The Practice of Physical Medicine and Rehabilitation in subSaharan Africa and Antarctica:A White Paper or a Black Mark?

Objective: To explore the practice of PM&R in subSaharan Africa and Antarctica. Method: Medline searches, membership data searches, fax survey of medical schools, Internet searches, and interviews with experts. Result:The continents are dissimilar in terms of climate and government. However both Antarctica and subSaharan Africa have no PM&R training programs, no professional organizations, no specialty board requirements, and no practicing physicians in the field. Since there is no known disabled child on Antarctica and adults are airlifted to world-class health care, the consequences of this deficit are minimal there. However the 788,000,000 permanent residents of subSaharan Africa including approximately 78 million persons with disability are left unserved.Conclusion:Antarctica is doing fine. Africa is in a crisis. Local medical schools, hospitals doctors, and persons with disability; along with foreign volunteers, aid groups, and policymakers can impact the crisis. However government - specifically national ministries of health - is ultimately responsible for the health and wellbeing of citizens.     

Physical and Rehabilitation Medicine (PRM) care pathways: “Patients after total hip arthroplasty”

This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. “Care pathways in PRM” is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total hip arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients.     

Physical and Rehabilitation Medicine (PRM) care pathways: “Patients after total knee arthroplasty”

This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. “Care pathways in PRM” is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after total knee arthroplasty are classified into three care sequences and two clinical categories, each one being treated with the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients.     

Report of the Exploratory Meeting of the Cochran Field “Physical Therapy and Rehabilitation”: The Cochrane Collaboration

Abstract

Recently published evidence has shown an increasing number of golfers reporting the presence of low back pain (LBP). Research has shown the occurrence and recurrence of LBP to be associated with the dysfunction of the deep abdominal muscle, transversus abdominis (TrA). To investigate the reduction in its stabilising role, the pressure biofeedback unit (PBU) was developed as an objective assessment and monitoring tool. This instrument is also used in the rehabilitation of TrA.

Twenty male golfers, age 20-44, were recruited by newsletter article and direct approach to see whether golfers with a history of LBP showed a reduced muscle endurance time of TrA compared with golfers with no such history.

Subjects were taught TrA contraction in prone kneeling and in prone lying using the PBU. Using a cycle of 10 seconds contraction followed by 20 seconds rest, the total time each subject could maintain a TrA contraction was measured.

The results showed that golfers with a history of LBP had a statistically significant reduction (p<0.025) in the endurance of the static contraction time of TrA compared to golfers without a history of LBP.

The results are discussed in relation to previous research, and the implications for clinicians for the rehabilitation of golfers with LBP are identified.     

Demonstrating Construct Validity of the American Board of Physical Medicine and Rehabilitation Part I Examination: An Analysis of Dimensionality

Background

Ideally, high-stakes examinations assess 1 dimension of medical knowledge to produce precise estimates of a candidate’s performance. It has not been reported whether the American Board of Physical Medicine and Rehabilitation Part 1 Certification Examination (ABPMR-CE-1) is unidimensional or not.

Preferences for place of care and place of death: What,how, when and who to ask?

As healthcare systems worldwide are confronted with increasing numbers of aging patients and those living with life-limiting illnesses, the topic of where people want to spend their last days has received considerable attention. However, the strategies that researchers and clinicians use to capture these end-of-life views vary greatly in four key questions. These include: what, how, when and who to ask about location preferences. We will argue that how researchers and clinicians choose to answer these questions directly influences their findings. Based on these considerations, we will highlight ways to improve future palliative care and empirical end-of-life studies by addressing the precision, methods, timing and sources of preference assessments. Only when we are able to accurately identify where people want to spend their last days, can we begin to meet the needs of patients as they approach the final stage of their lives.     

What Is the Impact of Targeted Health Education for Mental Health Nurses in the Provision of Physical Health Care? An Integrated Literature Review

Individuals with a severe mental illness have a gap in life expectancy of up to 20 years in comparison to the general population. Nurses who work in mental health services have been identified as best placed to improve the physical health outcomes of individuals with mental illness. The literature identifies a lack of nursing knowledge related to physical health care and the presence of metabolic syndrome which is impeding nurses in providing essential physical health care to patients. An integrated literature review was carried out due to the dearth of research evidence pertaining to the impact of targeted education specifically with psychiatric/mental health nurses in the provision of physical healthcare. A search for literature included the following databases: CINAHL, Medline, PsycINFO, Embase and Web of Science revealed nine studies: seven quantitative, one qualitative and one mixed method. Qualitative synthesis has shed light on the value of targeted education on improving knowledge and skills in providing physical health care that can then be translated into clinical practice. Targeted education in physical healthcare grows psychiatric/mental health nurse's confidence and develops the skills necessary to enable them to screen and monitor and offer range of physical health interventions to individuals with severe mental illness.

Accessible summary ? The poor physical health outcomes and premature death of individuals with severe mental illness is of growing concern; a contributing factor is a lack of knowledge and confidence amongst psychiatric/mental health nurses to providing physical health screening and intervening in preventable diseases such as cardiovascular disease, stroke cancer, and type 2 diabetes mellitus.

? An integrated literature review was used to ascertain if targeted education on physical health care can improve the knowledge base of psychiatric/mental health nurses within physical health care.

