Miracle-dz/UniFAR-FTUs huggingface dataset:
Adherence to Clinical Practice Guidelines for Low Back Pain in Physical Therapy: Do Patients Benefit?

Background Various guidelines for the management of low back pain have been developed to enhance the effectiveness and efficiency of care. Evidence that guideline-adherent care results in better health outcomes, however, is not conclusive. Objective The main objective of this study was to assess whether a higher percentage of adherence to the Dutch physical and manual therapy guidelines for low back pain is related to improved outcomes. The study further explored whether this relationship differs for the individual steps of the process of care and for distinct subgroups of patients. Design This was an observational prospective cohort study (2005–2006) in the Netherlands that included a sample of 61 private practice therapists and 145 patients. Methods Therapists recorded the process of care and the number of treatment sessions in Web-based patient files. Guideline adherence was assessed using quality indicators. Physical functioning was measured by the Dutch version of the Quebec Back Pain and Disability Scale, and average pain was measured with a visual analog scale. Relationships between the percentage of guideline adherence and outcomes of care were evaluated with regression analyses. Results Higher percentages of adherence were associated with fewer functional limitations (β=−0.21, P=.023) and fewer treatment sessions (β=−0.27, P=.005). Limitations The relatively small self-selected sample might limit external validity, but it is not expected that the small sample greatly influenced the internal validity of the study. Larger samples are required to enable adequate subgroup analyses. Conclusions The results indicate that higher percentages of guideline adherence are related to better improvement of physical functioning and to a lower utilization of care. A proper assessment of the relationship between the process of physical therapy care and outcomes may require a comprehensive set of process indicators to measure guideline adherence.
Why do enterprise risk management systems fail? Evidence from a case study of AIG

In this paper we use the enterprise risk management (ERM) framework as proposed by the COSO to analyse eight components of the American International Group’s (AIG) risk management system, and then study how such a poor risk management system led to AIG’s liquidity crisis. We address two research questions in this paper: First, we examine the direct reasons for AIG’s liquidity risk in September 2008. Second, we conduct a qualitative case study to analyse how the limitations of AIG’s enterprise-wide risk management system led to its liquidity crisis. We identify that issuing credit default swaps (CDSs) and investing in residential mortgage backed securities (RMBS) and commercial mortgage backed securities (CMBS) were the direct causes of AIG’s liquidity crisis. However, the fundamental reason was AIG’s poor risk management system. Our field case study is consistent with the Erickson et al. (2000, pp.165–194) research design of first-hand and second-hand evidence for drawing inferences, and follows the prescriptions of Merchant and Van der Stede (2006, pp.117–134); and Ahrens and Chapman (2006, pp.819–841). We provide public policy and practical implications based on the conclusions of this case study.
Strengthening and Optimal Movements for Painful Shoulders (STOMPS) in Chronic Spinal Cord Injury: A Randomized Controlled Trial

Background Shoulder pain is a common problem after spinal cord injury (SCI), with negative effects on daily activities and quality of life (QOL). Objective The purpose of this study was to determine the effect of an exercise program and instruction to optimize performance of upper-extremity tasks on shoulder pain in people with paraplegia from SCI. Methods/Design Eighty individuals with paraplegia from SCI and shoulder pain were randomly assigned to receive either an exercise/movement optimization intervention or an attention control intervention. The exercise/movement optimization intervention consisted of a 12-week home-based program of shoulder strengthening and stretching exercises, along with recommendations on how to optimize the movement technique of transfers, raises, and wheelchair propulsion. The attention control group viewed a 1-hour educational video. Outcome measures of shoulder pain, muscle strength (force-generating capacity), activity, and QOL were assessed at baseline, immediately after intervention, and 4 weeks later. Results Shoulder pain, as measured with the Wheelchair User's Shoulder Pain Index, decreased to one third of baseline levels after the intervention in the exercise/movement optimization group, but remained unchanged in the attention control group. Shoulder torques, most 36-Item Short-Form Health Survey questionnaire (SF-36) subscale scores, and QOL scores also were improved in the exercise/movement optimization group, but not in the attention control group. Improvements were maintained at the 4-week follow-up assessment. Limitations Many of the outcome measures were self-reported, and the participant dropout rate was high in both groups. Additional studies are needed to determine whether the results of this study can be generalized to individuals with tetraplegia. Conclusions This home-based intervention was effective in reducing long-standing shoulder pain in people with SCI. The reduction in pain was associated with improvements in muscle strength and health-related and overall QOL.
Fetal Wastage Syndrome due to Blood Protein/Platelet Defects: Results of Prevalence Studies and Treatment Outcome with Low-Dose Heparin and Low-Dose Aspirin

