The evidence base for interprofessional education within health professions education: A protocol for an update review.

Interprofessional education (IPE) interventions aiming to promote collaborative competence and improve the delivery of health and social care processes and outcomes continue to evolve. This paper reports on a protocol for an update review that we will conduct to identify and describe how the IPE evidence base has evolved in the last 7 years. We will identify literature through a systematic search of the following electronic databases: Medline, Embase, CINAHL, Education Source, ERIC, and BEI. We will consider all IPE interventions delivered to health professions students and accredited professionals. Peer-reviewed empirical research studies published in any language from June 2014 onwards will be eligible for inclusion. The outcomes of interest are changes in the reaction, attitudes/perceptions, knowledge/skills acquisition, behaviors, organizational practice, and/or benefits to patients. We will perform each task of screening, critical appraisal, data abstraction, and synthesis using at least two members of the review team. The review will enable an update and comprehensive understanding of the IPE evidence base to inform future IPE developments, delivery and evaluation across education and clinical settings.

Do we overtreat patients with presumed neutropenic sepsis?

PURPOSE: Many aspects of the management of neutropenic sepsis remain controversial. These include the choice of empiric antibiotic, the duration of antibiotic therapy and the possibility that very low-risk cases may be managed safely with oral rather than intravenous therapy. STUDY DESIGN: Retrospective cohort study conducted in a district general hospital serving a population of 148 000 in south west Scotland. RESULTS: Fifty one patients with cancer, whose neutrophil count was less than 1.0×109/L within 21 days of their last chemotherapy, were admitted as a medical emergency in 2019. All received antibiotic because of presumed neutropenic sepsis. A total of 4 patients had positive blood cultures (group 1), 12 patients had a clinical focus of infection but no clear pathogen (group 2), while 35 patients had neither (group 3). Group 3 patients were more likely to have a solid tumour, less likely to be febrile, had shorter time to neutrophil recovery and higher Multinational Association of Supportive Care in Cancer scores, though not all of these comparisons achieved statistical significance. Median intravenous plus oral antibiotic duration in group 3 patients was 9 days with median hospital stay of 7 days, raising the possibility of overtreatment. Retrospectively, 23 (66%) group 3 patients had MASSC Risk Index greater than 21 suggesting they were at low risk of complications. CONCLUSIONS: It seems likely that many low-risk neutropenic cancer patients with solid tumours could be managed as effectively and as safely with shorter courses of antibiotic, with oral rather than intravenous antibiotic, as outpatients rather than inpatients and with an overall positive impact on antimicrobial stewardship.

Evaluating collaborative practice within community-based integrated health and social care teams: a systematic review of outcome measurement instruments.

Collaborative practice is a workforce priority for integrated health and social care systems internationally, requiring robust outcome measurement instruments (OMIs) to enable team development and good quality research. In this systematic review, we appraised self-administered OMIs that could be used to measure team-based collaborative practice within integrated health and social care teams in community settings. The most important measurement properties when selecting between OMIs are content and structural validity and internal consistency. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) systematic review method was modified to evaluate each OMI. For each measurement property, the methodological quality of individual studies and quality of each parameter were rated, and the level of evidence graded. A search strategy applied to 19 bibliographic databases identified 7 instruments that met eligibility criteria. A total of 6 development studies, 6 content validity studies, 8 studies for structural validity, and 10 for internal consistency were included. Only the shortened version of the Assessment of Interprofessional Team Collaboration Scale (ATICS-II) was rated as Sufficient for each measurement property with Very Low or Moderate quality evidence. Further validation of each OMI for use by community integrated teams is needed; studies evaluating relevance, comprehensibility and comprehensiveness are a priority.

Top tips for interprofessional education and collaborative practice research: a guide for students and early career researchers.

