A comparative evaluation of telehealth and direct assessment when screening for spasticity in residents of two long-term care facilities.

OBJECTIVE: To evaluate the performance of telehealth as a screening tool for spasticity compared to direct patient assessment in the long-term care setting. DESIGN: Cross-sectional, observational study. SETTING: Two long-term care facilities: a 140-bed veterans' home and a 44-bed state home for individuals with intellectual and developmental disabilities. SUBJECTS: Sixty-one adult residents of two long-term care facilities (aged 70.1 ± 16.2 years) were included in this analysis. Spasticity was identified in 43% of subjects (Modified Ashworth Scale rating mode = 2). Contributing diagnoses included traumatic brain injury, spinal cord injury, birth trauma, stroke, cerebral palsy, and multiple sclerosis. MAIN MEASURES: Movement disorders neurologists conducted in-person examinations to determine whether spasticity was present (reference standard) and also evaluated subjects with spasticity using the Modified Ashworth Scale. Telehealth screening examinations, facilitated by a bedside nurse, were conducted remotely by two teleneurologists using a three-question screening tool. Telehealth screening determinations of spasticity were compared to the reference standard determination to calculate sensitivity, specificity, and the area under the curve (AUC) in receiver operating characteristics. Teleneurologist agreement was evaluated using Cohen's kappa. RESULTS: Teleneurologist 1 had a specificity of 89% and sensitivity of 65% to identify the likely presence of spasticity (n = 61; AUC = 0.770). Teleneurologist 2 showed 100% specificity and 82% sensitivity (n = 16; AUC = 0.909). There was almost perfect agreement between the two examiners at 94% (kappa = 0.875, 95% CI: 0.640-1.000). CONCLUSION: Telehealth may provide a useful, efficient method of identifying residents of long-term care facilities that likely need referral for spasticity evaluation.

Polymerized bovine hemoglobin (Oxyglobin Solution) administration in two river otters (Lutra canadensis).

Polymerized bovine hemoglobin (Oxyglobin Solution®) was successfully administered to two river otters (Lutra canadensis) that required general anesthesia and surgery for trap-related injuries. In both animals, blood oxygen content was maintained at presurgical levels despite a 47-70% decrease in their hematocrit. Otter 1 received a dose of 19 mL kg-1, given at a rate of 29 mL kg-1 h-1. Otter 2 received a dose of 20 mL kg-1, given at a rate of 5 mL kg-1 h-1. For many of the uncommon species, there are limited resources in the form of blood products to treat anemia, blood loss or hypovolemia. Successful use of polymerized bovine hemoglobin in these two otters suggests that it is useful for acute treatment of anemia and blood loss in such species.