Reliability and Measurement error of Active Knee extension Range of Motion in a Modified slump Test Position: A Pilot study

Abstract: The slump test is a tool to assess the mechanosensitivity of the neuromeningeal structures within the vertebral canal. While some studies have investigated the reliability of aspects of this test within the same day, few have assessed the reliability across days. Therefore, the purpose of this pilot study was to investigate reliability when measuring active knee extension range of motion (AROM) in a modified slump test position within trials on a single day and across days. Ten male and ten female asymptomatic subjects, ages 20-49 (mean age 30.1, SD 6.4) participated in the study. Knee extension AROM in a modified slump position with the cervical spine in a flexed position and then in an extended position was measured via three trials on two separate days. Across three trials, knee extension AROM increased significantly with a mean magnitude of 2° within days for both cervical spine positions (P>0.05). The findings showed that there was no statistically significant difference in knee extension AROM measurements across days (P>0.05). The intraclass correlation coefficients for the mean of the three trials across days were 0.96 (lower limit 95% CI: 0.90) with the cervical spine flexed and 0.93 (lower limit 95% CI: 0.83) with cervical extension. Measurement error was calculated by way of the typical error and 95% limits of agreement, and visually represented in Bland and Altman plots. The typical error for the cervical flexed and extended positions averaged across trials was 2.6° and 3.3°, respectively. The limits of agreement were narrow, and the Bland and Altman plots also showed minimal bias in the joint angles across days with a random distribution of errors across the range of measured angles. This study demonstrated that knee extension AROM could be reliably measured across days in subjects without pathology and that the measurement error was acceptable. Implications of variability over multiple trials are discussed. The modified set-up for the test using the Kincom dynamometer and elevated thigh position may be useful to clinical researchers in determining the mechanosensitivity of the nervous system

Knowledge to action for solving complex problems: insights from a review of nine international cases

Abstract Introduction: Solving complex problems such as preventing chronic diseases introduces unique challenges for the creation and application of knowledge, or knowledge to action (KTA). KTA approaches that apply principles of systems thinking are thought to hold promise, but practical strategies for their application are not well understood. In this paper we report the results of a scan of systems approaches to KTA with a goal to identify how to optimize their implementation and impact

Review Articles Bipolar Disorder and Complementary Medicine: Current Evidence, Safety Issues, and Clinical Considerations

Abstract Background: Bipolar disorder (BD) is a debilitating syndrome that is often undiagnosed and undertreated. Population surveys show that persons with BD often self-medicate with complementary and alternative medicine (CAM) or integrative therapies in spite of limited research evidence supporting their use. To date, no review has focused specifically on nonconventional treatments of BD. Objectives: The study objectives were to present a review of nonconventional (complementary and integrative) interventions examined in clinical trials on BD, and to offer provisional guidelines for the judicious integrative use of CAM in the management of BD. Methods: PubMed, CINAHL, Ò Web of Science, and Cochrane Library databases were searched for human clinical trials in English during mid-2010 using Bipolar Disorder and CAM therapy and CAM medicine search terms. Effect sizes (Cohen's d) were also calculated where data were available. Results: Several positive high-quality studies on nutrients in combination with conventional mood stabilizers and antipsychotic medications in BD depression were identified, while branched-chain amino acids and magnesium were effective (small studies) in attenuating mania in BD. In the treatment of bipolar depression, evidence was mixed regarding omega-3, while isolated studies provide provisional support for a multinutrient formula, n-acetylcysteine, and l-tryptophan. In one study, acupuncture was found to have favorable but nonsignificant effects on mania and depression outcomes. Conclusions: Current evidence supports the integrative treatment of BD using combinations of mood stabilizers and select nutrients. Other CAM or integrative modalities used to treat BD have not been adequately explored to date; however, some early findings are promising. Select CAM and integrative interventions add to established conventional treatment of BD and may be considered when formulating a treatment plan. It is hoped that the safety issues and clinical considerations addressed in this article may encourage the practice of safety-conscious and evidence-based integrative management of BD

