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1.
Acad Med ; 96(9): 1353-1365, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33883396

RESUMO

PURPOSE: Performing a gynecological exam is an essential skill for physicians. While interventions have been implemented to optimize how this skill is taught in medical school, it remains an area of concern and anxiety for many medical students. To date, a comprehensive assessment of these interventions has not been done. The authors conducted a systematic review of the literature on interventions that aim to improve medical student education on gynecological exams. METHOD: The authors searched 6 databases (Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, Scopus, Web of Science Core Collection, and ERIC [Proquest]) from inception to August 4, 2020. Studies were included if they met the following criteria: focus on medical students, intervention with the purpose of teaching students to better perform gynecological exams, and reported outcomes/evaluation. Extracted data included study location, study design, sample size, details of the intervention and evaluation, and context of the pelvic exam. All outcomes were summarized descriptively; key outcomes were coded as subjective or objective assessments. RESULTS: The search identified 5,792 studies; 50 met the inclusion criteria. The interventions described were diverse, with many controlled studies evaluating multiple methods of instruction. Gynecological teaching associates (GTAs), or professional patients, were the most common method of education. GTA-led teaching resulted in improvements in student confidence, competence, and communication skills. Physical adjuncts, or anatomic models and simulators, were the second most common category of intervention. Less resource-intensive interventions, such as self-directed learning packages, online training modules, and video clips, also demonstrated positive results in student comfort and competence. All studies highlighted the need for improved education on gynecological exams. CONCLUSIONS: The literature included evaluations of numerous interventions for improving medical student comfort and competence in performing gynecological exams. GTA-led teaching may be the most impactful educational tool described, though less resource-intensive interventions can also be effective.


Assuntos
Competência Clínica , Exame Ginecológico/psicologia , Ginecologia/educação , Aprendizagem Baseada em Problemas/métodos , Estudantes de Medicina/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Simulação de Paciente , Relações Médico-Paciente
2.
BMC Womens Health ; 21(1): 122, 2021 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-33757512

RESUMO

BACKGROUND: Though cervical cancer is one of the leading causes of cancer-related death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening as this population has historically been under-screened. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines. The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening (CCS) among adolescents and young people globally. METHODS: We conducted a systematic review following PRISMA guidelines of three key databases: Medline-OVID, EMBASE, and CINAHL. Supplementary searches were done through ClinicialTrials.Gov and Scopus. Databases were examined from 1946 until the date of our literature searches on March 12th 2020. We only examined original, peer-reviewed literature. Articles were excluded if they did not specifically discuss CCS, were not specific to individuals under the age of 35, or did not report outcomes or evaluation. All screening, extraction, and synthesis was completed in duplicate with two independent reviewers. Outcomes were summarized descriptively. Risk of bias for individual studies was graded using an adapted rating scale based on the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. RESULTS: Of the 2177 original database citations, we included 36 studies that met inclusion criteria. The 36 studies included a total of 14,362 participants, and around half (17/36, 47.2%) of studies specifically targeted students. The majority of studies (31/36, 86.1%) discussed barriers and facilitators to Pap testing specifically, while one study analyzed self-sampling (1/36, 2.8%), one study targeted HPV DNA testing (1/36, 2.8%), and the remainder (4/36, 11.1%) were not specified. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and systemic barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. CONCLUSION: There are unique barriers and facilitators that affect CCS rates in adolescents and young people. Health systems and healthcare providers worldwide should address the challenges for this unique population.


Assuntos
Neoplasias do Colo do Útero , Adolescente , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Pessoal de Saúde , Humanos , Programas de Rastreamento , Neoplasias do Colo do Útero/diagnóstico
3.
J Matern Fetal Neonatal Med ; : 1-9, 2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541166

