Review article: Telehealth in Emergency Medicine in Australasia: Advantages and barriers.

The COVID-19 pandemic catapulted Telehealth to the forefront of Emergency Medicine (EM) as an alternative way of assessing and managing patients. This challenged the traditional idea that EM can only be practised within brick-and-mortar EDs. Many Emergency Physicians may find the idea of practising Telehealth in Emergency Medicine (TEM) confronting, particularly in the absence of training and clear practice guidelines. The purpose of the present paper is to describe the current use of TEM in Australasia, and outline the advantages and barriers in adopting this practice domain.

Strategy-based reasoning training modulates cortical thickness and resting-state functional connectivity in adults with chronic traumatic brain injury.

INTRODUCTION: Prior studies have demonstrated training-induced changes in the healthy adult brain. Yet, it remains unclear how the injured brain responds to cognitive training months-to-years after injury. METHODS: Sixty individuals with chronic traumatic brain injury (TBI) were randomized into either strategy-based (N = 31) or knowledge-based (N = 29) training for 8 weeks. We measured cortical thickness and resting-state functional connectivity (rsFC) before training, immediately posttraining, and 3 months posttraining. RESULTS: Relative to the knowledge-based training group, the cortical thickness of the strategy-based training group showed diverse temporal patterns of changes over multiple brain regions (pvertex < .05, pcluster < .05): (1) increases followed by decreases, (2) monotonic increases, and (3) monotonic decreases. However, network-based statistics (NBS) analysis of rsFC among these regions revealed that the strategy-based training group induced only monotonic increases in connectivity, relative to the knowledge-based training group (|Z| > 1.96, pNBS < 0.05). Complementing the rsFC results, the strategy-based training group yielded monotonic improvement in scores for the trail-making test (p < .05). Analyses of brain-behavior relationships revealed that improvement in trail-making scores were associated with training-induced changes in cortical thickness (pvertex < .05, pcluster < .05) and rsFC (pvertex < .05, pcluster < .005) within the strategy-based training group. CONCLUSIONS: These findings suggest that training-induced brain plasticity continues through chronic phases of TBI and that brain connectivity and cortical thickness may serve as markers of plasticity.

Academic-Practice Partnership in Public Health Nursing: Working with Families in a Village-Based Collaboration.

OBJECTIVES: The purpose of this program development and evaluation project was to promote healthy families and communities by creating academic-practice partnerships, educating BSN students and building family-nursing student partnerships that were supported by a "village" of interconnected resources. DESIGN AND SAMPLE: A mixed-methods design was used for the project. Data were collected from a convenience sample of vulnerable families, BSN students engaged in PHN practica, and partner members. MEASURES: Nine tools were developed to capture data over two semesters including a GIS mapping strategy. RESULTS: One hundred and seventy-five home visits were completed with 20 families, 14 of whom needed interpreter assistance. Families reported satisfaction with the quality of home visits, education, and assistance toward health goals. Fifty-three students provided 202 educational interventions, 39 community resource connections, and 46 care transitions. Students reported linking theory with practice and valued the PHN practicum experience. Academic-practice partners identified opportunities for program development and sustainability. GIS mapping illustrated complex family linkages to community resources. CONCLUSIONS: Results suggest that young, vulnerable families benefit from public health nursing (PHN) home visits, but sustaining home visit programs is challenging. Academic-practice partnerships can guide students and families partnered in a reciprocal relationship with "village" resources.

Senior work-up assessment and treatment team in an emergency department: a randomised control trial.

OBJECTIVE: To evaluate the impact of a senior early assessment model of care on performance measures in a single ED. METHODS: A pragmatic single-blinded randomised control trial with day of ED presentation randomised to one of three study arms: senior work-up assessment and treatment (SWAT) model of care intervention, non-SWAT control or control. PRIMARY OUTCOME: The primary outcomes were the proportion of patients meeting National Emergency Access Target (NEAT) criteria (ED length of stay less than 4 h) and ED length of stay. Secondary outcome measured was time to decision to admit in the subgroup of admitted patients. RESULTS: A total of 1737 patients were analysed. There was no overall difference in NEAT performance (48% [95% CI 44, 51] vs 41% ([95% CI 37, 45] vs 46% [95% CI 41, 50], P = 0.09) or ED length of stay (P = 0.65) between SWAT, non-SWAT and standard of care control groups, respectively. In the subgroup of patients discharged from ED (non-admitted), the SWAT intervention group was associated with higher NEAT performance (P = 0.004) compared with non-SWAT and control. CONCLUSION: A senior early assessment model of care was not associated with improved overall NEAT performance and ED length of stay. However, there is evidence that improvements were made in the subgroup of discharged patients. There was no difference in overall NEAT performance among the three study groups.

