scholarly journals Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Caroline Coulthard ◽  
Mindy C Cairns ◽  
Deborah Williams ◽  
Ben Hughes ◽  
Anju Jaggi
Keyword(s):  
Shoulder Instability ◽  
Treatment Strategies ◽  
Management Approach ◽  
Free Text ◽  
National Guidelines ◽  
Cross Sectional ◽  
Physiotherapy Practice ◽  
Treatment Techniques ◽  
Wide Range ◽  
The Impact

Abstract Background The impact of atraumatic shoulder instability (ASI) on patients can be extensive, its management complex, with a biopsychosocial approach recommended. Currently how physiotherapists manage ASI is unknown or the extent to which current clinical practice aligns with existing evidence. At the time of this study no national guidelines or consensus to direct practice existed. Methods A cross-sectional electronic survey was distributed between July-September 2018, targeting UK-based physiotherapists managing shoulder pathology. Respondents were invited to describe their management of ASI, and rate their awareness and utilisation of various treatment techniques on a Likert-scale; median and interquartile ranges were calculated. Free text survey items were analysed using quantitative content analysis (QCA) to identify codes and categories. Means and percentages were calculated to summarise QCA and descriptive data. Results Valid survey responses were analysed (n = 135). Respondents had between 2 and 39 years of physiotherapy experience (mean = 13.9 years); the majority (71.1 %) reported that ASI made up < 10 % of their caseload. Only 22.9 % (n = 31/135) of respondents reported feeling ‘very confident’ in managing ASI; the majority feeling ‘somewhat confident’ (70.4 %, n = 95/135) or ‘not confident’ (6.7 %, n = 9/135). The majority of respondents (59.3 %) used an ASI classification system, > 90 % citing the Stanmore Classification. Physiotherapists adapted their management according to clinical presentation, responding to differing biopsychosocial needs of the patient scenario. Most respondents (> 80 %) did not use a protocol to guide their management. Exercise was the most utilised management approach for ASI, followed by education; novel treatment strategies, including cortical rehabilitation, were also reported. Conclusion Findings indicate physiotherapists utilise a wide range of treatment strategies and respond to biopsychosocial cues when managing patients with ASI. The majority reported not being very confident in managing this condition, however only a minority use rehabilitation protocols to support their management. Some interventions that respondents reported using lacked evidence to support their use in ASI management and further research regarding effectiveness is required. Guidelines have been published since this survey; the impact of these will need evaluating to determine their effectiveness in the future.

Prevalence of Hand Malformations in Patients With Moebius Syndrome and Their Management

Hand ◽  
2021 ◽  
pp. 155894472199426
Author(s):  
Jose E. Telich-Tarriba ◽  
David F. Navarro-Barquin ◽  
Karol Verdezoto-Gaibor ◽  
Alexander Cardenas-Mejia
Keyword(s):  
Upper Extremity ◽  
Treatment Strategies ◽  
Abducens Nerve ◽  
Poland Syndrome ◽  
Statistical Association ◽  
Moebius Syndrome ◽  
Cross Sectional ◽  
Reconstructive Procedures ◽  
Nerve Paralysis ◽  
Wide Range

Background: Moebius syndrome is a disorder characterized by facial and abducens nerve paralysis. Patients can present a wide range of upper extremity malformations. Literature focused on orthopedic manifestations of Moebius syndrome shows variability in the prevalence and clinical presentation of upper extremity anomalies. The aim of this work is to evaluate the prevalence of upper extremity malformations in patients with Moebius syndrome, clarify its various clinical presentations, and present treatment strategies for their management. Methods: This is a retrospective, cross-sectional study including patients with Moebius syndrome and upper extremity malformations between 2012 and 2019. Data include demographic characteristics, Moebius syndrome subtype, type of malformation, affected extremity, and surgical procedures underwent. Quantitative data were recorded as mean (standard deviation [SD]), and qualitative data were expressed in terms of totals and percentages. Statistical association between Moebius syndrome subtype and development of upper extremity anomalies was evaluated using binary logistic regression. Results: Twenty-five out of 153 patients (16.3%) presented upper extremity malformations (48% male). Mean age of presentation was 9.08 ± 9.43 years. Sixty-eight percent of the malformations were unilateral. The most common presentations included Poland syndrome and simple syndactyly with 8 cases each (32%), followed by 5 cases of brachysyndactyly (20%), 3 cases of amniotic band syndrome (12%), and 1 case of cleft hand (4%). No statistical association was found between Moebius syndrome subtype and odds ratio for development of upper extremity anomalies. Thirteen patients (52%) underwent reconstructive procedures. Conclusion: Poland syndrome and syndactyly are the most common anomalies in patients with Moebius syndrome. Patients may present with a wide range of hand malformations, each patient should be carefully evaluated in order to determine whether surgical treatment is needed and to optimize rehabilitation protocols.