Fetal wastage syndrome is characterized by recurrent spontaneous abortion. Many syndromes are associated with recurrent fetal loss, including anatomical anomalies, endocrine/hormonal abnormalities, and coagulation defects, with coagulation defects accounting for ∼30% of cases. Most procoagulant factor defects are due to inadequate fibrin-mediated implantation of the fertilized ovum into the decidua. However, blood protein/ platelet defects leading to hypercoagulability and thrombosis are associated with thrombosis of placental vessels, precluding viability of the implanted ovum or later fetus. During the past 2 years, we have seen 46 patients with fetal wastage syndrome due to thrombosis-associated hemostasis defects. In this group, there have been three patients with sticky platelet syndrome, one patient with dysfibrinogenemia, four patients with congenital protein S deficiency, 35 patients with anticardiolipin antibodies, and one patient with a lupus anticoagulant. Patients were started on one low-dose aspirin (ASA), 81 mg per day preconception, at time of diagnosis, and low-dose s.c. porcine heparin at 5,000 units every 12 h was added immediately postconception. The combination of low-dose ASA plus low-dose s.c. porcine heparin was used throughout pregnancy. All patients achieving pregnancy have had uneventful, normal deliveries. It appears that blood protein/platelet defects leading to thrombosis and associated with recurrent fetal loss can be successfully managed with the use of preconception low-dose ASA, followed by immediate postconception addition of fixed low-dose porcine heparin, both used throughout pregnancy. Using this regimen, our success rate has been 100%. Ideal heparin doses, which might be much lower than our empirically chosen and currently used doses, remain to be defined in this particular indication. Key Words: Fetal wastage syndrome—Heparin—Aspirin.
Direct Access: Factors That Affect Physical Therapist Practice in the State of Ohio

Background Direct access to physical therapist services is permitted by law in the majority of states and across all practice settings. Ohio enacted such legislation in 2004; however, it was unknown how direct access had affected actual clinical practice. Objectives The purpose of this study was to describe physical therapist and physical therapist practice environment factors that affect direct access practice. Design A 2-phase, mixed-method descriptive study was conducted. Methods In the first phase, focus group interviews with 32 purposively selected physical therapists were completed, which resulted in 8 themes for an electronically distributed questionnaire. In the second phase, survey questionnaires were distributed to physical therapists with an e-mail address on file with the Ohio licensing board. An adjusted return rate of 23% was achieved. Data were analyzed for descriptive statistics. A constant comparative method assessed open-ended questions for common themes and patterns. Results Thirty-one percent of the respondents reported using direct access in physical therapist practice; however, 80% reported they would practice direct access if provided the opportunity. Physical therapists who practiced direct access were more likely to be in practice 6 years or more and hold advanced degrees beyond the entry level, were American Physical Therapy Association members, and had supportive management and organizational practice policies. The direct access physical therapist practice was generally a locally owned suburban private practice or a school-based clinic that saw approximately 6% to 10% of its patients by direct access. The majority of patients treated were adults with musculoskeletal or neuromuscular impairments. Limitations Nonresponse from e-mail may be associated with sample frame bias. Conclusions Implementation of a direct access physical therapist practice model is evident in Ohio. Factors related to reimbursement and organizational policy appear to impede the process.
Understanding Falls in Multiple Sclerosis: Association of Mobility Status, Concerns About Falling, and Accumulated Impairments

