Predicting outcome in acute low back pain using different models of patient profiling

Study Design: Prospective observational study of prognostic indicators, utilising data from a randomised, controlled trial of physiotherapy care of acute low back pain (ALBP) with follow up at 6 weeks, 3 months and 6 months. Objective: To evaluate which patient profile offers the most useful guide to long-term outcome in ALBP. Summary of Background Data: The evidence used to inform prognostic decision-making is derived largely from studies where baseline data is used to predict future status. Clinicians often see patients on multiple occasions so may profile patients in a variety of ways. It is worth considering if better prognostic decisions can be made from alternative profiles. Methods: Clinical, psychological and demographic data were collected from a sample of 54 ALBP patients. Three clinical profiles were developed from information collected at baseline, information collected at 6 weeks, and the change in status between these two time points. A series of regression models were used to determine the independent and relative contributions of these profiles to the prediction of chronic pain and disability. Results: The baseline profile predicted long-term pain only. The 6-week profile predicted both long-term pain and disability. The change profile only predicted long-term disability (p \u3c 0.01). When predicting long-term pain, after the baseline profile had been added to the model, the 6-week profile did not add significantly when forced in at the second step (p \u3e 0.05). A similar result was obtained when the order of entry was reversed. When predicting long-term disability, after the 6-week profile was entered at the first step, the change profile was not significant when forced in at the second step. However, when the change profile was entered at the first step and the 6-week clinical profile was forced in at the second step, a significant contribution of the 6-week profile was found. Conclusions: The profile derived from information collected at 6 weeks provided the best guide to long-term pain and disability. The baseline profile and change in status offered less predictive value

International low back pain guidelines: A comparison of two research based models of care for the management of acute low back pain.

Evidence based guidelines for the management of acute low back pain (ALBP) have been formulated by numerous countries. There are discrepancies between guidelines regarding physiotherapy treatment. The aim of this study was to compare two research based models derived from international LBP guidelines. A single-blind randomised controlled trial was undertaken in a physiotherapy outpatients department. Subjects with ALBP were randomly allocated to an ‘assess/advise/treat’ group (n = 50) or an ‘assess/advise/wait’ group (n = 52). The primary outcome measure was the Roland and Morris Disability Questionnaire (RMDQ). Secondary outcome measures of pain (VAS, usual pain intensity) depressive symptoms (MZSRDS) somatic distress (MSPQ) anxiety (STAIS) quality of life (SF36) and general health (EuroQol) were also obtained. Outcomes were assessed at 6-weeks, 3-months and 6-months. At 6-weeks subjects in the assess/advise/treat group demonstrated less LBP related disability (p = 0.02) and depressive symptoms (p = 0.01), as well as better general health (p = 0.006, p = 0.05), vitality (p \u3c 0.001), social functioning (p = 0.004) and mental health (p = 0.002). At long-term assessment (3 and 6 months) subjects in the assess/advise/treat group were less distressed (p = 0.004), anxious (p = 0.01) and had fewer depressive symptoms (p = 0.001), as well as reporting better general health (p = 0.009, p = 0.05), emotional role (p = 0.03) and mental health (p = 0.04). Active physiotherapy produces better short-term outcomes than advice. Delaying treatment has no long-term consequences on pain or disability, but affects the development of psychosocial features

O preconceito linguístico e sua relação com a aprendizagem de alunos do 7º ano

O presente trabalho teve como objetivo verificar a interferência do preconceito linguístico na aprendizagem de alunos do 7º ano do ensino fundamental de uma escola pública situada em Planaltina - DF. Tal objetivo surgiu ao notar-se na matéria de língua portuguesa um enfoque ao ensino tradicionalista, fator que centraliza a gramática normativa, tratando-a como se fosse a única forma correta, desprezando, assim, as demais variedades linguísticas, o que vai acarretar no preconceito linguístico com relação às demais variedades, que são classificadas como erradas perante a norma padrão. A partir deste fato, surgiu a pergunta que deu norte a esta pesquisa: o preconceito linguístico interfere na aprendizagem de alunos do 7º ano do ensino fundamental? Para se chegar a essa resposta, foram utilizados como métodos a pesquisa bibliográfica juntamente com uma pesquisa de campo, de cunho qualitativo, sendo realizada por meio de observação, entrevista e grupo focal. O resultado da pesquisa foi promissor, pois trouxe bastante contribuição com relação ao objetivo principal do trabalho, comprovando que realmente há uma interferência do preconceito linguístico no desenvolvimento e aprendizagem dos alunos

Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

This article is made available through the Brunel Open Access Publishing Fund. Copyright @ 2014 Informa UK Ltd.Purpose: The aim of this study is to describe the clinical features of powered wheelchair users with severely disabling multiple sclerosis (MS) and explore the problematic clinical features influencing prescription. Method: Retrospective review of electronic and case note records of recipients of electric-powered indoor/outdoor powered wheelchairs (EPIOCs) attending a specialist wheelchair service between June 2007 and September 2008. Records were reviewed by a consultant in rehabilitation medicine, data systematically extracted and entered into a computer database. Further data were entered from clinical records. Data were extracted under three themes; demographic, diagnostic, clinical and wheelchair factors. Results: Records of 28 men mean age 57 (range 37–78, SD 12) years and 63 women mean age 57 (range 35–81, SD 11) years with MS were reviewed a mean of 64 (range 0–131) months after receiving their wheelchair. Twenty two comorbidities, 11 features of MS and 8 features of disability were thought to influence wheelchair prescription. Fifteen users were provided with specialised seating and 46 with tilt-in-space seats. Conclusions: Our findings suggest that people with severe MS requiring an EPIOC benefit from a holistic assessment to identify problematic clinical features that influence the prescription of the EPIOC and further medical and therapeutic interventions

CONFLITOS ÉTICOS VIVENCIADOS PELOS ENFERMEIROS FRENTE AOS FAMILIARES DA MULHER EM PROCESSO DE ABORTAMENTO

A assistência em saúde, de modo geral, encontra-se limitada em um cuidar com abordagem biomédica, haja vista que o enfoque volta-se ao organismo físico, desvalorizando questões outras pertinentes e integrantes do ser, como o cuidado holístico no atendimento. Estudo realizado por Costa et al., (2016) salienta que o cuidar é a essência do trabalho na enfermagem, caracterizando além das necessidades de saúde e o vínculo construído, ações e posturas na assistência ofertada

DILEMAS ÉTICOS VIVIDOS PELA EQUIPE DE SAÚDE NO CUIDADO À MULHER EM ABORTAMENTO INDUZIDO

No contexto social em que estamos inseridos percebemos a necessidade que açõeséticas estejam presentes no nosso cotidiano e principalmente no que concerne aocuidado à pessoa. Para Verona (2017, p. 2), “Ética pode ser entendida como um estudoou um pensar sobre uma conduta humana que pode ser: científica, filosófica, teológica,cultural e, propriamente dita, sobre as ações humanas”

Percepção docente sobre o atendimento ao estudante autista em escolas de Formosa-GO e Planaltina-DF

This paper presents the result of a study about the teaching perception about the care offered to autistic students in public schools in Formosa-GO and Planaltina-DF. The study was carried out in two parts: 1) observations in the classroom of two regular public schools (one in each city); 2) applying a questionnaire to teachers from a regular school and a special education school (one in each city). From the responses to the questionnaires and observations, it was possible to detect that teachers tend to focus on the limitations of autistic students and not on their potential, which we infer to be detrimental to the teaching and learning process.Este trabajo presenta un estudio sobre la percepción docente sobre el servicio ofrecido a estudiantes autistas en escuelas públicas de Formosa-GO y Planaltina-DF. El estudio se realizó en dos partes: 1) observaciones en el aula de dos escuelas públicas regulares (una en cada ciudad); 2) aplicación de un cuestionario a maestros de una escuela regular y una escuela de educación especial (una en cada ciudad). A partir de las observaciones y respuestas de los cuestionarios, fue posible detectar que los maestros tienden a centrarse en las limitaciones de los estudiantes autistas y no en su potencial, que inferimos que va en detrimento del proceso de enseñanza y aprendizaje.Este trabalho apresenta estudo a respeito da percepção docente sobre atendimento oferecido a estudantes autistas em escolas públicas de Formosa-GO e de Planaltina-DF. O estudo foi feito em duas partes: 1) observações em sala de aula de duas escolas públicas regulares (uma em cada cidade); 2) aplicação de questionário a docentes de uma escola de ensino regular e uma escola de educação especial (uma em cada cidade). A partir das observações e respostas aos questionários, foi possível detectar que os professores tendem a focar nas limitações dos estudantes autistas e não em suas potencialidades, o que inferimos ser prejudicial para o processo de ensino e aprendizagem

