Perceptions of the effectiveness of using patient encounter data as an education and reflection tool in general practice training.

Introduction Patient encounter tools provide feedback and potentially reflection on general practitioner (GP) registrars' in-practice learning and may contribute to the formative assessment of clinical competencies. However, little is known about the perceived utility of such tools. Aim To investigate the perceived utility of a patient encounter tool by GP registrars, their supervisors, and medical educators (MEs). Methods General practice registrars, supervisors and MEs from two Australian regional training organisations completed a cross-sectional questionnaire. Registrars rated how Registrar Clinical Encounters in Training (ReCEnT), a patient encounter tool, influenced their reflection on, and change in, clinical practice, learning and training. Supervisors' and MEs' perceptions provided contextual information about understanding their registrars' clinical practice, learning and training needs. Results Questionnaires were completed by 48% of registrars (n = 90), 22% of supervisors (n = 182), and 61% of MEs (n = 62). Most registrars agreed that ReCEnT helped them reflect on their clinical practice (79%), learning needs (69%) and training needs (72%). Many registrars reported changing their clinical practice (54%) and learning approaches (51%). Fewer (37%) agreed that ReCEnT influenced them to change their training plans. Most supervisors (68%) and MEs (82%) agreed ReCEnT reports helped them better understand their registrars' clinical practice. Similarly, most supervisors (63%) and MEs (68%) agreed ReCEnT reports helped them better understand their registrars' learning and training needs. Discussion ReCEnT can prompt self-reflection among registrars, leading to changes in clinical practice, learning approaches and training plans. Reaching its potential as an assessment for learning (as opposed to an assessment of learning) requires effective engagement between registrars, their supervisors and MEs.

Exploring how a patient encounter tracking and learning tool is used within general practice training: a qualitative study.

Introduction In Australian general practitioner (GP) training, feedback and reflection on in-practice experience is central to developing GP registrars' (trainees') clinical competencies. Patient encounter tracking and learning tools (PETALs) that encompass an audit of consecutive patient consultations, feedback, and reflection are used to determine registrars' in-practice exposure and have been suggested as a tool for learning within a programmatic assessment framework. However, there is limited qualitative literature on the utility of PETALs in GP training. Aim To provide greater understanding of how PETALs are used in GP training, using Registrars' Clinical Encounters in Training (ReCEnT) as a case study. Methods Medical educators, supervisors, and registrars from two Australian regional GP training organisations participated in focus groups and interviews, designed to explore participants' perceptions of ReCEnT's utility. Data were analysed using reflexive thematic analysis. Results Eight themes were identified that enhance our understanding of: how ReCEnT reports are used (reassuring registrars, facilitating self-reflection, identifying learning needs), what enables ReCEnT to reach its full potential (a culture of reflection, meaningful discussions with supervisors and medical educators, valuing objective data), and differences in understanding about ReCEnT's role in a programmatic assessment framework (as a tool for learning, as 'one piece of the puzzle'). Discussion The findings were used to develop a Structure-Process-Outcomes model to demonstrate how ReCEnT is currently used and explores how it can be used for learning, rather than of learning, in a programmatic assessment framework for GP training. ReCEnT's longitudinal format has potential for enhancing learning throughout training.

Educational models, participant experience and outcomes of a diploma course in practice management for Aboriginal Medical Services: a qualitative study.

BACKGROUND: Practice managers and other administrative and management staff in Aboriginal Medical Services operate in a highly specialised cultural, social and administrative environment requiring a unique skill set. The TAFE NSW Diploma in Practice Management for Aboriginal Medical Services (DPMAMS) addresses the need for training in these skills. This study sought to explore DPMAMS graduates' experiences of having undertaken the diploma course, and the effects on their subsequent work practice and career. METHODS: A qualitative study utilising individual, semi-structured interviews conducted via videoconference and employing a thematic analysis approach was performed. RESULTS: Ten DPMAMS alumni participated. At the time of DPMAMS completion, two participants were Aboriginal Medical Services practice managers, two were reception staff, five were in non-practice manager administrative or management roles and one was in a clinical role. Principal themes in the study findings were related to (1) the rich and singular learning environment with emphasis on peer-to-peer learning (which also facilitated 'communities of practice' extending the collaborative learning model to post-DMAMS peer learning and support); (2) knowledge and subsequent professional and personal confidence (leading to taking on increased workplace responsibility including post-DPMAMS mentoring roles); (3) translational effects on personal work and professional performance; (4) translational effects on work processes at the participants' Aboriginal Medical Services; and (5) the permeating influence of Aboriginal culture and commitment to Aboriginal communities. CONCLUSIONS: The DPMAMS is an education/training program of perceived high value and fitness for purpose. The findings of utility of education that is empowered by culture, values and peer support may be applicable in wider settings.