Assessing the Preparedness of Healthcare Facilities for Disasters and Emergencies in Damghan, Iran

2021 ◽  
pp. 1-7
Author(s):  
Behrad Pourmohammadi ◽  
Ahad Heydari ◽  
Farin Fatemi ◽  
Ali Modarresi
Keyword(s):  
Health Care ◽  
Cross Sectional Study ◽  
Health Care Facilities ◽  
Mitigation Measures ◽  
Health Staff ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Wide Range ◽  
Care Facilities ◽  
The Impact

Abstract Objectives: Iran is exposed to a wide range of natural and man-made hazards. Health-care facilities can play a significant role in providing life-saving measures in the minutes and hours immediately following the impact or exposure. The aim of this study was to determine the preparedness of health-care facilities in disasters and emergencies. Methods: This cross-sectional study was conducted in Damghan, Semnan Province, in 2019. The samples consisted of all the 11 health-care facilities located in Damghan County. A developed checklist was used to collect the data, including 272 questions in 4 sections: understanding threatening hazards, functional, structural, and nonstructural vulnerability of health-care facilities. The data were analyzed using SPSS 21. Results: The results revealed that the health-care facilities were exposed to 22 different natural and man-made hazards throughout the county. The total level of preparedness of the health-care centers under assessment was 45.8%. The average functional, structural, and nonstructural vulnerability was assessed at 49.3%, 31.6%, and 56.4%, respectively. Conclusions: Conducting mitigation measures is necessary for promoting the functional and structural preparedness. Disaster educational programs and exercises are recommended among the health staff in health-care facilities.

scholarly journals Application of natural language processing methods to extract coded data from administrative data held in the Scottish Prescribing Information System

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Clifford Nangle ◽  
Stuart McTaggart ◽  
Margaret MacLeod ◽  
Jackie Caldwell ◽  
Marion Bennie
Keyword(s):  
Information System ◽  
Natural Language Processing ◽  
Natural Language ◽  
Language Processing ◽  
Drug Exposure ◽  
Drug Dose ◽  
Free Text ◽  
Wide Range ◽  
The Impact ◽  
Prescribing Information

ABSTRACT ObjectivesThe Prescribing Information System (PIS) datamart, hosted by NHS National Services Scotland receives around 90 million electronic prescription messages per year from GP practices across Scotland. Prescription messages contain information including drug name, quantity and strength stored as coded, machine readable, data while prescription dose instructions are unstructured free text and difficult to interpret and analyse in volume. The aim, using Natural Language Processing (NLP), was to extract drug dose amount, unit and frequency metadata from freely typed text in dose instructions to support calculating the intended number of days’ treatment. This then allows comparison with actual prescription frequency, treatment adherence and the impact upon prescribing safety and effectiveness. ApproachAn NLP algorithm was developed using the Ciao implementation of Prolog to extract dose amount, unit and frequency metadata from dose instructions held in the PIS datamart for drugs used in the treatment of gastrointestinal, cardiovascular and respiratory disease. Accuracy estimates were obtained by randomly sampling 0.1% of the distinct dose instructions from source records, comparing these with metadata extracted by the algorithm and an iterative approach was used to modify the algorithm to increase accuracy and coverage. ResultsThe NLP algorithm was applied to 39,943,465 prescription instructions issued in 2014, consisting of 575,340 distinct dose instructions. For drugs used in the gastrointestinal, cardiovascular and respiratory systems (i.e. chapters 1, 2 and 3 of the British National Formulary (BNF)) the NLP algorithm successfully extracted drug dose amount, unit and frequency metadata from 95.1%, 98.5% and 97.4% of prescriptions respectively. However, instructions containing terms such as ‘as directed’ or ‘as required’ reduce the usability of the metadata by making it difficult to calculate the total dose intended for a specific time period as 7.9%, 0.9% and 27.9% of dose instructions contained terms meaning ‘as required’ while 3.2%, 3.7% and 4.0% contained terms meaning ‘as directed’, for drugs used in BNF chapters 1, 2 and 3 respectively. ConclusionThe NLP algorithm developed can extract dose, unit and frequency metadata from text found in prescriptions issued to treat a wide range of conditions and this information may be used to support calculating treatment durations, medicines adherence and cumulative drug exposure. The presence of terms such as ‘as required’ and ‘as directed’ has a negative impact on the usability of the metadata and further work is required to determine the level of impact this has on calculating treatment durations and cumulative drug exposure.

