Patient Experience as a Metric for Performance in Outpatient Bone Marrow Transplant Patient Populations

Problem: Patient satisfaction and perception of care provided have been linked to the overall quality of healthcare delivery. The Acute Infection Management clinical support department lacks a standardized method to collect information from patients regarding their satisfaction with care provided therefore impeding the units’ ability to capture performance results related to satisfaction, and improve care delivery processes accordingly. Context: The Acute Infection Management unit is an outpatient clinical support department located within a large university-affiliated hospital that has been recently designated as the unit to operate the facility’s new outpatient bone marrow transplant program. Intervention: The proposed project seeks to implement an outpatient unit-based patient satisfaction tool, in the form of a standardized questionnaire to be administered upon the conclusion of a bone marrow transplant (BMT) patient’s last outpatient clinic visit. Measures: Bone marrow transplant patients surveyed and the percentage of BMT survey respondents are the primary project measurement. The percent of BMT patients who provide a specific patient- reported outcome answer choice for each of the 10 item quantitative survey responses will be utilized to establish a patient satisfaction benchmark metric score for each question category. Result: Since the development and implementation of the unit-based patient satisfaction tool, a baseline benchmark of unit satisfaction has been captured by utilizing the responses from the first three outpatient bone marrow transplant patients following the conclusion of outpatient treatment. Conclusion: The use of a unit-designed patient satisfaction survey tool can facilitate the capture of comparable patient satisfaction data used to identify needs specific to a patient population

Cellular mechanisms underlying behavioral state-dependent bidirectional modulation of motor cortex output

Neuronal activity in primary motor cortex (M1) correlates with behavioral state, but the cellular mechanisms underpinning behavioral state-dependent modulation of M1 output remain largely unresolved. Here, we performed in vivo patch-clamp recordings from layer 5B (L5B) pyramidal neurons in awake mice during quiet wakefulness and self-paced, voluntary movement. We show that L5B output neurons display bidirectional (i.e., enhanced or suppressed) firing rate changes during movement, mediated via two opposing subthreshold mechanisms: (1) a global decrease in membrane potential variability that reduced L5B firing rates (L5Bsuppressed neurons), and (2) a coincident noradrenaline-mediated increase in excitatory drive to a subpopulation of L5B neurons (L5Benhanced neurons) that elevated firing rates. Blocking noradrenergic receptors in forelimb M1 abolished the bidirectional modulation of M1 output during movement and selectively impaired contralateral forelimb motor coordination. Together, our results provide a mechanism for how noradrenergic neuromodulation and network-driven input changes bidirectionally modulate M1 output during motor behavior

Thalamic neuron models encode stimulus information by burst-size modulation

Thalamic neurons have been long assumed to fire in tonic mode during perceptive states, and in burst mode during sleep and unconsciousness. However, recent evidence suggests that bursts may also be relevant in the encoding of sensory information. Here, we explore the neural code of such thalamic bursts. In order to assess whether the burst code is generic or whether it depends on the detailed properties of each bursting neuron, we analyzed two neuron models incorporating different levels of biological detail. One of the models contained no information of the biophysical processes entailed in spike generation, and described neuron activity at a phenomenological level. The second model represented the evolution of the individual ionic conductances involved in spiking and bursting, and required a large number of parameters. We analyzed the models' input selectivity using reverse correlation methods and information theory. We found that n-spike bursts from both models transmit information by modulating their spike count in response to changes to instantaneous input features, such as slope, phase, amplitude, etc. The stimulus feature that is most efficiently encoded by bursts, however, need not coincide with one of such classical features. We therefore searched for the optimal feature among all those that could be expressed as a linear transformation of the time-dependent input current. We found that bursting neurons transmitted 6 times more information about such more general features. The relevant events in the stimulus were located in a time window spanning ~100 ms before and ~20 ms after burst onset. Most importantly, the neural code employed by the simple and the biologically realistic models was largely the same, implying that the simple thalamic neuron model contains the essential ingredients that account for the computational properties of the thalamic burst code. Thus, our results suggest the n-spike burst code is a general property of thalamic neurons

