Rehabilitation medicine offers an individualized patient-centered service to optimize function and maximize quality of life of patients. Psychological distress can impact rehabilitation process and its outcomes [1]. In regional and rural areas, rehabilitation services are different from the ones in metropolitan areas. There are limited medical specialists and allied health services in those areas.

Sacred Heart Rehabilitation Service at St Vincent’s Hospital in Sydney Australia has been providing outreach rehabilitation services to Griffith Base Hospital (GBH), New South Wales (570 km away from Sydney). A rehabilitation clinic at GBH run by an outreach rehabilitation physician is well established with approximately 100 new referrals per year [2]. Although rehabilitation patients often have psychosocial issues requiring multidisciplinary input, there is limited study on the presence and extent of depression, anxiety and stress symptoms among patients attending an outreach rehabilitation clinic. This audit study aimed to screen the levels of negative emotional status who attended a regional rehabilitation clinic.

In transitional age youth living with HIV or AIDS, non-adherence (<80%) to anti-retroviral medication is associated with viral resistance, disease progression, and an increased risk of death. This feasibility study investigated the Maya MedMinder electronic pillbox and cell phone texting with personalized motivational interviewing strategies to improve medication adherence in non-adherent youth. Twenty patients out of 30 identified as non-adherent by the Pediatric HIV team at the Medical University of South Carolina were approached, and 15 were recruited (Ages 12 to 20; 13.3% male, 86.7% female; 100% African-American). Following baseline MedMinder monitoring, subjects were randomized to intervention groups with reminder signals on or off. The time medications were taken was collected by the MedMinder, resulting in adherence scores. All were interviewed for readiness to change utilizing the Motivational Interviewing (MI) Stages of Change scores. Viral load and CD4 labs were scheduled every 6 weeks. Despite monetary incentives and personalized support, recruitment and adherence to the protocol was a challenge. Only 6/15 subjects completed the entire study scheduled for 6 months .Stages of change scores revealed that those that transitioned to making changes had higher CD4 percentages midway through the study. Challenges included missed appointments and labs despite efforts by text and phone to schedule convenient appointment times with participants. Device challenges included the large size of the MedMinder and faulty electronic signaling, especially from rural areas. The methodology was feasible with these patients. This small feasibility study highlights that technological tools to promote adherence and motivational enhancement strategies in teens and young adults who are non-adherent to HIV medication regimens can enhance biomarker outcomes associated with medication adherence.

Background: A Bone Marrow (BM) evaluation is often required in patients with plasma cell dyscrasias,at the time of initial presentation for diagnostic purposes and risk stratification, and during the follow up for an accurate assessment of the response to therapy. In the vast majority of cases, the preferred site for obtaining a BM specimen is the posterior superior iliac crest. The role of sternal aspirates has fallen out of favor in 21st century medical practice. However, in certain clinical situations it appears to be the easiest site for specimen collection. Our study was designed to answer a set of basic clinical questions such as whether sternal Bone Marrow Aspirate (BMA) can provide reliable and sufficient specimen for morphologic, immunophenotypic and molecular evaluation of patients with clinical suspicion of plasma cell dyscrasias.

Methods: We reviewed indications, performed BM biopsies and obtained BMA from sternum in 51 patients with Multiple Myeloma (MM) and other plasma cell dyscrasias.

Results: No significant complications were observed. The most common indication for the sternal aspirates were: inability to reach the pelvic bone due to morbid obesity (65% of cases), followed by other factors, such as tetraplegia/immobility, pelvic fractures, infections, or radiotherapy. The concordance with the disease status, as defined by the presence or absence of a detectable paraprotein, was excellent, observed in 91.7% of samples.

Conclusions: Sternal aspirates provided satisfactory samples not only for morphologic evaluation, but also for ancillary studies, such as flow cytometry, metaphase cytogenetics, and Fluorescence In Situ Hybridization (FISH) studies.

Aim: This study aimed to document the effect of Maxillary Expansion (ME) during childhood on Sleep Disordered Breathing (SDB) symptoms in adults. The secondary aim is to try to find a screening tool for daily use in the orthodontic/dental office in children who are not yet diagnosed with OSA. We try to develop a tool that could help us in deciding which children should be referred for OSA screening, possibly including polysomnography, based on the cephalometric radiograph and the symptoms they report.

Methods: This is a retrospective study (S) focusing on cephalometric measurements performed on 27 Children (C), which had received maxillary expansion (RCS group) and as Adults (A) attended a post-treatment follow-up on average 21.1 (±7.24) years later (RAS group). A cephalometric radiograph before treatment and a cephalometric radiograph at post-treatment follow-up were traced. These were compared with untreated control (Co) groups of 50 subjects each (RCCo group and RACo group). Questionnaires related to SDB symptoms were administered in the RAS and RACo groups.

Results: Small changes in cephalometric measurements were seen comparing patients with (RCS group and RAS group) and without (RCCo group and RACo group) maxillary expansion. Questionnaires were answered similarly by the study (RAS group) and control group (RACo group).

Conclusions: Small cephalometric changes were seen between groups.

Current knowledge: The favorable effect of expansion of the maxilla on SDB symptoms has been demonstrated in several studies, the aim of this research was to document if patients treated with maxillary expansion during childhood can benefit from this intervention concerning Sleep Disordered Breathing (SDB) at adult age.

Study impact: Maxillary expansion during childhood might improve SDB symptoms at adult age.