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  • Article
    Lee H, Calvert J, Bishawi M, Wong G, Soloniuk LJ, Stier G.
    Cureus. 2024 Dec;16(12):e76040.
    The perioperative surgical home (PSH) is a care delivery model designed to improve the perioperative and long-term outcomes of patients undergoing surgery by promoting holistic care and seamless cooperation between different services and subspecialties. An aging population and increased surgical complexity have led to renewed interest in PSH models. An 86-year-old female with diabetes and critical limb ischemia presented with sepsis due to right calcaneal gangrene. A structured, comprehensive evaluation by the inpatient PSH service identified perioperative concerns including malnutrition and elevated cardiac risk and led to the discovery of an airway-compromising mass. A coordinated care plan, devised by the PSH team resulted in a joint operation by otolaryngology and orthopedic surgery departments, thus avoiding what would have been an otherwise unexpected difficult airway, and likely complications. Our case highlights the explicit and implicit benefits of interdisciplinary care coordinated by an inpatient PSH service, which includes risk stratification, comprehensive evaluation, and prevention of complications.
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  • Article
    Willinge G, Spierings J, Mathijssen E, Goslings C, Twigt B, van Veen R.
    BMJ Open. 2024 02 21;14(2):e076040.
    OBJECTIVES: This study aimed to identify factors influencing orthopaedic trauma patients' experiences and satisfaction with emergency department (ED) care and follow-up through Virtual Fracture Care (VFC) review workflow.
    DESIGN: This study employed an explorative, descriptive, qualitative design using individual, semistructured interviews.
    SETTING: An urban level 2 trauma centre and teaching hospital in Amsterdam, the Netherlands.
    PARTICIPANTS: Eligible patients were Dutch-speaking or English-speaking orthopaedic trauma patients, aged 18 years or above, who visited the hospital's ED between June and September 2022, and were treated through VFC review workflow. Exclusion criteria were: reason for follow-up other than injury, eye/motor/verbal score <15 at ED admission, follow-up treatment in another hospital, treatment initiated in another hospital, acute hospital admission (<24 hours). Twenty-three patients were invited for participation, of whom 15 participated and were interviewed.
    RESULTS: Several influential factors contributed to seven generic themes: (1) waiting times, (2) information provision, (3) healthcare professional communication, (4) care expectations, (5) care coordination, (6) care environment and (7) patient condition. Overall, participants were satisfied with received care. Interpersonal skills of healthcare professionals, and timing and content of provided information were specifically valued. Additionally, patients stated that their needs in the ED differed from those after ED discharge, and appreciated the way the VFC review workflow addressed this. Points of improvement included more active involvement of patients in the care process and prevention of inconsistent instructions by different healthcare professionals.
    CONCLUSIONS: Patient experiences with ED care and VFC review follow-up are influenced by factors categorised into seven themes. The VFC review workflow effectively addresses these factors, leading to positive feedback. Recommendations for healthcare professionals include anticipating evolving post-ED information needs, engaging patients early to provide clarity about the care process, involving them in treatment decisions and expanding information provision across the entire care pathway.
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  • Article
    Vokaer B, Charbonnier LM, Lemaître PH, Spilleboudt C, Le Moine A.
    PLoS One. 2013;8(10):e76040.
    Several evidences suggest that regulatory T cells (Treg) promote Th17 differentiation. Based on this hypothesis, we tested the effect of IL-17A neutralization in a model of skin transplantation in which long-term graft survival depends on a strong in vivo Treg expansion induced by transient exogenous IL-2 administration. As expected, IL-2 supplementation prevented rejection of MHC class II disparate skin allografts but, surprisingly, not in IL-17A-deficient recipients. We attested that IL-17A was not required for IL-2-mediated Treg expansion, intragraft recruitment or suppressive capacities. Instead, IL-17A prevented allograft rejection by inhibiting Th1 alloreactivity independently of Tregs. Indeed, T-bet expression of naive alloreactive CD4+ T cells and the subsequent Th1 immune response was significantly enhanced in IL-17A deficient mice. Our results illustrate for the first time a protective role of IL-17A in CD4+-mediated allograft rejection process.
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  • Book
    By Joan Toglia.
