Medicine and Health Sciences Commons^™

Evidence-Based Practice Approach Over Three Visits In The Management Of A Patient With Tibio-Femoral Osteoarthritis: A Case Study, Sjaan R. Gomersall, Maureen P. Mcevoy

Internet Journal of Allied Health Sciences and Practice

Supervised training is essential for developing an evidence-based practice (EBP) approach for future health care clinicians. While the skills associated with asking a research question, accessing databases for best research evidence (BRE), and appraising this evidence can be taught in the classroom, the day-to-day application into patient management needs to be taught, and there is a lack of best practice models for this. This case study of a patient with osteoarthritis of the knee demonstrates over a series of three clinic visits how EBP can be used as a framework for guiding assessment and management from the perspective of a …

What Education Do Stroke Patients Receive In Australian Hospitals?, Tammy Hoffmann, Tammy Cochrane

Tammy Hoffmann

Objective: This study evaluated the educational practices of staff working in acute stroke wards in Australian hospitals, including the coordination and methods of patient education provision, postdischarge education and support services available, and the education and support services that health professionals would like to provide.

Methods: Health professionals who worked in acute stroke wards in Australian hospitals were surveyed about the stroke education practices of staff in their ward. Thirty-four hospitals returned a completed questionnaire via email or fax.

Results: Verbal communication and written materials were the most frequently used methods of information provision. Twenty-three (67.6%) wards developed their own …

What Is Complementary And Alternative Medicine, Michael Weir

Michael Weir

This chapter provides a definition of Complementary and Alternative Medicine and Orthodox Medicine and deals with the fundamental criteria at the basis of the CAM healing philosophy. The current usage of CAM and its philosophy sets the scene for the conflicts with OM discussed in later chapters.

Impact Of Obesity On Perioperative Morbidity And Mortality Following Pancreaticoduodenectomy, Timothy K. Williams, Ernest L. Rosato, Eugune P. Kennedy, Karen A. Chojnacki, Jocelyn Andrel, Terry Hyslop, Cataldo Doria, Patricia K. Sauter, Jordan Bloom, Charles J. Yeo, Adam C. Berger

Department of Surgery Faculty Papers

Background: Obesity has been implicated as a risk factor for perioperative and postoperative complications. The aim of this study was determine the impact of obesity on morbidity and mortality in patients undergoing pancreaticoduodenectomy (PD).

Study Design: Between January 2000 and July 2007, 262 patients underwent PD at Thomas Jefferson University Hospital (TJUH), of whom 240 had complete data, including body mass index (BMI) for analysis. Data on BMI, preoperative parameters, operative details, and post-operative course were collected. Patients were categorized as obese (BMI >30 kg/m2), overweight (25≤BMI<30), or normal weight (BMI<25). Complications were graded according to previous published scales. Other endpoints included length of postoperative hospital stay, blood loss, and operative duration. Analyses were performed using univariate and multivariable models.

Results: There were 103 (42.9%) normal weight, 71 (29.6%) overweight and 66 (27.5%) …

Massage Therapy: Your Immune System May Knead It, Julia E. Reid

Quill & Scope

Massage therapy has been shown to enhance immune system function through both physical and psychological mechanisms. Massage therapy physically increases lymph circulation and white blood cell distribution. Psychologically, it reduces stress hormone levels thereby disinhibiting proper immune system function. Appreciation for these positive clinical effects could allow massage therapy to be more widely accepted as a complementary medical treatment for many diseases.

Handbook On Sensitive Practice For Health Care Practitioners: Lessons From Adult Survivors Of Childhood Sexual Abuse, Candice L. Schachter, Carol Stalker, Eli Teram, Gerri C. Lasiuk, Alanna Danilkewich

Lyle S. Hallman Social Work Faculty Publications

This handbook is the culmination of a multiphase, multidisciplinary research project that used grounded theory and participatory action research to illuminate ways that healthcare providers can work sensitively (in a trauma-informed way) with adult survivors of childhood sexual abuse.