scholarly journals COVID-VU an ENT UK National Survey of Flexible Nasendoscopy in the Upper Aerodigestive Tract Amidst the COVID-19 Pandemic

2021 ◽  
Author(s):  
Avgi Loizidou ◽  
Taranjit Singh Tatla ◽  
Ian Harvey ◽  
Miriayi Aibibula ◽  
Justin Roe ◽  
...  
Keyword(s):  
Aerodigestive Tract ◽  
Upper Aerodigestive Tract ◽  
Speech And Language ◽  
National Guidelines ◽  
Healthcare Settings ◽  
Wide Range ◽  
Window Opening ◽  
Operating Theatres ◽  
The Uk ◽  
The Impact

Abstract BackgroundFlexible nasendoscopy (FNE) is an invaluable multi-disciplinary tool for upper aerodigestive tract (UADT) examination. During the COVID-19 pandemic concerns were raised that FNE had the potential of generating aerosols resulting in human cross-contamination when performed on SARS-COV2 carriers. In the UK, and other European countries, national guidelines were issued restricting FNE to essential cases. We surveyed ENT UK members and Royal College of Speech and Language Therapists (RCSLT) members to determine the impact of the COVID-19 pandemic (first peak) on FNE practice in the UK.MethodsAn observational internet-based survey constructed in accordance to the CHERRIES checklist and setup in SurveyMonkeyof FNE practice amongst UK-based ENT surgeons and speech and language therapists in community clinics, the outpatient department, inpatient wards, ICU, emergency department and operating theatres (through the NHS and private sector) prior to, during and following the first COVID-19 wave in the UK. Results 314 responses collected (24% response rate), 82% from ENT clinicians, 17% from SLTs and 1% from other allied healthcare professionals. Overall, there has been a large reduction in the volume and indications for FNE during the first peak of the COVID-19 pandemic with limited recovery by mid-August 2020. Cancer and airway assessments were impacted less. A wide range of FNE protocols influenced by local factors are reported, varying in endoscope preference, Personal Protective Equipment (PPE) and sterilization methods. Where dedicated Aerosol Generating Procedure (AGP) rooms were unavailable, clinicians resorted to window opening and variable room “down-time” between patients. Endoscope preference reflected availability and user familiarity, ENT trainees favoring the use of single-use video endoscopes. ConclusionDespite national guidance, local practice of FNE remains interrupted and highly variable in the UK. A collaborative inter-disciplinary approach is required to re-introduce FNE safely in volume across healthcare settings, re-establishing timely endoscopic diagnosis and pre-pandemic levels of patient care.

