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Resident and Staff Experiences with Palliative Care Services Provided in Nursing Homes: Qualitative Content Analysis of Focus Group Transcripts
Research Posters Key Words: Stroke, postural balance, kinematics Disclosures: None disclosed. Research Poster 460 Paretic Kinematic Determinants of Temporal Asymmetry in Subacute Post-Stroke Patients Maria Julieta Russo (FLENI), Lisandro Olmos, Christian Gath, Marcos Crespo, Marcelo Gatti, MatA˜-as Gianella, Lucas Bonamico, Lisandro Olmos Research Objectives: Temporal asymmetry and kinematic analysis are useful outcome to study the negative consequences of gait alterations. Our objectives were: 1) to know the level of relationship between the peaks of extension and flexion of the hip, knee and ankle of the paretic limb and the temporal asymmetry, 2) to identify those kinematic alterations of the paretic limb that determine temporal asymmetry in subacute poststroke patients. Design: Case series. Setting: Neurorehabilitation department of a tertiary hospital. Participants: A convenience sample of 17 subacute post-stroke subjects was included. Interventions: Not Applicable. Main Outcome Measure(s): The kinematic variables of interest were peak hip flexion/extension, peak knee flexion/extension, and peak ankle dorsiflexion/extension in a gait laboratory. The Temporal Swing Symmetry (TSS) Ratio was calculated (TSSZ paretic swing time/nonparetic swing time). Results: Six (35.30%) were haemorrhagic and 10 (58.7%) ischemic. Mean age was 52.94 ( 14.11) years and 12 (70.6%) were male. A multiple linear regression was calculated to predict TSS based on age, side stroke, walking velocity, motor function, spasticity, and kinematic variables. A significant regression equation was found (F (2, 14) Z 27.138, p<.001), with an R2 of .795. TSS ratio was positively correlated with peak hip flexion and negatively with walking velocity (p < .001). Conclusions: These results suggest that an increased peak hip flexion reflects a possible compensatory strategy to advance the paretic limb in swing phase. In those more asymmetric the compensatory strategy would start at stance phase with a flexed hip posture that move the body mass forward the knee and then a wider range of motion is needed to advance the paretic limb, furthermore it decreases the swing time of the nonparetic limb and also modifies the TSS ratio. Key Words: Stroke, gait analysis, Kinematic Disclosures: None disclosed. Research Poster 461 Resident and Staff Experiences with Palliative Care Services Provided in Nursing Homes: Qualitative Content Analysis of Focus Group Transcripts Marie Earl (School of Physiotherapy, Dalhousie University), Tamara Sussman, Sharon Kaasalainen Research Objectives: To describe the experiences of Residents and Staff related to the impact of palliative care services on health and well-being of seniors who live in long-term-care (LTC). Design: Qualitative study, using transcripts of focus groups. Setting: Long-term Care. Participants: Following ethical approval, and informed consent, volunteers for separate Resident or Staff focus groups were recruited from each of two LTC facilities. Interventions: Not Applicable. Main Outcome Measure(s): Thematic analysis based on the World Health Organization International Classification of Functioning (WHO, 2002) combined with five domains associated with health and well-being: Mobility, Self-Care, Usual Activities, Pain/Discomfort and Anxiety/ Depression (Rabin and de Charro, 2001).
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e69 Results: Both Resident and Staff informants focused on experiences during terminal and after-care stages of palliative care. Within that timeframe, informants emphasized factors affecting privacy, physical and emotional comfort, and relationships of the dying resident; consequences of environmental factors (e.g. room design, shared rooms, staffing levels, access to medical care), and personal factors (e.g. culture, relationships) on health status were raised. Opportunities for discussion of palliative care at, or after, admission to the LTC facility were not common. Conclusions: The emphasis on terminal and after care, raised by these Resident and Staff informants, prompts further inquiry about strategies to protect the health and quality of life of residents, when death of a resident is imminent, or has just occurred. Since palliative care strategies are indicated as part of integrated care for those with chronic and progressive diseases (Davies et al, 2004; Meier et al, 2010), further attention to the use of palliative strategies that protect function, and address symptoms such as pain, dyspnea, depression and anxiety, is warranted to advance geriatric care for this vulnerable population. Key Words: Palliative Care, Long-term Care, Rehabilitation Disclosures: None Disclosed. Research Poster 462 Effects of Circulating Reproductive Hormones and Traumatic Brain Injury (TBI) Onset on Short-Term TBI Outcomes for Women Ages 18-35 Janet Niemeier (Carolinas Medical Center, Department of Physical Medicine and Rehabilitation), Bradley Hurst, David Foureau Research Objectives: To identify effects of injury onset and circulating reproductive hormones (Progesterone) on short-term outcomes following TBI. Design: Case controlled, repeated measures design pilot. Setting: Emergency Department, Level 1 Trauma Center Hospital; General community. Participants: Subjects: By order of admission, 21 women Ages 18- 35, presenting with TBI at Level 1 Trauma Center Emergency Department; 21 healthy controls matched for age. Exclusions: pregnancy, prior TBI. Interventions: Not Applicable. Main Outcome Measure(s): Two 20 mL serum samples Estradiol, FSH, LSH, Progesterone, Cortisol. Baseline MiniMental Status Examination (MMSE), FIMs, medical and reproductive history. Six months follow-up MMSE, and CIQ. Medical and reproductive updates. Hypotheses: 1) Highest levels of Progesterone at time of injury will predict better short-term TBI outcomes. 