'Low-value' clinical care in general practice: associations of low value care in GP trainees' practice, including formative and summative examination performance - protocol for cross-sectional and retrospective cohort study analyses using the QUestionable In Training Clinical Activities (QUIT-CA) index.

INTRODUCTION: 'Low value' clinical care and overuse of medical services are 'questionable' clinical activities that entail provision of medical services that are more likely to cause harm than good or whose benefit is disproportionately low compared with its cost. This study will seek to establish clinical practice associations of a non-observed work-based assessment of general practitioner (GP) trainees' (registrars') questionable practice (the QUestionable In Training Clinical Activities (QUIT-CA) index). We will also explore association of the QUIT-CA index with a formative observed work-based assessment, and will establish if registrars' QUIT-CA indexes are associated with summative examination performance. METHODS AND ANALYSIS: We will conduct three analyses, all using data from the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing (from 2010) cohort study in which Australian GP registrars record details of their in-consultation clinical and educational practice. The QUIT-CA index is compiled from ReCEnT consultation data. A cross-sectional analysis, using negative binomial regression, will establish clinical practice associations of the QUIT-CA index. A cross-sectional analysis using linear regression will be used to establish associations of QUIT-CA index with formative observed in-practice assessment (the General Practice Registrar-Competency Assessment Grid). A retrospective cohort study analysis using linear regression will be used to establish associations of the QUIT-CA index with summative examination performance (Royal Australian College of General Practice fellowship examinations results). ETHICS AND DISSEMINATION: The study has ethical approval from the University of Newcastle HREC(H-2009-0323). Findings will be disseminated in peer-reviewed journal articles and conference presentations.

Storytelling and the Humanbecoming Family Model.

The authors in this article will present storytelling through the lens of the humanbecoming family model. From this perspective, storytelling can be viewed as the following: (a) family storytelling as a mode of fostering personal and family becoming, (b) family storytelling as a confirming of family beliefs and values, and (c) family storytelling as a way of addressing issues of grief and loss. Selected literature is presented to highlight the essences, paradoxes, and processes of the humanbecoming family model.

Product Integration of Established Crash Sensors for Safety Applications in Lightweight Vehicles.

The functionality of products increases when more sensors are used. This trend also affects future automobiles and becomes even more relevant in connected and autonomous applications. Concerning automotive lightweight design, carbon fibre-reinforced polymers (CFRP) are suitable materials. However, their drawbacks include the relatively high manufacturing costs of CFRP components in addition to the difficulty of recycling. To compensate for the increased expenditure, the integration of automotive sensors in CFRP vehicle structures provides added value. As a new approach, established sensors are integrated into fibre-reinforced polymer (FRP) structures. The sensors are usually mounted to the vehicle. The integration of sensors into the structure saves weight and space. Many other approaches specifically develop new sensors for integration into FRP structures. With the new approach, there is no need for elaborate development of new sensors since established sensors are used. The present research also showed that the range of applications of the sensors can be extended by the integration. The present paper outlines the functional behaviour of the integrated sensor utilized for crashing sensing. First of all, the integration quality of the sensor is relevant. Different requirements apply to the usual mounting of the sensor. The self-sensing structure must fulfil those requirements. Moreover, unfamiliar characteristics of the new surrounding structure might affect the sensing behaviour. Thus, the sensing behaviour of the self-sensing composite was analyzed in detail. The overarching objective is the general integration of sensors in products with reasonable effort.

Cross-sectional survey of rehabilitation service availability for stroke and hip fracture in Australian public hospitals.

