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CAEP 2021 Academic Symposium: recommendations for addressing racism and colonialism in emergency medicine. CAN J EMERG MED 2022; 24:144-150. [PMID: 35020176 PMCID: PMC8752581 DOI: 10.1007/s43678-021-00244-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
Purpose Racism and colonialism impact health, physician advancement, professional development and medical education in Canada. The Canadian Association of Emergency Physicians (CAEP) has committed to addressing inequities in health in their recent statement on racism. The objective of this project was to develop recommendations for addressing racism and colonialism in emergency medicine. Methods The authors, in collaboration with a 40 member working group, conducted a literature search, held a community consultation, solicited input from expert medical, academic and community advisors, conducted a national survey of emergency physicians, and presented draft recommendations at the 2021 CAEP Academic Symposium on Equity, Diversity and Inclusion for a live facilitated discussion with a post-session survey. Results Sixteen recommendations were generated in the areas of patient care, hospital and departmental commitment to Equity, Diversity, and Inclusion, physician advancement, and professional development and medical education. Conclusion Emergency physicians are uniquely positioned to promote equity at each encounter with patients, peers and learners. The 16 recommendations presented here are practical steps to countering racism and colonialism everyday in emergency medicine. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-021-00244-2.
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Maintaining a global health partnership during the COVID-19 pandemic: a road map from the Toronto Addis Ababa Academic Collaboration in Emergency Medicine. CAN J EMERG MED 2021; 23:242-244. [PMID: 33595809 PMCID: PMC7887712 DOI: 10.1007/s43678-021-00083-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/23/2020] [Indexed: 10/27/2022]
Abstract
The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is an educational global health partnership established 10 years ago to support the growth of EM in Ethiopia. In-person global health partnership activities were disrupted by the COVID-19 pandemic. We describe our five-step process for transitioning our global health partnership to a virtual space. Each step was conducted in collaboration between the University of Toronto and Addis Ababa University EM physicians: (1) risk identification and needs assessment, (2) discussing mitigation strategies, (3) crafting and piloting an approach, (4) revising based on pilot results, 5) implementation with continuous evaluation and revision. Teaching was modified iteratively in response to feedback. Our experience shows that virtual teaching, while not a replacement for in-person engagement, can be a valuable tool both to supplement partnership activities when travel is not possible, and to enhance global health partnerships long term. This approach can also inform the transition of other forms of medical education to the virtual space.
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Mask shortage during epidemics and pandemics: a scoping review of interventions to overcome limited supply. BMJ Open 2020; 10:e040547. [PMID: 33247019 PMCID: PMC7703444 DOI: 10.1136/bmjopen-2020-040547] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To characterise published evidence regarding preclinical and clinical interventions to overcome mask shortages during epidemics and pandemics. DESIGN Systematic scoping review. SETTINGS All healthcare settings relevant to epidemics and pandemics. SEARCH STRATEGY English peer-reviewed studies published from January 1995 to June 2020 were included. Literature was identified using four databases (Medline-OVID, EMBASE, CINAHL, Cochrane Library), forwards-and-backwards searching through Scopus and an extensive grey literature search. Assessment of study eligibility, data extraction and evidence appraisal were performed in duplicate by two independent reviewers. RESULTS Of the 11 220 database citations, a total of 47 articles were included. These studies encompassed six broad categories of conservation strategies: decontamination, reusability of disposable masks and/or extended wear, layering, reusable respirators, non-traditional replacements or modifications and stockpiled masks. Promising strategies for mask conservation in the context of pandemics and epidemics include use of stockpiled masks, extended wear of disposable masks and decontamination. CONCLUSION There are promising strategies for overcoming face mask shortages during epidemics and pandemics. Further research specific to practical considerations is required before implementation during the COVID-19 pandemic.
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Public trust in the information age. CMAJ 2019; 191:E899. [DOI: 10.1503/cmaj.72514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
STUDY DESIGN A crossover experimental design with repeated measures. OBJECTIVE To determine whether the forearm support band alters wrist extensor muscle fatigue. BACKGROUND Fatigue of the wrist extensor muscles is thought to be a contributing factor in the development of lateral epicondylitis. The forearm support band is purported to reduce or prevent symptoms of lateral epicondylitis but the mechanism of action is unknown. METHODS AND MEASURES Fifty unimpaired subjects (36 men, 14 women; mean age = 29 +/- 6 years) were tested with and without a forearm support band before and after a fatiguing bout of exercise. Peak wrist extension isometric force, peak isometric grip force, and median power spectral frequency for wrist extensor electromyographic activity were measured before and after exercise and with and without the forearm support band. A 2 x 2 repeated measures multivariate analysis of variance was used to analyze the data, followed by univariate analysis of variance and Tukey's multiple comparison tests. RESULTS Peak wrist extension isometric force, peak grip isometric force, and median power spectral frequency were all reduced after exercise. However, there was a significant reduction in peak grip isometric force and peak wrist extension isometric force values for the with-forearm support band condition (grip force 28%, wrist extension force 26%) compared to the without-forearm support band condition (grip force 18%, wrist extension force 15%). CONCLUSIONS Wearing the forearm support band increased the rate of fatigue in unimpaired individuals. Our findings do not support the premise that wearing the forearm support band reduces muscle fatigue in the wrist extensors.
