bluuebunny/crossref_metadata_2025_split huggingface dataset:
The adoption and implementation of evidence-based practice (EBP) among allied health professions
Authors: Upton Penney , Scurlock-Evans Laura , Stephens Danielle , Upton Dominic 
Published: May 2014

Background and aims: Evidence-based practice (EBP) is widely accepted within patient care as it ensures health care professionals remain informed of recent evidence and research relating to their clinical practice. However, the particular characteristics detrimental to the successful implementation of EBP within Allied Health Professionals' (AHP) clinical practice are unknown. The purpose of this study was to assess and characterise adoption of EBP within AHP's clinical practice. Methods: Questionnaires comprising the Evidence-Based Practice Questionnaire (EBPQ; Upton and Upton, 2006a ) were administered to 154 (response rate=273%) newly qualified practitioners (NQPs) from NHSScotland. Data were analysed to determine attitudes, knowledge and skill of EBP; K-means cluster and chi-square analyses were conducted in order to differentiate profiles of NPQs within high-, medium-and low-categories on the EBPQ practice and knowledge/skills sub-sections. Findings: Moderate scores were recorded for NQP's implementation, knowledge, and attitudes toward EBP. Chi-square analysis performed on the high-, moderate-and low-practice and skills' profiles revealed no significant results for NQP's year qualified, age, or year of clinical practice. Conclusions: The findings illustrate that the majority of NQPs have a good understanding of the application and importance of EPB, and suggests the improvement in NQPs training with regards to EBP enables them to successfully transfer acquired knowledge within their clinical practice.
Single- and dual-task assessments in elderly patients in a falls intervention programme
Authors: Quinn Patricia , Horgan Frances 
Published: May 2014

Background/aim: Falls are associated with impaired cognitive performance in the elderly, but the optimal method of assessing cognitive risk factors remains to be determined. We investigated the association between measures of balance under single- and dual-task conditions, with cognition and falls in older people participating in a falls intervention programme in a long-term care facility. Methods: This was a cross-sectional study. The Timed Up and Go (TUG) test was performed under single-task (TUG1) and dual-task (TUG2) conditions to evaluate the impact of a concurrent attentionally demanding cognitive task. Dynamic balance was assessed using the Berg Balance Scale (BBS). Results: Sixty-six patients with a mean age of 84 years (SD=5.7) participated. The mean delta TUG (the difference in time to complete TUG1 and 2) was 13.7 seconds (SD=9.25). Using a paired sample t test, the delta TUG was found to be statistically significant (t=12.089, df=65, P < 0.001, [95% CI 11.48–16.03 seconds]). Logistic regression analysis also found the delta TUG2 to be statistically significant (beta=2.34, SD=0.87, P < 0.0075) and associated with fallers. Conclusions: An error score in cognitive task in TUG2 was the best discriminator of fallers. The TUG2 may be used to optimise risk identification in patients with balance deficits that are attentional in origin, and not detected under single-task conditions.
Who's next? Referral prioritisation criteria for home care occupational therapy
Authors: Raymond Marie-Hélène , Feldman Debbie , Prud'homme Marie-Pier , Demers Louise , Hunt Linda A , Bissett Michelle , Slater Craig E 
Published: May 2014

Background/aims: Prioritising referrals on waiting lists is common practice in rehabilitation. However, little is known about the exact criteria that are used in home-based occupational therapy to determine the level of urgency. This study aimed to identify prioritisation criteria in home-based occupational therapy services in Quebec, Canada, and to describe how they are used in practice. Methods: A mail and telephone survey of 55 home care programmes across Quebec was conducted. Participants provided information about occupational therapy wait times, and referral prioritisation tools and practices. A detailed quantitative content analysis compared the content of all referral prioritisation tools. Results: This study identified 48 main categories of referral prioritisation criteria, but only nine of them were present in the majority of tools. Wait times vary greatly between priority levels, with a median of 2 days for urgent referrals and 20 months for low-priority referrals. In general, problems related to safety and remaining at home are considered more urgent than problems related to independence, quality of life, and activities outside the home. Conclusions: These findings highlight the need for more consistent and evidence-based prioritisation criteria for occupational therapy in home care in order to facilitate equitable access to these services.
Rehabilitation after pectus excavatum corrective surgery: A single case report
Authors: Schewitz Jacqui , Aswegen Helena Van 
Published: May 2014

