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Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis
No full textBackground: Congenital Muscular Torticollis (CMT) is the third most common musculoskeletal condition in infancy, and if untreated can lead to significant disability. While a range of conservative treatments are commonly used in the management of CMT, an understanding of their efficacy and safety is limited. This systematic review and meta-analysis, without language or discipline restriction, was conducted to address this knowledge gap. Methods: Electronic searches of CENTRAL, PubMed, 22 other electronic databases, three trials registers and Google Scholar, were conducted for randomised controlled trials, which examined any non-surgical, non-pharmacological interventions, including but not limited to manual treatments, movement therapy, acupuncture, adjunctive therapies and physical support, in children aged 0 to 5 years with CMT. Two reviewers independently assessed the risk of bias of the included studies using the Cochrane Risk of bias 1 tool, rated their certainty of evidence using grading of recommendations assessment, development and evaluation (GRADE) framework, and performed random-effects meta-analyses. Results: One hundred studies (80 from China) involving 8125 participants published between 1990 and 2023 were included. Adding manual therapy to an active control resulted in short-term improvements in passive cervical rotation (odds ratio (OR) 9.79, 95%CI 4.26,22.50), passive cervical lateroflexion (OR 2.66, 95%CI 1.17,6.04), active cervical rotation (OR 3.94, 95%CI 1.08,14.35), symmetric head posture (OR 4.55, 95%CI 2.57,8.05), sternocleidomastoid tumour thickness (mean difference (MD) -2.12 mm, 95%CI -2.98,-1.26) and development of symmetrical movement (standardised MD -0.70, 95%CI -0.95,-0.45). The addition of an electrophysical agent to an active control reduced sternocleidomastoid tumour thickness (MD -2.03 mm, 95%CI -2.67,-1.39) and optimised Tuina reduced tumour thickness more than traditional Tuina (MD -1.20 mm, 95%CI -1.80,-0.59). Adverse events were uncommon but poorly reported, with 71 (71%) of studies providing no data. Study heterogeneity limited pooling of data for meta-analysis, and there was very low to low certainty evidence for all results, due to high risk of bias, small sample sizes and study heterogeneity. Conclusions: This review found that non-surgical, non-pharmacological treatments may be effective for CMT, but the certainty of evidence is very low to low. These findings are important in informing clinical guidelines and management for CMT and highlight an urgent need for large definitive trials that address the limitations of current studies. Protocol registration: Cochrane Database of Systematic Reviews (No.: CD012987)
‘Devastation, fear and loss’: Lessons from Ukraine revealed after three brutal years of war
No full textOn February 24, 2022, Russia began its full-scale invasion of Ukraine. Three years later, I remain in awe of the Ukrainian people’s resilience. They are still fighting a war they neither started nor wanted
The Routledge Handbook on Sports Law and Governance
No full textA co-edited collection of contemporary chapters addressing sport and governance. <br/
Delphi definition of general practice/family medicine specialty for a post-COVID world: in-person and remote care delivery: in-person and remote care delivery
No full textIntroduction: The evolving landscape of general practice (GP)/family medicine (FM) in the post-COVID-19 era, focussing on integrating telemedicine and remote consultations requires a new definition for this specialty. Hence, a broader consensus-based definition of post-COVID-19 GP/FM is warranted.Methods: This study involved a modified electronic Delphi technique involving 27 specialists working in primary care recruited via convenient and snowball sampling. The Delphi survey was conducted online between August 2022 and April 2023, utilizing the Google Forms platform. Descriptive statistics were employed to analyse consensus across Delphi rounds.Results: Twenty-six international experts participated in the survey. The retention rate through the second and third Delphi rounds was 96.2% (n = 25). The broader consensus definition emphasizes person-centred care, collaborative patient-physician partnerships, and a holistic approach to health, including managing acute and chronic conditions through in-person or remote access based on patient preferences, medical needs, and local health system organization.Conclusion: The study highlights the importance of continuity of care, prevention, and coordination with other healthcare professionals as core values of primary care. It also reflects the role of GP/FM in addressing new challenges post-pandemic, such as healthcare delivery beyond standard face-to-face care (e.g. remote consultations) and an increasingly important role in the prevention of infectious diseases. This underscores the need for ongoing research and patient involvement to continually refine and improve primary healthcare delivery in response to changing healthcare landscapes
The Impact of Timely Formative Feedback on University Student Motivation
Get PDFWhile key attributes of effective feedback have frequently been included in studies on student learning, little research has focused on the impact of the timeliness of feedback on student motivation. By providing students with written feedback at 1, 3, 7, 10, or 14 days after submission, this mixed design study enriches our understanding of the feedback timeliness and its importance on student motivation. Based on survey data of undergraduate and postgraduate students from a wide range of disciplines including health and social sciences, screenwriting, business administration, and finance over a three-year period, our findings indicate that students express significantly lower levels of motivation if the feedback took greater than 10 days but they did not distinguish between ‘timely’ and ‘extremely timely’ feedback. Our quantitative analysis reveals that feedback comments and turnaround are significant determinants of student motivation, providing areas of focus for both educators and administrators. However, content of feedback showed the highest impact and our qualitative analysis supported this, with 57% of students mentioning content of the feedback. Students especially appreciate thorough, personalised, and specific assessment of strengths and weaknesses. Not surprisingly, 48% mentioned the importance of a high-quality educator, so great teaching is also important in motivating our students
Profiling paramedic job tasks, injuries, and physical fitness: A scoping review
