A survey to examine attitudes and patterns of practice of physiotherapists who perform cervical spine manipulation

As part of the process of developing a Clinical Practice Guideline (CPG) on cervical spine manipulation (CSM), a working group sent out an 82-item postal survey to 150 randomly selected Ontario physiotherapists (PTs) who perform spinal manipulation, to collect information on the socio-demographics, practices, opinions of risk, and attitudes towards CPGs of these PTs (n = 118; response rate = 79%). Of the 118 respondents who performed spinal manipulation, 41 performed CSM. Respondents strongly agreed with three out of six indications listed in the survey for applying CSM: segmental fixation, stiff but stable joint, internal derangement (over 70%). Respondents also strongly agreed (over 88%) that all screening tests listed in the survey should be performed prior to applying CSM: tests for irritability, stability, vascular and neurological systems. Respondents rated patient education, other manual therapy, and exercise as the most common adjuncts to CSM (over 88%). Respondents reported seeing mild complications or side effects only rarely following the application of CSM. Fourteen percent of respondents reported having a written CSM policy or CPG on CSM in their work setting. Feedback from this survey will be used in developing a CSM CPG. A future survey will evaluate changes in clinical practice and in attitudes toward CPGs some time after the dissemination of the CSM CPG.     

Strain Differences in the Radiosensitivity of Mouse Spermatogonia

Summary

The radiosensitivity of spermatogonia was found to be greater by up to a factor of 2 in C3H mice than in B6D2F₁ mice, whether assessed for the highly sensitive spermatogonia (types A₂ to In) or the much more resistant clonogenic spermatogonia which repopulate tubules. The latter were similarly resistant in the B6D2F₁ hybrid and in the DBA2 parent, but were much more sensitive in the C57BL parent strain. A difference in sensitivity by up to a factor of 2 results in a variation by a factor of 10 or more in the level of survival of clonogenic cells after high doses. This variation is also observed when comparing data in the literature from different authors using various strains of mice. Using the radiosensitizer misonidazole, it was shown that hypoxia did not play a major role in the lesser sensitivity demonstrated in B6D2F₁ mice. The variation in sensitivity is similar to the range reported in the literature for reciprocal translocations.     

Barriers to undergraduate peer-physical examination of the lower limb in the health sciences and strategies to improve inclusion: a review

Peer-physical examination is a widely adopted and an integral component of the undergraduate curriculum for many health science programs. Unwillingness or perceived inability to participate in peer-physical examination classes may have a negative impact upon students’ abilities to competently conduct physical examinations of patients in future as registered health professionals. A literature review on the perceptions and attitudes of peer-physical examination of the lower limb amongst medical and health science students was conducted to identify potential barriers to participation, and to review strategies to improve participation in classes designed to develop clinical examination skills. A pragmatic search strategy of the literature from PubMed and Google Scholar published prior to June 2012 yielded 23 relevant articles. All articles were concerned with the views of medical students’ education and there were no articles explicitly addressing the role of peer-physical examination in health science disciplines. Several ethical issues were identified including feelings of coercion, embarrassment, and perceptions of a lack of consideration for cultural and religious beliefs. The available evidence suggests that barriers to participation may be overcome by implementing standard protocols concerned with obtaining informed written consent, adequate choice of peer-examiner, changing facilities and garment advice, and possible alternative learning methods.     

Quantitative multiplex assay for simultaneous detection of the Indiana serotype of vesicular stomatitis virus and HIV gag

Assessment of in vivo viral replication of live attenuated recombinant vesicular stomatitis virus (rVSV) vaccine vector candidates encoding HIV gag requires comprehensive preclinical safety studies, and development of sensitive assays to monitor the outcome of vaccination of animals is important. In this study, two 2-step quantitative real-time RT-PCR assays were developed; a singleplex assay to detect VSV genomic RNA from ferrets inoculated intra-cranially (IC) or intra-nasally (IN) with either a wild-type (wt) virus or an attenuated rVSV vector engineered to express HIV gag protein, and a duplex assay to simultaneously detect VSV-N and HIV-gag mRNAs from cynomolgus macaques inoculated intra-thalamically (IT) with the same viruses. Using synthetic oligonucleotides as standards, the lower limit of detection of VSV-N and HIV-gag was 50 copies. Results showed high levels of wt VSV(IN) genomic RNA and mRNA in ferret and macaque tissues, respectively, and significantly lower levels of VSV genomic RNA and VSV-N and HIV-gag mRNAs in tissues from animals inoculated with the attenuated rVSV vector. These assays correlated with both the course of infection for these animals, and the infectious viral load measured by a standard plaque assay, and could be used to determine the safety profile of rVSV vaccine vectors.     

Diagnostic performance of a biomarker panel as a negative predictor for acute appendicitis in adult ED patients with abdominal pain

Objectives

Evaluate the diagnostic accuracy of the APPY1TM biomarker panel, previously described for use in pediatric patients, for identifying adult ED patients with abdominal pain who are at low risk of acute appendicitis.

Sharing control of appointment length with patients in general practice: a qualitative study

Background

There is little published research into the impact, on both doctor and patient, of handing over responsibility for choosing appointment length to the patient.

Aim

To investigate what impact giving patients control of their appointment length has on the patient and doctor experience.

Design and setting

A qualitative study in a single medical practice in Inverness, Scotland.

Method

Eligible patients making a ‘routine’ appointment were given a choice of appointment length (5, 10, 15, or 20 minutes). After the consultation, patients were invited to take part in a focused interview. Doctors were asked to keep an audio diary and their experience was explored further in a facilitated focus group. Data were analysed using a thematic analysis approach.

Results

Key themes that emerged for patients included the impact of the shift in power and the impact of introducing the issue of time. For doctors, important themes that emerged were impacts on the provider, on the doctor–patient relationship, and on the consultation.

Conclusion

Giving patients greater responsibility for choosing appointment length may improve the experience for both doctors and patients.     

Reduced Inflammation and CD4 Loss in Acute SHIV Infection During Oral Pre-Exposure Prophylaxis

Background.The impact of pre-exposure prophylaxis (PrEP) with antiretrovirals on breakthrough HIV or SHIV infection is not fully documented. We addressed the hypothesis that SHIV(SF162P3) infection despite active PrEP results in altered early immune parameters, compared with untreated infection. Methods.Eleven rhesus macaques were infected during repeated, rectal, low-dose SHIV(SF162P3) exposures while receiving concurrent oral PrEP (Truvada [n?=?2] or GS7340 [n?=?4]) or as untreated controls (n?=?5). We measured SHIV RNA, inflammatory cytokines, CD4 cells, and SHIV-specific and memory T cells until 20 weeks after peak viremia. Results.SHIV infection during PrEP resulted in 100-fold lower peak viremia and lower IL-15, IL-18, and IL-1Ra levels, compared with controls (P?相似文献