Interprofessional research within the contexts of education and health and social care practice has grown exponentially within the past three decades. To maintain the momentum of high-quality research, it is important that early career researchers embarking on their first research journey and new to interprofessional education or interprofessional collaborative practice feel supported in making their contribution to the field. This guide, developed by the Center for the Advancement of Interprofessional Education (CAIPE) Research Group, has been written with these groups in mind who are embarking on their first research journey, and new to the interprofessional field. It aims to raise awareness of academic resources and share practical advice from those who have previously experienced problems when undertaking interprofessional research in education or health and social care practice.

The clinical- and cost-effectiveness of functional electrical stimulation and ankle-foot orthoses for foot drop in Multiple Sclerosis: a multicentre randomized trial.

OBJECTIVE: To compare the clinical- and cost-effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) over 12 months in people with Multiple Sclerosis with foot drop. DESIGN: Multicentre, powered, non-blinded, randomized trial. SETTING: Seven Multiple Sclerosis outpatient centres across Scotland. SUBJECTS: Eighty-five treatment-naïve people with Multiple Sclerosis with persistent (>three months) foot drop. INTERVENTIONS: Participants randomized to receive a custom-made, AFO (n = 43) or FES device (n = 42). OUTCOME MEASURES: Assessed at 0, 3, 6 and 12 months; 5-minute self-selected walk test (primary), Timed 25 Foot Walk, oxygen cost of walking, Multiple Sclerosis Impact Scale-29, Multiple Sclerosis Walking Scale-12, Modified Fatigue Impact Scale, Euroqol five-dimension five-level questionnaire, Activities-specific Balance and Confidence Scale, Psychological Impact of Assistive Devices Score, and equipment and National Health Service staff time costs of interventions. RESULTS: Groups were similar for age (AFO, 51.4 (11.2); FES, 50.4(10.4) years) and baseline walking speed (AFO, 0.62 (0.21); FES 0.73 (0.27) m/s). In all, 38% dropped out by 12 months (AFO, n = 21; FES, n = 11). Both groups walked faster at 12 months with device (P < 0.001; AFO, 0.73 (0.24); FES, 0.79 (0.24) m/s) but no difference between groups. Significantly higher Psychological Impact of Assistive Devices Scores were found for FES for Competence (P = 0.016; AFO, 0.85(1.05); FES, 1.53(1.05)), Adaptability (P = 0.001; AFO, 0.38(0.97); FES 1.53 (0.98)) and Self-Esteem (P = 0.006; AFO, 0.45 (0.67); FES 1 (0.68)). Effects were comparable for other measures. FES may offer value for money alternative to usual care. CONCLUSION: AFOs and FES have comparable effects on walking performance and patient-reported outcomes; however, high drop-outs introduces uncertainty.

MRI characteristics for "phantom" scratching in canine syringomyelia.

BACKGROUND: A classic sign of canine syringomyelia (SM) is scratching towards one shoulder. Using magnetic resonance imaging (MRI) we investigate the spinal cord lesion relating to this phenomenon which has characteristics similar to fictive scratch secondary to spinal cord transection. Medical records were searched for Cavalier King Charles spaniels with a clinical and MRI diagnosis of symptomatic SM associated with Chiari-like malformation (CM). The cohort was divided into SM with phantom scratching (19 dogs) and SM but no phantom scratching (18 dogs). MRI files were anonymised, randomised and viewed in EFILM ™. For each transverse image, the maximum perpendicular dimensions of the syrinx in the dorsal spinal cord quadrants were determined. Visual assessment was made as to whether the syrinx extended to the superficial dorsal horn (SDH). RESULTS: We showed that phantom scratching appears associated with a large dorsolateral syrinx that extends to the SDH in the C3-C6 spinal cord segments (corresponding to C2-C5 vertebrae). Estimated dorsal quadrant syrinx sizes based on the perpendicular diameters were between 2.5 and 9.5 times larger in dogs with phantom scratching, with the largest mean difference p-value being 0.009. CONCLUSION: SM associated phantom scratching appears associated with MRI findings of a large syrinx extending into the mid cervical SDH. We hypothesise that damage in this region might influence the lumbosacral scratching central pattern generator (CPG). If a scratching SM affected dog does not have a large dorsolateral cervical syrinx with SDH involvement then alternative explanations for scratching should be investigated.

