bluuebunny/crossref_metadata_2025_split huggingface dataset:
Six-minute walk test in adults with cerebral palsy. A study of reliability
Authors: Andersson Christina , Asztalos Lena , Mattsson Eva 
Published: May 2006

Objective: To determine the reliability of a six-minute walk test in adults with cerebral palsy. Design: Four repeated walk tests during two weeks. Setting: The tests were conducted in a 40-m-long corridor at a rehabilitation centre for outpatients. Subjects: Twenty-five adults (9 women and 16 men) with CP. Mean age 36 (26 58) years. Twelve subjects walked with walking aids and 13 without. Interventions: No intervention. Measures: The subjects were instructed to walk as far as possible for 6 min. The distance walked, heart rate and perceived exertion were assessed. Results: Mean distances walked by the subjects in the four tests were 316, 336, 341 and 345 m. The repeatability between test 1 and the other tests was 66 m, and when the first walk test was excluded 40 m. The coefficient of variation (CV) between test 1 and the other tests varied between 7.1 and 8.7%, and when the first walk test was excluded between 3.7 and 4.5%. Intraclass correlation (ICC 1.1) was 0.97 in the four tests, and when the first walk test was excluded 0.99. Walking distance was longer ( P<0.01) and varied less in subjects walking without walking aids ( n=13) compared with subjects using walking aids ( n=12). Conclusions: Six-minute walk test showed high reliability, with a repeatability of 40 m. One practice test is recommended, as the walking distance in the first test was significantly shorter (P B=0.01) than the other three tests.
The effect of rehabilitation service use on coping patterns over time among older adults with age-related vision loss
Authors: Boerner Kathrin , Reinhardt Joann P , Horowitz Amy 
Published: May 2006

Objective: To enhance our understanding of coping and rehabilitation in the context of adaptation to disability by examining how coping may change over a two-year time period, and how different vision rehabilitation services may affect coping over time. Design: Longitudinal two-wave study (baseline and two-year follow-up). Setting: Vision rehabilitation agency. Subjects: Older adults with visual impairment. Method: In-person interviews using structured assessments of functional vision loss and functional disability, rehabilitation service use and coping strategies. Results: Ninety-five people participated in both study waves. Findings showed change in patterns of coping over the two-year period of the study, as participants adjusted to living with age-related vision loss. Although instrumental coping was the only coping mode with evidence for average change (a decrease), affective and escape/distraction strategies showed individual variation in change over time. Rehabilitation use explained variance in coping at time 2 over and above impairment status and coping at time 1. Those who used a greater number of assistive aids between time points were likely to report more instrumental coping at time 2, and those who used counselling between time points were likely to report more affective coping at the two-year follow-up. Finally, those who used more optical aids were likely to report more escape/distraction coping at time 2, whereas those who saw a low vision specialist tended to report less of this type of coping over time. Conclusions: Findings suggest that rehabilitation interventions can affect coping patterns over time, and that direction and magnitude of such an effect may depend on the type of rehabilitation received.
The relationship between depressive symptoms and shoulder mobility among older women: assessment at one year after breast cancer diagnosis
Authors: Caban Mabel E , Freeman Jean L , Zhang Dong D , Jansen Caroline , Ostir Glenn , Hatch Sandra S , Goodwin James S 
Published: May 2006

