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Bland MD, Moore JL, Anderl E, Eikenberry M, McCarthy A, Olivier GN, Rice T, Siles A, Zeleznik H, Romney W. Knowledge Translation Task Force for core measures clinical practice guideline: a short report on the process and utilization. Implement Sci Commun 2024; 5:43. [PMID: 38641675 PMCID: PMC11027410 DOI: 10.1186/s43058-024-00580-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/05/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND As part of the 2018 Clinical Practice Guideline (CPG): A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation, a Knowledge Translation (KT) Task Force was convened. The purpose of this short report was to (1) demonstrate the potential impact of a CPG KT Task Force through a practical example of efforts to implement a CPG into neurologic physical therapy practice and (2) describe the process to convene a KT Task Force and develop products (KT Toolkit) to facilitate implementation of the CPG. METHODS To describe the process used by the KT Task Force to develop and review a KT Toolkit for implementation of the CPG. RESULTS Utilizing the Knowledge-To-Action Cycle framework, eight tools were developed as part of the KT Toolkit and are available with open access to the public. Findings indicate that the Core Outcome Measures Homepage, which houses the KT Toolkit, has had greater than 70,000 views since its publication. CONCLUSIONS This short report serves as an example of the efforts made to implement a CPG into physical therapy practice. The processes to facilitate KT and the tools developed can inform future implementation efforts and underscore the importance of having a KT Task Force to implement a CPG. Moving forward, KT Task Forces should be convened to implement new or revised guidelines. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Marghuretta D Bland
- Physical Therapy, Neurology, & Occupational Therapy, Program in Physical Therapy, Washington University, St. Louis, MO, USA.
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Regional Center for Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | | | - Megan Eikenberry
- College of Health Sciences, Physical Therapy Program, Midwestern University, Glendale, AZ, USA
| | - Arlene McCarthy
- PT, MS, DPT, Board Certified in Neurologic Physical Therapy, Former Program Director of Neurologic Physical Therapy Residency, Rehabilitation Services, Kaiser Permanente, San Francisco, CA, USA
| | - Geneviève N Olivier
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Tracy Rice
- Department of Human Performance, Division of Physical Therapy, West Virginia University, Morgantown, WV, USA
| | - Amelia Siles
- School of Health and Rehabilitation Services, Physical Therapy Division, The Ohio State University, Columbus, OH, USA
| | - Hallie Zeleznik
- Strategic Initiatives and Professional Development, UPMC Centers for Rehab Services Pittsburgh, Pittsburgh, PA, USA
| | - Wendy Romney
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
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Van Criekinge T, Heremans C, Burridge J, Deutsch JE, Hammerbeck U, Hollands K, Karthikbabu S, Mehrholz J, Moore JL, Salbach NM, Schröder J, Veerbeek JM, Weerdesteyn V, Borschmann K, Churilov L, Verheyden G, Kwakkel G. Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2024; 19:158-168. [PMID: 37824730 DOI: 10.1177/17474930231205207] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. METHODS Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement. RESULTS Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used. CONCLUSIONS The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.
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Affiliation(s)
| | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Judith E Deutsch
- RiVERS Lab, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - Ulrike Hammerbeck
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust and The Tamil Nadu Dr. M.G.R. Medical University, Coimbatore, India
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Nancy M Salbach
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | | | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - Karen Borschmann
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
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Evensen J, Soberg HL, Sveen U, Hestad KA, Moore JL, Bronken BA. Individualized goals expressed by patients undergoing stroke rehabilitation: an observational study. J Rehabil Med 2024; 56:jrm15305. [PMID: 38226892 PMCID: PMC10807545 DOI: 10.2340/jrm.v56.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/06/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVES To explore the rehabilitation goals measured with the Patient-Specific Functional Scale (PSFS) in patients undergoing acute and subacute stroke rehabilitation. In addition, to assess whether PSFS goals corresponded to impairments and activity limitations, as identified by standardized measures. DESIGN Observational study. PARTICIPANTS A total of 71 participants undergoing inpatient stroke rehabilitation. METHODS The PSFS goals were linked to second-level categories in the International Classification of Functioning, Disability and Health (ICF), using established linking rules. Frequencies of the linked ICF categories were calculated. Frequencies of participants with limitations in walking, activities of daily living (ADL), vision, language, and cognition, were calculated, along with goals in corresponding areas of functioning. RESULTS The participants' goals were linked to 50 second-level ICF categories, comprising areas such as walking and moving, ADL, language, vision, and cognition. The most frequent ICF categories were "Moving around in different locations" (n = 24), "Walking" (n = 23), "Toileting" (n = 16), "Hand and arm use (n = 12) and "Fine hand use (n = 12)". Of participants with limitations in walking, cognition, and vision, 85%, 10%, and 16%, respectively, had goals in these areas. CONCLUSION Participants' goals included walking, ADL, language, vision, and cognition. Few with impairments in cognition or vision had goals in these corresponding areas on the PSFS.
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Affiliation(s)
- Janne Evensen
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Gjøvik, Norway.
| | - Helene Lundgaard Soberg
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Unni Sveen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Knut A Hestad
- Department of Health and Nursing Sciences, Faculty of Health and Social Sciences, The Inland Norway University of Applied Sciences, Elverum, Norway; Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jennifer L Moore
- Regional Center of Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo/ Nesodden, Norway; Institute for Knowledge Translation, Carmel, IN, USA
| | - Berit Arnesveen Bronken
- Department of Health and Nursing Sciences, Faculty of Health and Social Sciences, The Inland Norway University of Applied Sciences, Elverum, Norway
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Van Criekinge T, Heremans C, Burridge J, Deutsch JE, Hammerbeck U, Hollands K, Karthikbabu S, Mehrholz J, Moore JL, Salbach NM, Schröder J, Veerbeek JM, Weerdesteyn V, Borschmann K, Churilov L, Verheyden G, Kwakkel G. Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:41-51. [PMID: 37837351 DOI: 10.1177/15459683231209154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
BACKGROUND Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. METHODS Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement. RESULTS Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used. CONCLUSIONS The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.
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Affiliation(s)
| | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Judith E Deutsch
- RiVERS Lab, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - Ulrike Hammerbeck
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust and The Tamil Nadu Dr. M.G.R. Medical University, Coimbatore, India
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Nancy M Salbach
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | | | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - Karen Borschmann
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
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Moore JL, Rosseland I, Nordvik JE, Glittum J, Halvorsen J, Henderson CE, Speyer R. Identification of a know-do gap: An observational study of the assessment and treatment of dysphagia during inpatient stroke rehabilitation in primary healthcare in Norway. Top Stroke Rehabil 2024; 31:57-65. [PMID: 36976923 DOI: 10.1080/10749357.2023.2194090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Oropharyngeal dysphagia is a common swallowing impairment post-stroke managed by speech language pathologists (SLP). This article aims to demonstrate a local know-do gap assessment for usual dysphagia care for patients undergoing inpatient stroke rehabilitation in primary healthcare in Norway, which included an assessment of the functional level of the patients and characteristics and outcomes of treatment. MATERIALS AND METHODS In this observational study, we assessed the outcomes and interventions of patients admitted to inpatient rehabilitation following stroke. The patients received usual care from SLPs while the research team administered a dysphagia assessment protocol that included assessment of several swallowing domains including oral intake, swallowing, patient self-reported functional health status and health-related quality of life, and oral health. The treating SLPs documented the treatments provided in a treatment diary. RESULTS Of 91 patients who consented, 27 were referred for SLP and 14 received treatment. During the median treatment period of 31.5 days (IQR = 8.8-57.0), patients received 7.0 treatment sessions (IQR = 3.8-13.5) of 60 minutes (IQR = 55-60). The patients who received SLP treatment demonstrated no/minor disorders (n = 7) and moderate/severe disorders (n = 7). Dysphagia treatments primarily included oromotor training and advice on bolus modification and were provided without association to dysphagia severity. Patients with moderate/severe swallowing impairments received slightly more SLP sessions over a longer time. CONCLUSIONS This study identified gaps between current and best practices and opportunities to improve assessment, decision-making, and implement evidence-based practices.
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Affiliation(s)
- Jennifer L Moore
- Regional Center of Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Institute for Knowledge Translation, Carmel, Indiana, USA
| | - Ingvild Rosseland
- Forsterket rehabilitering Aker, Helseetaten, Oslo kommune, Oslo Norway
| | - Jan E Nordvik
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Jonas Glittum
- Forsterket rehabilitering Aker, Helseetaten, Oslo kommune, Oslo Norway
| | - Joakim Halvorsen
- Forsterket rehabilitering Aker, Helseetaten, Oslo kommune, Oslo Norway
| | - Christopher E Henderson
- Institute for Knowledge Translation, Carmel, Indiana, USA
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Renée Speyer
- Department Special Needs Education, University of Oslo, Oslo, Norway
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Reszel J, Daub O, Leese J, Augustsson H, Bellows DM, Cassidy CE, Crowner BE, Dunn SI, Goodwin LB, Hoens AM, Hunter SC, Lynch EA, Moore JL, Rafferty MR, Romney W, Stacey D, Graham ID. Essential content for teaching implementation practice in healthcare: a mixed-methods study of teams offering capacity-building initiatives. Implement Sci Commun 2023; 4:151. [PMID: 38012798 PMCID: PMC10680357 DOI: 10.1186/s43058-023-00525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Applying the knowledge gained through implementation science can support the uptake of research evidence into practice; however, those doing and supporting implementation (implementation practitioners) may face barriers to applying implementation science in their work. One strategy to enhance individuals' and teams' ability to apply implementation science in practice is through training and professional development opportunities (capacity-building initiatives). Although there is an increasing demand for and offerings of implementation practice capacity-building initiatives, there is no universal agreement on what content should be included. In this study we aimed to explore what capacity-building developers and deliverers identify as essential training content for teaching implementation practice. METHODS We conducted a convergent mixed-methods study with participants who had developed and/or delivered a capacity-building initiative focused on teaching implementation practice. Participants completed an online questionnaire to provide details on their capacity-building initiatives; took part in an interview or focus group to explore their questionnaire responses in depth; and offered course materials for review. We analyzed a subset of data that focused on the capacity-building initiatives' content and curriculum. We used descriptive statistics for quantitative data and conventional content analysis for qualitative data, with the data sets merged during the analytic phase. We presented frequency counts for each category to highlight commonalities and differences across capacity-building initiatives. RESULTS Thirty-three individuals representing 20 capacity-building initiatives participated. Study participants identified several core content areas included in their capacity-building initiatives: (1) taking a process approach to implementation; (2) identifying and applying implementation theories, models, frameworks, and approaches; (3) learning implementation steps and skills; (4) developing relational skills. In addition, study participants described offering applied and pragmatic content (e.g., tools and resources), and tailoring and evolving the capacity-building initiative content to address emerging trends in implementation science. Study participants highlighted some challenges learners face when acquiring and applying implementation practice knowledge and skills. CONCLUSIONS This study synthesized what experienced capacity-building initiative developers and deliverers identify as essential content for teaching implementation practice. These findings can inform the development, refinement, and delivery of capacity-building initiatives, as well as future research directions, to enhance the translation of implementation science into practice.
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Affiliation(s)
- Jessica Reszel
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada.
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada.
| | - Olivia Daub
- School of Communication Sciences and Disorders, Western University, London, Canada
| | - Jenny Leese
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Hanna Augustsson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm, Sweden
| | - Danielle Moeske Bellows
- School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences, Worcester, USA
| | - Christine E Cassidy
- School of Nursing, Dalhousie University, Halifax, Canada
- IWK Health Centre, Halifax, Canada
| | | | - Sandra I Dunn
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Canada
| | - Lisa B Goodwin
- Inpatient Rehabilitation, University of Vermont Medical Center, Colchester, USA
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Sarah C Hunter
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Elizabeth A Lynch
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Jennifer L Moore
- Regional Rehabilitation Knowledge Center, Sunnaas Hospital, Oslo, Norway
- Institute for Knowledge Translation, Carmel, Indiana, USA
| | - Miriam R Rafferty
- Shirley Ryan AbilityLab and Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, USA
| | - Wendy Romney
- Physical Therapy, Sacred Heart University, Fairfield, USA
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ian D Graham
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Evensen J, Soberg HL, Sveen U, Hestad KA, Moore JL, Bronken BA. Measurement Properties of the Patient-Specific Functional Scale in Rehabilitation for Patients With Stroke: A Prospective Observational Study. Phys Ther 2023; 103:pzad014. [PMID: 37140476 PMCID: PMC10158643 DOI: 10.1093/ptj/pzad014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/22/2022] [Accepted: 12/05/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE This study investigated the validity, reliability, responsiveness, and interpretability of the Patient-Specific Functional Scale (PSFS) in subacute stroke rehabilitation to determine its suitability to measure patient-identified rehabilitation goals. METHODS A prospective observational study was designed according to the checklist from Consensus-Based Standards for Selecting Health Measurement Instruments. Seventy-one patients diagnosed with stroke were recruited in the subacute phase from a rehabilitation unit in Norway. The International Classification of Functioning, Disability and Health was used to assess the content validity. Assessment of construct validity was based on hypotheses for correlation of the PSFS and comparator measurements. We assessed reliability by calculating the Intraclass Correlation Coefficient (ICC) (3.1) and the standard error of measurement. The assessment of responsiveness was based on hypotheses for the correlation of change scores between the PSFS and the comparator measurements. A receiver operating characteristic analysis was conducted to assess responsiveness. The smallest detectable change and minimal important change were calculated. RESULTS Eighty percent of the PSFS items were classified as activities and participation in the International Classification of Functioning, Disability and Health, indicating satisfactory content validity. The reliability was satisfactory with an ICC of 0.81 (95% CI = 0.69-0.89). The standard error of measurement was 0.70 point, and the smallest detectable change was 1.94 points. Five of 7 hypotheses were confirmed for construct validity, and 5 of 6 were confirmed for responsiveness, indicating moderate construct validity and high responsiveness. Assessing responsiveness with a criterion approach resulted in an area under the curve of 0.74. A ceiling effect was identified for 25% of the participants 3 months after discharge. The minimal important change was estimated to be 1.58 points. CONCLUSION This study demonstrates satisfactory measurement properties for the PSFS in individuals undergoing inpatient stroke rehabilitation. IMPACT This study supports the use of the PSFS to document and monitor patient-identified rehabilitation goals in patients receiving subacute stroke rehabilitation when applied using a shared decision approach.
