Systematic review of the behavioural assessment of pain in cats

Objectives The objectives were to review systematically the range of assessment tools used in cats to detect the behavioural expression of pain and the evidence of their quality; and to examine behavioural metrics (considering both the sensory and affective domains) used to assess pain. Methods A search of PubMed and ScienceDirect, alongside articles known to the authors, from 2000 onwards, for papers in English was performed. This was followed by a manual search of the references within the primary data sources. Only peer-reviewed publications that provided information on the assessment tool used to evaluate the behavioural expression of pain in cats, in conscious animals (not anaesthetised cats), were included. Results No previous systematic reviews were identified. One hundred papers were included in the final assessment. Studies were primarily related to the assessment of pain in relation to surgical procedures, and no clear distinction was made concerning the onset of acute and chronic pain. Ten broad types of instrument to assess pain were identified, and generally the quality of evidence to support the use of the various instruments was poor. Only one specific instrument (UNESP-Botucatu scale) had published evidence of validity, reliability and sensitivity at the level of a randomised control trial, but with a positive rather than placebo control, and limited to its use in the ovariohysterectomy situation. The metrics used within the tools appeared to focus primarily on the sensory aspect of pain, with no study clearly discriminating between the sensory and affective components of pain. Conclusions and relevance Further studies are required to provide a higher quality of evidence for methods used to assess pain in cats. Furthermore, a consistent definition for acute and chronic pain is needed. Tools need to be validated that can detect pain in a range of conditions and by different evaluators (veterinary surgeons and owners), which consider both the sensory and emotional aspects of pain

Eye quietness and quiet eye in expert and novice golf performance: an electrooculographic analysis

Quiet eye (QE) is the final ocular fixation on the target of an action (e.g., the ball in golf putting). Camerabased eye-tracking studies have consistently found longer QE durations in experts than novices; however, mechanisms underlying QE are not known. To offer a new perspective we examined the feasibility of measuring the QE using electrooculography (EOG) and developed an index to assess ocular activity across time: eye quietness (EQ). Ten expert and ten novice golfers putted 60 balls to a 2.4 m distant hole. Horizontal EOG (2ms resolution) was recorded from two electrodes placed on the outer sides of the eyes. QE duration was measured using a EOG voltage threshold and comprised the sum of the pre-movement and post-movement initiation components. EQ was computed as the standard deviation of the EOG in 0.5 s bins from –4 to +2 s, relative to backswing initiation: lower values indicate less movement of the eyes, hence greater quietness. Finally, we measured club-ball address and swing durations. T-tests showed that total QE did not differ between groups (p = .31); however, experts had marginally shorter pre-movement QE (p = .08) and longer post-movement QE (p < .001) than novices. A group × time ANOVA revealed that experts had less EQ before backswing initiation and greater EQ after backswing initiation (p = .002). QE durations were inversely correlated with EQ from –1.5 to 1 s (rs = –.48 - –.90, ps = .03 - .001). Experts had longer swing durations than novices (p = .01) and, importantly, swing durations correlated positively with post-movement QE (r = .52, p = .02) and negatively with EQ from 0.5 to 1s (r = –.63, p = .003). This study demonstrates the feasibility of measuring ocular activity using EOG and validates EQ as an index of ocular activity. Its findings challenge the dominant perspective on QE and provide new evidence that expert-novice differences in ocular activity may reflect differences in the kinematics of how experts and novices execute skills

Jefferson Digital Commons quarterly report: January-March 2020

This quarterly report includes: New Look for the Jefferson Digital Commons Articles COVID-19 Working Papers Educational Materials From the Archives Grand Rounds and Lectures JeffMD Scholarly Inquiry Abstracts Journals and Newsletters Master of Public Health Capstones Oral Histories Posters and Conference Presentations What People are Saying About the Jefferson the Digital Common

Provider Based Interventions to Mitigate Risk for Opioid Pain Medication Abuse Among Adult Patients in a Primary Care Setting