Functional Electrical Stimulation for Foot Drop in Multiple Sclerosis: A Systematic Review and Meta-Analysis of the Effect on Gait Speed.

OBJECTIVE: To review the efficacy of functional electrical stimulation (FES) used for foot drop in people with multiple sclerosis (pwMS) on gait speed in short and long walking performance tests. DATA SOURCES: Five databases (Cochrane Library, CINAHL, Embase, MEDLINE, and PubMed) and reference lists were searched. STUDY SELECTION: Studies of both observational and experimental design where gait speed data in pwMS could be extracted were included. DATA EXTRACTION: Data were independently extracted and recorded. Methodologic quality was assessed using the Effective Public Health Practice Project tool. DATA SYNTHESIS: Nineteen studies (described in 20 articles) recruiting 490 pwMS were identified and rated as moderate or weak, with none gaining a strong rating. All studies rated weak for blinding. Initial and ongoing orthotic and therapeutic effects were assessed regarding the effect of FES on gait speed in short and long walking tests. Meta-analyses of the short walk tests revealed a significant initial orthotic effect (t=2.14, P=.016), with a mean increase in gait speed of .05m/s, and ongoing orthotic effect (t=2.81, P=.003), with a mean increase of .08m/s. There were no initial or ongoing effects on gait speed in long walk tests and no therapeutic effect on gait speed in either short or long walk tests. CONCLUSIONS: FES used for foot drop has a positive initial and ongoing effect on gait speed in short walking tests. Further fully powered randomized controlled trials comparing FES with alternative treatments are required.

Physiotherapy Rehabilitation for People With Progressive Multiple Sclerosis: A Systematic Review.

OBJECTIVE: To assess the efficacy of physiotherapy interventions, including exercise therapy, for the rehabilitation of people with progressive multiple sclerosis. DATA SOURCES: Five databases (Cochrane Library, Physiotherapy Evidence Database [PEDro], Web of Science Core Collections, MEDLINE, Embase) and reference lists of relevant articles were searched. STUDY SELECTION: Randomized experimental trials, including participants with progressive multiple sclerosis and investigating a physiotherapy intervention or an intervention containing a physiotherapy element, were included. DATA EXTRACTION: Data were independently extracted using a standardized form, and methodologic quality was assessed using the PEDro scale. DATA SYNTHESIS: Thirteen studies (described by 15 articles) were identified and scored between 5 and 9 out of 10 on the PEDro scale. Eight interventions were assessed: exercise therapy, multidisciplinary rehabilitation, functional electrical stimulation, botulinum toxin type A injections and manual stretches, inspiratory muscle training, therapeutic standing, acupuncture, and body weight-supported treadmill training. All studies, apart from 1, produced positive results in at least 1 outcome measure; however, only 1 article used a power calculation to determine the sample size and because of dropouts the results were subsequently underpowered. CONCLUSIONS: This review suggests that physiotherapy may be effective for the rehabilitation of people with progressive multiple sclerosis. However, further appropriately powered studies are required.

A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39.

