RESUMEN
Occupational therapists view play through a unique lens. Considering play as a human occupation, and one to which all people have a right, places occupational therapists among a special group of professionals championing play. This State of the Science article seeks to increase awareness regarding the occupational therapy profession's contributions and to situate those contributions within the larger body of literature on play while also promoting further study of play as an occupation.
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Terapia Ocupacional , Juego e Implementos de Juego , Humanos , InvestigaciónRESUMEN
IMPORTANCE: Internationally, it is suggested that school-based occupational therapy (SBOT) has an important role in supporting inclusion in educational settings. In SBOT, multitiered service delivery models are identified as a way forward to maximize school inclusion. Therefore, identifying evidence for the implementation of tiered interventions in SBOT is vital. OBJECTIVE: To identify and map evidence in the occupational therapy literature relating to SBOT interventions delivered in elementary schools for all children, for those at risk, and for those with identified diagnoses. DATA SOURCES: Peer-reviewed literature published in 14 occupational therapy journals between 1990 and 2020, indexed in the EBSCOhost database. STUDY SELECTION AND DATA COLLECTION: Included studies were those within the scope of SBOT that reported on school occupations and focused on elementary school-age children (excluding kindergarteners or preschoolers). FINDINGS: Forty studies met the criteria. Individual-tier intervention studies (n = 22) primarily reported direct interventions with children at risk or with identified diagnoses (Tier 2 or Tier 3), focusing mostly on remedial approaches. None adopted a whole-school approach. Despite handwriting and self-regulation being dominant areas of concern, these studies were not explicitly related to inclusion outcomes. Evidence for implementing multitiered models primarily used indirect, collaborative consultation, embedded in the school context (n = 18). These studies identified positive school staff and child outcomes when collaboration was timely, consistent, and authentic. CONCLUSIONS AND RELEVANCE: More rigorous individual-tier intervention studies are required to inform the design and implementation of multitiered interventions in SBOT and to support participation and inclusion in schools. What This Article Adds: This scoping review provides evidence to support occupational therapists' professional reasoning in developing evidence-based, contextual, educationally relevant multitiered models of intervention in SBOT.
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Terapia Ocupacional , Niño , Humanos , Instituciones Académicas , Ocupaciones , Terapeutas OcupacionalesRESUMEN
BACKGROUND: Evaluation of perioperative hypersensitivity (POH) is challenging, and accurate screening tools are needed to optimize the diagnostic process. We aimed to assess and validate the diagnostic value of a published algorithm (using tryptase and clinical presentation) to identify appropriate individuals for further testing for IgE-mediated POH. METHODS: We analysed the clinical presentation (tryptase elevation, cardiovascular, respiratory, skin involvement) of patients proceeding to testing for possible IgE-mediated POH at a single tertiary referral centre, relative to subsequent skin testing and specific IgE results. Clinical presentations by drug class were also determined. RESULTS: In 293 consecutive patients, the use of a published algorithm based on one or more of; (i) defined increase in serum tryptase, (ii) involvement of at least two-organ systems, or (iii) presentation with new urticaria and/or angioedema; was highly sensitive [98.8% (CI95: 95.7-99.9%)] but less specific [34.6% (CI95: 25.7-44.4%)] in identifying patients testing positive on skin testing and/or specific IgE. Presentation with cardiovascular symptoms was also sensitive [89.8%(CI95: 84.2-94.0%)], while the combination of respiratory symptoms and increased tryptase was most specific [85.9%(CI95:76.6-92.5%)]. Respiratory involvement was more common in neuromuscular blocking agent allergy, while urticaria/angioedema was more common in antibiotic allergy. CONCLUSION: The published algorithm (of tryptase rise, two-organ involvement or new urticaria/angioedema) is highly sensitive, and appropriate as a screening tool to identify patients suitable for testing for IgE-mediated POH.