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Affiliation(s)
- Janne Evensen
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Gjøvik, Norway
| | - Helene Lundgaard Soberg
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Unni Sveen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Knut A Hestad
- Department of Mental Health and Rehabilitation, Faculty of Health- and Social Sciences, The Inland Norway University of Applied Sciences, Elverum, Norway
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jennifer L Moore
- Regional Center of Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo/Nesodden, Norway
| | - Berit Arnesveen Bronken
- Department of Mental Health and Rehabilitation, Faculty of Health- and Social Sciences, The Inland Norway University of Applied Sciences, Elverum, Norway
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Reszel J, van den Hoek J, Nguyen T, Aravind G, Bayley MT, Bird ML, Edwards K, Eng JJ, Moore JL, Nelson MLA, Ploughman M, Richardson J, Salbach NM, Tang A, Graham ID. The Stroke Recovery in Motion Implementation Planner: Mixed Methods User Evaluation. JMIR Form Res 2022; 6:e37189. [PMID: 35904870 PMCID: PMC9377478 DOI: 10.2196/37189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background As more people are surviving stroke, there is a growing need for services and programs that support the long-term needs of people living with the effects of stroke. Exercise has many benefits; however, most people with stroke do not have access to specialized exercise programs that meet their needs in their communities. To catalyze the implementation of these programs, our team developed the Stroke Recovery in Motion Implementation Planner, an evidence-informed implementation guide for teams planning a community-based exercise program for people with stroke. Objective This study aimed to conduct a user evaluation to elicit user perceptions of the usefulness and acceptability of the Planner to inform revisions. Methods This mixed methods study used a concurrent triangulation design. We used purposive sampling to enroll a diverse sample of end users (program managers and coordinators, rehabilitation health partners, and fitness professionals) from three main groups: those who are currently planning a program, those who intend to plan a program in the future, and those who had previously planned a program. Participants reviewed the Planner and completed a questionnaire and interviews to identify positive features, areas of improvement, value, and feasibility. We used descriptive statistics for quantitative data and content analysis for qualitative data. We triangulated the data sources to identify Planner modifications. Results A total of 39 people participated in this study. Overall, the feedback was positive, highlighting the value of the Planner’s comprehensiveness, tools and templates, and real-world examples. The identified areas for improvement included clarifying the need for specific steps, refining navigation, and creating more action-oriented content. Most participants reported an increase in knowledge and confidence after reading the Planner and reported that using the resource would improve their planning approach. Conclusions We used a rigorous and user-centered process to develop and evaluate the Planner. End users indicated that it is a valuable resource and identified specific changes for improvement. The Planner was subsequently updated and is now publicly available for community planning teams to use in the planning and delivery of evidence-informed, sustainable, community-based exercise programs for people with stroke.
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Affiliation(s)
- Jessica Reszel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Tram Nguyen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Marie-Louise Bird
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Kate Edwards
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer L Moore
- South Eastern Norway Regional Knowledge Translation Center, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Institute for Knowledge Translation, Carmel, IN, United States
| | - Michelle L A Nelson
- March of Dimes Canada, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Nancy M Salbach
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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9
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Reszel J, van den Hoek J, Nguyen T, Aravind G, Bayley MT, Bird ML, Edwards K, Eng JJ, Moore JL, Nelson MLA, Ploughman M, Richardson J, Salbach NM, Tang A, Graham ID. How Community-Based Teams Use the Stroke Recovery in Motion Implementation Planner: Longitudinal Qualitative Field Test Study. JMIR Form Res 2022; 6:e37243. [PMID: 35904855 PMCID: PMC9377454 DOI: 10.2196/37243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The Stroke Recovery in Motion Implementation Planner guides teams through the process of planning for the implementation of community-based exercise programs for people with stroke, in alignment with implementation science frameworks. Objective The purpose of this study was to conduct a field test with end users to describe how teams used the Planner in real-world conditions; describe the effects of Planner use on participants’ implementation-planning knowledge, attitudes, and activities; and identify factors influencing the use of the Planner. Methods This field test study used a longitudinal qualitative design. We recruited teams across Canada who intended to implement a community-based exercise program for people with stroke in the next 6 to 12 months and were willing to use the Planner to guide their work. We completed semistructured interviews at the time of enrollment, monitoring calls every 1 to 2 months, and at the end of the study to learn about implementation-planning work completed and Planner use. The interviews were analyzed using conventional content analysis. Completed Planner steps were plotted onto a timeline for comparison across teams. Results We enrolled 12 participants (program managers and coordinators, rehabilitation professionals, and fitness professionals) from 5 planning teams. The teams were enrolled in the study between 4 and 14 months, and we conducted 25 interviews. We observed that the teams worked through the planning process in diverse and nonlinear ways, adapted to their context. All teams provided examples of how using the Planner changed their implementation-planning knowledge (eg, knowing the steps), attitudes (eg, valuing community engagement), and activities (eg, hosting stakeholder meetings). We identified team, organizational, and broader contextual factors that hindered and facilitated uptake of the Planner. Participants shared valuable tips from the field to help future teams optimize use of the Planner. Conclusions The Stroke Recovery in Motion Implementation Planner is an adaptable resource that may be used in diverse settings to plan community-based exercise programs for people with stroke. These findings may be informative to others who are developing resources to build the capacity of those working in community-based settings to implement new programs and practices. Future work is needed to monitor the use and understand the effect of using the Planner on exercise program implementation and sustainability.
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Affiliation(s)
- Jessica Reszel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Tram Nguyen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Marie-Louise Bird
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
- Department of Physical Therapy, University of British Columbia, Vancouver, ON, Canada
| | - Kate Edwards
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, ON, Canada
| | - Jennifer L Moore
- South Eastern Norway Regional Knowledge Translation Center, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Institute for Knowledge Translation, Carmel, IN, United States
| | - Michelle L A Nelson
- March of Dimes Canada, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Nancy M Salbach
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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10
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Henderson CE, Fahey M, Brazg G, Moore JL, Hornby TG. Predicting Discharge Walking Function With High-Intensity Stepping Training During Inpatient Rehabilitation in Nonambulatory Patients Poststroke. Arch Phys Med Rehabil 2022; 103:S189-S196. [PMID: 33227267 DOI: 10.1016/j.apmr.2020.10.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This cohort investigation identified primary predictors of discharge walking function of nonambulatory individuals poststroke with high-intensity training (HIT) during inpatient rehabilitation. DESIGN Observational cohort investigation. SETTING Inpatient rehabilitation. PARTICIPANTS Data were collected from individuals (N=257) <6 months poststroke who required assistance to walk at admission. INTERVENTION Clinical physical therapy interventions attempted to maximize stepping practice at higher intensities. MAIN OUTCOME MEASURES Primary outcomes included the discharge level of assistance required during walking (minimal or no assistance) and attainment of specific gait speed thresholds (0.4 and 0.8 m/s) during the 10-m walk test. Independent predictors were demographics, training interventions (including steps/day), baseline Berg Balance Scale (BBS), and paretic leg strength. RESULTS Participants performed a median (interquartile range) of 1270 (533-2297) steps per day throughout inpatient rehabilitation, with significant differences between those who walked with versus without assistance at discharge. Logistic regressions indicate steps per day was a primary predictor of unassisted walking recovery; removal of steps per day resulted in primary predictors of baseline BBS and strength. Receiver operating characteristic (ROC) analyses indicate significant areas under the curve for BBS and relatively low cutoff scores of 5.5 points at admission to walk without assistance at any speed. ROC analyses performed using 1-week outcomes indicate BBS scores of 5-17 points were needed to achieve locomotor thresholds. CONCLUSION Stepping activity, BBS, and paretic leg strength were primary predictors of walking outcomes in patients performing HIT, and ROC analyses indicated recovery of independent walking could be achieved in low functioning patients early poststroke.
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Affiliation(s)
- Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN; Institute of Knowledge Translation, Carmel, IN
| | | | | | - Jennifer L Moore
- Institute of Knowledge Translation, Carmel, IN; SouthEastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN; Institute of Knowledge Translation, Carmel, IN.
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11
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Henderson C, Virva R, Lenca L, Butzer JF, Lovell L, Roth E, Hornby TG, Moore JL. Gait and Balance Outcome Measures are Responsive in Severely Impaired Individuals Undergoing Inpatient Stroke Rehabilitation. Arch Phys Med Rehabil 2022; 103:1210-1212.e1. [PMID: 35093332 DOI: 10.1016/j.apmr.2022.01.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate whether gait and balance outcome measures in patients with severe gait and balance impairments at admission to inpatient rehabilitation provided additional and meaningful information beyond customary measures. Specifically, this study investigated whether individuals who obtained low scores at admission exhibited improvements that exceeded the established minimal detectable change (MDC) during inpatient rehabilitation. We also investigated whether gait outcomes would capture changes in function not identified by customary measures. DESIGN Secondary analysis of a knowledge translation project aimed at increasing the systematic collection of these outcome measures in a poststroke cohort. SETTING Subacute inpatient rehabilitation facility. PARTICIPANTS Individuals <2 months poststroke (n=157) with 34-43 with severe deficits including Berg Balance Scale ≤5, 10-meter walk test =0 m/s, or 6-minute walk test =0 m. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Berg Balance Scale, 10-meter walk test, 6-minute walk test RESULTS: After one week of rehabilitation, 41%-53% of severely impaired individuals had changes above MDCs in gait and balance outcomes, which increased to 68%-84% at discharge. Across the entire cohort, Functional Independence Measure locomotion scores failed to identify changes in gait function for 35% of participants after one week of rehabilitation. CONCLUSIONS Routine assessment of gait and balance outcome measures with patients with severe deficits early poststroke may be beneficial. These measures were responsive after one week of rehabilitation and detected changes not captured by customary measures. Routine use of a standardized gait and balance assessments may provide clinicians with important information to guide clinical decision-making.
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Affiliation(s)
- Christopher Henderson
- Indiana University School of Medicine, Indianapolis, IN; Institute for Knowledge Translation, Carmel IN.
| | - Roberta Virva
- Mary Free Bed Rehabilitation Hospital, Grand Rapids MI
| | - Lauren Lenca
- Mary Free Bed Rehabilitation Hospital, Grand Rapids MI
| | - John F Butzer
- Mary Free Bed Rehabilitation Hospital, Grand Rapids MI
| | | | - Elliot Roth
- Shirley Ryan AbilityLab, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - T George Hornby
- Indiana University School of Medicine, Indianapolis, IN; Institute for Knowledge Translation, Carmel IN
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel IN; South Eastern Norway Regional Center of Knowledge Translation in Rehabilitation, Oslo, Norway
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12
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Moore JL, Davies AR, Santaolalla A, Van Hemelrijck M, Maisey N, Lagergren J, Gossage JA, Kelly M, Baker CR. Clinical Relevance of the Tumor Location-Modified Laurén Classification System for Gastric Cancer in a Western Population. Ann Surg Oncol 2022; 29:3911-3920. [PMID: 35041098 PMCID: PMC9072452 DOI: 10.1245/s10434-021-11252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
Background The Tumor Location-Modified Laurén Classification (MLC) system combines Laurén histologic subtype and anatomic tumor location. It divides gastric tumors into proximal non-diffuse (PND), distal non-diffuse (DND), and diffuse (D) types. The optimum classification of patients with Laurén mixed tumors in this system is not clear due to its grouping with both diffuse and non-diffuse types in previous studies. The clinical relevance of the MLC in a Western population has not been examined. Methods A cohort study investigated 404 patients who underwent gastrectomy for gastric adenocarcinoma between 2005 and 2020. The classification of Laurén mixed tumors was evaluated using receiver operating characteristic (ROC) curve analysis and comparison of clinicopathologic characteristics (chi-square). Survival analysis was performed using multivariable Cox regression. Results The ROC curve analysis demonstrated a slightly higher area under the curve value for predicting survival when Laurén mixed tumors were grouped with intestinal-type rather than diffuse-type tumors (0.58 vs 0.57). Survival, tumor recurrence, and resection margin positivity in mixed tumors also was more similar to intestinal type. Distal non-diffuse tumors had the best 5-year survival (DND 64.7 % vs PND 56.1 % vs diffuse 45.1 %; p = 0.006) and were least likely to have recurrence (DND 27.0 % vs PND 34.3 % vs diffuse 48.3 %; p = 0.001). Multivariable analysis demonstrated that MLC was an independent prognostic factor for survival (PND: hazard ratio [HR], 1.64; 95 % confidence interval [CI], 1.16–2.32 vs diffuse: HR, 2.20; 95 % CI, 1.56–3.09) Conclusions The MLC was an independent prognostic marker in this Western cohort of patients with gastric adenocarcinoma. The patients with PND and D tumors had worse survival than those with DND tumors.
Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-11252-y.
