Journal of Oral RehabilitationEarly View LETTER TO THE EDITOR A commentary on 'Focal vibration in dysphagia: A technological treatment for severe acquired brain injury rehabilitation' F. Camerota, F. Camerota Physical Medicine and Rehabilitation, Umberto I University Hospital, Rome, ItalySearch for more papers by this authorM. Toscano, M. Toscano Department of Human Neurosciences, "Sapienza" University of Rome, Rome, ItalySearch for more papers by this authorV. Di Piero, V. Di Piero Department of Human Neurosciences, "Sapienza" University of Rome, Rome, ItalySearch for more papers by this authorC. Celletti, Corresponding Author C. Celletti [email protected] orcid.org/0000-0001-7154-5882 Physical Medicine and Rehabilitation, Umberto I University Hospital, Rome, Italy Correspondence C. Celletti, Physical Medicine and Rehabilitation, Umberto I University Hospital, Rome, Italy. Email: [email protected]Search for more papers by this author F. Camerota, F. Camerota Physical Medicine and Rehabilitation, Umberto I University Hospital, Rome, ItalySearch for more papers by this authorM. Toscano, M. Toscano Department of Human Neurosciences, "Sapienza" University of Rome, Rome, ItalySearch for more papers by this authorV. Di Piero, V. Di Piero Department of Human Neurosciences, "Sapienza" University of Rome, Rome, ItalySearch for more papers by this authorC. Celletti, Corresponding Author C. Celletti [email protected] orcid.org/0000-0001-7154-5882 Physical Medicine and Rehabilitation, Umberto I University Hospital, Rome, Italy Correspondence C. Celletti, Physical Medicine and Rehabilitation, Umberto I University Hospital, Rome, Italy. Email: [email protected]Search for more papers by this author First published: 27 December 2023 https://doi.org/10.1111/joor.13644Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Open Research PEER REVIEW The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1111/joor.13644. DATA AVAILABILITY STATEMENT Not applicable. REFERENCES 1Galluccio C, Pazzaglia C, Spaccatrosi S, Giovannini S, Castelli L, Padua L. Focal vibration in dysphagia: a technological treatment for severe acquired brain injury rehabilitation. J Oral Rehabil. 2023; 50(8): 679-686. doi:10.1111/joor.13465 10.1111/joor.13465 CASPubMedWeb of Science®Google Scholar 2Murillo N, Valls-Sole J, Vidal J, et al. Focal vibration in neurorehabilitation. Eur J Phys Rehabil Med. 2014; 50(2): 231-242. CASPubMedWeb of Science®Google Scholar 3Casale R. Focal, local or segmental vibration? Eur J Phys Rehabil Med. 2015; 51(4): 507-508. CASPubMedWeb of Science®Google Scholar 4Viganò A, Celletti C, Giuliani G, et al. Focal muscle vibration (fMV) for post-stroke motor recovery: multisite neuroplasticity induction, timing of intervention, clinical approaches, and prospects from a narrative review. Vibration. 2023; 6(3): 645-658. doi:10.3390/vibration6030040 10.3390/vibration6030040 Google Scholar 5Celletti C, Suppa A, Bianchini E, et al. Promoting post-stroke recovery through focal or whole body vibration: criticisms and prospects from a narrative review. Neurol Sci. 2020; 41: 11-24. doi:10.1007/s10072-019-04047-3 10.1007/s10072-019-04047-3 PubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Background and purpose Dysphagia occurs in up to 50% of all patients with acute stroke. There is debate regarding which is the most effective screening tool in identifying aspiration in patients with acute stroke. We assessed the accuracy of the Sapienza Global Bedside Evaluation of Swallowing after Stroke ( GLOBE ‐3S), which combines the Toronto Bedside Swallowing Screening Test ( TOR ‐ BSST ©) with oxygen desaturation and laryngeal elevation measurement during swallowing. Methods We prospectively enrolled consecutive patients with stroke within 72 h of symptom onset. All patients with stroke firstly underwent a standard neurological examination, then the GLOBE ‐3S evaluation and finally the fiberoptic endoscopic evaluation of swallowing ( FEES ). Two different assessors, a neurologist and a speech pathologist, blind to both the clinical data and each other's evaluation, administered the GLOBE ‐3S and FEES examination. We assessed the accuracy of the GLOBE ‐3S in detecting post‐stroke swallow impairment with aspiration using the FEES as the standard. Results We enrolled 50 patients with acute stroke, 28 of whom (56%) had swallowing impairment with aspiration at FEES evaluation. A total of 33 patients (66%) failed the GLOBE ‐3S evaluation. The GLOBE ‐3S reached a sensitivity of 100% and a specificity of 77.3% (negative predictive value, 100%; positive likelihood ratio, 4.34). The median time required for the GLOBE ‐3S to be performed was 297 s. Conclusions GLOBE ‐3S is quick to perform at the bedside and can accurately identify aspiration in patients with acute stroke. By including the measurement of laryngeal elevation and monitoring of oxygen desaturation, it could represent a highly sensitive instrument to avoid the misdiagnosis of silent aspirators.

