A cluster randomised controlled trial of a nutrition education intervention in the community.

BACKGROUND: Patients with enteral feeding tubes are increasingly managed in their home environment and these patients require support from a range of healthcare professionals. METHODS: A cluster randomised trial of an educational intervention was undertaken among General Practitioners and nurses both in the community and in nursing home caring for patients recently discharged to primary care. This was a short, duration (<1 h), nutrition education programme delivered in the work place soon after the patient was discharged from hospital. The primary outcome was an improvement in knowledge immediately after the intervention and the secondary outcome was knowledge at 6 months. RESULTS: Those in the intervention group had improved knowledge, which was significantly greater than those in the control group (P < 0.001), although this knowledge was not sustained at 6 months. CONCLUSIONS: A short, work-based targeted nutrition education programme is effective for improving knowledge among general practitioners and nurses both in the community and in nursing homes.

An audit of orthodontic referrals using IOTN as a comparison.

UNLABELLED: It is important that resources for orthodontic treatment within the Health Service Executive (HSE) are directed towards those children most in need of treatment. At present, children are referred using existing HSE guidelines. OBJECTIVES: To assess the level of treatment need in a sample of patients on the orthodontic waiting list in the North Eastern division of the HSE using the Index of Orthodontic Treatment Need (IOTN) as an objective comparison. Also, to compare these results with the findings of a similar audit in 2003 and to assess the effectiveness of recommendations from the 2003 audit. METHOD: Fifty models from each of two orthodontic units were selected. These were scored for the dental health component (DHC) and aesthetic component (AC) of IOTN by a calibrated examiner. RESULTS: In the 2005 audit, 100% of patients fell into DHC grades 4 or 5. These grades constitute a great need for treatment on dental health grounds. In the 2003 audit, 97% of patients fell into these two grades. The remaining 3% of children in 2003 were fostered and therefore entitled to orthodontic treatment under HSE guidelines. An average of 63.5% of patients fell into AC grades 8-10, i.e., deemed to be in great need of treatment on aesthetic grounds. CONCLUSION: The HSE screening guidelines identify patients in great need of orthodontic treatment using IOTN as an objective assessment of this need. The sensitivity of these guidelines requires assessment by measuring the level of unmet treatment need in 15-year-olds in the region. Recommendations arising from the 2003 audit relating to the filling of referral forms and the improvement of study model quality were found to have been effective.

Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols.

BACKGROUND: The use of cryotherapy in the management of acute soft tissue injury is largely based on anecdotal evidence. Preliminary evidence suggests that intermittent cryotherapy applications are most effective at reducing tissue temperature to optimal therapeutic levels. However, its efficacy in treating injured human subjects is not yet known. OBJECTIVE: To compare the efficacy of an intermittent cryotherapy treatment protocol with a standard cryotherapy treatment protocol in the management of acute ankle sprains. SUBJECTS: Sportsmen (n = 44) and members of the general public (n = 45) with mild/moderate acute ankle sprains. METHODS: Subjects were randomly allocated, under strictly controlled double blind conditions, to one of two treatment groups: standard ice application (n = 46) or intermittent ice application (n = 43). The mode of cryotherapy was standardised across groups and consisted of melting iced water (0 degrees C) in a standardised pack. Function, pain, and swelling were recorded at baseline and one, two, three, four, and six weeks after injury. RESULTS: Subjects treated with the intermittent protocol had significantly (p<0.05) less ankle pain on activity than those using a standard 20 minute protocol; however, one week after ankle injury, there were no significant differences between groups in terms of function, swelling, or pain at rest. CONCLUSION: Intermittent applications may enhance the therapeutic effect of ice in pain relief after acute soft tissue injury.

Are sports medicine journals relevant and applicable to practitioners and athletes?

OBJECTIVE: To examine the evidence base of sports medicine research and assess how relevant and applicable it is to everyday practice. METHODS: Original research articles, short reports, and case reports published in four major sport and exercise medicine journals were studied and classified according to the main topic of study and type of subjects used. RESULTS: The most common topic was sports science, and very few studies related to the treatment of injuries and medical conditions. The majority of published articles used healthy subjects sampled from the sedentary population, and few studies have been carried out on injured participants. CONCLUSIONS: There is a dearth of studies addressing diagnostic and treatment interventions in the sports medicine literature. The evidence base for sports medicine must continue to increase in terms of volume and quality.

Defining the sports medicine specialist in the United Kingdom: a Delphi study.

OBJECTIVE: To define the role and responsibilities of the sports medicine specialist using a recognised research technique. METHODS: A Delphi technique was employed using anonymous postal questionnaires sent to a random sample of 300 members of the British Association of Sport and Exercise Medicine. The questionnaire of 300 putative attributes was developed in a pilot study and the Delphi technique used allowed participants to modify their responses according to the responses of other participants. RESULTS: There was a 53% response to both rounds of the study with 75.6% of the respondents being male, 39% having a higher qualification in sports medicine, and 45.6% being general practitioners. Some 86.3% strongly agreed that sport and exercise medicine should be a recognised speciality and 90% strongly agreed that it should be available on the National Health Service (NHS). The most important specialist attributes were orthopaedic and soft tissue medicine (83.6% strongly agreed) and emergency medical management (79.7% strongly agreed). More than 75% of respondents did not agree that either research or personal playing experience were relevant. CONCLUSION: Sports and exercise medicine is an evolving speciality in the United Kingdom. We believe this is the first systematic attempt to define the role and responsibilities of the sports medicine specialist and the findings are of relevance to the future development of a career pathway.

Immediate care of school sport injury.

School sport is a major cause of injury in the post-primary age group. The importance of primary prevention in sport has been identified; however secondary prevention of school related sport injury has not been described in Ireland. A random sample of 450 schools in Northern Ireland and the Republic of Ireland was studied using a postal questionnaire. Current management of sport injury, with particular interest in the expertise and training of teachers and coaches, was explored. Replies were received from 333 (74%) schools. There was no physical education teacher with up to date first aid training in 37% schools. Immediate care in terms of mechanisms and equipment to deal with injury was available in 35%-81% of schools responding. Correct response ranged from 65%-90% to four scenarios: commonly presenting yet potentially serious management problems. This study demonstrated deficiencies in sport injury care. In addition to concern about current training, a need for basic life support training is highlighted. These findings have implications for the prevention of school sports injuries.