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Affiliation(s)
- J L Moore
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK. .,School of Cancer and Pharmaceutical Sciences, King's College, London, UK.
| | - A R Davies
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - A Santaolalla
- School of Cancer and Pharmaceutical Sciences, King's College, London, UK.,Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - M Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, King's College, London, UK.,Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - N Maisey
- Department of Medical Oncology, St. Thomas' Hospital, London, UK
| | - J Lagergren
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J A Gossage
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - M Kelly
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
| | - C R Baker
- Department of Upper Gastrointestinal and General Surgery, St. Thomas' Hospital, London, UK.,School of Cancer and Pharmaceutical Sciences, King's College, London, UK
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13
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Avagyan S, Henninger JE, Mannherz WP, Mistry M, Yoon J, Yang S, Weber MC, Moore JL, Zon LI. Resistance to inflammation underlies enhanced fitness in clonal hematopoiesis. Science 2021; 374:768-772. [PMID: 34735227 DOI: 10.1126/science.aba9304] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- S Avagyan
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - J E Henninger
- Whitehead Institute for Biomedical Research, Cambridge, MA, USA
| | | | - M Mistry
- Harvard Chan Bioinformatics Core, Boston, MA, USA
| | - J Yoon
- Harvard Chan Bioinformatics Core, Boston, MA, USA
| | - S Yang
- Boston Children's Hospital, Boston, MA, USA
| | - M C Weber
- Boston Children's Hospital, Boston, MA, USA
| | - J L Moore
- Boston Children's Hospital, Boston, MA, USA
| | - L I Zon
- Boston Children's Hospital, Boston, MA, USA.,Howard Hughes Medical Institute, Harvard Medical School, Boston, MA, USA
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14
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Moore JL, Bø E, Erichsen A, Rosseland I, Halvorsen J, Bratlie H, Hornby TG, Nordvik JE. Development and Results of an Implementation Plan for High-Intensity Gait Training. J Neurol Phys Ther 2021; 45:282-291. [PMID: 34369450 PMCID: PMC8423140 DOI: 10.1097/npt.0000000000000364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND PURPOSE High-intensity gait training is recommended in stroke rehabilitation to improve gait speed, walking distance, and balance. However, identifying effective and efficient implementation methods is a challenge for rehabilitation providers. This article describes the development of an implementation plan, presents findings of each implementation phase, and identifies the project's impact on clinicians and the health system. METHODS Two inpatient rehabilitation facilities, including 9 physical therapists, collaborated with a knowledge translation center to implement this program. We developed an implementation plan using the Knowledge-to-Action Framework and utilized the Consolidated Framework for Implementation Research to identify barriers and select implementation strategies. Using mix-methods research, including surveys and informal discussions, we evaluated current practice, barriers, outcomes, and the sustainability of high-intensity gait training in practice. RESULTS A multicomponent implementation plan that targeted barriers was developed. Before implementation, clinicians reported providing several balance, strength training, and gait interventions to improve walking. Barriers to using high-intensity gait training included knowledge, beliefs, adaptability of high-intensity gait training, resources, culture, and others. Twenty-six implementation strategies were selected to target the barriers. Surveys and informal discussions identified significant changes in perceived practice, adoption of high-intensity gait training, and positive impacts on the health system. The 2-year follow-up survey indicated that the new practice was sustained. DISCUSSION AND CONCLUSIONS Using a multicomponent implementation plan that targeted barriers, we successfully implemented high-intensity gait training in clinical practice. Contributors to successful implementation may include the implementation methods, usual care interventions, and clinicians' readiness for this change.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A352.).
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Affiliation(s)
- Jennifer L. Moore
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Elisabeth Bø
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Anne Erichsen
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Ingvild Rosseland
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Joakim Halvorsen
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Hanne Bratlie
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - T. George Hornby
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
| | - Jan Egil Nordvik
- First Oslo team members are as follows: Tonje Barkenæs, Miriam Byhring, Magnus Hågå, Chris Henderson, Mari Klokkerud, Julia Mbalilaki, Stein-Arne Rimehaug, Thomas Tomren, and Karen Vergoossen
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15
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Bresnahan BW, Vodicka E, Babigumira JB, Malik AM, Yego F, Lokangaka A, Chitah BM, Bauer Z, Chavez H, Moore JL, Garrison LP, Swanson JO, Swanson D, McClure EM, Goldenberg RL, Esamai F, Garces AL, Chomba E, Saleem S, Tshefu A, Bose CL, Bauserman M, Carlo W, Bucher S, Liechty EA, Nathan RO. Cost estimation alongside a multi-regional, multi-country randomized trial of antenatal ultrasound in five low-and-middle-income countries. BMC Public Health 2021; 21:952. [PMID: 34016085 PMCID: PMC8135981 DOI: 10.1186/s12889-021-10750-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency. METHODS We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and hospital-based (facility) care for pregnant women, in general, with selective complication-related data collection in women participating in a large maternal health registry and clinical trial in five LMICs. We estimated average costs from a facility/health system perspective for outpatient and inpatient services. We converted all country-level currency cost estimates to 2015 United States dollars (USD). We compared average costs across countries for ANC visits, deliveries, higher-risk pregnancies, and complications, and conducted sensitivity analyses. RESULTS Our study included sites in five countries representing different regions. Overall, the relative cost of individual ANC and delivery-related healthcare use was consistent among countries, generally corresponding to country-specific income levels. ANC outpatient visit cost estimates per patient among countries ranged from 15 to 30 USD, based on average counts for visits with and without US. Estimates for antenatal screening US visits were more costly than non-US visits. Costs associated with higher-risk pregnancies were influenced by rates of hospital delivery by cesarean section (mean per person delivery cost estimate range: 25-65 USD). CONCLUSIONS Despite substantial differences among countries in infrastructures and health system capacity, there were similarities in resource allocation, delivery location, and country-level challenges. Overall, there was no clear suggestion that adding antenatal screening US would result in either major cost savings or major cost increases. However, antenatal screening US would have higher training and maintenance costs. Given the lack of clinical effectiveness evidence and greater resource constraints of LMICs, it is unlikely that introducing antenatal screening US would be economically efficient in these settings--on the demand side (i.e., patients) or supply side (i.e., healthcare providers). TRIAL REGISTRATION Trial number: NCT01990625 (First posted: November 21, 2013 on https://clinicaltrials.gov ).
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Affiliation(s)
- B W Bresnahan
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - E Vodicka
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - J B Babigumira
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - A M Malik
- Aga Khan University, Karachi, Pakistan
| | - F Yego
- Moi University, Eldoret, Kenya
| | - A Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Z Bauer
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - H Chavez
- University of Francisco Marroquin, Guatemala City, Guatemala
| | | | - L P Garrison
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - J O Swanson
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - D Swanson
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | | | | | | | - E Chomba
- University of Zambia, Lusaka, Zambia
| | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - C L Bose
- University of North Carolina, Chapel Hill, NC, USA
| | - M Bauserman
- University of North Carolina, Chapel Hill, NC, USA
| | - W Carlo
- University of Alabama Birmingham, Birmingham, AL, USA
| | - S Bucher
- Indiana University, Indianapolis, IN, USA
| | | | - R O Nathan
- Department of Radiology, University of Washington, Seattle, WA, USA
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16
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Moore JL, Bjørkli C, Havdahl RT, Lømo LL, Midthaug M, Skjuve M, Klokkerud M, Nordvik JE. A qualitative study exploring contributors to the success of a community of practice in rehabilitation. BMC Med Educ 2021; 21:282. [PMID: 34001073 PMCID: PMC8130156 DOI: 10.1186/s12909-021-02711-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Communities of Practice (CoPs) focus on learning, knowledge sharing, and creation, and research indicates they can improve healthcare performance. This article describes the development of a CoP that focused on synthesizing and adapting evidence in Physical Medicine and Rehabilitation (PM&R). This study aimed to investigate the CoP members' experiences and perceived barriers and enablers of CoP success in the early phase of a CoP. METHODS Physical therapists and a physician (n = 10) volunteered for a CoP that synthesized literature of PM&R evidence. CoP members participated in education and training on critical appraisal and knowledge synthesis, practiced critical appraisal skills, and summarized literature. Three months after CoP initiation, semi-structured interviews were conducted to understand the CoP members' experiences and reflections. Members also completed an online survey that included the Evidence-Based Practice Confidence scale (EPIC), questions related to CoP activities, and demographics before CoP initiation. We utilized the Capability, Opportunity, and Motivation Model of Behaviour (COM-B) to explore how these experiences related to the behavioral adaptation and participation. RESULTS Ten themes related to the potential contributors to CoP success and failure were identified. These included project management, technological solutions, efficacy, organizational support, interaction, the bigger picture, self-development, time, and motivation. CONCLUSIONS Contributors to CoP success may include clearly articulated project goals and participant expectations, education and training, reliable technology solutions, organizational support, face-to-face communication, and good project management. Importantly, CoP members need time to participate in activities.
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Affiliation(s)
- Jennifer L. Moore
- Regional Center for Knowledge translation in Rehabilitation South Eastern Region, Sunnaas Sykehus, Nesodden, Oslo, Norway
- Institute for Knowledge Translation, Carmel, IN USA
| | - Cato Bjørkli
- University of Oslo, Department of Psychology, Oslo, Norway
| | - Richard Tidemann Havdahl
- Regional Center for Knowledge translation in Rehabilitation South Eastern Region, Sunnaas Sykehus, Nesodden, Oslo, Norway
- University of Oslo, Department of Psychology, Oslo, Norway
- AFF at the Norwegian School of Economics, Oslo, Norway
| | - Linn Lien Lømo
- Regional Center for Knowledge translation in Rehabilitation South Eastern Region, Sunnaas Sykehus, Nesodden, Oslo, Norway
- University of Oslo, Department of Psychology, Oslo, Norway
- AFF at the Norwegian School of Economics, Oslo, Norway
| | - Mari Midthaug
- Regional Center for Knowledge translation in Rehabilitation South Eastern Region, Sunnaas Sykehus, Nesodden, Oslo, Norway
- University of Oslo, Department of Psychology, Oslo, Norway
- Hartmark Executive Search, Oslo, Norway
| | - Marita Skjuve
- University of Oslo, Department of Psychology, Oslo, Norway
| | - Mari Klokkerud
- Regional Center for Knowledge translation in Rehabilitation South Eastern Region, Sunnaas Sykehus, Nesodden, Oslo, Norway
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Jessani S, Saleem S, Hoffman MK, Goudar SS, Derman RJ, Moore JL, Garces A, Figueroa L, Krebs NF, Okitawutshu J, Tshefu A, Bose CL, Mwenechanya M, Chomba E, Carlo WA, Das PK, Patel A, Hibberd PL, Esamai F, Liechty EA, Bucher S, Nolen TL, Koso-Thomas M, Miodovnik M, McClure EM, Goldenberg RL. Association of haemoglobin levels in the first trimester and at 26-30 weeks with fetal and neonatal outcomes: a secondary analysis of the Global Network for Women's and Children's Health's ASPIRIN Trial. BJOG 2021; 128:1487-1496. [PMID: 33629490 DOI: 10.1111/1471-0528.16676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Limited data are available from low- and middle-income countries (LMICs) on the relationship of haemoglobin levels to adverse outcomes at different times during pregnancy. We evaluated the association of haemoglobin levels in nulliparous women at two times in pregnancy with pregnancy outcomes. DESIGN ASPIRIN Trial data were used to study the association between haemoglobin levels measured at 6+0 -13+6 weeks and 26+0 -30+0 weeks of gestation with fetal and neonatal outcomes. SETTING Obstetric care facilities in Pakistan, India, Kenya, Zambia, The Democratic Republic of the Congo and Guatemala. POPULATION A total of 11 976 pregnant women. METHODS Generalised linear models were used to obtain adjusted relative risks and 95% CI for adverse outcomes. MAIN OUTCOME MEASURES Preterm birth, stillbirth, neonatal death, small for gestational age (SGA) and birthweight <2500 g. RESULTS The mean haemoglobin levels at 6+0 -13+6 weeks and at 26-30 weeks of gestation were 116 g/l (SD 17) and 107 g/l (SD 15), respectively. In general, pregnancy outcomes were better with increasing haemoglobin. At 6+0 -13+6 weeks of gestation, stillbirth, SGA and birthweight <2500 g, were significantly associated with haemoglobin of 70-89 g/l compared with haemoglobin of 110-129 g/l The relationships of adverse pregnancy outcomes with various haemoglobin levels were more marked at 26-30 weeks of gestation. CONCLUSIONS Both lower and some higher haemoglobin concentrations are associated with adverse fetal and neonatal outcomes at 6+0 -13+6 weeks and at 26-30 weeks of gestation, although the relationship with low haemoglobin levels appears more consistent and generally stronger. TWEETABLE ABSTRACT Both lower and some higher haemoglobin concentrations were associated with adverse fetal and neonatal outcomes at 6-13 weeks and 26-30 weeks of gestation.
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Affiliation(s)
- S Jessani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - S Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - M K Hoffman
- Department of Obstetrics and Gynecology, Christiana Care, Newark, DE, USA
| | - S S Goudar
- KLE Academy of Higher Education and Research Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - R J Derman
- Thomas Jefferson University, Philadelphia, PA, USA
| | - J L Moore
- RTI International, Research Triangle Park, Durham, NC, USA
| | - A Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - L Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - N F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | - J Okitawutshu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - C L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - E Chomba
- University Teaching Hospital, Lusaka, Zambia
| | - W A Carlo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - P K Das
- Lata Medical Research Foundation, Nagpur, India
| | - A Patel
- Lata Medical Research Foundation, Nagpur, India.,Datta Meghe Institute of Medical Sciences, Wardha, India
| | - P L Hibberd
- Boston University School of Public Health, Boston, MA, USA
| | - F Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - E A Liechty
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - S Bucher
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - T L Nolen
- RTI International, Research Triangle Park, Durham, NC, USA
| | - M Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - M Miodovnik
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - E M McClure
- RTI International, Research Triangle Park, Durham, NC, USA
| | - R L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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Moore JL, Mbalilaki JA, Graham ID. Knowledge Translation in Physical Medicine and Rehabilitation: A Citation Analysis of the Knowledge-to-Action Literature. Arch Phys Med Rehabil 2021; 103:S256-S275. [PMID: 33556348 DOI: 10.1016/j.apmr.2020.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To (1) provide an overview of the use of the Knowledge-to-Action Cycle (KTA) to guide a clinical implementation project; (2) identify activities performed in each phase of the KTA; and (3) provide suggestions to improve KTA activities in physical medicine and rehabilitation. DATA SOURCES Google Scholar and PubMed were searched through December 31, 2019. STUDY SELECTION Two reviewers screened titles, abstracts, and full-text articles to identify published studies that used the KTA to implement a project. DATA EXTRACTION Two reviewers examined full-text articles. Data extraction included activities performed in each phase of the KTA, including measurements used to evaluate the project's effectiveness. DATA SYNTHESIS Commonly performed KTA activities were identified and country of study, area of rehabilitation, and other factors related to the use of the KTA in rehabilitation were described. A total of 46 articles that met the study's inclusion criteria provided an overview of the use of the KTA in rehabilitation. Strengths and weaknesses of the articles are discussed and recommendations for improved KTA use are provided. CONCLUSIONS Implementation of evidence-based practice requires focused engineering and efforts. This review provides an overview of the knowledge translation activities occurring in physical medicine and rehabilitation and considerations to improve knowledge translation research and practice.
