Determinants of research use in clinical decision making among physical therapists providing services post-stroke: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Despite evidence of the benefits of research use in post-acute stroke rehabilitation where compliance with clinical practice guidelines has been associated with functional recovery and patient satisfaction, the rate of reliance on the research literature in clinical decision making among physical therapists is low. More research examining factors that motivate physical therapists to consider research findings in neurological practice is needed to inform efforts to intervene. The objective of this study was to identify practitioner, organizational, and research characteristics associated with research use among physical therapists providing services post-stroke.</p> <p>Methods</p> <p>A cross-sectional mail survey of physical therapists providing services to people with stroke in Ontario, Canada was conducted. The survey questionnaire contained items to evaluate practitioner and organizational characteristics and perceptions of research considered to influence evidence-based practice (EBP), as well as the frequency of using research evidence in clinical decision making in a typical month. Ordinal regression was used to identify factors associated with research use.</p> <p>Results</p> <p>The percentage of respondents reporting research use in clinical decision making 0 to 1, 2 to 5, or 6+ times in a typical month was 33.8%, 52.9%, and 13.3%, respectively (n = 263). Academic preparation in the principles of EBP, research participation, service as a clinical instructor, self-efficacy to implement EBP, a positive attitude towards research, perceived organizational support of research use, and Internet access to bibliographic databases at work were each associated with research use and placed in the final regression model. In the final model (n = 244), academic preparation in EBP, EBP self-efficacy, agreement that research findings are useful, and research participation each remained significantly associated with research use after adjusting for the effects of the other variables in the model.</p> <p>Conclusions</p> <p>A third of therapists rarely use research evidence in clinical decision making. Education in the principles of EBP, EBP self-efficacy, a positive attitude towards research, and involvement in research at work may promote research use in neurological physical therapy practice. Future research is needed to confirm these findings and to determine the type of research participation that may promote research use.</p

Outcomes following autologous hematopoietic stem cell transplant for patients with relapsed Wilms' tumor: a CIBMTR retrospective analysis.

Despite the marked improvement in the overall survival (OS) for patients diagnosed with Wilms' tumor (WT), the outcomes for those who experience relapse have remained disappointing. We describe the outcomes of 253 patients with relapsed WT who received high-dose chemotherapy (HDT) followed by autologous hematopoietic stem cell transplant (HCT) between 1990 and 2013, and were reported to the Center for International Blood and Marrow Transplantation Research. The 5-year estimates for event-free survival (EFS) and OS were 36% (95% confidence interval (CI); 29-43%) and 45% (95 CI; 38-51%), respectively. Relapse of primary disease was the cause of death in 81% of the population. EFS, OS, relapse and transplant-related mortality showed no significant differences when broken down by disease status at transplant, time from diagnosis to transplant, year of transplant or conditioning regimen. Our data suggest that HDT followed by autologous HCT for relapsed WT is well tolerated and outcomes are similar to those reported in the literature. As attempts to conduct a randomized trial comparing maintenance chemotherapy with consolidation versus HDT followed by stem cell transplant have failed, one should balance the potential benefits with the yet unknown long-term risks. As disease recurrence continues to be the most common cause of death, future research should focus on the development of consolidation therapies for those patients achieving complete response to therapy

Scoping study to identify potential circular economy actions, priority sectors, material flows and value chains

The circular economy is rapidly rising up political and business agendas. In contrast to today’s largely linear, ‘take-make-use-dispose’ economy, a circular economy represents a development strategy that enables economic growth while aiming to optimise the chain of consumption of biological and technical materials. A deep transformation of production chains and consumption patterns is envisaged to keep materials circulating in the economy for longer, re-designing industrial systems and encouraging cascading use of materials and waste. Although there are some elements of circularity such as recycling and composting in the linear economy (see Figure E1) where progress needs to be maintained, a circular economy goes beyond the pursuit of waste prevention and waste reduction to inspire technological, organisational and social innovation across and within value chains (see Figure E2). There are already several policies in place and activities underway that support a circular economy; however there remain a range of untapped opportunities, costs to be avoided and obstacles to be addressed in order to accelerate the move towards a circular economy in the EU. Against this backdrop, the European Commission (DG Environment) launched a Scoping study to identify potential circular economy actions, priority sectors, material flows & value chains. The study was carried out by the Policy Studies Institute (PSI), Institute for European Environmental Policy (IEEP), BIO and Ecologic Institute between November 2013 and July 2014. The aim of the study was to provide an initial scoping assessment of potential priorities and policy options to support the transition to a circular economy in the EU. The study reviewed existing literature, identified potential priority areas for action where accelerating the circular economy would be beneficial and where EU policy has a particular role to play, and developed policy options for consideration across a range of areas

Four cases of audio-vestibular disorders related to immunisation with SARS-CoV-2 mRNA vaccines.