BACKGROUND: Interprofessional education (IPE) aims to bring together different professionals to learn with, from, and about one another in order to collaborate more effectively in the delivery of safe, high-quality care for patients/clients. Given its potential for improving collaboration and care delivery, there have been repeated calls for the wider-scale implementation of IPE across education and clinical settings. Increasingly, a range of IPE initiatives are being implemented and evaluated which are adding to the growth of evidence for this form of education. AIM: The overall aim of this review is to update a previous BEME review published in 2007. In doing so, this update sought to synthesize the evolving nature of the IPE evidence. METHODS: Medline, CINAHL, BEI, and ASSIA were searched from May 2005 to June 2014. Also, journal hand searches were undertaken. All potential abstracts and papers were screened by pairs of reviewers to determine inclusion. All included papers were assessed for methodological quality and those deemed as "high quality" were included. The presage-process-product (3P) model and a modified Kirkpatrick model were employed to analyze and synthesize the included studies. RESULTS: Twenty-five new IPE studies were included in this update. These studies were added to the 21 studies from the previous review to form a complete data set of 46 high-quality IPE studies. In relation to the 3P model, overall the updated review found that most of the presage and process factors identified from the previous review were further supported in the newer studies. In regard to the products (outcomes) reported, the results from this review continue to show far more positive than neutral or mixed outcomes reported in the included studies. Based on the modified Kirkpatrick model, the included studies suggest that learners respond well to IPE, their attitudes and perceptions of one another improve, and they report increases in collaborative knowledge and skills. There is more limited, but growing, evidence related to changes in behavior, organizational practice, and benefits to patients/clients. CONCLUSIONS: This updated review found that key context (presage) and process factors reported in the previous review continue to have resonance on the delivery of IPE. In addition, the newer studies have provided further evidence for the effects on IPE related to a number of different outcomes. Based on these conclusions, a series of key implications for the development of IPE are offered.

Increasing physical activity in stroke survivors using STARFISH, an interactive mobile phone application: a pilot study.

BACKGROUND: Following stroke, people are generally less active and more sedentary which can worsen outcomes. Mobile phone applications (apps) can support change in health behaviors. We developed STARFISH, a mobile phone app-based intervention, which incorporates evidence-based behavior change techniques (feedback, self-monitoring and social support), in which users' physical activity is visualized by fish swimming. OBJECTIVE: To evaluate the potential effectiveness of STARFISH in stroke survivors. METHOD: Twenty-three people with stroke (12 women; age: 56.0 ± 10.0 years, time since stroke: 4.2 ± 4.0 years) from support groups in Glasgow completed the study. Participants were sequentially allocated in a 2:1 ratio to intervention (n = 15) or control (n = 8) groups. The intervention group followed the STARFISH program for six weeks; the control group received usual care. Outcome measures included physical activity, sedentary time, heart rate, blood pressure, body mass index, Fatigue Severity Scale, Instrumental Activity of Daily Living Scale, Ten-Meter Walk Test, Stroke Specific Quality of Life Scale, and Psychological General Well-Being Index. RESULTS: The average daily step count increased by 39.3% (4158 to 5791 steps/day) in the intervention group and reduced by 20.2% (3694 to 2947 steps/day) in the control group (p = 0.005 for group-time interaction). Similar patterns of data and group-time interaction were seen for walking time (p = 0.002) and fatigue (p = 0.003). There were no significant group-time interactions for other outcome measures. CONCLUSION: Use of STARFISH has the potential to improve physical activity and health outcomes in people after stroke and longer term intervention trials are warranted.

Playing-Related Musculoskeletal Problems Among Professional Orchestra Musicians in Scotland: A Prevalence Study Using a Validated Instrument, the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM).

UNLABELLED: Many epidemiological surveys on playing-related musculoskeletal problems (PRMPs) have been carried out on professional musicians, but none have evaluated or confirmed the psychometric properties of the instruments that were used. The aim of the present study was to evaluate the prevalence of PRMPs among professional orchestra musicians and to gather information on pain intensity and pain interference on function and psychosocial variables, using a self-report instrument developed and validated specifically for a population of professional orchestra musicians. METHODS: Out of 183 professional orchestra players, 101 took part in the study (55% response rate) and completed the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM). RESULTS: Lifetime prevalence of PRMPs was 77.2%, 1-year prevalence was 45.5%, and point prevalence was 36.6%. Of the PRMP group, 43% reported having pain in three or more locations, most commonly the right upper limb, neck, and left forearm and elbow. However, predominant sites of PRMPs varied between instrument groups. The mean pain intensity score for the PRMP group was 12.4±7.63 (out of 40). The mean pain interference score was 15.2±12.39 (out of 50), increasing significantly with the number of reported pain locations (F=3.009, p=0.044). CONCLUSION: This study confirms that musculoskeletal complaints are common in elite professional musicians and that the use of an operational definition and a validated self-report instrument allows for more accurate and meaningful estimates of pain prevalence.