The research identified nine Principles of Sensitive Practice: respect, rapport, taking time, sharing information and control, respecting boundaries, fostering mutual learning, understanding non-linear healing and demonstrating an understanding of trauma to patients. Specific guidelines were developed for a wide variety of issues pertinent to clinical practice such as, removal of clothing, touch, responding to disclosures of abuse, managing triggers among others. …

Use Of Aquatic Therapy/Core Stabilization And A Multi-Disciplinary Treatment For A Patient With Chronic Low Back Pain: A Case Report, Jesse Elis

Physical Therapy Scholarly Projects

Background and Purpose: This case report describes the use of two different conservative treatment approaches on a patient suffering from chronic nonspecific low back pain. The case report illustrates the difference between aquatic therapy/core stabilization, which focuses on the biological aspect of the injury, and multi-disciplinary treatment, which treats the injury on a biopsychosocial level.

Case description: The patient was a 32-year old man that suffered two disc herniations from lifting a large box at work. After the injury, the patient received conservative treatments 3 months prior to this specific case report. Neurological deficits were present and the patient had …

Outpatient Physical Therapy Management Of A Patient Who Is Status Post Right Lunate: Open Reduction Internal Fixation With Hardware Removal: A Case Report, Jaime Garness

Physical Therapy Scholarly Projects

Background and Purpose: This case report follows a 20 year old male through his five week out patient rehabilitation for an open reduction internal fixation (ORIF) pinning of his right lunate and subsequent hardware removal following a motor vehicle accident. The patient presented with pain, decreased strength and range of motion of his right wrist. A deficit was also identified in his right shoulder stemming from decreased use of his right upper extremity. The reason for this case study is to look into benefits of physical therapy interventions as well as their functional outcomes.

Interventions: Patient warmed up on …

The Self Reported Aggravating Activities Of Chronic Non Specific Low Back Pain Patients Do Not Demonstrate A Consistent Directional Pattern: An Observational Study, Benedict M. Wand, Rebecca Hunter, Neil E. O'Connell, Louise Marston, James Mcauley

Health Sciences Papers and Journal Articles

Question: Do the self-reported aggravating activities of chronic non-specific low back pain patients demonstrate a consistent directional pattern?

Design: Cross-sectional observational study. Participants: 240 chronic non specific low back pain patients.

Outcome measure: We invited experienced clinicians to classify each of the three self-nominated aggravating activities from the Patient Specific Functional Scale by the direction of lumbar spine movement. Patients were described as demonstrating a directional pattern if all nominated activities moved the spine into the same direction. Analyses were undertaken to determine if the proportion of patients demonstrating a directional pattern was greater than would be expected by chance. …

Predicting Outcome In Acute Low Back Pain Using Different Models Of Patient Profiling, Benedict M. Wand, James H. Mcauley, Louise Marston, Lorraine H. De Souza

Health Sciences Papers and Journal Articles

Study Design: Prospective observational study of prognostic indicators, utilising data from a randomised, controlled trial of physiotherapy care of acute low back pain (ALBP) with follow up at 6 weeks, 3 months and 6 months.

Objective: To evaluate which patient profile offers the most useful guide to long-term outcome in ALBP.

Summary of Background Data: The evidence used to inform prognostic decision-making is derived largely from studies where baseline data is used to predict future status. Clinicians often see patients on multiple occasions so may profile patients in a variety of ways. It is worth considering if better prognostic decisions …

Cortical Training In The Management Of Acute Upper Limb Burns: A Pilot Randomised Controlled Trial, L M. Zorzi, D Edgar, Benedict M. Wand, F Wood

Health Sciences Conference Papers

The aim of this study is to examine the feasibility, safety and efficacy of a prophylactic cortical training programme in patients with an acute upper limb burn.

A randomised controlled pilot study is being carried out at the Royal Perth Hospital (RPH) Telstra Burns Outpatient Department. Subjects who have sustained isolated upper limb burns and presented to RPH within seven days of injury are randomised into experimental or control groups.