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Affiliation(s)
- Jennifer L Moore
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway; Institute for Knowledge Translation, Carmel, IN, United States.
| | - Julia A Mbalilaki
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Moore JL, Virva R, Henderson C, Lenca L, Butzer JF, Lovell L, Roth E, Graham ID, Hornby TG. Applying the Knowledge-to-Action Framework to Implement Gait and Balance Assessments in Inpatient Stroke Rehabilitation. Arch Phys Med Rehabil 2020; 103:S230-S245. [PMID: 33253695 DOI: 10.1016/j.apmr.2020.10.133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/01/2020] [Accepted: 10/06/2020] [Indexed: 11/02/2022]
Abstract
OBJECTIVES The overall objectives of this project were to implement and sustain use of a gait assessment battery (GAB) that included the Berg Balance Scale, 10-meter walk test, and 6-minute walk test during inpatient stroke rehabilitation. The study objective was to assess the effect of the study intervention on clinician adherence to the recommendations and its effect on clinician perceptions and the organization. DESIGN Pre- and post-training intervention study. SETTING Subacute inpatient rehabilitation facility. PARTICIPANTS Physical therapists (N=6) and physical therapist assistants (N=2). INTERVENTION The intervention comprised a bundle of activities, including codeveloping and executing the plan with clinicians and leaders. The multicomponent implementation plan was based on the Knowledge-to-Action Framework and included implementation facilitation, implementation leadership, and a bundle of knowledge translation interventions that targeted barriers. Implementation was an iterative process in which results from one implementation phase informed planning of the next phase. MAIN OUTCOME MEASURES Clinician administration adherence, surveys of perceptions, and organizational outcomes. RESULTS Initial adherence to the GAB was 46% and increased to more than 85% after 6 months. These adherence levels remained consistent 48 months after implementation. Clinician perceptions of measure use were initially high (>63%), with significant improvements in knowledge and use of one measure after implementation. CONCLUSIONS We successfully implemented the assessment battery with high levels of adherence to recommendations, likely because of using the bundle of knowledge translation activities, facilitation, and use of a framework to codevelop the plan. These changes in practice were sustainable, as determined by a 4-year follow-up.
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Affiliation(s)
- Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN; South Eastern Norway Regional Center of Knowledge Translation in Rehabilitation, Oslo, Norway.
| | - Roberta Virva
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI
| | - Chris Henderson
- Institute for Knowledge Translation, Carmel, IN; Indiana University School of Medicine, Indianapolis, IN
| | - Lauren Lenca
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI
| | - John F Butzer
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI
| | | | - Elliot Roth
- Shirley Ryan AbilityLab, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - T George Hornby
- Institute for Knowledge Translation, Carmel, IN; Indiana University School of Medicine, Indianapolis, IN
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Moore JL, Nordvik JE, Erichsen A, Rosseland I, Bø E, Hornby TG. Implementation of High-Intensity Stepping Training During Inpatient Stroke Rehabilitation Improves Functional Outcomes. Stroke 2019; 51:563-570. [PMID: 31884902 DOI: 10.1161/strokeaha.119.027450] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Therapeutic strategies that capitalize on the intrinsic capacity for neurological recovery early poststroke to improve locomotion are uncertain. Emerging data suggest that task-specific stepping practice provided at higher cardiovascular intensities may be critical dosage parameters that could maximize locomotor recovery. The purpose of this investigation was to determine the comparative effectiveness of providing high-intensity training on locomotor capacity early poststroke as compared with usual care. Methods- A quasi-experimental design was used to compare changes in stepping activity (StepWatch), walking, and balance outcomes during usual care (n=56) versus high-intensity stepping intervention (n=54) in inpatient stroke patients. Primary outcomes assessed weekly included self-selected and fastest gait speed, 6-minute walk test, and the Berg Balance Scale, with secondary outcomes of Swedish Postural Assessment Scale for Stroke-Norwegian version, Functional Ambulation Category, 30-s sit-to-stand, strength (average manual muscle testing), and Barthel Index. Regression analyses identified relationships between demographics, baseline function, and training activities (steps per day; duration achieved, 70%-85% maximum heart rates) and primary outcomes at discharge. Results- Following implementation of high-intensity stepping, average steps per day (5777±2784) were significantly greater than during usual care (3917±2656; P<0.001). Statistically different and clinically meaningful changes in self-selected speed (0.39±0.28 versus 0.16±0.26 m/s) and fastest gait speed (0.47±0.41 versus 0.17±0.38 m/s; both P<0.001) were observed following high-intensity interventions versus usual care and at every assessment throughout the length of stay. Changes in Berg Balance Scale and 6-minute walk test were also statistically and clinically different between groups, while secondary measures of Functional Ambulation Category and strength were also different at discharge. Primary predictors of improved walking capacity were steps per day, baseline impairments, and age. Conclusions- Provision of high-intensity stepping training applied during inpatient rehabilitation resulted in significantly greater walking and balance outcomes. This training paradigm should be further tested in other contexts to determine the generalizability to real-world and community settings.
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Affiliation(s)
- Jennifer L Moore
- From the Regional Center of Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo/Nesodden, Norway (J.L.M.).,Institute for Knowledge Translation, Carmel, IN (J.L.M.)
| | - Jan E Nordvik
- CatoSenteret Rehabilitation Hospital, Son, Norway (J.E.N.)
| | - Anne Erichsen
- Section of Physiotherapy, Department of Medicine, Oslo University Hospital, Norway (A.E., E.B.)
| | - Ingvild Rosseland
- City of Oslo, Reinforced Interdisciplinary Rehabilitation Aker, Norway (I.R.)
| | - Elisabeth Bø
- Section of Physiotherapy, Department of Medicine, Oslo University Hospital, Norway (A.E., E.B.)
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis (T.G.H.)
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Risch AC, Zimmermann S, Ochoa-Hueso R, Schütz M, Frey B, Firn JL, Fay PA, Hagedorn F, Borer ET, Seabloom EW, Harpole WS, Knops JMH, McCulley RL, Broadbent AAD, Stevens CJ, Silveira ML, Adler PB, Báez S, Biederman LA, Blair JM, Brown CS, Caldeira MC, Collins SL, Daleo P, di Virgilio A, Ebeling A, Eisenhauer N, Esch E, Eskelinen A, Hagenah N, Hautier Y, Kirkman KP, MacDougall AS, Moore JL, Power SA, Prober SM, Roscher C, Sankaran M, Siebert J, Speziale KL, Tognetti PM, Virtanen R, Yahdjian L, Moser B. Soil net nitrogen mineralisation across global grasslands. Nat Commun 2019; 10:4981. [PMID: 31672992 PMCID: PMC6823350 DOI: 10.1038/s41467-019-12948-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 10/10/2019] [Indexed: 11/17/2022] Open
Abstract
Soil nitrogen mineralisation (Nmin), the conversion of organic into inorganic N, is important for productivity and nutrient cycling. The balance between mineralisation and immobilisation (net Nmin) varies with soil properties and climate. However, because most global-scale assessments of net Nmin are laboratory-based, its regulation under field-conditions and implications for real-world soil functioning remain uncertain. Here, we explore the drivers of realised (field) and potential (laboratory) soil net Nmin across 30 grasslands worldwide. We find that realised Nmin is largely explained by temperature of the wettest quarter, microbial biomass, clay content and bulk density. Potential Nmin only weakly correlates with realised Nmin, but contributes to explain realised net Nmin when combined with soil and climatic variables. We provide novel insights of global realised soil net Nmin and show that potential soil net Nmin data available in the literature could be parameterised with soil and climate data to better predict realised Nmin.
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Affiliation(s)
- A C Risch
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Zuercherstrasse 111, 8903, Birmensdorf, Switzerland.
| | - S Zimmermann
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Zuercherstrasse 111, 8903, Birmensdorf, Switzerland
| | - R Ochoa-Hueso
- Department of Biology, IVAGRO, University of Cádiz, Campus de Excelencia Internacional Agroalimentario (ceiA3), Campus Rio San Pedro, 11510, Puerto Real, Cádiz, Spain
| | - M Schütz
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Zuercherstrasse 111, 8903, Birmensdorf, Switzerland
| | - B Frey
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Zuercherstrasse 111, 8903, Birmensdorf, Switzerland
| | - J L Firn
- Queensland University of Technology (QUT), School of Earth, Environmental and Biological Sciences, Science and Engineering Faculty, Brisbane, QLD, 4001, Australia
| | - P A Fay
- USDA-ARS Grassland Soil, and Water Research Laboratory, Temple, TX, 76502, USA
| | - F Hagedorn
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Zuercherstrasse 111, 8903, Birmensdorf, Switzerland
| | - E T Borer
- Department of Ecology, Evolution, and Behavior, University of Minnesota, St. Paul, MN, USA
| | - E W Seabloom
- Department of Ecology, Evolution, and Behavior, University of Minnesota, St. Paul, MN, USA
| | - W S Harpole
- Department of Physiological Diversity, Helmholtz Center for Environmental Research-UFZ, Permoserstrasse 15, Leipzig, 04318, Germany
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, Leipzig, 04103, Germany
- Institute of Biology, Martin Luther University Halle-Wittenberg, Am Kirchtor 1, Halle (Saale), 06108, Germany
| | - J M H Knops
- School of Biological Sciences, University of Nebraska, 211A Manter Hall, Lincoln, NE, 68588, USA
- Department of Health and Environmental Sciences, Xi'an Jiaotong Liverpool University, Suzhou, 215213, China
| | - R L McCulley
- Department of Plant & Soil Sciences, University of Kentucky, Lexington, KY, 40546-0312, USA
| | - A A D Broadbent
- School of Earth and Environmental Sciences, Michael Smith Building, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- Lancaster Environment Centre, Lancaster University, Lancaster, LA1 4YQ, UK
| | - C J Stevens
- Lancaster Environment Centre, Lancaster University, Lancaster, LA1 4YQ, UK
| | - M L Silveira
- University of Florida, Range Cattle Research and Education Center, Ona, FL, 33865, USA
| | - P B Adler
- Department of Wildland Resources and the Ecology Center, Utah State University, 5230 Old Main, Logan, UT, 84103, USA
| | - S Báez
- Departamento de Biología, Escuela Politécnica Nacional del Ecuador, Ladrón de Guevera E11-253 y Andalucía, Quito, Ecuador
| | - L A Biederman
- Department of Ecology, Evolution, and Organismal Biology, Iowa State University, Ames, IA, 50011, USA
| | - J M Blair
- Division of Biology, Kansas State University, Manhattan, KS, 66502, USA
| | - C S Brown
- Department of Bioagricultural Sciences and Pest Management, Graduate Degree Program in Ecology, Colorado State University, 1177 Campus Delivery, Fort Collins, CO, USA
| | - M C Caldeira
- Centro de Estudos Florestais, Instituto Superior de Agronomia, Universidade de Lisboa, Tapada da Ajuda, 1349-017, Lisboa, Portugal
| | - S L Collins
- Department of Biology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - P Daleo
- Instituto de Investigaciones Marinas y Costeras (IIMyC), Universidad Nacional de Mar del Plata, CONICET, Mar del Plata, Argentina
| | - A di Virgilio
- INIBIOMA (CONICET-UNCOMA), Universidad Nacional del Comahue, Grupo de Investigaciones en Biología de la Conservación (GrInBiC) Laboratorio Ecotono, Quintral, 1250, Bariloche, Argentina
| | - A Ebeling
- Institute of Ecology and Evolution, Friedrich-Schiller-University Jena, Dornburger Str. 159, 07743, Jena, Germany
| | - N Eisenhauer
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, Leipzig, 04103, Germany
- Institute of Biology, Leipzig University, Deutscher Platz 5e, 04103, Leipzig, Germany
| | - E Esch
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92037, USA
| | - A Eskelinen
- Department of Physiological Diversity, Helmholtz Center for Environmental Research-UFZ, Permoserstrasse 15, Leipzig, 04318, Germany
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, Leipzig, 04103, Germany
- Department of Ecology and Genetics, University of Oulu, Pentti Kaiteran katu 1, 90014, Oulu, Finland
| | - N Hagenah
- Mammal Research Institute, Department of Zoology & Entomology, University of Pretoria, Pretoria, South Africa
| | - Y Hautier
- Ecology and Biodiversity Group, Department of Biology, Utrecht University, Padualaan 8, 3584 CH, Utrecht, The Netherlands
| | - K P Kirkman
- University of KwaZulu-Natal, Pietermaritzburg, Private Bag X01, Scottsville, 3209, South Africa
| | - A S MacDougall
- Department of Integrative Biology, University of Guelph, Guelph, N1G 2W1, ON, Canada
| | - J L Moore
- School of Biological Sciences, Monash University, Claytion, VIC, 3800, Australia
| | - S A Power
- Hawkesbury Institute for the Environment, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - S M Prober
- CSIRO Land and Water, Private Bag 5, Wembley, WA, 6913, Australia
| | - C Roscher
- Department of Physiological Diversity, Helmholtz Center for Environmental Research-UFZ, Permoserstrasse 15, Leipzig, 04318, Germany
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, Leipzig, 04103, Germany
| | - M Sankaran
- National Centre for Biological Sciences, TIFR, Bangalore, 560065, India
- School of Biology, University of Leeds, Leeds, LS2 9JT, UK
| | - J Siebert
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, Leipzig, 04103, Germany
- Institute of Biology, Leipzig University, Deutscher Platz 5e, 04103, Leipzig, Germany
| | - K L Speziale
- INIBIOMA (CONICET-UNCOMA), Universidad Nacional del Comahue, Grupo de Investigaciones en Biología de la Conservación (GrInBiC) Laboratorio Ecotono, Quintral, 1250, Bariloche, Argentina
| | - P M Tognetti
- Universidad de Buenos Aires, Facultad de Agronomía, Instituto de Investigaciones Fisiológicas y Ecológicas vinculadas a la Agricultura (IFEVA), CONICET, Buenos Aires, Argentina
| | - R Virtanen
- Department of Physiological Diversity, Helmholtz Center for Environmental Research-UFZ, Permoserstrasse 15, Leipzig, 04318, Germany
- German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig, Deutscher Platz 5e, Leipzig, 04103, Germany
- Department of Ecology and Genetics, University of Oulu, Pentti Kaiteran katu 1, 90014, Oulu, Finland
| | - L Yahdjian
- Universidad de Buenos Aires, Facultad de Agronomía, Instituto de Investigaciones Fisiológicas y Ecológicas vinculadas a la Agricultura (IFEVA), CONICET, Buenos Aires, Argentina
| | - B Moser
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Zuercherstrasse 111, 8903, Birmensdorf, Switzerland
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Borer ET, Lind EM, Firn J, Seabloom EW, Anderson TM, Bakker ES, Biederman L, La Pierre KJ, MacDougall AS, Moore JL, Risch AC, Schutz M, Stevens CJ. More salt, please: global patterns, responses and impacts of foliar sodium in grasslands. Ecol Lett 2019; 22:1136-1144. [PMID: 31074933 DOI: 10.1111/ele.13270] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 12/19/2022]
Abstract
Sodium is unique among abundant elemental nutrients, because most plant species do not require it for growth or development, whereas animals physiologically require sodium. Foliar sodium influences consumption rates by animals and can structure herbivores across landscapes. We quantified foliar sodium in 201 locally abundant, herbaceous species representing 32 families and, at 26 sites on four continents, experimentally manipulated vertebrate herbivores and elemental nutrients to determine their effect on foliar sodium. Foliar sodium varied taxonomically and geographically, spanning five orders of magnitude. Site-level foliar sodium increased most strongly with site aridity and soil sodium; nutrient addition weakened the relationship between aridity and mean foliar sodium. Within sites, high sodium plants declined in abundance with fertilisation, whereas low sodium plants increased. Herbivory provided an explanation: herbivores selectively reduced high nutrient, high sodium plants. Thus, interactions among climate, nutrients and the resulting nutritional value for herbivores determine foliar sodium biogeography in herbaceous-dominated systems.
