The physical therapy and society summit (PASS) meeting: observations and opportunities

Journal ArticleThe construct of delivering high-quality and cost-effective health care is in flux, and the profession must strategically plan how to meet the needs of society. In 2006, the House of Delegates of the American Physical Therapy Association passed a motion to convene a summit on ?how physical therapists can meet current, evolving, and future societal health care needs.? The Physical Therapy and Society Summit (PASS) meeting on February 27?28, 2009, in Leesburg, Virginia, sent a clear message that for physical therapists to be effective and thrive in the health care environment of the future, a paradigm shift is required. During the PASS meeting, participants reframed our traditional focus on the physical therapist and the patient/client (consumer) to one in which physical therapists are an integral part of a collaborative, multidisciplinary health care team with the health care consumer as its focus. The PASS Steering Committee recognized that some of the opportunities that surfaced during the PASS meeting may be disruptive or may not be within the profession?s present strategic or tactical plans. Thus, adopting a framework that helps to establish the need for change that is provocative and potentially disruptive to our present care delivery, yet prioritizes opportunities, is a critical and essential step. Each of us in the physical therapy profession must take on post?PASS roles and responsibilities to accomplish the systemic change that is so intimately intertwined with our destiny. This article offers a perspective of the dynamic dialogue and suggestions that emerged from the PASS event, providing further opportunities for discussion and action within our profession

Pilot evaluation of a novel unilateral onychectomy model and efficacy of an extended release buprenorphine product

Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs), transdermal fentanyl patches, and transmucosal buprenorphine are probably the most commonly used options for providing post-operative analgesia in the early at-home period. However, these require daily administration or are associated with abuse concerns. One of the significant unmet needs in veterinary surgery and pain management is for longer acting opioids for cats to effectively bridge the gap between the in-hospital and at-home recovery periods. A proof of concept study of an extended release formulation of buprenorphine HCL (ER-Bup) was conducted using objective kinetic measures and a unilateral onychectomy model. Using a blinded, randomized, two period crossover design, four cats were allocated to control (saline) or ER-Bup (0.6 mg/kg, subcutaneously [SC]) treatment groups. All animals underwent a unilateral forelimb onychectomy per period with a washout/recovery period in between. Observational pain scores and kinetic data (using a pressure sensitive walkway [PSW]) were collected prior to (baseline) and at intervals for 72 h following surgery. Symmetry indices were derived for kinetic variables (peak vertical force [PVF]; vertical impulse [VI]) of each forelimb for landing following a jump and for walking. A rescue analgesic protocol was in place. Effect of surgery and treatment were evaluated using a mixed model statistical approach. Results No cats required rescue analgesics based on subjective pain score. ER-Bup had a positive influence on subjective pain scores during the 72 h postsurgery (p = 0.0473). PVF and VI of the operated limb were significantly decreased for both landing (p < 0.0001 and p < 0.0001) and walking (p < 0.0001 and p < 0.0001 respectively) compared to control. ER-Bup resulted in significantly decreased asymmetry in limb use during landing (PVF, p < 0.0001; VI, p < 0.0001) and walking (PVF, p = 0.0002, VI, p < 0.0001). The novel use of data collected following a jump from an elevated platform appeared to provide all desired information and was easier to collect than walking data. Conclusion This study demonstrates that SC administration of ER-Bup may be an effective analgesic for a 72 h period postoperatively. Furthermore, landing onto a PSW from an elevated perch may be a useful and efficient way to assess analgesics in cats using a unilateral model of limb pain

Modelos de predicción de mortalidad en cirugía cardiaca: diseño de un modelo, evaluación de modelos generales y análisis de mortalidad ajustada a riesgo

Las intervenciones de cirugía cardiaca tienen costes elevados, emplean recursos complejos, y se asocian a riesgos quirúrgicos medios comparativamente más elevados que la mayor parte de las demás disciplinas quirúrgicas. Es un área de especial interés para los estudios de evaluación de riesgo y de análisis de calidad. El parámetro más empleado como variable de medición es la mortalidad hospitalaria, por su relevancia clínica, facilidad de medir, y estandarización. La necesidad de establecer rangos de mortalidad aceptable ha originado iniciativas nacionales para medirlo. Ningún organismo emite datos de mortalidad por tipo de procedimiento ajustado a riesgo de los servicios cardioquirúrgicos adaptados a criterios acordados con las sociedades científicas. Las fuentes existentes son las memorias de resultados de las Consejerías, los registros de gastos y el Registro de Actividad de la SECTCV. Ninguna de estas fuentes contiene información paciente a paciente, ni información pronóstica de los pacientes. La fuente más útil a nivel clínico es el Registro de Intervenciones de la SECTCV. El análisis de la mortalidad debe tener en cuenta el riesgo de los pacientes. Los modelos de predicción de mortalidad estiman este riesgo..