OBJECTIVE: To describe the rehabilitation services available for people with stroke and hip fracture across New South Wales/Australian Capital Territory metropolitan and rural/regional public hospitals in Australia. DESIGN: A cross-sectional study design was used. SETTING: New South Wales/Australian Capital Territory public hospital providing rehabilitation services for stroke and hip fracture. PARTICIPANTS: Delegates from 59 eligible hospitals. INTERVENTION: Information about the type, number and availability of inpatient and outpatient rehabilitation services at each hospital was collected via survey. MAIN OUTCOME MEASURES: Counts, percentages, mean (SD), median (IQR) were used to quantify the number and type of inpatient and outpatient services available. RESULTS: Across inpatient rehabilitation units, reduced availability was noted in the number of clinical disciplines available, availability of neuropsychology and social work in rural units. Across outpatient rehabilitation services, reduced availability was noted in the number of disciplines available, availability of occupational therapy, psychology, rehabilitation physicians, specialist nursing, geriatricians, and podiatry in rural services. Five rural hospitals had no access to outpatient rehabilitation. CONCLUSION: There was reduced availability of rehabilitation services and health disciplines in rural/regional settings. A follow-up study is underway investigating relationships between reduced outpatient service availability and inpatient length of stay in rural/regional versus metropolitan hospitals.

Study protocol: content and perceived educational utility of different modalities of clinical teaching visit (CTV) workplace-based assessments within Australian general practice vocational training: a cross-sectional study.

INTRODUCTION: Clinical teaching visits (CTVs) are formative workplace-based assessments that involve a senior general practitioner (GP) observing a clinical practice session of a general practice registrar (specialist vocational GP trainee). These visits constitute a key part of Australian GP training. Despite being mandatory and resource-intensive, there is a paucity of evidence regarding the content and educational utility of CTVs. This study aims to establish the content and educational utility of CTVs across varying practice settings within Australia, as perceived by registrars and their assessors ('CT visitors'). In addition, this study aims to establish registrar, CT visitor and practice factors associated with CTV content and perceived CTV utility ratings. METHODS AND ANALYSIS: This study will collect data prospectively using online questionnaires completed soon after incident CTVs. Participants will be registrars and CT visitors of CTVs conducted from March 2020 to January 2021. The setting is three Regional Training Organisations across four Australian states and territories (encompassing 37% of Australian GP registrars).Outcome factors will be a number of specified CTV content elements occurring during the CTV as well as participants' perceptions of CTV utility, which will be analysed using univariate and multivariable regression. ETHICS AND DISSEMINATION: Ethics approval has been granted by the University of Newcastle Human Research Ethics Committee, approval number H-2020-0037. Study findings are planned to be disseminated via conference presentation, peer-reviewed journals, educational practice translational workshops and the GP Synergy research subwebsite.

Parasite Presence Induces Gene Expression Changes in an Ant Host Related to Immunity and Longevity.

Most species are either parasites or exploited by parasites, making parasite-host interactions a driver of evolution. Parasites with complex life cycles often evolve strategies to facilitate transmission to the definitive host by manipulating their intermediate host. Such manipulations could explain phenotypic changes in the ant Temnothorax nylanderi, the intermediate host of the cestode Anomotaenia brevis. In addition to behavioral and morphological alterations, infected workers exhibit prolonged lifespans, comparable to that of queens, which live up to two decades. We used transcriptomic data from cestodes and ants of different castes and infection status to investigate the molecular underpinnings of phenotypic alterations in infected workers and explored whether the extended lifespan of queens and infected workers has a common molecular basis. Infected workers and queens commonly upregulated only six genes, one of them with a known anti-aging function. Both groups overexpressed immune genes, although not the same ones. Our findings suggest that the lifespan extension of infected workers is not achieved via the expression of queen-specific genes. The analysis of the cestodes' transcriptome revealed dominant expression of genes of the mitochondrial respiratory transport chain, which indicates an active metabolism and shedding light on the physiology of the parasite in its cysticercoid stage.

A general practice workplace-based assessment instrument: Content and construct validity.