Background Falls in people with multiple sclerosis (MS) are a serious health concern, and the percentage of people who restrict their activity because of concerns about falling (CAF) is not known. Mobility function and accumulated impairments are associated with fall risk in older adults but not in people with stroke and have not been studied in people with MS. Objective The purposes of this study were: (1) to estimate the percentage of people who have MS and report falling, CAF, and activity restrictions related to CAF; (2) to examine associations of these factors with fall status; and (3) to explore associations of fall status with mobility function and number of accumulated impairments. Design A cross-sectional survey was conducted. Methods A total of 575 community-dwelling people with MS provided information about sociodemographics, falls, CAF, activity restrictions related to CAF, mobility function, and accumulated impairments. Chi-square statistics were used to explore associations among these factors. Results In all participants, about 62% reported CAF and about 67% reported activity restrictions related to CAF. In participants who did not experience falls, 25.9% reported CAF and 27.7% reported activity restrictions related to CAF. Mobility function was associated with fall status; participants reporting moderate mobility restrictions reported the highest percentage of falls, and participants who were nonwalkers (ie, had severely limited self-mobility) reported the lowest percentage. Falls were associated with accumulated impairments; the participants who reported the highest percentage of 2 or more falls were those with 10 impairments. Limitations This cross-sectional study relied on self-reported falls, mobility, and impairment status, which were not objectively verified. Conclusions Both CAF and activity restrictions related to CAF were common in people with MS and were reported by people who experienced falls and those who did not. The association of fall status with mobility function did not appear to be linear. Fall risk increased with declining mobility function; however, at a certain threshold, further declines in mobility function were associated with fewer falls, possibly because of reduced fall risk exposure.
Changes in Body Weight After Total Hip Arthroplasty: Short-term and Long-term Effects

Background Elevated body weight is associated with hip osteoarthritis (OA) and subsequently with total hip arthroplasty (THA). Patients with hip OA who are overweight often mention their restricted mobility as a factor that thwarts their attempts to be physically active and lose weight. There is some evidence that THA increases physical activity, but none for losing body weight after THA. Objective The purpose of this study was to analyze the short-term (1-year) and long-term (4.5-year) effects of a THA on body weight. Design This was an observational, multicenter cohort study. Methods For the short-term effect, all patients (N=618) were analyzed; for the long-term effect, a random subgroup (n=100) was analyzed. Preoperative and postoperative body weight and height were self-reported. Patients were categorized according to their preoperative body mass index (BMI <25 kg/m2=normal weight, 25–30 kg/m2=overweight, >30 kg/m2=obese). Clinical relevancy was set at a minimum of 5% weight loss compared with baseline. Results The mean age of the study group was 70 years (SD=8), 74% were women, and mean preoperative body mass was 79 kg (SD=14). One year after THA, a significant decrease in body weight of 1% and 3.4% occurred for the overweight and obese BMI categories, respectively. After 4.5 years, a significant decrease in body weight of 6.4% occurred for the obese BMI category. Limitations Height and weight—and thus BMI—were self-reported. Conclusion Patients in the overweight and obese groups showed a decrease, albeit not clinically relevant, in body weight after 1 year. After 4.5 years, a decrease that was relevant clinically was observed in the patients who were obese. It can be concluded that no clinically relevant reduction of weight occurred after THA, except in the long term for patients who were obese.
Premature and low birth weight neonates and their management at neonatology unit of Shaikh Zayed Hospital Lahore.