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Affiliation(s)
- E T Borer
- Department of Ecology, Evolution and Behavior, University of Minnesota, St. Paul, MN, 55108, USA
| | - E M Lind
- Department of Ecology, Evolution and Behavior, University of Minnesota, St. Paul, MN, 55108, USA
| | - J Firn
- Queensland University of Technology (QUT), School of Earth, Environmental and Biological Sciences, Science and Engineering Faculty, Brisbane, Qld., 4001, Australia
| | - E W Seabloom
- Department of Ecology, Evolution and Behavior, University of Minnesota, St. Paul, MN, 55108, USA
| | - T M Anderson
- Wake Forest University, Department of Biology, 049 Winston Hall, Winston-Salem, NC, 27109, USA
| | - E S Bakker
- Department of Aquatic Ecology, Netherlands Institute of Ecology (NIOO-KNAW), Droevendaalsesteeg 10, 6708 PB, Wageningen, The Netherlands
| | - L Biederman
- Department of Ecology, Evolution, and Organismal Biology, Iowa State University, 251 Bessey Hall, Ames, Iowa, 50010, USA
| | - K J La Pierre
- Smithsonian Environmental Research Center, 647 Contees Wharf Road, Edgewater, MD, 21037, USA
| | - A S MacDougall
- Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada, N1G2W1
| | - J L Moore
- School of Biological Sciences, Monash University, Vic, 3800, Australia
| | - A C Risch
- Swiss Federal Institute for Forest, Snow and Landscape Research, Zuercherstrasse 111, 8903, Birmensdorf, Switzerland
| | - M Schutz
- Swiss Federal Institute for Forest, Snow and Landscape Research, Zuercherstrasse 111, 8903, Birmensdorf, Switzerland
| | - C J Stevens
- Lancaster Environment Centre, Lancaster University, Lancaster, LA1 4YQ, UK
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Moore JL, Siciliano PD, Pratt-Phillips SE. Effects of Diet Versus Exercise on Morphometric Measurements, Blood Hormone Concentrations, and Oral Sugar Test Response in Obese Horses. J Equine Vet Sci 2019; 78:38-45. [PMID: 31203982 DOI: 10.1016/j.jevs.2019.03.214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 12/27/2022]
Abstract
Weight loss plans in horses typically use dietary restriction, but exercise may have additional benefits. This study aimed to compare the effects of a diet or exercise protocol resulting in comparable caloric restriction in obese horses. Ten obese horses were paired according to sex, age, and breed or breed type. One horse from each pair was randomly assigned to either diet (DIET)-intake restricted to approximately 85% of digestible energy requirements or exercise (EX)-exercised to expend approximately 15% of digestible energy requirements, resulting in 85% of requirements available, for 4 weeks. Body weight (BW), heart girth (HG), girth-to-height ratio (G:H), neck circumference (NC), neck circumference-to-height ratio (NC:H), belly girth (BG), body condition score (BCS), cresty neck score (CNS), serum insulin, plasma leptin, and plasma ghrelin concentrations were measured weekly. An oral sugar test was conducted on days 0 and 28 to measure insulin to glucose ratio (Ins:glc) and 60-minute insulin sensitivity index (ISI60). Results were analyzed using repeated measures. A P ≤ .05 was considered significant, and .05 <P ≤ .10 was considered a tendency. Both groups showed similar decreases over time in BW, HG, G:H, BG, BCS, and CNS, but the EX group showed significantly greater losses in NC (and NC:H). The EX group showed significant improvements in (log) Ins:glc, as well as a tendency for improvements in (log) ISI60 and plasma leptin concentrations, while the DIET group showed no change. Horses showed no changes in (log) plasma ghrelin with weight loss.
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Affiliation(s)
- Jennifer L Moore
- Department of Animal Science, North Carolina State University, Raleigh, NC.
| | - Paul D Siciliano
- Department of Animal Science, North Carolina State University, Raleigh, NC
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Goldenberg RL, Nathan RO, Swanson D, Saleem S, Mirza W, Esamai F, Muyodi D, Garces AL, Figueroa L, Chomba E, Chiwala M, Mwenechanya M, Tshefu A, Lokangako A, Bolamba VL, Moore JL, Franklin H, Swanson J, Liechty EA, Bose CL, Krebs NF, Michael Hambidge K, Carlo WA, Kanaiza N, Naqvi F, Pineda IS, López-Gomez W, Hamsumonde D, Harrison MS, Koso-Thomas M, Miodovnik M, Wallace DD, McClure EM. Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial. BJOG 2018; 125:1591-1599. [PMID: 29782696 DOI: 10.1111/1471-0528.15287] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centres in resource-limited countries. DESIGN Cluster randomised trial. SETTING Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia) METHODS: Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds. MAIN OUTCOME MEASURES The primary outcome was a composite of maternal mortality, maternal near-miss mortality, stillbirth, and neonatal mortality. RESULTS During the 24-month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound-diagnosed condition, and 71% attended the referral. The ANC (RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies (RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (RR 1.09 95% CI 0.97, 1.23) or its individual components. CONCLUSIONS Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced. TWEETABLE ABSTRACT Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.
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Affiliation(s)
| | - R O Nathan
- University of Washington, Seattle, WA, USA
| | - D Swanson
- University of Washington, Seattle, WA, USA
| | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | - W Mirza
- Aga Khan University, Karachi, Pakistan
| | | | | | | | | | - E Chomba
- University of Zambia, Lusaka, Zambia
| | - M Chiwala
- University of Zambia, Lusaka, Zambia
| | | | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, DRC
| | - A Lokangako
- Kinshasa School of Public Health, Kinshasa, DRC
| | - V L Bolamba
- Kinshasa School of Public Health, Kinshasa, DRC
| | | | | | - J Swanson
- University of Washington, Seattle, WA, USA
| | | | - C L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N F Krebs
- University of Colorado, Denver, CO, USA
| | | | - W A Carlo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - F Naqvi
- Aga Khan University, Karachi, Pakistan
| | - I S Pineda
- San Carlos University, Guatemala City, Guatemala
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Moore JL, Friis S, Graham ID, Gundersen ET, Nordvik JE. Reported use of evidence in clinical practice: a survey of rehabilitation practices in Norway. BMC Health Serv Res 2018; 18:379. [PMID: 29801505 PMCID: PMC5970453 DOI: 10.1186/s12913-018-3193-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/08/2018] [Indexed: 03/20/2023] Open
Abstract
Background The South Eastern Health Region in Norway serves approximately 2.8 million people, which is more than half of Norway’s population. Physical medicine and rehabilitation services are provided by 9 public hospital trusts and 30 private rehabilitation facilities. The purposes of this study were to conduct a psychometric analysis of the EBP Implementation Scale (EBPIS) and describe rehabilitation clinicians’ self-reported 1) use of evidence-based practices (EBPs), 2) use of EBPs across hospitals, and 3) determine factors associated with use of EBPs in the South Eastern Health Region in Norway. Methods A cross-sectional study using an online survey was conducted with public hospitals and private rehabilitation centers. The survey, which was distributed throughout the region, included the EBPIS, 8 questions related to EBP in the health region, and demographics. Response frequencies were calculated and described. Internal consistency and factor structure of the EBPIS and its subscales were determined. Associations and differences in groups with similar demographics, EBPIS scores, and use of EBPs were identified. Results A total of 316 individuals completed the survey, including allied health clinicians, nurses, psychologists, social workers, and physicians. The EBPIS mean score was 30/72. A factor analysis identified that the EBPIS can be divided into 3 subscales: literature search and critical appraisal (α = .80), knowledge sharing (α = .83), and practice evaluation (α = .74). EBP activities reported were primarily related to literature searches, critical appraisal, and discussing evidence. Approximately 65 and 75% of respondents agreed that the same OMs and evidence based interventions were used within the local clinic respectively. Fewer agreed that the same OMs (13%) and evidence-based interventions (39%) are used regionally. Conclusion The EBPIS and its subscales demonstrated excellent internal consistency. Practice variability exists in rehabilitation throughout Southeastern Norway. An increased emphasis on use of EBP throughout the region is needed.
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Affiliation(s)
- Jennifer L Moore
- Regional Center of Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo/Nesodden, Norway. .,Institute for Knowledge Translation, Carmel, IN, USA.
| | - Svein Friis
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ian D Graham
- University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Jan E Nordvik
- Regional Center of Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo/Nesodden, Norway
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Pasha O, McClure EM, Saleem S, Tikmani SS, Lokangaka A, Tshefu A, Bose CL, Bauserman M, Mwenechanya M, Chomba E, Carlo WA, Garces AL, Figueroa L, Hambidge KM, Krebs NF, Goudar S, Kodkany BS, Dhaded S, Derman RJ, Patel A, Hibberd PL, Esamai F, Tenge C, Liechty EA, Moore JL, Wallace DD, Koso-Thomas M, Miodovnik M, Goldenberg RL. A prospective cause of death classification system for maternal deaths in low and middle-income countries: results from the Global Network Maternal Newborn Health Registry. BJOG 2018; 125:1137-1143. [PMID: 29094456 DOI: 10.1111/1471-0528.15011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the causes of maternal death in a population-based cohort in six low- and middle-income countries using a standardised, hierarchical, algorithmic cause of death (COD) methodology. DESIGN A population-based, prospective observational study. SETTING Seven sites in six low- to middle-income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia. POPULATION All deaths among pregnant women resident in the study sites from 2014 to December 2016. METHODS For women who died, we used a standardised questionnaire to collect clinical data regarding maternal conditions present during pregnancy and delivery. These data were analysed using a computer-based algorithm to assign cause of maternal death based on the International Classification of Disease-Maternal Mortality system (trauma, termination of pregnancy-related, eclampsia, haemorrhage, pregnancy-related infection and medical conditions). We also compared the COD results to healthcare-provider-assigned maternal COD. MAIN OUTCOME MEASURES Assigned causes of maternal mortality. RESULTS Among 158 205 women, there were 221 maternal deaths. The most common algorithm-assigned maternal COD were obstetric haemorrhage (38.6%), pregnancy-related infection (26.4%) and pre-eclampsia/eclampsia (18.2%). Agreement between algorithm-assigned COD and COD assigned by healthcare providers ranged from 75% for haemorrhage to 25% for medical causes coincident to pregnancy. CONCLUSIONS The major maternal COD in the Global Network sites were haemorrhage, pregnancy-related infection and pre-eclampsia/eclampsia. This system could allow public health programmes in low- and middle-income countries to generate transparent and comparable data for maternal COD across time or regions. TWEETABLE ABSTRACT An algorithmic system for determining maternal cause of death in low-resource settings is described.