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Abstract
STUDY DESIGN Single-group repeated measures with 2 raters. OBJECTIVES To determine the interrater and intrarater reliability of water volumetry and the figure of eight method on subjects with ankle joint swelling. BACKGROUND Measurements of ankle swelling are commonly performed to determine the nature and stage of injury and to monitor progress made during rehabilitation. Water volumetry and the figure of eight method are 2 techniques used to measure ankle swelling. METHODS AND MEASURES Twenty-nine subjects with ankle swelling were measured by 2 raters with the hypothesis that both measurement techniques would be reliable. Each rater performed 3 measurements of the swollen ankle using both measurement techniques during a single test session. The order of the rater and of the measurement technique was randomized, and the raters were blinded to each other's measurements. RESULTS We found high interrater reliability for both the water volumetry (ICC [intraclass correlation coefficient] = 0.99) and figure of eight methods (ICC = 0.98). Additionally, intrarater reliability was high for both raters using both methods (ICCs = 0.98-0.99). CONCLUSIONS Both methods are reliable measures of ankle swelling. The authors recommend the figure of eight method because of its ease of use, time efficiency, and cost effectiveness. However, water volumetry may be more appropriate when measuring diffuse lower-extremity swelling. Reliability of these 2 methods was established using subjects with foot or ankle pathology. Therefore, the results are applicable and generalizable to the clinical setting.
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The future of physical therapy. REHAB MANAGEMENT 1998; 11:48-50, 52, 54. [PMID: 10175968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Investigation of the validity and reliability of four objective techniques for measuring forward shoulder posture. J Orthop Sports Phys Ther 1997; 25:34-42. [PMID: 8979174 DOI: 10.2519/jospt.1997.25.1.34] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Clinicians often rely on visual inspection and descriptive terms to documents a patient's forward shoulder posture. The purpose of this study was to assess the validity and intrarater reliability of four objective techniques to measure forward shoulder posture. Subjects were 25 males and 24 females. Subjects had a lateral cervical spine radiograph taken, from which the horizontal distance from the C7 spinous process to the anterior tip of the left anterior acromion process was measured. Subjects then proceeded twice through a random order of four measurements: the Baylor square, the double square, the Sahrmann technique, and scapular position. These results were then used to determine the intrarater reliability of each technique. Multiple regression analyses were performed on each measure's mean scores to determine both the correlation with and the predictive value for the radiographic measurement. The intraclass correlation coefficients for intrarater reliability ranged from .89 to .91. The correlation coefficients ranged from -.33 to .77, and the coefficients of determination ranged from .10 to .59 (N = 49). The researchers demonstrated clinical reliability for each technique; however, validity compared with the radiographic measurement could not be established. These techniques may have clinical value in objectively measuring change in a patient's shoulder posture as a result of a treatment program. Before any of these measures could be universally recommended in clinical practice, future research is necessary to establish interrater reliability and assess each technique's ability to detect postural changes over time.
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Abstract
Dual energy x-ray absorptiometry was used to measure periprosthetic, distal femoral, and proximal tibial bone mass in the affected and contralateral limbs of eight patients 10 years after unilateral total hip arthroplasty with a cementless, porous-coated titanium alloy femoral stem. Gait analyses to assess the presence of asymmetries in loading of the lower extremities were also performed 10 years postoperatively. The patients had excellent clinical results and no other significant lower extremity pathology. On the basis of comparison of the affected and unaffected proximal femora, bone loss adjacent to the proximal medial aspect of the femoral stem was determined to be 34% (p < 0.001). However, the patients also had 16% less bone in the ipsilateral proximal tibia (p = 0.003) and 15% less bone in the ipsilateral femur 3 cm distal to the prosthesis (p = 0.007) compared with the contralateral limb. When normalized to the asymmetry in tibial bone mineral content, the estimated proximal medial periprosthetic bone loss was still statistically significant, but the magnitude was reduced from 34 to 17% (p = 0.009). The gait analyses indicated that several measures that influence the loads at the hip and knee joints were reduced in the involved limb compared with the contralateral limb. Furthermore, the bilateral difference in the vertical component of the external force acting on the proximal tibia was correlated with the bilateral difference in tibial bone mineral content (r = 0.80, p = 0.02). These data suggest that two mechanical factors, the local stress-shielding effect of the prosthesis and the global effect of decreased loading of the limb, can both make significant contributions to periprosthetic bone loss. It is apparent that the magnitude of the periprosthetic bone loss related to stress-shielding has been overestimated by as much as 50% in retrospective studies.
