Psychometric evaluation of the functional walking test for children with cerebral palsy.

Purpose. This study examined the psychometric properties of the functional walking test (FWT). Method. Fifty-six subjects with cerebral palsy (CP) (21 females and 35 males, mean age 9 years 6 months, SD 3 years 9months, range 4-17 years) were assessed on two occasions, 6 months apart, using both the FWT and the gross motor function measure (GMFM). Results. Generalisability correlation coefficients (GCC) for all 11 items were high (0.91-0.99). Inter-rater reliability was also high with excellent consensus in the scores given by the eight raters (intra-class correlation coefficient and GCC 0.99). Intra-rater reliability was equally high (GCC 0.99). The internal consistency of the FWT was estimated using Cronbach\u27s α as 0.95 and 0.94 at Time 1 and 2, respectively. The FWT had a high degree of correlation with the GMFM, when total scores were compared at Time 1 and 2 (Pearson\u27s r = 0.86 and 0.87, n = 56, p \u3c 0.01). The FWT also found statistically significant differences in total scores between the three Gross Motor Function Classification System (GMFCS) levels. The correlation between the FWT scores and GMFCS was -0.70 at Time 1 and -0.76 Time 2 (p \u3c 0.01) indicating the construct validity of the FWT. Conclusions. This study has demonstrated that the FWT has sound psychometric properties and is valid and reliable in a sample population of ambulant children with CP

Long term outcome of stroke: Stroke is a chronic disease with acute events.

Long term outcome of stroke: Stroke is a chronic disease with acute events

Irish Heart Foundation National Audit of Stroke Care

Stroke is the third leading cause of death and disability worldwide. It constitutes a formidable burden of disability for patients, their families, health professionals and the wider community. It combines aspects of both acute and chronic disease, and there is increasing evidence that those affected by stroke can benefit to a very significant extent from organised stroke care throughout the course of the illness. Delivering this care requires a unique combination of skills, drawing on neurosciences, cardiovascular medicine, general medicine, the science of ageing, rehabilitation, vascular surgery, and public health. Local and timely evidence on the service performance is essential to assess quality of care and to improve services. This has not been available to date in Ireland. The aim of this project was to conduct a national audit of stroke care in hospital and the community in the Republic of Ireland. This was achieved by completing six separate surveys and by drawing conclusions based on complementary information across the studies. The six surveys are described next. Where possible, audit systems used in the UK’s Sentinel audit were used to provide an opportunity for comparison of relative, as well as absolute, levels of achievement of recommended standards of care

A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital.

Ireland has an ageing population and the elderly are over-represented in Emergency Departments (ED)--a quarter of these presentations resulting from falls. A prospective study design was employed using a convenience sample to profile elderly fallers referred for physiotherapy in ED. Forty-subjects were assessed over 14 weeks. Mean age was 84.88 years (s.d. 7.3) and 31 (77.5%) were female. All demonstrated slow walking speed and 26 (65%) demonstrated poor grip strength. A quarter of subjects reported fear of falling and 30 (75%) were classified as frail. Elderly fallers in ED are a frail group of socially vulnerable patients who demonstrate a risk of further falls. Osteoporosis had been diagnosed in 9 (22.5%) subjects--a low prevalence compared with international research, but 25 (62.5%) subjects had never had a DEXA scan. The prevalence of frailty in the sample of elderly fallers in this study was very high (75%)

Stroke Knowledge in an Irish Semi-Rural Community-Dwelling Cohort and Impact of a Brief Education Session.

