Stroke Prevention Through Education

AbstractThis project focused on two concepts: a need for a stroke prevention program and what should be included. The problem with early identification of stroke is not formally addressed at the project site, physician’s office. A physician’s office can play a beginning key role in minimizing the risk of stroke. The purpose of this project was to explore the evidence to support the need for and to determine ideal content for a stroke prevention education program. This program focused on early detection and identification of risk factors to prevent stroke occurrence. The theoretical framework of Pender’s health promotion model aligns with individualized plan of care for nutrition and exercise for each patient that needs stroke prevention coaching. Data were collected on a form centered around each individual patients’ current medical history that relates to stroke. Descriptive statistics for modifiable and nonmodifiable data were obtained from medical charts (n = 56) using a mixed methodology for a convenience sample (M = 50 years; SD = 16.8). The following risk factors were most prominent: high Body Mass Index (M = 30.7; SD = 6.1), high glucose (M = 115; SD = 23.4), high LDL cholesterol (M = 135; SD = 24.9) along with diagnoses of hypertension (32%), type 2 diabetes (16%), anemia (12.5%), and angina (10.7%). This program targets diet modification, medication regimes, and daily exercise to enhance the patients’ interest in behavioral changes based on modifiable risk factors. A staff education program has the potential to bring about positive social change in an internal medicine practice by providing an early prevention approach

Gross Motor Function in Pediatric Onset TUBB4A-Related Leukodystrophy: GMFM-88 Performance and Validation of GMFC-MLD in TUBB4A

TUBB4A pathogenic variants are associated with a spectrum of neurologic impairments including movement disorders and leukodystrophy. With the development of targeted therapies, there is an urgent unmet need for validated tools to measure mobility impairment. Our aim is to explore gross motor function in a pediatric-onset TUBB4A-related leukodystrophy cohort with existing gross motor outcome tools. Gross Motor Function Measure-88 (GMFM-88), Gross Motor Function Classification System (GMFCS-ER), and Gross Motor Function Classification-Metachromatic Leukodystrophy (GMFC-MLD) were selected through face validity. Subjects with a confirmed clinical and molecular diagnosis of TUBB4A-related leukodystrophy were enrolled. Participants' sex, age, genotype, and age at disease onset were collected, together with GMFM-88 and concurrent GMFCS-ER and GMFC-MLD. Performances on each measure were compared. GMFM-88 floor effect was defined as total score below 20%. A total of 35 subjects participated. Median performance by GMFM-88 was 16.24% (range 0-97.31), with 42.9% (n = 15) of individuals performing above the floor. GMFM-88 Dimension A (Lying and Rolling) was the best-performing dimension in the GMFM-88 (n = 29 above the floor). All levels of the Classification Scales were represented, with the exception of the GMFC-MLD level 0. Evaluation by GMFM-88 was strongly correlated with the Classification Scales (Spearman correlations: GMFCS-ER:GMFM-88 r = 0.90; GMFC-MLD:GMFM-88 r = 0.88; GMFCS-ER:GMFC-MLD: r = 0.92). Despite overall observation of a floor effect, the GMFM-88 is able to accurately capture the performance of individuals with attenuated phenotypes. GMFM-88 Dimension A shows no floor effect. GMFC-MLD shows a strong correlation with GMFCS-ER and GMFM-88, supporting its use as an age-independent functional score in TUBB4A-related leukodystrophy

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Alternative protocols for the production of more sustainable agar-based extracts from Gelidium sesquipedale

Agar-based extracts from Gelidium sesquipedale were obtained by applying a conventional hot water treatment and alternative ultrasound- and microwave-assisted methods, with and without the application of an alkaline pre-treatment. The alkaline pre-treatment produced refined extracts with higher purity; however, extraction yields increased from 2–5% to 7–19% by omitting this step. In particular, the ultrasound-assisted extraction allowed reducing 4-fold the extraction time, while keeping constant or even increasing the yield (up to 19% for the 1 h extraction) with respect to the conventional protocol. Interestingly, the presence of proteins and polyphenols conferred the semi-refined extracts a relatively high antioxidant capacity (19–24 μmol TE/g extract). The refined extract produced by the standard protocol formed the strongest hydrogels (>1000 g/cm2). On the other hand, the semi-refined extracts produced by the alternative protocols formed slightly stronger hydrogels (337–438 g/cm2) than the refined counterparts (224–311 g/cm2), due to their greater molecular weights of the former ones. LCA assessment showed lower global warming potential for the semi-refined extracts, especially the ultrasound-assisted extraction, hence highlighting the potential of this method to produce more sustainable agarbased extracts for food-related applications