Get PDFIntroduction:The aim of this review was to identify, collect, appraise, and synthesise research profiling paramedic job tasks, injuries sustained, and current fitness levels, to guide optimal workplace performance and enhance injury mitigation efforts.Methods:Following the Preferred Reporting Items for Scoping Reviews, four databases (PubMed, SPORTdiscus, CINAHL, and Embase) were searched using key search terms (derivatives of ‘paramedic’ and ‘injury’, ‘physical fitness’ and ‘tasks’). Identified records were screened against eligibility criteria with remaining studies critically appraised.Results:Of 1675 identified records, 33 were retained. Musculoskeletal injuries exhibited the highest mean injury rate, with sprains and strains the predominant nature of injury, and the back the most frequently injured body part. Among paramedics, handling stretchers and equipment posed the most challenging tasks while for Emergency Medical Services patient extraction was the most physically and mentally demanding task. Male paramedics were generally stronger with more muscular endurance, but less flexibility, than female paramedics. Older paramedics displayed lower levels of strength and flexibility.Conclusion:Tasks involving stretcher handling and patient extraction are reported as being most strenuous for paramedics leading to musculoskeletal injuries, particularly sprains, strains, and back injuries
The Treatment Experiences of Vegetarians and Vegans with an Eating Disorder: A Qualitative Study
Get PDFBackground:Vegetarianism and veganism have long been tied to disordered eating and are frequently considered to be methods of limiting available food choices. Health professionals specializing in eating disorder treatment may modify their treatment practices to support their vegetarian or vegan clients. However, there are no formally recognized clinical guidelines for the treatment of eating disorders in these groups. Moreover, no studies have yet explored the experiences of seeking and receiving eating disorder treatment while adhering to vegetarianism or veganism, which are needed to inform the development of guidelines. The present study aims to explore the lived experiences of vegetarians and vegans on eating disorder treatment through semi-structured interviews and reflexive thematic analysis. Methods:Seventeen participants (aged 19–48, 76% female, 41% vegan) with a history of receiving eating disorder treatment were recruited. Results: We identified five themes that participants described as important experiences for the treatment of their eating disorder when sought as a vegetarian or vegan: (1) Health professional perspectives, (2) The interaction of dietary status with treatment quality, (3) The give and take of treatment, (4) Lack of flexibility in treatment services, and (5) Current treatment approaches not well equipped to support dietary variations. Conclusions: This paper identifies the complex relationship between eating disorders, veganism, and vegetarianism and the perceptions of treatment from the perspectives of those who have received treatment. Our findings suggest that acknowledgement and the flexibility to work with an individual’s vegan and vegetarian values within treatment may contribute to enhanced outcomes and treatment experiences. Limitations include potential participation and response biases and a predominantly female-identifying sample. This study will contribute to the development of clinical guidelines when working with vegan and vegetarian clients
Exercising Self-Control Increases Responsivity to Hedonic and Eudaimonic Rewards
No full textThe reward responsivity hypothesis of self-control proposes that irrespective of self-control success, exercising self-control is aversive and engenders negative affect. To countermand this discomfort, reward-seeking behavior may be amplified after bouts of self-control, bringing individuals back to a mildly positive baseline state. Previous studies indicated that effort-an integral component of self-control-can increase reward responsivity. We sought to test and extend the reward responsivity hypothesis by asking if exercising self-control increases a neural marker of reward responsivity [Reward Positivity (RewP)] differentially for hedonic rewards or eudaimonic rewards. We instructed participants (N = 114) to complete a speeded reaction time task where they exercised self-control (incongruent Stroop trials) or not (congruent Stroop trials) and then had the opportunity to win money for themselves (hedonic rewards) or a charity (eudaimonic rewards) while electroencephalography was recorded. Consistent with the reward responsivity hypothesis, participants evinced a larger RewP after exercising self-control (vs. not exercising self-control). Participants also showed a larger RewP for hedonic over eudaimonic rewards. Self-control and reward type did not interactively modulate RewP, suggesting that self-control increases reward responsivity in a domain-general manner. The findings provide a neurophysiological mechanism for the reward responsivity hypothesis of self-control and promise to revitalize the relevant literature.</p
Legal Education and First Nations teaching and Learning Methodologies: Storytelling/Yarning, Deep Listening and Lived Experience
Get PDFFirst Nations teaching and learning methodologies have an important role to perform in the decolonisation of legal education, because it is not just the law that is taught but the way that it is taught that must be changed. This chapter discusses the First Nations methodologies of storytelling and yarning, deep listening and lived experience and emphasises the potential for their inclusion in legal pedagogy and curriculum materials. The chapter then turns to reforms in Aotearoa/New Zealand, Canada and South Africa to support a call for urgent action to decolonise Australian legal education
Multidimensional Scaling of the Wechsler Intelligence Scales for Children in a Clinical Sample Assessed for Fetal Alcohol Spectrum Disorder (FASD)
Get PDFFetal Alcohol Spectrum Disorder (FASD) is a significant public health concern arising from prenatal alcohol exposure. This study examines the clinical utility of Wechsler intelligence tests in assessing cognition in 108 children with confirmed prenatal alcohol exposure. Data were analysed using multidimensional scaling and Guttman’s Structural Model of Intelligence, with a view to assessing the application of the Wechsler Intelligence Scale for Children 4th Edition (WISC-IV) and 5th Edition (WISC-V) in characterising cognitive ability for this clinical population. WISC-IV and WISC-V subtests exhibited distinct clustering patterns within the sample compared to normative populations. Subtests appeared to cluster based on response modality, aligning with Guttman’s Structural Model of Intelligence. The findings demonstrate an alternative interpretation approach for intelligence tests in children with prenatal alcohol exposure, which may complement existing FASD diagnostic frameworks. The clustering patterns underscore the importance of considering response modality in understanding cognitive abilities