Tuning the Mechanical and Geometric Properties of Electrochemically Aligned Collagen Threads Towards Applications in Biohybrid Robotics

2021 ◽  
Author(s):  
Wenhuan Sun ◽  
Jason Paulovich ◽  
Victoria Webster-Wood
Keyword(s):  
Tensile Modulus ◽  
Solution Concentration ◽  
Cross Sectional ◽  
Geometric Properties ◽  
Wide Range ◽  
Crosslinker Concentration ◽  
High Degree ◽  
The Impact ◽  
Fabrication Parameters ◽  
Manufacturing Parameters

Abstract Electrochemically Aligned Collagen (ELAC) threads fabricated by the isoelectric focusing (IF) of collagen have previously shown potential in tissue engineering and more recently in the fabrication of biohybrid robot structures. For applications in biohybrid robotics, ELAC structures are needed that are both robust and compliant enough to facilitate muscle actuation. However, studies on the effects of IF parameters, and the interactions of such fabrication parameters, on the mechanical and geometric properties of resulting ELAC threads have not been previously found in literature. Understanding the impact of these manufacturing parameters on the material properties is critical to facilitate biohybrid robot design. In this study, the effects of IF duration, IF voltage, and collagen solution concentration were investigated and showed statistically significant effects on adjusting ELAC properties via single-factor experiments. The interactions between parameters exhibited significant joint effects on ELAC property tuning through two-factor experiments. Scanning electron microscopy and 2,4,6-trinitrobenzenesulfonic assays revealed the correlation between high mechanical properties and a combination of low porosity and high degree of crosslinking. By simply tuning IF parameters without changing other fabrication steps, such as crosslinker concentration, ELAC threads with a wide range of mechanical and geometric properties were fabricated. The average tensile modulus of the resulting ELAC threads ranged from 198±90 to 758±138 MPa. The average cross-sectional area ranged from 7756±1000 to 1775±457 µm2. The resultant mapping between IF parameters and ELAC thread properties enabled the production of strong and flexible threads with customizable properties.

scholarly journals Regional Integration: Do Intra-African Trade and Migration Improve Income in Africa?

2019 ◽  
Vol 43 (6) ◽  
pp. 587-631 ◽  
Author(s):  
Blaise Gnimassoun
Keyword(s):  
Regional Integration ◽  
Capita Income ◽  
Per Capita Income ◽  
Cross Sectional ◽  
Wide Range ◽  
Per Capita ◽  
Migration Flows ◽  
And Migration ◽  
The Impact

Regional integration in Africa is a subject of great interest, but its impact on income has not been studied sufficiently. Using cross-sectional and panel estimations, this article examines the impact of African integration on real per capita income in Africa. Accordingly, we consider intra-African trade and migration flows as quantitative measures reflecting the intensity of regional integration. To address the endogeneity concerns, we use a gravity-based, two-stage least-squares strategy. Our results show that, from a long-term perspective, African integration has not been strong enough to generate a positive, significant, and robust impact on real per capita income in Africa. However, it does appear to be significantly income-enhancing in the short and medium terms but only through intercountry migration. These results are robust to a wide range of specifications.

Changes in Hospital Financing and Organization and Their Impact on Hospital Performance

2019 ◽  
Author(s):  
Jonas Schreyögg
Keyword(s):  
Financial Performance ◽  
Financial Incentives ◽  
Hospital Performance ◽  
Unintended Effects ◽  
Natural Experiments ◽  
Cross Sectional ◽  
Trade Offs ◽  
Wide Range ◽  
Improve Hospital ◽  
The Impact

Since the 1980s policymakers have identified a wide range of policy interventions to improve hospital performance. Some of these have been initiated at the level of government, whereas others have taken the form of decisions made by individual hospitals but have been guided by regulatory or financial incentives. Studies investigating the impact that some of the most important of these interventions have had on hospital performance can be grouped into four different research streams. Among the research streams, the strongest evidence exists for the effects of privatization. Studies on this topic use longitudinal designs with control groups and have found robust increases in efficiency and financial performance. Evidence on the entry of hospitals into health systems and the effects of this on efficiency is similarly strong. Although the other three streams of research also contain well-conducted studies with valuable findings, they are predominantly cross-sectional in design and therefore cannot establish causation. While the effects of introducing DRG-based hospital payments and of specialization are largely unclear, vertical and horizontal cooperation probably have a positive effect on efficiency and financial performance. Lastly, the drivers of improved efficiency or financial performance are very different depending on the reform or intervention being investigated; however, reductions in the number of staff and improved bargaining power in purchasing stand out as being of particular importance. Several promising avenues for future investigation are identified. One of these is situated within a new area of research examining the link between changes in the prices of treatments and hospitals’ responses. As there is evidence of unintended effects, future studies should attempt to distinguish between changes in hospitals’ responses at the intensive margin (e.g., upcoding) versus the extensive margin (e.g., increase in admissions). When looking at the effects of entering into a health system and of privatizations, there is still considerable need for research. With privatizations, in particular, the underlying processes are not yet fully understood, and the potential trade-offs between increases in performance and changes in the quality of care have not been sufficiently examined. Lastly, there is substantial need for further papers in the areas of multi-institutional arrangements and cooperation, as well as specialization. In both research streams, natural experiments carried out using program evaluation design are lacking. One of the main challenges here, however, is that cooperation and specialization cannot be directly observed but rather must be constructed based on survey or administrative data.