Introduction: Relatively few general practice (GP) workplace-based assessment instruments have been psychometrically evaluated. This study aims to establish the content validity and internal consistency of the General Practice Registrar Competency Assessment Grid (GPR-CAG).Methods: The GPR-CAG was constructed as a formative assessment instrument for Australian GP registrars (trainees). GPR-CAG items were determined by an iterative literature review, expert opinion and pilot-testing process. Validation data were collected, between 2014 and 2016, during routine clinical teaching visits within registrars' first two general practice training terms (GPT1 and GPT2) for registrars across New South Wales and the Australian Capital Territory. Factor analysis and expert consensus were used to refine items and establish GPR-CAG's internal structure. GPT1 and GPT2 competencies were analysed separately.Results: Data of 555 registrars undertaking GPT1 and 537 registrars undertaking GPT2 were included in analyses. A four-factor, 16-item solution was identified for GPT1 competencies (Cronbach's alpha range: 0.71-0.83) and a seven-factor 27-item solution for GPT2 competencies (Cronbach's alpha: 0.63-0.84). The emergent factor structures were clinically characterisable and resonant with existing medical education competency frameworks.Discussion: This study establishes initial evidence for the content validity and internal consistency of GPR-CAG. GPR-CAG appears to have utility as a formative GP training WBA instrument.

Medical training in private and public.

BACKGROUND: Globally, the need for medical student training to be undertaken in the private sector is likely to increase. In Australia, it has increased by 250 per cent in the last decade. Effective clinical education is highly dependent on the attitudes and willingness to participate of both patients and medical staff. We aimed to examine these attitudes in both private and public hospitals. METHODS: Patients and medical staff at a private and a public hospital in Sydney were surveyed during December 2016 and January 2017 to investigate attitudes to medical student training. Attitudes were compared between hospitals. We also compared recent attitudes in the private hospital with those obtained in 2012. RESULTS: Patients at the public hospital were significantly more likely to want a student present at a consultation than those at a private hospital. Public hospital doctors had more positive attitudes towards medical students than their private colleagues. The negative financial impact of teaching was more significant for those in private practice. Since 2012, attitudes of private hospital patients towards medical students became significantly more positive whereas doctors' attitudes became less positive. The expansion of clinical education into the private sector is likely to increase globally DISCUSSION: The willingness of patients to participate in medical student training in both public and private hospitals is encouraging for future expansion into the private sector. The reduced willingness amongst private hospital medical staff over time and, in comparison to public hospital staff, suggests a need to address barriers for staff in the private sector.

Sensor Systems for FRP Lightweight Structures: Automotive Features Based on Serial Sensor Products.

To achieve resource efficiency and an increased performance, as well as a higher safety and more features for vehicles, lightweight composites are a central sphere of activity for automotive innovations. This becomes particularly striking if the focus is not only a reduced vehicle weight but also an efficient overall concept. In addition to compatible material technologies and component design, new electronic solutions are of interest. A research contribution at the Robert Bosch Company deals with the direct integration of a current automotive acceleration sensor in fiber-reinforced polymer (FRP) parts. The sensor is part of the passive vehicle safety. Primarily, the principal application of the currently mounted sensor as an integrated part of the vehicle structure was proven. Sensor-integrated parts were evaluated on their sensing functionality as well as their structural performance. The present research is done to use the integrated sensor for a secondary feature. The study shows that the sensor can also be an indicator for the condition of its surrounding FRP structure. Hence, the sensor integration makes it possible to derive a secondary feature for automobiles by using the current sensor for future functionalized lightweight structures.

Rehabilitation and education are underutilized for mild stroke and TIA sufferers.

