- Email: [email protected]
Poster 56: Pneumonias in Tracheostomy Patients: Does Topical Oral Chlorhexidine Decrease Incidence During Inpatient Rehabilitation?
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
sive therapies. No adverse events related to DRX9000 treatment occurred. Conclusions: Overall, patients’ pain improved after DRX treatment, requiring fewer analgesics, with better function. There were no safety issues identified with the multimodal treatment routine. Nontreatment or control groups were not included, making efficacy outcome versus placebo or spontaneous recovery difficult to determine. Randomized double-blinded or comparative longterm outcome trials are needed to further prove the efficacy of the DRX9000 nonsurgical spinal decompression system for the routine treatment of chronic LBP. Key Words: Low back pain; Rehabiliation. Poster 56 Pneumonias in Tracheostomy Patients: Does Topical Oral Chlorhexidine Decrease Incidence During Inpatient Rehabilitation? Christina M. Marciniak, MD (McGaw Medical Center of Northwestern University, Northwestern Medical School/Rehabilitation Institute of Chicago, Chicago, IL); Mary Chung, MD; Adam Houghton; Patrick Semik, BA. Disclosure: M. Chung, none; A. Houghton, none; C.M. Marciniak, Allergan, research grants; P. Semik, none. Objective: To evaluate the effects of chlorhexidine, demographic variables, dysphagia, and their interaction on pneumonia incidence and resultant discharge destination in patients admitted to inpatient rehabilitation with tracheostomies. Design: Retrospective case-control study. Setting: Freestanding acute inpatient rehabilitation facility. Participants: 226 subjects admitted with tracheostomies over a 1-year period (2006). Interventions: All medical records of patients admitted to inpatient rehabilitation with a tracheostomy and discharged in 2006 were reviewed. Cases of hospital-acquired pneumonia were identified from the infectious disease database and by chart review. Chlorhexidine use was identified from the electronic medication record. Main Outcome Measures: Incidence of pneumonia and discharge destination. Results: 12.4% of all subjects developed at least 1 pneumonia during inpatient rehabilitation, compared to a pneumonia incidence of .49% in those admitted without a tracheostomy. Age and sex did not influence pneumonia incidence in these tracheostomy patients, nor did use of tube feedings. The presence of dysphagia did not influence pneumonia incidence (2⫽1.74, df⫽1, not significant), even when evaluated for dysphagia severity level. Of the 59 cases on chlorhexidine, 11.9% developed pneumonia while on this medication, compared to 14.1% of those not on chlorhexidine (2⫽.19, df⫽1, not significant). In looking at the interaction of medication use and dysphagia, chlorhexidine was not effective in reducing pneumonia incidence, even when evaluated for dysphagia severity level. Patients who developed pneumonia were less likely to be discharged home (2⫽10.431, df⫽1, P⫽.001). Conclusions: Chlorhexidine has been shown to be beneficial in preventing ventilator-associated pneumonia, particularly in cardiac surgery patients. However, in our high-risk population of inpatient rehabilitation patients with tracheostomies, chlorhexidine was not found to decrease pneumonia incidence. Age, sex, use of tube feedings, and presence of dysphagia also did not influence pneumonia incidence in this group. Patients who developed pneumonia were less likely to be discharged home. Key Words: Dysphagia; Pneumonia; Rehabilitation.