RESUMO

BACKGROUND: Renal stones are a common cause of non-obstetrical abdominal pain in pregnant women. Though the management of renal stones in pregnancy is challenging, it remains unclear how the incidence of kidney stones may affect the course of pregnancy and delivery. OBJECTIVE: To determine the incidence of renal stones in pregnancy and its impact on adverse obstetrical outcomes. DATA SOURCES: We conducted a systematic literature search of three databases: Ovid MEDLINE, Ovid EMBASE, and EBSCO CINAHL Plus. After the selection of articles, an additional hand-search of their citations was completed to maximize sensitivity. Databases were examined from the last four decades (19 March 1970) up to the search date (19 March 2020). STUDY ELIGIBILITY CRITERIA: Articles were excluded if they were not relevant to kidney stones or did not report outcomes related to pregnancy. Case reports, animal studies, and cadaveric studies were excluded. Conference abstracts, gray literature, and unpublished data were not eligible. STUDY APPRAISAL AND SYNTHESIS METHODS: All screening, extraction, and synthesis were completed in duplicate with two independent reviewers. All outcomes reported in the included studies were systematically evaluated to determine suitability for meta-analysis. Random-effects models and sensitivity analyses were used to account for interstudy variation. Renal stone incidence rates were pooled to generate summary proportions. Risk of bias assessment was completed using the Risk of Bias Assessment tool for Non-randomized Studies. RESULTS: Twenty-one studies were included through systematic review and approximately 4.7 million pregnancies across nine studies were included for meta-analysis. There are three major findings of this review regarding renal stone incidence in pregnancy and maternal, child, and birth-related outcomes associated with renal stones. First, we found pooled incidence of renal stones was 0.49%, or one case for every 204 pregnancies. Second, renal stones during pregnancy were significantly associated with the development of preeclampsia and urinary tract infection, as well as increased likelihood of low birth weight, preterm labor, and C-section deliveries. However, renal stones were not significantly associated with premature rupture of membranes or infant mortality. Third, there were limited obstetrical complications reported with either medical or surgical therapies although comparative outcomes were not provided in the majority of studies, precluding formal meta-analysis. CONCLUSIONS: Although renal stones in pregnancy are relatively rare, there may be an associated risk of serious adverse obstetrical outcomes. However, further research is required to understand whether these obstetrical outcomes are causal or due to other confounders. Interdisciplinary care and pregnancy-specific counseling should be advised for pregnant women with kidney stones.

4.
Acad Emerg Med ; 28(8): 890-908, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33508879

RESUMO

OBJECTIVES: Corneal abrasions are common ophthalmic presentations to emergency departments. Among emergency physicians and ophthalmologists, there are highly variable practice patterns with regard to management of resultant pain and discomfort. The goal of this study was to review and analyze the efficacy and safety of topical pain therapies for corneal abrasions, including topical anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), cycloplegics, steroids, pressure patching, and the use of a bandage contact lens (BCL). METHODS: The review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. The protocol was established a priori and published on PROSPERO (CRD42020201288). MEDLINE, EMBASE, CENTRAL, and Web of Science were searched until December 31, 2020. Primary studies comparing topical pain therapies to another therapy or control were included. Primary outcomes included percentage of corneal abrasions healed at 24, 48, and 72 hours, as well as pain control at 24 and 48 hours. Secondary outcomes included use of oral analgesia and incidence of complications. Risk of bias was assessed using validated tools. Quality of evidence was assessed using the GRADE methodology. RESULTS: Overall, 33 studies (31 randomized controlled trials [RCTs], two cohort studies) comprising 4,167 patients with corneal abrasions were analyzed. Only the data for topical NSAIDs were of adequate evidence from which to draw conclusions; topical NSAIDs demonstrated significantly reduced pain scores at 24 hours (standardized mean differences [SMD] -0.69, 95% CI = -0.98 to -0.41) and 48 hours (SMD = -0.56, 95% CI = -1.02 to -0.10) as well as 53% (95% CI = 34% to 67%) lower oral analgesia use compared to control. Based on available data, topical anesthetics, cycloplegics, patching, and the use of a BCL did not result in any significant difference in pain scores or use of oral analgesia, while no studies examined topical steroids. No interventions resulted in healing delays or significantly higher rates of complications compared to controls. CONCLUSIONS: There was strong evidence to support that topical NSAIDs reduce pain associated with corneal abrasions in the first 48 hours and the need for oral analgesia. The existing evidence was insufficient to support or refute the use of topical anesthetics, cycloplegics, steroids, or BCL for pain control in corneal abrasions. Pressure patching was ineffective at pain reduction and may increase the risk of complications. Delays in healing or other complications were not significantly different between any intervention or control for simple, uncomplicated corneal abrasions; however, larger RCTs are required to identify any differences in rare complications.