Subjects in the control condition receive usual physiotherapy care for four weeks; those in the experimental group receive usual care and the addition of a cortical training programme which includes …

Tactile Thresholds Are Preserved Yet Cortical Sensory Function Is Impaired In Chronic Non-Specific Low Back Pain Patients, Benedict M. Wand, Flavia S. Di Pietro, Pamela George, Neil E. O’Connell

Health Sciences Conference Papers

Introduction: A substantial amount of evidence points to an alteration in brain structure and function patients with chronic non-specific low back pain (CNSLBP) [1-6]. One interpretation of these findings is that the observed brain changes may represent a disruption of the brain’s representations of the body part and the resultant body perception disturbance may underpin this clinical problem. The current study aimed to investigate sensory dysfunction in CNSLBP. Specifically we aimed to distinguish cortically mediated sensory dysfunction from peripheral dysfunction by comparing simple tactile thresholds with more complex cortically mediated sensory tests

Methods: We investigated tactile thresholds (TTH), two point …

Respiratory-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Introduction

Spinal cord injury can affect normal breathing. The level of your injury will determine the effect it will have. It can be different for everyone. For example, the higher the level of your injury, the more complications you may face. Good pulmonary care can assist in keeping you healthy after your spinal cord injury.

Normal

The process of breathing (or respiration) is a two-step process: taking in air (inspiration) and exhaling the waste products. The process of taking in air (inhalation) is an active process, requiring the use of many muscles, while the process of exhaling is a passive …

Looking Inside The Black Box Of Community Rehabilitation And Intermediate Care Teams In The United Kingdom: An Audit Of Service And Staffing Configuration, Susan Nancarrow, Anna Moran, Jenny Freeman, Pamela Enderby, Simon Dixon, Stuart Parker, Mike Bradburn

Susan Nancarrow

OBJECTIVE:To generate a picture of the range, configuration and staffing of community and intermediate care services in the United Kingdom (UK) and to ascertain whether any relationships exist between service configuration and staffing models.METHOD:A service audit tool was sent to members of the Community Therapist's Network (CTN) and to chief executives of primary care and National Health Service trusts in the UK. Data were collected from the CTN and chief executives of primary care trusts (PCTs) and NHS trusts between late 2005 and early 2006.RESULTS:The overall response rate to the two audits was 37% (n …

Videoing As A Teaching And Learning Tool In An Undergraduate Nursing Curriculum, Selma Alliex, Karen Clark-Burg, Annie Das

Nursing Conference Papers

This conference addressed a range of critically important themes related to nursing education. It was designed to bring together nursing educators from across the globe, who are proactive in providing innovative educational practice to meet the changing needs of nursing; nursing students and healthcare personnel.

A Randomized Trial Comparing Digital Video Disc With Written Delivery Of Falls Prevention Education For Older Patients In Hospital, Anne-Marie Hill, Steven Mcphail, Tammy Hoffman, Keith Hill, David Oliver, Christopher Beer, Sandra Brauer, Terry P. Haines

Physiotherapy Papers and Journal Articles

Objectives: To compare the effectiveness of a digital video disc (DVD) with that of a written workbook delivering falls prevention education to older hospital patients on self-perceived risk of falls, perception of falls epidemiology, knowledge of prevention strategies, and motivation and confidence to engage in self-protective strategies. To compare the effect of receiving either education approach versus no education on patients' perception of falls epidemiology.

Design: Randomized trial (DVD vs workbook) with additional quasi-experimental control group.

Settings: Geriatric, medical, and orthopedic wards in Perth and Brisbane, Australia.

Participants: One hundred (n=51 DVD, n=49 workbook) hospital inpatients aged 60 and older …

A Return To Running Program For The Postpartum Client: A Case Report, Jason Brumitt

Faculty Publications - College of Physical Therapy

The purpose of this case report is to present a return to running program for a postpartum client who had delivered via cesarean section. The client, a 29-year-old female health care professional who was 8 months postcesarean section, was referred to physical therapy for a return to running exercise program. The client had three live births during a 30-month time period (February 2004 to August 2006). During her last labor she underwent an emergency cesarean section because of a low fetal heart rate. Since her surgery the client had not participated in an exercise routine. Following an 8-week training program …

Clinical Report: Land-Based Versus Pool-Based Exercise For People Awaiting Joint Replacement Surgery Of The Hip Or Knee: Results Of A Randomized Controlled Trial, C. Rudisile-Smith, M. Loosli, J. Brumitt