Web-based physiotherapy for people moderately affected with Multiple Sclerosis; quantitative and qualitative data from a randomized, controlled pilot study.

OBJECTIVE: To explore the effectiveness and participant experience of web-based physiotherapy for people moderately affected with Multiple Sclerosis (MS) and to provide data to establish the sample size required for a fully powered, definitive randomized controlled study. DESIGN: A randomized controlled pilot study. SETTING: Rehabilitation centre and participants' homes. SUBJECTS: Thirty community dwelling adults moderately affected by MS (Expanded Disability Status Scale 5-6.5). INTERVENTIONS: Twelve weeks of individualised web-based physiotherapy completed twice per week or usual care (control). Online exercise diaries were monitored; participants were telephoned weekly by the physiotherapist and exercise programmes altered remotely by the physiotherapist as required. MAIN MEASURES: The following outcomes were completed at baseline and after 12 weeks; 25 Foot Walk, Berg Balance Scale, Timed Up and Go, Multiple Sclerosis Impact Scale, Leeds MS Quality of Life Scale, MS-Related Symptom Checklist and Hospital Anxiety and Depression Scale. The intervention group also completed a website evaluation questionnaire and interviews. RESULTS: Participants reported that website was easy to use, convenient, and motivating and would be happy to use in the future. There was no statistically significant difference in the primary outcome measure, the timed 25ft walk in the intervention group (P=0.170), or other secondary outcome measures, except the Multiple Sclerosis Impact Scale (P=0.048). Effect sizes were generally small to moderate. CONCLUSION: People with MS were very positive about web-based physiotherapy. The results suggested that 80 participants, 40 in each group, would be sufficient for a fully powered, definitive randomized controlled trial.

Quantifying severe maternal morbidity in Scotland: a continuous audit since 2003.

Since 2003, a continuous audit of severe maternal morbidity in Scotland has been conducted, collecting data on consistently defined events in all the consultant-led maternity units within Scotland. This review summarizes the methodology of the audit and describes some of the main results accumulated in the 10 years audited [2003-2012 (The 2012 Scottish Confidential Audit of Severe Maternal Morbidity report is yet to be published. This article refers to extracts from 2012 data where available, but on other occasions refers to data from 2003 to 2011.)]. Although most causes of severe maternal morbidity have decreased during the audit, major obstetric haemorrhage, the most common cause of severe maternal morbidity, has increased. Some key findings are as follows: admission to an ICU is required for 1 woman in every 700 births; major obstetric haemorrhage is experienced by 1 in 172 women; cases of eclampsia have decreased during the audit; there were deficiencies in antenatal risk identification and action planning; and the direct involvement of consultant obstetricians and anaesthetists in the care of women was below those recommended by the guidelines. The audit has demonstrated changes in clinical practice and in adherence to clinical guidelines over time. The information has been used to inform clinical practice within the Scottish maternity units.

Hands-off and hands-on casting consistency of amputee below knee sockets using magnetic resonance imaging.

Residual limb shape capturing (Casting) consistency has a great influence on the quality of socket fit. Magnetic Resonance Imaging was used to establish a reliable reference grid for intercast and intracast shape and volume consistency of two common casting methods, Hands-off and Hands-on. Residual limbs were cast for twelve people with a unilateral below knee amputation and scanned twice for each casting concept. Subsequently, all four volume images of each amputee were semiautomatically segmented and registered to a common coordinate system using the tibia and then the shape and volume differences were calculated. The results show that both casting methods have intra cast volume consistency and there is no significant volume difference between the two methods. Inter- and intracast mean volume differences were not clinically significant based on the volume of one sock criteria. Neither the Hands-off nor the Hands-on method resulted in a consistent residual limb shape as the coefficient of variation of shape differences was high. The resultant shape of the residual limb in the Hands-off casting was variable but the differences were not clinically significant. For the Hands-on casting, shape differences were equal to the maximum acceptable limit for a poor socket fit.