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Anafilaxia , Angioedema , Hipersensibilidad a las Drogas , Urticaria , Humanos , Anafilaxia/diagnóstico , Triptasas , Hipersensibilidad a las Drogas/diagnóstico , Pruebas Cutáneas/métodos , Algoritmos , Inmunoglobulina ERESUMEN
PURPOSE: Public playgrounds afford children and families important opportunities for outdoor play, social participation, and inclusion. Unfortunately, many children and families experience barriers to accessing, using, and being included in public playgrounds. Consequently, Universal Design (UD) is promoted for providing conceptual guidance for designing for inclusion in public playgrounds. However, a lack of research evidence means researchers have engaged in the ongoing interpretation of the UD concept and related non-discriminatory planning and design concepts. Therefore, the aim of this study was to examine how UD, and related concepts, are used in peer-reviewed articles concerning public playgrounds. MATERIALS AND METHODS: A scoping review was conducted in November 2019, which identified 15 peer-reviewed articles that met the inclusion criteria. RESULTS: Analysis revealed that the terms UD, inclusive design, accessibility, and usability are all being used to describe non-discriminatory planning and design concepts arbitrarily and without regard for higher or lower order concepts. Two broad interpretations were evident: (a) UD is synonymous with accessibility for some, and (b) UD is a higher-order concept that goes beyond accessibility for others. Nevertheless, findings highlight the utility of UD in underpinning the design of public playgrounds in many developed countries; however, the concept requires further clarity and specificity as it pertains to playground design and more pertinently inclusion in outdoor play. CONCLUSIONS: We argue for further conceptual refinement to consolidate the importance and future application of UD for Play (UDP) in the design of public playgrounds that promote outdoor play, social participation, and inclusion.IMPLICATIONS FOR REHABILITATIONMost peer-reviewed journal articles reviewed fail to define what is meant by the term Universal Design.Of those that do provide a definition, the outcome of inclusion in play, or the application of Universal Design to enable play in public playgrounds was unclear.Research to date has mostly focused on related concepts, including accessibility and usability, with less emphasis on Universal Design.Recommend a tailored perspective of Universal Design for Play (UDP).
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Accesibilidad Arquitectónica , Diseño Universal , Niño , Humanos , Parques Recreativos , Uridina DifosfatoRESUMEN
AIMS: To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. METHODS AND RESULTS: Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20-74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented left ventricular ejection fraction ≤40%, 84.0% were discharged on an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and 88.7% were discharged on beta-blockers. CONCLUSION: Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform delivery of guideline-recommended pharmacotherapies at time of hospital discharge.
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Síndrome Coronario Agudo , Cardiología , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Infarto del Miocardio con Elevación del ST/epidemiología , Infarto del Miocardio con Elevación del ST/terapia , Indicadores de Calidad de la Atención de Salud , Síndrome Coronario Agudo/terapia , Volumen Sistólico , Estudios Prospectivos , Función Ventricular Izquierda , Sistema de Registros , Resultado del TratamientoRESUMEN
PURPOSE: To synthesize evidence regarding the physical design features and non-physical aspects of public playgrounds that facilitate/hinder outdoor play, social participation, and inclusion; identify design recommendations; and explore the current discourses and concepts around designing for outdoor play, social participation, and inclusion in public playgrounds in the context of Universal Design (UD). METHODS: Published studies addressing public playgrounds, inclusion, and design, were identified via a systematic search of eleven databases from health, science, education, and humanities. RESULTS: Fifteen documents met the inclusion criteria. Three main themes were identified concerning physical design features and non-physical aspects of public playgrounds that facilitate/hinder outdoor play, social participation, and inclusion, with associated design recommendations. Although UD is recognized to have the potential to support the design of public playgrounds, no studies examined UD solutions for playgrounds or tested them for effectiveness. CONCLUSION: We cannot yet determine whether UD can support outdoor play, social participation, and inclusion in public playgrounds. Research to date has mostly focused on understanding users' perspectives; future research should continue to be informed by diverse users' perspectives to address gaps in knowledge concerning children's voice from migrants, lower socioeconomic communities, and intergenerational users with disabilities alongside researching design solutions for play.Implications for rehabilitationChildren, particularly children with disabilities and their families, continue to experience marginalization and exclusion in public playgrounds, despite a commitment to inclusion in international treaties.Universal design is recognized to have the potential to support the design of public playgrounds, however, the evidence is currently very sparse.While accessibility is an important consideration for playground design, it does not ensure that play occupations can take place.Extending knowledge on universal design as it applies explicitly to playgrounds and play occupation requires multi- and trans-disciplinary collaboration that includes a play-centered perspective.
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Personas con Discapacidad , Participación Social , Niño , Humanos , Parques Recreativos , Juego e Implementos de Juego , Diseño UniversalRESUMEN
AIMS: The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0-100%), fibrinolysis (18.8%; 0-100%), and no reperfusion therapy (9.0%; 0-75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5-5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8-97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1-70.1%) for timely reperfusion. CONCLUSIONS: The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.
