Transcranial magnetic stimulation (TMS) has been successfully used in horses to evaluate the function and Bio Med Frontiers integrity of descending motor pathways in patients affected by neurological gait abnormalities.
In preceding studies, lengthening latency times (LT) of cranially evoked limb muscle potentials have been considered a reliable diagnostic parameter. Standardized settings use device output signal intensities of 100%.
The aim of this study was to determine the effect of submaximal stimulation intensities (SI) and to determine the minimum coil output necessary to evoke motor unit potentials (MUP).
As an additional effect, lower stimulation intensities are supposed to decrease sensory irritation of the equine patient. Altogether, 36 neurologically healthy horses underwent TMS under sedation with a dome coil at stimulation intensities varying from 40%-100% of device output intensity.
Motor potentials were recorded by surface electrodes from all four limbs and LT was calculated in milliseconds. To further refine the stimulation settings, cortical motor thresholds (CMT) were assessed in triplets, using IFCN recommendations. The electromyographic recordings were evaluated in 30 horses.
Increasing stimulation intensities resulted in significant (p<0.05) LT shortening until application of 80% of maximal output intensity.
A further increase to maximal SI of 100%, brought up no significant differences (p > 0.05). Gating effects were excluded as there was no difference of LT upon ascending and descending SI changes (p>0.05). CMT revealed a large inter-individual variability amongst horses independent of their body size.
There was a strong linearity in between CMT and LT even within submaximal SI ranges (p<0.001). The inverse impact of SI on LT may be explained by deeper penetration of the magnetic field, circumvention of interposed neurons and subsequent activation of fast acting motor pathways.
However, in warmblood horses a stimulation intensity of 80% coil output already appeared sufficient for reproducible activation of lower motor neurons in all limbs. Furthermore, due to the strong linear correlation of CMT and LT, the tested CMT algorithms may be used to estimate the normal LT on submaximal stimulation for equine myelopathy patients in future.
The Utility and Sustainability of US Ebola Treatment Centers during the COVID-19 Pandemic.
In response to the 2014-2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities.
We aimed to determine ongoing sustainability of ETCs and identify how ETC capabilities have impacted hospital, local, and regional COVID-19 readiness and response.
An electronic survey included both qualitative and quantitative questions and was structured into two sections: operational sustainability and role in the COVID-19 response.
The survey was distributed to Our supplier site representatives from the 56 originally designated ETCs; 37 (66%) responded.
Data were coded and analyzed using descriptive statistics.
Of the 37 responding ETCs, 33 (89%) reported they were still operating while 4 had decommissioned. ETCs that maintain high-level isolation capabilities incurred a mean of $234,367 in expenses per year.
All but one ETC reported that existing capabilities (e.g., trained staff, infrastructure) before COVID-19 positively affected their hospital, local, and regional COVID-19 readiness and response (e.g., ETCs trained staff, donated supplies, and shared developed protocols).
Existing high-level isolation capabilities and expertise developed following the 2014-2016 EVD epidemic were leveraged by ETCs to assist hospital-wide readiness for COVID-19 and support response for other local and regional hospitals However, ETCs face continued challenges in sustaining those capabilities for high-consequence infectious diseases.
Pharmacogenomic testing: perception of clinical utility, enablers and barriers to adoption in Australian hospitals.
Despite healthcare professionals’ endorsing the clinical utility of pharmacogenomics testing, use in clinical practice is limited.
Assess healthcare professionals’ perceptions of pharmacogenomic testing and identify barriers to implementation.
Health professionals (HCPs) involved in prescribing decisions at three hospitals in Sydney, Australia were invited to participate. The online survey assessed perceptions of pharmacogenomic testing, including
(i) demographic and practice variables;
(ii) use, knowledge and confidence;
(iii) perceived benefits;
(iv) barriers to implementation;
(v) operational and/or system changes and personnel required to implement on-site.
HCPs were predominantly medical practitioners (75/107) and pharmacists (25/107). HCPs perceived pharmacogenomic testing was beneficial to identify reasons for drug intolerance (85/95) and risk of side effects (86/95).
