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1.
Mahnaz Daman Farideh Shiravani Ladan Hemmati Shohreh Taghizadeh 《Journal of bodywork and movement therapies》2019,23(1):202-205
Objective
Proprioception, the perception of limb movements and spatial orientation derived from body stimuli, plays a critical role in maintaining joint stability. This study aimed to investigate the effect of combined exercise therapy (closed kinetic chain exercises and proprioception exercises) on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome.Design
Single-blind randomized clinical trial.Setting
Shiraz School of Rehabilitation Sciences.Participants
Twenty four patients with hypermobility syndrome.Interventions
The patients were assigned to the control (no intervention) or intervention group (exercise therapy) by random allocation.Measurements
Knee proprioception, pain intensity and quality of life were evaluated before and immediately after the intervention. Exercise sessions were held 3 days a week for 4 weeks.Results
The results showed that knee proprioception improved significantly in the intervention group compared to the control group. Quality of life increased, and knee pain intensity decreased significantly in the intervention group compared to the control group.Conclusion
Combined exercise therapy can reduce pain intensity and increase knee proprioception and quality of life in patients with hypermobility syndrome. 相似文献2.
Christian J. Dameff Jordan A. Selzer Jonathan Fisher James P. Killeen Jeffrey L. Tully 《The Journal of emergency medicine》2019,56(2):233-238
Background
Cybersecurity risks in health care systems have traditionally been measured in data breaches of protected health information, but compromised medical devices and critical medical infrastructure present risks of disruptions to patient care. The ubiquitous prevalence of connected medical devices and systems may be associated with an increase in these risks.Objective
This article details the development and execution of three novel high-fidelity clinical simulations designed to teach clinicians to recognize, treat, and prevent patient harm from vulnerable medical devices.Methods
Clinical simulations were developed that incorporated patient-care scenarios featuring hacked medical devices based on previously researched security vulnerabilities.Results
Clinicians did not recognize the etiology of simulated patient pathology as being the result of a compromised device.Conclusions
Simulation can be a useful tool in educating clinicians in this new, critically important patient-safety space. 相似文献3.
Background
Point-of-care ultrasonography (POCUS) is increasingly used for both diagnostic and guided procedures. Increasingly, POCUS has been used for identification of pneumonia and to assist in the differentiation of pleural effusions, as well as to guide thoracentesis. As such, there is a need for training with ideally high-fidelity lung ultrasound phantoms to ensure ultrasound proficiency and procedural competency. Unfortunately, most commercial ultrasound phantoms remain expensive and may have limited fidelity.Objective
Our aim was to create and describe a homemade, high-fidelity ultrasound phantom model for demonstrating pneumonia with pleural effusions for teaching purposes.Discussion
An ultrasound phantom was constructed using a water-filled latex glove with a sliver of meat in it, covered over by a palm-sized piece of meat (skin and ribs are optional to increase ultrasonographic details and realism). This would appear like parapneumonic effusions with organized pneumonia under ultrasound examination. Creamer (or talc) can be added to the water in the glove to simulate empyema. The model can also be used to teach simple effusions and for ultrasound-guided thoracentesis and in clinical decision making.Conclusions
Easily prepared, homemade high-fidelity ultrasound phantom models for instructions on identification of pleural effusions and ultrasound-guided pleural tap of parapneumonic effusion were made. 相似文献4.
Bryan Spinelli Michael J. Kallan Xiaochen Zhang Andrea Cheville Andrea Troxel Joy Cohn Lorraine Dean Kathleen Sturgeon Margaret Evangelista Zi Zhang David Ebaugh Kathryn H. Schmitz 《Archives of physical medicine and rehabilitation》2019,100(2):315-326
Objective
The goal of this study was to develop and assess intra- and interrater reliability and validity of a clinical evaluation tool for breast cancer–related lymphedema, for use in the context of outcome evaluation in clinical trials.Design
Blinded repeated measures observational study.Setting
Outpatient research laboratory.Participants
Breast cancer survivors with and without lymphedema (N=71).Interventions
Not applicable.Main Outcome Measure
The assessment of intraclass correlation coefficients (ICCs) for the Breast Cancer–Related Lymphedema of the Upper Extremity (CLUE) standardized clinical evaluation tool.Results
Intrarater reliability for the CLUE tool was ICC: 0.88 (95% confidence interval [95% CI], 0.71-0.96). Interrater reliability for the CLUE tool was ICC: 0.90 (95% CI, 0.79-0.95). Concurrent validity of the CLUE score (Pearson r) was 0.79 with perometric interlimb difference and 0.53 with the Norman lymphedema overall score.Conclusions
The CLUE tool shows excellent inter- and intrarater reliability. The overall CLUE score for the upper extremity also shows moderately strong concurrent validity with objective and subjective measures. This newly developed clinical, physical assessment of upper extremity lymphedema provides standardization and a single score that accounts for multiple constructs. Next steps include evaluation of sensitivity to change, which would establish usefulness to evaluate intervention efficacy. 相似文献5.