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Cardiología , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Europa (Continente)/epidemiología , Hospitales , Humanos , Reperfusión Miocárdica , Estudios Prospectivos , Sistema de Registros , Infarto del Miocardio con Elevación del ST/terapia , Resultado del TratamientoRESUMEN
OBJECTIVE: Fast-track cardiac anesthesia (FTCA) is a technique that may improve patient access to surgery and maximize workforce utilization. However, feasibility and factors impacting FTCA implementation remain poorly explored both locally and internationally. We describe the specific intraoperative and postoperative protocols for our FTCA program, assess protocol compliance and identify reasons for FTCA failure. RESULTS: We tested the program in 16 patients undergoing elective cardiac surgery requiring cardiopulmonary bypass. There was 100% compliance with the FTCA protocols. Four (25%) patients successfully completed the FTCA protocol (extubated < 4 h postoperatively and discharged from the intensive care unit on the same operative day).
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Anestesia , Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Hospitales de Enseñanza , Humanos , Tiempo de Internación , Mejoramiento de la CalidadRESUMEN
Alice Moore argues that gender discrimination is still a big problem in the veterinary profession and that the tendency to focus purely on the gender pay gap is not helpful in solving the wider issues.
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Liderazgo , Sexismo , Medicina Veterinaria/organización & administración , Femenino , Humanos , Sociedades Veterinarias , Reino UnidoRESUMEN
BACKGROUND: Patients admitted to hospital with acute severe ulcerative colitis have a short-term in-hospital colectomy rate of 30%. The Oxford criteria state that if the CRP is greater than 45 mg/l or there are more than eight bowel movements in 24 h at day 3 of intravenous corticosteroids, there is an 85% risk of an in-hospital colectomy. AIM: The aim of this study was to determine whether this high rate of colectomy continues to be accurate in this medically refractory patient population. METHODS: We performed a retrospective chart review of 80 patients admitted to a tertiary hospital between 2013 and 2017 with acute severe ulcerative colitis. RESULTS: Sixteen (20%) patients required an in-hospital colectomy. Of the 33 patients that fulfilled the Oxford criteria, 12 (36%) patients required a colectomy during admission. Only four (9.5%) patients who did not fulfill the Oxford criteria required a colectomy during admission. Twenty-two patients that had fulfilled the Oxford criteria received infliximab as second-line medical therapy. CONCLUSION: In a patient population that fulfilled the Oxford criteria, the in-hospital colectomy rate has reduced from 85% in 1996 to 36% in 2017. These results should be considered when discussing with patients the opportunity to commence infliximab or cyclosporine as second-line medical therapy.
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Colectomía/estadística & datos numéricos , Colitis Ulcerosa/terapia , Ciclosporina/uso terapéutico , Fármacos Gastrointestinales/uso terapéutico , Glucocorticoides/uso terapéutico , Infliximab/uso terapéutico , Enfermedad Aguda , Administración Intravenosa , Adulto , Proteína C-Reactiva/metabolismo , Colitis Ulcerosa/metabolismo , Defecación , Femenino , Hospitalización , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
This review discusses the rare but potentially life-threatening cardiovascular side-effects of myocarditis and dilated cardiomyopathy associated with the use of Clozapine. The clinical presentation of these conditions is non-specific, making it difficult to both risk-stratify and identify patients who develop these consequences. This review aims to examine the proposed aetiologies, diagnostic approaches and subsequent management strategies of cardiotoxicity associated with clozapine use; offering guidance to psychiatrists and general physicians. Current evidence highlights the importance of accurate diagnosis to prevent premature and unnecessary cessation of clozapine. Guidance on monitoring and reintroduction of the drug is emerging and current practice recommends a combination of regular monitoring of biomarkers and imaging to make a diagnosis of cardiotoxicity although further work is needed to establish evidence-based guidelines.