SafeTalk, a multicomponent, motivational interviewing-based, safer sex counseling program for people living with HIV/AIDS: a qualitative assessment of patients' views.

With the continued transmission of HIV each year, novel approaches to HIV prevention are needed. Since 2003, the U.S. HIV prevention focus has shifted from primarily targeting HIV-negative at-risk persons to including safer sex programs for people already infected with HIV. At least 20-30% of people infected with HIV engage in risky sexual practices. Based on these data, policymakers have recommended that interventionists develop strategies to help HIV-infected people reduce their risky sexual behaviors. In the past, the few safer sex interventions that targeted HIV-infected people met with limited success because they basically adapted strategies previously used with HIV-uninfected individuals. In addition, often these adaptations did not address issues of serostatus disclosure, HIV stigma, or motivation to protect others from HIV. We had previously tested, in a demonstration project named the Start Talking About Risks (STAR) Program, a monthly three-session motivational interviewing (MI)-based intervention to help people living with HIV practice safer sex. In this study, we refined that program by enhancing its frequency and intensity and adding written and audio components to support the counseling. We theorized that an intervention such as MI, which is tailored to each individual's circumstances more than standardized prevention messages, would be more successful when supplemented with other components. We qualitatively assessed participants' perceptions, reactions, and preferences to the refined prevention with positives counseling program we called SafeTalk and learned that participants found the SafeTalk MI counseling and educational materials appealing, understandable, and relevant to their lives.

Subjective perceptual distortions and visual dysfunction in children with autism.

Case reports and sensory inventories suggest that autism involves sensory processing anomalies. Behavioral tests indicate impaired motion and normal form perception in autism. The present study used first-person accounts to investigate perceptual anomalies and related subjective to psychophysical measures. Nine high-functioning children with autism and nine typically-developing children were given a questionnaire to assess the frequency of sensory anomalies, as well as psychophysical tests of visual perception. Results indicated that children with autism experience increased perceptual anomalies, deficits in trajectory discrimination consistent with dysfunction in the cortical dorsal pathway or in cerebellar midsagittal vermis, and high spatial frequency contrast impairments consistent with dysfunctional parvocellular processing. Subjective visual hypersensitivity was significantly related to greater deficits across vision tests.

Development of audiovisual comprehension skills in prelingually deaf children with cochlear implants.

OBJECTIVE: The present study investigated the development of audiovisual comprehension skills in prelingually deaf children who received cochlear implants. DESIGN: We analyzed results obtained with the Common Phrases (Robbins et al., 1995) test of sentence comprehension from 80 prelingually deaf children with cochlear implants who were enrolled in a longitudinal study, from pre-implantation to 5 years after implantation. RESULTS: The results revealed that prelingually deaf children with cochlear implants performed better under audiovisual (AV) presentation compared with auditory-alone (A-alone) or visual-alone (V-alone) conditions. AV sentence comprehension skills were found to be strongly correlated with several clinical outcome measures of speech perception, speech intelligibility, and language. Finally, pre-implantation V-alone performance on the Common Phrases test was strongly correlated with 3-year postimplantation performance on clinical outcome measures of speech perception, speech intelligibility, and language skills. CONCLUSIONS: The results suggest that lipreading skills and AV speech perception reflect a common source of variance associated with the development of phonological processing skills that is shared among a wide range of speech and language outcome measures.

Limiting high-frequency hearing aid gain in listeners with and without suspected cochlear dead regions.

