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      • Supporting Communication Partners in a Leisure Setting to Enhance Social Interaction and Participation for Individuals with Complex Communication Needs

        David Joseph Hajjar,John Walter McCarthy,Molly Lanphear Hajjar 한국언어재활사협회 2018 Clinical Archives of Communication Disorders Vol.3 No.3

        Communication partners are critical supports for individuals with complex communication needs who participate in leisure activities. Partners (e.g., volunteers, program leaders, support staff) can enhance recreational experiences by facilitating opportunities for communication, interaction, and participation. In this study, a single subject multiple baseline design across two time periods was used to examine the accuracy of volunteers’ in their ability to implement a program designed to promote communication and participation. Four volunteers from therapeutic riding learned to apply a communication program that focused on providing participants with a method to capture and share their riding experience. Results indicated that the volunteers successfully learned the program and that riders increased the amount of communication turns taken with volunteers. Volunteers, participants, and caregivers also shared their overall perspectives after program implementation. Implications and recommendations for future practice are provided for volunteers, participants and caregivers, recreational therapists, and other related professionals.

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        Effects of Body Mass Index on Perioperative Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgery

        Roberto J. Perez-Roman,David McCarthy,Evan M. Luther,Julian G. Lugo-Pico,Roberto Leon-Correa,Wendy Gaztanaga,Karthik Madhavan,Steven Vanni 대한척추신경외과학회 2021 Neurospine Vol.18 No.1

        Objective: Obesity has become a public health crisis and continues to be on the rise. An elevated body mass index has been linked to higher rates of spinal degenerative disease requiring surgical intervention. Limited studies exist that evaluate the effects of obesity on perioperative complications in patients undergoing anterior cervical discectomy and fusion (ACDF). Our study aims to determine the incidence of obesity in the ACDF population and the effects it may have on postoperative inpatient complications. Methods: The National Inpatient Sample was evaluated from 2004 to 2014 and discharges with International Classification of Diseases procedure codes indicating ACDF were identified. This cohort was stratified into patients with diagnosis codes indicating obesity. Separate univariable followed by multivariable logistic regression analysis were performed for the likelihood of perioperative inpatient outcomes among the patients with obesity. Results: From 2004 to 2014, estimated 1,212,475 ACDFs were identified in which 9.2% of the patients were obese. The incidence of obesity amongst ACDF patients has risen dramatically during those years from 5.8% to 13.4%. Obese ACDF patients had higher inpatient likelihood of dysphagia, neurological, respiratory, and hematologic complications as well as pulmonary emboli, and intraoperative durotomy. Conclusion: Obesity is a well-established modifiable comorbidity that leads to increased perioperative complications in various surgical specialties. We present one of the largest retrospective analyses evaluating the effects of obesity on inpatient complications following ACDF. Our data suggest that the number of obese patients undergoing ACDF is steadily increasing and had a higher inpatient likelihood of developing perioperative complications.

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        National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery

        Roberto J. Perez-Roman,Evan M. Luther,David McCarthy,Julian G. Lugo-Pico,Roberto Leon-Correa,Steven Vanni,Michael Y. Wang 대한척추신경외과학회 2021 Neurospine Vol.18 No.1

        Objective: Anterior cervical discectomy and fusion (ACDF) is the most common performed surgery in the cervical spine. Dysphagia is one of the most frequent complications following ACDF. Several studies have identified certain demographic and perioperative risk factors associated with increased dysphagia rates, but few have reported recent trends. Our study aims to report current trends and factors associated with the development of inpatient postoperative dysphagia after ACDF. Methods: The National Inpatient Sample was evaluated from 2004 to 2014 and discharges with International Classification of Diseases procedure codes indicating ACDF were selected. Time trend series plots were created for the yearly treatment trends for each fusion level by dysphagia outcome. Separate univariable followed by multivariable logistic regression analyses were performed to evaluate predictors of dysphagia. Results: A total of 1,212,475 ACDFs were identified in which 3.3% experienced postoperative dysphagia. A significant increase in annual dysphagia rates was observed from 2004–2014. Frailty, intraoperative neuromonitoring, 4 or more level fusions, African American race, fluid/electrolyte disorders, blood loss, and coagulopathy were all identified as significant independent risk factors for the development of postoperative dysphagia following ACDF. Conclusion: Postoperative dysphagia is a well-known postsurgical complication associated with ACDF. Our cohort showed a significant increase in the annual dysphagia rates independent of levels fused. We identified several risk factors associated with the development of postoperative dysphagia after ACDF.

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