To gain medical insight into the clinical course and safety of otolaryngologic disorders following immunisation with severe acute respiratory coronavirus (SARS-CoV-2) mRNA-based vaccines. Case description. We report four cases of transient audio-vestibular symptoms, which occurred shortly after inoculation of two BNT162b2 (Pfizer-BioNTech &lt;sup&gt;®&lt;/sup&gt; ) and mRNA-1273 (Moderna®) vaccines. Hearing loss was unilateral in all cases and recovered at least partially: it was associated with persistent gait instability in two cases, after 1 and 7 months. Trigger mechanisms underpinning audio-vestibular impairment remain uncertain. Immune tolerance mechanisms with off-target innate activation of T-lymphocytes may be involved in vestibulocochlear nerve disorders, as for other cranial nerves involvement. The occurrence of audio-vestibular manifestations following mRNA-based vaccines needs ENT monitoring to support their causality in such rare vaccine-related adverse events. Audio-vestibular disorders appeared of transitory nature, including hearing loss, and should not deter further efforts in large-scale vaccination campaigns against SARS-CoV-2

A CLASSIFICATION MODEL FOR THE INFERENCE OF SPATIAL PRECISION OF OPENSTREETMAP BUILDINGS WITH INTRINSIC INDICATORS

To evaluate the quality of OSM data, similarities between OSM features and their homologous features represented in a reference database are relevant metrics. However, reference databases do not exist everywhere or are not freely available. Thus, having data quality assessment methods that rely only on intrinsic indicators (i.e. based on data itself without considering external information) would be useful in these cases. This article specifically uses the radial distance as a target quality metric to measure the quality of shapes. Its aim is to build a random-forest based classification method that reconstructs whether this distance is higher or lower than a specified threshold, using only intrinsic indicators as inputs. The classification algorithm is evaluated on a first dataset by computing the ROC (Receiver Operating Characteristic) curve and using the AUC (Area Under Curve) as an evaluation metric. The transferability of the resulting algorithm is then evaluated by measuring its performance on a second, distinct dataset. The experiments show that the algorithm performs reasonably well on both the initial and the second dataset, and that intrinsic indicators give relevant information to infer comparison-based shape quality (i.e. the radial distance)

Physiology of Angina and Its Alleviation With Nitroglycerin: Insights From Invasive Catheter Laboratory Measurements During Exercise

BACKGROUND: The mechanisms governing exercise-induced angina and its alleviation by the most commonly used antianginal drug, nitroglycerin, are incompletely understood. The purpose of this study was to develop a method by which the effects of antianginal drugs could be evaluated invasively during physiological exercise to gain further understanding of the clinical impact of angina and nitroglycerin. METHODS: Forty patients (mean age, 65.2±7.6 years) with exertional angina and coronary artery disease underwent cardiac catheterization via radial access and performed incremental exercise using a supine cycle ergometer. As they developed limiting angina, sublingual nitroglycerin was administered to half the patients, and all patients continued to exercise for 2 minutes at the same workload. Throughout exercise, distal coronary pressure and flow velocity and central aortic pressure were recorded with sensor wires. RESULTS: Patients continued to exercise after nitroglycerin administration with less ST-segment depression (P=0.003) and therefore myocardial ischemia. Significant reductions in afterload (aortic pressure, P=0.030) and myocardial oxygen demand were seen (tension-time index, P=0.024; rate-pressure product, P=0.046), as well as an increase in myocardial oxygen supply (Buckberg index, P=0.017). Exercise reduced peripheral arterial wave reflection (P<0.05), which was not further augmented by the administration of nitroglycerin (P=0.648). The observed increases in coronary pressure gradient, stenosis resistance, and flow velocity did not reach statistical significance; however, the diastolic velocity–pressure gradient relation was consistent with a significant increase in relative stenosis severity (k coefficient, P<0.0001), in keeping with exerciseinduced vasoconstriction of stenosed epicardial segments and dilatation of normal segments, with trends toward reversal with nitroglycerin. CONCLUSIONS: The catheterization laboratory protocol provides a model to study myocardial ischemia and the actions of novel and established antianginal drugs. Administration of nitroglycerin causes changes in the systemic and coronary circulation that combine to reduce myocardial oxygen demand and to increase supply, thereby attenuating exerciseinduced ischemia. Designing antianginal therapies that exploit these mechanisms may provide new therapeutic strategies