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Poster 57 Prospective, Single-Arm Pilot Study Evaluating the Safety and Efficacy of Two Hylan G-F 20 Injections in Patients With Advanced, Painful Glenohumeral Osteoarthritis With or Without Rotator Cuff Tear. Victoria Brander, MD (Northwestern University Feinberg School of Medicine, Chicago, IL); Mark Bowen; Michelle Chambers; Ameer Gomberawalla, BA; Gordon Nuber. Disclosure: M. Bowen, none; V. Brander, Genzyme, investigatorinitiated clinical research, research grants, consulting fees or other remuneration; M. Chambers, none; A. Gomberawalla, none; G. Nuber, none. Objective: To investigate the safety and efficacy of 2 hylan G-F 20 injections for painful glenohumeral osteoarthritis. Design: Prospective, open-label pilot study (conducted under an approved sponsor investigational device exemption and approved by an institutional review board). Setting: Orthopedic clinic. Participants: Ambulatory men and women (N⫽35), 35 years of age or older, with advanced symptomatic osteoarthritis of the glenohumeral joint of at least 3 months duration who failed conservative treatment after 3 months. 1 patient was lost to follow-up and 1 patient had a subsequent neck surgery and was included only in the safety analysis. Interventions: 2 injections (2cc each) of hylan G-F 20 2 weeks apart. Main Outcome Measures: Visual analog scale (VAS) for shoulder pain and Western Ontario Rotator Cuff Index (WORC) function rating scale were measured at baseline and at 6, 14, and 26 weeks. Rotator type analysis was performed by magnetic resonance imaging. Type and severity of adverse events were also assessed. An intent-to-treat analysis was performed. Results: Overall, a reduction in pain was observed over time. The mean VAS scores were significantly reduced at all time points (6 weeks, P⬍.03; 14 weeks, P⬍.00; 26 weeks, P⬍.006) compared with the mean baseline VAS score. A significant improvement (P⬍.006) in WORC was also observed at 26 weeks, with the most gains reported in the sports, symptoms, and lifestyle subcategories. There was no correlation between clinical response and age, sex, body mass index, and rotator cuff pathology. 3 subjects described heightened pain for a few days after injections. There were no inflammatory reactions. Conclusions: Our data suggest that treatment of painful glenohumeral osteoarthritis with 2 hylan G-F 20 injections improves pain and function and should be considered as part of a multimodal shoulder osteoarthritis treatment program. Key Words: Osteoarthritis; Rehabilitation. Poster 58 Rehabilitative Therapeutic Experience in a Patient With Secondary Parkinsonism Related to Hypoparathyroidism: A Case Report. Jae-Hyung Kim (Research Institute of Medical Sciences, Cardiovascular Research Institute, Chonnam National University Medical School and Hospital, Gwang-ju, South Korea); In-Sung Choi, MD, PhD; Jae-Young Han, MD; In-Sub Jang; Sam-Gyu Lee, MD, PhD; Su-Ra Ryu. Disclosure: I. Choi, Cardiovascular Research Instistute, research grants; Biohousing Research Institute, research grants; J. Han, none; I. Jang, none; J. Kim, none; S. Lee, none; S. Ryu, none. Setting: Tertiary-based rehabiliation center. Patient: A 16-year-old female with hypoparathyroidism. Case Description: The patient was admitted to rehabilitation unit with the chief complaint of progressive involuntary movement of all limbs and gait disturbance that had developed more than 2 weeks ago. She had a history of generalized seizures twice as an infant, and been diagnosed as having hypocalcemia caused by hypoparathyroidism. At admission, she was alert and oriented, but revealed facial hypomimia and dysarthria. Generalized rigidity was detected in all limbs. She could not help ambulating but wheelchair assist because of persistent involuntary movement and Arch Phys Med Rehabil Vol 89, November 2008
sive therapies. No adverse events related to DRX9000 treatment occurred. Conclusions: Overall, patients’ pain improved after DRX treatment, requiring fewer analgesics, with better function. There were no safety issues identified with the multimodal treatment routine. Nontreatment or control groups were not included, making efficacy outcome versus placebo or spontaneous recovery difficult to determine. Randomized double-blinded or comparative longterm outcome trials are needed to further prove the efficacy of the DRX9000 nonsurgical spinal decompression system for the routine treatment of chronic LBP. Key Words: Low back pain; Rehabiliation. Poster 56 Pneumonias in Tracheostomy Patients: Does Topical Oral Chlorhexidine Decrease Incidence During Inpatient Rehabilitation? Christina M. Marciniak, MD (McGaw Medical Center of Northwestern University, Northwestern Medical School/Rehabilitation Institute of Chicago, Chicago, IL); Mary Chung, MD; Adam Houghton; Patrick Semik, BA. Disclosure: M. Chung, none; A. Houghton, none; C.M. Marciniak, Allergan, research grants; P. Semik, none. Objective: To evaluate the effects of chlorhexidine, demographic variables, dysphagia, and their interaction on pneumonia incidence and resultant discharge destination in patients admitted to inpatient rehabilitation with tracheostomies. Design: Retrospective case-control study. Setting: Freestanding acute inpatient rehabilitation facility. Participants: 226 subjects admitted with tracheostomies over a 1-year period (2006). Interventions: All medical records of patients admitted to inpatient rehabilitation with a tracheostomy and discharged in 2006 were reviewed. Cases of hospital-acquired pneumonia were identified from the infectious disease database and by chart review. Chlorhexidine use was identified from the electronic medication record. Main Outcome Measures: Incidence of pneumonia and discharge destination. Results: 12.4% of all subjects developed at least 1 pneumonia during inpatient rehabilitation, compared to a pneumonia incidence of .49% in those admitted without a tracheostomy. Age and sex did not influence pneumonia incidence in these tracheostomy patients, nor did use of tube feedings. The presence of dysphagia did not influence pneumonia incidence (2⫽1.74, df⫽1, not significant), even when evaluated for dysphagia severity level. Of the 59 cases on chlorhexidine, 11.9% developed pneumonia while on this medication, compared to 14.1% of those not on chlorhexidine (2⫽.19, df⫽1, not significant). In looking at the interaction of medication use and dysphagia, chlorhexidine was not effective in reducing pneumonia incidence, even when evaluated for dysphagia severity level. Patients who developed pneumonia were less likely to be discharged home (2⫽10.431, df⫽1, P⫽.001). Conclusions: Chlorhexidine has been shown to be beneficial in preventing ventilator-associated pneumonia, particularly in cardiac surgery patients. However, in our high-risk population of inpatient rehabilitation patients with tracheostomies, chlorhexidine was not found to decrease pneumonia incidence. Age, sex, use of tube feedings, and presence of dysphagia also did not influence pneumonia incidence in this group. Patients who developed pneumonia were less likely to be discharged home. Key Words: Dysphagia; Pneumonia; Rehabilitation.
