Therapeutic alliances in stroke rehabilitation: a meta-ethnography

OBJECTIVE: To synthesize qualitative studies exploring patients' and professionals' perspectives and experiences of developing and maintaining therapeutic alliances in stroke rehabilitation. DATA SOURCES: A systematic literature search was conducted using the following electronic databases: PsycINFO, CINAHL, Embase, MEDLINE, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, and ComDisDome from inception to May 2014. This was supplemented by hand searching, reference tracking, generic web searching, and e-mail contact with experts. STUDY SELECTION: Qualitative peer reviewed articles reporting experiences or perceptions of the patient or professional in relation to therapeutic alliance construction and maintenance in stroke rehabilitation were selected for inclusion. After a process of exclusion, 17 publications were included in the synthesis. DATA EXTRACTION: All text identified in the results and discussion sections of the selected studies were extracted verbatim for analysis in a qualitative software program. Studies were critically appraised independently by 2 reviewers. DATA SYNTHESIS: Articles were synthesized using a technique of meta-ethnography. Four overarching themes emerged from the process of reciprocal translation: (1) the professional-patient relationship: degree of connectedness; (2) asymmetrical contributions; (3) the process of collaboration: finding the middle ground; and (4) system drivers. CONCLUSIONS: The findings from the meta-ethnography suggest that the balance of power between the patient and professional is asymmetrically distributed in the construction of the alliance. However, given that none of the studies included in the review addressed therapeutic alliance as a primary research area, further research is required to develop a conceptual framework relevant to stroke rehabilitation, in order to determine how this construct contributes to treatment efficacy

La autoeficacia docente en la práctica pedagógica

El presente estudio tiene como finalidad, en primer lugar, examinar la relación entre la autoeficacia del docente y la calidad del manejo de aula en su práctica pedagógica, teniendo en cuenta el auto reporte del maestro y el reporte de los estudiantes. En segundo lugar, hacer una comparación entre una escuela mixta privada y una escuela mixta pública, ambas del distrito de Chorrillos. Para ello, se aplicaron dos escalas a 38 docentes y una a 401 alumnos de ambas instituciones. Se utilizó la Escala de Eficacia Percibida de los Maestros (Tschannen-Moran y Woolfolk, 2001), para evaluar la autoeficacia docente en los maestros y la Escala del Modelo Instruccional de Situación Educativa-MISE de Rivas, Descals y Gómez-Artiga (2003), para evaluar la calidad del manejo de aula en la práctica pedagógica. Esta última contaba con dos versiones, una para docentes y otra para los estudiantes. Los resultados indicaron que los docentes que poseen un mayor sentido de autoeficacia reportaron también un mejor manejo de aula en su práctica pedagógica. Asimismo, los docentes, tanto del colegio público como del privado, evaluaron mejor la calidad de su manejo de aula de lo que lo hicieron sus propios estudiantes. En cuanto a la comparación entre ambas instituciones, se encontraron diferencias siendo que los docentes de la institución privada se autoevaluaron como más eficaces que los docentes de la institución pública. Finalmente, se encontró, que aspectos como, los años de docencia en general, haber obtenido el título profesional en educación y el género, no tuvieron relación significativa con la forma en que los docentes se autoevalúan a sí mismos y con el reporte de la calidad del manejo de aula en su práctica pedagógica. Palabras claves: Autoeficacia, Autoeficacia docente, Calidad de la práctica pedagógica, Calidad del manejo de aula.The present study aimed first, to examine the relation between teachers’ self-report of self-efficacy with the self-report of their quality of classroom management. Secondly, to compare the results between mixed private and public schools, both located in the district of Chorrillos, Lima, Peru. The Teachers’ Sense of Efficacy Scale (Tschannen- Moran and Woolfolk, 2001) and the Instructional Model of Educational Setting scale - MISE (Rivas, Descals and Gómez-Artiga, 2003) were applied to 38 teachers. The student version of the MISE was also applied to 401 students. Results showed that teachers, who have a higher sense of self-efficacy, also reported better quality of classroom management in their teaching practice. In addition, teachers from both institutions, private and public, evaluated their own classroom management significantly better than what their own students did. A comparison between both institutions showed that different reasons explain why private school teachers believe themselves to have a higher sense of self-efficacy than public school teachers. Finally, and regarding Peru’s educational system, variables such as, total number of teaching years, having obtained an education degree, and gender, had no significant relation with how teachers evaluate themselves on self-efficacy as well as on the quality of their classroom management in their teaching practice. Key words: Self-efficacy, Teachers’ self-efficacy, Quality of Teaching practices, Quality of classroom management.Tesi

People with aphasia’s perception of the therapeutic alliance in aphasia rehabilitation post stroke: a thematic analysis

