Hindfoot pain:Terminology, treatment and outcome

This thesis focuses on providing insight into terminology use, treatment and outcome of different causes of hindfoot pain. Hindfoot pain can be caused by a variety of pathologies and it is necessary to have uniform terminology as it provides the ability to communicate with an universal language. Regarding chronic Achilles tendon problems, the most common clinical diagnosis is mid-portion Achilles tendinopathy, followed by insertional problems such as retrocalcaneal bursitis. For mid-portion Achilles tendinopathy and retrocalcaneal bursitis, a wide variety of surgical techniques have proven to be effective. In this thesis the endoscopic treatment is evaluated. Furthermore, a patient-reported outcome measure specific for Achilles tendon ruptures is validated in Dutch. Two other issues are addressed in this thesis: flexor hallucis longus (stenosing) tenosynovitis and posterior ankle impingement syndrome

Assessment and management of dysphagia in acute stroke: an initial service review of international practice

The international approach to the assessment and management of dysphagia in the acute phase post stroke is little studied. A questionnaire was sent to clinicians in stroke services that explored the current practice in dysphagia screening, assessment, and management within the acute phase post stroke. The findings from four (the UK, the US, Canada, and Australia) of the 22 countries returning data are analysed. Consistent approaches to dysphagia screening and the modification of food and liquid were identified across all four countries. The timing of videofluoroscopy (VFS) assessment was significantly different, with the US utilising this assessment earlier post stroke. Compensatory and Postural techniques were employed significantly more by Canada and the US than the UK and Australia. Only food and fluid modification, tongue exercises, effortful swallow and chin down/tuck were employed by more than fifty percent of all respondents. The techniques used for assessment and management tended to be similar within, but not between, countries. Relationships were found between the use of instrumental assessment and the compensatory management techniques that were employed. The variation in practice that was found, may reflect the lack of an available robust evidence base to develop care pathways and identify the best practice. Further investigation and identification of the impact on dysphagia outcome is needed

Functional Health Status in Oropharyngeal Dysphagia

Patient self-evaluations on Functional Health Status (FHS) questionnaires are considered to be part of the assessment of oropharyngeal dysphagia. FHS questionnaires capture the unique personal perception of someone’s health, taking into account social, functional and psychological factors. Many FHS questionnaires have been reported on in literature. This paper describes a selection of FHS questionnaires in more detail; issues concerning the inclusion of Health Related Quality of Life (HRQOL) items, choices in target populations and the distinction between oropharyngeal versus esophageal dysphagia will be discussed. Recommendations are made about the evaluation and use of FHS questionnaires in daily clinical practice. In particular the psychometric properties of FHS questionnaires should be evaluated to determine if they meet quality criteria for measurement properties of health status questionnaires in order to guarantee valid and reliable outcome measurements

ECCO-ESGAR Topical Review on Optimizing Reporting for Cross-Sectional Imaging in IBD

Background and Aims: Diagnosis and follow up of patients with inflammatory bowel disease [IBD] requires cross-sectional imaging modalities, such as intestinal ultrasound [IUS], magnetic resonance imaging [MRI], and computed tomography [CT]. The quality and homogeneity of medical reporting are crucial to ensure effective communication between specialists and to improve patient care. The current topical review addresses optimized reporting requirements for cross-sectional imaging in IBD. // Methods: An expert consensus panel consisting of gastroenterologists, radiologists, and surgeons convened by the ECCO in collaboration with ESGAR performed a systematic literature review covering the reporting aspects of MRI, CT, IUS, endoanal ultrasonography, and transperineal ultrasonography in IBD. Practice position statements were developed utilizing a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when ≥80% of the participants agreed on a recommendation. // Results: Twenty-five practice positions were developed, establishing standard terminology for optimal reporting in cross-sectional imaging. Assessment of inflammation, complications, and imaging of perianal CD are outlined. The minimum requirements of a standardized report, including a list of essential reporting items, have been defined. // Conclusions: This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD

Embedding nursing interventions into the World Health Organization’s International Classification of Health Interventions (ICHI)

Objective: The International Classification of Health Interventions (ICHI) is currently being developed. ICHI seeks to span all sectors of the health system. Our objective was to test the draft classification’s coverage of interventions commonly delivered by nurses, and propose changes to improve the utility and reliability of the classification for aggregating and analyzing data on nursing interventions. Materials and methods: A two-phase content mapping method was used: (1) three coders independently applied the classification to a data set comprising 100 high-frequency nursing interventions; (2) the coders reached consensus for each intervention and identified reasons for initial discrepancies. Results: A consensus code was found for 80 of the 100 source terms: for 34% of these the code was semantically equivalent to the source term, and for 64% it was broader. Issues that contributed to discrepancies in Phase 1 coding results included concepts in source terms not captured by the classification, ambiguities in source terms, and uncertainty of semantic matching between ‘action’ concepts in source terms and classification codes. Discussion: While the classification generally provides good coverage of nursing interventions, there remain a number of content gaps and granularity issues. Further development of definitions and coding guidance is needed to ensure consistency of application. Conclusion: This study has produced a set of proposals concerning changes needed to improve the classification. The novel method described here will inform future health terminology and classification content coverage studies

UK and Ireland Joint Advisory Group (JAG) consensus statements for training and certification in diagnostic endoscopic ultrasound (EUS)

Background and Aims: International endoscopy societies vary in their approach for credentialing individuals in endoscopic ultrasound (EUS) to enable independent practice; however, there is no consensus in this or its implementation. In 2019, the Joint Advisory Group on GI Endoscopy (JAG) commissioned a working group to examine the evidence relating to this process for EUS. The aim of this was to develop evidence-based recommendations for EUS training and certification in the UK.Methods: Under the oversight of the JAG quality assurance team, a modified Delphi process was conducted which included major stakeholders from the UK and Ireland. A formal literature review was made, initial questions for study were proposed and recommendations for training and certification in EUS were formulated after a rigorous assessment using the Grading of Recommendation Assessment, Development and Evaluation tool and subjected to electronic voting to identify accepted statements. These were peer reviewed by JAG and relevant stakeholder societies before consensus on the final EUS certification pathway was achieved.Results: 39 initial questions were proposed of which 33 were deemed worthy of assessment and finally formed the key recommendations. The statements covered four key domains, such as: definition of competence (13 statements), acquisition of competence (10), assessment of competence (5) and postcertification mentorship (5). Key recommendations include: (1) minimum of 250 hands-on cases before an assessment for competency can be made, (2) attendance at the JAG basic EUS course, (3) completing a minimum of one formative direct observation of procedural skills (DOPS) every 10 cases to allow the learning curve in EUS training to be adequately studied, (4) competent performance in summative DOPS assessments and (5) a period of mentorship over a 12-month period is recommended as minimum to support and mentor new service providers.Conclusions: An evidence-based certification pathway has been commissioned by JAG to support and quality assure EUS training. This will form the basis to improve quality of training and safety standards in EUS in the UK and Ireland.</p