Acute Occupational and Physical Therapy for Patients With COVID-19: A Retrospective Cohort Study

OBJECTIVE

To describe the function of patients with COVID-19 admitted to an acute care hospital early in the pandemic and to characterize change in function among those admitted to intensive care units (ICU) and to non-critical care services.

DESIGN

This descriptive, retrospective cohort study examined patients infected with SARS-CoV-2 admitted to a tertiary care medical center during the first wave of the pandemic in 2020. Included patients were stratified into 4 cohorts based on whether or not they received therapy during their hospitalization and whether or not their hospitalization included time in the ICU. Data on demographic characteristics, functional impairments, medical interventions, and functional outcomes were collected.

SETTING

Hospital.

PARTICIPANTS

432 adult patients were included in this study (N=432).

RESULTS

ICU patients receiving therapy were more likely to have impaired cognition, impaired strength, and impaired sensation than non-ICU patients receiving therapy. Patients made improvements from evaluation to discharge on the Functional Status Score for the ICU, Activity Measure for Post-Acute Care Daily Activity, and AM-PAC Basic Mobility Short Forms.

CONCLUSION

Patients admitted with COVID-19 experienced significant functional impairments but also demonstrated improvement during the course of their hospitalizations. This study can facilitate health care provider awareness of the detrimental functional effects of COVID-19 and the potential role of rehabilitation services for these patients.

Navigating Clinical Ethics: Using Real Case Constellations to Guide Learners and Teachers in Medicine

Case-based learning is a staple of clinical ethics education in medicine. The sources for medical educators generally are lengthy case books or single, often rare, case analyses in the literature. Busy clinicians may not have the time or inclination to sift through case books to find suitable teaching material, and the latter present unusual cases that many physicians may never encounter in their own practice. Relatively few articles present multiple cases involving ethical issues that are likely to appear in everyday practice in an accessible format for teaching. To fill this gap, we developed a series of paradigmatic cases based on the recurrent themes we identified through a systematic analysis of our clinical ethics consultations in a 5-year period and our collective clinical ethics judgment. We constructed four amalgam "bread-and-butter" ethics cases that are not overly service specific and can be used in medical and residency education along with specific questions for discussion. Topics include decision-making capacity, withholding and withdrawing life-sustaining treatment, patient wishes and do not resuscitate orders, and brain death. Our objective was to help a range of residents and other physicians become more confident and facile in identifying and addressing recurrent ethical issues in their practice.

Protecting Threatened Identity: Sticking with the Group by Emphasizing Ingroup Heterogeneity

In two studies (Ns=163, 164), the authors tested the prediction that perceptions of group variability can steer and guide the way that loyalty is expressed in times of identity threat. In both studies, participants were classified as lower or higher identifiers on the basis of their scores on a group identification measure, and manipulations involved group variability perceptions (homogeneous ingroup vs. heterogeneous ingroup) and threat to the ingroup. Higher identifiers presented with a homogeneous ingroup perceived more ingroup homogeneity under threat than when there was no threat. In contrast, higher identifiers who perceived the ingroup initially as heterogeneous perceived more ingroup heterogeneity under threat than in no threat conditions. Lower identifiers perceived more ingroup heterogeneity under threat (vs. no threat) irrespective of manipulated group variability perceptions. Discussion focuses on different ways that group loyalty can be expressed in times of identity threat.

Direct and extended intergenerational contact and young people's attitudes towards older adults

Research suggests that positive intergenerational contact can improve young people's attitudes towards older adults. However, today's age‐segregated society may not provide ample opportunities for positive contact between younger and older adults to occur on a regular basis. In three studies, we investigated whether the positive attitudinal outcomes associated with direct contact might also stem from a more indirect form of intergenerational relationship: extended contact. In Study 1 (N = 70), extended contact was associated with more positive attitudes towards older adults even when controlling for direct intergenerational contact (contact frequency and contact quality). In Study 2 (N = 110), the positive effects of direct and extended contact on young people's age‐related attitudes were mediated by reductions in intergroup anxiety and ageing anxiety. The mediational effects of intergroup anxiety were replicated in Study 3 (N = 95) and ingroup norms additionally emerged as a mediator of the positive effects of extended contact on young people's attitudes towards older adults. Discussion focuses on the implications for strategies aimed at tackling ageism.

Corralling the ingroup: deviant derogation and perception of group variability

Two experiments investigated the relationship between the evaluation of a deviant group member and the perceived group variability among participants with varying degrees of ingroup identification. In Experiment 1 (N = 79) ingroup identification was negatively associated with perceived ingroup variability following the presentation of a deviant ingroup member. This relationship was mediated by ratings of the deviant: the stronger the identification, the more negatively the deviant was evaluated, and the more homogeneous the ingroup was perceived. These effects were replicated in Experiment 2 (N = 169), which also showed that there was no association between ingroup identification and the representation of the outgroup following exposure to a deviant outgroup member. The findings suggest that deviant derogation may serve to isolate undesirable members from the rest of the ingroup and protect the group's identity.

