Satisfaction With In-Home Speech Telerehabilitation in Post-Stroke Aphasia: an Exploratory Analysis

Patient satisfaction with healthcare has a major impact on clinical outcomes and compliance. Satisfaction with telehealth services for speech and language problems has been documented but not in post-stroke aphasia. The main objective here was to evaluate patient satisfaction with speech tele rehabilitation based on the PACE pragmatic rehabilitation approach in post-stroke aphasia. This study was embedded in a pre-/post-test feasibility and efficacy study in which 20 patients with chronic post-stroke aphasia received 3 weeks of speech therapy (9 sessions) through in-home tele-rehabilitation. A telerehabilitation platform based on a commercial videoconferencing system (Tandberg 550 MXP) with custom software was used to transmit audio, video and data through a high-speed Internet connection between the participant’s home and the clinician. Participants’ satisfaction with in-home telerehabilitation and healthcare received was assessed using French adaptations of the Telemedicine Satisfaction Questionnaire and Health Care Satisfaction Questionnaire. Satisfaction with functional communication, i.e. communication in common situations of daily life, was compared pre- and post-intervention with participants and caregivers. Participants’ satisfaction with in-home telerehabilitation was excellent (94%±4.3%). Satisfaction with healthcare received was good overall (80%±11.4%) and for three factors measured independently, i.e. relationship with healthcare professional (84%±12.5%), services delivered (73%±13.8%), and general healthcare  organization (84%±12.0%). Participants’ and caregivers’ satisfaction with communication was higher after the intervention (p=0.001 and p<0.001, respectively) and was correlated with age (r=-0.60; p=0.007). Patients with post-stroke aphasia receiving speech tele-therapy were very satisfied with this service delivery method. Also, technology use was not an issue for seniors post-stroke

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Whose City Is It? : A Thinking Tour of Darwin

Darwin has unique historic, political, economic, demographic, and sociocultural characteristics that have made the capital of the Northern Territory a fascinating but sometimes challenging place to live. Darwin's population is projected to grow substantially over the next twenty or thirty years. Managing future growth will require a thorough understanding of the conditions that have shaped the economic, urban and social fabric of the city. This book aims to provide a thinking guide to Darwin to encourage locals and visitors alike to debate the various aspects that determine the way the city is functioning as a place to live, work, invest or visit. The book will reports on a variety of information and perspectives, including formal research and informal accounts of personal experiences provided by guest commentators in leading positions within Darwin society. The book takes the reader on a tour through Darwin and its immediate surroundings. The tour stops at particular places of historic and contemporary interest along the way and critically reflects on the opportunities and challenges of a range of factors that create and influence urban and community space in Darwin. Topics examined include demographic trends, political governance, economic investment, planning, industrial development, Aboriginal interests, housing, transport, education, health services, employment, defence presence, tourism, entertainment, sports and recreation, and hinterland development. The Whose City is it? guide aims to help Darwin contextualise the opportunities and challenges it faces as it continues to grow.Jira Ticket : CDU-14: Collection Development Manager made the decision that for the books that have this message " This book is copyright. Apart from any fair dealing to the purpose of private study, research, criticism or review as permitted under the Copyright Act, no part may be reproduced, by any process, without written permission. Enquiries should be made to the publisher, Charles Darwin University Press, Charles Darwin University, Darwin NT 0909, Australia" in the front they would treat CDU NTU Press as the copyright holder based on this statement. CDU Press have given permission for these to be added to our site but no additional licencing terms provided. That is a reasonable risk management based decision

Differences in Antiretroviral Adherence Behaviors, Treatment Success, and Eligibility for Long-Acting Injectable Treatment between Patients Who Acquired HIV in Childhood vs. Those Who Acquired It in Adolescence/Early Adulthood

This study investigates the impact of the age at which HIV was acquired on adherence. There was no difference in adherence between patients who acquired HIV in childhood vs. those who acquired it in adolescence/early adulthood (83% vs. 90%; p = 0.24), but achievement of virological/immunological efficacy (78.8% vs. 93.5%, p = 0.02) was less likely in patients who had acquired HIV in childhood. On the basis of resistance, patients who acquired HIV in adolescence/early adulthood tended to be more eligible for cabotegravir/rilpivirine treatment (90.3% vs. 80.3%; p = 0.11)