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Selected AbstractsEffectiveness of primary conservative management for infants with obstetric brachial plexus palsyINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2005Andrea Bialocerkowski PhD MAppSc(Phty) GradDipPublicHealth Executive summary Background, Obstetric brachial plexus palsy, a complication of childbirth, occurs in 1,3 per 1000 live births internationally. Traction and/or compression of the brachial plexus is thought to be the primary mechanism of injury and this may occur in utero, during the descent through the birth canal or during delivery. This results in a spectrum of injuries that vary in severity, extent of damage and functional use of the affected upper limb. Most infants receive treatment, such as conservative management (physiotherapy, occupational therapy) or surgery; however, there is controversy regarding the most appropriate form of management. To date, no synthesised evidence is available regarding the effectiveness of primary conservative management for obstetric brachial plexus palsy. Objectives, The objective of this review was to systematically assess the literature and present the best available evidence that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy. Search strategy, A systematic literature search was performed using 14 databases: TRIP, MEDLINE, CINAHL, AMED, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Those studies that were reported in English and published over the last decade (July 1992 to June 2003) were included in this review. Selection criteria, Quantitative studies that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy were eligible for inclusion in this review. This excluded studies that solely investigated the effect of primary surgery for these infants, management of secondary deformities and the investigation of the effects of pharmacological agents, such as botulinum toxin. Data collection and analysis, Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion. Studies were assessed for clinical homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format. Results, Eight studies were included in the review. Most were ranked low on the Hierarchy of Evidence (no randomised controlled trials were found), and had only fair methodological quality. Conservative management was variable and could consist of active or passive exercise, splints or traction. All studies lacked a clear description of what constituted conservative management, which would not allow the treatment to be replicated in the clinical setting. A variety of outcome instruments were used, none of which had evidence of validity, reliability or sensitivity to detect change. Furthermore, less severely affected infants were selected to receive conservative management. Therefore, it is difficult to draw conclusions regarding the effectiveness of conservative management for infants with obstetric brachial plexus palsy. Conclusions, There is scant, inconclusive evidence regarding the effectiveness of primary conservative intervention for infants with obstetric brachial plexus palsy. Further research should be directed to develop outcome instruments with sound psychometric properties for infants with obstetric brachial plexus palsy and their families. These outcome instruments should then be used in well-designed comparative studies. [source] An Epidemiologic Study of Aboriginal Adolescent Risk in Canada: The Meaning of SuicideJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 1 2008Melanie S. MacNeil RN BACKGROUND:,Current rates of Aboriginal youth suicide suggest that an epidemiologic review is needed to understand the impact of culture, community, and environment specific to suicide within this population. PURPOSE:,This paper aims to (a) examine the literature on the incidence of suicide with special attention to that of adolescents in Aboriginal communities in Canada, (b) review factors hypothesized to place Aboriginals at risk, and (c) explore research directions that would contribute to our understanding of an Aboriginal perspective of suicide. CONCLUSION:,A clear description of the meaning of adolescent Aboriginal suicide and an understanding of the factors that create risk is needed. [source] The relationship between non-working-side occlusal contacts and mandibular positionJOURNAL OF ORAL REHABILITATION, Issue 10 2001T. Ogawa No clear description can be found regarding the lateral position when examining non-working-side occlusal contacts. The objective of this study was to test the hypothesis that the non-working-side contact pattern varies with the mandibular position. The characteristics of the non-working-side contact pattern were also determined relative to the working-side contact pattern. Occlusal contacts of 86 young adults were examined using shim stock in standardized lateral positions: 0·5, 1, 2 and 3 mm from the maximum intercuspation (MI), where the 0·5, 1 and 2 mm positions were defined as lateral positions close to the MI and the 3 mm position as an edge-to-edge position. The frequency of non-working-side occlusal contacts decreased gradually from 0·5 to 3 mm position. The frequency of non-working-side contacts was significantly greater in the 0·5 and 1 mm positions than in the 3 mm position. Non-working-side occlusal contacts occurred in nearly half of the 0·5 mm positions. Non-working-side contacts were significantly less frequent with