Framing the Value of Clinical and Field Education

Community/university partnerships play a critical role in higher education. Community-based research, service learning, guest lectures, internships, and a host of other activities illustrate the shared opportunities for students, educators, practitioners, employers, and consumers, as communities and institutions collaborate to educate the future workforce and develop an informed and engaged citizenry. Across the spectrum of health and professional disciplines, real world learning through community-based clinical/field education1 is essential to prepare practice-ready graduates. At St. Catherine University, for example, students complete over 7,000 clinical/field placements annually across multiple degrees and disciplines (see Appendix B). Without community/ university partnerships, our universities would not be able to provide high quality learning experiences and educate graduates who are both qualified and competitive in the workforce. Yet the long-standing model of clinical/field education is faced with pressures and competing demands. While universities strive to increase enrollment and meet rising competition and changing accreditation standards, providers face industry and regulatory reform, economic downturns, reduced funding and reimbursement, productivity demands, a retiring workforce, and a host of other pressures. This paper is intended to strengthen community/university partnerships by articulating the value that can come from clinical/field education. The authors of this paper serve as clinical/field educators for the Henrietta Schmoll School of Health at St. Catherine University and the School of Social Work at St. Catherine University - University of St. Thomas. We draw from our own experience, conversations with clinical and fieldwork partners, faculty and students, and existing literature to outline this complex issue. The goal of this paper is to provide information, a conceptual framework, and language that can inform stakeholders and foster dialogue as we work collaboratively to address the opportunities and challenges of workforce development

Risk of Fetal Death Associated With Maternal Drug Dependence and Placental Abruption: A Population-Based Study

Abstract Objective: Substance use in pregnancy is associated with placental abruption, but the risk of fetal death independent of abruption remains undetermined. Our objective was to examine the effect of maternal drug dependence on placental abruption and on fetal death in association with abruption and independent of it. Methods: To examine placental abruption and fetal death, we performed a retrospective population-based study of 1 854 463 consecutive deliveries of liveborn and stillborn infants occurring between January 1, 1995 and March 31, 2001, using the Canadian Institute for Health Information Discharge Abstract Database. Results: Maternal drug dependence was associated with a tripling of the risk of placental abruption in singleton pregnancies (adjusted odds ratio [OR] 3.1; 95% confidence intervals [CI] 2.6-3.7), but not in multiple gestations (adjusted OR 0.88; 95% CI 0.12-6.4). Maternal drug dependence was associated with an increased risk of fetal death independent of abruption (adjusted OR 1.6: 95% CI 1.1-2.2) in singleton pregnancies, but not in multiples. Risk of fetal death was increased with placental abruption in both singleton and multiple gestations, even after controlling for drug dependence (adjusted OR 11.4 in singleton pregnancy; 95% CI 10.6-12.2, and 3.4 in multiple pregnancy; 95% CI 2.4-4.9). Conclusion: Maternal drug use is associated with an increased risk of intrauterine fetal death independent of placental abruption. In singleton pregnancies, maternal drug dependence is associated with an increased risk of placental abruption. Résumé Objectif : Bien que la consommation d'alcool et de drogues au cours de la grossesse soit associée au décollement placentaire, le risque de mort foetale n'étant pas associé à ce dernier demeure indéterminé. Notre objectif était d'examiner l'effet de la dépendance de la mère aux drogues sur le décollement placentaire, ainsi que sur la mort foetale attribuable à ce dernier et sur la mort foetale n'y étant pas attribuable. Résultats : La dépendance de la mère aux drogues a été associée à un risque triplé de décollement placentaire dans le cas des grossesses monofoetales (rapport de cotes [RC] corrigé, 3,1; intervalle de confiance [IC] à 95 %, 2,6-3,7), mais non pas dans celui des grossesses multiples (RC corrigé, 0,88; IC à 95 %, 0,12-6,4). La dépendance de la mère aux drogues a été associée à une hausse du risque de mort foetale n'étant pas attribuable au décollement (RC corrigé, 1,6; IC à 95 %, 1,1-2,2) dans le cas des grossesses monofoetales, mais non pas dans celui des grossesses multiples. Le risque de mort foetale connaissait une hausse en présence d'un décollement placentaire, tant dans le cas des grossesses monofoetales que dans celui des grossesses multiples, et ce, même à la suite de la neutralisation de l'effet de la dépendance aux drogues (dans le cas des grossesses monofoetales : RC corrigé, 11,4; IC à 95 %, 10,6-12,2; dans celui des grossesses multiples : RC corrigé, 3,4; IC à 95 %, 2,4-4,9). Méthodes Conclusion : La consommation de drogues par la mère est associée à une hausse du risque de mort foetale intra-utérine, peu importe la présence ou non d'un décollement placentaire. Dans le cas des grossesses monofoetales, la dépendance de la mère aux drogues est associée à une hausse du risque de décollement placentaire