Social cohesion, mental wellbeing and health-related quality of life among a cohort of social housing residents in Cornwall: a cross sectional study

Background: Research and policy have identified social cohesion as a potentially modifiable determinant of health and wellbeing that could contribute to more sustainable development. However, the function of social cohesion appears to vary between communities. The aim of this study was to analyse the levels of, and associations, between social cohesion, mental wellbeing, and physical and mental health-related quality of life among a cohort of social housing residents from low socioeconomic status communities in Cornwall, UK. Social housing is below market-rate rental accommodation made available to those in certain health or economic circumstances. These circumstances may impact on the form and function of social cohesion. Methods: During recruitment, participants in the Smartline project completed the Short Warwick-Edinburgh Mental Wellbeing Scale, SF-12v2 and an eight item social cohesion scale. Cross sectional regression analyses of these data adjusted for gender, age, national identity, area socioeconomic status, rurality, education, employment, and household size were undertaken to address the study aim. Results: Complete data were available from 305 (92.7%) participants in the Smartline project. Univariable analyses identified a significant association between social cohesion, mental wellbeing and mental health-related quality of life. Within fully adjusted multivariable models, social cohesion only remained significantly associated with mental wellbeing. Sensitivity analyses additionally adjusting for ethnicity and duration of residence, where there was greater missing data, did not alter the findings. Conclusions: Among a relatively homogeneous cohort, the reported level of social cohesion was only found to be significantly associated with higher mental wellbeing, not physical or mental health-related quality of life. The efforts made by social housing providers to offer social opportunities to all their residents regardless of individual physical or mental health state may support the development of a certain degree of social cohesion. Sense of control or safety in communities may be more critical to health than social cohesion. Additional observational research is needed before attempts are made to alter social cohesion to improve health.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.The Smartline project is receiving up to £4,188,318 of funding from the England European Regional Development Fund as part of the European Structural and Investment Funds Growth Programme 2014–2020. The Ministry of Housing, Communities and Local Government (and in London the intermediate body Greater London Authority) is the Managing Authority for European Regional Development Fund. Established by the European Union, the European Regional Development Fund helps local areas stimulate their economic development by investing in projects which will support innovation, businesses, create jobs and local community regenerations. For more information visit https://www.gov.uk/european-growth-funding. Additional funding is from the South West Academic Health Science Network. KW is supported by the National Institute for Health Research Applied Research Collaboration South West Peninsula. KMa was funded by a National Institute for Health Research (NIHR) Knowledge Mobilisation Research Fellowship and ESRC Smartline Project for this research. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. The funders did not contribute to the design of the study or collection, analysis, and interpretation of data or in writing the manuscript in any way.published version, accepted versio

The role and potential of umbilical cord blood in an era of new therapies: a review

In light of pioneering findings in the 1980s and an estimation of more than 130 million global annual births, umbilical cord blood (UCB) is considered to be the most plentiful reservoir of cells and to have regenerative potential for many clinical applications. Although UCB is used mainly against blood disorders, the spectrum of diseases for which it provides effective therapy has been expanded to include non-hematopoietic conditions; UCB has also been used as source for regenerative cell therapy and immune modulation. Thus, collection and banking of UCB-derived cells have become a popular option. However, there are questions regarding the cost versus the benefits of UCB banking, and it also raises complex ethical and legal issues. This review discusses many issues surrounding the conservation of UCB-derived cells and the great potential and current clinical applications of UCB in an era of new therapies. In particular, we describe the practical issues inherent in UCB collection, processing, and long-term storage as well as the different types of ‘stem’ or progenitor cells circulating in UCB and their uses in multiple clinical settings. Given these considerations, the trend toward UCB will continue to provide growing assistance to health care worldwide