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Antipsicóticos/efectos adversos , Cardiomiopatías/inducido químicamente , Clozapina/efectos adversos , Miocarditis/inducido químicamente , Cardiotoxicidad , Humanos , PsiquiatríaRESUMEN
BACKGROUND: Fecal calprotectin (FC) is a stool biomarker that has been shown to be sensitive and specific for mucosal inflammation in patients with inflammatory bowel disease (IBD). The test is limited by the requirement for patients to collect and return stool samples. A home-based FC test may improve test adherence. The aim of this study is to evaluate the usability of the IBDoc, a home-based FC measuring test, and to determine the accuracy of results compared with traditional lab-based ELISA values. METHODS: Patients were prospectively enrolled from 3 tertiary sites across Canada between May and August 2017. Patients completed a questionnaire establishing ease-of-use of the IBDoc. Patients completed a FC measurement using the IBDoc, and results were compared with an ELISA-determined FC measurement on the same stool sample. RESULTS: Sixty-one participants were enrolled in the study (29 CD, 32 UC). Seventy-nine percent of patients (48 of 61) agreed that the IBDoc was easy to use, with 85% (52 of 61) of patients strongly agreeing that they were willing use the home kit in the future. The IBDoc and ELISA measurement comparison showed an 88% agreement across all values. There were no false positives or negatives using qualitative comparison. CONCLUSIONS: The home-based IBDoc FC measuring test is acceptable to patients and correlates extremely well with the standard ELISA-determined FC value. The IBDoc enables clinicians to more easily adopt a treat-to-target approach, improve long-term outcomes, and patients' quality of life with IBD. This study is registered at ClinicalTrials.gov, number NCT03408249.
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Biomarcadores/análisis , Heces/química , Inflamación/diagnóstico , Enfermedades Inflamatorias del Intestino/diagnóstico , Complejo de Antígeno L1 de Leucocito/análisis , Calidad de Vida , Autoexamen/métodos , Adulto , Canadá , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Humanos , Inflamación/complicaciones , Enfermedades Inflamatorias del Intestino/complicaciones , Masculino , Pronóstico , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosAsunto(s)
Extremidad Inferior/patología , Síndrome de Sturge-Weber/patología , Heridas y Lesiones/patología , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/patología , Celulitis (Flemón)/etiología , Celulitis (Flemón)/patología , Angiografía por Tomografía Computarizada/métodos , Embolización Terapéutica/métodos , Servicio de Urgencia en Hospital , Femenino , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Síndrome de Sturge-Weber/complicaciones , Síndrome de Sturge-Weber/diagnóstico por imagen , Síndrome de Sturge-Weber/terapia , Resultado del Tratamiento , Heridas y Lesiones/complicacionesRESUMEN
Cognitive decline impacts older adults, particularly their independence. The goal of this project was to increase understanding of how short-term, everyday lifestyle options, including physical activity, help an older adult sustain cognitive independence. Using a secondary analysis of lifestyle choices, we drew on a dataset of 4,620 community-dwelling elders in the US, assessed at baseline and one year later using 2 valid and reliable tools, the interRAI Community Health Assessment and the interRAI Wellness tool. Decline or no decline on the Cognitive Performance Scale was the dependent variable. We examined sustaining one's status on this measure over a one-year period in relation to key dimensions of wellness through intellectual, physical, emotional, social, and spiritual variables. Engaging in physical activity, formal exercise, and specific recreational activities had a favorable effect on short-term cognitive decline. Involvement with computers, crossword puzzles, handicrafts, and formal education courses also were protective factors. The physical and intellectual domains of wellness are prominent aspects in protection from cognitive decline. Inherent in these two domains are mutable factors suitable for targeted efforts to promote older adult health and well-being.
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Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/prevención & control , Terapia por Ejercicio/métodos , Ejercicio Físico , Terapia Recreativa/estadística & datos numéricos , Conducta de Reducción del Riesgo , Anciano , Anciano de 80 o más Años , Terapia Combinada/estadística & datos numéricos , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Heat illness is a preventable disorder in military populations. Measures that protect vulnerable individuals and contribute to effective Immediate Treatment may reduce the impact of heat illness, but depend upon adequate understanding and awareness among Commanders and their troops. OBJECTIVE: To assess risk factors for heat illness in British soldiers deployed to the hot Collective Training Environment (CTE) and to explore awareness of Immediate Treatment responses. METHODS: An anonymous questionnaire was distributed to British soldiers deployed in the hot CTEs of Kenya and Canada. Responses were analysed to determine the prevalence of individual (Intrinsic) and Command-practice (Extrinsic) risk factors for heat illness and the self-reported awareness of key Immediate Treatment priorities (recognition, first aid and casualty evacuation). RESULTS: The prevalence of Intrinsic risk factors was relatively low in comparison with Extrinsic risk factors. The majority of respondents were aware of key Immediate Treatment responses. The most frequently reported factors in each domain were increased risk by body composition scoring, inadequate time for heat acclimatisation and insufficient briefing about casualty evacuation. CONCLUSIONS: Novel data on the distribution and scale of risk factors for heat illness are presented. A collective approach to risk reduction by the accumulation of 'marginal gains' is proposed for the UK military. This should focus on limiting Intrinsic risk factors before deployment, reducing Extrinsic factors during training and promoting timely Immediate Treatment responses within the hot CTE.
