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1.
Lung ; 199(5): 527-534, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34623514

RESUMO

PURPOSE: Acute cough in children has a significant impact on the child and family. Relevant quality of life (QoL) instruments are essential for high-quality clinical research. This study aimed to (1) revalidate the 16-item Parent-proxy Children's Acute Cough-specific QoL questionnaire (PAC-QoL16) using a different dataset (i.e., different children), (2) confirm the minimally important difference (MID), and (3) develop and validate a short form. METHODS: Three datasets from two sources were utilized, comprising of 332 children with acute cough (< 2 weeks duration); the first dataset (n = 83, 54 boys; median age 2.04 years, IQR 1.08-4.06 years) was used for revalidation, the second dataset (n = 238, 141 boys; median age 2.17 years, IQR 1.21-4.21 years) was used to develop the short form, and the third dataset (n = 94, 62 boys; median age, 1.75 years, IQR 0.90-3.63 years) was used to confirm the short form. Psychometric properties were investigated. RESULTS: Six items were found to account for 96.4% of the variance in the PAC-QoL16. The PAC-QoL16 and short form (PAC-QoL6) scales correlated with cough scores (rs ≤ - 0.40, p < 0.001), were internally consistent (Cronbach α = 0.94 and 0.87, respectively) and demonstrated sensitivity to change over time. A MID of 0.71 to 1.11 is recommended. CONCLUSION: Both the PAC-QoL16 and newly developed short form (PAC-QoL6) are reliable and valid outcome measures that assess children's acute cough-specific QoL at a given time point, are easy to interpret and reflect changes over time. The new short form addresses the need for outcome measures to be as time effective as possible without loss of information.

3.
BMJ Open ; 11(8): e048115, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408044

RESUMO

INTRODUCTION: The fatigue-sleep disturbance-depression symptom cluster (FSDSC) is one of the most common and debilitating side effects in patients with breast cancer (BC) throughout their treatment trajectory. Tai chi has been supported as a promising non-pharmacological intervention for the individual symptom relief of cancer-related fatigue, sleep disturbance and depression. However, relevant evidence of using tai chi for FSDSC management in patients with BC has been lacking. METHODS: This study will be a two-arm, single-blinded pilot randomised controlled trial involving an 8-week intervention and a 4-week follow-up. Seventy-two patients with BC experiencing the FSDSC will be recruited from two tertiary medical centres in China. The participants will be randomised to either a tai chi group (n=36) or a control group (n=36). The participants in the tai chi group will receive an 8-week tai chi intervention in addition to standard care, while the participants in the control group will receive standard care only consisting of a booklet on the self-management of cancer symptoms. The primary outcomes will include a series of feasibility assessments of the study protocol in relation to the study's methodological procedures, including subject recruitment and follow-up process, completion of study questionnaires and the feasibility, acceptability and safety of the intervention. The secondary outcomes will be the clinical outcomes regarding the effects of tai chi on the FSDSC and quality of life, which will be evaluated by the Brief Fatigue Inventory, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale and the Functional Assessment of Cancer Therapy-Breast questionnaires. ETHICS AND DISSEMINATION: Ethics approval was obtained from relevant sites (H19094, KY2019133, 201932). The findings of the study will be published in peer-reviewed scientific journals and at conferences. TRAIL REGISTRATION NUMBER: NCT04190342; Pre-results.


Assuntos
Neoplasias da Mama , Tai Ji , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Depressão/terapia , Fadiga/etiologia , Fadiga/terapia , Estudos de Viabilidade , Feminino , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Sono , Síndrome
5.
Can J Public Health ; 112(5): 912-918, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34008136

