scholarly journals 2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older

2020 ◽  
Vol 80 (1) ◽  
pp. 57-64 ◽  
Author(s):  
Jo Adams ◽  
Nicky Wilson ◽  
Emalie Hurkmans ◽  
Margot Bakkers ◽  
Petra Balážová ◽  
...  
Keyword(s):  
Health Professionals ◽  
Task Force ◽  
Scientific Evidence ◽  
Fragility Fractures ◽  
Models Of Care ◽  
Level Of Evidence ◽  
Nutritional Interventions ◽  
Physician Health ◽  
The Mean ◽  
Level Of Agreement

ObjectiveTo establish European League Against Rheumatism (EULAR) points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.MethodsPoints to consider were developed in accordance with EULAR standard operating procedures for EULAR-endorsed recommendations, led by an international multidisciplinary task force, including patient research partners and different health professionals from 10 European countries. Level of evidence and strength of recommendation were determined for each point to consider, and the mean level of agreement among the task force members was calculated.ResultsTwo overarching principles and seven points to consider were formulated based on scientific evidence and the expert opinion of the task force. The two overarching principles focus on shared decisions between patients and non-physician health professionals and involvement of different non-physician health professionals in prevention and management of fragility fractures. Four points to consider relate to prevention: identification of patients at risk of fracture, fall risk evaluation, multicomponent interventions to prevent primary fracture and discouragement of smoking and overuse of alcohol. The remaining three focus on management of fragility fractures: exercise and nutritional interventions, the organisation and coordination of multidisciplinary services for post-fracture models of care and adherence to anti-osteoporosis medicines. The mean level of agreement among the task force for the overarching principles and the points to consider ranged between 8.4 and 9.6.ConclusionThese first EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older serve to guide healthcare practice and education.

scholarly journals Contenção mecânica nos serviços de urgência e emergência

2020 ◽  
Vol 14 ◽  
Author(s):  
Ana Carolina Siqueira de Carvalho ◽  
Patricia De Fatima Augusto Barros ◽  
Romulo DelValle ◽  
Rosimere Ferreira Santana
Keyword(s):  
Health Professionals ◽  
Emergency Services ◽  
Scientific Evidence ◽  
Rating System ◽  
Educational Strategies ◽  
Level Of Evidence ◽  
Mechanical Restraint ◽  
Intervention Treatment ◽  
Nursing Health ◽  
Perception Of Health

Objetivo: identificar evidências científicas sobre o uso da contenção mecânica em pacientes adultos e idosos nos serviços de urgências e emergências. Método: trata-se de um estudo bibliográfico, descritivo, tipo revisão integrativa da literatura, realizado nas bases de dados: Medline (via PubMed), CINAHL, Scopus e Lilacs, nos últimos cinco anos, 2014 a 2019. Avaliaram-se e classificaram-se os estudos quanto ao seu rigor científico, para a classificação do Nível de Evidência, por meio de um instrumento baseado na Rating System for the Hierachy of Evidence for Intervention/Treatment Question. Resultados: encontraram-se três estudos, no Havaí, Canadá e Austrália, produzidos em 2014 e 2016, sendo dois artigos com abordagem quantitativa e um artigo qualitativo, todos na língua inglesa. Informa-se que dois tratavam de implementação de estratégias de educação para reduzir o uso da contenção e um sobre a percepção dos profissionais de saúde sobre o uso da contenção. Conclusão: conclui-se que estratégias educacionais para profissionais de saúde são necessárias para reduzir o uso da contenção mecânica, evitando resultados deletérios não só para os pacientes, mas para a equipe. Descritores: Adultos; Idosos; Restrição Física; Serviços Médicos de Emergência; Enfermagem em Emergência; Saúde do Idoso.AbstractObjective: to identify scientific evidence on the use of mechanical restraint in adult and elderly patients in urgent and emergency services. Method: this is a bibliographic, descriptive, integrative review of the literature, carried out in the databases: MEDLINE (via PubMed), CINAHL, SCOPUS and LILACS, in the last five years, 2014 to 2019. They were evaluated and classified the studies are based on their scientific rigor, for the classification of the Level of Evidence, using an instrument based on the Rating System for the Hierachy of Evidence for Intervention / Treatment Question. Results: three studies were found, in Hawaii, Canada and Australia, produced in 2014 and 2016, two articles with a quantitative approach and one qualitative article, all in English. It is reported that two dealt with the implementation of education strategies to reduce the use of restraint and one about the perception of health professionals about the use of restraint. Conclusion: it is concluded that educational strategies for health professionals are necessary to reduce the use of mechanical restraint, avoiding deleterious results not only for patients, but for the team. Descriptors: Adults; Aged; Restraint, Physical; Emergency Medical Services; Emergency Nursing; Health of the Elderly.ResumenObjetivo: identificar evidencia científica sobre el uso de restricciones mecánicas en pacientes adultos y ancianos en servicios urgentes y de emergencia. Método: esta es una revisión bibliográfica, descriptiva, integradora de la literatura, realizada en las bases de datos: MEDLINE (a través de PubMed), CINAHL, SCOPUS y LILACS, en los últimos cinco años, 2014 a 2019. Fueron evaluados y clasificados los estudios en cuanto su rigor científico, para la clasificación del Nivel de Evidencia, utilizando un instrumento basado en el Rating System for the Hierachy of Evidence for Intervention/Treatment Question. Resultados: se encontraron tres estudios, en Hawai, Canadá y Australia, producidos en 2014 y 2016, dos artículos con un enfoque cuantitativo y un artículo cualitativo, todos en inglés. Se informa que dos se ocuparon de la implementación de estrategias educativas para reducir el uso de la contención y uno sobre la percepción de los profesionales de la salud sobre el uso de la contención. Conclusión: se concluye que las estrategias educativas para los profesionales de la salud son necesarias para reducir el uso de contención mecánica, evitando resultados nocivos no solo para los pacientes, sino también para el equipo. Descriptores: Adulto; Anciano; Restricción Física; Servicios Médicos de Urgencia; Enfermería de Urgencia; Salud del Anciano.