PURPOSE: Transient ischemic attack (TIA) and mild stroke represent a large proportion of cerebrovascular events, at high risk of being followed by recurrent, serious events. The importance of early education addressing risk management, secondary prevention and lifestyle modifications is the centerpiece of further stroke prevention. However, delivering education and rehabilitation to this population can be complex and challenging. METHODS: Via synthesis of a narrative review and clinical experience, we explore the unique and inherent complexities of rehabilitation management and education provision for patients following mild stroke and TIA. RESULTS: A considerable proportion of TIA/mild stroke survivors have ongoing rehabilitation needs that are poorly addressed. The need for rehabilitation in these patients is often overlooked, and available assessment tools lack the sensitivity to identify common subtle impairments in cognition, mood, language and fatigue. Active and accessible education interventions need to be initiated early after the event, and integrated with ongoing rehabilitation management. Priority areas in need of future development in this field are highlighted and discussed. Implications for rehabilitation Survivors of mild stroke and TIA have ongoing unmet rehabilitation needs and require a unique approach to rehabilitation and education. Rehabilitation needs are difficult to assess and poorly addressed in this cohort, where available assessment tools lack the sensitivity required to identify subtle impairments. Education needs to be initiated early after the event and involve active engagement of the patient in order to improve stroke knowledge, mood and motivate adherence to lifestyle modifications and secondary prevention. Rehabilitation physicians are currently an underutilized resource, who should be more involved in the management of all patients following TIA or mild stroke.

Early rehabilitation after hospital admission for road trauma using an in-reach multidisciplinary team: a randomised controlled trial.

OBJECTIVE: To investigate the impact of an in-reach rehabilitation team for patients admitted after road trauma. DESIGN: Randomised control trial of usual care versus early involvement of in-reach rehabilitation team. Telephone follow-up was conducted by a blind assessor at three months for those with minor/moderate injuries and six months for serious/severe injuries. SETTING: Four participating trauma services in New South Wales, Australia. SUBJECTS: A total of 214 patients admitted during 2012-2015 with a length of stay of at least five days. INTERVENTION: Provision of rehabilitation services in parallel with ward based therapy using an in-reach team for the intervention group. The control group could still access the ward based therapy (usual care). MAIN MEASURES: The primary outcome was acute length of stay. Secondary outcomes included percentage requiring inpatient rehabilitation, function (Functional Independence Measure and Timed Up and Go Test), psychological status (Depression Anxiety and Stress Score 21), pain (Orebro Musculoskeletal Pain Questionnaire) and quality of life (Short Form-12 v2). RESULTS: Median length of stay in acute care was 13 days (IQR 8-21). The intervention group, compared to the control group, received more physiotherapy and occupational therapy sessions (median number of sessions 16.0 versus 11.5, P=0.003). However, acute length of stay did not differ between the intervention and control groups (median 15 vs 12 days, P=0.37). There were no significant differences observed in the secondary outcomes at hospital discharge and follow-up. CONCLUSION: No additional benefit was found from the routine use of acute rehabilitation teams for trauma patients over and above usual care.

"Thank You for Giving Me a Voice!" A Longitudinal Evaluation of Patients' Experience of Partnering With Students in an Australian Medical School.

BACKGROUND: We evaluated the patient-partner experience in a longitudinal program called Integrated Population Medicine in the Sydney Medical School to assess its acceptability. The program exposed senior medical students to the lived experience of chronic disease. METHODS: We surveyed 267 people with chronic conditions recruited as patient-partners by the 2012 student cohort in a mixed-methods longitudinal cohort study. Surveys were administered 'over' 18 months: before, during, and after the program. RESULTS: A total of 155 (58%) patient-partners completed the baseline survey; 52 patients returned all 3 surveys. Patient-partners remained very positive about the program across all surveys. More than 95% of respondents enjoyed interacting with the student, and most were very positive about their role in teaching the student. Three major themes emerged: willingness to help, a sense of gratitude and enjoyment, and a chance to teach and learn. Participants were willing to discuss their illness experiences and were keen to spend more time with students. CONCLUSIONS: Patients are willing participants in longitudinal patient-partner programs. They perceive benefits for themselves and others, for the health system, and for students and would like to become more actively involved in medical education.

An initial loading-dose vitamin D versus placebo after hip fracture surgery: randomized trial.

