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Aims: Motor Neuron Disease (MND) is a progressive neurodegenerative neuromuscular disease, which can progressively impair arm-hand function. Needs and barriers of MND patients and their caregivers in performing oral hygiene were studied. Methods: An online survey was sent to 706 MND patients. The questions of the survey included self-reliance, self-reported oral health, and oral hygiene. The oral health-related quality of life (GOHAI-NL) and the subjective well-being (ALSAQ-5) were also measured. Results: A total of 259 patients responded (36.7%), of which 71.9% stated not to be informed about the importance of maintaining good oral health by their MND treatment team. Moreover, 40.4% would like to receive help concerning oral hygiene from a dental professional. 19.8% were not satisfied about oral care as conducted by themselves or their caregivers. Patients who do not ask for support with their daily oral care had a significantly worse oral health-related quality of life compared to patients who do ask for support. Conclusions: The support for daily oral hygiene of MND patients and their barriers to requesting support needs more attention from both MND-treatment teams and general dental professionals.

espanolEn este Trabajo Fin de Grado vamos a analizar los casos de menores en riesgo social que han sido cerrados por los profesionales del Equipo de Tratamiento Familiar sin el cumplimiento de los objetivos fijados en el municipio de Roquetas de Mar en el ano 2018.El Equipo de Tratamiento Familiar esta llamado a intervenir en casos donde la dinamica familiar precisa modificar los patrones de conducta inadecuados para asi garantizar el bienestar de ninos, ninas y adolescentes y su permanencia en el nucleo familiar.Esta derivacion al Equipo de Tratamiento Familiar para intentar solventar la problematica puede provenir desde los Servicios Sociales Comunitarios (SS.SS.CC), ubicados dentro de la atencion primaria o si la casuistica presenta una mayor gravedad la intervencion sera derivada desde el Servicio de Proteccion de Menores (SPM) o segundo nivel de atencion al Equipo de Tratamiento Familiar.Vamos a analizar las principales causas que han desembocado en una intervencion fallida y que situan a los menores en una situacion de desproteccion y vulnerabilidad que podria desencadenar en un desamparo y por tanto la consiguiente retirada de la custodia a los progenitores. EnglishIn this Final Degree Project we will analyze the cases of minors at social risk that have been closed by professionals of the Family Treatment Team without meeting the objectives set in the municipality of Roquetas de Mar in 2018. The Family Treatment Team is called to intervene in cases where the family dynamics needs to modify the inappropriate behavior patterns in order to guarantee the wellbeing of children and adolescents and their permanence in the family nucleus. This referral to the Family Treatment Team to try to solve the problem may come from the Community Social Services (SS.SS.CC), located within primary care or if the casuistry is more serious the intervention will be derived from the Protection Service of Minors (SPM)or second level of attention to the Family Treatment Team. We will analyze the main causes that have led to a failed intervention and that place the children in a situation of vulnerability and vulnerability that could trigger a helplessness and therefore the subsequent withdrawal of custody of the parents. Keywords: children, vulnerability, defencelessness, abandonment.

Sleep is a dynamic restorative process that is frequently disrupted in critically ill patients. Inadequate sleep can contribute to delirium and impaired healing. The etiology is multifactorial and practitioners often use a combination of nonpharmacologic and pharmacologic therapies to promote a healthy sleep cycle. There are many pharmacologic agents that may be used to promote sleep, and they display varying degrees of efficacy and safety. The selection of agent(s) should be based on patient- and disease-specific factors. All members of the treatment team can aid in assessing and optimizing sleep for critically ill patients.

