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Bilateral Low-Dose Computed Tomography Assessment for Post-Operative Rotational Malalignment After Intramedullary Nailing for Tibial Shaft Fractures: Reliability of a Practical Imaging Technique
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http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 12 month embargo from date of publication (July 2018) in accordance with the publisher’s archiving policyIntroduction
The purpose of this study is to evaluate the intra- and inter-observer reliability of low-dose protocolled bilateral postoperative Computed Tomography (CT)-assessment of rotational malalignment after intramedullary nailing (IMN) of tibial shaft fractures.
Materials and methods
156 patients were prospectively included with tibial shaft fractures that were treated with IMN in a Level-I Trauma Centre. All patients underwent post-operative bilateral low-dose CT-assessment (effective dose of 0.03784 – 0.05768 mGy) as per hospital protocol. Four observers performed the validated reproducible measurements of tibial torsion in degrees, based on standardized techniques. The Intra-Class Coefficient (ICC) was calculated to evaluate intra- and inter-observer reliability. The intra- and inter-observer reliability was categorized according to Landis and Koch.
ResultsIntra-observer reliability for quantification of rotational malalignment on post-operative CT after IMN of tibial shaft fractures was excellent with 0.95 (95% CI = 0.92-0.97).
The overall inter-observer reliability was 0.90 (95% CI = 0.87-0.92), also excellent according Landis and Koch.
Conclusion
Firstly, bilateral post-operative low-dose –similar radiation exposure as plain chest radiographs– CT assessment of tibial rotational alignment is a reliable diagnostic imaging modality to assess rotational malalignment in patients following IMN of tibial shaft fractures and it allows for early revision surgery. Secondly, it may contribute to our understanding of the incidence-, predictors- and clinical relevance of post-operative tibial rotational malalignment in patients treated with IMN for a tibial shaft fracture, and facilitates future studies on this topic.JND received an unrestricted Postdoc Research Grant from the Marti-Keuning-Eckhardt Foundation
Root caries incidence and increment in the population – A systematic review, meta-analysis and meta-regression of longitudinal studies
Get PDFThis manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 12 month embargo from date of publication (June 2018) in accordance with the publisher’s archiving policyObjectives
Previous meta-analyses of root caries incidence and increment studies reported different estimates due to the limited number of studies, heterogeneity and variations in studies included. Currently, new publications and approaches to handle heterogeneity are available. This research aims to systematically review and meta-analyse root caries incidence and increment, and use meta-regression to analyse heterogeneity.
Sources
PUBMED and EMBASE databases were searched systematically.
Study selection
Longitudinal studies on root caries incidence and increment, published in English language prior to 2017, were independently checked by two authors. A pooled incidence and increment of decayed/filled root surfaces (DFS) was estimated and meta-regression analysis was performed by length of follow-up (<2 years; 2years; 3–4years and ≥5years) and study type (observational population-based and clinical trial).
Data
Of 737 articles, 20 were included for meta-analysis. The annualised root caries incidence and increment were 18.25%[CI = 13.22%–23.28%] and 0.45[CI = 0.37–0.53] root DFS respectively. Length of follow-up influenced the estimates, but not the study type. The annual root DFS incidence and increment from studies <2years were 32.95%[CI = 29.13%–36.77%] and 0.64[CI = 0.38–0.89] root surfaces respectively. Studies with 5+years follow-up, the annualised root caries incidence and increment were 9.4%[CI = 3.32%–15.48%] and 0.43[CI = 0.21–0.64] root surfaces respectively.
Conclusions
Length of follow-up influenced root caries estimates due to a bias towards relatively healthier older adults retained in the study. Root caries increased over time even among the healthier older adults.
Clinical significance
The increase in root caries, even among the healthier older adults, should be considered by both clinicians and healthcare planners/policy makers in their provision of services.We thank the librarian Michael Draper for his help with the search strategy and the Indonesian government for the DG-RSTHE Postgraduate Scholarship. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors
Visualising latent DNA on swabs
Get PDFThis manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 12 month embargo from date of publication (August 2018) in accordance with the publisher’s archiving policyCollection for touch DNA either at scenes or on items submitted to a forensic laboratory is based on assumptions as to where a person made direct contact. In many instances a swab may be applied to an area where no contact has been made. Many swabs may therefore be submitted for DNA profiling on which no DNA is present, resulting in the loss of both time and resources by analysing such swabs. This study has developed a simple, fast, DNA-staining and fluorescence microscopy-based screening method for swabs to indicate if there is any DNA from which to generate a profile.