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

BACKGROUND: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003889. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Child and Family Therapy Process: Concordance of Therapist and Observational Perspectives

The objective of this study is to examine the characteristics of outpatient mental health services delivered in community-based outpatient clinics, comparing information obtained from two different sources, therapists serving children and families, and observational coders viewing tapes of the same treatment sessions. Videotaped therapy sessions were rated by therapists and independent coders regarding goals and strategies pursued during each session. Sixty-three sessions were taped of outpatient care provided to 18 children and their caregivers by 11 therapists. Children were 4–13 years old and families were receiving services at least in part due to reported child behavior problems, confirmed by ratings from the Child Behavior Checklist and Conners Parent Rating Scale—Revised. Analyses assessed the frequency, type, and intensity of goals and strategies pursued in therapy sessions from both therapist and observational coders’ perspectives. Reliability of observer ratings and correspondence between therapist and observer reports were also examined. The reliability of observational coding of goals and strategies was moderate to good, with 76% of 39 codes having ICCs of .5 or greater. Therapists reported pursuing 2.5 times more goals and strategies per session, on average, than identified by observational coders. Correspondence between therapists and coders about the occurrence of specific goals and strategies in treatment sessions was low, with 20.5% of codes having a Kappa of .4 or higher. Substantial differences exist in what therapists and independent coders report as occurring in outpatient treatment sessions. Both perspectives suggest major differences between the content of services provided in community-based outpatient clinics and the structure of evidence-based programs, which emphasize intense pursuit of a small number of goals and strategies in each treatment session. Implications of the findings for quality improvement efforts in community-based mental health care settings are discussed

A Randomized Trial Examining the Effects of Parent Engagement on Early Language and Literacy: The Getting Ready Intervention

Language and literacy skills established during early childhood are critical for later school success. Parental engagement with children has been linked to a number of adaptive characteristics in preschoolers including language and literacy development, and family-school collaboration is an important contributor to school readiness. This study reports the results of a randomized trial of a parent engagement intervention designed to facilitate school readiness among disadvantaged preschool children, with a particular focus on language and literacy development. Participants included 217 children, 211 parents, and 29 Head Start teachers in 21 schools. Statistically significant differences in favor of the treatment group were observed between treatment and control participants in the rate of change over 2 academic years on teacher reports of children’s language use (d = 1.11), reading (d = 1.25), and writing skills (d = .93). Significant intervention effects on children’s direct measures of expressive language were identified for a subgroup of cases where there were concerns about a child’s development upon entry into preschool. Additionally, other child and family moderators revealed specific variables that influenced the treatment’s effects

Can mHealth Technology Help Mitigate the Effects of the COVID-19 Pandemic?

n/

Supporting 3rd-Grade French Immersion Students In Literacy Via Schoology, A Learning Management System

Research has demonstrated that the nature of literacy is rapidly changing as new technology emerges. The goal of this project was to find out if technology could provide better literacy support for students. Bringing applications like Schoology to the forefront will allow teachers to use this LMS (Learning Management System) to promote new reading and writing strategies in French. In this project, 3rd-grade students work on Phonics, Word Recognition and Liaisons in French by reading and listening to French created text and videos. French immersion students are always in need of additional support in literacy which is why I addressed this question: How can Schoology help French Immersion teachers support 3rd-grade students with the challenge of the liaison in reading and writing? By using Schoology and using differentiation within the classroom, the goal will be for students to increase their proficiency in sound recognition, reading comprehension and fluency. I believe this project will help in reducing the literacy gap between French and English overtime by maximizing each student’s growth and individual success, by meeting each student where he or she is, and by assisting them in the learning process. In order to effectively carry out this technique, teachers must know their learners well. Learning styles and preferences, background knowledge, readiness, current level of ability, motivation, and interests all need to be considered when differentiating instruction. This project will be easily shared with teachers for the benefits of their students and I believe this project is the beginning of numerous videos about the different rules and strategies of pronunciation in the French language