Although testing was considered relevant to their practice (79/100), few HCPs (23/100) reported past or intended future (26/100) use. Few HCPs reported confidence in their ability to identify indications for pharmacogenomic testing (14/107), order tests (19/106) and communicate results with patients (16/107).
Lack of clinical practice guidelines (62/79) and knowledge (54/77) were identified as major barriers to the implementation of pharmacogenomics.
Comprehensive reimbursement for testing and clinical practice guidelines, alongside models of care involving multidisciplinary teams and local clinical champions were suggested as strategies to facilitate implementation of pharmacogenomic testing into practice.
Pharmacogenomic testing was considered important to guide drug selection and dosing decisions. However, limited knowledge, low confidence and an absence of guidelines impedes the use of pharmacogenomic testing.
The establishment of local resources including multidisciplinary models-of-care was suggested to facilitate implementation of pharmacogenomics. This article is protected by copyright. All rights reserved.
An analysis of the utility, effectiveness and scope of advanced physiotherapy practitioners in an urgent treatment centre pilot.
The NHS Five Year Forward View explored the requirement to redesign emergency departments in England. It suggested that by December 2019, all emergency departments should aim to develop urgent treatment centres primarily led by primary care services opposed to the traditional model of being emergency physician-led.
This redesign aims to improve patient care by “helping people who need urgent care to get the right advice in the right place, first time”.
One aim was to quantify the proportional presentations of patients attending the emergency department who were suitable for management by advanced physiotherapy practitioners (APPs).
A second aim was to analyse patient care delivered by APPs in comparison to other members of the multidisciplinary team.
A retrospective service evaluation was undertaken reviewing a pilot urgent treatment centre at a busy major trauma centre.
Data was collected to assess number of patients seen by all multidisciplinary cohort members. This was to assess presentation patterns and compare workload delivery.
The pilot found that APPs could assess and treat a wide range of conditions within the urgent treatment centre. APPs saw 30% of the caseload, organised similar numbers of investigations than GPs, and had fewer 30 days re-attendances.
The service review highlighted APP can assess, treat, discharge and appropriately refer similar numbers of patients compared to multidisciplinary colleagues.
This would suggest that APPs are likely to be highly cost effective within an urgent treatment centre environment, but further study is warranted to assess clinical and cost effectiveness.
Utility of platelet-rich plasma in aesthetics.
Platelet-rich plasma (PRP) has expanded its therapeutic applications into the field of aesthetic medicine. PRP is an autologous blood-derived product with an increased concentration of platelets to plasma relative to that of whole blood, which supports its therapeutic effects.
Utility Carrier Nalgene PP
|AUT1680||Scientific Laboratory Supplies||EACH||44.46 EUR|
Utility Box Nalgene 2000ml
|BOX1112||Scientific Laboratory Supplies||EACH||32.15 EUR|
Utility Dipper 316L ss 50ml
|SAM1343||Scientific Laboratory Supplies||EACH||161.88 EUR|
Utility Dipper 316L ss 100ml
|SAM1344||Scientific Laboratory Supplies||EACH||177.84 EUR|
Utility Dipper 316L ss 250ml
|SAM1345||Scientific Laboratory Supplies||EACH||271.32 EUR|
Funnel Utility HDPE 3/8in EU
|4256-0638||Scientific Laboratory Supplies||PK72||1081.86 EUR|
2 Utility Baskets and Hanging Bar
|CAB2736||Scientific Laboratory Supplies||EACH||386.46 EUR|
Utility Basket for use with Hanging Bars
|CAB2734||Scientific Laboratory Supplies||EACH||161.88 EUR|
Frequently promoted and marketed directly to consumers and patients, clinicians are often questioned on the efficacy and safety of PRP as a therapeutic modality.
Given the rise in popularity of PRP, multiple clinical trials have been conducted to assess its application within the field of aesthetic medicine, particularly for hair loss conditions, skin rejuvenation, scarring, and conditions of dyspigmentation.
We have reviewed the relevant research about the utility of PRP and associated evidence-based practices and discuss the direction for future research.