Evaluating the Liverpool Care Pathway for care of the terminally ill in rural Australia

© 2015, Springer-Verlag Berlin Heidelberg. Purpose: This study evaluates a pilot implementation of the Liverpool Care Pathway (LCP), a clinical tool used to guide the care of dying patients in the last days of life, on the end-of-life care for dying patients in three regions in rural Australia. Methods: The LCP was implemented at 13 participating sites: nine hospitals (general wards), one community-based palliative care service, and three in-hospital palliative care units. To evaluate the implementation of the LCP, 415 eligible patient records were examined: 223 pre-implementation and 192 post-implementation (116 on the LCP and 76 receiving usual care). The primary analysis compared all patients pre-implementation of the LCP versus all patients post-implementation. Results: Increases were found post-implementation for communication with other health professionals and with patients or family (pre-69 %, post-87 %; p ≤ 0.000), use of palliative medications (pre-87 %, post-98 %; p ≤ 0.000) and frequency of symptom assessments (pre-66 %, post-82 %; p ≤ 0.000). Fewer blood and radiological investigations were conducted and venous access devices used in the post-implementation groups than in the pre-implementation period. Conclusions: This study suggests that when rigorously implemented, the LCP improves important components of end-of-life care for dying patients and their families

Shoulder Pain Is Associated With Rate of Rise and Jerk of the Applied Forces During Wheelchair Propulsion in Individuals With Paraplegic Spinal Cord Injury

OBJECTIVE: To investigate the association between propulsion biomechanics, including variables that describe smoothness of the applied forces, and shoulder pain in persons with SCI. DESIGN: Cross-sectional, observational study. SETTING: Non-university research institution. PARTICIPANTS: 30 (age: 48.6±9.3 years, 83% males) community dwelling, wheelchair dependent participants with a chronic paraplegia between T2 and L1, with and without shoulder pain. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE: Rate of rise and jerk of applied forces during wheelchair propulsion. Participants were stratified in low, moderate and high pain groups based on their Wheelchair User Shoulder Pain Index (WUSPI) score at the day of measurement. RESULTS: A mixed-effect multilevel analysis showed that wheelchair users in the high pain group propelled with significantly greater rate of rise and jerk - measures that describe smoothness of the applied forces - as compared to persons with less or no pain, when controlling for all co-variables. CONCLUSIONS: Persons with severe shoulder pain propelled with less smooth strokes as compared to persons with less or no pain. This supports a possible association between shoulder pain and rate of rise and jerk of the applied forces during wheelchair propulsion

Shoulder load during synchronous handcycling and handrim wheelchair propulsion in persons with paraplegia

Objective: To compare the shoulder load during handcycling and wheelchair propulsion under similar conditions of external power in persons with spinal cord injury. Design: Cross-sectional. Subjects: Eight men with spinal cord injury. Methods: Kinetics and kinematics were measured during handbike and wheelchair propulsion at 25, 35, 45 and 55 W on a treadmill. Shoulder load (glenohumeral contact forces, relative muscle forces) was calculated with the Delft Shoulder and Elbow Model. Results: At all power output levels, glenohumeral contact forces were significantly lower during handcycling compared with wheelchair propulsion (p < 0.001). At 55 W, the mean glenohumeral contact force was 345 N for handcycling, whereas it was 585 N for wheelchair propulsion. Also, relative muscle forces were lower during handcycling. The largest differences between handbike and wheelchair propulsion were found in the supraspinatus (4.5% vs. 20.7%), infraspinatus (3.7% vs. 16.5%) and biceps (5.0% vs. 17.7%). Conclusion: Due to continuous force application in handcycling, shoulder load was lower compared with wheelchair propulsion. Furthermore, muscles that are prone to overuse injuries were less stressed during handcycling. Therefore, handcycling may be a good alternative for outdoor mobility and may help prevent overuse injuries of the shoulder complex. © 2012 The Authors

MRI evaluation of shoulder pathologies in wheelchair users with spinal cord injury and the relation to shoulder pain

OBJECTIVE: To describe the number, specifics and co-occurrence of shoulder pathologies detected by MRI in manual wheelchair users with spinal cord injury and to evaluate the association between shoulder pathologies and presence of shoulder pain.DESIGN: Cross-sectional observation study.SETTING: Community.PARTICIPANTS: Fifty-one wheelchair-dependent persons with spinal cord injury (44 males, 7 females, median age 50 years (IQR 14), median time since injury 24 years (IQR 16)) were allocated to pain or no-pain group based on the Wheelchair User Shoulder Pain Index.INTERVENTIONS: Not applicable.OUTCOME MEASURES: All persons underwent shoulder MRI. Pathologies were scored blinded by two experienced radiologists. Participant characteristics, number and severity of shoulder pathologies were analyzed descriptively. Logistic regression was performed to evaluate the association between MRI findings and shoulder pain.RESULTS: The median number of co-occurring MRI findings per person ranged from 0 to 19 (out of 31 possible findings). The cluster of MRI findings occurring most often together were tendon tears of supraspinatus (present in 84%), subscapularis (69%) and biceps (67%) and osteoarthritis of acromioclavicular joint (80%). When correcting for age and time since injury, the logistic regression showed no statistically significant correlation between the individual pathologies and shoulder pain.CONCLUSION: MRI findings of shoulder pathology are very frequent in persons with and without shoulder pain. Therefore, when diagnosing the cause of shoulder pain and planning interventions, health care professionals should keep this finding in mind and MRI should not be interpreted without careful consideration of clinical history and functional testing.</p