Assuntos
Analgesia , Lesões da Córnea , Anti-Inflamatórios não Esteroides/uso terapêutico , Lesões da Córnea/complicações , Humanos , Dor/tratamento farmacológico , Dor/etiologia , Manejo da Dor
5.
Can Urol Assoc J ; 15(3): E169-E174, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32807286

RESUMO

INTRODUCTION: Fasting is a common cultural practice worldwide for both religious and dietary reasons. However, there is concern that fasting may be a risk factor for the development of renal stones. To date, there has not been a systematic assessment of the literature regarding the association between renal stones and fasting. METHODS: We conducted a systematic review following PRISMA guidelines of three databases: Medline-OVID, EMBASE, and CINAHL. All screening and extraction was completed in parallel with two independent reviewers. RESULTS: Of the 1501 database citations, a total of 10 observational studies with a total of 9906 participants were included. Nine of the studies were conducted in the context of Islamic fasting during Ramadan, with the majority (7/9) finding that renal colic incidence was unaffected by the month of fasting. In contrast, two studies noted an increased incidence among fasting populations. Two other studies noted that urine metabolites and density were altered with fasting but did not translate into clinical outcomes. CONCLUSIONS: Based on the available evidence, it is unlikely that fasting significantly increases the risk of renal stones. Physicians should counsel higher-risk patients on safe fasting practices.

6.
Death Stud ; 45(5): 361-370, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31397639

RESUMO

In this Australian, constructivist grounded theory study, we undertook in-depth interviews with 11 dying people and 8 caregivers to examine their perspectives on role relations at end-of-life. We found that situations of role alignment between dying people and their family and friends support positive relational and practical outcomes, whereas role mismatch can cause considerable distress. Factors contributing to role mismatch at end-of-life were: dying people and their caregivers' efforts to shield each other from emotional harm; fear of social exclusion; and unwanted focus on the dying identity. Our findings highlight a need for flexibility and adaptability in end-of-life role relations.

7.
Eye Brain ; 12: 139-167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33173368

RESUMO

Objective: Immune checkpoint inhibitors (ICIs) are novel cancer therapies that may be associated with immune-related adverse events (IRAEs) and come to the attention of neuro-ophthalmologists. This systematic review aims to synthesize the reported ICI-associated IRAEs relevant to neuro-ophthalmologists to help in the diagnosis and management of these conditions. Methods: A systematic review of the literature indexed by MEDLINE, Embase, CENTRAL, and Web of Science databases was searched from inception to May 2020. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Primary studies on ICIs and neuro-ophthalmic complications were included. Outcomes included number of cases and incidence of neuro-ophthalmic IRAEs. Results: Neuro-ophthalmic complications of ICIs occurred in 0.46% of patients undergoing ICI and may affect the afferent and efferent visual systems. Afferent complications include optic neuritis (12.8%), neuroretinitis (0.9%), and giant cell arteritis (3.7%). Efferent complications include myasthenia gravis (MG) (45.0%), thyroid-like eye disease (11.9%), orbital myositis (13.8%), general myositis with ptosis (7.3%), internuclear ophthalmoplegia (0.9%), opsoclonus-myoclonus-ataxia syndrome (0.9%), and oculomotor nerve palsy (0.9%). Pembrolizumab was the most common causative agent for neuro-ophthalmic complications (32.1%). Mortality was highest for MG (19.8%). Most patients (79.8%) experienced improvement or complete resolution of neuro-ophthalmic symptoms due to cessation of ICI and immunosuppression with systemic corticosteroids. Conclusion: While incidence of neuro-ophthalmic IRAEs is low, clinicians involved in the care of cancer patients must be aware of their presentation to facilitate prompt recognition and management. Collaboration between oncology and neuro-ophthalmology teams is required to effectively manage patients and reduce morbidity and mortality.

8.
Scand J Occup Ther ; : 1-16, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33136461

RESUMO

BACKGROUND: Occupational therapists have skills to work with people considering or experiencing the transition from paid work to retirement. AIM: The aims were to explore: (1) occupational therapists' experiences and perceptions in working with people transitioning to retirement; (2) current scope of practice of occupational therapy in the work-to-retirement transition; and (3) factors influencing current scope of practice of occupational therapy in the work-to-retirement transition. METHODS: Qualitative semi-structured interviews with Australian occupational therapists were thematically analysed. RESULTS: Fourteen Australian occupational therapists were interviewed. Three overarching themes (12 sub themes) emerged: (1) occupational therapists' application of a contemporary occupational paradigm; (2) current approaches adopted by occupational therapists are add on, stylistic and talk based; and (3) contextual challenges and opportunities encountered by occupational therapists. CONCLUSION/SIGNIFICANCE: Occupational therapists use enablement skills (e.g. coach; collaborate) and consider various professional reasons (e.g. engagement in meaningful occupation; health responsibility) when addressing the transition from work to retirement. Overcoming barriers to service provision (e.g. funding; lack of role clarity) will facilitate a more comprehensive service provision to enable health and well-being of older adults.