Shabana Yusuf Audrey C. Wassef Alan Schlesinger 《The Journal of emergency medicine》2019,56(4):e51-e54
Background
Urachal cysts are remnants of urachal ducts and usually present when they get infected or undergo malignant transformation.Case Report
A 4-year-old girl presented to the Emergency Department (ED) with intermittent abdominal pain, fever, dysuria, and umbilical swelling. She was diagnosed with an abscess related to an infected urachal cyst by ultrasound. The patient was treated with antibiotics, and the abscess was drained by Interventional Radiology with ultrasound guidance. She recovered uneventfully and was discharged home. The urachal cyst was excised a month later.Why Should an Emergency Physician Be Aware of This?
Though urachal cysts are rare, it is important to consider this entity in the differential diagnosis of acute abdomen and recurrent abdominal pain in the ED setting. 相似文献6.
7.
Objective
To assess whether robot-assisted reach training (RART) with an active assistant protocol can improve upper extremity function and kinematic performance in chronic stroke survivors.Design
This study was conducted as a randomized controlled trial.Setting
National rehabilitation center.Participants
Chronic stroke survivors (N=38) were randomized into 2 groups: a robot-assisted reach training with assist-as-needed (RT-AAN) group and a robot-assisted reach training with guidance force (RT-G) group.Intervention
The RT-AAN group received robot-assisted reach training with an assist-as-needed mode for 40 minutes per day, 3 times per week over a 6-week period, and the RT-G group participated in the RART with a guidance mode for 40 minutes per day, 3 times per week over a 6-week period.Main Outcome Measures
Upper extremity functions were measured with Fugl–Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box and Block Test. In addition, movement velocities were measured as an index for upper extremity kinematic performances in 6 directions.Results
Both groups showed significant improvements in FMA, ARAT, and kinematics (movement velocity) in all directions (targets 1-6, P<.05). However, the RT-AAN group showed significantly more improvement than the RT-G group in FMA and ARAT (P<.05).Conclusions
RART with an active assistant protocol showed improvements of upper extremity function and kinematic performance in chronic stroke survivors. In particular, assist-as-needed robot control was effective for upper extremity rehabilitation. Therefore robot-assisted training may be suggested as an effective intervention to improve upper extremity function in chronic stroke survivors. 相似文献8.
Samantha Backhaus Dawn Neumann Devan Parrott Flora M. Hammond Claire Brownson James Malec 《Archives of physical medicine and rehabilitation》2019,100(2):195-204.e1
Objectives
This study aimed to (1) examine the efficacy of a treatment to enhance a couple’s relationship after brain injury particularly in relationship satisfaction and communication; and (2) determine couples’ satisfaction with this type of intervention.Design
Randomized waitlist-controlled trial.Setting
Midwestern outpatient brain injury rehabilitation center.Participants
Participants (N=44; 22 persons with brain injury and their intimate partners) were randomized by couples to the intervention or waitlist-controlled group, with 11 couples in each group.Interventions
The Couples Caring and Relating with Empathy intervention is a 16-week, 2-hour, manualized small group treatment utilizing psychoeducation, affect recognition, empathy training, cognitive-behavioral and dialectical-behavioral strategies, communication skills training, and Gottman’s theoretical framework for couples adjusted for individuals with brain injury.Main Outcome Measures
The Dyadic Adjustment Scale, Quality of Marriage Index (QMI), and the Four Horsemen of the Apocalypse communication questionnaire were implemented. Measures were completed by the person with brain injury and that person’s partner at 3 time points: baseline, immediate postintervention, 3-month follow-up.Results
The experimental group showed significant improvement at posttest and follow-up on the Dyadic Adjustment Scale and the Horsemen questionnaire compared to baseline and to the waitlist-controlled group which showed no significant changes on these measures. No significant effects were observed on the QMI for either group. Satisfaction scores were largely favorable.Conclusions
Results suggest this intervention can improve couples’ dyadic adjustment and communication after brain injury. High satisfaction ratings suggest this small group intervention is feasible with couples following brain injury. Future directions for this intervention are discussed. 相似文献9.
