Does patient-physiotherapist agreement influence the outcome of low back pain? A prospective cohort study

BACKGROUND: Recent research suggests that agreement between patients' and health professionals' perceptions may influence the outcome of various painful conditions. This issue has received little attention in the context of low back pain and physiotherapy interventions. The current study aimed at exploring the relationship between patient-physiotherapist agreement on baseline low back pain intensity and related functional limitations, and changes in patient outcomes four weeks later. METHODS: Seventy-eight patient-physiotherapist dyads were included in the study. At baseline, patients and physiotherapists completed a Numerical Rating Scale and the Roland-Morris Disability Questionnaire. Patients' perceptions were reassessed over the phone at follow-up. RESULTS: Using multiple regression, baseline level of patient-physiotherapist agreement on pain intensity was associated with both outcome measures at follow-up. Agreement on functional limitations had no impact on outcomes. CONCLUSION: The results of this study indicate that patient-physiotherapist agreement has some impacts on the short-term outcomes of low back pain. Further research is needed to confirm these findings

Hearing aid effectiveness after aural rehabilitation - individual versus group (HEARING) trial: RCT design and baseline characteristics

<p>Abstract</p> <p>Background</p> <p>Hearing impairment is the most common body system disability in veterans. In 2008, nearly 520,000 veterans had a disability for hearing loss through the Department of Veterans Affairs (VA). Changes in eligibility for hearing aid services, along with the aging population, contributed to a greater than 300% increase in the number of hearing aids dispensed from 1996 to 2006. In 2006, the VA committed to having no wait times for patient visits while providing quality clinically-appropriate care. One approach to achieving this goal is the use of group visits as an alternative to individual visits. We sought to determine: 1) if group hearing aid fitting and follow-up visits were at least as effective as individual visits, and 2) whether group visits lead to cost savings through the six month period after the hearing aid fitting. We describe the rationale, design, and characteristics of the baseline cohort of the first randomized clinical trial to study the impact of group versus individual hearing aid fitting and follow-up visits.</p> <p>Methods</p> <p>Participants were recruited from the VA Puget Sound Health Care System Audiology Clinic. Eligible patients had no previous hearing aid use and monaural or binaural air-conduction hearing aids were ordered at the evaluation visit. Participants were randomized to receive the hearing aid fitting and the hearing aid follow-up in an individual or group visit. The primary outcomes were hearing-related function, measured with the first module of the Effectiveness of Aural Rehabilitation (Inner EAR), and hearing aid adherence. We tracked the total cost of planned and unplanned audiology visits over the 6-month interval after the hearing aid fitting.</p> <p>Discussion</p> <p>A cohort of 659 participants was randomized to receive group or individual hearing aid fitting and follow-up visits. Baseline demographic and self-reported health status and hearing-related measures were evenly distributed across the treatment arms.</p> <p>Outcomes after the 6-month follow-up period are needed to determine if group visits were as least as good as those for individual visits and will be reported in subsequent publication.</p> <p>Trial Registration</p> <p>NCT00260663</p

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Montane forest birds in winter: do they regularly move to lower altitudes? Observations from the Eastern Cape, South Africa

Seasonal altitudinal migration to lower altitudes including the coast has been ascribed to a number of forest birds, of which 14 species occur at Fort Fordyce Reserve in the Eastern Cape, South Africa. Based on our observations and ringing at this site (2007–2017), as well as concurrent data from the South African Bird Atlas Project (SABAP2), we suggest that in this region only three species, the African Dusky Flycatcher Muscicapa adusta, White-starred Robin Pogonocichla stellata and Barratt’s Warbler Bradypterus barratti, are regular altitudinal migrants. For two other species, the Grey Cuckooshrike Coracina caesia and Yellow-throated Woodland Warbler Phylloscopus ruficapilla, local movements apparently occur, but these may take place within the coastal zone rather than between the coast and inland forests.Keywords: altitudinal migration, Bradypterus, Coracina, Cossypha, Muscicapa, Phylloscopus, Pogonocichla, ringing, seasonal distributio