9.
BMJ Open ; 10(11): e040547, 2020 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-33247019

RESUMO

OBJECTIVE: To characterise published evidence regarding preclinical and clinical interventions to overcome mask shortages during epidemics and pandemics. DESIGN: Systematic scoping review. SETTINGS: All healthcare settings relevant to epidemics and pandemics. SEARCH STRATEGY: English peer-reviewed studies published from January 1995 to June 2020 were included. Literature was identified using four databases (Medline-OVID, EMBASE, CINAHL, Cochrane Library), forwards-and-backwards searching through Scopus and an extensive grey literature search. Assessment of study eligibility, data extraction and evidence appraisal were performed in duplicate by two independent reviewers. RESULTS: Of the 11 220 database citations, a total of 47 articles were included. These studies encompassed six broad categories of conservation strategies: decontamination, reusability of disposable masks and/or extended wear, layering, reusable respirators, non-traditional replacements or modifications and stockpiled masks. Promising strategies for mask conservation in the context of pandemics and epidemics include use of stockpiled masks, extended wear of disposable masks and decontamination. CONCLUSION: There are promising strategies for overcoming face mask shortages during epidemics and pandemics. Further research specific to practical considerations is required before implementation during the COVID-19 pandemic.


Assuntos
COVID-19 , Pessoal de Saúde , Controle de Infecções/métodos , Máscaras/provisão & distribuição , Respiradores N95/provisão & distribuição , Pandemias , SARS-CoV-2 , COVID-19/prevenção & controle , COVID-19/transmissão , COVID-19/virologia , Atenção à Saúde , Reutilização de Equipamento , Humanos , Dispositivos de Proteção Respiratória
10.
Alzheimers Res Ther ; 11(1): 98, 2019 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801630

RESUMO

BACKGROUND: Dementia has been presenting an imminent public health challenge worldwide. Studies have shown a combination of cognitive and physical trainings may have synergistic value for improving cognitive functions. Daily functional tasks are innately cognitive demanding and involve components found in common exercise. Individuals with mild cognitive impairment may demonstrate difficulties with complex activities of daily living. Functional tasks could possibly be used as a means of combined cognitive and exercise training for improving cognitive functions. This pilot aims to validate the effects of functional tasks exercise on cognitive functions and functional status in older adults with mild cognitive impairment. METHODS: A four-arm, rater-blinded randomized controlled trial. Participants (N = 59) were randomized to either a functional task exercise group, a cognitive training group, an exercise training group, or a waitlist control group for 8 weeks. All outcome measures were undertaken at baseline and post-intervention using Neurobehavioral Cognitive Status Examination, Trail Making Test A and B, Chinese Version Verbal Learning Test, Lawton Instrumental Activities of Daily Living Scale, and Zarit Burden Interview. RESULTS: Results of the Kruskal-Wallis one-way ANOVA showed higher improvement in the functional task exercise group with significant between-group differences in memory (p = 0.009) compared to the exercise group and cognitive training group, functional status (p = 0.005) compared to the cognitive training group and waitlist control group, and caregiver burden (p = 0.037) compared to the exercise group and cognitive training group. CONCLUSION: This pilot study showed that functional tasks exercise using simulated functional tasks as a means of combined cognitive and exercise program is feasible and beneficial in improving the memory and functional status of older adults with mild cognitive impairment as well as reducing the care-related burdens of their caregivers. The present findings warrant further well-designed longitudinal studies to examine the sustainability of effects and draw more definitive conclusions. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN 12616001635459. Registered on 25 November 2016.