A comparative investigation of the efficacy of CO2 and high power diode lasers for the forming of EN3 mild steel sheets

A comparative investigation of the effectiveness of a high power diode laser (HPDL) and a CO2 laser for the forming of thin section EN3 mild steel sheet has been conducted. The buckling mechanism was identified as the laser forming mechanism responsible for the induced bending. For both lasers it was found that the induced bending angles increased with an increasing number of irradiations and high laser powers, whilst decreasing as the traverse speed was increased. Also, it was apparent from the experimental results that the laser bending angle was only linearly proportional to the number of irradiations when the latter was small due to local material thickening along the bend edge with a high number of irradiations. Owing to the mild steel’s greater beam absorption at the HPDL wavelength, larger bending angles were induced when using the HPDL. However, under certain conditions the performance of the CO2 laser in terms of induced bending angle was seen to approach that of the HPDL. Nevertheless, similar results between the two lasers were only achieved with increasing irradiations, thus it was concluded that the efficacy of the HPDL was higher than that of the CO2 laser insofar as it was more efficient. From graphical results and the employment of an analytical procedure, the laser line energy range in which accurate control of the HPDL bending of the mild steel sheets could be exercised efficiently was found to be 53 J mm-1 < P/v < 78 J mm-1, whilst for the CO2 laser the range was 61 J mm-1 < P/v < 85 J mm-1

Massive sacrococcygeal teratoma in a preterm infant

In extreme preterm infants, massive congenital sacrococcygeal teratomas with great hemodynamic commitment may be a situation for limitation of care

Cerenkov radiation of longitudinal photons by neutrinos

In a relativistic plasma neutrino can emit plasmons by the Cerenkov process which is kinematically allowed for a range of frequencies for which refractive index is greater than one. We have calculated the rate of energy emission by this process. We compute the energy deposited in a stalled supernova shock wave by the Cerenkov process and find that it is much smaller than the Bethe-Wilson mechanism.Comment: 11 pages, 2 figures available on reques

Bayesian mixed model analysis uncovered 21 risk loci for chronic kidney disease in boxer dogs

Author summaryChronic kidney disease (CKD) is described as a set of heterogeneous disorders affecting kidney structure and function. CKD is common in dogs and has been diagnosed in nearly all breeds. In this study, we identified 21 genetic regions associated with CKD in a boxer population and investigated the relevant genes and putative regulatory variants in these regions. Studies of canine CKD may help to better understand the pathology of kidney disease in both dogs and humans, and shows an important potential for early identification of high-risk individuals.Chronic kidney disease (CKD) affects 10% of the human population, with only a small fraction genetically defined. CKD is also common in dogs and has been diagnosed in nearly all breeds, but its genetic basis remains unclear. Here, we performed a Bayesian mixed model genome-wide association analysis for canine CKD in a boxer population of 117 canine cases and 137 controls, and identified 21 genetic regions associated with the disease. At the top markers from each CKD region, the cases carried an average of 20.2 risk alleles, significantly higher than controls (15.6 risk alleles). An ANOVA test showed that the 21 CKD regions together explained 57% of CKD phenotypic variation in the population. Based on whole genome sequencing data of 20 boxers, we identified 5,206 variants in LD with the top 50 BayesR markers. Following comparative analysis with human regulatory data, 17 putative regulatory variants were identified and tested with electrophoretic mobility shift assays. In total four variants, three intronic variants from the MAGI2 and GALNT18 genes, and one variant in an intergenic region on chr28, showed alternative binding ability for the risk and protective alleles in kidney cell lines. Many genes from the 21 CKD regions, RELN, MAGI2, FGFR2 and others, have been implicated in human kidney development or disease. The results from this study provide new information that may enlighten the etiology of CKD in both dogs and humans

Biophysical aspects of handcycling performance in rehabilitation, daily life and recreational sports; a narrative review

Aim In this narrative review the potential and importance of handcycling are evaluated. Four conceptual models form the framework for this review; (1) the International Classification of Functioning, Disability and Health; (2) the Stress-Strain-Capacity model; (3) the Human-Activity-Assistive Technology model; and (4) the power balance model for cyclic exercise. Methods Based on international handcycle experience in (scientific) research and practice, evidence-based benefits of handcycling and optimization of handcycle settings are presented and discussed for rehabilitation, daily life and recreational sports. Results As the load can be distributed over the full 360° cycle in handcycling, peak stresses in the shoulder joint and upper body muscles reduce. Moreover, by handcycling regularly, the physical capacity can be improved. The potential of handcycling as an exercise mode for a healthy lifestyle should be recognized and advocated much more widely in rehabilitation and adapted sports practice. The interface between handcycle and its user should be optimized by choosing a suitable person-specific handcycle, but mainly by optimizing the handcycle dimensions to one’s needs and desires. These dimensions can influence efficient handcycle use and potentially improve both endurance and speed of handcycling. Conclusion To optimize performance in rehabilitation, daily life and recreational sports, continued and more systematic research is required. Implications for rehabilitation Handcycling allows users to travel farther distances at higher speeds and to train outdoors. It should be recognized as an alternative exercise modality for daily outdoor use, also already in early rehabilitation, while it contributes to a healthy lifestyle. To individualize handcycle performance, the user-handcycle (assistive device) interface as well as the vehicle mechanics should be optimized to minimize external power and reduce friction, so that the upper body capacity can be efficiently used. To optimize handcycling individual performance, both the physiological and biomechanical aspects of handcycling should be considered when monitoring or testing handcycle exercise