Putting the brain on the map: use of transcranial magnetic stimulation to assess and induce cortical plasticity of upper-extremity movement

The plasticity of the brain is an increasingly important topic for physical therapists interested in childhood development, learning, and repair following injury. The study of plasticity directly in the human nervous system presents numerous challenges, such as the ability to assess neuronal function in vivo because of physical impediments, such as the skull, skin, and dura. Transcranial magnetic stimulation (TMS), however, has become a suitable, noninvasive, and painless technique that can be applied to detect changes in cortical excitability as an indicator of neurological changes. Furthermore, repetitive trains of TMS themselves can induce plasticity. This article discusses the use of TMS to investigate and manipulate plasticity in the human nervous system.     

Staff and patient perceptions of research in an integrated mental health service

The purpose of this research was to survey staff and patients about their experience, knowledge, and attitudes regarding research. One hundred and sixty patients were interviewed using a questionnaire. In addition, a modified version of the same questionnaire was sent to multidisciplinary staff (n = 476), and about two-fifths (n = 181, 38%) were returned. Participants were interested in research and keen to know more about methods and processes. There were significant differences between staff and patients in terms of attitudes towards evidence-based practice and knowledge about research. The findings support the notion that staff and patients hold similar views about research methods and influences.     

Automated solutions for total RNA isolation from diverse sample types

In response to the increasing demands to generate larger amounts of quality data faster, specifically in the area of RNA isolation to support gene expression assays, the authors have adopted several automated solutions for isolating total RNA from a variety of sample types, (eg, blood, cells, and tissue). By using automated solutions, the authors were able to increase their throughput without compromising data integrity.     

General practitioners' perceptions of antimicrobial resistance: a qualitative study

OBJECTIVES: Interventions aimed at enhancing the quality of antibiotic prescribing often highlight the threat of antimicrobial resistance. Although most antibiotics are prescribed by general practitioners (GPs), little is known of their perceptions of this issue. The aim of this study was therefore to achieve a deeper understanding of GPs' perceptions of antimicrobial resistance. METHODS: A qualitative interview, grounded theory study. Forty GPs were interviewed, 26 from high fluoroquinolone prescribing practices and 14 from average fluoroquinolone prescribing practices. RESULTS: Most GPs were concerned about the broad issue of antimicrobial resistance and agreed that it was a growing problem. However, many said they infrequently encountered its consequences in their everyday practice and some questioned the evidence linking their prescribing decisions to resistance and poorer outcomes for their patients. They felt conflicted by their apparent inability to influence the problem in the face of many other competing demands. A number said they would welcome more information from their microbiological colleagues about resistance patterns locally, and felt that undergraduate and graduate education about antimicrobial prescribing and resistance should be enhanced. However, a few mentioned that a heightened awareness of antimicrobial resistance locally may cause them to prescribe more second line agents as empirical therapy. CONCLUSIONS: Antimicrobial resistance is only one of a range of important influences on GPs decisions whether or not to prescribe an antibiotic and is not the most immediate. These influences all need to be taken into account when promoting a more cautious use of antibiotics in primary care. More information from microbiologist colleagues about local resistance would be clinically useful, but on its own, may paradoxically influence some GPs to prescribe newer, broader spectrum agents more often.     

Screening tools for depressed mood after childbirth in UK-based South Asian women: a systematic review

Aim. This paper is a report of a systematic review to answer the question: what is the relevance, acceptability, validity and effectiveness of tools designed to screen for postnatal depressed mood for South Asian women living in the UK? Background. Standard methods to screen women for postnatal depressed mood were developed with Caucasian populations. This study reviews postnatal screening tools adapted or developed for United Kingdom‐based South Asian women. Method. A structured systematic review of English language studies initially was completed between 1980 and May 2003, and later updated to January 2005. The review was based on an a priori search strategy with inclusion and exclusion criteria and analysis included a quality assessment tool. Findings were tabulated against criteria for acceptability and effectiveness of diagnostic tools. Results. Seven papers were included in the review. None addressed all preset quality criteria. Four papers among them reported on translations of two existing tools (Edinburgh Postnatal Depression Scale and General Household Questionnaire). Two new tools were reported between the remaining three papers (Punjabi Postnatal Depression Scale and ‘Doop Chaon’©). Doop Chaon is a visual tool. The other tools used either Bengali or Punjabi, based on written scales. The General Household Questionnaire did not appear to be appropriate for this population. None of the studies were rigorous enough to demonstrate generalizable sensitivity or specificity. Qualitative data indicated that women preferred face‐to‐face interviews to self‐complete questionnaires. Conclusions. None of the tools are currently sufficiently evaluated for clinical practice. Questions are raised specifically about use of language‐based tools to measure postnatal depressed mood in this population and about the extent to which focused interviews could be used as an alternative for specific sub‐sections of population groups.     

Hyperbare Sauerstofftherapie bei Unterkiefer-Osteomyelitis

Background

Chronic osteomyelitis of the jaw is a relapsing disease with multiple treatment strategies described in the literature. Hyperbaric oxygen therapy is one of them. The purpose of this study was to evaluate the clinical outcome of hyperbaric oxygen therapy in these patients.

Method

All patients with a chronic osteomyelitis of the mandible who received in our department hyperbaric oxygen therapy between 2000 and 2004 were included in this study. The clinical outcome (lack of symptoms e.g. pain, swelling, etc.) was the pivotal evaluation parameter. All patients were divided in three groups according to their medical history. Group 1: All patients with osteomyelitis of the mandible, who received no treatment before. Group 2: All patients with one local relapse, who received only antimicrobial treatment. Group 3: Patients with at least one local relapse after antimicrobial and surgical treatment.

Results

27 patients were evaluated in this study. Seven out of 13 patients in group 1 were relapse free after performing 40 hyperbaric oxygen therapies. However, only 4 of 9 patients in group 3 were relapse free after treatment. In group 2 the hyperbaric oxygen therapy was successful particularly in the younger patients (3 of 4).

Conclusion

Adjuvant hyperbaric oxygen therapy was successful in the treatment of patients with chronic recurrent osteomyelitis of the mandible. Therefore, it is an treatment option which can avoid ablative surgery in some cases.     

Dimensionality and construct validity of the Fugl-Meyer Assessment of the upper extremity

OBJECTIVE: To investigate the dimensionality and construct validity of the Fugl-Meyer Assessment of the upper extremity by using Rasch analysis. DESIGN: Secondary analysis of pooled data from 2 existing datasets: a randomized therapeutic exercise clinical trial and a cohort longitudinal study of stroke recovery. SETTING: University research center. PARTICIPANTS: A total of 512 subjects, ages 69.8+/-11.1 years, who were 0 to 145 days poststroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dimensionality was examined with principal components analysis and Rasch item-fit statistics. The Rasch-derived item hierarchy was examined for consistency with the expected course of poststroke upper-extremity recovery suggested by the reflex-hierarchical conceptual model underlying the assessment. RESULTS: Factor loadings and item infit statistics suggested that the 3 reflex items were empirically disconnected from other assessment items. The reflex items were removed. The modified 30-item assessment showed a unidimensional structure. The Rasch-item-difficulty order was not consistent with the expected item order. CONCLUSIONS: The items testing resting-state reflexes may threaten the assessment's dimensionality. With reflex items removed, the assessment is a unidimensional measure of volitional movement. The Rasch-generated item-difficulty order challenges the hierarchical structure implied by the instrument's underlying conceptual framework.