Background: Healthcare professionals (HCPs) who are physically active are regarded as more likely to act as credible physical activity (PA) role models and promote healthy lifestyles. This study ...explores PA levels and underlying motivations, within and between HCP students, first testing the validity and reliability of the Behavioral Regulation in Exercise Questionnaire (BREQ-2). Methods: The International Physical Activity Questionnaire (IPAQ) and BREQ-2 were administered to 296 HCP university students (physiotherapy n = 47, medicine n = 105, nursing n = 121, radiography n = 23). Data were summarized using descriptive statistics. Mann Whitney and Kruskal Wallis tests compared scores between subgroups. Confirmatory factor analysis and internal consistency testing of the BREQ-2 was also undertaken. Results: Fifty-six percent (n = 166) of respondents were moderately active, 40% (n = 118) highly active and 4% (n = 12) inactive. Participants' responses indicated mainly self-determined motivation for exercise. Significantly different Relative Autonomy Index (RAI) (p ≤ 0.001), identified (p ≤ 0.001) and intrinsic (p ≤ 0.001) motivation subscale scores were noted between HCP groups and among low, moderate and high-level PA groups. Conclusions: This HCP cohort were found to be active and intrinsically motivated to exercise. The BREQ-2 was shown to be a valid and reliable tool with strong subscale internal consistency.
Effective intersectoral collaboration across health and education has been a policy priority for decades as a means of meeting the needs of children with neurodevelopmental disorders in school yet ...remains rare in practice. A meta-ethnography was undertaken to explore the experiences of occupational therapists (OTs) and speech and language therapists (SLTs) with the aim of contributing new insights into the nature of their collaborative work in schools, and how it may best be facilitated. Electronic and manual searches were conducted. Papers were double-screened and critically appraised. A line of argument analysis was undertaken. Fourteen papers were analyzed, reporting the experiences of 369 practitioners from schools across six countries. Five concepts were identified: (a) negotiating liminal professional spaces; (b) gaining entry; (c) collaborative endeavor; (d) collaborative inertia; and (e) collaborative conviction. We describe the complex, effortful, and relational nature of intersectoral collaboration. We propose a conceptualization of SLT and OT collaborative practice in schools as articulation work, with elements of boundary work, much of which is invisible and non-routine. We argue the need for collaborative leadership to promote knowledge and awareness of the role of SLTs and OTs in school, and to support the contextual integration of their relational work in this setting.
The transversus abdominis plane (TAP) block has proven effective in reducing opioid requirements and pain scores for some procedures involving the lower abdominal wall. In this study we assessed its ...efficacy in patients with end-stage renal failure undergoing cadaveric renal transplantation.
Sixty-five adult renal transplant recipients were prospectively randomized to receive a standard general anesthetic technique supplemented with levobupivacaine 0.375% 20 mL TAP block or sham block with 20 mL 0.9% saline. Both groups received patient-controlled morphine analgesia and acetaminophen. Patient assessment occurred in the postanesthetic care unit and at 2, 4, 6, 12, and 24 hours. The primary outcome was total morphine consumption in the first 24 hours after renal transplantation. Other outcomes assessed included pain scores, presence of nausea or vomiting, excessive sedation, and respiratory depression.
Morphine requirements did not differ between the 2 groups, 31.6 ± 5.6 mg in the TAP group and 32.6 ± 5.5 mg in the control group (95% confidence interval CI, -8.96 to 7.09, P = 0.817). Pain scores also did not differ significantly at any time point after surgery. Nausea was reported in 53% of the TAP group and 24% of the control group. The relative risk of nausea associated with treatment was 2.2 (95% CI, 1.1 to 4.3, P = 0.017). No patient exhibited excessive sedation or respiratory depression.
The addition of a TAP block to the analgesia regimen for renal transplantation did not reduce morphine requirements.
Abstract
Background
Diabetes is a prominent health problem with prevalence increasing as the population ages. It is estimated that 11.9% of the Irish population aged 75 years and older are living ...with type 2 diabetes. This condition puts older people at risk of polypharmacy, incontinence in setting of poor control and neuropathic pain. In addition, they are at risk of premature death and functional impairment arising from associated complications. There is an estimated resource use of 10% of the total healthcare budget including medication costs, hospitalisations and attending non-diabetic specialists for disease associated complications.
