Mitigating the HIV and Viral Hepatitis Workforce Crisis Through Development of an HIV/Hepatitis C Coinfection Mobile Application.

A decline in the HIV workforce has led to a crisis of insufficient expertise to manage people with HIV (PWH), roughly a quarter of whom are coinfected with hepatitis C. Task shifting to nonspecialist providers can contribute to solving the HIV workforce shortage problem, but nonspecialist providers require sufficient training and support to acquire and retain the necessary knowledge and skills. Digital tools including mobile applications (apps) and telementoring which utilizes telecommunication technology for education and skill acquisition can be used for professional development. Described is the development and dissemination of a mobile app specifically for providers managing HIV/HCV coinfection in the United States. The app, through provider professional development, facilitates access to curative HCV treatment in PWH, encourages integration of HCV care into primary care and contributes to national goals to eliminate HIV and viral hepatitis by 2030.

Virtual Reality and Noninvasive Brain Stimulation in Stroke: How Effective Is Their Combination for Upper Limb Motor Improvement?-A Meta-Analysis.

BACKGROUND: Efforts to augment post-stroke upper limb (UL) motor improvement include the use of newer interventions such as noninvasive brain stimulation (NIBS) and task practice in virtual reality environments (VEs). Despite increasing interest in using a combination of these 2 interventions, the effectiveness of this combination to enhance UL motor improvement outcomes has not been examined. OBJECTIVE: To evaluate the effectiveness of a combination of NIBS and task practice in a VE to augment post-stroke UL motor improvement. METHODS: We conducted a systematic search of the published literature using standard methodology. The Down and Black checklist and the Physiotherapy Evidence Database Research Organization Scale were used to assess study quality. We compared changes in UL impairment and activity levels between active stimulation and sham or other interventions using standardized mean differences and derived a summary effect size. RESULTS: We retrieved 5 studies that examined the role of a combination of NIBS and task practice in a VE to optimize UL motor improvement. These 5 studies included 3 randomized controlled trials, 1 cross-sectional study, and 1 crossover study. There was level 1a evidence that the combination was beneficial in subacute stroke. There was level 1b evidence that provision of real stimulation was not superior to sham stimulation in chronic stroke. Effect sizes favoring the combination were moderate for improvements in UL impairment and small for activity levels. CONCLUSIONS: Preliminary evidence supports the effectiveness of this combination in subacute stroke. Emergent questions need to be addressed to derive maximum benefit of this combination to augment post-stroke UL motor improvement. LEVEL OF EVIDENCE: I.

Community engagement and knowledge translation: progress and challenge in autism research.

The last decade has seen significant growth in scientific understanding and public awareness of autism. There is still a long road ahead before this awareness can be matched with parallel improvements in evidence-based practice. The process of translating evidence into community care has been hampered by the seeming disconnect between the mainstream scientific research agenda and the immediate priorities of many communities. The need for community engagement in the process of translating knowledge into impact has been recognized. However, there remains little consensus or empirical data regarding the process of such engagement and how to measure its impact. We shed light on a number of engagement models and tools, previously advocated in health research, as they apply to autism research. Furthermore, we illustrate the utility of such tools in supporting identification of knowledge gaps and priorities, using two community-based case studies. The case studies illustrate that information generated from research is indeed relevant and critical for knowledge users in the community. Simple and systematic methods can support the translation and uptake of knowledge in diverse communities, therefore enhancing engagement with research and bridging research findings with immediate community needs.

Why do people delay accessing health care for knee osteoarthritis? Exploring beliefs of health professionals and lay people.

PURPOSE: In knee osteoarthritis (OA), opportunity for non-surgical intervention is reduced by time lost between symptom onset and diagnosis. The study's purpose was to understand, from the perspective of various stakeholders, the reasons for delay and useful strategies to enhance early awareness of knee OA. METHOD: In this qualitative study, focus groups of health professionals (n=6) and community-dwelling individuals (n=7) discussed questions relating to knowledge, attitudes, and beliefs about OA; experiences with people with OA; health care seeking behaviour; and access to services, and suggested strategies to enhance public awareness. Qualitative analyses identified dominant themes. RESULTS: Reasons for delay from the laypersons' perspective included lack of knowledge about risk factors and prevention and a belief that knee pain is expected with age. Reasons related to the health care system included long wait times and frustration getting appointments. Health professionals were unclear on which discipline should discuss prevention and risk factors. Suggested strategies included advocating a healthy lifestyle, developing prevention programs, and using celebrities to inform the public. CONCLUSIONS: Participants identified multiple reasons for delays and strategies to counter them. Knowledge about gaps in the OA care process can facilitate physiotherapists' participation in developing strategies for early intervention.

Objectif : En matière d'arthrose du genou, la possibilité d'une intervention non chirurgicale est réduite par le temps écoulé entre l'apparition des symptômes et le diagnostic. L'objectif de l'étude était de comprendre, du point de vue de divers intervenants, les raisons des délais, et de réfléchir à des stratégies susceptibles d'améliorer la prise de conscience précoce de l'arthrose du genou. Méthode : Pour cette étude qualitative, des groupes de discussion de professionnels de la santé (n=6) et de personnes résidant dans la communauté (n=7) ont discuté de questions liées aux connaissances, aux attitudes et aux croyances par rapport à l'arthrose ; des expériences de vie des personnes souffrant d'arthrose ; des comportements relatifs à la recherche de soins de santé ; de l'accès aux services et de stratégies suggérées pour accroître la sensibilisation du public. Des analyses qualitatives ont permis d'identifier les thèmes dominants. Résultats : Les raisons expliquant les délais, selon les personnes de la communauté, comprenaient l'absence de connaissance sur les facteurs de risque et la prévention possible de la maladie, ainsi que la croyance selon laquelle la douleur au genou fait partie des conséquences du vieillissement. Les raisons liées au système de santé qui ont été mentionnées sont notamment les longs délais d'attente et la frustration engendrée par les tentatives d'obtenir un rendez-vous. Les professionnels de la santé n'ont pas précisé quelles disciplines devraient aborder la prévention et les facteurs de risque. Les stratégies suggérées comprenaient entre autres la promotion d'un mode de vie sain, la mise sur pied de programmes de prévention et le recours à des célébrités pour informer le public. Conclusion : Les participants ont mentionné de multiples raisons expliquant les retards et les stratégies pour les éliminer. La connaissance des lacunes dans le processus de soins de l'arthrose pourrait faciliter la participation des physiothérapeutes à l'élaboration de stratégies visant une intervention précoce.