Ma José Ariza-Mateos Irene Cabrera-Martos Araceli Ortiz-Rubio Irene Torres-Sánchez Janet Rodríguez-Torres Marie Carmen Valenza 《Archives of physical medicine and rehabilitation》2019,100(1):9-16
Objective
To explore the effects of a 6-week patient-centered graded exposure intervention added to manual therapy in women with chronic pelvic pain (CPP) and fear of movement/(re)injury.Design
Prospective 3-armed randomized controlled trial.Setting
Faculty of Health Sciences.Participants
A total of 49 women with CPP and substantial fear of movement were randomly allocated to 1 of 3 groups: (1) patient-centered graded exposure intervention added to manual therapy; (2) manual therapy; (3) control group.Interventions
The 6-week intervention consisted of 12 sessions in the group receiving manual therapy and 6 additional sessions of graded exposure therapy in the group receiving both interventions.Main Outcome Measures
Primary outcomes were fear-avoidance behavior assessed using the Fear-Avoidance Beliefs Questionnaire and pain interference and severity evaluated with the Brief Pain Inventory. The secondary outcome was disability evaluated with the Oswestry Disability Index. All the variables were assessed in a blinded manner at baseline, after the treatment, and at 3-month follow-up.Results
Our results show interaction effects (P<.05) for all the outcomes. Graded exposure added to manual therapy is distinctly superior to manual therapy alone in maintaining improvements for long-term fear-avoidance behavior and physical functioning.Conclusions
Graded exposure added to manual therapy is a promising approach with long-term effects for women with CPP and fear of movement/(re)injury. 相似文献10.
Ashley T. Panicker Kenneth Nugent Jennifer Mink Jeffrey Glaser Kevin Bradley Franjo Siric Jason T. Nomura 《The Journal of emergency medicine》2019,56(2):197-200
Background
Injuries from nail guns are a unique type of penetrating trauma seen in emergency departments (EDs), rising in prevalence in the United States. These devices can lead to life-threatening injuries that require rapid diagnosis to help guide management.Case Report
An elderly man was brought to the ED having sustained a nail gun injury to the chest. After loss of pulses, brief closed chest compressions and rapid blood product administration led to a return of spontaneous circulation. Using bedside ultrasound, a metallic foreign body was identified tracking through the right ventricle with associated pericardial fluid and pericardial clot. This rapid diagnosis with bedside ultrasound helped facilitate timely transport to the operating room for median sternotomy, foreign body removal, and pledgeted cardiac repair.Why Should an Emergency Physician Be Aware of This?
With continued developments in image quality and acquisition, and improvements of physician operator performance, ultrasonography has continued to make significant impacts in traumatically injured patients in new ways. We present this case report to highlight precordial nail gun injuries and to emphasize the diagnostic capabilities of bedside ultrasound for these patients. 相似文献11.
Jayme S. Knutson Amy S. Friedl Kristine M. Hansen Terri Z. Hisel Mary Y. Harley 《Archives of physical medicine and rehabilitation》2019,100(1):140-143.e1
Objective
To evaluate the convergent validity and responsiveness of the Stroke Upper Limb Capacity Scale (SULCS) in comparison to the Arm Motor Ability Test (AMAT), the Box and Blocks Test (BBT), and the upper limb Fugl-Meyer Assessment (FMA). The SULCS is a relatively new measure that was designed to be easier to score and less time consuming than some existing measures.Design
Prospective repeated-measures design.Setting
Clinical research laboratory of a large public hospital.Participants
Patients (N=61) <2 years poststroke with moderate to severe upper limb hemiparesis.Intervention
Participants received 12 weeks of therapy that included neuromuscular electrical stimulation of the paretic finger and thumb extensors. The SULCS, AMAT, BBT, and FMA were administered at weeks 0, 6, 12 (end of therapy), 20, 28, and 36 (6mo post-therapy).Main Outcome Measures
Convergent validity was evaluated with Spearman’s correlation coefficients between pairs of measures at each time point. Responsiveness from 0 to 12 weeks and 0 to 36 weeks was evaluated with the standardized response mean (SRM).Results
The SULCS demonstrated strong correlation with the AMAT (ρ=0.81-0.93), BBT (ρ=0.73-0.92), and FMA (ρ=0.78-0.92), at all 6 time points. All 4 measures had moderate to large SRMs (SULCS, 0.71-0.77; AMAT, 0.83-0.97; BBT, 0.73-0.82; FMA, 0.75-0.76). There was no significant difference in responsiveness among the 4 measures.Conclusions
The results support the use of the SULCS to measure upper limb capacity in patients who are less than 2 years poststroke with moderate to severe hemiplegia. 相似文献12.