Background: Pectus excavatum deformity, often diagnosed in children and adults, results in psychological and physiological impairments. The minimally invasive Nuss surgical procedure is more frequently used to correct this deformity. The purpose of this single case report is to report on the interdisciplinary management provided for a 9-year-old girl who underwent this procedure for congenital pectus excavatum deformity. Content: A retrosternal steel bar was surgically placed through two small chest wall incisions made on either side of the chest and twisted over to push the sternum upwards. Interventions such as pre- and postoperative patient and family education, early postoperative mobilization, regular assessment of analgesic needs, deep breathing and coughing formed part of the rehabilitation provided in the intensive care unit and continued in the ward. Conclusion: This evidence-based inter-disciplinary approach to rehabilitation was important in the postoperative management of the patient to facilitate an uncomplicated recovery. This case report contributes to the limited body of evidence available on rehabilitation after the Nuss procedure for pectus excavatum deformity.
Adverse effects of central tendency, lateral difference, and reciprocal inter-limb weight adjustment on performance accuracy during lateral body weight shifting
Authors: Watanabe Miyoko , Higuchi Takahiro , Ishihara Masami , Tani Hiroaki , Imanaka Kuniyasu 
Published: May 2014

Aims: Lateral body weight shifting tasks are used in rehabilitation programmes, particularly in programmes for patients with orthopaedic complaints or hemiparesis. In the present study, we aimed to identify the inherent factors that could lead to deterioration of performance in such tasks. Methodology: Twenty four healthy participants were asked to accurately load a target of one or two thirds of their body weight onto their left and right lower limbs. Results: Constant error showed a relative central tendency effect during body weight shifting. ‘Central tendency’ refers to people undershooting heavier target loads by a large extent, and undershooting lighter target loads by a small extent during body weight shifting. Overall accuracy (root-mean-squared error) and variability significantly differed for the two target loads during weight shift to the left but not during that to the right. Inter-limb weight adjustment between the upper and lower limbs deteriorated the weight adjustment for the target load. Conclusion: Having a central tendency can potentially deteriorate a person’s performance of the task both in the early (when a lighter target is used) and late (when a heavier target is used) phases of rehabilitation. Lateral differences in both overall accuracy and consistency may occur while shifting heavy (rather than light) loads, particularly when the left lower limb is affected. Heavy reliance on the upper limb while attempting accurate loading on the target limb can also deteriorate loading accuracy.
Sustainable development and allied health professionals
Authors: Gower Gill 
Published: May 2014

Background: Allied health professionals and health-care providers work within organisations and communities that are having to respond to the effects of climate change and the demand for lower carbon consumption. This requires changes for all individuals whatever their skills or level of responsibility. Content: This article considers the role of allied health and social care professionals in developing and delivering a low carbon or sustainable care service. It looks at services in the light of international and national policy and guidelines, and gives an overview of legislation and targets relevant to healthcare. There is also discussion of the drivers for change as well as the aspects of health promotion, models of care and practice development. This article also considers personal and professional aspects of a sustainable lifestyle. Conclusion: Sustainable development is now an essential factor for health and social care providers to consider in how they provide their services. Adaptions can be made at all levels of these services and allied health professions can be vital at both an individual and organisational level.
Anaemia in paediatric CKD
Authors: Reid Chris 
Published: May 2014

Overall key points Anaemia is common in children and adolescents with chronic kidney disease. Iron deficiency and anaemia can impair neurocognitive development in infancy, which may have long-lasting effects. Correction of anaemia improves exercise tolerance and appetite, and may improve protein intake. Intravenous iron is standard therapy in children on haemodialysis; darbopoietin is increasingly used.
Evaluating the impact on 911 calls by an in-home programme with a multidisciplinary team
Authors: Ruest Michel , Stitchman Amber , Day Chris 
Published: May 2014

Introduction Collaboration of emergency medical services and community organisations such as primary health care providers, social service agencies, and public safety groups can enable innovative initiatives that have the potential to improve the level of health care within a community and reduce health care system pressures. The purpose of this research is to evaluate the impact of an ‘aging at home’ program that uses an integrated health care team involving community paramedics on 911 calls. Methods This study involved a retrospective case series involving a chart review of clients participating in the ‘Aging at Home’ program located in a rural community in Ontario between January 1 2010 and April 30 2011. Each record was evaluated for the presenting problem and whether transport to a local hospital emergency department was initiated by using 911. Results Of the 129 client interactions by community paramedics and personal support workers, 13 chief complaint categories were determined and 15 incidents resulted in emergency department visits by using 911. Conclusion The use of community paramedics in an integrated health care team aimed at supporting clients living at home demonstrates a negative correlation in the use of 911 calls.
Which paediatric weight formula is best suited for the out-of-hospital field?
Authors: Winship Christian , Williams Brett , Boyle Malcolm 
Published: May 2014