ملخص البحث استهدفت الدراسة الحالية التعرف على أدوار البيئة الاجتماعية متمثلة في نسق کل من (الأسرة والأصدقاء والفريق العلاجي) في وقاية المتعافين ببيوت منتصف الطريق من الانتکاسة والتوصل الى تصور مقترح من منظور الممارسة العامة في الخدمة الاجتماعية لتعزيز هذه الأدوار. وتنتمي الدراسة الحالية الى الدراسات الوصفية التحليلية التي تسعى إلى تحقيق الوصف الکيفي والکمي لدور البيئة الاجتماعية لوقاية المتعافين ببيوت منتصف الطريق من الانتکاسة. ولقد تم الاستفادة من منهج المسح الاجتماعي بالعينة. وطبقت الدراسة على عينة عمدية ( غير عشوائية ) قوامها (56) من الأعضاء المتعافين ببيت منتصف الطريق بمستشفى دکتور جمال ماضي أبو العزائم فرع التجمع الأول بالقاهرة الجديدة وفرع العياط بالجيزة. ومن أهم نتائج الدراسة أن هناک علاقة إيجابية ذات دلالة إحصائية بين دور البيئة الاجتماعية متمثلة في نسق کل من (الأسرة والأصدقاء والفريق العلاجي ) ووقاية المتعافين ببيت منتصف الطريق من الانتکاسة ، وکذلک التوصل لتصور مقترح من منظور الممارسة العامة في الخدمة الاجتماعية لوقاية المتعافين ببيت منتصف الطريق من الانتکاسة. الکلمات المفتاحية: البيئة الاجتماعية، الانتکاسة، بيت منتصف الطريق. The role of the social environment in protecting those recovering from relapse or setback in halfway houses and a suggested perception from the perspective of generalist practice of social work to strengthen it Abstract The current study aimed to identify the roles of the social environment represented in the role of (family, friends and the treatment team) in protecting those recovering in halfway houses from relapse or setback and to come up with a suggested perception from the perspective of generalist practice of social work to strengthen these roles. The current study belonged to the descriptive and analytical studies that seek to achieve a qualitative and quantitative description of the role of the social environment to protect those recovering in halfway houses from relapse or setback. The social survey method has been used. The study was applied to a non- random sample of (56) members recovering from the halfway houses at Dr. Jamal Madi Abu Al-Azim Hospital, First Settlement Branch in New Cairo and Al-Ayyat Branch in Giza. Among the most important results of the study was that there was a positive relationship with statistical significance between the role of the social environment represented in the pattern of each of (family, friends and the treatment team) and the prevention of those recovering in the halfway houses from relapse or setback, as well as reaching a suggested perception from the perspective of generalist practice of social work to prevent recovered people in the halfway houses from relapse or setback. Key words: Social environment, relapse or setback, midway house.

As social workers and nurses comprise much of the substance dependence treatment team, it is critical to evaluate how well they perform in a context where they bring different professional orientat...

Physical rehabilitation is common after an individual ex-periences a spinal cord injury. A coordinated multidis-ciplinary team provides services to assist the individual to be as independent as possible when discharged from rehabilitation. There is extensive literature reporting that age, admission FIM™ scores, and the severity of injury are predictive of independence at discharge. The purpose of this study was to investigate change in FIM™ scores based on combination of time spent in different therapies while controlling for severity of injury. We abstracted data from 142 individuals diagnosed with an SCI, between the ages 18 and 91. Results indicate the higher the full stay sever-ity, as computed by the computerized severity index, the smaller gains in global and motor FIM™ scores. We also found that treatment time by occupational, physical, and recreational therapies were independent of patient sever-ity level. Much like the existing literature, individuals with higher severity scores generally have smaller gains in functional independence. It may be important that recreational therapists, along with other treatment team members provide more opportunities for therapy and training to further improve upon an individual’s func-tional independence scores. Subscribe to JPRA

Goeckerman therapy is a highly effective treatment regimen for moderate-to-severe psoriasis. It involves regular exposure to ultraviolet B radiation and the application of crude coal tar. To our knowledge, only three centers in the USA currently offer a formal Goeckerman therapy treatment program; thus, access to this therapy is geographically limited. In this article, a motivated patient discusses his experience with generalized plaque psoriasis. This patient, while living in a Goeckerman-inaccessible area, deferred treatment with biologics and outpatient phototherapy to develop a modified Goeckerman regimen for at-home use. This home regimen, which did not involve the use of prescription-strength medications, resulted in full clearance of his psoriasis. We also discuss the patient’s case from the perspective of a dermatology treatment team that has reviewed his experience.

» Shoulder instability is a complex problem with a high rate of recurrence in athletes. Treatment of a first-time subluxation or dislocation event is controversial and depends on patient-specific factors as well as the identified pathology. » Athletic trainers and physical therapists are an integral part of the treatment team of an in-season athlete who has experienced a shoulder instability event. Through comprehensive physiological assessments, these providers can effectively suggest modifications to the patient's training regimen as well as an appropriate rehabilitation program. » Surgical intervention for shoulder stabilization should use an individualized approach for technique and timing. » A team-based approach is necessary to optimize the care of this high-demand, high-risk population.