BACKGROUND: Improving vitamin D (25-OHD) status may be an important modifiable factor that could reduce disability severity, fall-rates and mortality associated after hip fracture surgery. Providing a loading-dose post-surgery may overcome limitations in adherence to daily supplementation. METHOD: In this randomized, double-blind, placebo-controlled trial, 218 adults, aged 65-years or older, requiring hip fracture surgery were assigned to receive a single loading-dose of cholecalciferol (250,000 IU vitamin-D3, the REVITAHIP - Replenishment of Vitamin D in Hip Fracture strategy) or placebo, both receiving daily vitamin-D(800 IU) and calcium (500 mg) for 26-weeks. Outcome measures were 2.4 m gait-velocity, falls, fractures, death (Week-4), 25-OHD levels, quality-of-life measure (EuroQoL) and mortality at weeks-2, 4 and 26. RESULTS: Mean age of 218 participants was 83.9(7.2) years and 77.1 % were women. Baseline mean 25-OHD was 52.7(23.5)nmol/L, with higher levels at Week-2 (73 vs 66 nmol/L; p = .019) and Week-4 (83 vs 75 nmol/L; p = .030) in the Active-group, but not at Week-26. At week-4, there were no differences in 2.4 m gait-velocity (0.42 m/s vs 0.39 m/s, p = .490), fractures (2.7 % vs 2.8 %, p = .964) but Active participants reported less falls (6.3 % vs 21.1 %, χ(2) = 4.327; p = 0.024), with no significant reduction in deaths at week-4 (1 vs 3, p = 0.295), higher percentage reporting 'no pain or discomfort' (96.4 % vs 88.8 %, p = 0.037), and trended for higher EuroQoL-scores (p = 0.092) at week-26. One case of hypercalcemia at week-2 normalised by week-4. CONCLUSION: Among older people after hip fracture surgery, the REVITAHIP strategy is a safe and low cost method of improving vitamin-D levels, reducing falls and pain levels. TRIAL REGISTRATION: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry ANZCTRN ACTRN12610000392066 (Date of registration: 14/05/2010).

Palliative care and spiritual well-being in lung cancer patients and family caregivers.

BACKGROUND: Spiritual well-being is an important dimension of quality of life (QOL) and is a core component of quality oncology and palliative care. In this analysis, we aimed to describe spiritual well-being outcomes in a National Cancer Institute (NCI)-supported Program Project that tested the effectiveness of an interdisciplinary palliative care intervention in lung cancer patients and their family caregivers (FCGs). METHODS: Patients undergoing treatments for NSCLC and their FCGs were enrolled in a prospective, quasi-experimental study. Patients and FCGs in the intervention group were presented at interdisciplinary care meetings and received four educational sessions that included one session focused on spiritual well-being. Spiritual well-being for patients was measured using the FACIT-Sp-12, and FCG spiritual well-being was measured using the COH-QOL-FCG spiritual well-being subscale. Multivariate analysis of covariance was undertaken for subscale and item scores at 12 weeks, controlling for baseline, by religious affiliations (yes or no) and group assignment. RESULTS: Religiously affiliated patients reported better scores in the Faith subscale and items on finding strength and comfort in faith and spiritual beliefs compared to non-affiliated patients. Non-affiliated patients had better scores for feeling a sense of harmony within oneself. By group, patients who received the intervention had significantly better scores for the Meaning/Peace subscale. CONCLUSIONS: Our findings support the multidimensionality of spiritual well-being that includes constructs such as meaning and faith for lung cancer patients and FCGs with or without religious affiliations. Palliative care interventions should include content that targets the spiritual needs of both patients and FCGs. Copyright © 2015 John Wiley & Sons, Ltd.

Effect of Skin-to-Skin Holding on Stress in Mothers of Late-Preterm Infants: A Randomized Controlled Trial.

PURPOSE: To examine the effect of skin-to-skin care (SSC) on stress perception between mothers who provided SSC to their late-preterm born infants and mothers who provided blanket holding. DESIGN AND METHODS: This was a longitudinal 2-group randomized controlled trial of 40 infant-mother dyads recruited from a level 3 neonatal intensive care unit in the upper Midwest. OUTCOME MEASURE: Maternal stress was measured using the Parental Stressor: Neonatal Intensive Care Unit (PSS: NICU) scale pre- and post-SSC intervention. Demographic and other mother and infant covariates were extracted from medical records. Physiologic stability was measured by the Stability of the Cardiorespiratory System in Preterm Infants (SCRIP) score. Study personnel used daily logs to track frequency and duration of SSC and holding sessions. RESULTS: The intervention and the control groups had similar pre- (mean ± standard deviation, 2.34 ± 0.86 for SSC and 2.94 ± 0.87 for holding) and post-intervention (mean ± standard deviation, 2.55 ± 0.95 for SSC and 2.78 ± 0.90 for holding) overall stress scores. Hours of SSC holding positively correlated with the change in stress scores for the entire scale (r = 0.58; P = .001), and for infant appearance (r = 0.58; P = .001) and parent role alteration (r = 0.48; P = .02) subscales. This relationship remained significant after controlling for the infant's length of stay and SCRIP score. IMPLICATIONS FOR PRACTICE: Mothers who provide SSC may experience more stress related to a more facilitated progression in the mother and infant relationship. IMPLICATIONS FOR RESEARCH: The relationship between increased stress and the number of hours of SSC holding warrants further investigation.