Background: Weight estimation in pre-hospital paediatric emergencies is often required for the calculation of drug dosages, fluid therapy and defibrillation. In the pre-hospital field the treatment of a patient needs to occur in a timely and accurate fashion, this necessity drives the need for an accurate weight estimation formula. The objective of this study was to identify a paediatric weight estimation formula relevant to the pre-hospital field. Methods: A literature review was undertaken using a variety of electronic medical databases from their commencement date until the end of May 2012. Keywords used in the search included: Weight estimation, drug calculations, pediatric, paediatric, EMS, EMT, paramedic, emergency medical service, emergency medical technician, pre-hospital, out-of-hospital and ambulance. The keywords were used individually and in combination. The inclusion criterion was any study type that described the development or evaluation of a paediatric weight calculation in the pre-hospital or hospital setting. Findings: There were 635 articles located with 25 meeting the inclusion criteria. The commonly used APLS weight estimation formula significantly underestimates a child's weight. The best guess formula appears to be more accurate at estimating the weight; however more research needs to be conducted to validate this method for the pre-hospital field. Conclusion: As the average weight of children increases, the accuracy of weight estimation formulas decreases, suggesting that these methods will be unable to sufficiently adjust to deal with future rises in average weights of children. Further research is required to determine the most appropriate formula for paramedics to use in the pre-hospital setting.
ED staff knowledge and attitudes towards the paramedic profession in Israel
Authors: Wacht Oren , Dopelt Keren , Schwartz Dagan , Goldeberg Avishay , Aharonson-Daniel Limor , Davidovitch Nadav 
Published: May 2014

Objective: To examine the level of knowledge and attitudes of emergency department (ED) personnel towards the paramedic profession in Israel, and to examine opinions of the ED staff regarding integration of paramedics into the ED work staff. Study design: Cross-sectional survey conducted among health care workers. Sample and setting: The research population was physicians and nurses in four level 1 hospitals in Israel. The sample population includes 92 physicians (approximately 61%) and 102 nurses (approximately 34%). Methods: The questionnaire, distributed from November 2011 to February 2012, was composed of five parts: demographics, questions examining interactions with paramedics, knowledge about the paramedics’ work, their assessment of paramedics’ skills, and their attitudes about expanding the paramedic's scope of practice. The questionnaire was sent to 150 personal emails of ED staff members (physicians and nurses). 68 additional questionnaires were filled in EDs. Results: About one fifth of the physicians (21.7%) reported encountering a paramedic on a daily basis, while 87.3% of the nurses reported encountering a paramedic on a daily basis. 72% of the physicians and 77.5% of the nurses knew how to distinguish between a paramedic and a basic or intermediate EMT based on differences in their uniforms. Only 31.5% of the physicians and 43.1% of the nurses knew that the majority of MICUs (Mobile Intensive Care Unit) in Israel have no physician on board. Most physicians and nurses had a high degree of knowledge of the scope of practice of paramedics and a high regard for their clinical skills. Although both physicians and nurses agreed that paramedics can expand their scope of practice to EDs, physicians supported such a measure more than nurses.
Providing feedback on clinical performance to student nurses in children’s nursing: challenges facing preceptors
Authors: Clynes Mary 
Published: May 2014

While the importance of providing feedback to student nurses on clinical practice is widely acknowledged, there appears to be inconsistency in the amount, type and timing of feedback they receive (Cahill, 1996; Pertab, 1999; Glover, 2000; Gray and Smith, 2000; Raftery, 2001). However, little is known of preceptors/mentors’ experiences of providing feedback and the challenges they face in this area. This study explores preceptors’ experiences of giving feedback to student nurses undertaking a post-registration programme in children’s nursing. Data were collected from ten preceptors using semi-structured interviews. Thematic content analysis was carried out. The main themes that emerged from the data related to the provision of negative feedback and the factors that may inhibit the provision of feedback. Preceptors described challenges in terms of providing negative feedback, both oral and written and maintaining student relationships. A number of factors such as insufficient student contact time, busy wards and inadequate preparation for the role were viewed as inhibiting the feedback process.
A systematic review of laser therapy for venous leg ulcers
Authors: Flemming K.A. , Cullum N.A. , Nelson E.A. 
Published: May 2014

A systematic review of randomised controlled trials (RCTs) was conducted to establish the effectiveness of low-level laser therapy as a treatment for venous leg ulcers. Wound-care journals, conference proceedings and electronic databases (including Medline and Cinahl) were searched up to October 1997 for RCTs comparing low-level laser therapy with sham laser, no laser, or non-coherent light of other wavelengths. In addition, companies who manufacture or distribute therapeutic lasers were contacted for any unpublished or ongoing studies. Results from searches were scrutinised by one reviewer to identify possible RCTs and full reports of these were obtained. Details of eligible studies were extracted and summarised using a data extraction sheet. Data extraction was checked by a second reviewer. Meta-analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar. A total of four eligible RCTs were identified. Two compared treatment with laser therapy to sham or placebo laser treatment. One study compared laser therapy with ultraviolet therapy. The fourth was a three-armed study which compared the effects of laser therapy alone, laser therapy plus infrared light, and non-coherent unpolarised red light. The comparisons of laser therapy with placebo, and laser therapy with ultraviolet therapy, showed no significant difference between treatments with regard to ulcer healing rates. The comparison of laser with red light showed a significant increase in complete healing at nine months for the combination of laser and infrared light compared to non-coherent unpolarised red light. We have not found any evidence of the benefit of low-level laser therapy per se on venous leg ulcer healing. It appears that a combination of HeNe laser and infrared light may promote the healing of venous ulcers, however more research is needed.
A follow-up study of leg ulcer patients in South Stockholm
Authors: Ebbeskog B. , Lindholm C. , Grauers M. , Öhman S. 
Published: May 2014

