Medicine and Health Sciences Commons^™

Leg Power As An Indicator For Risk Of Injury Or Illness In Police Recruits, Rob Orr, Rodney Pope, Samantha Peterson, Michael Stierli, Ben Hinton

Rob Marc Orr

Access abstract in the Conference Abstract E-book, page 123

Rehabilitation And Cancer Survivorship, Matthew Denning, Samantha Fisk, Alyssa Grigware, Mary Leopold, Erika Lopez, Margaret Masiak, Sebastian Stoltzfus, Ashley Tomaswick

Disease Prevention and Health Promotion Resources

Presentation given at Central Maine Medical Center on December 4, 2015, to build awareness of the role of rehabilitation services in cancer survivor management and discuss strategies to address existing needs. This presentation was based on a project undertaken to determine which physical distress screening tools are most appropriate to trigger a wellness or rehabilitation referral when it is warranted for a survivor. The use of effective screening tools will assist in directing cancer survivors, who experience physical and emotional burdens caused by the disease and subsequent treatment, to access services that will continue to improve their overall quality of …

Breast Cancer Rehabilitation: Clinical Examination And Outcomes Assessment, Nicole L. Stout, Shana Harrington, Lucinda Pfalzer, Mary Insana Fisher

Mary Insana Fisher

Breast cancer is the most commonly diagnosed cancer in women in the United States. The treatment for breast cancer occurs along a protracted time period and includes many different disease treatment modalities. These treatments carry with them a large number of adverse effects that negatively impact function in both the short term and long term. It is necessary for rehabilitation providers to interface with patients being treated for breast cancer throughout the continuum of care so that interval assessments can be conducted to identify emerging impairments and alleviate disability. To achieve this, the rehabilitation provider must have an understanding of …

A Prospective Analysis Of Factors Associated With Decreased Physical Activity In Patients With Cirrhosis Undergoing Transplant Evaluation, Anna Christina Dela Cruz, Valery Vilchez, Sooyeon Kim, Benjamin Barnes, Abhishek Ravinuthala, Anthony Zanni, Roberto Galuppo, Achuthan Sourianarayanane, Trushar Patel, Erin Colleen Maynard, Malay B. Shah, Michael F. Daily, Timothy L. Uhl, Karyn A. Esser, Roberto Gedaly

Internal Medicine Faculty Publications

BACKGROUND: Physical activity has been associated with improved recovery time after transplantation. Handgrip strength has been related to post-transplant outcomes.

AIM: To evaluate predictors of physical activity and grip strength in cirrhotic patients undergoing liver transplant evaluation.

METHODS: Single center, prospective analysis.

RESULTS: A hundred patients were evaluated (54% male, mean age 53 ± 9). Common etiologies of liver disease were non-alcoholic hepatitis (27%), hepatitis C (22%), and alcoholic liver disease (21%). Mean MELD score was 13.5. Forty one percent had a history of smoking. Ninety-three patients completed the International Physical Activity Questionnaire. The median total physical activity score of …

Effect Of Continuous Passive Motion On Knee Flexion Range Of Motion After Total Knee Arthroplasty, Naveed Baloch, Akbar Jaleel Zubairi, Rizwan Haroon Rashid, Pervaiz Hashmi, Riaz Hussain Lakdawala

Department of Surgery

Abstract

OBJECTIVE:

To compare mean knee flexion in patients on continuous passive motion and those without it after total knee arthroplasty.

METHODS:

The randomised controlled study was conducted at Aga Khan University Hospital, from July 2013 to June 2014, and comprised patients who underwent total knee arthroplasty. Patients were randomly assigned to either group, with Group A receiving standardised physiotherapy from 1st postoperative day, and Group B receiving physiotherapy and one hour of continuous passive motion twice a day from 1st postoperative day until discharge. Outcome assessment was done on the day of discharge.

RESULTS:

Of the 76 patients, there …

Role Of Acute Pain Service In Optimizing Postoperative Pain Relief In A Tertiary Care Teaching Hospital, Aliya Ahmed, Muhammad Yasir

Department of Anaesthesia

Objective: To assess the frequency and types of adjustments that acute pain service makes to postoperative analgesic regimes to improve pain relief or treat side effects.Methods: The prospective observational study was conducted at the Aga Khan University Hospital, Karachi, from December 1, 2012, to March 31, 2013. Data was collected from Acute Pain Service register four hours after the pain rounds by a Service member not involved in rounds. Data was collected on a standardised form and analysed using SPSS 19.Results: Of the 323 patients, 209(65%) were receiving epidural infusions and 114(35%) were receiving intravenous patient-controlled analgesia. Overall, 114(35%) required …

Osats For Total Knee Replacement: Assessment Of Surgical Competence In The Operating Room, Shahryar Noordin, Salim Allana

Department of Surgery

No abstract provided.