2) Hormone levels will distinguish cases and controls. Results: Hypothesis 1: Partially supported. Baseline Progesterone had a substantial positive correlation with social integration but no significant main effect of Progesterone for group. Hypothesis 2: Supported partially women with TBI had lower Estradiol, FSH, LSH and higher Cortisol than healthy controls. Conclusions: Compared to healthy controls, women with even mild TBI have significant post-injury changes in sex hormone levels, and evidence of the physical stresses of TBI. Some of these changes were associated with post-injury social and productivity outcomes. Further research needed with larger samples. Key Words: Traumatic brain injury, gender, outcomes Disclosures: None disclosed. Research Poster 463 The Results of Image Guided Surgery Using Neuronavigation in Resection of Cerebral Gliomas in Eloquent Cortical Areas Amir Nikouei (Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences), Afsoun Seddighi, Amir Saied Seddighi, Amir Nikouei
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e69 Results: Both Resident and Staff informants focused on experiences during terminal and after-care stages of palliative care. Within that timeframe, informants emphasized factors affecting privacy, physical and emotional comfort, and relationships of the dying resident; consequences of environmental factors (e.g. room design, shared rooms, staffing levels, access to medical care), and personal factors (e.g. culture, relationships) on health status were raised. Opportunities for discussion of palliative care at, or after, admission to the LTC facility were not common. Conclusions: The emphasis on terminal and after care, raised by these Resident and Staff informants, prompts further inquiry about strategies to protect the health and quality of life of residents, when death of a resident is imminent, or has just occurred. Since palliative care strategies are indicated as part of integrated care for those with chronic and progressive diseases (Davies et al, 2004; Meier et al, 2010), further attention to the use of palliative strategies that protect function, and address symptoms such as pain, dyspnea, depression and anxiety, is warranted to advance geriatric care for this vulnerable population. Key Words: Palliative Care, Long-term Care, Rehabilitation Disclosures: None Disclosed. Research Poster 462 Effects of Circulating Reproductive Hormones and Traumatic Brain Injury (TBI) Onset on Short-Term TBI Outcomes for Women Ages 18-35 Janet Niemeier (Carolinas Medical Center, Department of Physical Medicine and Rehabilitation), Bradley Hurst, David Foureau Research Objectives: To identify effects of injury onset and circulating reproductive hormones (Progesterone) on short-term outcomes following TBI. Design: Case controlled, repeated measures design pilot. Setting: Emergency Department, Level 1 Trauma Center Hospital; General community. Participants: Subjects: By order of admission, 21 women Ages 18- 35, presenting with TBI at Level 1 Trauma Center Emergency Department; 21 healthy controls matched for age. Exclusions: pregnancy, prior TBI. Interventions: Not Applicable. Main Outcome Measure(s): Two 20 mL serum samples Estradiol, FSH, LSH, Progesterone, Cortisol. Baseline MiniMental Status Examination (MMSE), FIMs, medical and reproductive history. Six months follow-up MMSE, and CIQ. Medical and reproductive updates. Hypotheses: 1) Highest levels of Progesterone at time of injury will predict better short-term TBI outcomes. 2) Hormone levels will distinguish cases and controls. Results: Hypothesis 1: Partially supported. Baseline Progesterone had a substantial positive correlation with social integration but no significant main effect of Progesterone for group. Hypothesis 2: Supported partially women with TBI had lower Estradiol, FSH, LSH and higher Cortisol than healthy controls. Conclusions: Compared to healthy controls, women with even mild TBI have significant post-injury changes in sex hormone levels, and evidence of the physical stresses of TBI. Some of these changes were associated with post-injury social and productivity outcomes. Further research needed with larger samples. Key Words: Traumatic brain injury, gender, outcomes Disclosures: None disclosed. Research Poster 463 The Results of Image Guided Surgery Using Neuronavigation in Resection of Cerebral Gliomas in Eloquent Cortical Areas Amir Nikouei (Shohada Tajrish Neurosurgical Center of Excellence, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences), Afsoun Seddighi, Amir Saied Seddighi, Amir Nikouei