Objective: To examine the association between depressive symptoms and shoulder range of motion at one year after breast cancer diagnosis, controlling for patient characteristics, tumour stage and cancer therapy (surgery, axillary node dissection and radiation). Design: Prospective trial of nurse case management involving 187 older women with complete data, age 60 years and older, newly diagnosed with breast cancer, from 1 November, 1993 to 31 October, 1996 in south-eastern Texas. Depressive symptoms, sociodemographic characteristics and breast cancer treatment were measured at two months and shoulder range of motion at 12 months. The relationship among the variables was evaluated with bivariate chi-square statistics and logistic regression analysis. All logistic models also included a variable indicating whether or not the woman received nurse case management, to control for intervention status. Results: Increasing depressive symptoms at baseline were associated with lower arm mobility at 12 months following breast cancer diagnosis. Each unit increase in depressive symptoms at baseline was associated with an 8% decreased odds of having full range of motion of the shoulder (odds ratio (OR) 0.92, 95% confidence interval (CI) 0.87, 0.97), after controlling for relevant patient and treatment factors. Conclusion(s): Older women with depressive symptoms have an elevated risk of not fully recovering shoulder mobility after being treated for breast cancer. Future studies are needed to assess benefits from early intervention with psychological and or physical interventions in the presence of depressive symptoms on shoulder mobility.
Itermittent catheterization in the rehabilitation setting: a comparison of clean and sterile technique
Authors: Moore Katherine N , Burt Jean , Voaklander Donald C 
Published: May 2006

Objective: To compare the onset of symptomatic urinary tract infection in individuals with spinal cord injury in a rehabilitation setting who are randomized to clean or sterile intermittent catheterization technique. Design: Randomized controlled design. Setting: Spinal cord rehabilitation units in western Canada. Subjects: Thirty-six patients with cervical spinal cord injuries requiring intermittent catheterization by nursing staff were recruited. None had a previous history of voiding dysfunction or urinary tract infections. Interventions: Subjects were randomized to either clean or sterile intermittent catheterization technique. Protocols for both clean and sterile techniques were standardized and followed by nursing staff and caregivers. Main measures: Primary outcome measure was symptomatic urinary tract infection as diagnosed by urine culture ≥ 105 colony-forming units/mL, pyuria (≥ 10 leukocytes on high-power field), and accompanying symptoms. Results: A total of 189 urine specimens from 36 subjects were cultured. Of the 36 subjects, 15 (43%) developed a symptomatic urinary tract infection: 6/16 (37%) from the clean group; 9/20 (45%) from the sterile group (P>0.05). Mean time to onset for symptomatic urinary tract infection for the clean group was 3.0 (standard deviation (SD) 2.4) weeks and for the sterile group, 3.6 (SD 1.3) weeks (P>0.05). The most common urinary organisms at onset of symptomatic urinary tract infection were Enterococcus species followed by Klebsiella. Conclusion: Clean intermittent catheterization in the rehabilitation setting does not appear to place the patient with spinal cord injury at increased risk for developing symptomatic urinary tract infection, and has significant cost and time saving benefits for the health care system, as well as enhancing the transition for the patient from rehabilitation to community.
Family-centred services in the Netherlands: validating a self-report measure for paediatric service providers
Authors: Siebes Renate C , Ketelaar Marjolijn , Wijnroks Lex , van Schie Petra EM , Nijhuis Bianca JG , Vermeer Adri , Gorter Jan Willem 
Published: May 2006

Objective: To validate the Dutch translation of the Canadian Measure of Processes of Care for Service Providers questionnaire (MPOC-SP) for use in paediatric rehabilitation settings in the Netherlands. Design: The construct validity, content validity, face validity, and reliability of the Dutch MPOC-SP were determined. Subjects: The 163 service providers that participated in the validation study represented seven children's rehabilitation centres and affiliated schools in the Netherlands (overall response rate 55.6%). In this sample 19 disciplines were represented. Main measures: The MPOC-SP consists of 27 items (assessing four domains) and was designed to examine how service providers think about the quality of care they provide and to assess the extent to which these services are family centred. Fifty-three service providers filled out an additional face validity questionnaire. Results: All items correlated best and significantly with their own scale score (rs 0.48-0.82, P < 0.001). The Pearson's correlation coefficients were all significant and confirmed that the four scales measure different aspects of a same construct, namely family-centred service. The content validity and the face validity of the Dutch MPOC-SP were good, indicating the questionnaire measures relevant aspects of family-centred service delivery in paediatric rehabilitation settings in the Netherlands. The test-retest analyses (intraclass correlation coefficient (ICC) 0.83-0.89) and the internal consistency analyses (alpha 0.65-0.84) showed that the Dutch MPOC-SP is a reliable tool. Conclusions: The Dutch MPOC-SP is a reliable and valid instrument to measure the family-centredness of service delivery.
Dynamic interactions between impairment and activity after stroke: examining the utility of decision analysis methods
Authors: Skidmore Elizabeth R , Rogers Joan C , Chandler Lynette S , Holm Margo B 
Published: May 2006