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Comparison of "inside-out" and "outside-in" interference screw fixation for anterior cruciate ligament surgery in a bovine knee. Arthroscopy 1996; 12:76-81. [PMID: 8838733 DOI: 10.1016/s0749-8063(96)90223-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite numerous advances in graft fixation with anterior cruciate ligament (ACL) reconstruction, few studies have compared the fixation strength of interference screws placed "outside-in" and from "inside-out" techniques. To compare techniques, a bovine model was designed to fail at the femoral tunnel bone-screw interface. Twenty-four fresh bovine knees were stripped of all soft tissues except the ACL. The native ACL was loaded the failure at a strain rate of 50 cm/min with the knee flexed 45 degrees. One standardized femoral tunnel was created on all specimens. A 3/32-inch guide pin was drilled into the center of the ACL femoral origin and overreamed with an 11-mm reamer from inside-out until the lateral cortex was reamed. Consistently sized patellar bone blocks were created (8 x 5 x 25 mm) with an 8-mm tendon width. The bone blocks were randomized to an "inside-out" (group 1) and "outside-in" (group 2) technique. Bone blocks were secured with a 7 x 25 interference screw. Specimens were mounted with the femoral tunnel and bone block aligned parallel to the tensile force and strained to failure at 50 cm/min. Failure of the native bovine ACL occurred at a mean of 2,304 N (SD +/- 472 N; n = 24). The mode of failure for group 1 was 9 of 13 at the bone-screw interface and 4 of 13 interligamentous failures. The mode of failure for group 2 was 7 of 11 at the bone-screw interface, 3 of 11 interligamentous, and 1 bone block failure. The mean load to failure for group 1 was 1,151 N (SD +/- 320 N, n = 13) including the four ligamentous failures and 1,143 N (SD +/- 306 N, n = 9) excluding the ligamentous failures. The mean load to failure for group 2 was 1,017 N (SD +/- 262 N, n = 11), including all specimens and 843 N (SD +/- 262 N, n = 7) excluding the interligamentous and bone block failure specimens. The "inside-out" technique averaged 100 N greater fixation strength than the "outside-in" technique. Statistical analysis using two-sample Student's t-test showed no statistically significant differences between group 1 and group 2. Both techniques demonstrate comparable maximum load to failure in a bovine model tested at 50 cm/min.
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Abstract
Consulting with business and industry represents a very new world for physical therapists--a world in which most have had little formal academic preparation. Some competencies in consulting in occupational health physical therapy are beyond specific clinical skills and knowledge. The purpose of this research was to survey occupational health physical therapists (OHPTs) concerning a previously identified list of nonclinical competencies in consulting with business and industry. The survey addressed how OHPTs rated the importance of these competencies, how they rated their own level of competence for each, and how they developed these competencies. The survey sample was based on members of the American Physical Therapy Association Orthopaedic Section's Special Interest Group in Occupational Health Physical Therapy. The response rate was 98% (61/62). Mean importance of competencies was 3.66/4.00 (range 3.00-3.88), which further validated the list of nonclinical competencies. The mean level of competence was 3.17/4.00 (range 2.40-3.50). The mean importance of individual competencies was consistently higher than level of competence. This discrepancy is of practical significance in terms of professional development of OHPTs consulting with business and industry. Primary sources of competence were practical experience (59.87%) and continuing education for physical therapists (15.51%). These results may indicate that current continuing education programs are not meeting OHPTs' educational needs and may serve as a basis for developing programs to better meet these needs. The survey instrument may help OHPTs identify and prioritize their own educational needs and to plan their own professional development accordingly.
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Abstract
Industrial physical therapists (IPTs) are working as external consultants with business and industry to provide injury prevention and/or rehabilitation services. This consulting presents a very new practice setting for therapists and requires specialized nonclinical competencies. The purpose of this study was to identify these nonclinical competencies. The research was based on an evaluation research model using a stakeholder group. Stakeholders represented five groups: 1) IPTs, 2) continuing education providers, 3) business and industry employers of IPTs, 4) safety/risk managers, and 5) human resource development professionals. Thirty-five nonclinical competencies were identified through qualitative analysis of in-depth interviews with 17 subject matter experts representing the five groups. The competencies addressed marketing, program planning, managing the consulting process, training, and understanding organizations. This list of nonclinical competencies may serve as a self-assessment tool that IPTs can use to help plan their professional development. It may also facilitate planning continuing education programs for IPTs.
