Using the assessment of motor and process skills to measure functional change in adults with severe traumatic brain injury: A pilot study.

AIM: To measure functional change in 10 adults following severe traumatic brain injury using the Assessment of Motor and Process Skills (AMPS). METHODS: This clinical pilot study used a standardised occupational therapy tool, the AMPS, to measure motor and process scores during activities of daily living, for over 3 weeks of inpatient rehabilitation. RESULTS: Wilcoxon signed ranks tests indicate significant improvement in motor and process scores from initial assessment to repeat evaluation (z = -2.70, p = 0.01; z = -2.81, P = 0.01, respectively). CONCLUSIONS: The AMPS measured statistically and clinically significant change in motor and process abilities over 3 weeks of neurosurgical rehabilitation. Findings suggest that the AMPS is a sensitive measure of functional change for the study sample and timeframe.

The use of a non-cultured autologous cell suspension and Integra dermal regeneration template to repair full-thickness skin wounds in a porcine model: a one-step process.

Integra is a skin substitute used for dermal reconstruction. Current clinical practice consists of two procedures, first applying Integra to the wound and then replacing the silicone pseudo-epidermis with an epidermal autograft 3 weeks later. This two-step repair limits the clinical use of the product. An effective one-step procedure could reduce the time taken to repair and decrease the number of procedures for use of Integra. This study examined the effects of simultaneous application of a non-cultured autologous suspension of cells, isolated using the ReCell autologous cell harvesting device, in combination with Integra, to achieve a one-step skin repair. In two female Yorkshire swine, 10 full-thickness wounds were created. Wounds were treated with Integra seeded with cell suspension and compared to controls of Integra alone and cell suspension alone. Weekly macroscopic and histological assessment demonstrated that the wounds treated simultaneously with Integra and non-cultured autologous cells had enhanced epithelialization at an early time-point compared to controls. Wounds treated simultaneously with Integra and cell suspension demonstrate that cells remain viable, migrate through the Integra template and self-organize into differentiated epidermis. The results indicate that combining Integra with autologous cells facilitates one-step skin reconstruction of a full-thickness skin wound.

Prevalence of peripheral arterial disease: persistence of excess risk in former smokers.

OBJECTIVE: To determine the age-standardised prevalence of peripheral arterial disease (PAD) and associated risk factors, particularly smoking. DESIGN: Cross-sectional survey of a randomly selected population. SETTING: Metropolitan area of Perth, Western Australia. PARTICIPANTS: Men aged between 65-83 years. RESULTS: The adjusted response traction was 77.2%. Of 4,470 men assessed, 744 were identified as having PAD by the Edinburgh Claudication Questionnaire and/ or the ankle-brachial index of systolic blood pressure, yielding an age-standardised prevalence of PAD of 15.6% (95% confidence intervals (CI): 14.5%: 16.6%). The main risk factors identified in univariate analyses were increasing age, smoking-current (OR = 3.9, 95% CI 2.9-5.1) or former (OR = 2.0, 95% CI 1.6-2.4), physical inactivity (OR = 1.4, 95% CI 1.2-1.7), a history of angina (OR = 2.2, 95% Cl 1.8-2.7) and diabetes mellitus (OR = 2.1, 95% Cl 1.7-2.6). The multivariate analysis showed that the highest relative risk associated with PAD was current smoking of 25 or more cigarettes daily (OR = 7.3, 95% Cl 4.2-12.8). In this population, 32% of PAD was attributable to current smoking and a further 40% was attributable to past smoking by men who did not smoke currently. CONCLUSIONS: This large observational study shows that PAD is relatively common in older, urban Australian men. In contrast with its relationship to coronary disease and stroke, previous smoking appears to have a long legacy of increased risk of PAD. IMPLICATIONS: This research emphasises the importance of smoking as a preventable cause of PAD.

Improving maximum walking distance in early peripheral arterial disease: randomised controlled trial.

The purpose of this study was to determine the impact of increased physical activity and cessation of smoking on the natural history of early peripheral arterial disease. We conducted a randomised controlled trial in Perth, Western Australia, involving 882 men with early peripheral arterial disease identified via population-based screening using the Edinburgh Claudication Questionnaire and the ankle:brachial index. Members of the control group (n = 441) received "usual care" from their general practitioner while members of the intervention group (n = 441) were allocated to a "stop smoking and keep walking" regime - a combined community-based intervention of cessation of smoking (where applicable) and increased physical activity. Postal follow-up occurred at two and 12 months post-entry into the trial. The main outcome of interest was maximum walking distance. There were no statistically significant differences in the characteristics of the "intervention" and "usual care" groups at recruitment. Follow-up information at two and 12 months was available for 85% and 84% of participants, respectively. At 12 months, more men allocated to the intervention group had improved their maximum walking distance (23% vs 15%; chi2 = 9.74, df = 2, p = 0.008). In addition, more men in the intervention group reported walking more than three times per week for recreation (34% vs 25%, p = 0.01). Although not statistically significant, more men in the intervention group who were smokers when enrolled in the trial had stopped smoking (12% vs 8%, p = 0.43). It is concluded that referral of older patients with intermittent claudication to established physiotherapy programs in the community can increase levels of physical activity and reduce disability related to peripheral arterial disease. A combination of simple and safe interventions that are readily available in the community through physiotherapists and general practitioners has the potential to improve early peripheral arterial disease.