David B. Matchar Kirsten Eom Pamela W. Duncan Mina Lee Rita Sim Nirmali R. Sivapragasam Christopher T. Lien Marcus Eng Hock Ong 《Archives of physical medicine and rehabilitation》2019,100(1):1-8
Objective
To perform a cost-effectiveness analysis of a multifactorial, tailored intervention to reduce falls among a heterogeneous group of high-risk elderly people.Design
Randomized control trial.Settings
Communities.Participants
Adults aged at least 65 years (N=354) seen at the emergency department (ED) for a fall or fall-related injury and discharged home.Interventions
The intervention group received a tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of 3 months. They also received screening and referrals for low vision, polypharmacy, and environmental hazards. The Short Physical Performance Battery (SPPB) test was assessed at regular intervals to allocate participants into either a home-based or group center-based program. The control group received usual care prescribed by a physician and educational materials on falls prevention.Main Outcome Measures
The incremental cost-effectiveness ratio (ICER) over the 9-month study period based on intervention costs and utility in terms of quality-adjusted life years (QALYs) calculated from EuroQol-5D scores.Results
The ICER was 120,667 Singapore dollars (S$) per QALY gained (S$362/0.003 QALYs), above benchmark values (S$70,000). However, the intervention was more effective and cost-saving among those with SPPB scores of greater than 6 at baseline, higher cognitive function, better vision and no more than 1 fall in the preceding 6 months. The intervention was also cost-effective among those with 0-1 critical comorbidities (S$22,646/QALY).Conclusion
The intervention was, overall, not cost-effective, compared to usual care. However, the program was cost-effective among healthier subgroups, and even potentially cost-saving among individuals with sufficient reserve to benefit. 相似文献13.
14.
Josephine McMurray Heather McNeil Alicia Gordon Jacobi Elliott Paul Stolee 《Archives of physical medicine and rehabilitation》2019,100(1):39-44
Objective
To develop and test face and content validity, and user interface design of a rehabilitative care patient experience measure.Design
Mixed methods, cross-sectional validation study that included subject matter expert input. Cognitive interviewing tested user interface and design.Setting
Outpatient rehabilitative care settings.Participants
Subject matter experts (n=3), health care providers (n=137), and patients and caregivers (n=5) contributed to the question development. Convenience and snowball sampling were used to recruit rehabilitative care patients postdischarge (n=9) for cognitive interviews to optimize survey design and user interface (N=154).Interventions
Not applicable.Main Outcome Measure
This novel survey instrument measures 6 concepts previously identified as key to outpatient rehabilitative care patients’ experience: ecosystem issues, client and informal caregiver engagement, patient and health care provider relations, pain and functional status, group and individual identity, and open-ended feedback.Results
502 survey questions from psychometrically tested instruments, secondary data from a related ethnographic study, and consultations with health care providers, patients, caregivers, and subject matter experts, were analyzed to create a 10-item questionnaire representing 6 key constructs that influence patient experience quality. Cognitive interviewing with 9 patients (3 rounds of 3 participants each), produced 3 progressively edited versions of the survey instrument. A final version required no further modifications.Discussion
Rehabilitative care clients have characteristics that differentiate their experience from that of other sectors and patient groups, warranting a distinct experience measure. The survey instrument includes a parsimonious set of questions that address strategic issues in the ongoing improvement of care delivery and the patient experience in the rehabilitative care sector.Conclusion
The rehabilitative care patient experience survey instrument developed has an acceptable user interface, and content and face validity. Psychometric testing of the survey instrument is reported elsewhere. 相似文献15.
Objective
The aim of this evidence-based practice change was to implement use of nitrous oxide as a pain management option during labor and to examine women’s satisfaction with that option.Design
Evidence-based practice change guided by the model for evidence-based practice change.Setting
Labor and delivery unit in a tertiary medical center in the southwestern United States.Participants
Laboring women who met eligibility criteria were offered the option of nitrous oxide during a 2-month period.Measurements
Process indicators to measure compliance with the practice change among staff, uptake of nitrous oxide among women, and women’s satisfaction with the choice to use nitrous oxide.Results
Nitrous oxide was offered to 26% (n = 55) of eligible women. Most of the 55 women who used nitrous oxide during the implementation period reported satisfaction with it and indicated that they would consider nitrous oxide for a future labor.Conclusion
Our experience implementing a practice change to offer nitrous oxide to laboring women indicated that use of nitrous oxide was feasible in this setting and that women were receptive to this option, were satisfied with its use, and would use nitrous oxide for a future labor. 相似文献16.