scholarly journals Physiotherapists’ views on the Australian Physiotherapy Association’s Choosing Wisely recommendations: a content analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031360 ◽  
Author(s):  
Joshua Zadro ◽  
Aimie L Peek ◽  
Rachael H Dodd ◽  
Kirsten McCaffery ◽  
Christopher Maher
Keyword(s):  
Content Analysis ◽  
Decision Rules ◽  
Choosing Wisely ◽  
Secondary Outcome ◽  
Free Text ◽  
Similar Response ◽  
Physiotherapy Practice ◽  
Free Text Response ◽  
Key Terms ◽  
The Impact

ObjectivesChoosing Wisely holds promise for increasing awareness of low-value care in physiotherapy. However, it is unclear how physiotherapists’ view Choosing Wisely recommendations. The aim of this study was to evaluate physiotherapists’ feedback on Choosing Wisely recommendations and investigate agreement with each recommendation.SettingThe Australian Physiotherapy Association emailed a survey to all 20 029 physiotherapist members in 2015 seeking feedback on a list of Choosing Wisely recommendations.ParticipantsA total of 9764 physiotherapists opened the email invitation (49%) and 543 completed the survey (response rate 5.6%). Participants were asked about the acceptability of the wording of recommendations using a closed (Yes/No) and free-text response option (section 1). Then using a similar response format, participants were asked whether they agreed with each Choosing Wisely recommendation (sections 2–6).Primary and secondary outcomesWe performed a content analysis of free-text responses (primary outcome) and used descriptive statistics to report agreement and disagreement with each recommendation (secondary outcome).ResultsThere were 872 free-text responses across the six sections. A total of 347 physiotherapists (63.9%) agreed with the ‘don’t’ style of wording. Agreement with recommendations ranged from 52.3% (electrotherapy for back pain) to 76.6% (validated decision rules for imaging). The content analysis revealed that physiotherapists felt that blanket rules were inappropriate (range across recommendations: 13.9%–30.1% of responses), clinical experience is more valuable than evidence (11.7%–28.3%) and recommendations would benefit from further refining or better defining key terms (7.3%–22.4%).ConclusionsAlthough most physiotherapists agreed with both the style of wording for Choosing Wisely recommendations and with the recommendations, their feedback highlighted a number of areas of disagreement and suggestions for improvement. These findings will support the development of future recommendations and are the first step towards increasing the impact Choosing Wisely has on physiotherapy practice.

scholarly journals Physiotherapists perceived role in managing anxiety in patients with Relapsing-Remitting Multiple Sclerosis: a mixed-methods study.

2021 ◽  
Author(s):  
Lauren Lucas ◽  
Jack Parker
Keyword(s):  
Mixed Methods ◽  
Clinical Supervision ◽  
Management Practices ◽  
Training Needs ◽  
Outpatient Rehabilitation ◽  
Structured Interviews ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Physiotherapy Practice ◽  
The Impact

ABSTRACT Objectives: To explore how physiotherapists manage anxiety in patients with RRMS in community and outpatient settings. To identify further training and research to better develop physiotherapy practice. Design: A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists. Participants: Sixteen UK-registered physiotherapists: 11 in the survey, 5 in the interviews. Methods: To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety, physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. Results: The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. Conclusion: Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.

Sign in / Sign up

Export Citation Format

Share Document