Breast Cancer Rehabilitation: Clinical Examination And Outcomes Assessment, Nicole L. Stout, Shana Harrington, Lucinda Pfalzer, Mary Insana Fisher

Physical Therapy Faculty Publications

Breast cancer is the most commonly diagnosed cancer in women in the United States. The treatment for breast cancer occurs along a protracted time period and includes many different disease treatment modalities. These treatments carry with them a large number of adverse effects that negatively impact function in both the short term and long term. It is necessary for rehabilitation providers to interface with patients being treated for breast cancer throughout the continuum of care so that interval assessments can be conducted to identify emerging impairments and alleviate disability. To achieve this, the rehabilitation provider must have an understanding of …

Home Exercise Adherence In An Underserved Ecuadorian Community, Joseph M. Day, Jean Irion, Meridith Anile, Jared Henson, Ben Roussel, Christina Shepherd, Huybrechts Bindele

Physical Therapy Faculty Publications

Purpose: Physical therapy service learning projects and volunteer experiences in foreign countries are becoming more commonplace. Patients in underserved regions are not likely to receive therapy services regularly; therefore, adherence to a home exercise program (HEP) is critical. The primary purpose of this study was to observe home exercise adherence rates between the 1st and 2nd visits in an underserved population. The secondary purpose of this study was to determine specific factors that affect HEP adherence in this population.

Methods: Consecutive patients seen in Santo Domingo, Ecuador were considered for participation in this observational study. All patients were recruited from …

A Randomized Controlled Behavioral Intervention Trial To Improve Medication Adherence In Adult Stroke Patients With Prescription Tailored Short Messaging Service (Sms)-Sms4stroke Study., Ayeesha Kamran Kamal, Quratulain Shaikh,, Omrana Pasha, Iqbal Azam Syed, Muhammad Islam,, Adeel Ali Memon, Hasan Rehman, Masood Ahmed Akram,, Muhammad Affan, Sumaira Nazir, Salman Aziz, Muhammad Jan, Anita Andani, Abdul Muqeet, Bilal Ahmed, Shariq Khoja

Department of Medicine

Background: The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan.

Methods: This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition …

Isoniazid Induced Motor-Dominant Neuropathy, Rabeeya Arsalan, Saniya Sabzwari

Department of Family Medicine

Isoniazid though a very effective treatment for tuberculosis can cause severe motor-dominant neuropathy which can be reversible with pyridoxine supplementation. A 45-year-old female diagnosed with psoas abscess, culture positive for mycobacterium tuberculosis, was started on anti- tuberculous treatment with four drugs, including isoniazid at a dose of 5 mg/kg/day. Three months later she developed severe motor weakness of lower limbs with loss of ankle and knee reflexes. She was treated with vitamin B6 injections and isoniazid treatment was continued. Her motor weakness gradually improved in a few months, but mild sensory impairment persisted even after two years. There is need …

A Randomized Clinical Trial To Compare The Effect Of Non Operative Treatment With And Without Autologous Conditioned Plasma (Acp) On Healing And Function In Patients With Achilles Tendon Ruptures, Tyler M. Pratt

Electronic Thesis and Dissertation Repository

The purpose of this study was to determine whether there is evidence to support conducting a larger randomized control trial (RCT) to compare the non-operative treatment of Achilles tendon (AT) ruptures with or without Autologous Conditioned Plasma (ACP®). Twenty-four patients were randomized to receive an ACP® or saline injection within seven days and again at two weeks post-rupture. Tendon healing was longitudinally evaluated using ultrasound (US) and magnetic resonance imaging (MRI). Functional and patient-reported quality of life measures were also assessed. A small sample size limited our ability to detect statistically significant differences. The mean rankings of healing were slightly …

Oncolog, Volume 60, Number 09, September 2015, Sarah Bronson, Bryan Tutt, K. Nair