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Affiliation(s)
- O Pasha
- Aga Khan University, Karachi, Pakistan.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | | | - A Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - C L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - E Chomba
- University Teaching Hospital, Lusaka, Zambia
| | - W A Carlo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - K M Hambidge
- University of Colorado, School of Medicine, Denver, CO, USA
| | - N F Krebs
- University of Colorado, School of Medicine, Denver, CO, USA
| | - S Goudar
- KLE University's JN Medical College, Belagavi, India
| | - B S Kodkany
- KLE University's JN Medical College, Belagavi, India
| | - S Dhaded
- KLE University's JN Medical College, Belagavi, India
| | - R J Derman
- Thomas Jefferson University, Philadelphia, PA, USA
| | - A Patel
- Lata Medical Research Foundation, Nagpur, India
| | | | | | - C Tenge
- Moi University, Eldoret, Kenya
| | | | | | | | | | | | - R L Goldenberg
- Columbia University School of Medicine, New York, NY, USA
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Dworkin JP, Adelman LA, Ajluni T, Andronikov AV, Aponte JC, Bartels AE, Beshore E, Bierhaus EB, Brucato JR, Bryan BH, Burton AS, Callahan MP, Castro-Wallace SL, Clark BC, Clemett SJ, Connolly HC, Cutlip WE, Daly SM, Elliott VE, Elsila JE, Enos HL, Everett DF, Franchi IA, Glavin DP, Graham HV, Hendershot JE, Harris JW, Hill SL, Hildebrand AR, Jayne GO, Jenkens RW, Johnson KS, Kirsch JS, Lauretta DS, Lewis AS, Loiacono JJ, Lorentson CC, Marshall JR, Martin MG, Matthias LL, McLain HL, Messenger SR, Mink RG, Moore JL, Nakamura-Messenger K, Nuth JA, Owens CV, Parish CL, Perkins BD, Pryzby MS, Reigle CA, Righter K, Rizk B, Russell JF, Sandford SA, Schepis JP, Songer J, Sovinski MF, Stahl SE, Thomas-Keprta K, Vellinga JM, Walker MS. OSIRIS-REx Contamination Control Strategy and Implementation. Space Sci Rev 2018; 214:19. [PMID: 30713357 PMCID: PMC6350808 DOI: 10.1007/s11214-017-0439-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OSIRIS-REx will return pristine samples of carbonaceous asteroid Bennu. This article describes how pristine was defined based on expectations of Bennu and on a realistic understanding of what is achievable with a constrained schedule and budget, and how that definition flowed to requirements and implementation. To return a pristine sample, the OSIRIS-REx spacecraft sampling hardware was maintained at level 100 A/2 and <180 ng/cm2 of amino acids and hydrazine on the sampler head through precision cleaning, control of materials, and vigilance. Contamination is further characterized via witness material exposed to the spacecraft assembly and testing environment as well as in space. This characterization provided knowledge of the expected background and will be used in conjunction with archived spacecraft components for comparison with the samples when they are delivered to Earth for analysis. Most of all, the cleanliness of the OSIRIS-REx spacecraft was achieved through communication among scientists, engineers, managers, and technicians.
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Affiliation(s)
- J P Dworkin
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - L A Adelman
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Arctic Slope Research Corporation, Beltsville, MD USA
| | - T Ajluni
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Arctic Slope Research Corporation, Beltsville, MD USA
| | | | - J C Aponte
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Catholic University of America, Washington, DC, USA
| | - A E Bartels
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - E Beshore
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - E B Bierhaus
- Lockheed Martin Space Systems, Littleton, CO, USA
| | - J R Brucato
- INAF Astrophysical Observatory of Arcetri, Florence, Italy
| | - B H Bryan
- Lockheed Martin Space Systems, Littleton, CO, USA
| | - A S Burton
- NASA Johnson Space Center, Houston, TX, USA
| | | | | | - B C Clark
- Space Science Institute, Boulder, CO, USA
| | - S J Clemett
- NASA Johnson Space Center, Houston, TX, USA
- Jacobs Technology, Tullahoma, TN, USA
| | | | - W E Cutlip
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - S M Daly
- NASA Kennedy Space Center, Titusville, FL, USA
| | - V E Elliott
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J E Elsila
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - H L Enos
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - D F Everett
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | | | - D P Glavin
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - H V Graham
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
- University of Maryland, College Park, MD, USA
| | - J E Hendershot
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Ball Aerospace, Boulder, CO, USA
| | - J W Harris
- Lockheed Martin Space Systems, Littleton, CO, USA
| | - S L Hill
- Jacobs Technology, Tullahoma, TN, USA
- NASA Kennedy Space Center, Titusville, FL, USA
| | | | - G O Jayne
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Arctic Slope Research Corporation, Beltsville, MD USA
| | - R W Jenkens
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - K S Johnson
- Lockheed Martin Space Systems, Littleton, CO, USA
| | - J S Kirsch
- Jacobs Technology, Tullahoma, TN, USA
- NASA Kennedy Space Center, Titusville, FL, USA
| | - D S Lauretta
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - A S Lewis
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J J Loiacono
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - C C Lorentson
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | | | - M G Martin
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Catholic University of America, Washington, DC, USA
| | - L L Matthias
- NASA Kennedy Space Center, Titusville, FL, USA
- Analex, Titusville, FL, USA
| | - H L McLain
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
- Catholic University of America, Washington, DC, USA
| | | | - R G Mink
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J L Moore
- Lockheed Martin Space Systems, Littleton, CO, USA
| | | | - J A Nuth
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - C V Owens
- NASA Kennedy Space Center, Titusville, FL, USA
| | - C L Parish
- Lockheed Martin Space Systems, Littleton, CO, USA
| | - B D Perkins
- NASA Kennedy Space Center, Titusville, FL, USA
| | - M S Pryzby
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
- ATA Aerospace, Albuquerque, NM, USA
| | - C A Reigle
- Lockheed Martin Space Systems, Littleton, CO, USA
| | - K Righter
- NASA Johnson Space Center, Houston, TX, USA
| | - B Rizk
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ, USA
| | - J F Russell
- Lockheed Martin Space Systems, Littleton, CO, USA
| | - S A Sandford
- NASA Ames Research Center, Moffett Field, CA, USA
| | - J P Schepis
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J Songer
- Lockheed Martin Space Systems, Littleton, CO, USA
| | - M F Sovinski
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - S E Stahl
- NASA Johnson Space Center, Houston, TX, USA
- JES Tech., Houston, TX, USA
| | - K Thomas-Keprta
- NASA Johnson Space Center, Houston, TX, USA
- Jacobs Technology, Tullahoma, TN, USA
| | - J M Vellinga
- Lockheed Martin Space Systems, Littleton, CO, USA
| | - M S Walker
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
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Moore JL, Carpenter J, Doyle AM, Doyle L, Hansen P, Hahn B, Hornby TG, Roth HR, Spoeri S, Tappan R, Van Der Laan K. Development, Implementation, and Use of a Process to Promote Knowledge Translation in Rehabilitation. Arch Phys Med Rehabil 2017; 99:82-90. [PMID: 28928025 DOI: 10.1016/j.apmr.2017.08.476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the use and effect of the Battery of Rehabilitation Assessments and Interventions on evidence-based practice (EBP) over 6 years. DESIGN Successive independent samples study. SETTING Large rehabilitation system. PARTICIPANTS Successive samples of allied health clinicians (N=372) in 2009 (n=136), 2012 (n=115), and 2015 (n=121). INTERVENTIONS The Battery of Rehabilitation Assessments and Interventions includes 2 components: (1) a process to synthesize, adapt, and make recommendations about the application of evidence; and (2) a process to implement the recommended practices in 3 levels of care. MAIN OUTCOME MEASURES To assess the effect of the project, surveys on EBP perspectives, use, and barriers were conducted before Battery of Rehabilitation Assessments and Interventions implementation and 3 and 6 years after implementation. Questions about effect of the project on clinical practice were included 3 and 6 years postimplementation. RESULTS Survey data indicate the Battery of Rehabilitation Assessments and Interventions resulted in a significant increase in use of EBPs to make clinical decisions and justify care. As a result of the project, survey participants reported a substantial increase in use of outcome measures in 2012 (74%) and 2015 (91%) and evidence-based interventions in 2012 (62%) and 2015 (82%). In 2012, significant differences (P≤.01) in effect of the Battery of Rehabilitation Assessments and Interventions on practice were identified between therapists who were directly involved in the project and Interventions compared with uninvolved therapists. In 2015, no significant differences existed between involved and uninvolved therapists. CONCLUSIONS After 6 years of sustained implementation efforts, the Battery of Rehabilitation Assessments and Interventions expedited the adoption of EBPs throughout a large system of care in rehabilitation.
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Affiliation(s)
- Jennifer L Moore
- Regional Center of Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo/Nesodden, Norway; Institute for Knowledge Translation, Carmel, IN.
| | | | | | | | | | | | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis, IN
| | - Heidi R Roth
- Shirley Ryan AbilityLab, Chicago, IL; Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL
| | | | - Rachel Tappan
- Shirley Ryan AbilityLab, Chicago, IL; Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL
| | - Krista Van Der Laan
- Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL
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McClure EM, Garces A, Saleem S, Moore JL, Bose CL, Esamai F, Goudar SS, Chomba E, Mwenechanya M, Pasha O, Tshefu A, Patel A, Dhaded SM, Tenge C, Marete I, Bauserman M, Sunder S, Kodkany BS, Carlo WA, Derman RJ, Hibberd PL, Liechty EA, Hambidge KM, Krebs NF, Koso-Thomas M, Miodovnik M, Wallace DD, Goldenberg RL. Global Network for Women's and Children's Health Research: probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system. BJOG 2017; 125:131-138. [PMID: 28139875 DOI: 10.1111/1471-0528.14493] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm. DESIGN Prospective, observational study. SETTING Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya. POPULATION Pregnant women residing in defined study regions. METHODS Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions. MAIN OUTCOME MEASURES Primary cause of stillbirth. RESULTS Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre-eclampsia/eclampsia. About two-thirds (67.4%) of the stillbirths did not have signs of maceration. CONCLUSIONS Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. TWEETABLE ABSTRACT Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.
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Affiliation(s)
| | - A Garces
- Materno Infantil Unidad de Planificación, INCAP, Guatemala City, Guatemala
| | - S Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - C L Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - F Esamai
- Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya
| | - S S Goudar
- KLE University's JN Medical College, Belagavi, India
| | - E Chomba
- Department of Paediatrics, University of Zambia, Lusaka, Zambia
| | - M Mwenechanya
- Department of Paediatrics, University of Zambia, Lusaka, Zambia
| | - O Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, DRC
| | - A Patel
- Lata Medical Research Foundation, Nagpur, India
| | - S M Dhaded
- KLE University's JN Medical College, Belagavi, India
| | - C Tenge
- Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya
| | - I Marete
- Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya
| | - M Bauserman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Sunder
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - B S Kodkany
- KLE University's JN Medical College, Belagavi, India
| | - W A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R J Derman
- Department of Obstetrics, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - E A Liechty
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - K M Hambidge
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | - N F Krebs
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | - M Koso-Thomas
- Perinatology and Pregnancy Branch, NICHD, Bethesda, MD, USA
| | - M Miodovnik
- Perinatology and Pregnancy Branch, NICHD, Bethesda, MD, USA
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Zeigler M, Smiley J, Ehrlich-Jones L, Moore JL. Use of the Pressure Ulcer Scale for Healing (PUSH) in Inpatient Rehabilitation: A Case Example. Rehabil Nurs 2016; 41:207-10. [DOI: 10.1002/rnj.258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 11/09/2022]
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Doman CA, Waddell KJ, Bailey RR, Moore JL, Lang CE. Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke. Am J Occup Ther 2016; 70:7003290040p1-7003290040p11. [PMID: 27089298 DOI: 10.5014/ajot.2016.020891] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study explored how upper-extremity (UE) functional capacity and daily performance change during the course of outpatient rehabilitation in people with stroke. METHOD Fifteen participants receiving outpatient occupational therapy services for UE paresis poststroke were enrolled. UE motor capacity was measured with the Action Research Arm Test (ARAT), and UE performance was measured using bilateral, wrist-worn accelerometers. Measurements were taken at or near the start of therapy, at every 10th visit or every 30 days throughout the duration of services, and at discharge. RESULTS Three patterns were observed: (1) increase in ARAT scores and more normalized accelerometry profiles, (2) increase in ARAT scores but no change in accelerometry profiles, and (3) no change in ARAT scores or in accelerometry profiles. CONCLUSION UE performance in daily life was highly variable, with inconsistencies between change in UE capacity and change in UE performance. UE capacity and performance are important constructs to assess separately during rehabilitation.
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Affiliation(s)
- Caitlin A Doman
- Caitlin A. Doman, MS, OTR/L, is Occupational Therapist, Rehabilitation Institute of Chicago, Chicago, IL
| | - Kimberly J Waddell
- Kimberly J. Waddell, MS, OTR/L, is Graduate Student, Movement Science and Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Ryan R Bailey
- Ryan R. Bailey, MSOT, MSCI, PhD, was Graduate Student, Movement Science Program and Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, at the time of the study
| | - Jennifer L Moore
- Jennifer L. Moore, PT, DHS, NCS, is Physical Therapist, Rehabilitation Institute of Chicago, Chicago, IL
| | - Catherine E Lang
- Catherine E. Lang, PT, PhD, is Professor, Program in Physical Therapy, Program in Occupational Therapy, and Department of Neurology, Washington University School of Medicine, St. Louis, MO;
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Sauers-Ford HS, Moore JL, Guiot AB, Simpson BE, Clohessy CR, Yost D, Mayhaus DC, Simmons JM, Gosdin CH. Local Pharmacy Partnership to Prevent Pediatric Asthma Reutilization in a Satellite Hospital. Pediatrics 2016; 137:peds.2015-0039. [PMID: 26983469 DOI: 10.1542/peds.2015-0039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In our previous work, providing medications in-hand at discharge was a key strategy to reduce asthma reutilization (readmissions and emergency revisits) among children in a large, urban county. We sought to spread this work to our satellite hospital in an adjacent county. A key initial barrier was the lack of an outpatient pharmacy on site, so we sought to determine if a partnership with community pharmacies could improve the percentage of patients with medications in-hand at discharge, thus decreasing reutilization. METHODS A multidisciplinary team partnered with community pharmacies. Using rapid-cycle improvement methods, the team aimed to reduce asthma reutilization by providing medications in-hand at discharge. Run charts were used to display the proportion of patients with asthma discharged with medications in-hand and to track 90-day reutilization rates. RESULTS During the intervention period, the median percentage of patients with asthma who received medications in-hand increased from 0% to 82%. A key intervention was the expansion of the medication in-hand program to all patients. Additional changes included expanding team to evening stakeholders, narrowing the number of community partners, and building electronic tools to support key processes. The mean percentage of patients with asthma discharged from the satellite who had a readmission or emergency department revisit within 90 days of their index admission decreased from 18% to 11%. CONCLUSIONS Impacting population-level asthma outcomes requires partnerships between community resources and health providers. When hospital resources are limited, community pharmacies are a potential partner, and providing access to medications in-hand at hospital discharge can reduce asthma reutilization.