RESUMO

OBJECTIVE: In Canada, Indigenous people experience racism across diverse settings, including within the health sector. This has negatively impacted both the quality of care that Indigenous people receive as well as how research related to Indigenous populations is conducted. Therefore, an Indigenous-led council at a kidney research network, in partnership with other key stakeholders, sought to create a learning pathway that aims to distill the racism that Indigenous people face, and build cultural competence, within the health sector. PARTICIPANTS: The learning pathway was designed for researchers, health care providers, patient partners and administrators. SETTING: Various components of the pathway are established trainings in healthcare and research settings at provincial and national levels. Provincially, some components are implemented in British Columbia, Alberta, Saskatchewan, Manitoba and Ontario. INTERVENTION: The pathway, called Wabishki Bizhiko Skaanj (meaning "White Horse" in Anishinaabemowin), involves six key steps: a culturally tailored blanket exercise that walks participants through the history of local Indigenous Nations/peoples; a more detailed online training program (San'yas); a series of webinars on Indigenous research ethics and protocols; an educational booklet about engaging Knowledge Keepers in research, as well as sharing details about their traditional knowledge and culture; two certification programs about Indigenous ownership of data; and a "book club," wherein the conversation of racism-and the goal for finding solutions-is continually discussed. OUTCOMES: Wabishki Bizhiko Skaanj is working to build cultural competence in the Canadian health sector. IMPLICATIONS: This learning pathway has the potential to address racial disparities across the country and improve health outcomes for Indigenous peoples.

6.
Int J STD AIDS ; 32(6): 533-537, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33533690

RESUMO

Guidance on contact tracing in Chlamydia trachomatis (CT) is limited. CT contacts data over 12 months (1 December 2018-29 November 2019) at a UK sexual health clinic were analysed to determine the appropriateness of the currently recommended six-month 'look-back' interval. Age and sex of CT contacts were associated with clinical outcomes. Subgroups of 100 CT positive/negative contacts (each N = 100) were randomly selected. The relationship between time since sexual intercourse with the index case (Last Sexual Intercourse; LSI) and CT positivity was examined; suitability of varying look-back intervals was explored. Of 891 CT contacts (mean age = 25.0 years, 66.2% men), 66.9% tested positive for CT. Positive CT contacts were significantly younger (23.8 ± 6.8 years vs. 27.4 ± 9.1, p < 0.001) and more often women (36.4% vs. 28.5%, p = 0.018) than negative contacts. In the subgroups, the Mann-Whitney U test revealed no significant difference between the LSI of positive and negative contacts (p = 0.081). 95% of positive CT contacts (N = 82) were captured within a hypothetical three-month look-back interval. While most CT positive contacts were captured within three months, they appeared to remain proportionately represented beyond this point. Although this supports current guidelines, further research should investigate whether CT contacts involved in longer look-back intervals may require disproportionately greater resources to trace.


Assuntos
Infecções por Chlamydia , Saúde Sexual , Adulto , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Busca de Comunicante , Feminino , Humanos , Masculino , Comportamento Sexual , Reino Unido/epidemiologia
7.
J Biomater Appl ; 35(6): 602-614, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32915666

RESUMO

Cranioplasty implants are routinely fabricated from commercially pure titanium plates by maxillofacial prosthetists. The differing fabrication protocols adopted by prosthetists working at different hospital sites gives rise to considerable variations in surface topography and composition of cranioplasty implants, with residues from the fabrication processes having been found to become incorporated into the surface of the implant. There is a growing recognition among maxillofacial prosthetists of the need to standardise these protocols to ensure quality and consistency of practice within the profession. In an effort to identify and eliminate the source of the inclusions associated with one such fabrication protocol, the present study examined the surfaces of samples subjected to each of the manufacturing steps involved. Surface and elemental analysis techniques identified the main constituent of the surface inclusions to be silicon from the glass beads used to texture the surface of the implant during fabrication. Subsequent analysis of samples prepared according to a revised protocol resulted in a more homogeneous titanium dioxide surface as evidenced by the reduction in area occupied by surface inclusions (from 8.51% ± 2.60% to 0.93% ± 0.62%). These findings may inform the development of improved protocols for the fabrication of titanium cranioplasty plates.