Background: The therapeutic alliance has been found to be a critical component of treatment delivery in mental health interventions. This construct may have the potential to inform both treatment efficacy and adherence in aphasia rehabilitation. However, little is known about how people with aphasia perceive therapeutic alliance construction in the context of aphasia rehabilitation. Aims: This study aimed to investigate people with aphasias’ subjective experiences and reflections of constructing and maintaining therapeutic alliances in aphasia rehabilitation. Methods & procedures: In-depth interviews were conducted with eighteen people with aphasia who had received aphasia rehabilitation following a stroke. Interviews were subject to thematic analysis. Outcomes & results: Data analysis revealed five core themes: (1) readiness to contribute to the alliance; (2) proximity with the therapist; (3) perceived attunement with the therapist; (4) receiving information; and (5) collaborative engagement. The therapist’s perceived ability to read and respond effectively to individuals’ relational and situational needs contributed to the success of the alliance. Conclusions: These findings offer novel insights into current practice, highlighting considerable variation in alliance formation across the profession, with ineffectual alliances obstructing engagement and eroding hope and effective alliances promoting adherence and instilling hope. Further research is recommended to understand which aspects of the therapeutic alliance are essential for optimising therapeutic efficacy

Effect of enteric coating on antiplatelet activity of low-dose aspirin in healthy volunteers.

BACKGROUND AND PURPOSE: Aspirin resistance may be relatively common and associated with adverse outcome. Meta-analysis has clearly shown that 75 mg plain aspirin is the lowest effective dose; however, it is not known whether the recent increased use of enteric-coated aspirin could account for aspirin resistance. This study was designed to determine whether enteric-coated aspirin is as effective as plain aspirin in healthy volunteers. METHODS: Seventy-one healthy volunteers were enrolled in 3 separate bioequivalence studies. Using a crossover design, each volunteer took 2 different aspirin preparations. Five aspirin preparations were evaluated, 3 different enteric-coated 75-mg aspirins, dispersible aspirin 75 mg and asasantin (25-mg standard release aspirin plus 200-mg modified-release dipyridamole given twice daily). Serum thromboxane (TX) B2 levels and arachidonic acid-induced platelet aggregation were measured before and after 14 days of treatment. RESULTS: All other aspirin preparations tested were inferior to dispersible aspirin (P99%) inhibition (

Feed efficiency and carcass metrics in growing cattle

Some definitions of feed efficiency such as residual energy intake (REI) and residual gain (RG) may not truly reflect production efficiency. The energy sinks used in the derivation of the traits include metabolic live-weight; producers finishing cattle for slaughter are, however, paid on the basis of carcass weight, as opposed to live-weight. The objective of the present study was to explore alternative definitions of REI and RG which are more reflective of production efficiency, and quantify their relationship with performance, ultrasound, and carcass traits across multiple breeds and sexes of cattle. Feed intake and live-weight records were available on 5,172 growing animals, 2,187 of which also had information relating to carcass traits; all animals were fed a concentrate-based diet representative of a feedlot diet. Animal linear mixed models were used to estimate (co)variance components. Heritability estimates for all derived REI traits varied from 0.36 (REICWF; REI using carcass weight and carcass fat as energy sinks) to 0.50 (traditional REI derived with the energy sinks of both live-weight and ADG). The heritability for the RG traits varied from 0.24 to 0.34. Phenotypic correlations among all definitions of the REI traits ranged from 0.90 (REI with REICWF) to 0.99 (traditional REI with REI using metabolic preslaughter live-weight and ADG). All were different (P \u3c 0.001) from one suggesting reranking of animals when using different definitions of REI to identify efficient cattle. The derived RG traits were either weakly or not correlated (P \u3e 0.05) with the ultrasound and carcass traits. Genetic correlations between the REI traits with carcass weight, dressing difference (i.e., live-weight immediately preslaughter minus carcass weight) and dressing percentage (i.e., carcass weight divided by live-weight immediately preslaughter) implies that selection on any of the REI traits will increase carcass weight, lower the dressing difference and increase dressing percentage. Selection on REICW (REI using carcass weight as an energy sink), as opposed to traditional REI, should increase the carcass weight 2.2 times slower but reduce the dressing difference 4.3 times faster. While traditionally defined REI is informative from a research perspective, the ability to convert energy into live-weight gain does not necessarily equate to carcass gain, and as such, traits such as REICW and REICWF provide a better description of production efficiency for feedlot cattle

