bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing outcomes in an Australian rehabilitation service: Using an ICF-based approach
Authors: Graham Susan K , Cameron Ian D 
Published: May 2014

Aims Rehabilitation services provide multidisciplinary management of complex clients and therefore require a multifactorial assessment tool to assess standards, discriminate between services and clients, and suggest areas requiring improvement. The World Health Organization International Classifi cation of Functioning Disability and Health (ICF) provides a structure based on impairment, activity, participation and environment that may be a useful basis for assessing rehabilitation outcomes. The authors developed a set of clinical indicators including the Australian Faculty of Rehabilitation Medicine (AFRM) clinical indicators (which largely concern the rehabilitation process) and additional outcome measures based on the ICF domains, and undertook this pilot study to assess its usefulness. Method In July and August 2004 a clinical reviewer assessed 30 client records from an inpatient and a community-based rehabilitation service respectively, using a proforma which included the AFRM clinical indicators and additional indicators relating to goal attainment and the ICF domains. The reviewer ascertained which ICF domains were relevant for each client and if the relevant domains were addressed in the records. Findings After practice, the pro forma was easy to use but time consuming. Items based on the AFRM clinical indicators tended to be complied with 100% (i.e. for most clients, all of the AFRM clinical indicators were fulfi lled). Scores based on improvement in activity and participation, and goal attainment had means of 0.23-0.43 (medians 0.0-0.6) with a range between clients of 0 (improvement in all areas assessed) and 1 (no improvement), suggesting that these scores are potentially more discriminatory than the AFRM clinical indicators. Conclusions The high level of compliance with the AFRM clinical indicators suggests that these indicators may not be useful for discriminating between services, but are likely to provide a useful measure of minimum standards. Items based on activity, participation and goal attainment, or a previously published instrument such as the Goal Attainment Scaling Tool, may be more appropriate methods for assessing outcomes in different settings. Further work is needed to appropriately assess potential confounding factors via use of the ICF concept of environmental facilitators and barriers.
Review of upper limb ability assessments in acute stroke care, from a practice perspective
Authors: Rowland Tennille J , Gustafsson Louise , Henderson Robert D , Turpin Merrill , Read Stephen J 
Published: May 2014

Aims The purpose of this study was to compare three upper limb ability assessments – the Action Research Arm Test (ARAT), Arm Motor Ability Test (AMAT), and Chedoke Arm and Hand Activity Inventory (CAHAI) – in acute stroke occupational therapy practice during a 6-month period, to identify whether any or all were appropriate for use in acute stroke care. Methods Medical records of clients with stroke admitted to an acute stroke unit were reviewed retrospectively. Inclusion criteria were: (a) admission between March and August 2006, (b) new diagnosis of stroke, (c) upper limb involvement, and (d) assessed by an occupational therapist with ARAT, AMAT or CAHAI. Included records were reviewed and the following noted: diagnosis, upper limb weakness, gender, age, assessment score, when assessed, time to administer, test items completed, and qualitative notations. Findings Thirty three records satisfied the inclusion criteria. A range of stroke subtypes were assessed. The mean ARAT score was 21.4/45, CAHAI was 66.5/91 and AMAT was 3.0/5. The median number of days post-stroke when assessed was 9 days. Conclusions Overall, ARAT, CAHAI and AMAT were useful for assessment of upper limb ability. The results cannot specifically identify which assessment is most suited to the acute stroke setting. The findings do support the inclusion of ARAT, CAHAI and AMAT in standard clinical care.
Using qualitative observational methods in rehabilitation research: Part one
Authors: Clarke David J 
Published: May 2014

Background Research in rehabilitation practice commonly aims to evaluate the effectiveness of complex interventions, and qualitative research—often as part of a mixed methods approach—is being increasingly employed to address important research questions in rehabilitation. Such questions often focus on the activities, experiences and perceptions of patients, carers and practitioners, as well as on the outcomes of rehabilitation. Qualitative observational methods can provide detailed accounts of social processes, which are often hidden or taken for granted, but which constitute the day-to-day reality of rehabilitation practice. Content This two-part article examines the characteristics of systematic qualitative observational methods in the context of rehabilitation research. The first article will introduce this methodology, discuss its merits, philosophical and methodological influences, and then illustrate how qualitative observational research should be planned and conducted. The next article will discuss participant observation, and explore the approaches to recording fieldnotes and working with qualitative observational data. Conclusions Increasingly researchers and practitioners are recognizing that reliance on traditional quantitative approaches alone cannot fully account for the all of the individual, social and organizational factors which may have a bearing on the outcomes of rehabilitation interventions. Qualitative observation is an approach available to researchers to understand the impact of these complex factors.
Case report of multidisciplinary management of a unilateral transhumeral amputee
Authors: Wang Joy Phang Yuen , Wa Ho Kam , Yin Frank Lai Ho , Wai Law Sheung , Kit Eddy Siu Hon , Cheung Herman Lau Mun , Ming Cavor Chan Kai 
Published: May 2014