8.
Complement Ther Med ; 56: 102634, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33259909

RESUMO

OBJECTIVE: To develop an evidence-based tai chi intervention protocol for managing the fatigue-sleep disturbance-depression symptom cluster (FSDSC) in breast cancer (BC) patients. METHODS: The Medical Research Council (MRC) Framework for Developing and Evaluating Complex Interventions (the MRC framework) was utilized to guide the study design. This study focused on Phase І of the MRC framework-the development of the intervention-to develop an evidence-based tai chi intervention protocol for managing the FSDSC in BC patients based on existing research evidence, theories, practice standards/guidelines, and experts' consensus. An extensive literature search was performed to identify current systematic reviews, theories, and practice standards/guidelines that can be utilized to inform the intervention dosage and techniques of tai chi and practice instructions. Content validity assessment was also conducted to assess the content validity of the tai chi protocol through expert panel consensus. The content validity index (CVI) was calculated to identify whether the intervention required further refinement. RESULTS: The components of the tai chi protocol were identified by current research evidence and relevant practice standards/guidelines, including the selection of an appropriate tai chi modality and intensity and the duration of the intervention. The Easy 8 form Yang-style tai chi was selected based on the guidelines of the National Comprehensive Cancer Network, the American College of Sports Medicine, and China's State Commission for Physical Culture and Sports. The intensity and duration of the tai chi intervention were scheduled, respectively, twice per week, with each session lasting about one hour, for eight weeks based on the current systematic review evidence on traditional Chinese exercise for the alleviation of cancer-related symptoms. The practise techniques of tai chi were identified from practise standards released by the State Sport General Administration of China. All the items in the tai chi protocol were determined to be content valid after the first round of rating, with all item-level CVIs at 1.00. The scale-level CVI for the tai chi protocol was also identified as excellent, at 1.00. CONCLUSION: An evidence-based tai chi program for managing the FSDSC in BC patients was developed by following the MRC framework. The results provided a clear specification of the tai chi intervention protocol for healthcare professionals and researchers in the next phase of the study-pilot testing the tai chi intervention protocol for FSDSC management through a preliminary randomized controlled trial.

9.
Int J Sports Phys Ther ; 15(5): 832-839, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33110703

RESUMO

Background and Purpose: Postural Restoration Institute® (PRI) theories and rehabilitation techniques focus on restoring balance to anatomical systems. Common postural asymmetries can present in athletes as dysfunctions and limitations. The purpose of this case report was to examine the use of PRI exercises and theories to address pelvic alignment, along with core stabilization, during treatment of shoulder dysfunction in a collegiate volleyball player. Case Description: A 22-year-old female volleyball athlete reported unresolved right rotator cuff tendinopathy. She presented with bilateral rib cage flare, anterior pelvic tilt, and bilateral ROM differences in hip and shoulder internal and external rotation. PRI® special test findings included a positive left and right Adduction Drop Test (ADT), positive left Extension Drop, and Hruska Adduction Lift test (left=2, right=3) indicating posterior exterior chain (PEC) pattern of dysfunction. The traditional shoulder rehabilitation program from the previous season was eliminated and a PRI based intervention was performed. Intervention exercises included the 90/90 dead bug diaphragmatic breathing, 90/90 hamstring hip lift, and right sidelying respiratory left adductor pull back. Exercises were performed as three sets of ten diaphragmatic breathing repetitions, a minimum of three times weekly prior to activity. Outcomes: Likert scale ratings of pain decreased from a six pre-intervention to two. The left hip gained 10° of internal rotation and the right hip gained 14° of external rotation. Right shoulder internal rotation increased 15°. Hruska Adduction Lift improved to a four bilaterally (right by day 24, and left by day 31). Left extension drop test was negative following day 17. Discussion: PRI® exercises focusing on core and pelvic stability translated to improved hip and shoulder ROM, and decreased shoulder pain associated with rotator cuff tendinopathy. By treating pelvic alignment with the PRI® exercises, the ROM imbalance and pain at the shoulder joint were addressed. Conclusion: Incorporating PRI exercises and theories into the rehabilitation program of a volleyball player was useful in addressing underlying imbalances throughout the kinetic chain. Level of Evidence: 3b.