Self-Motion Signals in Vestibular Nuclei Neurons Projecting to the Thalamus in the Alert Squirrel Monkey

Sixty vestibular nuclei neurons antidromically activated by electrical stimulation of the ventroposterior thalamus were recorded in two alert squirrel monkeys. The majority of these neurons were monosynaptically activated by vestibular nerve electrical stimulation. Forty-seven neurons responded to animal rotations around the earth-vertical axis; 16 of them also responded to translations in the horizontal plane. The mean sensitivity to 0.5-Hz rotations of 80°/s velocity was 0.40 ± 0.31 spikes·s−1·deg−1·s−1. Rotational responses were in phase with stimulus velocity. Sensitivities to 0.5-Hz translations of 0.1 g acceleration varied from 92.2 to 359 spikes·s−1·g−1 and response phases varied from 10.1° lead to −98° lag. The firing behavior in 28 neurons was studied during rotation of the whole animal, of the trunk, and voluntary and involuntary rotations of the head. Two classes of vestibulothalamic neurons were distinguished. One class of neurons generated signals related to movement of the head that were similar either when the head and trunk move together or when the head moves on the stationary trunk. A fraction of these neurons fired during involuntary head movements only. A second class of neurons generated signals related to movement of the trunk. They responded when the trunk moved alone or simultaneously with the head, but did not respond to head rotations while the trunk was stationary

Hip angular sway during standing with and without vibration of ankle muscles.

<p><b>(A</b>, <b>B)</b> Hip sway during standing with eyes open (EO), and eyes closed (EC), respectively. <b>(C</b>, <b>D</b>, <b>E)</b> Individual hip sway during standing with 40 Hz vibration are plotted against sway during quiet standing in participants of HY, HE, and FR groups, respectively. <b>(F</b>, <b>G</b>, <b>H)</b> Individual hip sway measured during standing with 30 Hz vibration plotted against sway during quiet standing in participants of HY, HE, and FR groups, respectively. Designations as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0194720#pone.0194720.g003" target="_blank">Fig 3</a>.</p

Ankle angular deviations and sway during standing without and with calves’ vibration.

<p>Difference in a parameter before (baseline) and during vibration assessed using repeated measures MANOVA. Differences in frequencies of parameter increases and decreases that occurred during vibration assessed using χ² test. Underlined bold characters highlight statistically significant difference between the balance parameter in two conditions (p<0.05). Bold characters highlight difference between the balance parameter that was just above statistical significance (0.1</p

Low intensity vibration of ankle muscles improves balance in elderly persons at high risk of falling

<div><p>In our study we examined postural performance of young healthy persons (HY), elderly healthy persons (HE), and elderly persons at high risk of falling (FR). Anterio-posterior (AP) and medio-lateral (ML) ankle and hip angular deviations, as well as linear displacements of the center of mass (COM) were assessed in persons standing with eyes either open or closed, while none, and 40 and 30 Hz vibrations were applied bilaterally to the ankle muscle gastrocnemius. During quiet standing with eyes open, balance parameters in FR group differed from those in healthy groups. ML ankle and hip angular deviations, as well as COM linear displacements were noticeably larger in FR group. During quiet standing with eyes closed, all balance parameters in participants of all groups had a clear trend to increase. During standing with eyes open, 40 Hz vibration increased all but one balance parameter within HY group, ankle angular deviations in HE group, but none in FR group. In response to 30 Hz vibration, only ankle angular deviations and COM linear displacements increased in HY group. There were no changes in both elderly groups. During standing with eyes closed, 40 and 30 Hz vibrations did not produce consistent changes in balance parameters in HY and HE groups. In FR persons, 40 Hz vibration did not change balance parameters. However, in FR groups, 30 Hz vibration decreased ankle and hip angular deviations, and COM linear displacements. The major result of the study is a finding that low intensity vibration of ankle muscles makes balance better in elderly persons at high risk of falling. This result is clinically relevant because it suggests that applying mild vibration to ankle muscles while standing and walking might benefit elderly persons, improving their postural performance and reducing a risk of unexpected falls.</p></div