Marcia A. Clevesy Tricia K. Gatlin Callie Cheese Kord Strebel 《Nursing for Women's Health》2019,23(1):21-30
Objective
The purpose of this project was to improve health care providers’ postpartum depression (PPD) knowledge and screening practices with the implementation of a standardized screening tool.Design
The plan–do–study–act model was used as a framework to measure and implement a practice change aimed at universal screening for PPD.Setting/Local Problem
Health care providers’ screening practices for PPD were inconsistent and lacked use of a standardized screening tool at a southwestern U.S. community women’s health care clinic serving minority women of lower socioeconomic status.Participants
Health care providers at a community women’s health care clinic.Intervention/Measurements
A single educational in-service was presented to health care providers regarding preventive PPD screening practices and documentation recommendations. Measurements included pre- and post-education questionnaire results and electronic health record chart reviews.Results
PPD screening documentation rates increased from 56% to 92.7% (p < .5).Conclusion
PPD screening education for health care providers and the addition of EPDS criteria to the electronic health record were associated with increased screening rates for PPD at a community women’s health care clinic. 相似文献17.
In Soo Kim Donghwi Park Jin Young Ko Ju Seok Ryu 《Archives of physical medicine and rehabilitation》2019,100(2):247-253
Objective
To evaluate whether medial knee support (MKS) in seating systems aggravates hip displacement in children with cerebral palsy (CP).Design
Retrospective chart review.Setting
Rehabilitation department of tertiary university hospital.Participants
Children with CP (N=76) using seating systems (intervention group, n=42; mean age 6.86y) and using regular wheelchairs (control group, n=34; mean age 8.15y).Interventions
The intervention group was provided with a seating system with MKS. We enrolled children who did not use a seating system in the control group, retrospectively.Main Outcome Measures
By radiographic images, Reimer’s migration index (MI), lateral center edge angle (CEA), and femur neck shaft angle (NSA) were measured. We compared the demographic data, clinical variables, and radiographs between the 2 groups.Results
In the intervention group, there was a significant deterioration in the MI, from 26.89% to 44.18% after using the system (P<.001). The progression of MI was 14.72% and 7.82% per year in the intervention and control groups, respectively (P=.016).Conclusion
We should consider the possibility that seating systems with MKS may exacerbate hip displacement in children with CP. 相似文献18.
Taylor W. Burkholder Oliwier Dziadkowiec Kelly Bookman Renee A. King 《The Journal of emergency medicine》2019,56(1):7-14
Background
During the 2014 West African Ebola Virus Disease (EVD) outbreak, the U.S. Centers for Disease Control and Prevention recommended that all emergency department (ED) patients undergo travel screening for risk factors of importing EVD.Objectives
We sought to determine the overall adherence rate to the recommended travel screening protocol and to identify factors associated with nonadherence to the protocol.Methods
We conducted a multicenter, retrospective analysis of adherence to the travel screening program in an academic hospital and three affiliated community hospitals. A regression model identified patient and hospital factors associated with nonadherence.Results
Of the 147,062 patients included for analysis, 93.7% (n = 137,834) had travel screenings completed. We identified several characteristics of patients that were most likely to be missed by the screening protocol—patients with low English proficiency, patients who arrive via ambulance or helicopter, and patients with more severe illness or injury based on initial triage acuity.Conclusions
These findings should be used to improve adherence to the travel screening protocol for future emerging infectious disease threats. 相似文献19.
Hillary D. Lum Adreanne Brungardt Sarah R. Jordan Phoutdavone Phimphasone-Brady Lisa M. Schilling Chen-Tan Lin Jean S. Kutner 《Journal of pain and symptom management》2019,57(1):112-117.e2
Background
Electronic health record–based portal tools may help patients engage in advance care planning (ACP). We designed and implemented portal-based ACP tools to enable patients to create a medical durable power of attorney (MDPOA).Measures
MDPOA documentation and System Usability Scale were assessed.Intervention
Stakeholder-informed portal-based ACP tools include an electronic MDPOA form, patient educational webpage, online messaging, and patient access to completed advance directives.Outcomes
A total of 2814 patients used the tools over 15 months. Patients had a mean age 45 years (17–98 years) and 69% were women. Eighty-nine percent completed an MDPOA form, 2% called or sent online messages, and 8% viewed the MDPOA form but did not complete it. The tools were rated highly usable.Conclusions/Lessons Learned
Patients demonstrated willingness to use the portal to complete an MDPOA and rated the new ACP tools as highly usable. Future work will optimize population-based outreach strategies to engage patients in ACP through the portal. 相似文献20.
Kanako Shimoura Hirotaka Iijima Yusuke Suzuki Tomoki Aoyama 《Archives of physical medicine and rehabilitation》2019,100(2):300-306.e1