Increasing the delivery of upper limb constraint-induced movement therapy post-stroke: A feasibility implementation study.

INTRODUCTION: Few stroke survivors receive upper limb constraint-induced movement therapy (CIMT). The aims of this study were to evaluate whether a behaviour change program for occupational therapists increased the number of stroke survivors receiving CIMT, describe the time and process involved in delivering the first program, any adverse events, fidelity and dose of CIMT provided, and upper limb outcomes. METHODS: A feasibility pre-post implementation study design was used, with intervention and measures for therapists and stroke survivors. Intervention for occupational therapists was informed by the Behaviour Change Wheel and included CIMT training, barrier identification, mentoring and a community of practice. Therapists delivered 2-week CIMT programs with 1:1 supervision, first assisting stroke survivors to identify upper limb goals using the Canadian Occupational Performance Measure. The primary outcome was change in the number of stroke survivors receiving CIMT (program reach). Hours associated with program delivery, adverse events and participant repetitions were recorded (program fidelity and dose). Change in motor function was measured (fidelity) using the Motor Assessment Scale (Upper Limb), Box and Block Test, Nine Hole Peg Test and Motor Activity Log at baseline, program completion (2 weeks), 1 and 12 months. RESULTS: Program reach: Sixteen stroke participants were recruited (mean 15.3 months post-stroke, SD 11.9) and six CIMT programs conducted over 24 months, compared to none pre-implementation. The first CIMT program required a mean of 242 hours for preparation and delivery. All programs were student-assisted. Fidelity and dose: Stroke participants completed a mean of 360.6 repetitions/hour (SD 183.7), and 12,719.6 repetitions/program (SD 6,872.8). Statistically significant changes in upper limb motor function were recorded; some changes were clinically important. CONCLUSIONS: The behaviour change program resulted in multiple CIMT programs being delivered safely and with fidelity. Capacity building and skill development took many hours, as did preparation for the first CIMT program.

A importância da imunofenotipagem no diagnóstico da leucemia aguda bifenotípica: estudo de prontuários de dois casos / The importance of the imunophenotyping in the diagnosis of the biphenotypic acute leukemia: charts study of two cases

análise de dois casos de leucemia aguda bifenotípica (LAB) ilustrando a importância da imunofenotipagem no diagnóstico diferencial das leucemias agudas mais freqüentes. Método: estudo analítico de dois casos de LAB de clínica particular associado à revisão de literatura sobre o tema. Conclusão: os casos estudados ratificam a impossibilidade de estabelecer o diagnóstico de LAB com base apenas na citologia sanguínea, tornandoimpreterível a solicitação da imunofenotipagem nos casos de suspeita de leucemia aguda

analysis of two cases of biphenotypic acute leukemia (BAL), presenting the importance of the imunophenotyping in the different diagnosis of the most frequent acute leukemias. Method: analytic study of two BAL cases from a private practice, associated to the review of articles related. Conclusion: the cases studied reaffirm the impossibility of establishing the diagnosis of BAL based only in the blood cytology. The request ofimunophenotyping becomes essential in the cases of acute leukemia suspicion.