Objectives: The study was conducted to identify some of the risk factors among mothers which lead to premature and low birth weight (P&LBW) and the progress of such neonates in a tertiary care hospital. Methods: An analytic study of 1178 deliveries at Shaikh Zayed Hospital Lahore during calender year was conducted. By WHO definition of prematuriety and low birth weight neonates out of 1178 deliveries only 150 could be identified as premature and low birth weight neonates( live born neonates either delivered before 37 weeks from first day of the last menstrual period or having a birth weight of <2.5kg.) Results: Among the total deliveries 12.7%were premature and /or low birth neonates. The proportion of neonates with congenital anomalies was 7.3% among the P&LBW group and 5.4%among the remaining deliveries. Fifty percent of the P&LBW needed antibiotics with neutral environment and oxygen therapy. Early neonatal mortality among the P&LBW group was found to be 12%. Hospital situation did not permit calculation of neonatal mortality rate of all the deliveries as majority of the normal deliveries get discharged with in 72 hours post partum. The national rate of neonatal mortality for the corresponding year was 51.4/1000 live births. (authors)
Decision making by senior social workers at point of first referral

Summary In the United Kingdom there has been difficulty in implementing the family support provisions contained in the 1989 Children Act, largely because of continued emphasis on child protection activity by local authorities. There is an observable international tendency for child-care referrals to receive investigative response, resulting in families being traumatized and children's needs left unmet. There has been a lack of research into how child-care referrals are initially categorized by senior social workers. This paper reports on research undertaken in two Health and Social Services Trusts within Northern Ireland to ascertain if it might be possible to treat more initial referrals as 'child-care problem enquiries' as opposed to 'child protection investigations'. Results demonstrate that, while such potential may exist, a preoccupation with the manage ment of risk could lead to the development of child-care problems receiving quasi-child protection responses. Consequently, changes in initial decision making may not have the full intended effects in terms of the organizational release of resources for family support or a lessening of the traumatic impact upon families.
BREAST CANCER AMONG ATOMIC BOMB SURVIVORS

Three hundred and sixty cases of breast cancer were collected from among the 63,000 female members of the Radiation Effect Research Foundation (RERF) extended Life Span Study sample which includes atomic bomb exposed women and controls of Hiroshima and Nagasaki. The relationship of these breast cancer cases to A‐bomb radiation was sought, and in studying of 5‐year survival, the following conclusions were obtained concerning its relationship to histopathological findings. The prognosis of the 50+ rad high dose group is the best, followed by the nonexposed group and the low dose group. The apparently better survival may be due to the fact that this group is heavily weighted in favor of those who were younger at the time of the bomb (ATB). There is no specificity of the histologic type of breast cancer in the survivors by dose. Nor is any significant difference observed in the distribution of tumor size and histological grade, though the survival rates of this series are worse than those of usual Japanese women with breast cancer. Cellular reaction is significantly marked in the stroma of carcinoma tissue in the high dose group. Immune reaction is considered to be strong in the affected site of breast cancer in the high dose group and this can be regarded as a finding suggestive of good prognosis. Further extended studies are therefore warrented.
Effect of Therapeutic Exercise on Pain and Disability in the Management of Chronic Nonspecific Neck Pain: Systematic Review and Meta-Analysis of Randomized Trials