ed from JAMA Oncol 2015;1:1251–1260 The aims of this study were to identify factors associated with use of BRCA testing and to determine whether current genetic counseling referral and testing services in a community setting adhere to recommended professional guidelines.

IMPORTANCEBRCA genetic testing has substantial public health impact, yet little is known of the real-world experiences of the more than 100 000 Americans undergoing testing annually.OBJECTIVETo identify factors associated with use of BRCA testing, assess whether delivery of genetic counseling and testing services adheres to professional guidelines, and measure the impact on patient-reported outcomes.DESIGN, SETTING, AND PARTICIPANTSThe American BRCA Outcomes and Utilization of Testing (ABOUT) Study analyzed data from a consecutive national series of 11 159 women whose clinicians ordered BRCA testing between December 2011 and December 2012. Aetna mailed recruitment information across the United States to commercial health plan members whose clinicians had ordered BRCA testing. A total of 3874 women (34.7%) completed questionnaires. Deidentified clinician-reported data from all respondents and a random sample of 2613 nonrespondents were also analyzed.MAIN OUTCOMES AND MEASURESThe proportion of eligible participants who met testing criteria and respondents' report of receiving genetic counseling by a genetics clinician and its association with BRCA knowledge, understanding, and satisfaction were assessed.RESULTSAmong 3628 women respondents whose clinicians ordered comprehensive BRCA testing, most were white non-Hispanic (2502 [69.0%]), college educated (2953 [81.4%]), married (2751 [75.8%]), and had higher incomes (2011 [55.4%]). Approximately 16.4% (596) did not meet testing criteria. Mutations were identified in 161 (5.3%) of these women who received comprehensive testing. Only 1334 (36.8%) reported receiving genetic counseling from a genetics clinician prior to testing; the lowest rates (130 [12.3%]) were among patients of obstetrician/gynecologists. The most commonly reported reason for not receiving this clinical service was lack of clinician recommendation. Those who received it demonstrated greater knowledge about BRCA (mean score difference adjusted for demographics and clinician specialty, β = 0.99 [95% CI, 0.83-1.14]; P < .001) and expressed greater understanding (β = 0.47 [95% CI, 0.41-0.54]; P < .001) and satisfaction (β = 2.21 [95% CI, 1.60-2.81]; P < .001).CONCLUSIONS AND RELEVANCEDespite improved patient knowledge, understanding, and satisfaction among patients who receive genetic counseling provided by a genetics clinician, as well as multiple guidelines emphasizing the importance of genetic counseling, most US women undergoing BRCA genetic testing do not receive this clinical service. Lack of physician recommendation is the most commonly reported reason. These findings demonstrate important gaps in clinical genetics services. Recently mandated coverage of genetic counseling services as a preventive service without patient cost sharing should contribute to improving clinical genetics services and associated outcomes in the future.

With the Affordable Care Act reducing coverage disparities, social factors could prominently determine where and for whom innovations first diffuse in health care markets. Gene expression profiling is a potentially cost-effective innovation that guides chemotherapy decisions in early-stage breast cancer, but adoption has been uneven across the United States. Using a sample of commercially insured women, we evaluated whether income inequality in metropolitan areas was associated with receipt of gene expression profiling during its initial diffusion in 2006-07. In areas with high income inequality, gene expression profiling receipt was higher than elsewhere, but it was associated with a 10.6-percentage-point gap between high- and low-income women. In areas with low rates of income inequality, gene expression profiling receipt was lower, with no significant differences by income. Even among insured women, income inequality may indirectly shape diffusion of gene expression profiling, with benefits accruing to the highest-income patients in the most unequal places. Policies reducing gene expression profiling disparities should address low-inequality areas and, in unequal places, practice settings serving low-income patients.