OncoLog MD Anderson's Report to Physicians (All issues)

• Enhanced Surgical Recovery Programs Improve Perioperative Outcomes for Cancer Patients: For patients undergoing cancer surgery, potential complications and long recovery times can delay the delivery of additional life-saving therapy. To improve patients' perioperative outcomes and clear the way for timely administration of additional therapies, several surgical teams at The University of Texas MD Anderson Cancer Center gave begun using enhanced surgical recovery programs (ESRPs).
• New Treatments for Respiratory Viruses in Immunocompromised Patients: Viral respiratory infections are a major concern for immunocompromised patients, in whom such infections are difficult to treat and can lead to pneumonia and even death. Although few …

Stability Study: A Multicentre Rct Comparing Acl Reconstruction With And Without Lateral Extra-Articular Tenodesis For Individuals At High Risk Of Graft Failure, Christopher Eric Hewison

Electronic Thesis and Dissertation Repository

Seventy patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomly assigned to receive ACLR alone or ACLR plus a lateral extra-articular tenodesis (LET). Our primary outcome was Limb Symmetry Index (LSI) calculated using a series of four hop tests at six months postoperative. Secondary outcomes measures included pain, subjective function and isokinetic strength testing. We found no statistically significant difference between the two groups in LSI calculations. We found statistically significant differences favouring the ACLR alone group in quadriceps average power and peak torque symmetry measurements at six-months postoperative when we adjusted for baseline measurements. No other statistically significant …

The Association Between Soft Tissue Releases And Bony Resections Performed During Total Knee Arthroplasty And Patients' Pain And Satisfaction Postoperatively, Matt Carter

Electronic Thesis and Dissertation Repository

Total knee arthroplasty (TKA) is a surgical treatment of degenerative knee conditions such as osteoarthritis to reduce pain and increase function. Intraoperative soft tissue releases (STRs) and bony resections (BRs) are necessary for a balanced and aligned TKA. It is possible that the degree of STRs and BRs is related to final outcome following TKA and thus there may be implications for patient rehabilitation, patient expectations, pain medications, and timelines for recovery. Thus, our primary objective was to examine the association between the number of STRs and BRs performed intraoperatively and patients’ satisfaction and pain at three months. We performed …

Ultrasound Guided Motor Sparing Knee Blocks For Postoperative Analgesia Following Total Knee Arthroplasty, Olawale A. Sogbein

Electronic Thesis and Dissertation Repository

Postoperative total knee arthroplasty (TKA) pain is severe and can inhibit patients’ rehabilitation. We devised a single injection motor sparing knee block (MSB) by targeting the adductor canal and lateral femoral cutaneous nerve with a posterior knee infiltration under ultrasound. Our primary objective was to evaluate the duration of the MSB compared to a standard periarticular infiltration (PAI) using time to first rescue analgesia as the end point. We randomized 82 patients undergoing TKA to receive either preoperative MSB or intraoperative periarticular infiltration. Duration of analgesia was significantly longer in the MSB group with a mean difference of 8.8 hours. …

Effect Of Therapeutic Massage On Pain In Patients With Dementia, Yamini Kapoor, Rob Orr

Rob Marc Orr

Introduction

The aim was to investigate whether therapeutic massage was effective in relieving pain in elderly residents with dementia.

Methods

A randomized controlled study was conducted in an aged care facility. Ten participants with dementia or advanced dementia were allocated to an intervention group or a control group. The intervention group received 10?min of massage (effleurage, kneading, and trigger point therapy) four times per week for 4 weeks. The Pain Assessment in Advanced Dementia scale was used as the outcome measure.

Results

No significant changes in mean outcome measure scores were found post intervention (Intervention mean?=?5.0?±?3.49; Control mean?=?5.2?±?3.49: t(8)?=?0.09, p?=?0.93). …

Effects Of Yoga On Arm Volume Among Women With Breast Cancer Related Lymphedema: A Pilot Study, Mary Insana Fisher, Betsy Donahoe-Fillmore, Laura Leach, Colleen O'Malley, Cheryl Paeplow, Tess Prescott, Harold L. Merriman