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Affiliation(s)
| | - Jennifer L Moore
- Department of Patient Services, Cincinnati Children's Hospital Medicine Center, Cincinnati, Ohio; and
| | - Amy B Guiot
- Division of Hospital Medicine, Department of Pediatrics, and
| | - Blair E Simpson
- Division of Hospital Medicine, Department of Pediatrics, and
| | | | | | - David C Mayhaus
- Department of Patient Services, Cincinnati Children's Hospital Medicine Center, Cincinnati, Ohio; and
| | | | - Craig H Gosdin
- Division of Hospital Medicine, Department of Pediatrics, and
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Waddell KJ, Birkenmeier RL, Moore JL, Hornby TG, Lang CE. Feasibility of high-repetition, task-specific training for individuals with upper-extremity paresis. Am J Occup Ther 2016; 68:444-53. [PMID: 25005508 DOI: 10.5014/ajot.2014.011619] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE. We investigated the feasibility of delivering an individualized, progressive, high-repetition upper-extremity (UE) task-specific training protocol for people with stroke in the inpatient rehabilitation setting. METHOD. Fifteen patients with UE paresis participated in this study. Task-specific UE training was scheduled for 60 min/day, 4 days/wk, during occupational therapy for the duration of a participant's inpatient stay. During each session, participants were challenged to complete ≥300 repetitions of various tasks. RESULTS. Participants averaged 289 repetitions/session, spending 47 of 60 min in active training. Participants improved on impairment and activity level outcome measures. CONCLUSION. People with stroke in an inpatient setting can achieve hundreds of repetitions of task-specific training in 1-hr sessions. As expected, all participants improved on functional outcome measures. Future studies are needed to determine whether this high-repetition training program results in better outcomes than current UE interventions.
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Affiliation(s)
- Kimberly J Waddell
- Kimberly J. Waddell, MS, OTR/L, is Occupational Therapist, Rehabilitation Institute of Chicago, Chicago, IL
| | - Rebecca L Birkenmeier
- Rebecca L. Birkenmeier, OTD, OTR/L, is Research Assistant Professor, Program in Occupational Therapy, Program in Physical Therapy, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Jennifer L Moore
- Jennifer L. Moore, PT, DHS, NCS, is Clinical Therapy Lead and Physical Therapist, Rehabilitation Institute of Chicago, Chicago, IL
| | - T George Hornby
- T. George Hornby, PhD, PT, is Research Scientist, Rehabilitation Institute of Chicago, Chicago, IL, and Associate Professor, Department of Physical Therapy and Kinesiology and Nutrition, University of Illinois at Chicago
| | - Catherine E Lang
- Catherine E. Lang, PhD, PT, is Associate Professor, Program in Physical Therapy, Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8502, St. Louis, MO 63108-2212;
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Hornby TG, Holleran CL, Leddy AL, Hennessy P, Leech KA, Connolly M, Moore JL, Straube D, Lovell L, Roth E. Feasibility of Focused Stepping Practice During Inpatient Rehabilitation Poststroke and Potential Contributions to Mobility Outcomes. Neurorehabil Neural Repair 2015; 29:923-32. [PMID: 25721233 DOI: 10.1177/1545968315572390] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Optimal physical therapy strategies to maximize locomotor function in patients early poststroke are not well established. Emerging data indicate that substantial amounts of task-specific stepping practice may improve locomotor function, although stepping practice provided during inpatient rehabilitation is limited (<300 steps/session). OBJECTIVE The purpose of this investigation was to determine the feasibility of providing focused stepping training to patients early poststroke and its potential association with walking and other mobility outcomes. METHODS Daily stepping was recorded on 201 patients <6 months poststroke (80% < 1 month) during inpatient rehabilitation following implementation of a focused training program to maximize stepping practice during clinical physical therapy sessions. Primary outcomes included distance and physical assistance required during a 6-minute walk test (6MWT) and balance using the Berg Balance Scale (BBS). Retrospective data analysis included multiple regression techniques to evaluate the contributions of demographics, training activities, and baseline motor function to primary outcomes at discharge. RESULTS Median stepping activity recorded from patients was 1516 steps/d, which is 5 to 6 times greater than that typically observed. The number of steps per day was positively correlated with both discharge 6MWT and BBS and improvements from baseline (changes; r = 0.40-0.87), independently contributing 10% to 31% of the total variance. Stepping activity also predicted level of assistance at discharge and discharge location (home vs other facility). CONCLUSION Providing focused, repeated stepping training was feasible early poststroke during inpatient rehabilitation and was related to mobility outcomes. Further research is required to evaluate the effectiveness of these training strategies on short- or long-term mobility outcomes as compared with conventional interventions.
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Affiliation(s)
- T George Hornby
- Rehabilitation Institute of Chicago, Chicago, IL, USA University of Illinois at Chicago, Chicago, IL, USA Northwestern University, Chicago, IL, USA
| | | | | | | | - Kristan A Leech
- Rehabilitation Institute of Chicago, Chicago, IL, USA Northwestern University, Chicago, IL, USA
| | - Mark Connolly
- Rehabilitation Institute of Chicago, Chicago, IL, USA
| | | | | | - Linda Lovell
- Rehabilitation Institute of Chicago, Chicago, IL, USA Northwestern University, Chicago, IL, USA
| | - Elliot Roth
- Rehabilitation Institute of Chicago, Chicago, IL, USA Northwestern University, Chicago, IL, USA
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Thomas TA, Heysell SK, Houpt ER, Moore JL, Keller SJ. Outbreak of pyrazinamide-monoresistant tuberculosis identified using genotype cluster and social media analysis. Int J Tuberc Lung Dis 2015; 18:552-8. [PMID: 24903792 DOI: 10.5588/ijtld.13.0663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Monoresistance to pyrazinamide (PZA) has infrequently been associated with Mycobacterium tuberculosis. OBJECTIVE To report an outbreak of PZA-monoresistant M. tuberculosis in Virginia involving two genotype clusters from December 2004 to August 2010. RESULTS Thirty cases were identified involving a predominantly young, US-born population with histories of substance use and incarceration and a large proportion of children aged <15 years (n= 6, 20%); of these, 23 cases (77%) were culture-confirmed as M. tuberculosis complex. DNA fingerprinting and molecular analysis of the PZA resistance gene, pncA, demonstrated a clonal strain that was not M. bovis. Genotypic data provided the initial link between seemingly unrelated cases, and helped reveal a historic genotype cluster of cases from 2004. Further genotype cluster and contact investigation procedures, including the novel use of the social networking website Facebook.com, revealed additional links between the 2004 and 2009 genotype clusters and described an ongoing, extensive outbreak necessitating an enhanced screening and treatment protocol for contacts. CONCLUSIONS This outbreak demonstrates how tuberculosis can spread through a young, vulnerable population. The use of genotypic data and the novel incorporation of social media investigations were critical to understanding the settings and context of infectivity.
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Affiliation(s)
- T A Thomas
- University of Virginia, Charlottesville, Virginia, USA
| | - S K Heysell
- University of Virginia, Charlottesville, Virginia, USA
| | - E R Houpt
- University of Virginia, Charlottesville, Virginia, USA
| | - J L Moore
- Virginia Department of Health, Richmond, Virginia, USA
| | - S J Keller
- Virginia Department of Health, Richmond, Virginia, USA
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Martin JT, Wolf A, Moore JL, Rolenz E, DiNinno A, Reneker JC. The effectiveness of physical therapist-administered group-based exercise on fall prevention: a systematic review of randomized controlled trials. J Geriatr Phys Ther 2014; 36:182-93. [PMID: 23449007 DOI: 10.1519/jpt.0b013e3182816045] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Falls are a verified cause of morbidity and mortality in adults older than 65 years. Exercise under the direction of a physical therapist has been shown to reduce the risk of falls in older adults; however, it is not clear whether physical therapist-directed group-based exercise could produce similar results. PURPOSE The purpose of this systematic review was to summarize the evidence on the effectiveness of physical therapist-administered group-based exercise when compared with various controls for falls prevention and improvement of quality of life. METHODS A computerized search of PubMed and CINAHL was performed. An exhaustive hand search was also performed of the references of all full-text articles. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. Studies were included if they met the following criteria: (1) comparison of group-based exercise led by a physical therapist to a control group; (2) ambulatory elderly men or women, aged 65 years or older; (3) subjects in the community or institutional setting; (4) the use of 1 or more outcome measures related to functional balance and/or quality of life; (5) randomized controlled or clinical trials; and (6) published in English, between December 1, 2001, and June 7, 2012. The PEDro scale was used to assess the quality of each study included in this review. RESULTS The computerized search strategy and hand search revealed 213 potential articles, 10 of which met the inclusion criteria. After assessment with the PEDro scale, 8 of these were considered high-quality studies (score > 6/10). Seven studies compared group-based exercise to a nonexercise control group, while 3 studies compared group-based exercise with a physical therapist-prescribed home exercise program. Outcomes measured include fall rate, balance, physical performance, health-related quality of life, and fear of falling. DISCUSSION When group-based exercise was compared with no intervention, group-based exercise was found to be more effective in decreasing fall frequency, increase balance, and improve quality of life. When compared with a physical therapist-prescribed home exercise program, the group-based exercise results were not statistically different but showed improvements in some quality of life and physical functioning measures. There is also some evidence to suggest that group-based exercise promotes greater patient satisfaction and exercise adherence. CONCLUSION There is preliminary evidence to suggest that the group-based exercise is effective for falls prevention, quality-of-life enhancement, and balance improvements in the older adults comparable with traditional home exercise programs.
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Moore JL, Raad J, Ehrlich-Jones L, Heinemann AW. Development and use of a knowledge translation tool: the rehabilitation measures database. Arch Phys Med Rehabil 2013; 95:197-202. [PMID: 24076083 DOI: 10.1016/j.apmr.2013.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/18/2013] [Accepted: 09/21/2013] [Indexed: 10/26/2022]
Abstract
Clinical translation of research evidence is a challenge for rehabilitation clinicians. Publicly accessible and free, online educational resources that summarize research evidence can support implementation of research evidence into practice. Several online resources have been developed recently to overcome common knowledge translation barriers. The Rehabilitation Measures Database (RMD) is a free, web-based searchable database of standardized instruments that was designed to support knowledge translation. It helps clinicians select valid and sensitive instruments for screening patients, monitoring progress, and assessing rehabilitation outcomes. The RMD was developed using feedback from focus groups and beta-test participants. Since its launch in 2011, RMD use has grown to an average of 1851 hits per day from 168 countries. As of September 2013, 202 instrument summaries are viewable in the RMD. Most summaries are linked to copies of the instrument or to purchase instructions. A challenge in updating and expanding the RMD is securing the resources to ensure its future. Collaborative relationships with professional associations and graduate programs in the health sciences are critical in sustaining this resource.
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Affiliation(s)
- Jennifer L Moore
- Rehabilitation Institute of Chicago, Chicago, IL; Center for Rehabilitation Outcomes Research at the Rehabilitation Institute of Chicago, Chicago, IL.
| | - Jason Raad
- Rehabilitation Institute of Chicago, Chicago, IL; Center for Rehabilitation Outcomes Research at the Rehabilitation Institute of Chicago, Chicago, IL
| | - Linda Ehrlich-Jones
- Rehabilitation Institute of Chicago, Chicago, IL; Center for Rehabilitation Outcomes Research at the Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Health Care Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Allen W Heinemann
- Rehabilitation Institute of Chicago, Chicago, IL; Center for Rehabilitation Outcomes Research at the Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Health Care Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Hogan MJ, Kenney JPM, Roche RAP, Keane MA, Moore JL, Kaiser J, Lai R, Upton N. Behavioural and electrophysiological effects of visual paired associate context manipulations during encoding and recognition in younger adults, older adults and older cognitively declined adults. Exp Brain Res 2011; 216:621-33. [DOI: 10.1007/s00221-011-2966-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/20/2011] [Indexed: 10/15/2022]
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Abstract
The use of N-heterocyclic carbenes as catalysts for organic transformations has received increased attention in the past 10 years. A discussion of catalyst development and nucleophilic characteristics precedes a description of recent advancements and new reactions using N-heterocyclic carbenes in catalysis.
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Moore JL, Silvestri AP, de Alaniz JR, DiRocco DA, Rovis T. Mechanistic investigation of the enantioselective intramolecular stetter reaction: proton transfer is the first irreversible step. Org Lett 2011; 13:1742-5. [PMID: 21355598 PMCID: PMC3064720 DOI: 10.1021/ol200256a] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A study on the mechanism of the asymmetric intramolecular Stetter reaction is reported. This investigation includes the determination of the rate law, kinetic isotope effects, and competition experiments. The reaction was found to be first order in aldehyde and azolium catalyst or free carbene. A primary kinetic isotope effect was found for the proton of the aldehyde. Taken together with a series of competition experiments, these results suggest that proton transfer from the tetrahedral intermediate formed upon nucleophilic attack of the carbene onto the aldehyde is the first irreversible step.
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Affiliation(s)
| | - Anthony P. Silvestri
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523
| | | | - Daniel A. DiRocco
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523
| | - Tomislav Rovis
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523
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McGrain PN, Moore JL. Pursuing the panderer: an analysis of United States v. Williams. J Child Sex Abus 2010; 19:190-203. [PMID: 20390787 DOI: 10.1080/10538711003622760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In May 2008, the Supreme Court addressed whether the government can regulate the ownership and distribution of virtual child pornography. U.S. v. Williams marked the first time the Court directly addressed the concept of pandering virtual child pornography. This article examines the Court's decision in U.S. v. Williams and the relative importance of its holding. In U.S. v. Williams, the Supreme Court upheld an act of Congress targeting the business people behind the child pornography market. Restricting the sale of both real and virtual child pornography is essential to combat the various problems surrounding its existence, which include policing its creation and distribution on the Internet as well as the connection between child pornography and subsequent sexual offenses against children.