Assuntos
Atividades Cotidianas/psicologia , Cognição/fisiologia , Disfunção Cognitiva/psicologia , Terapia por Exercício/métodos , Aprendizagem Verbal/fisiologia , Idoso , Idoso de 80 Anos ou mais , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Projetos Piloto , Método Simples-Cego , Resultado do Tratamento
11.
Work ; 64(2): 341-354, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31524199

RESUMO

BACKGROUND: Work experiences have the potential to influence retirement. Occupational therapists' understanding of the importance of engagement in occupation for active healthy ageing places them in a position to facilitate the work-to-retirement transition. OBJECTIVE: To describe the experience of work from retirees' perspectives to understand the influence of work on retirement and to discuss the role of occupational therapy in the work-to-retirement transition. METHODS: Semi-structured interviews with retirees were utilised. Thematic analysis identified themes and categories in relation to the experience of work. Categories were related to the Model of Human Occupation (MOHO). RESULTS: Eleven retirees were interviewed. Twelve categories relating to the experience of work were identified and were captured under three over-arching themes: Varied experiences and motivators; Intersection of work and life; and Impact of context. Categories collectively covered all MOHO concepts. Questions to guide therapeutic reasoning were developed to assist putting MOHO theory in to practice. CONCLUSIONS: Working experiences can be an influencing factor on retirement life. Occupational therapy could enable active healthy ageing through understanding the experience of work and how this can assist older workers to remain in the workforce, find a balance between work and other areas of life, and to choose retirement activities.


Assuntos
Terapia Ocupacional/normas , Aposentadoria/psicologia , Idoso , Emprego/psicologia , Emprego/normas , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Motivação , Terapia Ocupacional/métodos , Terapia Ocupacional/tendências , Pesquisa Qualitativa , Queensland , Aposentadoria/estatística & dados numéricos , Equilíbrio Trabalho-Vida
12.
Death Stud ; 43(10): 601-610, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30285566

RESUMO

Improvements in the diagnosis and disclosure of dying mean that nowadays dying people typically live with an awareness of their status for longer than they have previously. However, little is known regarding how transitions between living and dying roles occur during this time. In this grounded theory study, we investigated role transitions at end-of-life. We found that dying people periodically foreground and background living and dying selfhoods, focus on living day-by-day and goal-by-goal and reframe dying roles with an orientation to living. We argue that with better understanding of role transitions at end-of-life more compassionate and responsive care becomes possible.


Assuntos
Atitude Frente a Morte , Autoimagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Feminino , Teoria Fundamentada , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Assistência Terminal
13.
Aust Occup Ther J ; 65(4): 314-328, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29363140

RESUMO

BACKGROUND: The transition from work to retirement is a complex process and unique experience with a relationship existing between work and retirement with implications for health in later life. This review explored the relationship between pre-retirement job and participation in the work-to-retirement transition process in Australia by exploring: (i) factors influencing retirement in relation to pre-retirement job; (ii) how jobs are classified; (iii) the effect of pre-retirement job (based on categories) on this occupational transition; and (iv) the potential role for occupational therapy in this occupational transition. METHOD: An integrative literature review was completed. PRISMA guidelines were used. Study designs were analysed for methodological quality using the National Health and Medical Research Council levels of evidence. Thematic analysis determined retirement factors which were used to compare differences between jobs. RESULTS: This review included 15 papers. There were two Level III-2, one Level III-3 and 13 Level IV studies. Factors influencing retirement related to the stages of work, preparation, transition and retired. White collar and blue collar was the most common job classification system. Although white collar and blue collar worker definitions utilised were inconsistent, differences between the two groups were still determined in all stages. CONCLUSION: Differences in the work-to-retirement transition process, based on pre-retirement job, are evident. Understanding differences by job groupings may assist occupational therapists to understand individualised needs during this occupational transition and subsequent tailoring of interventions (both individual and group based) to enable engagement in meaningful occupation in the work-to-retirement occupational transition to effect active healthy ageing.


Assuntos
Acontecimentos que Mudam a Vida , Terapia Ocupacional/organização & administração , Aposentadoria/psicologia , Austrália , Humanos , Satisfação no Emprego , Ocupações
14.
Omega (Westport) ; 76(4): 328-350, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29284312

RESUMO

This narrative review explores the literature regarding the drama of dying from several academic perspectives. Three key themes were identified including "The impact of blurred boundaries on roles and transitions," "The orchestration of death and dying through time," and "Contemporary dying and new machinery of control." This review reveals the manner in which tightly scripted dying roles serve the needs of the living to a greater extent than those of the dying, by ensuring the depiction of both dying and death as phenomena which have been brought under the control of the living, thereby countering death anxiety. An incongruence between the actual experience of dying and contemporary dying scripts is also highlighted. The authors argue that this incongruence is hidden from the broader societal audience through the maintenance of a dying role that demands serenity and acceptance, thus downplaying or even hiding the actual end-of-life experiences of the dying themselves.