Rethinking clinical trials of transcranial direct current stimulation: Participant and assessor blinding is inadequate at intensities of 2mA

Copyright @ 2012 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and 85 reproduction in any medium, provided the original author and source are credited. The article was made available through the Brunel University Open Access Publishing Fund.Background: Many double-blind clinical trials of transcranial direct current stimulation (tDCS) use stimulus intensities of 2 mA despite the fact that blinding has not been formally validated under these conditions. The aim of this study was to test the assumption that sham 2 mA tDCS achieves effective blinding. Methods: A randomised double blind crossover trial. 100 tDCS-naïve healthy volunteers were incorrectly advised that they there were taking part in a trial of tDCS on word memory. Participants attended for two separate sessions. In each session, they completed a word memory task, then received active or sham tDCS (order randomised) at 2 mA stimulation intensity for 20 minutes and then repeated the word memory task. They then judged whether they believed they had received active stimulation and rated their confidence in that judgement. The blinded assessor noted when red marks were observed at the electrode sites post-stimulation. Results: tDCS at 2 mA was not effectively blinded. That is, participants correctly judged the stimulation condition greater than would be expected to by chance at both the first session (kappa level of agreement (κ) 0.28, 95% confidence interval (CI) 0.09 to 0.47 p = 0.005) and the second session (κ = 0.77, 95%CI 0.64 to 0.90), p = <0.001) indicating inadequate participant blinding. Redness at the reference electrode site was noticeable following active stimulation more than sham stimulation (session one, κ = 0.512, 95%CI 0.363 to 0.66, p<0.001; session two, κ = 0.677, 95%CI 0.534 to 0.82) indicating inadequate assessor blinding. Conclusions: Our results suggest that blinding in studies using tDCS at intensities of 2 mA is inadequate. Positive results from such studies should be interpreted with caution.GLM is supported by the National Health & Medical Research Council of Australia ID 571090

Optimising physiotherapy care for acute low back pain – identifying non-responders to treatment

Recent evidence suggests that positive effects of physiotherapy for acute low back pain patients can be achieved if treatment is delivered early enough. However it is clear that not all patients treated with physiotherapy are likely to report equally positive outcomes from their treatment. The identification of clinical characteristics of those patients who do less well will help refine models of care for acute low back pain. Aim: To identify non-responders to early active physiotherapy. Method: A secondary analysis was conducted on the data from a recently published randomised controlled trial of early physiotherapy for acute low back pain. All patients were randomised into two groups: immediate physiotherapy or advice and wait list and completed a series of physical, psychological and pain measures at baseline and again at six weeks. Multivariate statistical analysis was conducted to identify which patient baseline characteristics were associated with unsuccessful outcomes at the six week follow up. Control group comparisons permitted only those relationships associated with the intervention to be described. Results: Data analysis indicated that subgroups of patients who responded poorly to their physiotherapy treatment could be identified by a priori knowledge of their pain, mental health and physical function (p\u3c0.05). Conclusions: The results of the current analysis suggest that there are identifiable subgroups of patients who respond less well to physiotherapy treatment. Attention to these patient characteristics needs to be included in models of care for acute low back pain so that effects of therapy for all patients can be optimised