    Summary: Occupational therapists frequently work with people who are independent in routine or basic ADLs but who have difficulty with non-routine or complex activities. The WCPA was designed to be useful across a variety of populations that exhibit difficulties in executive functioning or higher level cognitive independent ADLs and can be used to screen for these difficulties to understand the underlying nature of performance problems. Appropriate for use with adolescents and adults, the WCPA involves following and organizing a list of appointments or errands into a weekly schedule while keeping track of rules, avoiding conflicts, monitoring passage of time, and inhibiting distractions. Because performance on multiple-step activities such as the WCPA requires coordinating and integrating various cognitive abilities, this assessment provides the opportunity to observe how an individual manages a cognitively challenging task. The WCPA provides a broad analysis of how a person manages and copes with a complex and cognitively challenging activity. In addition to including a weekly schedule, the assessment features client profiles on error analysis, visual performance, awareness of task difficulty, and pretest–posttest comparisons. A flash drive contains worksheets and scoring materials for both the Adult and Youth versions. Research on the WCPA and videos providing an overview and set-up and administration techniques are available here. Contents Chapter 1. Overview Chapter 2. Administration Chapter 3. Guidelines for Scoring Appointments Chapter 4. Interpretation Chapter 5. Research and Normative Studies Chapter 6. Dynamic Assessment: Use of the WCPA in the Test-Teach-Retest Format Appendixes Appointment Lists and Scoring Sheets: Adult/Older Adult Population (Ages 18-94) Appointment Lists and Scoring Sheets: Middle/High School (Ages 12-18) Appointment Lists and Scoring Sheets: Youth (Ages 16-21) Appointment Lists and Scoring Sheets: WCPA-S (College Students Ages 20-34) General Forms for Administration Worksheets and Templates for Summarizing Results Raw Score to Percentile Conversion

    Contents:
    Chapter 1. Overview. Executive function
    For whom is the WCPA Appropriate?
    Administration of the WCPA
    Identifying Performance Deficits: Objective Scores and Normative Comparison
    Performance Analysis and Treatment Implications
    Test-Teach-Retest Format
    Description of the WCPA
    Summary
    Chapter 2: Administration. Selecting the Appointment List and Obtaining Materials
    Administration Procedure
    General Administration Guidelines for Use and Completion of the WCPA Recording Form
    Strategy Use and Observations During Administration
    Strategy Scoring: Observed Strategies-- After-Tasking Interview and Rating Scale
    Summary
    Chapter 3: Guidelines for Scoring Appointments. Self-Recognition of Errors
    Appointment Errors
    Instructions for Using the Calendar Scoring Worksheet
    Guidelines for Detailed Error Scoring and Examples
    FAQ on Administering the WCPA
    FAQ on Scoring the WCPA
    Summary
    Chapter 4: Interpretation. Objective Scores and Normative Comparison
    Summarizing WCPA Scores
    After-Task Interview and Rating Scale: Summarizing Self-Ratings (optional)
    Interpretation: Performance Analysis and Implications for Treatment
    Examples of Performance Analysis and Interpretations
    Using the Summary Worksheets and Report Templates
    Summary Chapter 5: Research and Normative Studies. Studies on Youths
    Normative Data for Healthy Adults
    WCPA Level II Normative Sample: Adults (Ages 18-94)
    Future Research
    Future Development
    Chapter 6: Dynamic Assessment: Use of the WCPA in a Test-Teach-Retest Format. Test-Teach-Retest
    Dynamic Assessment
    Test-Teach-Retest Format
    Summary
    Appendix A: Appointment Lists and Scoring Sheets: Adult/Older Adult Population(Ages 18-94)
    Appendix B: Appointment Lists and Scoring Sheets: Middle/High School (Ages 12-18)
    Appendix C: Appointment Lists and Scoring Sheets: Youth (Ages 16-21)
    Appendix D: Appointment Lists and Scoring Sheets: WCPA-S (College Students Ages 20-34)
    Appendix E: General Forms for Administration
    Appendix F: Worksheets and Templates for Summarizing Results
    Appendix G: Raw Score to Percentile Conversions.
    Digital Access EBSCOhost [2015], ©2015