Background After the 12 May 2008 Sichuan disaster, thousands of injured survivors required intensive rehabilitation. Stand Tall project volunteered to help the earthquake victims with state-ofthe-art prosthesis and rehabilitation technology. Content This case report highlights the multidisciplinary rehabilitation module for a 9-year-old girl with unilateral transhumeral amputee. Early intervention for rehabilitation and multidisciplinary approach were the keys to her successful pathway. In pre-prosthetic phase, physical and activities of daily livings training, prosthesis fitting and motor training for myoelectric hand were essential. Conclusions Despite her young age, functional training for usage of prosthesis was successful and her rehabilitation outcome was satisfactory. The ultimate goal of rehabilitation in her case would be use of bilateral hands, psychological adjustment and social reintegration.
Managing a patient with a rapidly progressing neurodegenerative condition
Authors: Ramaswamy Bhanu , Sheppard Amy 
Published: May 2014

Background This case report details aspects of the care of a patient with motor neurone disease (MND) who transferred to a rehabilitation ward for intervention following a fall at home. It reports the context and the journey travelled by both staff and the patient, following her admission. Although MND is a recognized degenerative condition, the rapidity of decline was not anticipated, as the expectation was one of recovery and of a functional return home. Content This article explores how management strategies had to alter to deal with the unexpected deterioration, offering an insight into the experiences of staff dealing with this neurological condition, the psychological distress to all concerned, and of the occasional conflict caused by differences in the approach to the management of the patient. Conclusions As the available literature does little to support the day to day practicalities of managing such an issue, this article offers reflection on the dilemmas experienced by all parties, with practical suggestions recommended that might assist others who find themselves in this situation.
Comparing and contrasting health profiles: one dimension of critical thinking
Authors: Castle Alan 
Published: May 2014

Background Critical thinking skills are seen as being important for health professionals to operate effectively in a modern health care setting. As a result of this, for example, an undergraduate radiography curriculum involves defining, teaching and assessing appropriate components of critical thinking skills. Contents Using the example of the radiography curriculum, the components of critical thinking skills are explained. These components include: investigation, interpretation, application, generation, evaluation and justification. Each of these components can be divided into two dimensions to encourage students to focus on a specific intellectual skill. One dimension of the investigation component is being able to compare and contrast information requiring students to understand, analyse and differentiate data from a range of sources. Since knowledge and understanding of the social context of health is important in the delivery of high quality care, the Health Profiles of England have been used to illustrate how students might go about demonstrating this skill. Conclusions The worked examples involve analysing the data from two unitary authorities in order to identify key similarities and differences in people's health in each area and with the England average. Finally, possible reasons for any variations in terms of social, environmental and lifestyle factors were explored.
‘Appearing the team’: from practice to simulation
Authors: Stephens John , Abbott-Brailey Hilary , Platt Alan 
Published: May 2014

Background: The growing trend in the development of high fidelity simulation within undergraduate health care education has produced a range of frameworks and guidelines to structure learning opportunities offered through simulation. An attempt to articulate the process of learning through simulation based on clinical practice experience would appear to be a useful step in the development of simulation-practice links in the provision of further options to facilitate students' learning and continuing professional development. Content: The experience of team identity and integration for undergraduate health care students (n=16, adult nursing, physiotherapy, radiography) undertaking their first critical care practice placement is explored and used to underpin a reflective model to inform learning opportunities offered through high fidelity simulation. The analysis of human interaction offered by Erving Goffman through the use of dramaturgical metaphor is applied to frame the key emergent themes of the critical care experience—'observation', fitting in’, and ‘making a difference’—and shape the developing reflective model. Conclusions: Within the proposed model, the importance of ‘space for reflection’ and ‘meaningful dialogue’ within the context, participation, accessibility, and credibility (CPAC) schema are critical aspects that facilitate the integration and development of confidence in task/technical and interpersonal competencies supporting effective clinical outcome.
Including open-ended questions in quantitative questionnaires—theory and practice
Authors: Harland Nicholas , Holey Elizabeth 
Published: May 2014