Terror Management and Biculturalism

Terror management theory posits that cultural worldviews provide protection against death-related anxiety. To the extent that worldviews often encompass competing beliefs, the present research investigated the effect of the salience of an incompatibility between worldview elements. French nationals of second- or third-immigrant generation (N = 193) were exposed to compatible or incompatible aspects of their cultural identities and then induced to contemplate their own death or a neutral topic. Participants reminded of their mortality renounced their ethnic identity more in the cultural incompatibility condition, and this effect was confined to those who initially presented an integrated (or bicultural) identity. Mortality salience led to monoculturalism striving when bicultural participants considered incompatible aspects of both their cultures, hence verifying the importance of upholding a strong and unwavering cultural worldview to cope with death awareness. The role of death-thoughts accessibility and religious attitudes following participants’ efforts to shore up their cultural worldview is discussed.

Innovation credit: when can leaders oppose their group's norms?

Two preliminary studies and 5 experiments examined judgments of leaders who challenge their group's norms. Participants viewed information about group members whose attitudes were normative or deviated in a pronormative or antinormative direction. The antinorm member was identified as (a) either a nonleader or an established leader (Study 1), (b) an ex-leader (Studies 2 and 5), or (c) a future leader (Studies 3, 4, and 5). Antinorm future leaders were judged more positively and were granted greater innovation credit (license to innovate and remuneration) relative to antinorm members, ex-leaders, and established leaders. Results are discussed in terms of the idea that leadership can accrue from prototypicality and can also confer the right to define prescriptive norms. However, innovation credit is only granted in the case of future leaders.

A population-based study of the prevalence and influence of gifts to radiation oncologists from pharmaceutical companies and medical equipment manufacturers

PURPOSE

Hospital-based physicians are responsible for the purchase of expensive equipment. Little is known about the influence of gift giving on their behavior. We wanted to ascertain the prevalence of gift giving from the pharmaceutical industry and medical equipment manufacturers to radiation oncologists and determine whether or not the size of accepted gifts influences their opinions regarding gifts.

METHODS AND MATERIALS

A population-based survey of hospital-based physicians conducted between 2002 and 2003. The study population consisted of all radiation oncologists who were members of the American Society of Therapeutic Radiology and Oncology between 2000 and 2001. A random number generator was used to identify 20% of the population. This group was invited by e-mail and conventional mail to complete a Likert scale questionnaire. Those asked to complete the questionnaire electronically were directed to a specially designed web site.

RESULTS

Of 640 individuals who were asked to participate, 241 (38%) completed the questionnaire. 96% admitted accepting gifts. The most commonly accepted low value gifts were: pen or pencil (78%), drug samples for patient's use (70%), meal (66%), and a note pad (59%). The most commonly accepted high value gifts were trips to "equipment-users meetings" (15%), honoraria for speaking at a conference (10%), and participation in a conference call (9%). Only 5% of radiation oncologists agreed with the statement "my prescribing practices are affected" by gifts; however, 33% agreed with the statement "I believe that other physicians prescribing practices are affected." Similarly, although only 4% felt that their recommendations concerning purchases of medical equipment are affected by gifts, 19% felt that other physicians would be influenced. A test of the hypothesis that physicians believe that their conduct is less affected than those of their colleagues (i.e., "I am not influenced by gifts but someone else is" was strongly affirmed by a correlation statistic) (p < 0.0001). Of the radiation oncologists surveyed, 74% felt that they should be free to accept gifts of small value, 31% felt they should be free to accept meals or gifts of any type, 16% felt that residency programs should ban free meals provided by companies, 13% felt professional associations should discourage companies from hosting parties at the annual meeting, 17% felt that gift giving should stop, and 66% agreed that clinical information provided by companies provides a useful continuing medical education service. Those who accepted larger gifts were far more likely to disagree with statements such as "professional societies should actively discourage companies from hosting parties and providing free meals and giving gifts to physicians attending the annual meeting" (p = 0.0003) and "the practice of gift giving by companies should stop" (p = 0.0017); they were slightly more likely to agree with statements such as "clinical information provided to radiation oncologists by companies provides a useful continuing medical education service."

CONCLUSIONS

To our knowledge, this study represents the first large-scale population based study of a hospital-based specialty and gift giving. This study demonstrates that: (1) Gift giving in radiation oncology is endemic. (2) Although each physician is likely to consider himself or herself immune from being influenced by gift giving, he or she is suspicious that the "next person" is influenced. (3) There is a correlation between the willingness of individual physician to accept gifts of high value and their sympathy toward this practice.

'Hooligans' abroad? Inter-group dynamics, social identity and participation in collective 'disorder' at the 1998 World Cup Finals

During the 1998 Football World Cup Finals in France, English supporters were, once again, involved in major incidents of collective 'disorder'. Explanations for these incidents concentrated on the conflictual norms held by 'hooligans'. In contrast, Scottish supporters attending the tournament displayed norms of non-violence, explained by the popular press in terms of the absence of 'hooligans'. This study challenges this tendency to explain the presence or absence of 'disorder' in the context of football solely in terms of the presence or absence of 'hooligan' fans. Using data obtained from an ethnographic study of both Scottish and English supporters attending the tournament (N = 121), we examine the processes through which ordinarily 'peaceful' supporters would or would not become involved in collective conflict. In line with the Elaborated Social Identity Model (ESIM) of crowd behaviour, the analysis highlights the role of the intergroup context. Where out-group activity was understood as illegitimate in in-group terms, in-group members redefined their identity such that violent action toward out-group members came to be understood as legitimate. By contrast, where there was no out-group hostility, in-group members defined themselves through an explicit contrast with the 'hooligan' supporters of rival teams. This analysis represents an advance on previous studies of crowd behaviour by demonstrating how the ESIM can account for not only the presence, but also the absence, of collective 'disorder'.

