The Canadian C-Spine Rule

Description: The Canadian C-Spine Rule was designed in 2001 to assist clinicians assess the need for imaging in people who present to the emergency department with a cervical spine injury following blunt trauma. Specifically, this clinical decision rule was developed for use in adults who are alert (score of 15 on the Glasgow Coma Scale), stable and in whom a clinically important cervical spine injury is a concern (eg, unstable fracture, dislocation).1Instructions and scoring: The Canadian C-Spine Rule is based on three high-risk criteria (age ≥ 65 years, dangerous injury mechanism, paresthesia in extremities), five low-risk criteria (simple rear-end motor vehicle collision, sitting position in the emergency department, ambulatory at any time, delayed onset of neck pain; absence of midline cervical-spine tenderness), and the ability of the person to rotate their neck.2Reliability, validity and sensitivity to change: The Canadian C-Spine Rule has good-to-excellent inter-rater reliability when applied by physicians (kappa = 0.63), nurses (kappa = 0.80) and paramedics (kappa = 0.93).2, 3 The sensitivity of the Canadian C-Spine Rule has been reported to range from 90 to 100%, whereas specificity has ranged from 1 to 77%.4 The large range in specificity reflects the heterogeneity between studies in the number of people who unnecessarily receive imaging (ie, people who do not have a serious cervical spine injury but are still referred for imaging). However, the rule itself errs on the side of caution, as clinicians will not miss a clinically important cervical spine injury. In the only direct comparison, the Canadian C-Spine Rule was found to have better diagnostic accuracy than the National Emergency X-Radiography Utilization Study (NEXUS) criteria,5 which form another widely used clinical decision rule.

Exercise for falls prevention in community-dwelling older adults: Trial and participant characteristics, interventions and bias in clinical trials from a systematic review

IntroductionThere is strong evidence that exercise prevents falls in community-dwelling older people. This review summarises trial and participant characteristics, intervention contents and study quality of 108 randomised trials evaluating exercise interventions for falls prevention in community-dwelling older adults.MethodsMEDLINE, EMBASE, CENTRAL and three other databases sourced randomised controlled trials of exercise as a single intervention to prevent falls in community-dwelling adults aged 60+ years to May 2018.Results108 trials with 146 intervention arms and 23 407 participants were included. Trials were undertaken in 25 countries, 90% of trials had predominantly female participants and 56% had elevated falls risk as an inclusion criterion. In 72% of trial interventions attendance rates exceeded 50% and/or 75% of participants attended 50% or more sessions. Characteristics of the trials within the three types of intervention programme that reduced falls were: (1) balance and functional training interventions lasting on average 25 weeks (IQR 16–52), 39% group based, 63% individually tailored; (2) Tai Chi interventions lasting on average 20 weeks (IQR 15–43), 71% group based, 7% tailored; (3) programmes with multiple types of exercise lasting on average 26 weeks (IQR 12–52), 54% group based, 75% tailored. Only 35% of trials had low risk of bias for allocation concealment, and 53% for attrition bias.ConclusionsThe characteristics of effective exercise interventions can guide clinicians and programme providers in developing optimal interventions based on current best evidence. Future trials should minimise likely sources of bias and comply with reporting guidelines

Consequences of a Diagnostic Label: A Systematic Scoping Review and Thematic Framework

