Interventions to increase physical activity in disadvantaged communities: A review of behavioural mechanisms. ESRI Working Paper No. 646 December 2019

Physical inactivity is now a significant driver of health and social inequalities among socioeconomically disadvantaged communities and poses a major challenge to policymakers, worldwide. Although a vast amount of research has focused on designing and evaluating interventions to increase physical activity, there remains little consensus on which interventions are likely to work. In this narrative review, we build on previous reviews by not only examining what interventions tend to work but by trying to understand why certain interventions tend to work, while others do not, through the lens of behavioural science. We present a behavioural framework through which the existing body of physical activity research could be viewed, in order to identify potentially effective mechanisms that would be likely to work in their intended domain. Our analysis finds that while there is evidence that the physical and educational environment matter for increasing levels of physical activity, interventions are more likely to be successful where they involve a social component. We conclude that a behaviourally informed physical activity intervention would thus employ a set of focused educational and socially-mediated behavioural mechanisms, within an appropriate physical environment

Anabolic steroids for rehabilitation after hip fracture in older people (Protocol)

THIS IS NOT THE MOST RECENT VERSION OF THIS PROTOCOL please see: http://hdl.handle.net/2328/39182 Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This review is made available in accordance with Cochrane Database of Systematic Review's repositories policyThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To examine the effects of anabolic steroids on functional outcome (independence, mobility and activities of daily living) after surgical treatment of hip fracture in older people. The following main comparisons are intended, set in the context of usual or conventional care: Anabolic steroids versus no or placebo intervention Anabolic steroids with other intervention (either nutrition or exercises or both) versus no or placebo interventio

Assessment of the Geometric Interaction Between the Lotus Transcatheter Aortic Valve Prosthesis and the Native Ventricular Aortic Interface by 320-Multidetector Computed Tomography

AbstractObjectivesThis study sought to assess the geometric interaction between the Lotus Valve System transcatheter aortic prosthesis (Boston Scientific, Natick, Massachusetts) and the native aortoventricular interface using multidetector computed tomography (MDCT).BackgroundThe interaction between transcatheter aortic valve prostheses and native anatomy is variable, although potentially predictable. The Lotus transcatheter device uses a novel mechanical means of expansion, the effect of which on native anatomic geometry has not previously been described.MethodsForty patients treated with the Lotus prosthesis were enrolled. The patients underwent 320-MDCT imaging before and after implantation. Prosthesis dimensions and relevant interaction parameters, including circularity and expansion, were assessed. The degree of paraprosthetic regurgitation (PAR) and prosthesis gradient were measured by transthoracic echocardiography at the same time points.ResultsThe mean baseline annular eccentricity index (EI) was 0.21 ± 0.06 and left ventricular outflow tract EI was 0.31 ± 0.09. The deployed prostheses had high rates of circularity with a mean EI across all device segments of 0.06 ± 0.04. In noncircular device deployment, an EI >0.1 was identified in 25% of prostheses and was associated with greater native annular eccentricity at baseline compared with circular devices (0.24 ± 0.04 vs. 0.19 ± 0.06; p = 0.01). The median percent of expansion was 97.5 ± 3.8% in the inflow portion of the prosthesis. Twenty-five percent of prostheses were <90% expanded in at least 1 segment with a numerical, but not statistically significant, association between oversizing and underexpansion. No correlation was found between device underexpansion and the mean transprosthesis gradient or between noncircularity and PAR.ConclusionsThe Lotus prosthesis results in nearly full device expansion and circularization of the native basal plane. Awareness of the anatomic interaction between this unique device and the native architecture may help in the formulation of appropriate device-specific sizing algorithms

Using audit and feedback to increase clinician adherence to clinical practice guidelines in brain injury rehabilitation: v

ObjectiveThis study evaluated whether frequent (fortnightly) audit and feedback cycles over a sustained period of time (>12 months) increased clinician adherence to recommended guidelines in acquired brain injury rehabilitation.DesignA before and after study design.SettingA metropolitan inpatient brain injury rehabilitation unit.ParticipantsClinicians; medical, nursing and allied health staff.InterventionsFortnightly cycles of audit and feedback for 14 months. Each fortnight, medical file and observational audits were completed against 114 clinical indicators.Main outcome measureAdherence to guideline indicators before and after intervention, calculated by proportions, Mann-Whitney U and Chi square analysis.ResultsClinical and statistical significant improvements in median clinical indicator adherence were found immediately following the audit and feedback program from 38.8% (95% CI 34.3 to 44.4) to 83.6% (95% CI 81.8 to 88.5). Three months after cessation of the intervention, median adherence had decreased from 82.3% to 76.6% (95% CI 72.7 to 83.3, pConclusionA fortnightly audit and feedback program increased clinicians’ adherence to guideline recommendations in an inpatient acquired brain injury rehabilitation setting. We propose future studies build on the evidence-based method used in the present study to determine effectiveness and develop an implementation toolkit for scale-up.</div

Practitioner Feedback on Lung Cancer Practice Guidelines in Ontario

Purpose:Practitioner feedback (PF) surveys are sent to practitioners who care for lung cancer patients as each new practice guideline is completed. In this study, the PF was reviewed to assess the frequency of response to the surveys, the respondents’ characteristics, the nature of the feedback, and the intention to adopt the guideline in practice.Methods:Fourteen practice guidelines (PGs) were sent to Ontario practitioners treating lung cancer, and feedback on the PGs was obtained through either an eight- or 21-item survey.Results:Between 1995 and 2002, 1198 surveys were sent to 223 practitioners. The overall response rate was 58.9% but varied by specialty (radiation and medical oncologists, 67%; thoracic surgeons, 46%; respirologists, 38%), by location of practice (cancer center, 65%; community-based practice, 55%), by geographic region of the province (highest, 72%; lowest, 42%), and by PG topic (chemotherapy, 60%; radiotherapy, 63%; combined modality therapy, 52%). The response rate to the PF surveys did not decline over time. Eighty-six percent of respondents agreed with the lung cancer guidelines and indicated that they were likely or very likely to use the PGs in their practice.Conclusion:The results suggest that practitioners view the guideline development process as credible and useful to guide practice. Whether the stated intention to use the guidelines will actually translate into practice requires further study