Methods
We reviewed all acute hospital diabetes consultations over a two-month period to identify persons aged 75 years and over who had contact with our clinical nurse specialists and consult service.
Results
46 patients aged 75 years and older (median age 79 years) were reviewed on request by the consults service. 6.5% (n=3) had Type 1 Diabetes. 41.3% (n=19) were on insulin and the remainder were on oral medications alone. They had a median HbA1c of 63mmol/mol. 91.3% (n=42) were living at home prior to admission. All patients were reviewed and educated by our clinical nurse specialists. Issues addressed included hypoglycaemic awareness, glucometer use and insulin administration. 17.4% (n=8) had medications discontinued due to hypoglycaemia and/or chronic kidney disease. 32.6% (n=15) had up-titration of insulin and/or addition of new agents. 58.7% (n=27) were subsequently followed up in clinic by telephone.
Conclusion
The 2018 American Diabetes Association guidelines now recommend treatment goals based on functional status rather than age. Our experience locally is reflective of the spectrum of issues that arise in management of diabetes in the older person. This highlights the positive impact of a multidisciplinary diabetes service in minimising complications and promoting individualised person-centred care.
Multiple national and international trends and drivers are radically changing what biological security means for the United Kingdom (UK). New technologies present novel opportunities and challenges, ...and globalisation has created new pathways and increased the speed, volume and routes by which organisms can spread. The UK Biological Security Strategy (2018) acknowledges the importance of research on biological security in the UK. Given the breadth of potential research, a targeted agenda identifying the questions most critical to effective and coordinated progress in different disciplines of biological security is required. We used expert elicitation to generate 80 policy-relevant research questions considered by participants to have the greatest impact on UK biological security. Drawing on a collaboratively-developed set of 450 questions, proposed by 41 experts from academia, industry and the UK government (consulting 168 additional experts) we subdivided the final 80 questions into six categories: bioengineering; communication and behaviour; disease threats (including pandemics); governance and policy; invasive alien species; and securing biological materials and securing against misuse. Initially, the questions were ranked through a voting process and then reduced and refined to 80 during a one-day workshop with 35 participants from a variety of disciplines. Consistently emerging themes included: the nature of current and potential biological security threats, the efficacy of existing management actions, and the most appropriate future options. The resulting questions offer a research agenda for biological security in the UK that can assist the targeting of research resources and inform the implementation of the UK Biological Security Strategy. These questions include research that could aid with the mitigation of Covid-19, and preparation for the next pandemic. We hope that our structured and rigorous approach to creating a biological security research agenda will be replicated in other countries and regions. The world, not just the UK, is in need of a thoughtful approach to directing biological security research to tackle the emerging issues.
Aquatic invasive alien species (IAS) negatively impact freshwater ecosystems worldwide. As suppression and eradication of established invader populations are often complex, costly and ...resource-intensive, the prevention of further invader spread is considered a key aspect of proactive management measures. Although broad-spectrum aquatic disinfectants have been suggested as a suitable decontamination mechanism to enhance invader spread-prevention strategies, inconsistencies concerning their effectiveness are reported within the literature. Here, we examine the use of two aquatic disinfectants, which were developed to kill damaging microbes, to induce substantial degradation of the apical fragmentary propagules of five invasive macrophytes: Crassula helmsii (Kirk) Cockayne; Egeria densa Planchon; Elodea canadensis Michx; Hydrocotyle ranunculoides Linnaeus; Lagarosiphon major (Ridley) Moss. Apical fragments were exposed to 0% (0 g L-1), 2% (20 g L-1) or 4% (40 g L-1) solutions of Virkon® Aquatic and Virasure® Aquatic, for submergence treatments of five, fifteen, thirty or sixty minutes. After 28 days, degradation of treated fragments was significantly greater than that of control groups, particularly for 4% solutions and longer exposure times. Despite this, sustained viability in relation to shoot and/or root regrowth was exhibited by almost all plant species. However, new shoot growth rates were significantly reduced following exposure to all treatments. At matched concentrations, there was no significant difference between the two disinfectants. Overall, it appears that the examined aquatic disinfectants will not curtail the spread of these invasive macrophytes. Yet, longer submergence times, multiple applications and synergistic effects of different biosecurity treatments may enhance preventative measures against further spread and this requires investigation.
PDF