scholarly journals 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis

2019 ◽  
Vol 79 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Bianca Bech ◽  
Jette Primdahl ◽  
Astrid van Tubergen ◽  
Marieke Voshaar ◽  
Heidi A Zangi ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Psychosocial Support ◽  
Task Force ◽  
Healthcare Team ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Chronic Inflammatory Arthritis ◽  
Eular Recommendations ◽  
Level Of Agreement

To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse’s role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.

scholarly journals Identification and assessment of the current scientific evidence on percutaneous needle electrolysis

2019 ◽  
Vol 02 (02) ◽  
pp. 117-118
Author(s):  
Valera Garrido F. ◽  
Minaya Muñoz F. ◽  
Martínez Ramírez P. ◽  
Espinola Marcos A.
Keyword(s):  
Clinical Trials ◽  
Full Text ◽  
Task Force ◽  
Scientific Evidence ◽  
Scientific Journal ◽  
Current Evidence ◽  
Kappa Index ◽  
Scientific Publications ◽  
Level Of Evidence ◽  
Manual Search

Abstract Introduction Percutaneous needle electrolysis is an invasive physical therapy technique which was first published in a scientific journal in the year 2008. The aim of the present study was to evaluate the current scientific evidence on percutaneous needle electrolysis in neuro-musculoskeletal system disorders. Material and Methods A retrospective observational study of scientific publications on percutaneous needle electrolysis. An online search was performed in the following databases to access abstracts: MEDLINE, PEDro, COCHRANE, IME, ENFISPO, in addition non-indexed journals were revised, using the following key words: [(“percutaneous electrolysis,” “galvanic electrolysis,” “percutaneous direct current stimulation,” “percutaneous microelectrolysis” and the Spanish terms “electrolisis,” “electrolisis percutánea,” “microelectrolisis”)]. The search period ranged from the year the database was created until the time of the study (September 2018) with no other search limitation and including publications in any language. Furthermore, a manual search was performed based on the citations included in the articles. A first screen was performed based on the retrieved abstracts, and the full-text of each article was evaluated to analyze the scientific evidence of each study, based on the scale described by the US Preventive Task Force, which assigns level I to those studies with a greater quality design and scientific rigor, whereas level III is assigned to those of poorer quality. The assignment of the level of evidence of each study was independently and simultaneously evaluated by two observers with no communication between each other. To determine reliability, the Kappa index was used (K) with a 95% CI. The score reached by the clinical trials and systematic reviews was also revised based on the Pedro Score Database. Results In total, 64 documents were identified related with electrolysis, following the PRISMA recommendations for the search and selection of primary studies. Concretely, 39 papers were retrieved directly from database searches (Medline, PEDro, Cochrane, ENFISPO), whereas 25 were indirectly accessed via other sources based on internet searches and citation searches. Eight papers were excluded after filtering by title and abstract. After reading the full-text of the 56 articles selected, one further article was excluded. Finally, 55 articles were included in the review. The evidence of the studies retrieved was evaluated. The reliability analysis obtained an acceptable Kappa index (0.6–0.8). Based on criteria regarding the quality of evidence, the studies were classified into three groups:a) High-level of evidence. This group included clinical trials (of which there were 9, which constitute 16.7% of the total) (77.8% were published after 2017).b) Medium-level of evidence, identified in 35.2% of papers.c) Low evidence was provided in 48.1% of papers. Conclusions In recent years, there has been a considerable increase in the current evidence available on percutaneous needle electrolysis. However, many of these studies are part of the gray literature and are difficult to access. High quality evidence was identified in 16.7% of papers. The remaining 83.3% papers were of low to medium quality.