Assuntos
Atitude Frente a Morte , Morte , Cuidados Paliativos/métodos , Assistência Terminal/métodos , Humanos
15.
BMJ Glob Health ; 3(Suppl 5): e001093, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30899556

RESUMO

Health technology is increasingly recognised as a feasible method of addressing health needs in low and middle-income countries (LMICs). Primary Care 101, now known as PACK (Practical Approach to Care Kit), is a printed, algorithmic, checklist-based, comprehensive clinical decision support tool. It assists clinicians with delivering evidence-based medicine for common primary care presentations and conditions. These assessment and treatment guides have been adopted widely in primary care clinics across South Africa. This paper focuses on the process of designing, developing, and implementing a digital version of the clinical decision support tool for use on a tablet computer. Lessons learnt throughout its development and pilot implementation could apply to the creation of electronic health interventions and the digitisation of clinical tools in LMICs.

16.
Aust Occup Ther J ; 63(4): 277-92, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27188410

RESUMO

BACKGROUND: Retirement from paid work is an occupational transition, which can have a profound impact on a person's life. This review explored occupational therapy's contribution to and involvement in the work-to-retirement transition process in Australia. METHODS: An integrative literature review was undertaken using seven article repository databases. PRISMA guidelines informed searches. Articles were included if participants were Australian; researchers' discussed retirement from an occupational perspective or the scope of practice of occupational therapists; and publication was from 1994 to June 2015 in a peer-reviewed journal. Articles were critically appraised and thematic analysis explored: (i) occupational perspective, (ii) occupational therapy scope of practice, (iii) theory and (iv) retirement definitions. RESULTS: Eight articles met the review criteria. Three occupational perspective themes were identified: retirement intention influences, retirement preparation and retirement roles and activities. No articles on the current scope of practice of occupational therapy were found. Three articles discussed potential occupational therapy approaches. Three themes on what retirement is were identified: complete cessation, gradual transition and intermittent worker. Four theory themes were identified: occupational therapy, ageing, identity and work. CONCLUSION: Occupational therapy has the potential to be involved in improving health and well-being for people in the work-to-retirement transition process. It is suggested that future research explore not only people's experiences but also the approaches of occupational therapy in assisting people through this occupational transition. The use of theory to guide Australian occupational therapy practice on retirement should also be explored. The use of consistent retirement definitions will assist in understanding research.


Assuntos
Envelhecimento , Terapia Ocupacional/organização & administração , Aposentadoria/psicologia , Austrália , Humanos , Relações Interpessoais , Satisfação no Emprego , Atividades de Lazer , Fatores de Tempo
17.
J Hand Ther ; 29(1): 30-40, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26847318

RESUMO

STUDY DESIGN: Randomized Controlled Trial (RCT). INTRODUCTION: Engagement in daily occupations and day to day activities helps to restore function in individuals with injured hands and provides a platform to practise selected occupations. PURPOSE: The purpose of this study was to investigate the effectiveness of a combination of Occupation Based Intervention (OBI) and Therapeutic Exercise (TE) compared to TE alone for the rehabilitation of hand injuries. METHOD: A single center RCT, parallel group was conducted at the Kuala Lumpur General Hospital (KLGH), Malaysia. Forty-six adult clients with hand injuries who consented to participate were randomly allocated to either the OBI + TE group or to the TE group. RESULTS: Following a ten week intervention program, statistical significance differences were found in DASH score (TE = 18.64 ± 14.84 vs OBI + TE = 9.50 ± 9.14, p = 0.02); total active motion (TE = 1035.85 ± 179.84 vs OBI + TE = 1203.65 ± 133.60, p = 0.01); neuropathic pain (TE = 2.90 ± 2.79 vs OBI + TE = 1.05 ± 2.01, p = 0.02); COPM performance (TE = 7.62 ± 2.03 vs OBI + TE = 9.53 ± 0.64, p < 0.001); and COPM satisfaction (TE = 7.60 ± 2.11 vs OBI + TE = 9.49 ± 0.76, p < 0.001) in favor of OBI + TE group. CONCLUSION: This study highlighted the integration of OBI into hand injury rehabilitation improved outcomes for clients.