Factors associated with the weight of individual primal cuts and their inter-relationship in cattle

peer-reviewedInput parameters for decision support tools are comprised of, amongst others, knowledge of the associated factors and the extent of those associations with the animal-level feature of interest. The objective of the present study was to quantify the association between the animal-level factors with primal cut yields in cattle and to understand the extent of the variability in primal cut yields independent of other primal cuts or as carcass weight itself. The data used consisted of the weight of 14 primal carcass cuts (as well as carcass weight, conformation and fat score) on up to 54,250 young cattle slaughtered between 2013 and 2017. Linear mixed models, with contemporary group of herd-sex-season of slaughter as a random effect, were used to quantify the associations between a range of model fixed effects with each primal cut separately. Fixed effects in the model were dam parity, heterosis coefficient, recombination loss, a covariate per breed representing the proportion of Angus, Belgian Blue, Charolais, Jersey, Hereford, Limousin, Simmental, and Holstein-Friesian and a three-way interaction between whether the animal was born in a dairy or beef herd, sex, and age at slaughter, with or without carcass weight as a covariate in the mixed model. The raw correlations among all cuts were all positive varying from 0.33 (between the bavette and the striploin) to 0.93 (between the topside and knuckle). The partial correlation among cuts, following adjustment for differences in carcass weight, varied from -0.36 to 0.74. Age at slaughter, sex, dam parity and breed were all associated (P<0.05) with the primal cut weight. Knowledge of the relationship between the individual primal cuts, and the solutions from the models developed in the study, could prove useful inputs for decision support systems level to increase performance

Large variability in feeding behavior among crossbred growing cattle

The purpose of this study was to define an extensive suite of feeding behavior traits in growing crossbred cattle and to investigate their phenotypic inter-relationships as well as relationships with other performance and efficiency traits. Time-series feeding behavior data, as well as feed intake and liveweight records, were available for 624 growing crossbred cattle, of which 445 were steers and 179 were heifers. Feeding behavior repeatability estimates were calculated using linear mixed models. Additionally, partial Spearman correlations were estimated among 14 feeding behavior traits, as well as between feeding behavior with both performance and feed efficiency traits, using residuals retained from linear mixed models. The marginal contribution of several feeding behavior traits to the variability in metabolizable energy intake (MEI) was also determined. Repeatability estimates of 0.57, 0.36, and 0.48 were calculated for the number of feed events per day, the total time spent feeding per day, and the feeding rate, respectively. Cattle that ate more frequently each day, ate at a faster rate and consumed less energy in each visit to the feed bunk. More efficient cattle fed less often per day and fed for a shorter duration per day; they also had a slower feeding rate and fed for longer in each visit to the feed bunk. Moreover, heavier cattle fed for a longer duration per day had a faster feeding rate, but fed less often per day; heavier animals also fed first in the pen after the fresh feed was offered. The number of feed events per day and feeding time per day together explained an additional 13.4 percentage points of the variability in MEI above that already explained by all of growth rate, liveweight, and backfat depth. The results from the present study suggest that several repeatable time-series-related feeding behavior traits, that are less resource intensive to measure, may have a role as useful predictor traits of important but relatively difficult to record traits, such as feed intake and efficiency

Blackwater fever and acute kidney injury in children hospitalized with an acute febrile illness: pathophysiology and prognostic significance

Background: Acute kidney injury (AKI) and blackwater fever (BWF) are related but distinct renal complications of acute febrile illness in East Africa. The pathogenesis and prognostic signifcance of BWF and AKI are not well understood. Methods: A prospective observational cohort study was conducted to evaluate the association between BWF and AKI in children hospitalized with an acute febrile illness. Secondary objectives were to examine the association of AKI and BWF with (i) host response biomarkers and (ii) mortality. AKI was defned using the Kidney Disease: Improving Global Outcomes criteria and BWF was based on parental report of tea-colored urine. Host markers of immune and endothelial activation were quantifed on admission plasma samples. The relationships between BWF and AKI and clinical and biologic factors were evaluated using multivariable regression. Results: We evaluated BWF and AKI in 999 children with acute febrile illness (mean age 1.7 years (standard deviation 1.06), 55.7% male). At enrollment, 8.2% of children had a history of BWF, 49.5% had AKI, and 11.1% had severe AKI. A history of BWF was independently associated with 2.18-fold increased odds of AKI (95% CI 1.15 to 4.16). When examining host response, severe AKI was associated with increased immune and endothelial activation (increased CHI3L1, sTNFR1, sTREM-1, IL-8, Angpt-2, sFlt-1) while BWF was predominantly associated with endothelial activation (increased Angpt-2 and sFlt-1, decreased Angpt-1). The presence of severe AKI, not BWF, was associated with increased risk of in-hospital death (RR, 2.17 95% CI 1.01 to 4.64) adjusting for age, sex, and disease severity. Conclusions: BWF is associated with severe AKI in children hospitalized with a severe febrile illness. Increased awareness of AKI in the setting of BWF, and improved access to AKI diagnostics, is needed to reduce disease progression and in-hospital mortality in this high-risk group of children through early implementation of kidney-protective measures