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Addressing attitudes during diabetes education: suggestions from adult education. DIABETES EDUCATOR 1991; 17:470-3. [PMID: 1935555 DOI: 10.1177/014572179101700610] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Suggestions from adult education can improve the effectiveness of diabetes education programs. While information and knowledge are noted as important factors in diabetes education, the literature indicates that they are insufficient to insure improved treatment outcomes. Research suggests that addressing psychosocial variables can improve diabetes education effectiveness. Although there are a multitude of psychosocial variables, attitude is consistently identified as an important contributor to positive diabetes management. Practical suggestions from adult education are offered to improve the learner's attitude about diabetes, the learning process, and the instructor.
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How effective are health fairs? Quantitative evaluation of a community health fair. Am J Health Promot 1991; 6:85-8. [PMID: 10146785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Flexible ruler. Phys Ther 1990; 70:397-8. [PMID: 2345783 DOI: 10.1093/ptj/70.6.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
The need for quick, accurate, and reproducible methods to measure the amount of bone within porous metals has increased as the use of these materials has become more common within orthopedics. The purpose of this paper is to compare measurements of bone ingrowth using microradiography, stained histology, and backscattered electron imaging-scanning electron microscopy (BEI-SEM) in cementless, porous-coated acetabular components retrieved from human patients. BEI-SEM of bone ingrowth into porous metal provided excellent images for quantitative analysis. The stained sections and BEI-SEM images provided very comparable results, while microradiography consistently underestimated the porosity of the porous coating and overestimated the amount of bone ingrowth.
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Abstract
Biofilms were present on 16 of 33 urethral catheters examined. In 11 cases the catheter carried a different microbial flora from that of the bladder urine. The length of time the catheter was in situ did not influence biofilm formation, and all types of materials tested supported biofilm growth. Biofilms were seen on 2 of the 7 catheters where prophylactic antibiotics had been used.
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Abstract
The purposes of this study were to investigate differences in lumbar lordosis in black and white adult females and to explain the clinical impression that blacks have a greater lordosis than whites. An actual lumbosacral lordosis angle (ALS) was measured from a standing right lateral lumbosacral radiograph using the angle formed from the intersection of lines drawn across the top of the second lumbar vertebral body (L2) and across the top of the sacrum. An actual lumbo-lumbar angle (ALL) was measured in the same manner, except the second line was drawn across the bottom of the fifth vertebral body (L5). To determine whether gluteal prominence gives a false impression of increased lumbar lordosis, an apparent lordosis (APL) measurement was taken, measuring the distance from the subject's greater trochanter to the most posterior aspect of the buttocks. No significant differences were found in ALS or ALL between 25 black and 27 white adult female subjects (ALS, P = 0.26; ALL, P = 0.41). Significant differences were found between black and white APL, with blacks demonstrating a larger APL than whites (P less than 0.01). A high correlation was noted between ALS and ALL in both blacks (0.70, P less than 0.01) and whites (0.77, P less than 0.01). The investigators therefore contend that the clinician's assumption that blacks have a greater lordosis than whites is based on an apparent increased lordosis due to more prominent buttocks (APL).
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Robert Mills' sources for the South Carolina Lunatic Asylum, 1822. JOURNAL OF THE SOUTH CAROLINA MEDICAL ASSOCIATION (1975) 1979; 75:264-8. [PMID: 381773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Reports to the Center for Disease Control on isolation of non-polio enteroviruses for the years 1971--1975 were analysed. During the 5 year period, enterovirus isolations were reported from 7 075 individuals. 90% of these occurred in the 7 month interval of May--November. Enteroviruses were isolated more frequently from males than females for all age groups in all 5 years. The incidence of reported isolations decreased with increasing age, and an inverse relationship between severity of disease and age was suggested. Clinical diagnoses associated with enteroviral isolations included aseptic meningitis, encephalitis, upper respiratory tract disease, non-specific febrile illness, gastroenteritis, pneumonia and lower respiratory tract disease, exanthem, and enanthem.
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Dallas EMS system advocates mechanical CPR. EMERGENCY MEDICAL SERVICES 1978; 7:39-40, 42, 94. [PMID: 10308053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Diagnostic ultrasound to determine renal size and position for renal blocking in radiation therapy. Int J Radiat Oncol Biol Phys 1977; 2:1217-20. [PMID: 599074 DOI: 10.1016/0360-3016(77)90136-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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