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Aclimatación , Composición Corporal , Trastornos de Estrés por Calor/epidemiología , Personal Militar , Aptitud Física , Antagonistas Adrenérgicos beta/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Canadá/epidemiología , Deshidratación/epidemiología , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Hambre , Kenia/epidemiología , Prevalencia , Factores de Riesgo , Privación de Sueño/epidemiología , Encuestas y Cuestionarios , Reino Unido/epidemiologíaRESUMEN
Several pathogenic processes have been implicated in the development of abdominal ascites. Portal hypertension, most usually in the context of liver cirrhosis, can explain about 75% of the cases, whereas infective, inflammatory and infiltrative aetiologies can account for the rest. In this article, we discuss the consensus best practice as published by three professional bodies for the management of ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). The aim of this study was to compare available clinical guidelines and identify areas of agreement and conflict. We carried out a review of the guidance documentation published by three expert bodies including the British Society of Gastroenterology, the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD), as well as a wider literature search for ascites, SBP and HRS. Abdominal ultrasonography, diagnostic paracentesis and ascitic fluid cultures are recommended by all three guidelines, especially when there is strong clinical suspicion for infection. EASL and AASLD advocate the use of ascitic amylase and mycobacterial cultures/PCR when there is strong suspicion for tuberculosis and pancreatitis, respectively. Ascitic cytology can be useful when cancer is suspected and has a good diagnostic yield if performed correctly. EASL supports the use of urinary electrolytes for all patients; however, the British Society of Gastroenterology and AASLD only recommend their use for therapy monitoring. All three societies recommend cefotaxime as the antibiotic of choice for SBP and large-volume paracentesis for the management of ascites greater than 5 l in volume. For HRS, cautious diuresis, volume expansion with albumin and the use of vasoactive drugs are recommended. There appears to be good concordance between recommendations by the European, American and British guidelines for the management of ascites and the possible complications arising from it.
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Ascitis/terapia , Infecciones Bacterianas/terapia , Síndrome Hepatorrenal/terapia , Peritonitis/terapia , Guías de Práctica Clínica como Asunto , Albúminas/uso terapéutico , Antibacterianos/uso terapéutico , Ascitis/diagnóstico , Ascitis/epidemiología , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Cefotaxima/uso terapéutico , Consenso , Diuréticos/uso terapéutico , Medicina Basada en la Evidencia , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/epidemiología , Humanos , Paracentesis , Peritonitis/diagnóstico , Peritonitis/epidemiología , Peritonitis/microbiología , Sustitutos del Plasma/uso terapéutico , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Playgrounds are important outdoor environments in many communities during childhood. However, playground spaces often do not meet the needs of typically developing children or children with disabilities, resulting in social exclusion for many children. AIMS/OBJECTIVES: This study explored the evidence regarding accessibility and usability of playgrounds for children of all abilities, to identify factors that enable or constrain social inclusion in community playgrounds. MATERIALS AND METHODS: A scoping method was used as little research in this area has been collated and synthesized. Scoping reviews are effective for exploring and synthesizing broad and varied methods of inquiry around a phenomenon of interest. RESULTS: A total of 14 key articles were identified and two major themes emerged: (i) accessible playground environments--features and factors; (ii) from excluding to including--making playground environments usable. Findings indicate that numerous environmental barriers contribute to making playground environments inaccessible and unusable for many children, particularly children with disabilities. However, playground design is identified as a significant factor in enabling inclusion. CONCLUSION: Occupational therapists are in an ideal position to advocate for children's occupational right to play, by combining knowledge of environmental barriers with an understanding of disability and specific knowledge of occupation. Through focusing on advocacy and change at policy and community levels, therapists can work to maximize social inclusion in playground settings.