The objective of this study was to follow up patients with leg ulcers, previously identified in an epidemiological study in South Stockholm. Rate of healing, non-healing, recurrence, amputation and mortality were recorded. A total of 254 patients were identified for follow-up after 18 months, using a questionnaire; at the time of the follow-up study, 61% of the ulcers were healed, 29% of the patients still had open ulcers, and 8% of the ulcers had recurred after healing. During this period, 20% of the patients had died, with arterial disease (39%) being more common than venous insufficiency.A further objective was to investigate 21 patients with non-healed venous leg ulcers by means of a structured assessment instrument, and to study if wound healing could be encouraged by using a triple-layer bandage for three months. Patients with non-healed venous leg ulcers treated in community care were recruited for assessment by means of a standardised form and given a triple-layer bandaging treatment for a three-month period. Two ulcers had healed and nine ulcers had improved and were healing. In the group of patients with healed or improved ulcers, five had normal mobility. Venous aetiology was also more common than arterial aetiology
The structure and composition of chronic wound eschar
Authors: Thomas A.M.L. , Harding K.G. , Moore K. 
Published: May 2014

Wounds with a covering of eschar require debridement before optimal wound healing can proceed. There are several different methods available but these have been derived empirically with no direct evidence of the structure or composition of the tissue they are designed to remove, or of the potential autolytic mechanisms which are the targets for some of these treatments. The aim of this study therefore was to determine the composition of chronic wound eschar and hence identify potential targets for the induction of autolytic debridement. Chronic wound eschar was removed by surgical debridement and analysed using immunohistochemistry, polyacrylamide gel electrophoresis (PAGE) and gelatin zymography. Immunohistochemistry using antibodies specific for extracellular matrix (ECM) proteins revealed a definite tissue structure, consisting of many fibrous regions and fine fibrillar elements separated by areas of tissue which were of a more irregular and amorphous nature. An antibody specific for all leucocytes revealed the presence of leucocytes in the region of tissue closest to the wound bed. The presence of this leucocyte population correlated to elevated levels of gelatinase activity as identified by gelatin zymography. PAGE analysis identified various protein species in the range 3.5-60 kDa molecular weight. These data indicate that wound debridement is likely to require multiple enzyme specificities to degrade the eschar and that these enzymes may be supplied by inflammatory leucocytes infiltrating the eschar from the wound bed. The various protein species demonstrated by PAGE may represent ECM proteins, those with lower molecular weight possibly representing the degradation products of autolytic debridement.
Nutritional intake in community patients with pressure ulcers
Authors: Green S.M. , Winterberg H. , Franks P.J. , Moffatt C.J. , Eberhardie C. , McLaren S. 
Published: May 2014

Nutritional status has been associated with the development and healing of pressure ulcers. This study aimed to examine the dietary intake of adults who had pressure ulcers (n = 75) and a control group with no pressure ulcers (n = 100), randomly selected from those receiving treatment from community nurses. All participants were considered to be at risk of developing pressure damage. Dietary intake was assessed using a 24-hour recall method (completed by 84 participants) and a nutritional questionnaire (completed by all 175 participants). The mean age of participants was 79 ± 6 years and 70% were women. Patients who had pressure ulcers had a lower energy intake (mean difference -185kcal, 95% confidence interval −413 to 43) and intake of protein (mean difference −6.73g/day, 95% CI -16.20 to 2.74) but neither factor achieved a standard level of statistical signifiance. However, when protein was categorised into quartiles, a significantly higher proportion of participants with low intake had pressure ulcers on chi-squared analysis (p = 0.043). More participants who had pressure ulcers required assistance with eating (odds ratio 4.55, 95% CI 1.53 to 13.54) and more had experienced recent taste changes (odds ratio 3.28, 95% CI 1.19 to 9.10). While these differences were significant, there were few major differences between those who had pressure ulcers and the control group. A number of participants in both groups had poor nutritional intake and other risk factors for malnutrition were also found. Poor nutrition is a problem for all patients receiving community nursing care, not just those with pressure ulceration. Due to acknowledged difficulties in recording nutritional intake in elderly patients, further assessment of dietary intake in those receiving community nursing services should be undertaken to support these results.