Features, management, and long-term outcome in dogs with pancreatitis and bile duct obstruction treated medically and surgically: 41 dogs (2015-2021).

OBJECTIVE: Pancreatitis resulting in extrahepatic biliary obstruction (EHBO) can cause substantial morbidity and mortality. Endoscopic retrograde cholangiopancreatography is utilized for diagnostic and therapeutic purposes in humans; however, this is not available in veterinary medicine. Treatment options include medical management and biliary drainage procedures. The aim of this study was to describe the management of EHBO secondary to pancreatitis in dogs, treated medically and surgically and to determine whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) differ between the treatment groups. ANIMALS: 41 dogs treated for EHBO secondary to pancreatitis during the period of May 2015 to November 2021. METHODS: Records from 41 dogs diagnosed with EHBO secondary to pancreatitis were reviewed, and information extracted included clinical signs, ultrasound findings, NLR, PLR, histopathology, treatment, and outcomes. RESULTS: 18 of 19 (95%) surgical patients survived, while 12 of 21 (57%) medical patients survived. There was no difference in the length of hospitalization or time to return to adequate function between the groups; however, there was a significant difference in the 2- and 12-month survival between those treated surgically and medically. There was no difference in the NLR or PLR between surgically versus medically treated dogs or between survivors and nonsurvivors. CLINICAL RELEVANCE: The mortality rate of surgery for EHBO secondary to pancreatitis may be lower than previously described, and in this cohort of dogs, those treated surgically had improved survival at 2 and 12 months compared to those treated medically.

Feedback Training Improves Compliance with Sternal Precaution Guidelines during Functional Mobility: Implications for Optimizing Recovery in Older Patients after Median Sternotomy.

Patients often need to use their arms to assist with functional activities, but after open heart surgery, pushing with the arms is limited to <10 lb (4.5 kg) to help minimize force across the healing sternum. The main purposes of this study were to determine if older patients (>60 years old) (1) accurately estimated upper extremity (UE) weight bearing force of 10 lb or less and (2) if feedback training improved their ability to limit UE force and pectoralis major muscle contraction during functional activities. An instrumented walker was used to measure UE weight bearing force, and electromyography was used to measure pectoralis major muscle activity simultaneously during 4 functional mobility tasks. After baseline testing, healthy older subjects (n = 30) completed a brief session of visual and auditory concurrent feedback training. Results showed that the self-selected UE force was >10 lb for all tasks (20.0-39.7 lb [9.1-18.0 kg]), but after feedback training, it was significantly reduced (10.6-21.3 lb [4.8-9.7 kg]). During most trials (92%), study participants used >12 lb (5.5 kg) of arm weight bearing force. Pectoralis major muscle peak electromyography activity was <23% of maximal voluntary isometric contraction and was reduced (9.8-14.9%) after feedback training. Older patients may not be able to accurately estimate UE arm force used during weight bearing activities, and visual and auditory feedback improves accuracy and also modulation of pectoralis major muscle activation. Results suggest that an instrumented walker and feedback training could be clinically useful for older patients recovering from open heart surgery.

Predicting falls in older adults using the four square step test.

The Four Square Step Test (FSST) is a performance-based balance tool involving stepping over four single-point canes placed on the floor in a cross configuration. The purpose of this study was to evaluate properties of the FSST in older adults who lived independently. Forty-five community dwelling older adults provided fall history and completed the FSST, Berg Balance Scale (BBS), Timed Up and Go (TUG), and Tinetti in random order. Future falls were recorded for 12 months following testing. The FSST accurately distinguished between non-fallers and multiple fallers, and the 15-second threshold score accurately distinguished multiple fallers from non-multiple fallers based on fall history. The FSST predicted future falls, and performance on the FSST was significantly correlated with performance on the BBS, TUG, and Tinetti. However, the test is not appropriate for older adults who use walkers. Overall, the FSST is a valid yet underutilized measure of balance performance and fall prediction tool that physical therapists should consider using in ambulatory community dwelling older adults.

Predicting falls in community dwelling older adults using the Activities-specific Balance Confidence Scale.

OBJECTIVES: Falls are a significant problem associated with aging, and can lead to serious consequences including injury and death. The purpose of this study was to determine whether balance confidence differed between future fallers and non-fallers, and whether the construct prospectively predicted falls. METHODS: Forty-five community dwelling older adults aged 65 or older completed the Activities-specific Balance Confidence scale (ABC) and reported falls experienced during the next 6 months. RESULTS: Eleven (24.4%) subjects were fallers, and had significantly poorer ABC scores (x=50.6%) than their non-faller counterparts (x=76.3%). The regression model was significant, where the ABC score predicted falls at 6 months. DISCUSSION: Our findings suggest that balance confidence differs between fallers and non-fallers, and that ABC scores can predict future falls in community dwelling older adults. CONCLUSION: Balance confidence is a fall risk predictor, and thus a critical component of fall risk assessment. Balance confidence should be measured regularly in community dwelling older adults using the ABC.

Perceptions of exercise and quality of life in older patients in the United States during the first year following coronary artery bypass surgery.