Objective: To examine the utility of decision analysis methods for examining the dynamic nature of impairment-activity interactions following stroke. Design: Decision analyses (Chi-squared Automatic Interaction Detector) of a prospective cohort study. Setting: Community and institutional settings based on the location of participants three months after stroke. Participants: Individuals were recruited from consecutive admissions to a regional academic health center and were assessed three months after stroke (N=67). Main outcome measures: Neurological impairment was measured with the National Institutes of Health Stroke Scale (NIHSS). Mobility, self-care and instrumental activities of daily living (instrumental ADL) performance were assessed with a performance observation measure, the Performance Assessment of Self-care Skills (PASS). Decision analysis methods were used to examine interactions between neurological impairments and activity outcomes. Results: Unique neurological impairments were associated with each activity outcome (bowel and bladder urgency interacted with mobility; hand function interacted with self-care; mental functions interacted with instrumental ADL), and these findings are supported by previous studies. The predictive validity of mobility and self-care analyses was stronger than the instrumental ADL analyses. Conclusions: Decision analysis methods show promise for understanding dynamic impairment-activity interactions. This understanding may enhance methods for informing rehabilitation decisions.
Responsiveness of isokinetic dynamometry parameters, pain and activity level scores to evaluate changes in patients with capsulitis of the shoulder
Authors: van Meeteren J , Roebroeck M E , Selles R W , Stam H J 
Published: May 2006

Objective: To determine the responsiveness to change of isokinetic dynamometry of the shoulder and to compare this responsiveness with outcome measures of pain and activity level. Design: Responsiveness was evaluated as the change in outcome after intra articular steroid injection in patients with capsulitis of the shoulder. Effect sizes of all outcome measures, quantified as standardized response means, were compared. Relationships between change scores of shoulder function and activities were assessed. Subjects: Ten patients with unilateral capsulitis of the shoulder. Main outcome measures: Muscle strength and active range of motion were measured by isokinetic dynamometry. We then calculated involved/uninvolved ratios of the maximal peak torques of abduction, adduction, external and internal rotation, active range of motion of abduction and external rotation. In addition, pain was scored using the numeric rating scale (NRS-101) and activity level was scored using the Shoulder Disability Questionnaire. Results: The standardized response mean of all outcome parameters was equal to or greater than 0.8, except for active range of motion of abduction. No significant differences between the standardized response means were found. There is a significant correlation between the change scores of NRS-101 and Shoulder Disability Questionnaire. No significant correlations were found between the change scores of NRS-101 and Shoulder Disability Questionnaire on the one hand, and involved/uninvolved ratios of peak torques and active range of motion on the other. Conclusions: Responsiveness of all outcome measures is good. Parameters of isokinetic dynamometry may provide additional information as compared with the usual outcome measures of pain and functional level.
Attitudes to falls and injury prevention: what are the barriers to implementing falls prevention strategies?
Authors: Whitehead Craig H , Wundke Rachel , Crotty Maria 
Published: May 2006