? Nine studies were critically appraised, and the data reduced using a narrative synthesis that tells a story of the findings from these research studies.

? The review found that targeted education with psychiatric/mental health nurses does result in a statistical increase in knowledge This review finds that nurses have not been regularly supported with physical health education to alter existing practices. This lack of knowledge within physical healthcare is hindering psychiatric/mental health nurses to fully engaging in physical health care activities in practice.

     

The right place in the right space? Awareness of site for needle thoracocentesis

Background: Invasive practical procedures require identification of surface anatomical landmarks to reduce risk of damage to other structures. Needle thoracocentesis has specific complications, which have been previously documented. An observational study was performed among emergency physicians to name the landmark for needle thoracocentesis and identify this point on a human volunteer as per Advanced Trauma and Life Support (ATLS) guidelines. Results: A cohort of 25 emergency physicians was studied, 21 (84%) of which were ATLS certified. The correct landmark was named by 22 (88%). Only 15 (60%) correctly identified the second intercostal space on the human volunteer, all placing the needle medial to the midclavicular line, with a range of 3 cm. Two (8%) named and identified the site of needle pericardiocentesis; one (4%) named and identified the fifth intercostal space in the anterior axillary line. Discussion: These results demonstrate a low accuracy among emergency physicians in identifying correct landmarks for needle thoracocentesis under elective conditions. Should greater emphasis be placed on competency based training in ATLS?     

The American Congress of Rehabilitation Medicine: where do we go from here?

This presidential address reflects on my last 2 years as president of American Congress of Rehabilitation Medicine (ACRM). It recognizes those individuals who have been of significant help and support. The address discusses choices I have made in my professional life including selecting physical medicine and rehabilitation as a subspecialty; committing to an academic career; and choosing to get involved in local, state, national, and international physical medicine and rehabilitation societies. I review my presidential speech of 2001 when I spoke about the path we choose-to succeed or not to succeed. ACRM has come a long way in trying to succeed but continued opportunities remain in obtaining financial security, increased membership, and cost-effective and efficient management. This address includes 11 suggestions designed not only to keep the organization viable but also to allow ACRM to succeed. These suggestions include a new commitment to our strategic plan and the implementation of prioritized goals, reorganization of ACRM's national office, and adherence to a realistic budget. Finally, we must continue to move the agenda of research in rehabilitation forward much more aggressively.     

Preference for place of care and place of death in palliative care: are these different questions?

Place of death is at times suggested as an outcome for palliative care services. This study aimed to describe longitudinal preferences for place of care and place of death over time for patients and their caregivers. Longitudinal paired data of patient/caregiver dyads from a prospective unblinded cluster randomised control trial were used. Patients and caregivers were separately asked by the palliative care nurse their preference at that time for place of care and place of death. Longitudinal changes over time for both questions were mapped; patterns of agreement (patient and caregiver; and preference for place of death when last asked and actual placed of death) were analysed with kappa statistics. Seventy-one patient/caregiver dyads were analysed. In longitudinal preferences, preferences for both the place of care (asked a mean of >6 times) and place of death (asked a mean of >4 times) changed for patients (28% and 30% respectively) and caregivers (31% and 30%, respectively). In agreement between patients and caregivers, agreement between preference of place of care and preferred place of death when asked contemporaneously for patients and caregivers was low [56% (kappa 0.33) and 36% (kappa 0.35) respectively]. In preference versus actual place of death, preferences were met for 37.5% of participants for home death; 62.5% for hospital; 76.9% for hospice and 63.6% for aged care facility. This study suggests that there are two conversations: preference for current place of care and preference for care at the time of death. Place of care is not a euphemism for place of death; and further research is needed to delineate these. Patient and caregiver preferences may not change simultaneously. Implications of any mismatch between actual events and preferences need to be explored.     

Emergency Medicine Residents and Statistics: What is the Confidence?

The objective of this study was to assess whether residents have the essential tools and a sense of competency when evaluating published studies, especially the statistics. Questionnaires were mailed to emergency medicine (EM) residency programs in the United States querying residents' demographics and training in statistics as well as their impressions and use of statistics in the current literature; a five-question statistical quiz was also included. Possible responses of—almost always, more than ½ time, ½ time, less than ½ time, almost never—were tallied individually as well as compared in groups of polarized answers: over 1/2 time (almost always + more than ½ time) vs. under ½ time (less than ½ time + almost never). There were 495 questionnaires returned from 42 centers. No significant difference was found when comparing quiz performance with participants' self-reported statistical knowledge. There were considerable differences in the polarized answers (Over vs. Under), whether statistics: were used appropriately (40% vs. 15%, respectively); were used to enhance weak data (54% vs. 13%, respectively); enhanced their understanding of information (38% vs. 24%, respectively); simplified complex data (26% vs. 41%, respectively); were understood by them (23% vs. 38%, respectively); confused them (37% vs. 24%, respectively); were skipped (52% vs. 23%, respectively). Participants felt there should be more statistical training (49% vs. 22%, Over vs. Under, respectively). There was no difference in respondents who did or did not read the statistics (39% vs. 34%, Over vs. Under, respectively). Many EM residents surveyed do not trust, read, or understand statistics presented in current journal articles. Residency programs may want to consider enhanced training in statistics.