BACKGROUND AND PURPOSE: It is important for patients recovering from coronary artery bypass (CAB) surgery to initiate and maintain recommended exercise guidelines. The purpose of this qualitative study was to describe factors that influence adherence to exercise, and perceptions of activity limitations and health-related quality of life (QoL) in older patients recovering from CAB surgery. SUBJECTS: Participants were 28 people aged 65 and older, prospectively recruited from a U.S. hospital following CAB surgery. PROCEDURES: A qualitative description methodology was used to identify factors that influenced participants' feelings about exercise and QoL. Data were collected using phone interviews 3, 6, and 12 months after surgery. Data were coded by identifying significant statements, grouping them into meaningful units or "themes", and generating descriptions of participants' experiences and understandings. RESULTS: Across time points, participants' most commonly described motivators were that it feels good to exercise, and belief that it improves physical health. The most commonly cited barriers to exercise were other time commitments, inclement weather, and pain/injury/illness related or unrelated to CAB surgery. DISCUSSION AND CONCLUSION: Motivating themes remained consistent across the time intervals but the number of responses regarding barriers to exercise increased over time. A better understanding of the patient experience may help to promote exercise initiation and adherence following CAB surgery.

Exercise self-efficacy, habitual physical activity, and fear of falling in patients with coronary heart disease.

The purpose of this study was to determine if a relationship exists between self-efficacy for physical activity and other pertinent factors in patients with coronary heart disease (CHD). A secondary purpose of this study was to determine if self-efficacy and exercise behavior are different in patients who report a fearing of falling (fallers) as compared to patients who do not report a fear of falling (non-fallers). This study included 50 patients who were admitted to the hospital for a CHD related diagnosis. Patients completed assessments of cardiac self-efficacy (Modified Barnason Efficacy Expectation Scale) and exercise behavior self-efficacy (Self Efficacy for Exercise Behavior Scale). In addition, the Physical Function subscale of the RAND 36-Item Health Survey and the Telephone Interview of Cognitive Function were used to characterize physical and cognitive function, respectively. Data analysis consisted of descriptive statistics, correlations, t-tests, and chi-square. Older patients reported higher levels of cardiac self-efficacy. Further, a positive correlation was found between cardiac self-efficacy and pre-hospitalization level of physical function. Patient income level and Self-efficacy for Exercise Behavior Resisting Relapse subscale scores were significantly correlated. A higher percent of fallers failed to meet minimum exercise guidelines as compared to non-fallers. It is important to identify the factors that are associated with exercise self-efficacy to improve health behavior adoption and adherence in patients with CHD.

Using the SF-36 to determine perceived health-related quality of life in rural Idaho seniors.

The purpose of this study was to establish the perceived health-related quality of life (HRQoL) in people aged 65 and older in rural southeastern Idaho. Ninety-five people aged 65 and older completed the Short Form 36 version 2 (SF-36 v2), a valid and reliable HRQoL instrument. Subject scores were then compared to established normative values for the general U.S. adult population and specifically to normative values for people aged 65 and older. In general, the participant's HRQoL was lower than that of the general population. However, females aged 75 and older had higher physical component summary (PCS) scores than their age- or gender-matched mates, and PCS scores of all participants aged 75 and older were higher than those of their age-matched mates. Results of a regression analysis indicated that number of prescription medications taken (p = 0.004) was the only variable predictive of PCS scores. The results of this study show a decrease in the physical aspects of HRQoL of participants, signifying that HRQoL does decline with age. Results suggest that participants aged 75 and older have a higher HRQoL than suspected, which could indicate that rural residence is not an immediate indicator of decreased quality of life in the elderly.

The educational interaction between physical therapy and occupational therapy students.

The objectives of this study were to identify the prevalence of shared learning in U.S. physical therapy (PT) and occupational therapy (OT) education programs; determine what terminology is used for these courses; and identify perceived barriers, benefits, and challenges of the educational interactions. A survey, designed to collect information about the educational interaction between PT and OT students, was mailed to all program directors (n = 206) at each of the academic institutions (N = 103) in the United States with accredited or developing entry-level programs in PT and OT. A census study was conducted, and the entire study population received a survey. A total of 206 surveys were mailed, and 123 were retured (59.7% response rate). Of program directors, 40 (67.8%) of the PT and 42 (65.6%) of the OT program directors reported that their students shared courses with each other. None of the PT and only 8 (12.5%) of the OT directors reported that students shared clinical experiences. The term interdisciplinary was used most frequently to refer to shared educational experiences. Benefits of shared learning included sharing resources, collaboration, learning about the other profession, and gaining respect for the other profession. Challenges to shared learning included resource constraints, curricular differences, competition and differences between disciplines, relevance of course work, and different faculty expectations. Barriers reported by program directors whose students did not engage in interdisciplinary education were resource constraints, curricular differences, faculty attitude, and failure of past attempts. A model of interdisciplinary education that seeks to instill collaboration and understanding among professions is difficult to implement without shared clinical experiences. Most students in entry-level PT and OT programs in the United States do not currently have the opportunity to practice the teamwork that will be essential when they enter their respective professions.