A Masterclass to Teach Public Health Professionals to Conduct Practice-Based Research to Promote Evidence-Based Practice: A Case Study From the Netherlands.
A masterclass to teach public health professionals to conduct practice-based research to promote evidence-based practice: a case study from the Netherlands.
Filed under: Rehab Centers
J Public Health Manag Pract. 2013 Jan; 19(1): 83-92
Jansen MW, Hoeijmakers M
: Public health professionals have a pivotal position in efforts to obtain more practice-based evidence about what people need and what works in real circumstances. Close collaboration with researchers should enable public health professionals to design and conduct research in practical settings to address today’s complex public health problems and increase the external validity of results. This requires expanding the research competencies of public health professionals. We developed and implemented a masterclass for public health professionals, modeled on an existing scientific training course for general practitioners and rehabilitation physicians.: The masterclass was evaluated using a multiple method design, involving quantitative and qualitative methods. Evaluation took place during, at the end of, and 9 months after the masterclass.: Twenty-one candidates (mean age, 41 y) started the program, 66% of whom completed it. Teaching materials, lectures, organization, and facilities were favorably evaluated. At the end of the masterclass, participants were able to design and implement a research proposal in their daily work setting, write a draft article, and critically appraise scientific research for practice and policy purposes. Participants had become more confident about their research competence. Management support from their employer proved crucial. Results obtained with the different methods were consistent.: The masterclass appeared to be an effective instrument to increase the practice-based research skills of public health professionals, provided the research is implemented in a supportive organization with management backing and supervision by senior university researchers. We recommend using masterclasses to contribute to the improvement of practice-based evidence for projects addressing current and future public health problems.
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Considerations for the Use of C7 Crossing Laminar Screws in Subaxial and Cervicothoracic Instrumentation.
Filed under: Rehab Centers
Spine (Phila Pa 1976). 2012 Nov 19;
Ilgenfritz RM, Gandhi AA, Fredericks DC, Grosland NM, Smucker JD
STRUCTURED ABSTRACT: Study Design. Radiographic and biomechanical analysesObjective. To determine the applicability of C7 laminar screw fixation using radiographic and biomechanical analysis.Summary of Background Data. The unique anatomy of C7 creates a challenge during instrumentation at the caudal aspect of the cervical spine and cervicothoracic junction. The C7 lateral mass is often smaller, resulting in increased difficulty for pedicle screw placement. The use of crossing laminar screw fixation is common in the upper cervical and thoracic spine; its use at the C7 level, however, has not been identified in the literature.Methods. Radiographic: CT images from seventy-two patients were used to measure laminar thickness, spinolaminar angle, and length (i.e., from the spinolaminar junction to the contralateral lamina-lateral mass junction) for each C7 vertebrae.Biomechanical. The C2 and C7 vertebrae from thirteen cadaveric cervical spines were obtained, scanned using pQCT for bone mineral density, and then instrumented in the following manner: (1) bilateral crossing intra-laminar screws in C2; (2) bilateral crossing intra-laminar screws in C7; (3) bilateral pedicle screws in each C7 specimen after completion of laminar screw biomechanical testing. Each specimen was cyclically loaded for 5,000 cycles after which axial screw pull out tests were performed.Results. Radiographic. Mean laminar thickness and length were 5.67 ± 1.00 mm and 25.49 ± 2.73 mm respectively.Biomechanical. The mean load to failure was 610.3 ± 251 N for C7 laminar screws, 666.33 ± 373N for C7 pedicle screws and 355 ± 250N for C2 laminar screws. A student t-test indicated no statistical difference in pullout strength between C7 laminar and C7pedicle screws (p = 0.6).Conclusion. The radiographic anatomy at C7 suggests intra-laminar screws can be placed in the majority of patients. The in-vitro biomechanical analysis performed indicates that C7 laminar screws are as strong as C7 pedicle screws and significantly stronger than laminar screws at C2.
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Late profound muscle weakness following heart transplantation due to danon disease.
Filed under: Rehab Centers
Muscle Nerve. 2012 Jul 12;
Van Der Starre P, Deuse T, Pritts C, Brun C, Vogel H, Oyer P
Introduction: Postoperative muscle weakness is a serious complication in surgical intensive care patients. It is mostly described as critical illness polyneuromyopathy. Risk factors include intensive care length of stay, sepsis, poor glycemic control, and combined use of corticosteroids and neuromuscular blocking agents, malnutrition, and electrolyte imbalance. Methods: We report a case of late-progressive, profound weakness after heart transplantation for noncompaction cardiomyopathy which required prolonged mechanical ventilation. The patient’s muscle strength recovered completely after prolonged rehabilitation. Results: Electromyographic assessment showed myopathy. Muscle biopsy revealed Danon disease, a genetic disorder affecting the lysosomal-associated membrane protein 2 gene (LAMP2). Conclusions: The finding of this genetic disorder was unexpected, because the preoperative echocardiographic diagnosis of noncompaction cardiomyopathy has not been reported in Danon disease. This report underlines the need for early availability of pathology results from the explanted heart, which showed the same disorder. Muscle Nerve, 2012.
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Physical therapy management of female chronic pelvic pain: Anatomic considerations.
Filed under: Rehab Centers
Clin Anat. 2012 Nov 21;
George SE, Clinton SC, Borello-France DF
The multisystem nature of female chronic pelvic pain (CPP) makes this condition a challenge for physical therapists and other health care providers to manage. This article uses a case scenario to illustrate commonly reported somatic, visceral, and neurologic symptoms and their associated health and participation impact in a female with CPP. Differential diagnosis of pain generators requires an in-depth understanding of possible anatomic and physiologic contributors to this disorder. This article provides a detailed discussion of the relevant clinical anatomy with specific attention to complex interrelationships between anatomic structures potentially leading to the patient’s pain. In addition, it describes the physical therapy management specific to this case, including examination, differential diagnosis, and progression of interventions. Clin. Anat., 2012. © 2012 Wiley Periodicals, Inc.
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