Pied Crows in the Eastern Cape: what bird club records reveal

Published records by bird clubs in Port Elizabeth, Kenton-on-Sea and Grahamstown (Makhanda) show that until 1980 Pied Crows were seldom&nbsp; recorded in this sector of the Eastern Cape, South Africa. Port Elizabeth, and apparently also East London, was colonised by Pied Crows in the 1980s, whereas the first records for Kenton-on- Sea and Port Alfred on the coast, and also inland in the Grahamstown (Makhanda) area, were after 1990. Since 2010, this species has been recorded more often both on the coast and in the adjacent inland regions. However, records of both Cape Crows and White-necked Ravens have also increased over the same period, suggesting that there has been no species replacement among the local corvids. Citizen-science data provide valuable information on changes in distribution and abundance of this bird species. French Title: Les Corbeaux pies au Cap de l’Est: ce que révèlent les observations par les sociétés ornithologiques L’information publiée par les sociétés ornithologiques à Port Elizabeth, Kenton-on-Sea et Grahamstown (maintenant appelé Makhanda) montre que jusqu’à 1980 le Corbeau pie Corvus albus était rarement rencontré dans cette région du Cap de l’Est, Afrique du Sud. Cette espèce a colonisé Port Elizabeth dans les années quatre vingt (80), et apparemment aussi East London, tandis que les premières observations sur la côte, à Kenton-on-Sea&nbsp; et Port Alfred à la côte, et également sur le continent à Grahamstown (Makhanda), sont notées après 1990. Depuis l’année 2010, le Corbeau pie est devenu plus commun dans les sites côtiers et à l’intérieur des terres. Neanmoins, à cette époque, des observations du Corneille du Cap Corvus capensis et du Corbeau à nuque blanche Corvus albicollis étaient aussi fréquentes, ce qui semble indiquer que le Corbeau pie n’a pas remplacé les autres corvides dans la région. L’information rassemblait par les citoyens scientifiques a fourni des données pertinentes sur la répartition et la démographie ce cette espèce. Keywords: corvidae, bird club records, distribution, Eastern Cap

Comparative perch selection in Southern Fiscal Lanius collaris and Fiscal Flycatcher Sigelus silens at Amakhala Game Reserve, South Africa

The Southern Fiscal Lanius collaris and the Fiscal Flycatcher Sigelus silens are common,  idespread and sympatric in much of southern Africa. They are similar in plumage and ecology, which may predispose them to competition and interspecific territorial aggression but this has not been tested to date. Here we tested for evidence of competition for perch space. At Amakhala Private Game Reserve, Eastern Cape, South Africa we monitored the occurrence and perch use of both species along transects. The birds do co-occur locally but there is evidence of small-scale spatial separation possibly a result of interspecific territoriality. Perch selection differed in respect of perch type but not perch height. Both species perched prominently in the majority of observations. Southern Fiscals make greater use of Searsia and Gymnosporia trees, whereas the Fiscal Flycatcher makes near-equal use of Vachellia karroo, Searsia and Gymnosporia trees. This may be an example of niche partitioning, though it remains unclear whether the birds actively compete for perch space, or if the separation is a product of different perch preferences, territoriality and the local plant community.Keywords: competition, interspecific territorial aggression, niche partitioning, sympatr

Urban birds in the Eastern Cape: local observations from Makhanda (Grahamstown) and future questions

In Makhanda (Grahamstown), a non-industrial town with approximately 85 000 inhabitants, we have recorded 174 bird species within the urban area, of which 104 species are likely to breed regularly. The source habitats of these birds include all the surrounding habitat types, and the bird community is evidently determined by both local conditions within the town (e.g. tree density) and regional changes affecting the eastern coast of South Africa (range shifts). Topics meriting future research on urban bird communities in South Africa are highlighted. French Title: Les oiseaux urbains du Cape Oriental: observations locales à Makhanda (Grahamstown) et questions futures A Makhanda (Grahamstown), une ville non industrielle d’environ 85 000 habitants, nous avons enregistré 174 espèces d’oiseaux en secteur urbain, parmi lesquelles 104 espèces probables qui s’y reproduisent. Les habitats sources de ces espèces comprennent toutes les types d’habitats environnants. La communauté aviaire est évidemment déterminée à la fois par les conditions locales à l’intérieur de la ville (p. ex. la densité des arbres) et le changement régionaux qui affectent la côte est de l’Afrique du Sud (déplacement des aires de répartition). Les sujets méritant des recherches complémentaires sur les communautés aviaires urbaines en Afrique du Sud sont mis en évidence. Keywords: alien species, South Africa, urban avifaun

Primary wing-moult and site fidelity in South African mousebirds (Coliidae)

Based on large samples of birds mist-netted in the Eastern Cape and the Western Cape, moult of the primary remiges in both Speckled Mousebirds Colius striatus and Red-faced Mousebirds Urocolius indicus  occurred throughout the year with no regional or seasonal patterns evident. The same picture emerged for the White-backed Mousebird Colius colius in the Western Cape. This aseasonality of wing-moult for all three species in South Africa was further supported by the full data set of moult records available in the Safring database. We were thus unable to use the Underhill–Zucchini model to estimate the moult parameters for these species, but an extended moult period seems likely. Recapture data for the Eastern Cape strongly suggest that Speckled Mousebirds are resident or revisit sites frequently, whereas this is not the case for Red-faced Mousebirds.Keywords: Coliiformes, moult, mousebirds, ringingOSTRICH 2014, 85(2): 171–17