Mary Insana Fisher

Lymphedema affects 3–58% of survivors of breast cancer and can result in upper extremity impairments. Exercise can be beneficial in managing lymphedema. Yoga practice has been minimally studied for its effects on breast cancer related lymphedema (BCRL). The purpose of this study was to determine the effect of yoga on arm volume, quality of life (QOL), self-reported arm function, and hand grip strength in women with BCRL. Six women with BCRL participated in modified Hatha yoga 3×/week for 8 weeks. Compression sleeves were worn during yoga sessions. Arm volume, QOL, self-reported arm function, and hand grip strength were measured at …

A Comparison Of The Upper Limb Lift Test Between Women With Breast Cancer And Healthy Control Subjects, Mary Insana Fisher, Lucinda Pfalzer, Ellen W. Levy, Shana Harrington, Lynn H. Gerber, Nicole L. Stout

Mary Insana Fisher

Presentation at the World Confederation for Physical Therapy Congress, held May 1-4, 2015, in Singapore. Background: Objective measures of upper limb (UL) function specific to breast cancer survivors (BC) are limited. Motion, strength, and muscular endurance are measurable components of UL function. A clinical test that quantifies these components is needed. Purpose: This study compares the Upper Limb Lift Test (ULLT) between women with BC and healthy control subjects (HC) at baseline, 1-3 months, and 12+ months post-operatively enrolled in a prospective surveillance trial with early intervention. A secondary purpose was to validate the ULLT by comparing findings to self-reported …

A Comparison Of The Scapular Flip Test Between Women With Breast Cancer And Healthy Controls, Mary Insana Fisher, Lucinda Pfalzer, Ellen W. Levy, Shana Harrington, Lynn H. Gerber, Nicole L. Stout

Mary Insana Fisher

Presentation at the World Confederation for Physical Therapy Congress, held May 1-4, 2015, in Singapore. Background: The Scapular Flip test was designed to screen for spinal accessory nerve palsy. The spinal accessory nerve can be damaged in breast cancer surgery and treatment, resulting in scapular dyskinesis and upper limb (UL) impairment in women with breast cancer (BC). This test could be useful to screen for UL impairment in BC. Purpose: The purpose of this study was to describe shoulder impairments as defined by a positive Flip Test in a group of women with BC at baseline, 1-3 months, and 12+ …

Predictors Of Appropriate Referral To Total Knee Arthroplasty: A Validation Study, Samuel J. Malian

Electronic Thesis and Dissertation Repository

Approximately 45% of referrals from primary care physicians to arthroplasty surgeons are inappropriate. Currently, Canadians are waiting over three months for consultation with an arthroplasty surgeon. Reducing the proportion of inappropriate referrals will reduce the wait time to first consultation with an arthroplasty surgeon. This study’s objective was to validate a model that identified patient-reported predictors of appropriate referrals to arthroplasty. We screened 258 patients attending their first consultation with an arthroplasty surgeon. Participants completed the questionnaires prior to their appointment and the surgeon detailed each consultation outcome on a standardized form. We constructed our validation model using the same …

A Prospective Cohort Study Investigating Functional Recovery In Patients With Osteoarthritis Following Total Hip Arthroplasty Using A Direct Anterior Versus Direct Lateral Surgical Approach, Bryn O. Zomar

Electronic Thesis and Dissertation Repository

We used a quasi-randomized cohort study to investigate whether there are differences in early functional recovery between patients who undergo total hip arthroplasty using a direct anterior (DA) or direct lateral (DL) surgical approach. We found significant differences in favour of the DA group for many functional outcomes including: gait velocity, stride length, operative limb single-limb support, single-limb support symmetry and time to complete the Timed Up and Go. Our primary outcome, gait velocity, was significantly greater in the DA group at discharge, two weeks and six weeks postoperative with adjusted mean differences of 0.12m/s, 0.15m/s and 0.17m/s respectively. There …

Venous Thromboembolism-Incidence Of Deep Venous Thrombosis And Pulmonary Embolism In Patients With Head And Neck Cancer: A Tertiary Care Experience In Pakistan, Naeem Sultan Ali, Ahmad Nawaz, Montasir Junaid, Maliha Kazi, Shabbir Akhtar

Department of Surgery

Abstract

Introduction Although venous thromboembolism (VTE) is seen with morbidity and mortality in various surgical specialties, scarce data are available in the head and neck surgery domain. Objective We aim to determine the incidence of VTE in patients receiving surgery for head and neck cancer. Methods Four hundred thirteen patients who underwent head and neck surgery procedures between 2005 and 2013 were reviewed retrospectively. All patients with head and neck surgery had received thromboprophylaxis (i.e., compression stockings and subcutaneous heparin). Patient demographics, operating time, and length of hospital stay were analyzed. The incidence of symptomatic deep venous thrombosis (DVT) and …