scholarly journals 2019 EULAR recommendations for the generic core competences of health professionals in rheumatology

2019 ◽  
Vol 79 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Lisa Edelaar ◽  
Elena Nikiphorou ◽  
George E Fragoulis ◽  
Annamaria Iagnocco ◽  
Catherine Haines ◽  
...  
Keyword(s):  
Health Professionals ◽  
Rating Scale ◽  
Physical Therapists ◽  
Task Force ◽  
National Level ◽  
Postgraduate Education ◽  
Specific Reference ◽  
Level Of Evidence ◽  
Eular Recommendations ◽  
Core Competences

Background/objectivesTo maintain and optimise the quality of care provided by health professionals in rheumatology (HPRs), adequate educational offerings are needed. This task force (TF) aimed to develop evidence-based recommendations for the generic core competences of HPRs, with specific reference to nurses, physical therapists (PTs) and occupational therapists (OTs) to serve as a basis for their postgraduate education.MethodsThe EULAR standardised operating procedures for the development of recommendations were followed. A TF including rheumatologists, nurses, PTs, OTs, patient-representatives, an educationalist, methodologists and researchers from 12 countries met twice. In the first TF meeting, 13 research questions were defined to support a systematic literature review (SLR). In the second meeting, the SLR evidence was discussed and recommendations formulated. Subsequently, level of evidence and strength of recommendation were assigned and level of agreement (LoA) determined (0–10 rating scale).ResultsThree overarching principles were identified and 10 recommendations were developed for the generic core competences of HPRs. The SLR included 79 full-text papers, 20 of which addressed the competences, knowledge, skills, attitudes and/or educational needs of HPRs from multiple professions. The average LoA for each recommendation ranged from 9.42 to 9.79. Consensus was reached both on a research and educational agenda.ConclusionEvidence and expert opinion informed a set of recommendations providing guidance on the generic core competences of HPRs. Implementation of these recommendations in the postgraduate education of HPRs at the international and national level is advised, considering variation in healthcare systems and professional roles.

scholarly journals EULAR recommendations for intra-articular therapies

2021 ◽  
pp. annrheumdis-2021-220266
Author(s):  
Jacqueline Uson ◽  
Sebastián Cruz Rodriguez-García ◽  
Raul Castellanos-Moreira ◽  
Terence W O'Neill ◽  
Michael Doherty ◽  
...  
Keyword(s):  
Health Professionals ◽  
Task Force ◽  
Healthcare Providers ◽  
Local Anaesthetics ◽  
Adult Patients ◽  
Background Information ◽  
Level Of Evidence ◽  
Safety Issues ◽  
Eular Recommendations ◽  
Final Agreement

ObjectivesTo establish evidence-based recommendations to guide health professionals using intra-articular therapies (IAT) in adult patients with peripheral arthropathies.MethodsA multidisciplinary international task force established the objectives, users and scope and the need for background information, including systematic literature reviews) and two surveys addressed to healthcare providers and patients throughout Europe. The evidence was discussed in a face-to-face meeting, recommendations were formulated and subsequently voted for anonymously in a three-round Delphi process to obtain the final agreement. The level of evidence was assigned to each recommendation with the Oxford levels of evidence.ResultsRecommendations focus on practical aspects to guide health professionals before, during and after IAT in adult patients with peripheral arthropathies. Five overarching principles and 11 recommendations were established, addressing issues related to patient information, procedure and setting, accuracy, routine and special aseptic care, safety issues and precautions to be addressed in special populations, efficacy and safety of repeated joint injections, use of local anaesthetics and aftercare.ConclusionWe have developed the first evidence and expert opinion-based recommendations to guide health professionals using IAT. We hope that these recommendations will be included in different educational programmes, used by patient associations and put into practice via scientific societies to help improve uniformity and quality of care when performing IAT in peripheral adult joints.