10.
Complement Ther Clin Pract ; 40: 101197, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32791319

RESUMO

BACKGROUND: Traditional Chinese exercise (TCE) has been found to be an effective and convenient treatment for cancer-related sleep disturbance. This study aimed to summarize and assess the effects of TCE on cancer-related sleep disturbance. METHODS: Randomized controlled trials utilizing TCE for managing cancer-related sleep disturbance were searched in 11 databases. The primary outcome was sleep quality measured by various patient-reported scales, and the secondary outcome was TCE-related adverse events. Descriptive analysis was adopted for outcome assessment. RESULTS: Ten studies and three ongoing trials were included. TCE had a significantly positive effect on sleep outcomes compared with usual care. However, contradictory findings were reported when comparing TCE with other exercises and a sham intervention. CONCLUSION: This study supported a potentially beneficial role of TCE in alleviating cancer-related sleep disturbance. More rigorously designed sham-controlled studies are necessary to further explore the role of TCE in managing cancer-related sleep disturbance.


Assuntos
Nível de Saúde , Neoplasias , Grupo com Ancestrais do Continente Asiático , Humanos , Neoplasias/complicações , Neoplasias/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Sono
11.
J Nurs Manag ; 28(6): 1418-1431, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32687641

RESUMO

AIM: To explore the expected and achieved competency levels of new graduate nurses. BACKGROUND: There are global concerns about a perceived disconnect between the educational preparation of new graduates and the expectations of employers about their work readiness. It is important to understand competency levels expected and achieved of new graduate nurses. METHOD(S): The study was conducted in three phases: the identification of competencies, development of a survey instrument and exploration of levels of competency from the perspectives of key stakeholders. RESULTS: New graduates were well prepared for demonstrating respect to patients, but needed to be closely supported when providing emergency care. Results highlighted that new graduates felt less competent than graduating students in those competencies related to legal and ethical practice. Importantly, expectations about new graduates' competency varied between educators and managers. CONCLUSION(S): The findings provide important information about new graduates' competency levels, revealing a mismatch in the perception of key stakeholders about competency levels. This has important implications for building new graduates readiness for practice and highlights the importance of collaboration between key stakeholders to address competency gaps. IMPLICATIONS FOR NURSING MANAGEMENT: Supportive opportunities should be provided to new graduate nurses to fill gaps in beginner competency.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Enfermagem , Humanos , Inquéritos e Questionários
13.
Artigo em Inglês | MEDLINE | ID: mdl-32419795

RESUMO

Aim: The aim of this systematic review was to analyze and synthesize available evidence for the effects of somatic acupoint stimulation (SAS) on cancer-related sleep disturbance in adults with cancer. Methods: Nine databases and four clinical trial registries were searched from their inception to July 2019 to identify potential articles and registered trials. Two authors independently extracted data and appraised the methodological quality of the included studies. The included studies could not be subjected to meta-analysis due to the significant variations in SAS intervention protocols and outcome measurement instruments. This systematic review therefore reported the results of the included trials narratively. Results: Seven studies were identified, which involved 906 cancer patients. SAS protocols varied across trials without an optimal evidence-based standard intervention protocol to manage cancer-related sleep disturbance. Sanyinjiao (SP6) was the most commonly selected acupoint. Manual acupuncture was typically 15-30 min in duration and was conducted once a day or once a week for a period of 1-5 weeks, whereas self-administered acupressure was typically 1-3 min in duration per point and was conducted once a day, such as during night time before going to bed, for a period of 1-5 months. The results indicated that SAS could potentially relieve cancer-related sleep disturbance and improve quality of life. Mild adverse effects were reported in three of the included studies, but none of them performed a causality analysis to clarify the association between the reported adverse events and the intervention. Conclusions: This systematic review showed that SAS is a useful approach to relieving cancer-related sleep disturbance. However, research evidence on SAS for managing cancer-related sleep disturbance has not been fully conclusive due to the limited number of existing clinical studies with relatively small sample size and suboptimal methodological quality. Clinical trials with large sample size and robust methodology are warranted in future research.