Laparoscopic Cholecystectomy: Outcome Of First 202 Cases In A District Hospital In Gilgit, Ghulam H, Dildar Hussain, Seema Waheed, Rehman Shah, Ali Ahmad Khan, Mumtaz Ibrahim, Syed Mahboob Ali Shah

Department of Medicine

BACKGROUND:

The incidence of gall stone disease is on the rise in Gilgit Baltistan. The objectives of the study were to assess the outcome of laparoscopic cholecystectomy in terms of conversion rate and postoperative morbidity, in The Aga Khan Medical Centre Gilgit.

METHODS:

It was descriptive case series. All patients that underwent laparoscopic cholecystectomy between June 2009 to May 2014 were included. The data was collected prospectively. Demographic features, operative time, and hospital stay were studied. Postoperative complications were documented and evaluated according to outcome measures (bile duct injuries, morbidity, mortality, conversion rates, wound infections).

RESULTS:

A total of 202 …

Non-Operative Management Of Hip Osteoarthritis, Ray Marks

Publications and Research

This paper reviews several non-operative and non-pharmacologic management strategies advocated for alleviating the pain and disability experienced by people with hip osteoarthritis. It analyzes whether painful debilitating hip osteoarthritis, which has no effective cure and is often progressive, may be affected positively by non-operative interventions designed to control osteoar- thritis pain. Finally, it provides an integrated plan of management for ameliorating hip osteoar- thritis pain and disability in light of this knowledge.

The Need And Roadmap For Stroke Rehabilitation Guidelines In Pakistan, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Marburg Variant Of Multiple Sclerosis; A Diagnostic And Therapeutic Challenge, Sadia Imtiaz, Maimoona Siddiqui, Arsalan Ahmad Md

Pakistan Journal of Neurological Sciences (PJNS)

Marburg variant of multiple sclerosis (MS) is a highly aggressive, fulminant demyelinating disease with very high morbidity and mortality. Early diagnosis and aggressive management is vital to limit severe disability and improve the outcome. We present a case of 35 years old male who presented with rapidly progressive demyelinating illness, leading to bed bound status over the course of a month. He was treated aggressively with intravenous (IV) steroids, plasma exchange (PLEX) and Mitoxantrone (MTX), leading to a remarkable recovery.

The Impact Of An Inpatient Hospital Admission On Patients’ Physical Functioning And Quality Of Life In The Oncology Setting, Andrew Murnane, Justin Keogh, Fiona Magat, Sonya Imbesi, Marie Coulombe, Sharni Patchell, Allan Abbott

Allan D. Abbott

Objective: Cancer can affect an individual’s level of physical function and health related quality of life (HRQoL). Those requiring hospital admission may be at risk of further decline during hospitalisation. The aim of this study was to investigate physical functioning and HRQoL of cancer patients on admission and over the course of their hospital admission. Methods: A prospective observational study was undertaken on the inpatient wards of a specialist oncology hospital. Assessment measures were taken bi-weekly until discharge from hospital or if they became too unwell to continue. Functional outcome measures included timed-up and go test (TUG), 30 second sit …

The Impact Of An Inpatient Hospital Admission On Patients’ Physical Functioning And Quality Of Life In The Oncology Setting, Andrew Murnane, Justin Keogh, Fiona Magat, Sonya Imbesi, Marie Coulombe, Sharni Patchell, Allan Abbott

Justin Keogh

Objective: Cancer can affect an individual’s level of physical function and health related quality of life (HRQoL). Those requiring hospital admission may be at risk of further decline during hospitalisation. The aim of this study was to investigate physical functioning and HRQoL of cancer patients on admission and over the course of their hospital admission. Methods: A prospective observational study was undertaken on the inpatient wards of a specialist oncology hospital. Assessment measures were taken bi-weekly until discharge from hospital or if they became too unwell to continue. Functional outcome measures included timed-up and go test (TUG), 30 second sit …

Preop Evaluation/Post Operative Care (Nutrition, Pain Management), Malia Eischen Md, Meghan L. Good Md, Lung-Ching Lee Md

Department of Surgery

No abstract provided.