Faculty Publications - College of Physical Therapy

Background: Individuals with either knee or hip osteoarthritis are at risk of experiencing pain and developing functional limitations (Bennell 2005). In many cases, to alleviate pain and improve one's quality of life, an individual may require a total joint replacement. Despite advances in surgical technique and joint replacement hardware, surgical procedures are not without risk. Conservative treatments, including therapeutic exercise programmes, may improve a patient's status while avoiding the potential risks associated with surgery (pain, medication utilisation, long bouts of rehabilitation, and/ or death). Researchers have demonstrated that some patients may experience improvements in pain and functional abilities after participating …

Atp Release During Cystometry In Women With Detrusor Overactivity And Painful Bladder Syndrome: Contribution To 'Urgency'?, Elizabeth Burcher, Kylie J. Mansfield, W Allan, C Walsh, Kate H. Moore, Ying Cheng

Graduate School of Medicine - Papers (Archive)

ATP is an important signalling molecule whose release from the bladder urothelium in response to stretch is thought to stimulate afferent nerves and thus convey information about bladder fullness (and the sensation of urgency). Our aim was to measure the release of ATP during urodynamic filling of bladders of women with idiopathic detrusor overactivity (DO), painful bladder syndrome (PBS) and stress incontinence (controls), in order to test the hypothesis that ATP release might play a role in bladder function and/or dysfunction.

Transforming Higher Education Through Learning-Oriented Assessment, Mike Keppell, Dominique Parrish

Faculty of Science, Medicine and Health - Papers: part A

Outcomes By the completion of the workshop participants will be able to: • Recognise the distinct characteristics of a learning-oriented assessment task • Determine the appropriateness of learning-oriented assessment for their own context • Design a learning-oriented assessment task for a subject they are currently teaching • Examine a model for transforming and leading change in higher education through learning-oriented assessment • Explore potential avenues for transforming and leading change in assessment in the university setting.

Increasing Capacity For Knowledge Translation: Understanding How Some Researchers Engage Policy-Makers, Anita Kothari, Lynne Mclean, Nancy Edwards

Health Studies Publications

The potential for research to influence policy, and for researchers to influence policy actors, is significant. The purpose of this qualitative study was to explore the experiences of health services researchers engaging in (or not able to engage in) policy-relevant research. Semi-structured telephone interviews were completed with 23 experienced researchers.The results paint a complex and dynamic picture of the policy environment and the relationship between government officials and academic researchers. Elements of this complexity included diverse understandings of the nature of policy and how research relates to policy; dealing with multiple stakeholders in the policy-making process; and identifying strategies to …

Table Of Contents-Spinal Cord Injury Manual, Thomas Jefferson University Hospital And Magee Rehabilitation

Spinal Cord Injury Manual (English)

Table of Contents for entire Spinal Cord Injury Manual.

(31 pages, 445Kb)

Perinatal Risk Factors For Developmental Coordination Disorder, Beth P. Hands, Garth Kendall, Dawne Larkin, Elizabeth Rose, Helen Parker

Health Sciences Papers and Journal Articles

The aetiology of mild motor disability (MMD) is a complex issue and as yet is poorly understood. The aim of this study was to identify the prevalence of perinatal risk factors in a cohort of 10-year-old boys and girls with (n = 362) and without (n = 1193) MMD. Among the males with MMD there was a higher prevalence of postpartum haemorrhage, caesarean section, low birth weight and stressful first year of life. Among the females with MMD, there was a higher prevalence of essential hypertension, anaemia, and threatened pre-term. Multivariable logistic regression revealed gender (male), anaemia, threatened pre-term birth …

Improving The Outcome Of Infants Born At <30 Weeks' Gestation - A Randomized Controlled Trial Of Preventative Care At Home, Alicia J. Spittle, Carmel Ferretti, Peter J. Anderson, Jane Orton, Abbey Eeles, Lisa Bates, Roslyn N. Boyd, Terrie E. Inder, Lex W. Doyle

Open Access Publications

No abstract provided.

