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71.
Physical therapists are trained and obligated to deliver optimal health care and put patients first above all else. In the changing health-care environment, health-care organizations are grappling with controlling cost and increasing revenues. Moral distress may be created when physical therapists’ desire to provide optimal care conflicts with their organization’s goals to remain financially viable or profitable. Moral distress has been associated with low perception of ethical environment, professional burnout, and high turnover in organizations. This study identified groups who may be vulnerable to low perception of organizational ethical environment and identified self-reported strategies to remedy these perceptions. An ethics environment questionnaire was mailed to a random sample of 1200 physical therapists in Georgia. Respondents (n = 340) were analyzed by age, workplace setting, and position in organization. Therapists working in skilled nursing/assisted living environments scored the lowest on the questionnaire and voiced concerns regarding their ethical work environments. Owners and executives perceived their organizations to be more ethical than front-line clinicians. Respondent concerns included high productivity standards, aggressive coding/billing policies, decreased reimbursement, and increased insurance regulation. Possible solutions included more frequent communication between management and clinicians about ethics, greater professional autonomy, and increased training in business ethics and finance. 相似文献
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Peter A. Smith MD Ken N. Kuo MD Adam N. Graf MS Joseph Krzak PT PhD Ann Flanagan PT Sahar Hassani MS Angela K. Caudill PT Fredrick R. Dietz MD Jose Morcuende MD Gerald F. Harris PE PhD 《Clinical orthopaedics and related research》2014,472(4):1281-1290
Background
Clubfoot can be treated nonoperatively, most commonly using a Ponseti approach, or surgically, most often with a comprehensive clubfoot release. Little is known about how these approaches compare with one another at longer term, or how patients treated with these approaches differ in terms of foot function, foot biomechanics, or quality-of-life from individuals who did not have clubfoot as a child.Questions/purposes
We compared (1) focused physical and radiographic examinations, (2) gait analysis, and (3) quality-of-life measures at long-term followup between groups of adult patients with clubfoot treated either with the Ponseti method of nonsurgical management or a comprehensive surgical release through a Cincinnati incision, and compared these two groups with a control group without clubfoot.Methods
This was a case control study of individuals treated for clubfoot at two separate institutions with different methods of treatment between 1983 to 1987. One hospital used only the Ponseti method and the other mainly used a comprehensive clubfoot release. There were 42 adults (24 treated surgically, 18 treated with Ponseti method) with isolated clubfoot along with 48 healthy control subjects who agreed to participate in a detailed analysis of physical function, foot biomechanics, and quality-of-life metrics.Results
Both treatment groups had diminished strength and motion compared with the control subjects on physical examination measures; however, the Ponseti group had significantly greater ankle plantar flexion ROM (p < 0.001), greater ankle plantar flexor (p = 0.031) and evertor (p = 0.012) strength, and a decreased incidence of osteoarthritis in the ankle and foot compared with the surgical group. During gait the surgical group had reduced peak ankle plantar flexion (p = 0.002), and reduced sagittal plane hindfoot (p = 0.009) and forefoot (p = 0.008) ROM during the preswing phase compared with the Ponseti group. The surgical group had the lowest overall ankle power generation during push off compared with the control subjects (p = 0.002). Outcome tools revealed elevated pain levels in the surgical group compared with the Ponseti group (p = 0.008) and lower scores for physical function and quality-of-life for both clubfoot groups compared with age-range matched control subjects (p = 0.01).Conclusions
Although individuals in each treatment group experienced pain, weakness, and reduced ROM, they were highly functional into early adulthood. As adults the Ponseti group fared better than the surgically treated group because of advantages including increased ROM observed at the physical examination and during gait, greater strength, and less arthritis. This study supports efforts to correct clubfoot with Ponseti casting and minimizing surgery to the joints, and highlights the need to improve methods that promote ROM and strength which are important for adult function.Level of Evidence
Level III, prognostic study. 相似文献74.
Daniel Rhon PT DPT DSc Benjamin Hando PT DSc 《Clinical orthopaedics and related research》2014,472(6):1989-1990
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David B. Reuben MD Thomas M. Gill MD Alan Stevens PhD Jeff Williamson MD Elena Volpi MD PhD Maya Lichtenstein MD Lee A. Jennings MD MSHS Zaldy Tan MD Leslie Evertson DNP RN GNP-BC David Bass PhD Lisa Weitzman MSSA LISW-S ASW-G C-ASWCM Martie Carnie Nancy Wilson MA MSW Katy Araujo MPH Peter Charpentier MPH Can Meng MS MPH Erich J. Greene PhD James Dziura PhD Jodi Liu PhD MSPH MSE BSE Erin Unger Mia Yang MD Katherine Currie BSPH MAT Kristin M. Lenoir MPH Aval-NaʼRee S. Green MD Sitara Abraham MPH Ashley Vernon MPH Rafael Samper-Ternent MD PhD Mukaila Raji MD MSc Roxana M. Hirst MS Rebecca Galloway PT PhD Glen R. Finney MD Ilene Ladd MS Alanna Kulchak Rahm PhD MS CGC Pamela Borek MSN RN-C Peter Peduzzi PhD 《Journal of the American Geriatrics Society》2020,68(11):2492-2499
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Matteo Beretta Piccoli MSc Alberto Rainoldi PhD Carolin Heitz PT MSc Marianne Wüthrich PT MSc Gennaro Boccia PhD Enrico Tomasoni MSc Carlo Spirolazzi PT Michele Egloff MA Marco Barbero PT 《Muscle & nerve》2014,49(3):413-421
Introduction: We describe the innervation zone (IZ) location in 43 muscles to provide information for appropriate positioning of bipolar electrodes for clinical and research applications. Methods: The IZ was studied in 40 subjects (20 men and 20 women) using multichannel surface electromyography (sEMG). Signal quality was checked visually to identify motor unit action potentials and estimate muscle fiber conduction velocity. Results: Results in 33 muscles were classified as excellent or good, because it was possible to identify an area which is favorable for appropriate positioning of an electrode pair without the need to previously determine the IZ location. Conclusions: Knowledge of IZ location will increase standardization and repeatability of sEMG measures. Muscle Nerve 49 :413–421, 2014 相似文献
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