Assuntos
Terapia por Exercício , Traumatismos da Mão/reabilitação , Terapia Ocupacional , Adulto , Avaliação da Deficiência , Feminino , Força da Mão , Humanos , Masculino , Neuralgia/terapia , Satisfação do Paciente , Amplitude de Movimento Articular
18.
Scand J Occup Ther ; 23(1): 57-66, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26153367

RESUMO

INTRODUCTION: In a previous study consensus was sought from Malaysian occupational therapists of occupation-based intervention (OBI) that was perceived as a means and an end. Occupation as a means refers to occupational and purposeful tasks as a therapeutic agent while occupation as an end refers to occupation as an outcome of intervention. The purpose of this follow-up study was to describe the occupational therapists' experiences of providing OBI in hand injury rehabilitation in Malaysia. METHODS: Sixteen occupational therapists with more than five years of experience in hand rehabilitation were individually interviewed on their experiences of using OBI in practice. Data were thematically analysed using interpretative phenomenological analysis. RESULTS: Definition of "Occupation as a means", and "Occupation as an end" was broadened after data analysis of interviews to include two new themes: "Rewarding yet challenging" and "Making OBI a reality". Occupational therapists had positive experiences with OBI and perceived that occupation as a means and an end can be merged into a single therapy session when the occupational therapists use an occupation that is therapeutic. CONCLUSION: Although occupation as a means and as an end have different purposes, when the ultimate goal is to enhance the clients' maximum level of functioning both can be used for successful rehabilitation of hand injuries.


Assuntos
Traumatismos da Mão/reabilitação , Terapia Ocupacional/métodos , Atividades Cotidianas , Adulto , Feminino , Seguimentos , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Pesquisa Qualitativa
19.
Age Ageing ; 43(6): 813-20, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24850540

RESUMO

OBJECTIVE: the aim of this study was to compare the effects of a functional tasks exercise programme to a cognitive training programme in older adults with mild cognitive impairment. DESIGN: a single-blind randomised control trial with the intervention group compared with an active control group. SETTING: out-patient clinic. PARTICIPANTS: older adults with mild cognitive impairment (n = 83) aged 60 and older living in the community. METHODS: participants were randomised to either a functional task exercise group (n = 43) or an active cognitive training group (n = 40) for 10 weeks. All outcome measures were undertaken at baseline, post-intervention and 6-month follow-up using Neurobehavioral Cognitive Status Examination, Trail Making Test, Chinese Version Verbal Learning Test, Category Verbal Learning Test, Lawton Instrumental Activities of Daily Living Scale and Problems in Everyday Living Test. RESULTS: the functional task exercise group showed significant between-group differences in general cognitive functions, memory, executive function, functional status and everyday problem solving ability. The improvements were sustained over time at 6-month follow-up. CONCLUSION: a functional tasks exercise programme is feasible for improving cognitive functions and functional status of older adults with mild cognitive impairment. This may serve as a cost-effective adjunct to the existing interventions for populations with mild cognitive impairment. TRIAL REGISTRATION NUMBER: ACTRN12610001025022.


Assuntos
Doença de Alzheimer/prevenção & controle , Cognição , Terapia Cognitivo-Comportamental/métodos , Disfunção Cognitiva/terapia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Instituições de Assistência Ambulatorial , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Progressão da Doença , Função Executiva , Estudos de Viabilidade , Feminino , Avaliação Geriátrica , Humanos , Vida Independente , Masculino , Memória , Pessoa de Meia-Idade , Testes Neuropsicológicos , Queensland , Fatores de Risco , Método Simples-Cego , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
20.
Ageing Res Rev ; 15: 61-75, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24632497

RESUMO

Global concern on the potential impact of dementia is mounting. There are emerging calls for studies in older populations to investigate the potential benefits of combining cognitive and exercise interventions for cognitive functions. The purpose of this systematic review is to examine the efficacy of combined cognitive and exercise training in older adults with or without cognitive impairment and evaluate the methodological quality of the intervention studies. A systematic search of Cinahl, Medline, PsycINFO, ProQuest, EMBASE databases and the Cochrane Library was conducted. Manual searches of the reference list from the included papers and additional internet searches were also done. Eight studies were identified in this review, five of which included a cognitively impaired population and three studies included a cognitively healthy population. The results showed that combined cognitive and exercise training can be effective for improving the cognitive functions and functional status of older adults with and without cognitive impairment. However, limited evidence can be found in populations with cognitive impairment when the evaluation included an active control group comparison. Further well-designed studies are still needed to explore the potential benefits of this new intervention paradigm.


Assuntos
Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Idoso , Transtornos Cognitivos/psicologia , Terapia Combinada , Humanos
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