Shoulder pain patients in primary care - Part 1: Clinical outcomes over 12 months following standardized diagnostic workup, corticosteroid injections, and community-based care

Objective: Measure changes in pain and disability of primary care shoulder pain patients over a 12-month period. Design: A non-randomized audit with repeated measures of pain and disability at 3 weeks, 3, 6 and 12 months. Patients: Of 208 patients, 161 agreed to participate with 96.9%, 98.1%, 86.3%, 83.9% follow-up at 3 weeks, at 3, 6 and 12 months, respectively. Mean age was 44 years, mean symptom duration 3.6 months. Methods: Patients were treated with protocol driven corticosteroid injection and community based care. Primary outcome measure was the Shoulder Pain and Disability index (SPADI) questionnaire. Based on the SPADI and minimal clinically important difference (MCID), outcomes were categorized into: total recovery, 90% or more improved, better, unchanged and worse. Results: There was significant reduction of pain and disability at 3 weeks (

A within-person theoretical perspective in sales research: outlining recommendations for adoption and consideration of boundary conditions

In the sales literature it is standard practice for researchers to collect cross-sectional data from multiple salespeople, and to compare those salespeople on the data obtained. This between-person approach is suitable for research aiming to draw conclusions between salespeople. However, many salesperson processes are dynamic and vary within salespeople over time, requiring datasets with repeated-measures. This article highlights the need to adopt a within-person theoretical perspective in sales research. Critically, the article shows how our present understanding of boundary conditions may change depending on whether a between-person or within-person level of analysis is adopted. Using examples from the sales literature, we show how the practical implications from between-persons research designs do not necessarily generalize to the within-person level. Further, we explain the methodological and analytical considerations that researchers must account for when undertaking within-person research. Furthermore, the article provides decision criteria that help to identify when within-person analysis should be conducted, outlining analysis tools that are capable of correctly estimating within-person effects without bias. Examples of how within-person research can enhance theory within future sales research, and how within-person research may influence management implications are also discussed. Finally, potential remedies to within-person research barriers are given

Increasing capacity for the treatment of common musculoskeletal problems: A non-inferiority RCT and economic analysis of corticosteroid injection for shoulder pain comparing a physiotherapist and orthopaedic surgeon

Background Role substitution is a strategy employed to assist health services manage the growing demand for musculoskeletal care. Corticosteroid injection is a common treatment in this population but the efficacy of its prescription and delivery by physiotherapists has not been established against orthopaedic standards. This paper investigates whether corticosteroid injection given by a physiotherapist for shoulder pain is as clinically and cost effective as that from an orthopaedic surgeon. Methods A double blind non-inferiority randomized controlled trial was conducted in an Australian public hospital orthopaedic outpatient service, from January 2013 to June 2014. Adults with a General Practitioner referral to Orthopaedics for shoulder pain received subacromial corticosteroid and local anaesthetic injection prescribed and delivered independently by a physiotherapist or a consultant orthopaedic surgeon. The main outcome measure was total Shoulder Pain and Disability Index (SPADI) score at baseline, six and 12 weeks, applying a non-inferiority margin of 15 points. Secondary outcomes tested for superiority included pain, shoulder movement, perceived improvement, adverse events, satisfaction, quality of life and costs. Results 278 participants were independently assessed by the physiotherapist and the orthopaedic surgeon, with 64 randomised (physiotherapist 33, orthopaedic surgeon 31). There were no significant differences in baseline characteristics between groups. Non-inferiority of injection by the physiotherapist was declared from total SPADI scores at 6 and 12 weeks (upper limit of the 95% one-sided confidence interval 13.34 and 7.17 at 6 and 12 weeks, respectively). There were no statistically significant differences between groups on any outcome measures at 6 or 12 weeks. From the perspective of the health funder, the physiotherapist was less expensive. Conclusions Corticosteroid injection for shoulder pain, provided by a suitably qualified physiotherapist is at least as clinically effective, and less expensive, compared with similar care delivered by an orthopaedic surgeon. Policy makers and service providers should consider implementing this model of care

Protein-bound veterinary drug residues in food

End of Project ReportBound residues of veterinary drugs have been recognised as an important aspect of food safety particularly (a) where such residues may persist for long periods after withdrawal of the drug treatment and (b) where the bound residues may be released, during digestion of edible tissues, in biologically active forms. Residues bound to proteins are not extractable by the conventional solvent extraction procedures for residue determination. Procedures for the release of bound residues from proteins, identification of their chemical structure, and determination of the amount of bound residues in edible tissues are required.EC-AIR programme (Project No. AIR2-CT93-0860

Micro-foundational ambidexterity and multinational enterprises: A systematic review and a conceptual framework

During the past decade, ambidexterity research has broadened from its traditional macro-level focus to examine the micro-level perspectives of ambidexterity on various settings. The authors systematically review and critically appraise the literature of ambidexterity from a micro-foundational perspective, within the context of Multinational Enterprises (MNEs). By synthesizing the review findings, the authors develop a comprehensive framework that maps extant literature within and across various disciplines and multiple levels of analysis. As part of their review, the authors also identify and discuss important emerging themes and fruitful areas for future research and present the implications to both research and management practice

Micro-foundational ambidexterity and multinational enterprises: a systematic review and a conceptual framework

During the past decade, ambidexterity research has broadened from its traditional macro-level focus to examine the micro-level perspectives of ambidexterity on various settings. The authors systematically review and critically appraise the literature of ambidexterity from a micro-foundational perspective, within the context of Multinational Enterprises (MNEs). By synthesizing the review findings, the authors develop a comprehensive framework that maps extant literature within and across various disciplines and multiple levels of analysis. As part of their review, the authors also identify and discuss important emerging themes and fruitful areas for future research and present the implications to both research and management practice

Knowledge and Confidence of Emergency Clinicians in Managing Toxicological Presentations

Background: Acute poisonings are common presentations to emergency departments (EDs) worldwide and require rapid assessment. Consultant emergency physicians (EPs) faced with various toxicological presentations must initiate rapid investigations and empirical management. This study aimed to determine emergency department doctors’ level of knowledge and confidence in toxicological presentations, and factors that predicted these outcomes. Methods: Target participants included members of the Australasian College for Emergency Medicine (ACEM) and readers of the emergency medicine website, “Life in the Fast Lane”. The survey was distributed electronically via the ACEM bulletin and posted on Life in the Fast Lane. A survey was designed based on toxicology multiple choice questions (MCQs). The questionnaire comprised 59 items: 10 demographic items; 20 items about confidence; 28 MCQs assessing knowledge of common and serious toxicological presentations. Results: There were 467 consenting respondents from 31 countries, with most residing in Australia (306/467, 66%). Respondents comprised similar proportions of consultant emergency physicians (196/467, 42.0%), and trainees (197/467, 42.2%).  Almost two-thirds (292/467; 62.1%) had received formal training in toxicological emergencies, while a third (166/467, 35.5%) had participated in a relevant conference or workshop. A total of 284/339 (83.8%) participants completing all items achieved a knowledge test score >50%. More than 65% incorrectly answered questions on pharmacology of serotonin syndrome and lithium toxicity, and more than half incorrectly answered questions on use of 12 lead ECG in toxicology, calcium channel antagonist or tricyclic antidepressant toxicities. Predictors of overall knowledge for toxicology were receipt of formal toxicology education, and clinicians’ experience and seniority. Conclusion: The knowledge and confidence of doctors working in emergency departments is varied, yet correlated. Emergency medicine training programs should consider the benefit of reviewing current toxicological education, including the provision of further educational support to regional and rural hospitals