Acute Physical Therapy Management Of Pediatric Patient With Traumatic Brain Injury, Michelle Holt

Physical Therapy Scholarly Projects

Background and Purpose: Traumatic brain injury can cause many deficits including decreased balance and coordination. The purpose of this case report is to describe the interventions used and subsequent outcomes for a pediatric patient following traumatic brain injury in the acute care setting. Also, this case report serves to describe the methods and tools used in a hospital that is not equipped with pediatric-specific equipment or utilities.

Case Description: This paper describes the four-day inpatient physical therapy management of a six-year-old female who fell from a horse and sustained a left open depressed frontal skull fracture with an underlying subdural …

Status Post Rotator Cuff Repair With Interrupted Therapy And Comorbidities: A Case Report, Whitney Lesnau

Physical Therapy Scholarly Projects

Background & Purpose: The purpose of this case study is to describe the plan of care that was completed despite interruption from multiple complications. Interrupted therapy has not been explored in research even though it is something physical therapists encounter often.

Case Description: This 45-year-old patient went through a right rotator cuff repair surgery followed by physical therapy to regain functional use of her shoulder. Her therapy was interrupted twice; first by her mother’s heart condition and then by her own neurological condition.

Intervention: The main component of treatment with this patient was range of motion exercises including passive, active-assistive, …

Provision Of Health Care Services In Canada: Challenges And Opportunities, Rosa Rodriguez-Monguio, Enrique Seoane-Vazquez, Fernando Antoñanzas Villar

Pharmacy Faculty Articles and Research

The Canadian health care system provides comprehensive coverage of hospital and outpatient care, including therapeutic, diagnostic and preventive services. The level of coverage of services varies across the country. This study examines the key characteristics of the Canadian health and long-term care systems; presents a structured analysis of the insurance, financing and provision of health and long-term care services in Canada; describes the main challenges of the Canadian health and long-term care systems; and concludes with feasible opportunities for the Canadian health policy.

Main challenges to the Canadian system are related to population ageing; prevalence of avoidable diseases caused by …

Associations Between Low Back Pain, Disability, Functional Status, And Serum Interleukin-1 \Beta Level, Ali̇ Aydeni̇z, Teki̇n Karsligi̇l, Savaş Gürsoy

Turkish Journal of Medical Sciences

Aim: In the past the role of biochemical mediators of inflammation in back pain received little attention. The purpose of the present study was to examine the association between serum IL-1 \beta level in patients with low back pain (LBP) and its effect on their functional status. Methods: This cross-sectional study included 88 LBP patients with symptom duration of 6 months or longer and 65 healthy controls. Serum analysis was performed using ELISA. The LBP group completed the Roland-Morris Disability Questionnaire and Oswestry Disability Index in order to evaluate their functional status. Results: Mean IL-1 \beta level was significantly higher …

Hospice Africa Uganda: End-Of-Project Evaluation Of Palliative Care Services, Annette Bongiovanni, Mary Alexis Greenan

HIV and AIDS

Hospice Africa Uganda (HAU) is a nongovernmental organization that provides palliative care services to people living with HIV/AIDS (PHA) and cancer. Based in Kampala, HAU aims to scale-up palliative care within and beyond the nation’s borders. From 2005–08, HAU sought to achieve the following objectives: 1) Increase coverage and scope of palliative care services available to PHA and their families; 2) Train health workers and other HIV/AIDS care providers to integrate pain management, symptom control, and end-of-life care into their existing HIV/AIDS support programs; 3) Build the capacity of families, communities, and community-based organizations in palliative care provision; 4) Integrate …

Media Reporting Of Health Interventions: Signs Of Improvement, But Major Problems Persist, Amanda J. Wilson, Billie Bonevski, Alison L. Jones, David Henry

Graduate School of Medicine - Papers (Archive)

Background: Studies have persistently shown deficiencies in medical reporting by the mainstream media. We have been monitoring the accuracy and comprehensiveness of medical news reporting in Australia since mid 2004. This analysis of more than 1200 stories in the Australian media compares different types of media outlets and examines reporting trends over time.

Methods and Findings: Between March 2004 and June 2008 1230 news stories were rated on a national medical news monitoring web site, Media Doctor Australia. These covered a variety of health interventions ranging from drugs, diagnostic tests and surgery to dietary and complementary therapies. Each story was …