A combination of constraint-induced therapy and motor control retraining in the treatment of focal hand dystonia in musicians: a long-term follow-up study.

UNLABELLED: Focal hand dystonia (FHD) in musicians is a painless, task-specific motor disorder characterized by involuntary loss of control of individual finger movements. The aim of this study was to investigate the long-term effects of a combined behavioral therapy intervention aimed at normalizing finger movement patterns. METHODS: Eight musicians with FHD had taken part in the 1-year study involving intensive constraint-induced therapy and motor control retraining at slow speed as the interventions. Four of these subjects volunteered to take part in this 4-year follow-up. A quasi-experimental, repeated measures design was used, with 9 testing sessions over 4 years. Video recordings of the subjects playing two pieces were used for data analysis. The Frequency of Abnormal Movements scale (FAM) was the main outcome measure. It was hypothesized that there would be significant differences in FAM scores achieved over the 4-year period. RESULTS: The results from the ANOVA revealed a significant decrease, by approximately 80%, in the number of abnormal movements for both pieces over the 4-year period (F=7.85, df=8, p<0.001). Tukey's post-hoc test revealed that significant improvements occurred after 6 months of therapy (p-values between p<0.001 and p=0.044). Although the results were not significant between month 12 and follow-up at year 4, the trend revealed that the progress achieved during the first year of intensive retraining was maintained at year 4. CONCLUSIONS: A 1-year period of intensive task-specific retraining may be a successful strategy with long-term, lasting effects for the treatment of musician's FHD. Results suggest that retraining strategies may need to be carried out for at least 6 months before statistically significant changes are noted.

Assessment of the impact of different N terminal pro brain natriuretic peptide thresholds on echocardiography services.

AIMS: N terminal pro brain natriuretic peptide (NT-proBNP) is considered a rule-out test for patients with suspected heart failure. The NT-proBNP thresholds recommended for echocardiography by the European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) are based on small studies of patients with heart failure and left ventricular (LV) systolic dysfunction (LVSD). The purpose of our study was to examine the relation between NT-proBNP and LVSD in a larger number of patients with symptoms suggestive of heart failure in a non-acute setting. METHODS AND RESULTS: One thousand patients with suspected chronic heart failure underwent echocardiography within 6 months of NT-proBNP measurement. NT-proBNP was the strongest predictor of any form of LVSD in univariate (OR 2.52, 95% CI 2.19-2.91, P value < 0.001) and multivariate (OR 2.73, 95% CI 2.32-3.21, P value < 0.001) analyses. Negative predictive value (NPV) of NT-proBNP for impaired LV systolic function (ejection fraction 35-49%) was 98% at 125 pg/mL (the ESC threshold), 93% at 400 pg/mL (the NICE threshold), 91% at 1000 pg/mL and 90% at 2000 pg/mL. Corresponding values for severe LVSD (ejection fraction <35%) were 100%, 99%, 98% and 96%. The number of patients per 1000 with suspected chronic heart failure requiring echocardiography at each threshold was 851, 543, 324, and 182, respectively. CONCLUSIONS: N terminal pro brain natriuretic peptide thresholds recommended by ESC and NICE result in large numbers of patients with suspected chronic heart failure being referred for echocardiography. Raising the NT-proBNP threshold would improve access to echocardiography with minimal negative impact on the clinical performance of this cardiac biomarker.

Teledermatology to reduce face-to-face appointments in general practice during the COVID-19 pandemic: a quality improvement project.