Independent living centres: an innovation with mental health implications?

The findings of a national study of Independent Living Centres (ILCs) in Canada suggest that the ILCs are a potentially powerful innovation for the consumer/survivor movement. Independent Living Centres are non-profit, cross-disability, consumer-driven, community-based centres which promote both individual empowerment and community change. The IL and mental health reform paradigms share in the development of empowerment theory, acknowledge the importance of consumer driven organizations, and utilize a socio-political analysis of disability which goes beyond the person and recognizes the environment as problematic. Accordingly, the reform paradigm seeks innovative services which are separate from the traditional mental health system. Before this can fully become a reality, mental health professionals need to increase their knowledge of the IL philosophy and ILC practice. Similarly, ILCs need to increase their knowledge of consumer/survivor empowerment and recovery and carefully assess any barriers that exist in terms of consumers/survivors accessing the ILCs. Collaboration between the IL movement and mental health will increase the likelihood of ILCs becoming a stronger resource for consumers/survivors.

Community services landscape in Canada: survey of developmental disability agencies

A survey of support services for adults with development disabilities living in community settings in Canada was conducted. Information gathered on services and changes occurring in the community services landscape is discussed. Along with a diminution of government's role in funding and guiding service provision, Canada has witnessed the emergence of private-for-profit services, a relatively recent phenomenon in human services. Differences between the private-for-profit and nonprofit sectors are discussed, including a greater propensity in the nonprofit agencies to engage in advocacy and community education. Overall, evidence indicates that some services are beginning to incorporate individualized approaches to funding and support. Implications for government and for services of emergent patterns of support are noted.

Canadian Independent Living Centres: impact on the community

There is now widespread interest in developing social policies and practices that are grounded in principles of independent living. The Independent Living (IL) paradigm reflects a shift in thinking away from traditional approaches to supporting persons with disabilities. Independent Living Centres (ILCs), which started in the early 1970s in the United States, and in the 1980s in Canada, are now a major force in the promotion of the IL concept worldwide. The guiding principles of these consumer-driven centres include: promoting an empowerment philosophy that incorporates consumer control/self-direction over decision-making; offering cross-disability support; providing options/choice and flexibility; and encouraging inclusion and full participation. Despite their prevalence, a surprisingly limited body of research exists on the impact of ILCs. A survey was used to investigate the impact of ILCs in Canada on their communities of interest (groups connected to the ILCs). Surveys were sent to formal organizations, informal groups, and family/friends. A final response rate of 52.6% was achieved (111 of 211 surveys returned). Overall, moderate to good levels of familiarity, involvement, and impact were found. The results affirmed the importance of independent living centres to individual empowerment, community change, and the IL movement.

Questionnaire for the identification of back pain for epidemiological purposes

OBJECTIVES

To design a questionnaire for the identification and assessment of severity of back pain for epidemiological purposes, and gain preliminary experience of its use.

METHODS

A group of specialists, experienced in the epidemiology and clinical assessment of back pain, designed the questionnaire, and tested it individually. It was also given cross sectionally by interview to a population of male coal mine workers.

RESULTS

The questionnaire comprised a maximum of 12 questions on the presence, radiation, frequency, and severity of back pain with reference to difficulty with specific activities, interference with normal work, and absence from work. 471 coal miners answered the questionnaire (66% of those invited). 56% (265 men) of the responders reported pain or ache in the back during the previous 12 months, and the incidence of first ever attacks during the same period was reported to be 34%. 69% reported having had back pain at some time. The responses to the questionnaire were partially validated by comparison with certified sickness absence for two days or more attributed to back pain. In men who were symptomatic in the previous 12 months, for the question relating to absence from work because of back pain, the sensitivity was 82% and specificity was 84%.

CONCLUSION

The questionnaire is easy to administer and generates clear cut data that could be useful for epidemiological or screening purposes. Preliminary, limited, studies of its validity are reasonably encouraging, although further validation is required. It is hoped that researchers will find the questionnaire useful, will extend its validation, and continue to develop it.

Lactation suppression with bromocriptine

The efficacy and acceptability of bromocriptine in suppressing postpartum lactation was determined in a double blind study in which bromocriptine 2.5 mg twice daily for 14 days was compared with a placebo. Forty women who decide during the antenatal period not to breast feed entered the study. The bromocriptine treated group had significantly less mammary secretion and breast engorgement than the control group and also required less analgesia. The most noticeable side effects during the trial were dizziness, headache and abdominal pain. The only statistical difference between the two groups was a higher incidence of dizziness in the bromocriptine treated group.