Objectives: To ascertain the reasons for not taking up a fall or injury prevention strategy among older people who have sustained a fall and attended an emergency department. Subjects: As part of another trial, we identified 60 people who attended the emergency department of a public hospital with a fall. Main measures: Participants were interviewed to ascertain the reasons for not taking up a falls prevention strategy, their falls-related health state, and the likelihood of them undertaking a falls and injury prevention strategy. Results: A total of 31 (52%) of the participants had considered falls prevention after their fall. There were high levels of reluctance to undertake a strategy with 43 (72%) reluctant to take exercise classes, 10 (59%) reluctant to cease psychotropic medications, 26 (43%) reluctant to have a home safety assessment and 17 (28%) reluctant to take osteoporotic medication. When asked specifically about taking up a strategy to prevent a worsening health state, 19 (63%) of participants would take up exercise, 17 (57%) a home safety assessment, 4 of the 17 (59%) already taking implicated medications would stop and 56 (93%) would begin osteoporotic medication. These decisions did not alter when the goal for treatment was to improve a much worse health state. In participants with a lower starting health state, home safety assessments were viewed more favourably. Conclusions: There were significant obstacles to the implementation of most falls prevention guidelines examined. Treatment for osteoporosis was more acceptable to participants than exercise classes, cessation of psychotropic medication, and having a home safety assessment. Osteoporosis treatment, which had the least resistance, also had the least impact on the participants' lifestyle.
Evidence-based policy-making
Authors: Moore R. Andrew 
Published: May 2006

AbstractThere is no large literature on evidence-based policy-making. We do know that one of the most difficult decisions is about the dependability of evidence we use to make policy. Unless the evidence can fulfil the criteria of quality, validity, and size, then it has the potential to mislead us, whatever study designs or methods have been used. The best examples of evidence-based policy-making come from development of care pathways, in which multidisciplinary groups merge best-available evidence with what is possible in local circumstances. These care pathways almost always have the ability to deliver better care for patients, with less fuss for professionals and at lower cost to the community. They may be the single best way of improving healthcare.
Integration between the Tele-Cardiology Unit and the central laboratory: methodological and clinical evaluation of point-of-care testing cardiac marker in the ambulance
Authors: Di Serio Francesca , Lovero Roberto , Leone Massimo , De Sario Rosalia , Ruggieri Vincenzo , Varraso Lucia , Pansini Nicola 
Published: May 2006

AbstractThe aim of this study was to identify patients with myocardial necrosis in pre-hospital phase during transport by ambulance, without ST-segment elevation (NSTE) on the ambulance ECG. The analytical performance of the i-STAT
ISO 15189:2003 – Quality management, evaluation and continual improvement
Authors: Burnett David 
Published: May 2006

AbstractThe requirements of ISO 15189:2003 are discussed in the context of a process- and outcome-based quality management model in which the user's needs are the central focus. The requirements of ISO 15189:2003 are examined in terms of organisation and a quality management system, stressing the importance of evidence, document control, and control of records and clinical material. Examples are provided from the areas of resource management, and pre-examination, examination and post-examination processes. In the final section the importance of evaluation and continual improvement is presented in relation to internal audit and external assessment, non-conformity, corrective and preventative action and management review.
Clinical Governance: from clinical risk management to continuous quality improvement
Authors: Chiozza Maria Laura , Plebani Mario 
Published: May 2006

AbstractReducing medical errors has become an international concern. Population-based studies from a number of nations around the world have consistently demonstrated unacceptably high rates of medical injury and preventable deaths. The introduction of effective reporting systems is a cornerstone of safe practice within hospitals and other healthcare organisations. Reporting can help to identify hazards and risks. However, reporting in itself does not improve safety. It is the response to reports that leads to change. Clinical teams must feel empowered to change the way in which they deliver their services, promoting effective clinical risk management. Process analysis, implementation of evidence-based practices, and a clear accountability system are effective tools not only for decreasing error rates, but also for improving effectiveness. Clinical Governance represents the context in which effective clinical risk management should be promoted and continuously improved. It should not be regarded as a separate activity, but should form part of the everyday practice of all healthcare professionals. It requires good multidisciplinary working and a willingness to reflect on and learn from errors to achieve a patient-centred and safer system.
Clinical Governance – from rhetoric to reality?
Authors: Lugon Myriam 
Published: May 2006