Ten different types of swabs were tested covering the major types used (foam, cotton and nylon). Each swab was treated by: no addition of dye or DNA, addition of dye only, addition of known DNA and addition of dye and DNA. The stain used was Diamond™ Nucleic Acid Dye (DD) and fluorescence microscopy was achieved with a digital microscope equipped with a blue LED light source (480 nm) for excitation and an emission filter of 510 nm. Two types of samples were tested, either buccal swabs or swabs collected from areas touched by volunteers and all analyses were performed in triplicate. The samples were collected and retained at room temperature with time intervals of 0 day, 7 days, 14 days, 21 days, and 28 days before detection using DD staining and fluorescence microscopy.
Seven of the swab types used were found to be unsuitable due to the lack of any difference in the fluorescence detected when no DNA, or only the dye, or a combination of DNA and dye were added. Three swab types (black cotton swab, Ultrafine dental applicator, and Cylinder dental applicator) were found to be much more effective for collection of DNA. Further, stained cellular material retained its fluorescence for up to 4 weeks and swabs containing cellular material that had been stored for four weeks could be stained and visualised. Additionally, DD did not affect DNA profiling. This screening method has the potential to be a routine step in a forensic laboratory to save costs of processing samples where swabs are devoid of any DNA. This technique is rapid, easy, cheap, non-destructive and safe.Piyamas Kanokwongnuwut was supported by the Development and Promotion of Science and Technology Talent Project (DPST), Royal Thai Government Scholarship. Funding for the work was provided by the Attorney General’s Department of South Australia via Forensic Science South Australia
Diagnosis of dementia in residential aged care settings in Australia: An opportunity for improvements in quality of care?
Get PDFThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is
properly cited.Objective: To examine the cognitive status of Australians living in residential aged care facilities (RACFs) and whether or not a dementia diagnosis was recorded.
Methods
Cross‐sectional study of 541 residents of 17 RACFs spanning four states. Examination of cognitive status by Psychogeriatric Assessment Scale Cognitive Impairment Scale (PAS‐Cog) and dementia diagnosis from medical records.
Results
The study population included 65% of residents with a diagnosis of dementia recorded, and 83% had a PAS‐Cog score of four or more indicating likely cognitive impairment. More than 20% of participants had likely cognitive impairment (PAS‐Cog ≥4), but no diagnosis of dementia; 11% had moderate‐to‐severe cognitive impairment (PAS‐Cog ≥10) but no recorded dementia diagnosis.
Conclusion
There may be a lack of formal diagnosis of dementia in Australian RACFs. Greater efforts from all health professionals to improve diagnosis in this setting are required. This is an opportunity for improved person‐centred care and quality of care in this vulnerable population.The work is supported by funding provided by the
National Health and Medical Research Council (NHMRC)
Partnership Centre on Dealing with Cognitive and Related
Functional Decline in Older People (Grant No.
GNT9100000)
Building capacity in primary care rehabilitation clinical practice guidelines: a South African initiative
Get PDFThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background
The large number of South Africans with disability who cannot access good quality rehabilitation presents a public health and human rights challenge. A cost-effective, efficient approach is required to address this. Implementation of high-quality, contextually relevant clinical practice guidelines (CPGs) could be a solution; however, this requires significant investment in innovative capacity-building.
Methods
A qualitative descriptive national study was conducted to explore the perspectives of South African stakeholders in rehabilitation, regarding CPG capacity-building. Twenty rehabilitation professionals (physiotherapists, occupational therapists, speech language therapists, podiatrists, rehabilitation managers or directors) were interviewed. Transcribed interview data were analysed using a deductive content analysis approach, mapping findings to an international capacity-building framework to produce new knowledge.
Results
Capacity-building is required in content, purpose and construction of locally relevant CPGs, as well as personal, workforce and systems capacity. Principles and strategies were derived to underpin implementation of CPGs that are user friendly, context specific, relevant to the needs of end-users, and achievable within available resources. Collaboration, networks and communication are required at national, provincial and regional level, within and between sectors. A central agency for CPG methods, writing, implementation and evaluation is indicated.
Conclusion
South African rehabilitation can benefit from a multi-level CPG capacity-building focusing on performance, personal, workforce and systems issues.MRC Flagship-funded SAGE project
How do persons with dementia experience 'epistemic injustice'?