Background: Though mixed-method approaches to medical and associated research are now relatively common, their use in physiotherapy research of musculoskeletal conditions remains rare. Contents: Argument for use of qualitative open-ended questions as an adjunct to common quantitative methods is given. Examples of results from a mixed-methods study are used to demonstrate the argument. Conclusions: The article concludes that using a comparatively simple method of adding open-ended questions to a quantitative self-report based questionnaire methodology can add significant value and depth to both the results and conclusions of studies undertaken.
The effect of cryotherapy and exercise on lateral epicondylitis: a controlled randomised study
Authors: Cherry Elizabeth , Agostinucci James , McLinden John 
Published: May 2014

Aims: The purposes of this randomised clinical trial were to determine the effect that exercise, cryotherapy, and exercise with cryotherapy have on treating lateral epicondylitis. The therapeutic efficacy of a newly designed controlled release cold pack was also investigated. Methods: Grip strength and pain were measured, and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) was given before and after a home programme consisting of either exercise only, exercise with a conventional cold pack, exercise with a Cryo-MAX®, and Cryo-MAX® without exercise. Cryo-Max® is the commercial name given to the cold pack that remains consistently cold for an extended time. Findings: ANCOVA showed significant improvements between pre and post-treatment values for DASH, pain level, and grip strength for all subject groups receiving treatment. No treatment group was superior to the other, indicating that exercise and cryotherapy alone was as effective as the combination of exercise and cryotherapy. In addition, the type of cold pack used (conventional or Cryo-Max®) also showed no significant difference. Conclusions: Exercise and cryotherapy used in isolation or in combination reduces the symptoms of lateral epicondylitis. Cryo-MAX® was preferred over conventional cold packs but it did not have any additional therapeutic benefit.
Risk factors for musculo-skeletal injuries in Australian paramedics
Authors: Bronieck Monica , Esterman Adrian , Grantham Hugh 
Published: May 2014

This cross-sectional study aimed to determine the individual, physical and psychosocial risk factors associated with back, neck and shoulder musculoskeletal pain, injuries and claims in paramedics. An internet-based survey of an Australian ambulance service was conducted between May and June 2011. The questionnaire included individual (demographic and psychological) items, and questions on the physical and psychosocial aspects of the job. The outcome measures included pain, injuries sustained and claims in the previous 12 months. Variables associated with pain included perceived heavy manual handling, not being consulted about work changes and the high physical and psychological consequences of the job including feeling worn out, while increased alcohol consumption was also found to be associated with pain. Variables associated with injuries included heavy manual handling, being consulted about work changes, work organisation factors, lack of psychological support from the line manager and feeling worn out. Variables associated with claims were older age, being female, having a busy last shift rotation, repetitive and heavy manual handling, worry about patient violence and increased alcohol consumption. Perceived injury risk mitigation strategies included reducing the physical job demands, including reducing the weight of kit and equipment.
Looking at contemporary pre-hospital trauma care systems
Authors: Meadley Ben 
Published: May 2014

Care for patients suffering from major trauma varies greatly throughout the world. This may range from no response at all, to advanced systems comprising multiple levels of response. Much of the understanding of the management of civilian trauma has been drawn from military experience in times of war. Holistic, integrated trauma systems are well-established in many parts of the developed world. These contemporary trauma systems are complex, can be costly, and are a significant undertaking to establish. Controversy surrounds the level of pre-hospital response, and the in-field skills required to improve patient outcomes. The ideal resourcing for pre-hospital response to trauma is not agreed upon, and requires further investigation. However, significant reductions in morbidity, mortality, suffering and societal burden can be expected following the establishment of an integrated trauma care system. A tiered response, encompassing basic and advanced level providers, who ultimately deliver patients to Major Trauma Centres, appears to be current best practice.
A survey of community paramedicine course offerings and planned offerings
Authors: Raynovich William , Weber Michael , Wilcox Michael , Wingrove Gary , Robinson-Montera Anne , Long Susan 
Published: May 2014

Introduction: This paper reports on the results of a survey that was sent to every recipient of a standardised Community Paramedic™ (CP) curriculum. The survey was sent out to 223 post-secondary educators and Government officials. Out of 223 total surveys, 68 (30.49%) responses were received. Forty-seven of the 68 responses (69.11%) answered the question: ‘When are you planning on giving a community paramedic course?’; 35 of the 47 respondents (74.46%) indicated that their institution had already conducted a CP course, was currently conducting a CP course, or are planning on conducting a CP course within the next five years; of the additional 12 programmes (25.53%), 6 (13.0%) were waiting for state approval, and the other 6 (13.0%) were unknown as to when they would be offering a course. Conclusions: At the time of the survey, many CP courses were in planning stages by programmes that had received the standardised CP curriculum, both in the US and internationally. It appears that the CP curriculum that has been disseminated internationally has been broadly accepted and will be widely utilised.
The internet as an information source for parents in talking to children about genetic conditions
Authors: Plumridge Gill , Metcalfe Alison , Coad Jane 
Published: May 2014

