 15-39% of acute stroke samples. Dysphagia can lead to malnutrition, dehydration, bronchoaspirative pneumonia and death, and have impact on health care costs. Available evidence suggests that screening dysphagia in the early stages of stroke onset reduces the risk of bronchoaspiration and is useful to determine the best therapeutic strategy. This thesis project is aimed to evaluate two different screening techniques, the Volume Viscosity Swallow Test (V-VST) and the Citric Cough Test (CCT), for detecting aspiration and silent aspiration, respectively. The V-VST consists of the administration of different liquid viscosities and food consistencies under pulse oximetry control. Changes in security signs as tone of voice, coughing during or after eating, or desaturation of more than 3% compared to baseline oxygen saturation, are considered as a failed test and classifies the patient as potential aspirator or no aspirator. The CCT records the number of cough peaks in the minute to the oral inhalation of a 1M mixture of saline and citric acid through an ultrasonic nebulizer. More than 5 cough peaks are considered as normal responders, whereas those with ≤4 are considered as reduced or absent responders. In comparison with the videofluoroscopic swallow study (VFSS), the gold standard, the V-VST detects aspiration with a sensitivity of 88.2% and specificity of 71.4%, whilst the CCT detects silent aspiration with sensitivity and specificity indexes of 19% and 71%, respectively. In conclusion, the V-VST is low in cost, easy to use and very sensitive, meeting the requirements of oropharyngeal dysphagia and aspiration screening test in subacute stroke; whilst the low sensitivity of the CCT using 1.0% (weight by volume) does not support its use as standalone tool to screen for silent aspiration in stroke patients. In addition, breaking results of a clinical trial aimed to determine effectiveness of two new therapeutic techniques, neuromuscular electrical stimulation (NMES) and inspiratory and expiratory muscle training (IEMT), are discussed. Patients were randomly assigned to standard swallow therapy (SST), IEMT and SST, NMES and SST. Dysphagia was assessed with the V-VST and VFSS, and respiratory muscle strength parameters were also recorded. The combination of IEMT or NMES to the SST was associated with significantly improved respiratory strength and better pharyngeal security. This study provides new evidences on emerging strategies to manage dysphagi

Intensive rehabilitation programme for patients with subacute stroke in an inpatient rehabilitation facility: describing a protocol of a prospective cohort study

Introduction: Rehabilitation is recognised as a cornerstone of multidisciplinary stroke care. Intensity of therapy is related to functional recovery although there is high variability on the amount of time and techniques applied in therapy sessions. There is a need to better describe stroke rehabilitation protocols to develop a better understanding of current practice increasing the internal validity and generalisation of clinical trial results. The aim of this study is to describe an intensive rehabilitation programme for patients with stroke in an inpatient rehabilitation facility, measuring the amount and type of therapies (physical, occupational and speech therapy) provided and reporting functional outcomes. Methods and analysis: This will be a prospective observational cohort study of patients with subacute stroke admitted to our inpatient rehabilitation facility during 2 years. A therapy recording tool was developed in order to describe the rehabilitation interventions performed in our unit. This tool was designed using the Delphi method, literature search and collaboration with senior clinicians. Therapists will record the time spent on different activities available in our unit during specific therapy sessions. Afterwards, the total time spent in each activity, and the total rehabilitation time for all activities, will be averaged for all patients. Outcome variables were divided into three different domains: body structure and function outcomes, activity outcomes and participation outcomes and will be assessed at baseline (admission at the rehabilitation unit), at discharge from the rehabilitation unit and at 3 and 6 months after stroke. Ethics and dissemination: This study was approved by the Medical Research Committee at Hospital del Mar Research Institute (Project ID: 34/C/2017). The results of this study will be presented at national and international congress and submitted for publication in peer-reviewed journals

The Retornus-2 study: impact of respiratory muscle training in subacute stroke patients with dysphagia, study protocol of a double-blind randomized controlled trial

Background: Stroke can lead to varying degrees of oropharyngeal dysphagia, respiratory muscle dysfunction and even increase medical complications such as aspiration, malnutrition and death. Recent studies suggest that inspiratory and expiratory respiratory muscle training (IEMT) can improve swallowing efficacy and may reduce aspiration events. The main purpose of this study is to examine whether an 8-week IEMT programme can improve respiratory muscle strength and swallow dysfunction severity in subacute stroke patients with dysphagia. Methods: Retornus-2 is a two-arm, prospectively registered, randomized controlled study with blinded assessors and the participation of fifty individuals who have suffered a stroke. The intervention group undergoes IEMT training consisting of 5 sets of 10 repetitions, three times a day for 8 weeks. Training loads increase weekly. The control group undergoes a sham-IEMT protocol. The primary outcome examines the efficacy of the IEMT protocol to increase respiratory muscle strength and reduce dysphagia severity. The secondary outcome assesses the longitudinal impact of dysphagia on body composition and nutritional assessment over a 6-month follow-up. Discussion: IEMT induces an improvement in respiratory muscle strength and might be associated with relevant benefits in dysphagia patterns, as well as a reduction in the number of aspiration events confirmed by videofluoroscopy or fiberoptic endoscopic evaluation of swallowing. The description of the impact of swallowing impairment on nutritional status will help develop new strategies to face this known side-effect. Trial registration: Clinicaltrials.gov NCT03021252. Registered on 10 January 2017. https://clinicaltrials.gov/ct2/results?cond=retornus+2&term=&cntry=ES&state=&city=&dist= WHO trial Registration data set: Due to heavy traffic generated by the COVID-19 outbreak, the ICTRP Search Portal does not respond. The portal recommends other registries such as clinicaltrials.gov. Protocol version: RETORNUS 2_ PROTOCOL_2