Effectiveness of Abdominal Functional Electrical Stimulation for Improving Bowel Function in People With a Spinal Cord Injury: A Study Protocol for a Double-Blinded Randomized Placebo-Controlled Clinical Trial.

Background: People with a spinal cord injury (SCI) have a high rate of bowel-related morbidity, even compared with people with other neurological disorders. These complications lower quality of life and place a financial burden on the health system. A noninvasive intervention that improves the bowel function of people with an SCI should reduce morbidity, improve quality of life, and lead to cost savings for health care providers. Objectives: To investigate the effectiveness of noninvasive abdominal functional electrical stimulation (FES) for improving bowel function in people with a chronic SCI. Methods: A prospective, double-blinded, 1:1 randomized, placebo-controlled intervention trial will be conducted with 80 adults with chronic SCI (>12 months since injury) above T8 single neurological level. The intervention will be a 45-minute abdominal FES (or placebo) session, 3 days per week, for 6 weeks. Main Study Parameters/Endpoints: Primary endpoint is whole gut transit time before and after 6 weeks of abdominal FES. Secondary endpoints measured before and after 6 weeks of abdominal FES are (1) colonic transit time; (2) quality of life (EQ-5D-5L); (3) participant-reported bowel function (International SCI Bowel Function Basic Data Set Questionnaire and visual analogue scale); (4) respiratory function (forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximal inspiratory pressure, and maximal expiratory pressure); (5) bladder symptoms (Neurogenic Bladder Symptom Score); (6) daily bowel management diary; and (7) unplanned hospital visits. Conclusion: Safety data will be collected, and a cost utility analysis using quality of life scores will be performed. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000386831.

Postgraduate Education in Pharmaceutical Medicine in Australia: Evaluation and Evolution to a Global Program Over 20 Years.

BACKGROUND: The Pharmaceutical Medicine program at the University of New South Wales provides postgraduate education for students seeking employment relating to development of new medicines and medical technology. The objective of this study was to determine which changes to the program were required to meet future educational needs of students. METHODS: Responses to questions from 76 students, tutors, lecturers, and stakeholders were obtained via Qualtrics surveys. RESULTS: Most respondents would recommend the program because of scope and program emphasis, content, quality of teaching, flexibility, and availability of distance and online content. Students valued links to industry and the national regulatory authority. Respondents recommended program content be current, expanded to meet needs of the Asia-Pacific region, and structured to ensure opportunities for networking and collaboration. CONCLUSIONS: Recommended changes to the program are being implemented to optimize skills and knowledge of graduates for roles in global pharmaceutical, medical technology, and biotechnology industries.

Prediction of voluntary activation, strength and endurance of elbow flexors in postpolio patients.

To examine the long-term effects of polio, maximal voluntary strength and voluntary activation of elbow flexor muscles of 177 patients from a postpolio clinic were investigated using twitch interpolation. Muscle endurance was studied in 142 patients during 45 min of submaximal exercise, and predictors of impaired muscle performance were investigated. Twenty-nine of 177 patients (16.4%) had impaired voluntary drive to their elbow flexor muscles, but only 16 (9.0%) had markedly reduced elbow flexor strength, despite 74 (41.8%) reporting they were initially affected in their tested limb and 172 (97.2%) patients reporting new generalized symptoms. Seven patients had impaired muscle endurance in the tests of strength and voluntary drive. During the submaximal exercise, 16 patients (11.3%) had impaired peripheral muscle endurance with normal voluntary activation. These results confirm a low incidence of impaired upper-limb muscle performance in postpolio patients, despite many patients having subjective symptoms consistent with postpolio syndrome. There was an increased relative risk for impaired muscle function in those patients with a subjective decrease in strength in the tested limb, a recent decline in activities of daily living in their tested limb, and who used orthotic devices in their tested limb. Monitoring of function in prior-polio patients with impaired muscle performance may be useful, particularly when combined with investigation of other potential contributory factors to the functional impairment.

Risk of falling: predictors based on reduced strength in persons previously affected by polio.

OBJECTIVES: To examine the contributions of sensorimotor factors to postural control and falling in people with prior polio and to determine whether these contributions differ from those found in normal populations. DESIGN: Survey and case-control study. SETTING: A falls and balance laboratory in Australia. PARTICIPANTS: Forty persons with prior polio (age range, 28-71 y) and 38 age- and sex-matched control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Lower-limb muscle strength, sway, vision, lower-limb sensation, reaction time, foot-tapping speed, and falls. RESULTS: Compared with the control subjects, the prior polio subjects performed similarly in sensory tests but worse in tests that involved a motor component. Within the prior polio group, lower-limb strength was strongly associated with postural sway on a compliant surface and explained more of the variance in sway than in control subjects. Prior polio subjects who fell multiple times had reduced lower-limb strength, slower reaction time, lower foot-tapping speed, and increased sway compared with those who fell less often. However, the rate of decline in lower-limb strength within the prior polio group did not exceed normal, age-related changes. CONCLUSIONS: This investigation of prior polio subjects provides an appropriate model for studying muscle weakness as a falls risk factor. Weakness was directly associated with falls, and had an indirect effect mediated through increased sway.