During the last 25 years there has been a gradual move towards more open communication with children and young people about the realities of chronic health conditions affecting themselves or members of their families. With genetic conditions, parents face not only telling children about the management of the condition, but also about potential future risks. Most parents want to discuss these issues with their children but have found little available help or support. The internet is one source of advice parents may consult. For this aurvey the internet was searched for web pages advising parents about talking to children about genetic or other chronic health conditions. Fourteen pages from 12 websites were found relating to genetic conditions and a further 30 to other chronic health conditions. These were analysed for content and for issues relating to reliability. The sites confirmed to parents that it was important to talk to their children and gave advice about how they should act when doing so, but little practical advice about how they could approach this task. Children’s feelings and emotions were rarely mentioned and there was very little advice about discussing genetics and heredity. Pages relating to other chronic illnesses gave a little more advice on what to tell children and a few more practical suggestions for how to do this. When compared to a meta-synthesis of previous research relating to family communication about genetic conditions, there was some mismatch between the information parents need and that provided by websites. Nurses must be aware of parents’ need for help in communicating with children about genetic conditions, and that if they search the internet the content and quality of advice they find will be variable and there will potentially be important areas that are not covered.
Early recognition of meningitis and septicaemia: the ‘red flag’ symptoms
Authors: Pariagh Sandra , Glennie Linda 
Published: May 2014

Meningitis and septicaemia can be deceptive in the diversity of their presentation in children. Added to this difficulty, most health professionals see few cases in their professional lifetimes. The meningococcus is the leading cause of bacterial meningitis in the UK, and it can kill within 24?hours of symptom onset. Many child survivors just starting out in life face debilitating and sometimes permanent disabilities including neurological damage, sensory deficits, limb amputations, and often damage to tissue, skin and organs. There may be further impact on quality of life even for those who appear to recover well. Group B meningococcus accounts for the great majority of meningococcal cases, however a vaccine that protects against it remains elusive. Consequently, given the severity of the disease, its ability to develop at an alarming rate, and the absence of universally protective vaccines against meningitis and septicaemia, it is crucial to be able to recognize the signs and symptoms. ‘Red flag’ symptoms have been recently identified as early warning symptoms of the disease. They manifest some 5 hours earlier than the well-known ‘classic’ symptoms. Knowledge of these earlier symptoms could speed up diagnosis and treatment thereby reducing morbidity and mortality. The purpose of this paper is to draw attention to this deadly disease and highlight the early ‘red-flag’ symptoms.
Moving and handling the infant in a hip spica cast: a systematic review
Authors: Aylott Marion 
Published: May 2014

Historically, patient handling injury-reduction strategies have been based on tradition and personal experience rather than scientific evidence. There is strong evidence that these approaches are not effective in reducing care-giver injury (Nelson et al, 2006). Manual handling of the infant, child or young person in a hip spica cast has been identified as a high-risk moving and handling activity. Evidence-based approaches are most likely to be clinically effective. Therefore peer-reviewed research which shows the efficacy of an approach may warrant integration into practice, and subsequently reduce safety risks and improve clinical effectiveness. A systematic review was conducted to compare the effectiveness and/or complications of methods used in the practice of moving and handling the infant/child in a ‘wet’ (first 24–48 hours until dry) hip spica cast. Searches were made using text words and subject headings relevant to moving and handling the infant, child or young person in a ‘wet’ hip spica cast. All potentially relevant titles and abstracts identified by the searches were retrieved. The reference lists/bibliographies of each article were reviewed for additional relevant titles, and these were also retrieved. Primary research using quantitative or qualitative methods and published audit data were sought but no studies were found meeting the criteria for inclusion in this review. There is no research-based evidence concerning the manual handling of the infant/child in a hip spica cast. The core of evidence-based practice is to integrate expertise derived from practice with research evidence when making clinical decisions, as successful practice cannot occur with one of these factors in isolation (Sackett et al, 1996). When research in a particular area of practice is deemed unfeasible, alternative evidence must be sought, especially if safety is to be a priority issue.