14.
Med Probl Perform Art ; 35(1): 28-34, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32135002

RESUMO

OBJECTIVES: To investigate intra- and inter-rater reliability of a ballet-based Dance Technique Screening Instrument used by physical therapists (PTs) and student PTs (SPTs) with prior dance medicine or dance experience. METHODS: Ten pre-professional dancers were video-recorded in the sagittal and frontal planes while performing four dance sequences: 1) second position grand plié; 2) développé à la seconde; 3) single-limb passé relevé balance; and 4) jumps in first position. Dance videos and electronic versions of the demographics and scoring forms were provided through a secure online survey to 28 PTs and SPTs who served as raters. Raters reviewed a training video prior to scoring the 10 dancers. Raters were asked to repeat their assessments 1-2 wks later. Intraclass correlations (ICC) were assessed for all-raters, PTs, and SPTs for total and sequence scores. RESULTS: Twenty-eight raters assessed the videos one time. Inter-rater reliability was ICC=0.98 (CI95=0.96-0.99) (all-raters), with PTs and SPTs displaying similar values (ICC=0.96 and 0.96, respectively). Eighteen raters (11 PTs, 7 SPTs) repeated the video analysis. Intra-rater reliability was ICC=0.78 (CI95=0.72-0.83) with PTs ICC=0.81 and SPTs ICC=0.70. CONCLUSIONS: Correlations were high for all-raters. SPTs were as reliable as PTs in inter-rater comparisons. PTs exhibited higher intra-rater reliability compared to SPTs. These results substantiate the reliability of a standardized testing instrument to conduct dance technique assessment. Validity of this instrument was demonstrated in a previous study which found dancers with better technique were less likely to sustain injury. The ability to identify technique deficits can guide preventative programs that may reduce injury risk. LEVEL OF EVIDENCE: Level III.


Assuntos
Traumatismos em Atletas , Dança , Traumatismos em Atletas/prevenção & controle , Dança/lesões , Humanos , Reprodutibilidade dos Testes , Inquéritos e Questionários
15.
Int J Exerc Sci ; 13(3): 216-224, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32148629

RESUMO

Cupping therapy, a form of traditional Chinese medicine, has recently gained popularity as a therapeutic modality among sports medicine clinicians. While the use of cupping therapy to decrease musculoskeletal pain is supported by recent research findings, evaluations on the use of cupping therapy to influence range of motion (ROM) are limited. The purpose of the study was to identify if cupping therapy applied passively for 10 minutes increases flexibility compared to sham treatment or control conditions. Twenty-five participants with hamstring ROM less than 80° and no previous cupping therapy experience completed the study. Participants reported to the laboratory on three occasions for one of three randomly assigned treatment conditions (cupping, sham, or control) for 10 minutes while prone. Hamstring flexibility was evaluated three times (pre-treatment, post-treatment, and 10-minutes post-treatment) via ROM measured during an active straight leg raise. Participants returned on two other occasions to receive the remaining treatment conditions. A 3 (treatment condition) × 3 (time) repeated measures analysis of variance was utilized for statistical analysis. There was no interaction between condition and time (p = 0.78). Within-subjects effects for time (p = 0.76) was not significant. Post hoc pairwise comparison of treatment conditions found no differences between control and cupping (p = 0.36), cupping and sham (p = 0.35), or control and sham (p=0.98) conditions. Cupping therapy applied statically for 10 minutes does not increase hamstring flexibility compared to a sham treatment or control condition.

16.
Front Pediatr ; 7: 428, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31737587

RESUMO

While once thought to be rare, bronchiectasis has been increasing globally over the last 15 years. Bronchiectasis is a major contributor to chronic lung morbidity and mortality but remains a neglected disease in respiratory health globally. Currently, few high-level evidence-based management strategies are available for children with bronchiectasis. Strategies to improve clinical outcomes associated with exacerbations are important. In other respiratory conditions such as asthma and chronic obstructive pulmonary disease, use of personalized written management plans have been shown to improve clinical outcomes. Personalized management plans have also been recommended as part of treatment plans in adults with bronchiectasis. We thus undertook a review of the current literature to determine available evidence, and to establish whether a personalized written bronchiectasis action management plan (BAMP) improves clinical outcomes in children with bronchiectasis. Our search identified 43 articles; 16 duplicates were removed and a further 23 were excluded on titles and abstracts alone. Four full-text articles were reviewed but excluded. In the absence of any published studies, it remains unknown whether the use of BAMP is beneficial for improving clinical outcomes for children with bronchiectasis. These results have highlighted this clinical gap and identified the need for high-quality research to inform practice. Until high-quality evidence is available, clinicians are advised to adhere to current national and/or international guidelines.