No full textThis abstract was prepared for the inaugural 'HDR Student Conference', Flinders University, November 2018. Copyright © the authorWhenever we hear a speaker assert something, we form judgments both about the credibility of the speaker and of what they said. When a hearer attributes too little credibility to a speaker, perhaps due to a prejudice they hold, the speaker is said to suffer an injustice. This kind of injustice is epistemic in nature: the speaker is harmed in their capacity as a 'knower'. Philosopher Miranda Fricker (2007) calls this 'epistemic injustice'. This theoretical concept has had recent uptake across health fields, including in dementia care. Whilst the concept is a useful tool to considering the injustice a person may experience, Fricker offers only a theoretical exploration of how epistemic injustice might manifest in everyday life, often using literary examples. Similarly, the existing work in epistemic injustice and dementia often relies on anecdotal evidence to support claims about the injustice persons with dementia experience. The aim of this paper is to demonstrate that one way to confirm, elaborate or indeed challenge the assumptions embodied in the concept of epistemic injustice would be to look to analysis of everyday interactions involving persons with dementia, using a Conversation Analytic approach. Heritage (2013), in his work on 'the epistemics of interaction', offers an empirically grounded method to exploring how interactants negotiate their relative epistemic positions ... in and through turns at talk and sequences of interaction (p. 556). There appears to be a compatibility between the concepts of epistemic injustice and epistemics of interaction. Although the concepts come from disparate fields of thought (i.e., philosophy and conversation analysis), both are concerned with how persons do or do not do justice to each other. Considered together, these concepts may illuminate how epistemic injustice manifests in the everyday lives of persons with dementia
The Voice of the Older Person with advanced dementia in residential aged care (RAC): What does it mean for a resident to have their voice in RAC?
No full textThis abstract was prepared for the inaugural 'HDR Student Conference', Flinders University, November 2018. Copyright © the authorThe voice of the person with advanced dementia is a significant aspect of how they live their daily life in a residential aged care home. Some studies investigate an aspect of the person's voice such as being embodied, or expressing their storied identity. However, there is a dearth of literature considering the person's own experience of their voice, and their perspectives on having their voice. Moreover, an integrated, multi-dimensional approach to understanding their voice has not been undertaken. This research took place within two memory support houses in two residential aged care homes, with people with advanced dementia becoming active participants. The aims were to explore how these people express their voices; and what are the meanings they give to having their voice. In addition, family and diverse staff members were interviewed about how the person with advanced dementia expresses their voice; and how they seek to promote the voices of people with advanced dementia
Developing a Dignity in Care Questionnaire for older people (and their carer) when in hospital
No full textThis abstract was prepared for the inaugural 'HDR Student Conference', Flinders University, November 2018. Copyright © the authorBackground The Dignity in Care Campaign, undergirded by the 10 Principles of Dignity in Care, has been strongly supported by clinicians and consumers in the United Kingdom. Surprisingly, the Campaign does not include a questionnaire for patients (and carers) to report on their experience of care, according to the 10 Principles of Dignity in Care. Objectives The questionnaire is being developed to enable older patients (and their carers) to measure their experience of receiving care according to the 10 Principles of Dignity in Care. Methods The research will utilise an exploratory sequential design in a four-stage process that includes a Delphi panel to assist in the development of the questionnaire, a pilot test of the questionnaire, extensive data collection to undertake reliability and validity testing and the development of an implementation plan. Results A Delphi panel of consumers, carers, clinicians, policy and instrument experts participated in three rounds of deliberations to develop the items to be included in the first draft of the questionnaire. This version of the questionnaire has been pilot tested with older patients (and their carers) at the Royal Adelaide Hospital. The questionnaire has been revised following the pilot test, and this post pilot version be used to collect data to test the validity and reliability of the questionnaire. Conclusions The Dignity in Care questionnaire has the potential to be used as a measure to report on the implementation of the first recommendation of the Clinical Guidelines for Dementia in Australia, which state The 10 Principles of Dignity in Care should be used as the standard by which care is delivered and evaluated
Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study
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International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background
Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions.
Methods
The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet’s Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent.
Results
Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds.
Conclusions
These findings, from a diverse range of schools with social accountability mandates in different settings, provide preliminary evidence for the selection and training of a medical workforce motivated to meet the needs of underserved populations. These respondents are being followed longitudinally to determine the degree to which these intentions translate into actual practice.THEnet has received support from Atlantic Philanthropies and the Arcadia Foundation.
GOS research on NOSM students builds on tracking studies funded by the Ministry of Health and Long-Term Care, Ontario, Canada
Facilitating Implementation of Research Evidence (FIRE): an international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework
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International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice. Methods: A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention. Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering. Results: Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time. Conclusions: This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and 'doses' of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors.The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 223646