Background Given the prevalence of chronic nonspecific neck pain (CNSNP) internationally, attention has increasingly been paid in recent years to evaluating the efficacy of therapeutic exercise (TE) in the management of this condition. Purpose The purpose of this study was to conduct a current review of randomized controlled trials concerning the effect of TE on pain and disability among people with CNSNP, perform a meta-analysis, and summarize current understanding. Data Sources Data were obtained from MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Physiotherapy Evidence Database (PEDro), and Cochrane Central Register of Controlled Trials (CENTRAL) databases from their inception to August 2012. Reference lists of relevant literature reviews also were tracked. Study Selection All published randomized trials without any restriction regarding time of publication or language were considered for inclusion. Study participants had to be symptomatic adults with only CNSNP. Data Extraction Two reviewers independently selected the studies, conducted the quality assessment, and extracted the results. Data were pooled in a meta-analysis using a random-effects model. Data Synthesis Seven studies met the inclusion criteria. Therapeutic exercise proved to have medium and significant short-term and intermediate-term effects on pain (g=−0.53, 95% confidence interval [CI]=−0.86 to −0.20, and g=−0.45, 95% CI=−0.82 to −0.07, respectively) and medium but not significant short-term and intermediate-term effects on disability (g=−0.39, 95% CI=−0.86 to 0.07, and g=−0.46, 95% CI=−1.00 to −0.08, respectively). Limitations Only one study investigated the effect of TE on pain and disability at follow-up longer than 6 months after intervention. Conclusions Consistent with other reviews, the results support the use of TE in the management of CNSNP. In particular, a significant overall effect size was found supporting TE for its effect on pain in both the short and intermediate terms.
Psychometric Properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) in Community-Dwelling Individuals With Chronic Stroke

Background The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a new balance assessment, but its psychometric properties have not been specifically tested in individuals with stroke. Objectives The purpose of this study was to examine the reliability and validity of the Mini-BESTest and its accuracy in categorizing people with stroke based on fall history. Design An observational measurement study with a test-retest design was conducted. Methods One hundred six people with chronic stroke were recruited. Intrarater reliability was evaluated by repeating the Mini-BESTest within 10 days by the same rater. The Mini-BESTest was administered by 2 independent raters to establish interrater reliability. Validity was assessed by correlating Mini-BESTest scores with scores of other balance measures (Berg Balance Scale, one-leg-standing, Functional Reach Test, and Timed “Up & Go” Test) in the stroke group and by comparing Mini-BESTest scores between the stroke group and 48 control participants, and between fallers (≥1 falls in the previous 12 months, n=25) and nonfallers (n=81) in the stroke group. Results The Mini-BESTest had excellent internal consistency (Cronbach alpha=.89–.94), intrarater reliability (intraclass correlation coefficient [3,1]=.97), and interrater reliability (intraclass correlation coefficient [2,1]=.96). The minimal detectable change at 95% confidence interval was 3.0 points. The Mini-BESTest was strongly correlated with other balance measures. Significant differences in Mini-BESTest total scores were found between the stroke and control groups and between fallers and nonfallers in the stroke group. In terms of floor and ceiling effects, the Mini-BESTest was significantly less skewed than other balance measures, except for one-leg-standing on the nonparetic side. The Berg Balance Scale showed significantly better ability to identify fallers (positive likelihood ratio=2.6) than the Mini-BESTest (positive likelihood ratio=1.8). Limitations The results are generalizable only to people with mild to moderate chronic stroke. Conclusions The Mini-BESTest is a reliable and valid tool for evaluating balance in people with chronic stroke.
Portal Hypertensive Enteropathy in Liver Cirrhosis

Background/Aim : Some studies found that portal hypertension cause complication such as portal hypertensive gastroenterocolopathy. This study was done to find any abnormalities in the small intestinal mucosa and villi of the portal hypertensive patients. Method : Thirty patients with liver cirrhosis, portal hypertension and esophageal varices between 2000 - 2001 were included in this study. A duodenoscopic examination was performed to determine any abnormalities. Biopsy specimens were taken from the descending part of duodenum and the duodenal bulb for histopathological examination. The findings were compared to 37 functional dyspepsia patients. Result : In the duodenal bulb and descending part of duodenum: the width of the villous of the portal hypertensive group was larger than the control (p < 0.001), the diameter of the mucosal villous vessel was larger than in the control (p < 0.001) and the thickness of the mucosal villous vessel wall was thicker than in the control (p < 0.001). Conclusion : There were abnormalities of the mucosa in portal hypertensive enteropathy patients including the mucosal vessel diameter, wall thickness, number of goblet cells. Keywords : portal hypertensive enteropathy, liver cirrhosis