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Poster 57 Prospective, Single-Arm Pilot Study Evaluating the Safety and Efficacy of Two Hylan G-F 20 Injections in Patients With Advanced, Painful Glenohumeral Osteoarthritis With or Without Rotator Cuff Tear. Victoria Brander, MD (Northwestern University Feinberg School of Medicine, Chicago, IL); Mark Bowen; Michelle Chambers; Ameer Gomberawalla, BA; Gordon Nuber. Disclosure: M. Bowen, none; V. Brander, Genzyme, investigatorinitiated clinical research, research grants, consulting fees or other remuneration; M. Chambers, none; A. Gomberawalla, none; G. Nuber, none. Objective: To investigate the safety and efficacy of 2 hylan G-F 20 injections for painful glenohumeral osteoarthritis. Design: Prospective, open-label pilot study (conducted under an approved sponsor investigational device exemption and approved by an institutional review board). Setting: Orthopedic clinic. Participants: Ambulatory men and women (N⫽35), 35 years of age or older, with advanced symptomatic osteoarthritis of the glenohumeral joint of at least 3 months duration who failed conservative treatment after 3 months. 1 patient was lost to follow-up and 1 patient had a subsequent neck surgery and was included only in the safety analysis. Interventions: 2 injections (2cc each) of hylan G-F 20 2 weeks apart. Main Outcome Measures: Visual analog scale (VAS) for shoulder pain and Western Ontario Rotator Cuff Index (WORC) function rating scale were measured at baseline and at 6, 14, and 26 weeks. Rotator type analysis was performed by magnetic resonance imaging. Type and severity of adverse events were also assessed. An intent-to-treat analysis was performed. Results: Overall, a reduction in pain was observed over time. The mean VAS scores were significantly reduced at all time points (6 weeks, P⬍.03; 14 weeks, P⬍.00; 26 weeks, P⬍.006) compared with the mean baseline VAS score. A significant improvement (P⬍.006) in WORC was also observed at 26 weeks, with the most gains reported in the sports, symptoms, and lifestyle subcategories. There was no correlation between clinical response and age, sex, body mass index, and rotator cuff pathology. 3 subjects described heightened pain for a few days after injections. There were no inflammatory reactions. Conclusions: Our data suggest that treatment of painful glenohumeral osteoarthritis with 2 hylan G-F 20 injections improves pain and function and should be considered as part of a multimodal shoulder osteoarthritis treatment program. Key Words: Osteoarthritis; Rehabilitation. Poster 58 Rehabilitative Therapeutic Experience in a Patient With Secondary Parkinsonism Related to Hypoparathyroidism: A Case Report. Jae-Hyung Kim (Research Institute of Medical Sciences, Cardiovascular Research Institute, Chonnam National University Medical School and Hospital, Gwang-ju, South Korea); In-Sung Choi, MD, PhD; Jae-Young Han, MD; In-Sub Jang; Sam-Gyu Lee, MD, PhD; Su-Ra Ryu. Disclosure: I. Choi, Cardiovascular Research Instistute, research grants; Biohousing Research Institute, research grants; J. Han, none; I. Jang, none; J. Kim, none; S. Lee, none; S. Ryu, none. Setting: Tertiary-based rehabiliation center. Patient: A 16-year-old female with hypoparathyroidism. Case Description: The patient was admitted to rehabilitation unit with the chief complaint of progressive involuntary movement of all limbs and gait disturbance that had developed more than 2 weeks ago. She had a history of generalized seizures twice as an infant, and been diagnosed as having hypocalcemia caused by hypoparathyroidism. At admission, she was alert and oriented, but revealed facial hypomimia and dysarthria. Generalized rigidity was detected in all limbs. She could not help ambulating but wheelchair assist because of persistent involuntary movement and Arch Phys Med Rehabil Vol 89, November 2008