Group physiotherapy with survivors of torture in urban and camp settings in Jordan and Kenya

Introduction: In this paper we report provisional field results on the impact of CVT’s (the Center for Victims of Torture) interdisciplinary group treatment on physiotherapy indicators in refugees living in urban and camp settings in Kenya and Jordan. The physiotherapy component of this model includes pain neuroscience education, sleep hygiene, posture and body mechanics instruction and healing of pain and trauma from a biopsychosocial perspective, in a program of ten weekly sessions. This program is supported by a clinical assessment that records a broad set of indicators of participant experience and functioning. In addition, some survivors report having pelvic floor dysfunction and data will be offered about a subset of survivors looking at prevalence of these issues. Methods: Survivors are identified through referral systems, community education and sensitization campaigns, contacts and trainings with other NGOs and health care providers. Prospective survivors are screened into CVT services or referred to other agencies that can better meet their needs. CVT focuses its services on refugees with physical and emotional difficulties that may be effectively treated through its interdisciplinary treatment model and who have survived torture or related human rights violations. Following an informed consent process, survivors participate in a comprehensive individual assessment and then progress to the 10-week program. Wherever possible, follow-up assessments are conducted 2 weeks after the sessions end, and at 3, and 9 months following completion of the 10-week long intervention. Results: On average, participants who completed 3-month follow-up assessments showed statistically and clinically significant improvements on physiotherapy indicators. Discussion: Provisional results are encouraging and suggest that the model is adaptable to the needs of different populations and settings. As nearly all participants receive both counseling and physiotherapy, it is difficult to know which benefits can be attributed to physiotherapy alone.

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Cannabis and breastfeeding

Paediatrics & Child Health ◽

10.1093/pch/pxaa037 ◽

2020 ◽

Vol 25 (Supplement_1) ◽

pp. S26-S28 ◽

Cited By ~ 1

Author(s):

Lisa Graves

Keyword(s):

Health Care Providers ◽

Small Sample ◽

Adverse Outcomes ◽

Care Providers ◽

High Quality ◽

High Quality Evidence ◽

Small Sample Sizes ◽

The Impact ◽

Quality Evidence

Abstract Cannabis is one of the most commonly used substances in Canada with 15% of Canadians reporting use in 2019. There is emerging evidence that cannabis is linked to an impact on the developing brain in utero and adverse outcomes in infants, children, and adolescents. The impact of cannabis during breastfeeding has been limited by studies with small sample sizes, follow-up limited to 1 year and the challenge of separating prenatal exposure from that during breastfeeding. In the absence of high-quality evidence, health care providers need to continue to engage women in conversation about the potential concerns related to breastfeeding and cannabis use.

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Use of the Ottawa Ankle Rules in children: a survey of physicians’ practice patterns

CJEM ◽

10.2310/8000.2011.110402 ◽

2011 ◽

Vol 13 (05) ◽

pp. 333-338 ◽

Cited By ~ 9

Author(s):

Shawn K. Dowling ◽

Ian Wishart

Keyword(s):

Health Care ◽

Health Care Providers ◽

Health Care Professionals ◽

Pediatric Emergency ◽

Ankle Fractures ◽

Care Providers ◽

Emergency Physicians ◽

Ottawa Ankle Rules ◽

Clinically Significant

ABSTRACT: Introduction: A number of studies have assessed the diagnostic accuracy of the Ottawa Ankle Rules (OAR) in children; however, the role of the OAR in guiding physician radiograph use is unclear. Objectives: The primary purpose of this study was to determine the extent to which Canadian pediatric emergency physicians report using the OAR. Secondary goals included determining current diagnostic and management strategies for Salter-Harris 1 (SH-1) injuries of the ankle and which fractures physicians deem to be clinically significant. Methods: A self-administered piloted survey was distributed by mail to 215 Canadian pediatric emergency physicians using a modified Dillman technique. Participants were selected through Pediatric Emergency Research Canada (PERC), a national network of health care professionals with an interest in pediatric emergency medicine research. Results: Of 209 surveys, 144 were returned, for a response rate of 68.9%. Of those, 87.5% (126 of 144) reported applying the OAR in children to determine the need for radiographs in acute ankle or midfoot injuries. Of those, 65.1% reported using the OAR always or usually, and 64.5% (93 of 144) of physicians stated that they believe all ankle fractures are clinically significant. Although physicians report that they most commonly order the radiographs, 36.2% of participants indicated that radiographs were requisitioned by nurses or other health care providers at their facilities. SH-1 fractures were reported to be most commonly managed by immobilization (83.3%; 120 of 144), with most patients going on to follow-up with an orthopedic surgeon. Conclusions: The majority of Canadian pediatric emergency physicians indicate that they use the OAR when assessing children with acute ankle and midfoot injuries. Most physicians believe that all ankle fractures, including SH-1, are clinically significant and have a management preference for immobilization and orthopedic follow-up.