Poor knowledge of stroke risk factors and failure to recognize and act on acute symptoms hinders efforts to prevent stroke and improve clinical outcomes. Levels of stroke knowledge are poorly established within Ireland. This study was conducted to establish levels of knowledge among men and women aged \u3e40 years in an Irish community, and also to determine the impact of a single education session on stroke knowledge. Subjects from 2 separate geographical locations were allocated to an intervention group (n = 200), who received stroke information over a 90-minute session, or a control group (n = 200). Both groups completed a stroke knowledge questionnaire at baseline and at 4 weeks after the educational session. Overall, the initial response rate was 70% (280/400); 52% of the respondents knew that the brain is affected by stroke, 58% could list 2 or more risk factors but only 27% could list 2 or more warning signs, 50% would call 999 (emergency number in Ireland) in response to stroke, 17% had heard of thrombolytic therapy, but only 1% knew the time frame for receiving thrombolytics. The response rate to the resurvey following the educational session was 57%, with 47 of 117 subjects in the intervention group (40%) attending the session. Stroke knowledge scores improved by 50% in the intervention group (P \u3c .001). Overall, the knowledge of stroke risk factors, warning signs, and thrombolytic therapy was poor in this Irish community-dwelling cohort. Our study demonstrates that a single educational session can improve short-term knowledge of stroke symptoms and thrombolytic therapy

Three-dimensional vision enhances task performance independently of the surgical method

Background: Within the next few years, the medical industry will launch increasingly affordable three-dimensional (3D) vision systems for the operating room (OR). This study aimed to evaluate the effect of two-dimensional (2D) and 3D visualization on surgical skills and task performance. Methods: In this study, 34 individuals with varying laparoscopic experience (18 inexperienced individuals) performed three tasks to test spatial relationships, grasping and positioning, dexterity, precision, and hand-eye and hand-hand coordination. Each task was performed in 3D using binocular vision for open performance, the Viking 3Di Vision System for laparoscopic performance, and the DaVinci robotic system. The same tasks were repeated in 2D using an eye patch for monocular vision, conventional laparoscopy, and the DaVinci robotic system. Results: Loss of 3D vision significantly increased the perceived difficulty of a task and the time required to perform it, independently of the approach (P<0.0001-0.02). Simple tasks took 25% to 30% longer to complete and more complex tasks took 75% longer with 2D than with 3D vision. Only the difficult task was performed faster with the robot than with laparoscopy (P=0.005). In every case, 3D robotic performance was superior to conventional laparoscopy (2D) (P<0.001-0.015). Conclusions: The more complex the task, the more 3D vision accelerates task completion compared with 2D vision. The gain in task performance is independent of the surgical metho

Access to In-Patient Stroke Services and Multidisciplinary Team (MDT) Rehabilitation: Current Demands and Capacity.

The objective of this project was to analyse the current access to in-patient stroke services and MDT rehabilitation in an acute stroke centre and to compare these services to the recommended “National Clinical Guidelines and Recommendations for the Care of People with Stroke and TIA” (IHF 2010). A retrospective chart review was carried out, recording activity statistics of all patients admitted with acute stroke over a three-month period. 73 patients (male=40, 54.8%) were included. Patients were discharged from the stroke service after a mean stay of 20.2 days (SD.= 19.3). 76.7% (N=56) of patients were admitted to the acute stroke unit (ASU). The mean length of time from admission to first assessment 3.4 days (SD.=2.68), with an average of 138 minutes of treatment received per day across all disciplines. This is compared to the IHF’s recommendation of patients being assessed within 24-48 hours of admission and receiving 180 minutes of treatment across all disciplines. As demands for stroke MDT services increase, it is important to recognise the benefits of increasing staff and resources to maintain and continue to improve standards of care

The field theoretic derivation of the contact value theorem in planar geometries and its modification by the Casimir effect

The contact value theorem for Coulomb gases in planar or film-like geometries is derived using a Hamiltonian field theoretic representation of the system. The case where the film is enclosed by a material of different dielectric constant to that of the film is shown to contain an additional Casimir-like term which is generated by fluctuations of the electric potential about its mean-field value.Comment: Link between Sine-Gordon and Coulomb gas pressures via subtraction of self interaction terms included. Discussion of results within Debye-Huckel approximation included. Added reference