17.
J Sport Rehabil ; 28(5): 532-535, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30300073

RESUMO

Context: Popularity of using handheld devices in clinical settings has increased, especially the use of motion analysis applications (MAAs). Video-based measurement tools have been found reliable in measuring knee valgus in subjects without anterior cruciate ligament (ACL) injury. However, there is a need for validation of using a MAA to measure knee valgus in an injured population, given that they may exhibit higher degrees of knee valgus. Objective: To examine the reliability and validity of using a MAA to measure knee valgus during functional activities used to assess return to sport after ACL reconstruction (ACLR). Design: Reliability and validity study. Setting: University laboratory. Participants: Twelve participants with ACLR and 20 healthy individuals. Interventions: Each subject performed single-leg drop landing, single-leg hop, and 90° cut with simultaneous 3-dimensional (3D) motion capture and video recording on an iPad. Main Outcome Measures: Peak knee valgus during the landing phase was measured using a MAA and 3D analysis. To obtain reliability, peak knee valgus was measured on 2 separate days. Reliability was determined using intraclass correlation coefficients and standard errors of measurement. Validity was assessed using Pearson correlation coefficients by comparing peak knee valgus between the MAA and 3D analysis. The t tests were used to compare knee valgus obtained between raters, within raters, and between the MAA and 3D analysis. Results: Our data revealed excellent intrarater and interrater reliability with low standard errors of measurement of using a MAA for both groups. Significant, moderate to large associations were found in comparing peak knee valgus between the MAA and 3D analysis. However, knee valgus was significantly different between the MAA and 3D analysis across all tasks in both groups. Conclusion: Although a MAA is reliable for measuring peak knee valgus in individuals with ACLR and healthy controls, the actual values obtained by a MAA should be viewed with caution.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Teste de Esforço , Joelho/fisiopatologia , Aplicativos Móveis , Adolescente , Adulto , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Gravação em Vídeo
18.
Aust Health Rev ; 43(3): 261-267, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29386096

RESUMO

Objective To compare annual costs of an intervention for acutely unwell older residents in residential age care facilities (RACFs) with usual care. The intervention, the Aged Care Emergency (ACE) program, includes telephone clinical support aimed to reduce avoidable emergency department (ED) presentations by RACF residents. Methods This costing of the ACE intervention examines the perspective of service providers: RACFs, Hunter Medicare Local, the Ambulance Service of New South Wales, and EDs in the Hunter New England Local Health District. ACE was implemented in 69 RACFs in the Hunter region of NSW, Australia. Analysis used 14 weeks of ACE and ED service data (June-September 2014). The main outcome measure was the net cost and saving from ACE compared with usual care. It is based on the opportunity cost of implementing ACE and the opportunity savings of ED presentations avoided. Results Our analysis estimated that 981 avoided ED presentations could be attributed to ACE annually. Compared with usual care, ACE saved an estimated A$921214. Conclusions The ACE service supported a reduction in avoidable ED presentations and ambulance transfers among RACF residents. It generated a cost saving to health service providers, allowing reallocation of healthcare resources. What is known about the topic? Residents from RACFs are at risk of further deterioration when admitted to hospital, with high rates of delirium, falls, and medication errors. For this cohort, some conditions can be managed in the RACF without hospital transfer. By addressing avoidable presentations to EDs there is an opportunity to improve ED efficiency as well as providing care that is consistent with the resident's goals of care. RACFs generate some avoidable ED presentations for residents who may be more appropriately treated in situ. What does this paper add? Telephone triaging with nursing support and training is a means by which ED presentations from RACFs can be reduced. One of the consequences of this intervention is 'cost avoided', largely through savings on ambulance costs. What are the implications for practitioners? Unnecessary transfer from RACFs to ED can be avoided through a multicomponent program that includes telephone support with cost-saving implications for EDs and ambulance services.