Mental and substance use disorders are predicted to exceed all physical disease processes causing major disability by 2020. Misuse and overdose of opioid pain medications is a significant public health concern in the United States. Approximately 1 in 4 patients receiving prescription opioids in primary care settings struggle with misuse. Half of all opioid prescriptions are written by primary care providers, including nurse practitioners. The purpose of this DNP project was to determine if nurse practitioner providers are implementing evidence-based practice guidelines including screening, brief intervention, and referral to treatment (SBIRT) to mitigate risk of prescription opioid pain medication misuse and abuse among patients who request a prescription for opioid pain medication. Nurse practitioner providers were instructed on current evidence-based opioid guidelines to include conducting a comprehensive assessment and screening for opioid misuse/abuse, brief intervention, and referral for behavioral health/addiction services treatment based on risk level scoring. There was a total of 9 out of 12 or 75% of patients age 18-25 that presented requesting an opioid pain medication. There was an even sex distribution, including 6 males (50%) and 6 females (50%). After implementing screening, brief intervention, and treatment, eight (66%) patients were identified as low risk; two (17%) patients were identified as moderate risk; and 2 (17%) patients were identified as high risk for opioid abuse. The two (17%) patients identified as high risk received brief intervention and were referred for treatment. This project identified the risk level for opioid pain medication misuse/abuse. Implementing evidence-based guidelines for prescribing opioid pain medications and SBIRT in the clinical setting conjunctly with other validated screening tools could prove to be quite effective in combating misuse/abuse of opioid pain medication based on results of the project

Comparison of embedded and added motor imagery training in patients after stroke: Study protocol of a randomised controlled pilot trial using a mixed methods approach

Copyright @ 2009 Schuster et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Two different approaches have been adopted when applying motor imagery (MI) to stroke patients. MI can be conducted either added to conventional physiotherapy or integrated within therapy sessions. The proposed study aims to compare the efficacy of embedded MI to an added MI intervention. Evidence from pilot studies reported in the literature suggests that both approaches can improve performance of a complex motor skill involving whole body movements, however, it remains to be demonstrated, which is the more effective one.Methods/Design: A single blinded, randomised controlled trial (RCT) with a pre-post intervention design will be carried out. The study design includes two experimental groups and a control group (CG). Both experimental groups (EG1, EG2) will receive physical practice of a clinical relevant motor task ('Going down, laying on the floor, and getting up again') over a two week intervention period: EG1 with embedded MI training, EG2 with MI training added after physiotherapy. The CG will receive standard physiotherapy intervention and an additional control intervention not related to MI.The primary study outcome is the time difference to perform the task from pre to post-intervention. Secondary outcomes include level of help needed, stages of motor task completion, degree of motor impairment, balance ability, fear of falling measure, motivation score, and motor imagery ability score. Four data collection points are proposed: twice during baseline phase, once following the intervention period, and once after a two week follow up. A nested qualitative part should add an important insight into patients' experience and attitudes towards MI. Semi-structured interviews of six to ten patients, who participate in the RCT, will be conducted to investigate patients' previous experience with MI and their expectations towards the MI intervention in the study. Patients will be interviewed prior and after the intervention period.Discussion: Results will determine whether embedded MI is superior to added MI. Findings of the semi-structured interviews will help to integrate patient's expectations of MI interventions in the design of research studies to improve practical applicability using MI as an adjunct therapy technique

Validity and reliability of accelerometers for examining vertical jump performance

Purpose. The objectives of this study were to determine the validity and reliability of an accelerometer as a device for estimating force-time curve characteristics and examine the effect of reducing sampling frequency.;Methods. Sixty college aged men and women (age=23.63.1 y; height=180.16.3 cm; weight=85.015.2kg; body fat=14.26.5%) performed 10 restricted (no arm swing) zero-load countermovement vertical jumps each for a total of 600 jumps. Peak force, rate of force development, peak power output, peak velocity, flight time and peak vertical displacement were assessed with the use of a tri-axial accelerometer and compared to a force platform + linear position transducer system. The data from the accelerometer were then resampled to determine the optimum sampling frequency. Reliability was assessed by intraclass correlation (ICC) and coefficient of variance (CV). Validity was evaluated by a linear regression analyses to determine a calibration equation, the standard error of the estimate (SEE) and a validity correlation coefficient.;Results. The accelerometer was found to be reliable for peak force, peak power, peak velocity and peak displacement for each sampling frequency. In regards to validity, the accelerometer significantly overestimated peak force, peak rate of force development, peak power and displacement while it underestimated peak velocity.;Conclusions. The accelerometer was found to be a reliable device at frequencies as low as 50 Hz, with the best validity at 250 Hz; therefore, 250 Hz is an acceptable sampling frequency when testing with accelerometers. The accelerometer overestimates some variables, which may be due to including bodyweight in the calculations.;Key words. Performance Testing, Athlete Monitoring, Sport Science, Power, Countermovement Jump