AbstractAlthough Clinical Governance now has a strong structural base in the National Health Service (NHS), its actual application in terms of service delivery is more inconsistent. Cross-agency and boundary working are still underdeveloped and true patient involvement remains the province of a minority of enthusiasts. Despite this, there have been some significant moves forward, in that quality is now intrinsically linked to service delivery, and managers and clinicians are more explicitly accountable for the care they provide. This article examines the introduction of Clinical Governance to the NHS and discusses what practical applications have been made. Case studies drawn from those who are working at the frontline are used to illustrate the impact that Clinical Governance components have had on service delivery and patient experience.
Forschen für die Internetgesellschaft – Trends, Technologien, Anwendungen: Der Feldafinger Kreis (Research for the Internet Society: Trends, Technologies, Applications)
Authors: Raffler Hartmut , Wahlster Wolfgang 
Published: May 2006

Zusammenfassung
Der Feldafinger Kreis wurde durch eine Initiative von Repräsentanten der deutschen Wissenschaftsorganisationen und dem Bundesverband der deutschen Industrie (BDI) im August 2001 gegründet. Er hat sich zum Ziel gesetzt, den Dialog zwischen Wissenschaft und Wirtschaft auf dem Gebiet ‚Forschung für die Internetgesellschaft‘ zu intensivieren, die Internetforschung in Deutschland zu stimulieren und Impulse zu geben zur besseren Nutzung der Innovationspotenziale, die das Internet bietet.
Effizienz und Dienstgüte von IP Netzwerken (Efficiency and Quality of Service of IP Networks)
Authors: Heckmann Oliver 
Published: May 2006

Zusammenfassung
Effizienz und Dienstgüte sind zwei sehr wichtige Eigenschaften von IP Netzwerken. Aus der Sicht eines Internet Netzwerkbetreibers (engl.: Internet Service Provider, ISP) untersuchen wir in dieser Arbeit, wie man die Effizienz und Dienstgüte verbessern kann. Hierzu betrachten wir die Netzwerkarchitektur, die Interkonnektion und die Verkehrs- und Netzwerkanpassungsmaßnahmen (engl.: network & traffic engineering).
A 26-Week, Randomized, Parallel, Treat-to-Target Trial Comparing Insulin Detemir With NPH Insulin as Add-On Therapy to Oral Glucose-Lowering Drugs in Insulin-Naïve People With Type 2 Diabetes
Authors: Hermansen Kjeld , Davies Melanie , Derezinski Taudeusz , Martinez Ravn Gabrielle , Clauson Per , Home Philip ,   on behalf of the Levemir Treat-to-Target Study Group
Published: May 2006

OBJECTIVE—To assess efficacy and tolerability of insulin detemir or NPH insulin added to oral therapy for type 2 diabetes in a treat-to-target titration protocol.
RESEARCH DESIGN AND METHODS—Individuals (n = 476) with HbA1c (A1C) 7.5–10.0% were randomized to addition of twice-daily insulin detemir or NPH insulin in a parallel-group, multicenter trial. Over 24 weeks, insulin doses were titrated toward prebreakfast and predinner plasma glucose targets of ≤6.0 mmol/l (≤108 mg/dl). Outcomes assessed included A1C, percentage achieving A1C ≤7.0%, risk of hypoglycemia, and body weight.
RESULTS—At 24 weeks, A1C had decreased by 1.8 and 1.9% (from 8.6 to 6.8 and from 8.5 to 6.6%) for detemir and NPH, respectively (NS). In both groups, 70% of participants achieved an A1C ≤7.0%, but the proportion achieving this without hypoglycemia was higher with insulin detemir than with NPH insulin (26 vs. 16%, P = 0.008). Compared with NPH insulin, the risk for all hypoglycemia with insulin detemir was reduced by 47% (P &lt; 0.001) and nocturnal hypoglycemia by 55% (P &lt; 0.001). Mean weight gain was 1.2 kg with insulin detemir and 2.8 kg with NPH insulin (P &lt; 0.001), and the difference in baseline-adjusted final weight was −1.58 (P &lt; 0.001).
CONCLUSIONS—Addition of basal insulin to oral drug therapy in people with suboptimal control of type 2 diabetes achieves guideline-recommended A1C values in most people with aggressive titration. Insulin detemir compared with NPH insulin achieves this with reduced hypoglycemia and less weight gain.