Despite the emergence of more effective targeted therapies, cancer treatment remains a complex process requiring a holistic patient-centered approach, beyond the direct medical care offered by the treating hematologist/oncologist. This entails empowering patients with knowledge about prescribed regimens and their risks and side effects, within a multifaceted treatment team involving hematologists/oncologists, advanced practice providers, nurses, nutritionists, and pharmacists, among others. Additionally, a multitude of resources are generally available including financial, religious, and spiritual support to help patients in the treatment journey. This chapter describes resources generally available to cancer patients, as well as an array of supporting services in a cancer center to address the patient needs.

BACKGROUND Although many cleft teams have adopted nasoalveolar molding to improve nasal form, few comparative studies have assessed the postoperative benefits of this treatment. Given that reported outcomes have been contradictory and that treatment involves considerable burden to families, the purpose of this study was to assess objective and subjective changes from nasoalveolar molding at approximately 5 years of age. METHODS All patients with complete unilateral cleft lip and palate who underwent primary cheiloplasty performed by a single surgeon over a 7-year period were reviewed. Patient results were grouped into nasoalveolar molding or no-nasoalveolar molding. Cleft severity and aesthetic outcomes were assessed by panels of raters who independently ranked subject images at presentation, immediately preoperative (after molding), and at 5-year follow-up. Objective symmetry was measured using standard anthropometric analysis on three-dimensional images. RESULTS Among 41 patients included, 16 successfully completed nasoalveolar molding. Both groups were similar at presentation; however, the nasoalveolar molding group had improved appearance following molding (p < 0.05). After surgery, at 5 years of age, the nasoalveolar molding group had better rank scores for overall appearance (p < 0.05), cleft nostril height, and cleft medial lip height (p < 0.05). Regression analysis revealed that nasoalveolar molding treatment was the most significant predictor of overall nasal appearance at 5 years, but that treatment team experience and initial severity were also significant predictors (p < 0.05). Qualitative audit following analysis identified favorable and unfavorable features of nasoalveolar molding. CONCLUSION In children with complete unilateral cleft lip and palate, nasoalveolar molding was associated with better overall nasal aesthetics and improved cleft nostril height and cleft medial lip height at approximately 5 years of age. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.

Funding Information: Outside the submitted work, the authors disclose the following. Bausell H received personal fees from BioMarin, Ultragenyx, Horizon and Vitaflo. Bélanger-Quintana A reports personal fees from BioMarin, Nutricia, Vitaflo, Orphan Europe, Takeda and Genzyme. Rocha JC received research grants from BioMarin, Glutamine and Cambrooke, as well as personal fees from BioMarin, Applied Pharma Research, Nutricia, Merck Serono, Vitaflo, Cambrooke, PIAM and Lifediet. MacDonald A reports research funding from BioMarin, Nutricia, Applied Pharma Research, Vitaflo, Galen, Metax, Mevalia and Arla, as well as lecture fees from BioMarin, Applied Pharma Research, Nutricia and Vitaflo, and consultancy fees from BioMarin, Applied Pharma Research, Arla, Nutricia and Vitaflo. Met Ed reports grant funding from BioMarin, Nutricia, Vitaflo and Horizon Pharmaceuticals. Bernstein L and Rohr F report lecture fees from Vitaflo. Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved. Background: The metabolic dietitian/nutritionist (hereafter ‘dietitian’) plays an essential role in the nutritional management of patients with phenylketonuria (PKU), including those on pegvaliase. Currently, more educational support and clinical experience is needed to ensure that dietitians are prepared to provide optimal nutritional management and counselling of pegvaliase-treated patients. Methods: Via a face-to-face data-review meeting, followed by a virtual consolidation meeting, a group of expert dietitians and one paediatrician discussed and developed a series of recommendations on the nutritional evaluation and management of patients receiving pegvaliase. The consensus group consisted of 10 PKU experts: six dietitians and one paediatrician from Europe and three dietitians from the US. One European and three US dietitians had experience with pegvaliase-treated patients. Results: The consensus group recommended that a physician, dietitian and nurse are part of the pegvaliase treatment team. Additionally, a psychologist/counsellor should be included if available. Practical proposals for the nutritional evaluation of pegvaliase-treated patients at baseline, during the induction and titration phases and for long-term maintenance were developed. The consensus group suggested assessment of blood Phe at least monthly or every 2 weeks in the event of low blood Phe (i.e., blood Phe