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Measuring the impact and sustainability of a statewide program for identifying minority and underserved clients at risk for hereditary breast and ovarian cancer (HBOC): An eight-year follow up including transitions during the COVID pandemic.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18546 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18546-e18546

Author(s):

Alice S. Kerber ◽

Sheryl G. A. Gabram ◽

Diane Durrence ◽

Janet Y. Shin ◽

Nancy M. Paris ◽

...

Keyword(s):

Public Health ◽

Genetic Testing ◽

High Risk ◽

Surveillance Data ◽

Health Centers ◽

Care Providers ◽

Underserved Women ◽

Clinically Significant ◽

The Impact

e18546 Background: The Georgia Breast Cancer Genomics Program was created with 2011-2014 funding from the Centers for Disease Control and Prevention and the Georgia Department of Public Health (GDPH). In collaboration with GDPH and the Georgia Center for Oncology Research and Education (Georgia CORE), the goal of the program has been to reduce disparities among high-risk minority and underserved women. The objective of this study is to report the 8-year surveillance data for women at increased risk for HBOC in statewide public health centers. The effect of the COVID pandemic on the program and sustainability is also reported. Methods: From 11/1/2012-12/31/2020, the program provided education, outreach and collected surveillance data using an online genetics referral screening tool as recommended by USPSTF. Providers in 159 counties and health centers across Georgia were educated in cancer family history collection and appropriate referral to genetics. When an individual was found to be at high risk, she was referred to the Georgia CORE Genetics Advanced Practice Nurse for additional education, genetic testing and follow-up. Results: Online screenings attributable to GDPH totaled 29,087 with 1,656 positive screens. 28 % of clients were less than 25 years of age and 56 % ranged from 25-54. Race: 33 % white, 41 % black, 15 % Hispanic and 11 % other or N/A. 92 % of referrals were uninsured. Genetic testing was started or completed on 430 clients. 36 individuals declined testing after counseling (reconsideration, insurance, unknown reasons) and were provided with contact information. 47 (11%) pathogenic, clinically significant mutations were identified including 37 (79 %) HBOC related mutations and 10 (21 %) Lynch related mutations. Variants of uncertain significance were identified in 90 (21 %) clients, with multiple variants in 40 of those. 27 clients have been served through GDPH for physician consultation and surveillance. 13 were referred to area resources: one diagnosed with cancer, and 7 chose referral to other health care providers. Because of the pandemic, the program transitioned to telecommunications and remote access to testing in 5/2020. From 5/2020-12/2020, 34 clients completed testing (41% minority, all uninsured). 10 (29%) clinically significant mutations were identified and heightened surveillance initiated. Conclusions: The GDPH and Georgia CORE collaborative genomics program has served clients over the past 8 years, adjusting to changing resources while reaching a significant number of minority and underserved women. The program successfully converted to remote services during the COVID pandemic. Lessons learned from this transition have been incorporated into planning for future program sustainability.

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Conservative Management of Acute Appendicitis In The Era Of COVID 19: A Multicenter prospective observational study at The United Arab Emirates

10.1101/2020.09.30.20204503 ◽

2020 ◽

Author(s):

Fatima Y. AL Hashmi ◽

Abeer Al Zuabi ◽

Ibrahim Y. Hachim ◽

Guido H.H. Mannaerts ◽

Omar Bekdache

Keyword(s):