The clinical pharmacist's role in post-discharge follow-up of patients with coronary heart disease. A follow-up program.

The papers of this thesis are not available in Munin: 1. Garcia B, Utnes J, Naalsund L, Giverhaug T: 'MAT-CHDSP, a novel medication assessment tool for evaluation of secondary prevention of coronary heart disease', Pharmacoepidemiology and Drug Safety (2011) 20(3):249-57. Available at http://dx.doi.org/10.1002/pds.2054 2. Garcia BH, Smabrekke L, Trovik T, Giverhaug T.: 'Guideline adherence and therapeutic target achievement in secondary prevention of coronary heart disease' (submitted manuscript). Published version with altered title in European Journal of Cardiovascular Prevention and Rehabilitation, March 2013, Volume 69, Issue 3, pp 703-709. Available at http://dx.doi.org/10.1007/s00228-012-1402-7 3. Garcia BH, Giverhaug T, Utnes J, Smabrekke L.: 'Influence of a pharmacist-led follow-up program on clinical outcomes and guideline adherence in patients with established coronary heart disease : a randomized controlled trial' (manuscript). 4. Garcia BH, Storli SL, Smabrekke L.: 'Patient experience with a pharmacist-led follow-up program : a qualitative study in post-discharged patients with coronary heart disease' (manuscript)Coronary heart disease (CHD) is the leading cause of death world-wide. Studies indicate that patients are treated inadequately. Pharmaceutical care programs delivered by pharmacists are known to improve quality of care for patients with a variety of chronic and acute diseases, also CHD. Most of the programs are developed and carried out in the United States and United Kingdom. The overall aim of this PhD project was to develop a pharmacist-led follow-up program for patients with established CHD after hospital discharge. First, this thesis elucidates the development and validation of a medication assessment tool within secondary prevention of CHD (MAT-CHDSP). Second, the thesis describes the use of the MAT-CHDSP to identify non-adherence with clinical practice guideline recommendations. Third, the thesis presents the development of the clinical pharmacist-led follow-up program that was carried out as a randomized controlled trial (RCT) to explore the effects of the program. Last, the thesis describes a qualitative study in the participants’ experiences of the follow-up program. The MAT-CHDSP was found applicable for use in this patient population, and good validity, feasibility and reliability results were achieved. Improvement potentials in secondary prevention of CHD were revealed, especially regarding follow-up on unachieved therapeutic targets and lifestyle counselling. The one-year follow-up program was developed, where the RCT results showed an increase in documentation of lifestyle recommendations, however no significant impact on clinical outcomes in favour of the intervention group. The qualitative study did however indicate that the program was highly appreciated by the participants, that it influenced their knowledge of drugs and made them feel safe. In order to offer the follow-up program on a continuous basis to patients with CHD, several changes are warranted; most important, the collaboration with the prescriber needs to be strengthened

Better communication research project : language and literacy attainment of pupils during early years and through KS2 : does teacher assessment at five provide a valid measure of children's current and future educational attainments?

It is well-established that language skills are amongst the best predictors of educational success. Consistent with this, findings from a population-based longitudinal study of parents and children in the UK indicate that language development at the age of two years predicts children’s performance on entering primary school. Moreover, children who enter school with poorly developed speech and language are at risk of literacy difficulties and educational underachievement is common in such children. Whatever the origin of children’s problems with language and communication, the poor educational attainment of children with language learning difficulties is an important concern for educational polic