Objectives: To evaluate the potential benefit of systematic preoperative coronary-artery angiography followed by selective coronary-artery revascularization on the incidence of myocardial infarction (MI) in patients undergoing carotid endarterectomy (CEA) without a previous history of coronary artery disease (CAD).Methods: We randomised 426 patients who were candidates for CEA, with no history of CAD, a normal electrocardiogram (ECG), and a normal cardiac ultrasound. In group A (n = 216) all patients underwent coronary angiography before CEA. In group B (n = 210) CEA was performed without coronary angiography. Patients were not blinded for relevant assessments during follow-up. Primary end-point was the occurrence of MI at 3.5 years. The secondary end-point was the overall survival rate. Median length of follow-up was 6.2 years.Results: In group A, coronary angiography revealed significant coronary artery stenosis in 68 patients (31.5%). Among them, 66 underwent percutaneous Intervention (PCI) prior to CEA and 2 received combined CEA and coronary-artery bypass grafting (CABG). Postoperatively, no MI was observed in group A, whereas 6 MI occurred in group B, one of which was fatal (p =.01). During the study period, 3 MI occurred in group A (1.4%) and 33 were observed in group B (15.7%), 6 of which were fatal. The Cox model demonstrated a reduced risk of MI for patients in group A receiving coronary angiography (HR,.078; 95% CI, 0.024-0.256; p < .001). In addition, patients with diabetes and patients <70 years presented with an increased risk of MI. Survival analysis at 6 years by Kaplan-Meier estimates was 95.6 +/- 3.2% in Group A and 89.7 +/- 3.7% in group B (Log Rank = 6.54, p = .01).Conclusions: In asymptomatic coronary-artery patients, systematic coronary angiography prior to CEA followed by selective PCI or CABG significantly reduces the incidence of late MI and increases long-term survival. (C) 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Research to date regarding identification and management of hereditary breast and ovarian cancer syndrome (HBOC) in the U.S. has been confined primarily to academic center-based studies with limited patient engagement. To begin to understand and address the current gaps and disparities in delivery of services for the appropriate identification and optimal risk management of individuals with HBOC, we designed and have initiated the American BRCA Outcomes and Utilization of Testing (ABOUT) Study. ABOUT relies on a collaborative patient advocacy, academic and industry partnership to recruit and engage U.S. individuals who are at increased risk for HBOC and investigate their experiences, decisions and outcomes. It utilizes an extensive research infrastructure, including an interactive web-based data system and electronic interfaces for secure online participation and automated data exchange. We describe the novel recruitment approach that was designed for collaboration with a national commercial health plan partner to identify all individuals for whom a healthcare provider orders a BRCA test and mail to each individual an invitation to participate and study packet. The study packet contains detailed information about the study, a baseline questionnaire and informed consent for participation in the study, for release of relevant medical and health plan records and for ongoing research engagement. This approach employs patient-reported, laboratory-reported and health plan-reported outcomes and facilitates longitudinal engagement. We believe that the type of innovative methodology and collaborative framework we have developed for ABOUT is an ideal foundation for a patient-powered research network. This approach can make substantial contributions to identifying current and best practices in HBOC, leading to improved strategies for clinical care and optimal health outcomes among individuals with high inherited risk for cancer.

Background:Methods of estimating race/ethnicity using administrative data are increasingly used to examine and target disparities; however, there has been no validation of these methods using clinically relevant outcomes.Objective:To evaluate the validity of the indirect method of race/ethnicity identification based on place of residence and surname for assessing clinically relevant outcomes.Data Sources:A total of 2387 participants in the Post-MI Free Rx Event and Economic Evaluation (MI FREEE) trial who had both self-reported and Bayesian Improved Surname Geocoding method (BISG)-estimated race/ethnicity information available.Study Design:We used tests of interaction to compare differences in the effect of providing full drug coverage for post-MI medications on adherence and rates of major vascular events or revascularization for white and nonwhite patients based upon self-reported and indirect racial/ethnic assignment.Results:The impact of full coverage on clinical events differed substantially when based upon self-identified race (HR=0.97 for whites, HR=0.65 for nonwhites; interaction P-value=0.05); however, it did not differ among race/ethnicity groups classified using indirect methods (HR=0.87 for white and nonwhites; interaction P-value=0.83). The impact on adherence was the same for self-reported and BISG-estimated race/ethnicity for 2 of the 3 medication classes studied.Conclusions:Quantitatively and qualitatively different results were obtained when indirectly estimated race/ethnicity was used, suggesting that these techniques may not accurately describe aspects of race/ethnicity related to actual health behaviors.