Health Care ◽

Acute Appendicitis ◽

United Arab Emirates ◽

Health Care Providers ◽

Conservative Management ◽

Length Of Hospital Stay ◽

Operative Management ◽

Care Providers ◽

The Impact

Background Since its emergence in December 2019, the Novel Coronavirus (COVID-19) pandemic resulted in a profound impact on the health care system worldwide. We propose herein to evaluate the impact of implementing conservative management as an alternative approach to surgical appendectomy in the treatment of proven acute appendicitis during COVID19 pandemic. Methods Our study is a prospective multicenter study that includes a cohort of 160 patients admitted to the surgical departments in both Tawam Hospital and Sheikh Shakhbout Medical City, Abu Dhabi, UAE, for the period from February 2020 till July 2020. Results Our results showed that 56 of our patients (35%) were treated conservatively, while the other 104 (65%) underwent operative management. There was a significant decrease in length of hospital stay (LOS) (2.32 days) among the first group compared to the second (2.8 days). Also, short term follow-up showed that 90% of those patients did not require further operative intervention or developed any serious complications. Out of the 110 patients that were swapped for COVID19, nine (8.18%) were confirmed to be positive. Our protocol was to avoid surgical management for COVID19 positive patients unless indicated. This resulted in (8/9) of COVID19 positive patients to be treated conservatively. Follow up was achieved by using telemedicine-based follow-up with the aim of empowering social distancing and reducing risk of viral exposure to patients as well as the health care providers. In conclusion, our results showed that the implementation of conservative management in treating patients with acute appendicitis who were COVID19 positive is a safe and feasible approach that maybe essential in reducing viral transmission risks as well as avoiding operative risks on COVID19 positive patients.

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The Impact of Physical Activity (PA) on the Prevention of Type 2 Diabetes; Evidence and Lessons Learned from the Diabetes Prevention Program (DPP), a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures

10.2337/figshare.13103333.v1 ◽

2020 ◽

Author(s):

Andrea M. Kriska ◽

Bonny Rockette-Wagner ◽

Sharon L. Edelstein ◽

George A. Bray ◽

Linda M. Delahanty ◽

...

Keyword(s):

Health Care Providers ◽

Diabetes Prevention ◽

Cox Proportional Hazards ◽

Lessons Learned ◽

Diabetes Incidence ◽

Care Providers ◽

Cross Sectional ◽

Entire Cohort ◽

The Impact

Objective: Across the DPP follow-up, cumulative diabetes incidence remained lower in the lifestyle compared to placebo and metformin randomized groups and could not be explained by weight. Collection of self-reported PA (yearly) with cross-sectional objective PA (in follow-up) allowed for examination of PA and its long-term impact on diabetes prevention. Research Design and Methods: Yearly self-reported PA and diabetes assessment, OGTT, (fasting glucose semi-annually) was collected for 3232 participants with one accelerometry assessment 11-13 years after randomization (n=1,793). Mixed models determined PA differences across treatment groups. The association between PA and diabetes incidence was examined using Cox proportional hazards models. Results: There was a 6% decrease (Cox proportional HR 0.94 [0.92, 0.96]; P< 0.001) in diabetes incidence per 6 MET-hrs/week increase in time-dependent PA for the entire cohort over an average 12 years (controlled for age, sex, baseline PA and weight). The effect of PA was greater (12% decrease) among participants less active at baseline (<7.5 MET-hrs/week) (n=1338; HR 0.88 [0.83, 0.93] P<0.0001) with stronger findings for lifestyle participants. Lifestyle had higher cumulative PA compared with metformin or placebo (p<0.0001) and higher accelerometry total minutes/day measured in follow-up (P=0.001 and 0.047). All associations remained significant with weight in the models. Conclusions: PA was inversely related to incident diabetes in the entire cohort across the study with cross-sectional accelerometry results supporting these findings. This highlights the importance of PA within lifestyle intervention efforts designed to prevent diabetes and urge health-care providers to consider both PA and weight when counseling high-risk patients.

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From common sense to evidence-based: An evaluation of survivorship planning.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.76 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 76-76

Author(s):

Sam Gaster

Keyword(s):