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Accesibilidad Arquitectónica , Niños con Discapacidad/rehabilitación , Planificación Ambiental/normas , Juego e Implementos de Juego , Niño , Preescolar , Ejercicio Físico , HumanosRESUMEN
BACKGROUND: Heart failure (HF) readmissions are a common and serious problem of heterogeneous etiology. Left ventricular (LV) ejection fraction has not been found to be a consistent risk marker. However, LV strain has been shown to predict outcomes in other settings, so the aim of this study was to determine the association of LV strain with 30-day HF readmission, independent of and incremental to clinical and basic echocardiographic parameters. METHODS: A total of 468 patients who underwent echocardiography at the time of the first admission for HF from July 2009 to June 2012 were retrospectively studied. Clinical parameters were comprehensively assessed, and standard echocardiographic parameters and two strain parameters (global longitudinal strain [GLS] and global circumferential strain) were measured using speckle-tracking. Patients were followed for all-cause 30-day hospital readmission or death after discharge, and the associations of parameters with outcome were assessed using Cox proportional hazards models. RESULTS: Readmission within 30 days (n = 92 patients [20%]) was associated with greater impairment of LV GLS (-8.6% [interquartile range, -10.9% to -5.9%] vs -11.1% [interquartile range, -14.6% to -7.7%], P < .01). The association of GLS with readmission (hazard ratio, 1.13; 95% confidence interval, 1.07-1.19; P < .01) was independent of age, male gender, systolic blood pressure, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and comorbidity, as well as renal function, sodium, hematocrit, LV mass, left atrial size, and mitral regurgitation. Global circumferential strain was associated with outcome but not was independent after adjustment with echocardiographic parameters. In sequential models for 30-day outcome, GLS added incremental information to clinical parameters and LV ejection fraction and significantly improved reclassification (categorical net reclassification improvement, 0.34; P = .04) when LV ejection fraction was >50%. CONCLUSIONS: GLS is associated with HF readmission, independent of and incremental to clinical and basic echocardiographic parameters.
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Ecocardiografía/estadística & datos numéricos , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/mortalidad , Readmisión del Paciente/estadística & datos numéricos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/mortalidad , Anciano , Anciano de 80 o más Años , Causalidad , Comorbilidad , Módulo de Elasticidad , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Pronóstico , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Volumen Sistólico , Tasa de Supervivencia , Tasmania/epidemiologíaRESUMEN
INTRODUCTION: Multisource feedback (MSF) is a mandatory assessment in the foundation programme. The current tool that is used is the validated Team Assessment of Behaviour (TAB). This assesses doctors on four domains: maintaining trust and professional relations; verbal communication skills; teamworking; and accessibility. The aims of our retrospective analysis were to analyse the number of doctors who had an MSF with any type of concern, and to assess if there is any relationship between the number of MSFs submitted and the number of concerns and the staff group. METHOD: Data were obtained from the e-portfolio Malta database. The anonymized MSFs for the doctors in the foundation programme (FP) in Malta between July 2009 and July 2010 were analysed. RESULTS: A total of 1868 MSF assessments from 83 FP doctors (50 foundation year-1 doctors, FY1s, and 33 FY2s) were analysed. Fifty-two FY doctors were female. The majority of assessments (97.86%) did not show any concern in any of the four domains. However, at least one concern was raised for 21.7 percent of the doctors (12 FY1s and 6 FY2s). The chance of there being a concern reported was statistically significantly higher when the MSF was completed by a more senior doctor, rather than by an FY doctor or a nurse (p = 0.016). CONCLUSION: The aim of the MSF tool is to collate the views from a range of clinical colleagues in order to assess trainee performance. In our opinion, besides indicating when the MSFs should be performed and the minimum number that need to be submitted, it should also be mandatory that a certain proportion of MSFs should be performed by specific people (e.g. by a clinical supervisor, basic specialist trainee or higher specialist trainee working with the team).
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Educación Médica Continua/métodos , Evaluación Educacional/métodos , Retroalimentación , Médicos , Competencia Clínica , Comunicación , Personal de Salud , Humanos , Estudios RetrospectivosRESUMEN
OBJECTIVES: This paper reports on a state agency's training activities undertaken to totally redesign a long-term-care (LTC) delivery system as part of the national Aging and Disability Resource Center (ADRC) initiative. METHOD: Through the development of an ADRC algorithm and the implementation of a corresponding client pathway, NJ DACS, a division of aging, aligned 14 separate core functions necessary for lifespan services. A Training Academy facilitated the adoption of five new health service delivery products and processes by state and county health and human services personnel. RESULTS: Intensive training activities resulted in the algorithm and client pathway framework being successfully disseminated in all 21 counties within a short timeframe. Barriers to training were reduced and acceptance of new protocols and processes were facilitated leading to rapid adoption. Implications for training of health and human service personnel are presented. Full adoption of the complete ADRC model across the state was directly linked to agency software integration. CONCLUSIONS: Promoting standardized service delivery for the aging population through the use of an algorithm and parallel client pathway is feasible as a training model for health care service delivery.