Assuntos
Custos e Análise de Custo , Prestação Integrada de Cuidados de Saúde/economia , Serviços Médicos de Emergência/economia , Serviços de Saúde para Idosos/economia , Instituição de Longa Permanência para Idosos/economia , Casas de Saúde/economia , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos de Coortes , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Serviços de Saúde para Idosos/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Casas de Saúde/estatística & dados numéricos
19.
Phys Ther Sport ; 31: 1-8, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29447910

RESUMO

OBJECTIVES: To investigate the effects of dance experience and movement instruction on lower extremity kinematics and muscle activation during a landing task. DESIGN: Cross-sectional case control. SETTING: Laboratory setting. PARTICIPANTS: 27 female subjects (age 18-25) in 2 groups: dancers (n = 12) and non-dancers (n = 15). MAIN OUTCOME MEASURES: Lower extremity biomechanics during drop landing were analyzed. Subjects performed drop landings after watching an instructional video without verbal instructions (NI), followed by repeat assessment after watching the same videos with specific verbal instructions (VI). Surface electromyography (EMG) was used to measure the activation of gluteus maximus and medius during the deceleration phase of landings. Peak knee and hip frontal plane angles during landing were acquired using a 3-D motion capture system. RESULTS: Compared to non-dancers, dancers demonstrated generally greater gluteus maximus activation and a decreased knee abduction (i.e. valgus) angle during drop landing. A significant interaction showed that instruction led to increased knee valgus angle in non-dancers but not dancers (p = .014). CONCLUSIONS: Our findings suggest that experienced dancers demonstrate safer landing strategies compared to recreational athletes. Providing acute movement instruction was shown to disrupt the landing mechanics in those with no dance training experience.


Assuntos
Lesões do Ligamento Cruzado Anterior/prevenção & controle , Traumatismos em Atletas/prevenção & controle , Dança/fisiologia , Extremidade Inferior/fisiologia , Músculo Esquelético/fisiologia , Adolescente , Adulto , Atletas , Fenômenos Biomecânicos , Estudos de Casos e Controles , Estudos Transversais , Eletromiografia , Feminino , Articulação do Quadril/fisiologia , Humanos , Articulação do Joelho/fisiologia , Movimento , Adulto Jovem
20.
Can J Kidney Health Dis ; 5: 2054358117749530, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29372064

RESUMO

Purpose of review: This article serves to describe the Can-SOLVE CKD network, a program of research projects and infrastructure that has excited patients and given them hope that we can truly transform the care they receive. Issue: Chronic kidney disease (CKD) is a complex disorder that affects more than 4 million Canadians and costs the Canadian health care system more than $40 billion per year. The evidence base for guiding care in CKD is small, and even in areas where evidence exists, uptake of evidence into clinical practice has been slow. Compounding these complexities are the variations in outcomes for patients with CKD and difficulties predicting who is most likely to develop complications over time. Clearly these gaps in our knowledge and understanding of CKD need to be filled, but the current state of CKD research is not where it needs to be. A culture of clinical trials and inquiry into the disease is lacking, and much of the existing evidence base addresses the concerns of the researchers but not necessarily those of the patients. Program overview: The Canadian Institutes of Health Research (CIHR) has launched the national Strategy for Patient-Oriented Research (SPOR), a coalition of federal, provincial, and territorial partners dedicated to integrating research into care. Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) is one of five pan-Canadian chronic kidney disease networks supported through the SPOR. The vision of Can-SOLVE CKD is that by 2020 every Canadian with or at high risk for CKD will receive the best recommended care, experience optimal outcomes, and have the opportunity to participate in studies with novel therapies, regardless of age, sex, gender, location, or ethnicity. Program objective: The overarching objective of Can-SOLVE CKD is to accelerate the translation of knowledge about CKD into clinical research and practice. By focusing on the patient's voice and implementing relevant findings in real time, Can-SOLVE CKD will transform the care that CKD patients receive, and will improve kidney health for future generations.

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