Health Care ◽

Cancer Survivors ◽

Health Care Providers ◽

Common Sense ◽

Care Providers ◽

Care Plans ◽

Follow Up Care ◽

The Future ◽

The Impact

76 Background: The Institute of Medicine’s (IOM; 2005) seminal report, From Cancer Patient to Cancer Survivor: Lost in Transition, recommended survivorship care plans (SCPs) as a common sense approach to improve the care of cancer survivors. The American Society of Clinical Oncology (ASCO; Mayer et al., 2014) reiterated the importance of these plans and provided strategic guidance for their implementation. The American College of Surgeons’ Commission on Cancer requires SCP delivery from accredited cancer programs as of 2015. Despite the push from these organizations, SCPs remain understudied (Mayer, Birken, Check, & Chen, 2014). The impact of SCPs on patient outcomes is poorly understood. Additionally, there is limited data on patients’ preferences for SCPs. This evaluation describes the use and assessment of SCPs at six regional cancer centers in the Midwest. Methods: Feedback was collected from 30 cancer survivors after receipt of a SCP. Responses were collected with 22-item questionnaire. Outcomes included survivors’ satisfaction with the clarity and detail of SCPs, likelihood to use SCPs in the future, intention to share SCPs with other health care providers, and perceived knowledge about treatment and follow-up care. Results: Over 75% (n = 23) of survivors agreed that SCPs were easy to understand. Ninety-three percent (n = 28) of survivors indicated that SCPs contained the right amount of information. Fifty-three percent (n = 16) of survivors are very likely to use their SCP in the future, whereas 47% (n = 14) are somewhat likely to use their SCP in the future. The majority (77%; n = 23) of survivors intend to share their SCP with another health care provider. Ninety-seven percent (n = 29) of survivors felt more knowledge about their treatment and follow-up car as a result of receiving a SCP. Conclusions: This evaluation highlights the many benefits of SCPs for cancer survivors. Results suggest that SCPs educate survivors about their treatment and follow-up care. Additionally, results indicate that many survivors intend to share SCPs, perhaps allowing for better coordination between oncology and primary care. Further research is warranted on the adoption of healthy lifestyle behaviors and receipt of routine health care after delivery of SCPs.

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The Impact of Physical Activity (PA) on the Prevention of Type 2 Diabetes; Evidence and Lessons Learned from the Diabetes Prevention Program (DPP), a Long-Standing Clinical Trial Incorporating Subjective and Objective Activity Measures

10.2337/figshare.13103333 ◽

2020 ◽

Author(s):

Andrea M. Kriska ◽

Bonny Rockette-Wagner ◽

Sharon L. Edelstein ◽

George A. Bray ◽

Linda M. Delahanty ◽

...

Keyword(s):

Health Care Providers ◽

Diabetes Prevention ◽

Cox Proportional Hazards ◽

Lessons Learned ◽

Diabetes Incidence ◽

Care Providers ◽

Cross Sectional ◽

Entire Cohort ◽

The Impact

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Breast Cancer Patients’ Experience and Wishes Regarding Communication on Sexual Health - The BEROSE Study

10.21203/rs.3.rs-427074/v2 ◽

2021 ◽

Author(s):

Marion Aupomerol ◽

Dan Chaltiel ◽

Patricia Pautier ◽

Delphine Wehrer ◽

Lucie Véron ◽

...

Keyword(s):

Breast Cancer ◽

Sexual Health ◽

Health Care Providers ◽

Care Pathway ◽

Cancer Center ◽

Care Providers ◽

Breast Cancer Patients ◽

Adequate Information ◽

The Impact

Abstract Purpose: Although sexual health (SH) is a major concern for many patients with breast cancer (BC), only few of them receive adequate information on this topic throughout their whole care pathway. BEROSE is a single-center pilot cross-sectional observational study, which aimed at evaluating communication on SH between women with BC and their health-care providers.Methods: From June 12th to July 31st, 2020, a survey was distributed to patients consulting at Breast Cancer Unit of Gustave Roussy Cancer Center. The primary endpoint was the rate of women reporting to have received information on SH from health professionals throughout active treatment administration or BC follow-up.Results: Of 348 surveys collected, 318 were fully completed and included in the analysis. Sixty-one percent of women were older than 50 years and 65% had a localized BC. The majority (63%) was receiving hormone-therapy (37%) or chemotherapy (26%). Overall, 65% reported that they had not received any information about SH throughout their care, while 69% felt it would have been important to discuss sexual issues. For 31% of women, professionals, preferably oncologists or gynecologists, should have initiated the discussion on SH, during an in-person consultation. Concerning satisfaction on SH, 83% reported being satisfied or very satisfied before BC diagnosis, and only 30% at the time they completed the survey.Conclusion: Most of women undergoing treatment or follow-up for BC feel that they lack of adequate information regarding sexual issues associated to BC. The impact of BC diagnosis and treatment on SH should be discussed with all women from the first visit and then regularly readdressed.

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