canine protection than with group function for the 0·5 and 1 mm positions. There were no significant differences between the two occlusal schemes for the 2 and 3 mm positions. In conclusions, the non-working-side contact pattern varied with the mandibular position. These results suggest that clinical examination should include contact patterns both in a position close to the MI and in an edge-to-edge position, i.e. in functional and parafunctional ranges. Likewise, data from occlusal contact research should include a standardized definition of mandibular position. [source] Classification of emergence and its relation to self-organizationCOMPLEXITY, Issue 5 2008Julianne. Emergence is a difficult concept to describe clearly. It has been characterized in the literature in a number of ways, none of which are easy to understand or describe clearly how other concepts in complex systems science are related to emergence. We provide a simple, clear description, and classification of emergence in terms of self-organization. This provides a framework for understanding how concepts such as thermodynamic equilibrium, nonlinearity, and computability are related to emergence. © 2008 Wiley Periodicals, Inc. Complexity, 2008. [source] Cardiac rehabilitation programme for coronary heart disease patients: An integrative literature reviewINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2009Nidal F Eshah RN, PhD(c) Previous Western cardiac rehabilitation (CR) purported to improve patients' quality of life and health-related parameters for cardiovascular diseases (CVD). Nursing's role in CR was minimally identified. The purpose of this integrative literature review was to determine the effectiveness of current CR programmes and to determine if nurses are included in multidisciplinary CR teams. An online search of databases for the National Institutes of Health Library, Medline, CINAHL, Blackwell Synergy and PsychINFO electronic databases, with keywords,cardiac rehabilitation, lifestyle modification, secondary prevention, quality of life, effects of rehabilitation,identified 13 articles published 2001,2006 for inclusion. Cardiac rehabilitation programmes provided significant improvement in participants' quality of life, exercise capacity, lipid profile, body mass index, body weight, blood pressure, resting heart rate, survival rate, mortality rate and decreased myocardial infarction (MI) risk factors, although there was limited participation. They also decreased depression and anxiety. Eight studies included Nurses as CR providers, but without clear descriptions of their role. Nurses in developing countries need to participate in CR programmes to improve patients' participation, and to focus on modalities with lower overhead costs, such as home-based CR, and to clearly articulate their unique contributions. [source] Guidelines for assessment of bone microstructure in rodents using micro,computed tomographyJOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2010Mary L Bouxsein Abstract Use of high-resolution micro,computed tomography (µCT) imaging to assess trabecular and cortical bone morphology has grown immensely. There are several commercially available µCT systems, each with different approaches to image acquisition, evaluation, and reporting of outcomes. This lack of consistency makes it difficult to interpret reported results and to compare findings across different studies. This article addresses this critical need for standardized terminology and consistent reporting of parameters related to image acquisition and analysis, and key outcome assessments, particularly with respect to ex vivo analysis of rodent specimens. Thus the guidelines herein provide recommendations regarding (1) standardized terminology and units, (2) information to be included in describing the methods for a given experiment, and (3) a minimal set of outcome variables that should be reported. Whereas the specific research objective will determine the experimental design, these guidelines are intended to ensure accurate and consistent reporting of µCT-derived bone morphometry and density measurements. In particular, the methods section for papers that present µCT-based outcomes must include details of the following scan aspects: (1) image acquisition, including the scanning medium, X-ray tube potential, and voxel size, as well as clear descriptions of the size and location of the volume of interest and the method used to delineate trabecular and cortical bone regions, and (2) image processing, including the algorithms used for image filtration and the approach used for image segmentation. Morphometric analyses should be based on 3D algorithms that do not rely on assumptions about the underlying structure whenever possible. When reporting µCT results, the minimal set of variables that should be used to describe trabecular bone morphometry includes bone volume fraction and trabecular number, thickness, and separation. The minimal set of variables that should be used to describe cortical bone morphometry includes total cross-sectional area, cortical bone area, cortical bone area fraction, and cortical thickness. Other variables also may be appropriate depending on the research question and technical quality of the scan. Standard nomenclature, outlined in this article, should be followed for reporting of results. © 2010 American Society for Bone and Mineral Research [source] | ||||||||||