Teledermatology is an important subspecialty of telemedicine that continues to evolve with advances in telecommunication and mobile phone technology. A 19-week primary care quality improvement project collected baseline data and tested three change ideas, using the Model for Improvement method, with primary and secondary aims: to increase the weekly percentage of remote dermatological consultations with supporting images that were successfully concluded remotely to greater than 80% and to reduce the weekly percentage of dermatological face-to-face consultations to less than 50%. We hypothesised that by improving the quality of patient images and the confidence of reception staff in triaging skin complaints, there would be a decrease in the weekly number of face-to-face dermatological appointments, thereby decreasing the risk of COVID-19 transmission within the practice and community. Two change ideas focused on supporting patients to improve image quality by introducing '4 Key Instructions' and a patient information leaflet (PIL). The third focused on increasing reception staff confidence in triaging skin complaints by introducing a triage pathway guidance tool. A total of 253 dermatological consultations were analysed: 170 of these were telephone consultations with 308 supporting images. Process measures showed clear improvements in the quality of images provided by patients which likely contributed to an increase in completed remote consultation. Our primary outcome measure was achieved. Our secondary outcome measure suggested that in the absence of high-quality images, it might not be possible to reduce dermatological face-to-face consultations much below 50% in primary care. Process measures showed clear improvements in the quality of images provided by patients which likely contributed to the increase in remote consultation. The implications of these findings for the theory of change are discussed.

A randomised controlled trial of interventions for taxane-induced nail toxicity in women with early breast cancer.

Onycholysis and paronychia has been associated with chemotherapy treatment for women with breast cancer. Our primary aim was to investigate the effectiveness of different topical interventions to ameliorate nail toxicity. Secondary aims were to explore the full range and severity of possible nail changes associated with taxane-based chemotherapy and the specific impact this had on quality of life, using two novel measures. This was an exploratory randomised controlled trial of three topical interventions (standard care, nail polish or specialist nail drops) for the prevention or reduction of nail changes induced by taxane-based chemotherapy. Outcomes included nail toxicity assessed at three time points (baseline, 3 weeks and 3 months post completion of chemotherapy) using two novel clinical tools (NToX-G12, NToX-QoL) and the Common Terminology Criteria for Adverse Events (CTCAE v3) and EQ-5D-5L. A total of 105 women were recruited (35 in each arm) and monitored up to three months post completion of chemotherapy. Almost 20% of patients were over the age of 60 years. There were 26 withdrawals, the majority from the nail polish arm. Residual Maximum Likelihood REML analysis indicated a significant arm, time and interaction effect for each intervention (p < 0.001). Less nail toxicity was observed in patients receiving specialist nail drops or standard care arms in comparison to those using nail polish. This study provides evidence to support clinicians' suggestions on nail care recommendations based on the patients' needs and preferences. Future investigations into comparing or combining cryotherapy and topical solutions that can support patient's decisions are warranted.

The trans-femoral fitting predictor: a functional measure to predict prosthetic fitting in transfemoral amputees--validity and reliability.

OBJECTIVE: To assess the psychometric properties of the Trans-femoral Fitting Predictor (TFP). DESIGN: Prospective observational study. SETTING: Hospital sites (N=9). PARTICIPANTS: Transfemoral amputees (N=93). INTERVENTION: The TFP, a 9-item instrument describing graded tasks, aims to assess the prosthetic potential of transfemoral amputees. The instrument was used in its paper form (N=93) and for a video assessment of a subset of these amputees (n=75). MAIN OUTCOME MEASURE(S): Reliability and validity of the TFP, both paper and video assessments. RESULTS: The TFP yielded Cronbach α of .92, and all intraclass correlation coefficients between values were greater than 0.8, with narrow 95% confidence intervals. Factor analysis suggested the TFP had 2 constructs representing more advanced and less advanced tasks. Both discriminant analysis and logistic regression suggested that tasks 7 (stand with early walking aid [EWA] for 30s) and 8 (walk to the end of the parallel bars with the EWA and turn around) were more predictive of whether an amputee will go on to receive a prosthesis. CONCLUSION: The TFP is a simple, valid, and reliable measure of prosthetic potential for transfemoral amputees. Video assessment with the TFP was very successful and in the future could be used for both training purposes and to provide expert assessment through telehealth.