Cancer rehabilitation: a barometer for survival?

PURPOSE: This pilot study was conducted to describe the clinical features and functional outcomes of patients attending inpatient rehabilitation for cancer-related deconditioning and neurological deficits and to explore factors associated with improved survival. METHODS: Using a retrospective audit, demographic characteristics, discharge outcomes, survival time, and functional status as measured by Functional Independence Measure (FIM) were recorded for 73 patients. Clinical status was estimated by Karnofsky Performance Status Scale (KPS). Cox regression was used to assess factors associated with improved survival following discharge from rehabilitation. RESULTS: Significant functional gains following rehabilitation were observed in total FIM (p = 0.02), motor FIM (p = 0.001), and KPS (p = 0.003). Length of survival ranged from 9.0 to 25.0 months, with 26 cases surviving to the end of study (censored). Patients scoring a total FIM of ≥80 survived significantly longer than patients scoring <80 (p = 0.002). At discharge, motor FIM scores (p = 0.004), FIM Efficiency (p = 0.001), KPS scores (p = 0.022), ambulation ability (p = 0.026), return to home (p = 0.009), and receipt of in-home services (p = 0.045) were significantly associated with improved survival. CONCLUSIONS: Functional improvement achieved through inpatient rehabilitation was associated with prolonged survival among cancer patients. Rehabilitation leading to improved independence among cancer patients may act as a marker of those with greater likelihood of better prognosis.

Contemporary Pain Management in Elderly Patients After Hip Fracture Surgery: Cross-sectional Analyses at Baseline of a Randomized Controlled Trial.

BACKGROUND: Adequate pain management following hip fracture surgery reduces length of stay, reduces incidence of delirium, promotes recovery, and improves mobility. Previous research suggests that hip fracture pain is undertreated in some patient subgroups, and that hypovitaminosis D can further aggravate pain which could hinder active rehabilitation. We provide a cross-sectional analysis of the baseline characteristics of participants in the REVITAHIP study with the aim of documenting pain intensity and its associations after hip fracture and to explore the characteristics of people who report higher levels of pain. METHOD: We analyzed the baseline characteristics with a focus on pain scores in patients admitted with a hip fracture (undergoing surgery) to 3 teaching hospitals over New South Wales, Australia, between January 2011 and April 2013. Patients were evaluated using the Verbal Rating Scale (VRS). Secondary measures including 25-hydroxyvitamin D levels at baseline, hip fracture subtype, type of surgical intervention, quality of life score, and cognitive and mobility status were correlated with the VRS using the Pearson correlation, ANOVA, and regression analysis. RESULTS: The 218 participants had a mean age of 83.9±7.2 years and 77.1% were women of whom 16.0% had a Mini Mental State Examination score of ≤23 of 30. The mean and SD VRS pain score was 3.5±2.3. More than half (61.9%, n=113) had VRS≥3 and 18.1% (n=52) had VRS≥5. Using the EuroQOL pain subscore, 78.1% had moderate pain or discomfort and 7.9% had extreme pain or discomfort. Using a multivariate regression model, postoperative VRS was significantly higher in persons with a higher comorbidity count, those previously living independently alone, and surgical fixative modality with hemiarthroplasty. CONCLUSIONS: Overall, the levels of pain reported by this cohort are acceptable although approximately 10% to 15% had higher than reasonable levels of pain. This study provides an insight into pain assessment and management by identifying certain patient subtypes who are vulnerable to undertreatment of pain.