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Moore JL, Roth EJ, Killian C, Hornby TG. Locomotor Training Improves Daily Stepping Activity and Gait Efficiency in Individuals Poststroke Who Have Reached a “Plateau” in Recovery. Stroke 2010; 41:129-35. [DOI: 10.1161/strokeaha.109.563247] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Individuals with chronic stroke often demonstrate a “plateau,” or deceleration of motor recovery, which may lead to discharge from physical therapy (PT). However, numerous studies report improvements in motor function when individuals are provided intensive practice of motor tasks. We suggest that reduced task-specific walking practice during clinical PT contributes to limited gains in ambulatory function in those with a perceived plateau poststroke, and suggest that further gains can be realized if intensive stepping, or locomotor training (LT) is provided after discharge.
Methods—
Twenty subjects with chronic stroke completed a repeated baseline measures, randomized crossover trial in which walking performance was assessed during the last 4 weeks of clinical PT before discharge secondary to reaching a plateau, followed by 4 weeks of intensive LT and 4 weeks of no intervention. Outcome measures included clinical and physiological (metabolic) measures of walking overground and on a treadmill, and measures of daily stepping activity in the home and community, including during clinical PT and subsequent LT sessions.
Results—
Stepping practice was more than 4-fold higher during LT versus clinical PT sessions, with significant improvements in daily stepping and gait efficiency only after LT. Changes in daily stepping after clinical PT and intensive LT were correlated (
P
<0.001) with the amount of stepping practice received during these interventions.
Conclusions—
Intensive LT results in improved daily stepping in individuals poststroke who have been discharged from PT because of a perceived plateau in motor function. These improvements may be related to the amount and intensity of stepping practice.
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Affiliation(s)
- Jennifer L. Moore
- From the Sensory Motor Performance Program (J.L.M., E.J.R., T.G.H.), Rehabilitation Institute of Chicago, Ill; the Department of Physical Medicine and Rehabilitation (E.J.R., T.G.H.), Northwestern University Feinberg School of Medicine, Chicago, Ill; the Department of Physical Therapy (C.K.), University of Indianapolis, Ind; and the Department of Physical Therapy (T.G.H.), University of Illinois at Chicago, Ill
| | - Elliot J. Roth
- From the Sensory Motor Performance Program (J.L.M., E.J.R., T.G.H.), Rehabilitation Institute of Chicago, Ill; the Department of Physical Medicine and Rehabilitation (E.J.R., T.G.H.), Northwestern University Feinberg School of Medicine, Chicago, Ill; the Department of Physical Therapy (C.K.), University of Indianapolis, Ind; and the Department of Physical Therapy (T.G.H.), University of Illinois at Chicago, Ill
| | - Clyde Killian
- From the Sensory Motor Performance Program (J.L.M., E.J.R., T.G.H.), Rehabilitation Institute of Chicago, Ill; the Department of Physical Medicine and Rehabilitation (E.J.R., T.G.H.), Northwestern University Feinberg School of Medicine, Chicago, Ill; the Department of Physical Therapy (C.K.), University of Indianapolis, Ind; and the Department of Physical Therapy (T.G.H.), University of Illinois at Chicago, Ill
| | - T. George Hornby
- From the Sensory Motor Performance Program (J.L.M., E.J.R., T.G.H.), Rehabilitation Institute of Chicago, Ill; the Department of Physical Medicine and Rehabilitation (E.J.R., T.G.H.), Northwestern University Feinberg School of Medicine, Chicago, Ill; the Department of Physical Therapy (C.K.), University of Indianapolis, Ind; and the Department of Physical Therapy (T.G.H.), University of Illinois at Chicago, Ill
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Hansel NN, Breysse PN, McCormack MC, Matsui EC, Curtin-Brosnan J, Williams DL, Moore JL, Cuhran JL, Diette GB. A longitudinal study of indoor nitrogen dioxide levels and respiratory symptoms in inner-city children with asthma. Environ Health Perspect 2008; 116:1428-32. [PMID: 18941590 PMCID: PMC2569107 DOI: 10.1289/ehp.11349] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Accepted: 07/23/2008] [Indexed: 05/04/2023]
Abstract
BACKGROUND The effect of indoor nitrogen dioxide concentrations on asthma morbidity among inner-city preschool children is uncertain. OBJECTIVES Our goal was to estimate the effect of indoor NO2 concentrations on asthma morbidity in an inner-city population while adjusting for other indoor pollutants. METHODS We recruited 150 children (2-6 years of age) with physician-diagnosed asthma from inner-city Baltimore, Maryland. Indoor air was monitored over a 72-hr period in the children's bedrooms at baseline and 3 and 6 months. At each visit, the child's caregiver completed a questionnaire assessing asthma symptoms over the previous 2 weeks and recent health care utilization. RESULTS Children were 58% male, 91% African American, and 42% from households with annual income < $25,000; 63% had persistent asthma symptoms. The mean (+/- SD) in-home NO2 concentration was 30.0 +/- 33.7 (range, 2.9-394.0) ppb. The presence of a gas stove and the use of a space heater or oven/stove for heat were independently associated with higher NO2 concentrations. Each 20-ppb increase in NO2 exposure was associated significantly with an increase in the number of days with limited speech [incidence rate ratio (IRR) = 1.15; 95% confidence interval (CI), 1.05-1.25], cough (IRR = 1.10; 95% CI, 1.02-1.18), and nocturnal symptoms (IRR = 1.09; 95% CI, 1.02-1.16), after adjustment for potential confounders. NO2 concentrations were not associated with increased health care utilization. CONCLUSIONS Higher indoor NO2 concentrations were associated with increased asthma symptoms in preschool inner-city children. Interventions aimed at lowering NO2 concentrations in inner-city homes may reduce asthma morbidity in this vulnerable population.
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Affiliation(s)
- Nadia N. Hansel
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patrick N. Breysse
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Meredith C. McCormack
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth C. Matsui
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jean Curtin-Brosnan
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - D’Ann L. Williams
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L. Moore
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L. Cuhran
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gregory B. Diette
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Address correspondence to G.B. Diette, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 East Monument St., Baltimore, MD 21205 USA. Telephone: (410) 502-7038. Fax: (410) 955-0036. E-mail:
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Hornby TG, Campbell DD, Kahn JH, Demott T, Moore JL, Roth HR. Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke: a randomized controlled study. Stroke 2008; 39:1786-92. [PMID: 18467648 DOI: 10.1161/strokeaha.107.504779] [Citation(s) in RCA: 316] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Locomotor training (LT) using a treadmill can improve walking ability over conventional rehabilitation in individuals with hemiparesis, although the personnel requirements often necessary to provide LT may limit its application. Robotic devices that provide consistent symmetrical assistance have been developed to facilitate LT, although their effectiveness in improving locomotor ability has not been well established. METHODS Forty-eight ambulatory chronic stroke survivors stratified by severity of locomotor deficits completed a randomized controlled study on the effects of robotic- versus therapist-assisted LT. Both groups received 12 LT sessions for 30 minutes at similar speeds, with guided symmetrical locomotor assistance using a robotic orthosis versus manual facilitation from a single therapist using an assist-as-needed paradigm. Outcome measures included gait speed and symmetry, and clinical measures of activity and participation. RESULTS Greater improvements in speed and single limb stance time on the impaired leg were observed in subjects who received therapist-assisted LT, with larger speed improvements in those with less severe gait deficits. Perceived rating of the effects of physical limitations on quality of life improved only in subjects with severe gait deficits who received therapist-assisted LT. CONCLUSIONS Therapist-assisted LT facilitates greater improvements in walking ability in ambulatory stroke survivors as compared to a similar dosage of robotic-assisted LT.
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Affiliation(s)
- T George Hornby
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W Taylor St, M/C 898, Chicago, IL 60612, USA.
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de Alaniz JR, Kerr MS, Moore JL, Rovis T. Scope of the asymmetric intramolecular stetter reaction catalyzed by chiral nucleophilic triazolinylidene carbenes. J Org Chem 2008; 73:2033-40. [PMID: 18302407 DOI: 10.1021/jo702313f] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A highly enantioselective intramolecular Stetter reaction of aromatic and aliphatic aldehydes tethered to different Michael acceptors has been developed. Two triazolium scaffolds have been identified that catalyze the intramolecular Stetter reaction with good reactivity and enantioselectivity. The substrate scope has been examined and found to be broad; both electron-rich and -poor aromatic aldehydes undergo cyclization in high yield and enantioselectivity. The tether can include oxygen, sulfur, nitrogen, and carbon linkers with no detrimental effects. In addition, the incorporation of various tethered Michael acceptors includes amides, esters, thioesters, ketones, aldehydes, and nitriles. The catalyst loading may be reduced to 3 mol % without significantly affecting the reactivity or selectivity of the reaction.
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Affiliation(s)
- Javier Read de Alaniz
- Department of Chemistry, Colorado State University, Fort Collins, Colorado 80523, USA
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Abstract
Increases in cadence may augment SV during submaximal cycling (> 65 % VO2max) via effects of increased muscle pump activity on preload. At lower workloads (45 - 65 % VO2max), SV tends to plateau, suggesting that effects of increases in cadence on pump activity have little influence on SV. We hypothesized that cadence-induced increases in CO at submaximal workloads, where SV tends to plateau, are due to elevations in HR and/or O2 extraction. SV, CO, HR, VO2, and delta a - vO2 were assessed at 80 and 100 rpm during workloads of 50 % (LO) or 65 % (HI) of VO2max in 11 male cyclists. No changes in SV were seen. CO was higher at 100 rpm in 10 of 11 subjects at LO (18.1 +/- 2.7 vs. 17.2 +/- 2.6 L/min). VO2 at both workloads was greater at 100 than 80 rpm as was HR (LO: 129 +/- 11 vs. 121 +/- 10 beats/min; HI: 146 +/- 13 vs. 139 +/- 14 beats/min) (p < 0.05). delta a - vO2 was greater at HI compared to LO at 80 (15.1 +/- 1.6 vs. 13.6 +/- 1.3 ml) and 100 rpm (16.0 +/- 1.7 vs. 15.1 +/- 1.6 ml) (p < 0.05). Results suggest that increases in O2 demand during low submaximal cycling (50 % VO2max) at high cadences are met by HR-induced increases in CO. At higher workloads (65 % VO2max), inability of higher cadences to increase CO and O2 delivery is offset by greater O2 extraction.
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Affiliation(s)
- J L Moore
- Sports Medicine, University of California, Davis, Sacramento, CA 95616, USA
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Augé RM, Toler HD, Moore JL, Cho K, Saxton AM. Comparing contributions of soil versus root colonization to variations in stomatal behavior and soil drying in mycorrhizal Sorghum bicolor and Cucurbita pepo. J Plant Physiol 2007; 164:1289-99. [PMID: 17189660 DOI: 10.1016/j.jplph.2006.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 07/31/2006] [Accepted: 08/18/2006] [Indexed: 05/13/2023]
Abstract
In prior studies we learned that colonization of soil can be as important as colonization of roots in determining mycorrhizal influence on the water relations of host plants. Here we use a path analysis modeling approach to test (a) whether quantity of hyphae in soil contributes to variations in stomatal behavior and soil drying, and (b) whether soil colonization or root colonization has a stronger influence on these stomatal and soil drying responses. Experiments were performed on Sorghum bicolor and Cucurbita pepo, with soils and roots colonized by a mixture of Glomus intraradices and Gigaspora margarita. Soil colonization generally made more significant contributions to stomatal conductance than did root colonization. Soil colonization did not make significant direct contributions to soil water potential measures (soil water potential at stomatal closure or soil drying rate), whereas root colonization did contribute a potentially important path to each. The findings further support a role for mycorrhization of the soil itself in contributing to the regulation of stomatal behavior of host plants.
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Affiliation(s)
- Robert M Augé
- Department of Plant Sciences, University of Tennessee, 2431 Joe Johnson Drive, Knoxville, TN 37996-4561, USA.
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50
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Cho K, Toler H, Lee J, Ownley B, Stutz JC, Moore JL, Augé RM. Mycorrhizal symbiosis and response of sorghum plants to combined drought and salinity stresses. J Plant Physiol 2006; 163:517-28. [PMID: 16473656 DOI: 10.1016/j.jplph.2005.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 05/02/2005] [Indexed: 05/06/2023]
Abstract
Arbuscular mycorrhizal (AM) symbiosis can confer increased host resistance to drought stress, although the effect is unpredictable. Since AM symbiosis also frequently increases host resistance to salinity stress, and since drought and salinity stress are often linked in drying soils, we speculated that the AM influence on plant drought response may be partially the result of AM influence on salinity stress. We tested the hypothesis that AM-induced effects on drought responses would be more pronounced when plants of comparable size are exposed to drought in salinized soils. In two greenhouse experiments, several water relations characteristics were measured in sorghum plants colonized by Glomus intraradices (Gi), Gigaspora margarita (Gm) or a mixture of AM species, during a sustained drought following exposure to salinity treatments (NaCl stress, osmotic stress via concentrated macronutrients, or soil leaching). The presence of excess salt in soils widened the difference in drought responses between AM and nonAM plants in just two instances. Days required for plants to reach stomatal closure were similar for Gi and nonAM plants exposed to drought alone, but with exposure to combined NaCl and drought stress, stomates of Gi plants remained open 17-22% longer than in nonAM plants. Promotion of stomatal conductance by Gm occurred with exposure to NaCl/drought stress but not with drought alone or with soil leaching before drought. In other instances, however, the addition of salt tended to nullify an AM-induced change in drought response. Our findings confirm that AM fungi can alter host response to drought but do not lend much support to the idea that AM-induced salt resistance might help explain why AM plants can be more resilient to drought stress than their nonAM counterparts.
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Affiliation(s)
- Keunho Cho
- Department of Plant Sciences, University of Tennessee, 2431 Joe Johnson Drive, Knoxville, TN 37996-4561, USA
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