Revisiting the Natural History of Chronic Scaphoid Nonunions: A Retrospective Study of 20 Cases

2021 ◽  
Author(s):  
J. Terrence Jose Jerome
Keyword(s):  
Retrospective Study ◽  
Natural History ◽  
Functional Outcome ◽  
Grip Strength ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Degenerative Arthritis ◽  
Level Of Evidence ◽  
History Of ◽  
The Mean

Abstract Background The natural history of scaphoid nonunion is the development of degenerative arthritis. A lot of information is still unclear about this progression. The purpose of this study is to analyze patients with scaphoid nonunions who had not received any kind of treatment and to assess the functional outcome. Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions between 2009 and 2019. None of the patients received any treatment. The age at the time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms, and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate angles were recorded. Pain score, modified mayo wrist score, grip strength, range of movement, and the functional outcome of these scaphoid nonunions were analyzed. A statistical correlation between the scaphoid nonunion presentations and the functional outcome was assessed. Results The mean age of the patients was 62 years (range: 35–82 years.). There were 17 male and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions. The mean duration of scaphoid nonunion was 34 years (range: 10–62 years). None of the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination, gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement ≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no significant impact on the functional outcome. Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis over a period of years, which is still unpredictable. Most of the patients become aware of the nonunion following a precedent injury or other reasons. Most of the patients have fair/good functional outcome despite reduced range of movements and grip strength. Many do not favor surgical intervention in the course of nonunion. Chronic nonunions open a lot of unanswered questions. Clinical relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with little knowledge about certain people with nonunion who did not have any kind of treatment. The demographics, clinical findings, and radiological parameters do confirm the progression of these nonunion to arthritis, but most of them had fair-to-good outcome throughout their life. It opens our thinking about the real need of treatment in such nonunions and raises numerous questions about the disease. Level of evidence This is a Level IV study.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Triage and resource allocation during crisis medical surge conditions (pandemics and mass casualty situations)

2020 ◽  
Vol 7 (1) ◽  
pp. 45-55
Author(s):  
Paul Hoehner ◽  
David H. Beyda ◽  
William P. Cheshire ◽  
Robert E. Cranston ◽  
John T. Dunlop ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Medical Association ◽  
Health Professionals ◽  
Task Force ◽  
Position Statement ◽  
Mass Casualty ◽  
Medical Conditions ◽  
Direct Response ◽  
Allied Health Professionals ◽  
A Current

The Christian Medical and Dental Associations (CMDA) was founded in 1931 and is made up of the Christian Medical Association (CMA) and the Christian Dental Association (CDA). CMDA has a current membership of over 19,000 physicians, dentists, and other allied health professionals. During and in direct response to the pressing urgencies of the COVID-19 universal pandemic of 2020 the President of CMDA commissioned a special task force to provide current and future Christian reflection and guidance on triage and resource allocation policies during pandemics and other forms of crisis surge medical conditions (e.g., mass casualty situations). This is a condensed version of the CMDA special task force position statement. 

KNOWLEDGE, ATTITUDE AND PRACTICES OF CARETAKERS AND HEALTH PROFESSIONALS TOWARD TEETHING IN INFANTS

2011 ◽  
pp. 52-59
Author(s):  
Binh Bao Son Bui
Keyword(s):  
Sleep Disturbance ◽  
Key Words ◽  
Breast Feeding ◽  
Health Professionals ◽  
Feeding Problems ◽  
Central Hospital ◽  
Pediatric Department ◽  
Correct Knowledge ◽  
The Mean

Objective and methods: a prospective questionnaire based study on 71 parents (caretakers) of consecutive children treated at the Pediatric Department, Hue Central Hospital and on 47 health professionals at the department was conducted from September until December 2009 to investigate the knowledge, attitude and practices of the caretakers, nurses and postgraduated doctors toward teething in infants. Results: Most responders believed that teething causes fever, irritability, feeding problems, drooling, biting, sleep disturbance, swollen gums, crying, lose of appetite for solids; and fever over 38oC was also believed to be associated with teething. The mean eruption time of the first tooth was from 6 months. Most caretakers had normal attitude to manifestations ascribed to teething (54.9%). The most common management to symptoms attributed to teething included increased breast-feeding, oral paracetamol, increased fluid supplying and physician consulting. Conclusion: Correct knowledge to teething in infants need to be educated for parents (caretakers) and even for health professionals. Key words: knowledge, attitude, practices, teething, infants.

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