The Characteristics, Experiences and Perceptions of Registered Massage Therapists in New Zealand: Results from a National Survey of Practitioners

Background: Massage therapy is widely recognized as offering many health benefits, with a growing number of studies finding it has value in stress management, pain reduction, and overcoming physical limitations. However, there are few studies of massage therapists practices and perceptions in New Zealand and internationally. This paper reports the findings from the first national survey examining the characteristics, perceptions, and experiences of New Zealand-based massage therapists on a range of aspects related to their role and practices.Purpose: This study sought to ascertain the characteristics, experiences, and perceptions of massage therapists in New Zealand, particularly in the aspects of: integration of health care; attitudes and practices related to research; and evidence and attitudes to registration.Setting: Massage practice in New Zealand (nationwide survey).Participants: Members of Massage New Zealand (a massage practitioners association).Research Design: Massage practitioners were surveyed online, using a 65-part questionnaire, on a range of characteristics of their practices and their attitudes to research, integration, and registration. Statistical analysis was performed using STATA. Statistical significance was set at 0.05.Main Outcome Measures: Four hundred massage therapists (MTs) were invited to participate and 115 responded, providing a response rate of 29%. MTs valued research (95%) and perceived that it had an impact for their practices (88%). Significant correlations were found for research value and: mean case-load (p = .009) and level of academic qualification (p = .004). The majority of MTs (79%) supported integration with conventional practitioners, and 83% referred clients to general practitioners, with 75% receiving referrals from general practitioners. Ninety-three percent of MTs supported registration, with 67% of those supporting statutory registration.Conclusion: Massage practitioners perceive that they make a significant contribution to health care, but area of practice, such as research, and referral and integration into mainstream health care require more in-depth investigation

Staff perceptions of primary healthcare service change: influences on staff satisfaction

Abstract. Strong primary healthcare (PHC) services are efficient, cost-effective and associated with better population health outcomes. However, little is known about the role and perspectives of PHC staff in creating a sustainable service. Staff from a single-point-of-entry primary health care service in Elmore, a small rural community in north-west Victoria, were surveyed. Qualitative methods were used to collect data to show how the key factors associated with the evolution of a once-struggling medical service into a successful and sustainable PHC service have influenced staff satisfaction. The success of the service was linked to visionary leadership, teamwork and community involvement while service sustainability was described in terms of inter-professional linkages and the role of the service in contributing to the broader community. These factors were reported to have a positive impact on staff satisfaction. The contribution of service delivery change and ongoing service sustainability to staff satisfaction in this rural setting has implications for planning service change in other primary health care settings. What is known about this topic? Integrated PHC services have an important role to play in achieving equitable population health outcomes. Many rural communities struggle to maintain viable PHC services. Innovative PHC models are needed to ensure equitable access to care and reduce the health differential between rural and metropolitan people. What does this paper add? Multidisciplinary teams, visionary leadership, strong community engagement combined with service partnerships are important factors in the building of a rural PHC service that substantially contributes to enhanced staff satisfaction and service sustainability. What are the implications for practitioners? Understanding and engaging local community members is a key driver in the success of service delivery changes in rural PHC services

The nurse educator role in the acute care setting in Australia: important but poorly described AUTHORS

ABSTRACT Objective The purpose of this paper is to describe the nurse educator role in the acute care setting in Australia

PEMBERDAYAAN MASYARAKAT MELALUI PENINGKATAN PENGETAHUAN, SIKAP DAN PERILAKU TENTANG GIZI SEIMBANG PADA ANAK SEKOLAH DASAR DI KOTA SURABAYA

LAPORAN PENELITIAN INI MEMBAHAS TENTANG PEMBERDAYAAN MASYARAKAT MELALUI PENINGKATAN PENGETAHUAN, SIKAP DAN PERILAKU TENTANG GIZI SEIMBANG PADA ANAK SEKOLAH DASAR DI KOTA SURABAY