Purpose Mental practice (MP) is a method of rehabilitating upper extremity function on
the affected side of the body post-stroke, with the aim of improving motor task
performance through the ...sustained repetition of motor imagery (MI). However, most studies
thus far have investigated MP for post-stroke paralytic upper limb function in patients in
the chronic phase. Therefore, it is necessary to obtain evidence regarding whether MP is
an effective intervention modality in the acute phase of stroke. In the present study, we
examined the effects of an intervention combining mirror therapy and MP initiated during
the acute phase of cerebral infarction. Participant and Methods A female patient
>80 years of age with a cerebral infarction was studied. Prior to cerebral infarction,
the patient was independent in her activities of daily living. Results As a result of
MP, sufficient improvement was observed in the upper extremity function on the paralyzed
side, as assessed using the Fugl–Meyer Assessment (FMA) and Motor Activity Log (MAL).
Conclusion In patients with MP initiated during the acute stroke phase, a combination of
mirror therapy and action observation to enable vivid MI may elicit a more significant
intervention effect.
Fertilizantes Tocantins was founded by José Eduardo Motta in 2003, out of his desire of taking advantage of the fast-growing agricultural businesses in the northern region of Brazil. He had previous ...knowledge of the fertilizer sector due to his work in his father’s business for several years. After an impressive success and enormous growth rates until 2016, 50% plus one shares of the company were sold to EuroChem, a European fertilizer producer. This was part of Fertilizantes Tocantins’ strategy to achieve even greater and sustainable growth. In 2020 EuroChem bought the remaining shares of Fertilizantes Tocantins, becoming its sole controller. The company still maintains most of its operational structure and now is fueled with capital and other assets from EuroChem. The challenge ahead lies in being able to maintain the organizational culture and winning position while bringing the best of its controller’s assets to achieve the goal of being a leader in the Brazilian fertilizer market.
Leaders at the VA Puget Sound Health Care System vaccinated Black, Hispanic, and multiracial patients at rates exceeding population averages through outreach efforts that are accessible to other ...health care organizations.
An array of factors hamper equitable Covid-19 vaccine deployment in the United States along racial, ethnic, age, and geographic lines. The Puget Sound Veterans Affairs facility developed a multidisciplinary vaccine delivery strategy to forestall systematic inequities in receipt of vaccination among veterans using methods that can be used by other health care organizations. The VA Puget Sound Health Care System deployed targeted outreach to individual patients on the basis of a simple score consisting of the sum of risk factors for severe Covid-19 disease and high-risk race or ethnicity. The health system then conducted sequential outreach using multiple communication modalities; worked with trusted community stakeholders to publicize and deploy mobile clinics to underserved areas; and monitored vaccination coverage rates by age, race, sex, and rural status at prespecified intervals and adjusted operations to ensure equity. Vaccination rates were highest in Black, multiracial, and Hispanic veterans compared with white veterans during the vaccine drive, a finding that persisted after the drive.
Case studies are a high impact educational practice that engage students in collaborative problem solving through storytelling. HITS, an NSF funded research coordination network dedicated to exposing ...students to high-throughput discovery science, drove creation of this case. In this case, students imagine themselves as researchers developing new therapeutic drugs for epilepsy. Specifically, students work with the Allen Cell Types Database, which is the result of collaborative, interdisciplinary open science. Neurosurgeons partnered with the Allen institute to provide living human brain tissue for electrophysiological, morphological, and transcriptomic study. Students collaborate to collect and organize data, investigate a research question they identified, and perform fundamental statistical analyses to address their question. By leveraging the unique Cell Types dataset the case enhances student knowledge of epilepsy, illuminates high-throughput scientific approaches, and builds quantitative and research related skills. The case is also versatile and was implemented in two distinct courses. The case can also be taught in different modalities, in person or remote, with a combination of synchronous and asynchronous work. Indirect and direct measures along with quantitative and qualitative approaches were used for case assessment and improvement. Students performed well on case related exam questions, reported high confidence in their achievement of the learning outcomes, and enjoyed the case's link to neurological disease, real research data and advanced technological approaches. Our assessment findings and instructor implementation experiences are also included to facilitate the adoption or adaptation of the case for a variety of courses and/or modalities in neuroscience and STEM related curricula.
Patients with progressive multifocal leukoencephalopathy (PML) in the context of human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) show a partial improvement following ...rehabilitation; however, this improvement is rapidly lost if the patient is not provided with intensive rehabilitation. A 42-year-old patient affected by HIV-AIDS had a clinical worsening within a few months following PML onset, despite being treated with antiretroviral drugs and conventional rehabilitation. He developed severe paraparesis and significant dependency in the activities of daily life. A first cycle of intensive rehabilitation provided the patient with some significant functional outcomes, although he experienced a worsening of the clinical condition after two months of rest, before admission to our rehabilitation unit. We thus sought to evaluate the effects of intensive robot-aided gait training (RAGT) coupled with transcranial direct current stimulation (tDCS). The patient significantly improved when provided with intensive RAGT coupled with tDCS (as per 10-meter Walk Test 10MWT and 6-minute Walk Test 6MWT), and the improvement was maintained at three-month follow-up. As this advanced approach was feasible, safe, and potentially effective, this case suggests that patients with PML-HIV require prolonged multidisciplinary rehabilitation treatment. We can speculate that individuals with PML should also be treated with innovative technology to improve their functional outcomes and therefore quality of life.
Delayed-onset nodules, a potential complication of injectable hyaluronic acid (HA) fillers, can be distressing to both patient and clinician. Current treatment options, including oral corticosteroids ...and antibiotics, have potential side effects and may be ineffective or contraindicated in some patients. Hyaluronidase is an enzyme used to degrade HA fillers. Although it is generally effective for resolving such nodules, it can interfere with the favorable aesthetic effects of filler treatment. This report describes a novel and successful method of treating delayed-onset nodules in facial tissue. Radial sound (shockwave) therapy was used to treat multiple delayed-onset facial nodules in two patients following HA filler injection. Substantial improvement was observed in both patients after the initial 10-minute session, and all nodules resolved fully by the third or fourth treatment. There were no side effects or downtime. Patients were satisfied with the results, particularly because the aesthetic effects of the HA filler were maintained.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Unplanned surgery cancellation (USC) was an important quality management issue in the course of medical care for surgical patients, which caused inappropriate use of hospital resources and had ...negative impacts on quality and safety. This study used Lean Six Sigma to reduce the incidence of USC. Following the Lean Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) process, the main factors influencing the USC were identified, such as the time of informing patient admission, the time of submitting operation notice, and the management of test report follow-up. A series of measures were implemented including improving the health education content of virtual bed patients, standardizing the way of communication between the Admission Management Center and the patients, improving the timing of anesthesia evaluation, optimizing the process of operation notice with an information system, and implementing the regulations of virtual bed management. The incidence of USC reduced from 10.21% in Jan. 2016 to 3.8% in Dec. 2016, and the Z-score increased from 1.25 to 1.68, which improved patient safety and demonstrated that Lean Six Sigma was an effective method to solve cross-department issues in hospital.
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