The purpose of this study was to compare threshold-matched ears with and without suspected cochlear dead regions in terms of the speech perception benefit from high-frequency amplification. The Threshold Equalizing Noise Test (TEN) was used to assess the presence of dead regions. Speech perception was measured while participants were wearing a hearing aid fit to approximate DSL[i/o] targets. Consonant identification of nonsense vowel-consonant-vowel combinations was measured in quiet using a forced-choice procedure. Phoneme recognition was measured at signal-to-noise ratios ranging from 0 to +15 dB using the Computer-Assisted Speech Perception Assessment test (CASPA). Recognition scores were obtained for unfiltered stimuli and stimuli that were low-pass filtered at the estimated boundary of the suspected dead regions, 1/2 octave above and 1 octave above the boundary. Filter settings for the ears without suspected dead regions were the same as settings of the threshold-matched counterpart. In quiet and in low levels of noise, speech perception scores were significantly higher for the wide-band (unfiltered) condition than for the filtered conditions, and performance was similar for the ears with and without suspected dead regions. In high levels of noise, mean scores were highest in the wide-band condition for the ears without suspected dead regions, but performance reached an asymptote for the ears with suspected dead regions. These results suggest that patients with cochlear dead regions may experience speech perception benefit from wide-band high-frequency gain in quiet and low levels of noise, but not in high levels of noise.

Visuomotor integration ability of pre-lingually deaf children predicts audiological outcome with a cochlear implant: a first report.

We investigated the predictive relations between pre-implant visuomotor integration ability and subsequent oral speech/language outcomes in prelingually deaf children who use cochlear implants (CIs). Prior to implantation, children were given a task that tested their accuracy in copying geometric forms. Performance on this task predicted speech perception, sentence comprehension, and speech intelligibility outcomes over 3 years of CI use. We conclude that individual differences in visuomotor integration ability are predictive of some audiological outcome measures in deaf children with CIs.

A pilot open-label trial of citalopram for restless activity and aberrant motor behaviors in Alzheimer disease.

OBJECTIVE: In a prospective, open-label pilot study in probable-Alzheimer disease (AD) outpatients, the authors investigated the efficacy of citalopram to reduce restless activity and aberrant motor behaviors. METHODS: Nineteen subjects were evaluated with Neuropsychiatric Inventory subscale and total scores. RESULTS: There was a significant decline in aberrant motor behaviors and overall behavior problems at 4, 8, and 12 weeks. CONCLUSION: This study provides initial evidence that citalopram may be effective in reducing aberrant motor behaviors in AD. However, because of the potential biases of an open-label study, these findings need to be confirmed in a larger, controlled trial.

Combination therapy of donepezil and vitamin E in Alzheimer disease.

A retrospective chart review was performed on 130 patients from the Ohio State University Memory Disorders Clinic to examine the long-term effects of combination therapy with donepezil and vitamin E on patients with Alzheimer disease. Subjects were included if they met National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer disease, had taken at least 5 mg donepezil and at least 1000 U vitamin E daily, had at least a 1-year follow-up while continuing these medications, and had a Mini-Mental State Examination score of 10-24. The Mini-Mental State Examination was then recorded annually thereafter. These data were compared with the Consortium to Establish a Registry for Alzheimer's Disease database for patients collected prior to the availability of these treatment options. Patients declined at a significantly lower rate as compared with the Consortium to Establish a Registry for Alzheimer's Disease data. The long-term combination therapy of donepezil and vitamin E appears beneficial for patients with Alzheimer disease. Future prospective studies would be needed to compare combination treatment to vitamin E and donepezil alone.

A Longitudinal Study of Audiovisual Speech Perception by Children with Hearing Loss Who have Cochlear Implants.

The present study investigated the development of audiovisual speech perception skills in children who are prelingually deaf and received cochlear implants. We analyzed results from the Pediatric Speech Intelligibility (Jerger, Lewis, Hawkins, & Jerger, 1980) test of audiovisual spoken word and sentence recognition skills obtained from a large group of young children with cochlear implants enrolled in a longitudinal study, from pre-implantation to 3 years post-implantation. The results revealed better performance under the audiovisual presentation condition compared with auditory-alone and visual-alone conditions. Performance in all three conditions improved over time following implantation. The results also revealed differential effects of early sensory and linguistic experience. Children from oral communication (OC) education backgrounds performed better overall than children from total communication (TC backgrounds. Finally, children in the early-implanted group performed better than children in the late-implanted group in the auditory-alone presentation condition after 2 years of cochlear implant use, whereas children in the late-implanted group performed better than children in the early-implanted group in the visual-alone condition. The results of the present study suggest that measures of audiovisual speech perception may provide new methods to assess hearing, speech, and language development in young children with cochlear implants.