Objectives: To develop a thematic framework for the range of consequences arising from a diagnostic label from an individual, family/caregiver, healthcare professional, and community perspective. Design: Systematic scoping review of qualitative studies. Search Strategy: We searched PubMed, Embase, PsycINFO, Cochrane, and CINAHL for primary studies and syntheses of primary studies that explore the consequences of labelling non-cancer diagnoses. Reference lists of included studies were screened, and forward citation searches undertaken. Study Selection: We included peer reviewed publications describing the perceived consequences for individuals labelled with a non-cancer diagnostic label from four perspectives: that of the individual, their family/caregiver, healthcare professional and/or community members. We excluded studies using hypothetical scenarios. Data Extraction and Synthesis: Data extraction used a three-staged process: one third was used to develop a preliminary framework, the next third for framework validation, and the final third coded if thematic saturation was not achieved. Author themes and supporting quotes were extracted, and analysed from the perspective of individual, family/caregiver, healthcare professional, or community member. Results: After deduplication, searches identified 7,379 unique articles. Following screening, 146 articles, consisting of 128 primary studies and 18 reviews, were included. The developed framework consisted of five overarching themes relevant to the four perspectives: psychosocial impact (e.g., positive/negative psychological impact, social- and self-identity, stigma), support (e.g., increased, decreased, relationship changes, professional interactions), future planning (e.g., action and uncertainty), behaviour (e.g., beneficial or detrimental modifications), and treatment expectations (e.g., positive/negative experiences). Perspectives of individuals were most frequently reported. Conclusions: This review developed and validated a framework of five domains of consequences following diagnostic labelling. Further research is required to test the external validity and acceptability of the framework for individuals and their family/caregiver, healthcare professionals, and community

Consequences of health condition labelling: protocol for a systematic scoping review

Introduction When health conditions are labelled it is often to classify and communicate a set of symptoms. While diagnostic labelling can provide explanation for an individual's symptoms, it can also impact how individuals and others view those symptoms. Despite existing research regarding the effects of labelling health conditions, a synthesis of these effects has not occurred. We will conduct a systematic scoping review to synthesise the reported consequences and impact of being given a label for a health condition from an individual, societal and health practitioner perspective and explore in what context labelling of health conditions is considered important. Methods and analysis The review will adhere to the Joanna Briggs Methodology for Scoping Reviews. Searches will be conducted in five electronic databases (PubMed, Embase, PsycINFO, Cochrane, CINAHL). Reference lists of included studies will be screened and forward and backward citation searching of included articles will be conducted. We will include reviews and original studies which describe the consequences for individuals labelled with a non-cancer health condition. We will exclude hypothetical research designs and studies focused on the consequences of labelling cancer conditions, intellectual disabilities and/or social attributes. We will conduct thematic analyses for qualitative data and descriptive or meta-analyses for quantitative data where appropriate. Ethics and dissemination Ethical approval is not required for a scoping review. Results will be disseminated via publication in a peer-reviewed journal, conference presentations and lay-person summaries on various online platforms. Findings from this systematic scoping review will identify gaps in current understanding of how, when, why and for whom a diagnostic label is important and inform future research

Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: a systematic review

Introduction Shoulder pain and dysfunction may occur following neck dissection among people being treated for head and neck cancer. This systematic review aims to examine the prevalence and incidence of shoulder and neck dysfunction after neck dissection and identify risk factors for these post-operative complications. Methods Electronic databases (Pubmed, CINAHL, EMBASE, Cochrane) were searched for articles including adults undergoing neck dissection for head and neck cancer. Studies that reported prevalence, incidence or risk factors for an outcome of the shoulder or neck were eligible and assessed using the Critical Review Form – Quantitative Studies. Results Seventy-five articles were included in the final review. Prevalence rates for shoulder pain were slightly higher after RND (range, 10–100%) compared with MRND (range, 0–100%) and SND (range, 9–25%). The incidence of reduced shoulder active range of motion depended on surgery type (range, 5–20%). The prevalence of reduced neck active range of motion after neck dissection was 1–13%. Type of neck dissection was a risk factor for shoulder pain, reduced function and health-related quality of life. Conclusions The prevalence and incidence of shoulder and neck dysfunction after neck dissection varies by type of surgery performed and measure of dysfunction used. Pre-operative education for patients undergoing neck dissection should acknowledge the potential for post-operative shoulder and neck problems to occur and inform patients that accessory nerve preservation lowers, but does not eliminate, the risk of developing musculoskeletal complications

Commentary on a paper by Holden et al.

No abstrac