Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1200 Main Street West, HSC-2C, Hamilton, Ontario, Canada L8N 3Z5; Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, 2000-25 Main Street West, Hamilton, Ontario, Canada L8P 1H1. Electronic address: email@example.com.
A systems analysis perspective was undertaken to evaluate access to surgery for children with medically refractory epilepsy (MRE) in Ontario, the largest province in Canada. The analysis focused on the assessment of referral patterns, healthcare utilization, time intervals and patient flow to determine surgical candidacy in children with MRE. The purpose of this systems analysis study was to identify rate limiting steps that may lead to delayed surgical candidacy decision and surgery.
Prolonged video electroencephalography (vEEG) is the common entry point into the process for all potential epilepsy surgery candidates. Therefore, a single centre retrospective chart review of children and adolescents referred to the epilepsy monitoring unit (EMU) for vEEG monitoring at the primary referral centre for paediatric epilepsy surgery in the province. Basic demographic and referral data were abstracted for all screened cases. Included cases were: (1) age 8h). Forty five percent (n=160) of patients came to seizure conference for discussion of their data, of whom 40% (64/160) were considered surgical candidates. Time from first seizure to EMU referral was approximately 4.6 years. Time from referral to admission and admission to first seizure conference were approximately 103 days and 71 days, respectively. From initial EMU referral to surgery ranged from 1.6 to 1.1 years depending on whether the patient required invasive monitoring with intracranial EEG. Overall, 95% of surgical patients had a reduction in seizure frequency, 74% were seizure free after one year post-surgery.
Referral rates for surgical assessment are low relative to the estimated number of children living with MRE in Ontario, less than 2%. Hence, only a limited number of children with this disorder in the province of Ontario who could benefit from epilepsy surgery are being assessed for surgical candidacy. The majority of Ontario children with MRE are not being provided the potential opportunity to be seizure free and live without functional limitations following surgical intervention. These data document the critical need for health system redesign in Ontario, the goal of which should be to provide more consistent and just access to evidence-based medical and surgical care for those citizens of the province who suffer from epilepsy.
The reproducibility and accuracy of routine echocardiographic measurements made by an inexperienced doctor using tele-instruction were evaluated. Thirty-eight patients were first examined at a local hospital by an inexperienced doctor instructed by a specialist 450 km away at a university hospital. The specialist then examined the patients at the local hospital using the same equipment, after an average of 50 days. The accuracy of M-mode and quantitative Doppler measurements was comparable to that observed in reproducibility studies made under normal examination conditions. There were no systematic measurement errors. No important M-mode information was missed except evidence of left ventricular hypertrophy in six patients. In the two-dimensional examination there were differences of clinical significance in only three patients. There were no clinically important differences in the Doppler quantification of mitral and aortic regurgitation. Tele-instructed echocardiography is also an excellent educational tool, allowing an inexperienced examiner gradually to take responsibility for the local echocardiographic service.
The aim of this study was to describe the activity profile of top-class female soccer referees during competition and to relate it to the position of the ball. Ten matches from the Fédération Internationale de Football Association (FIFA) under-20 female World Championships held in Russia in 2006 were filmed and the kinematical parameters of the female referees (n=10) and the ball were determined using a two-dimensional photogrammetric video system based on direct linear transformation (DLT) algorithms. Total distance covered during a match was 10 km, of which 1.3 km represented high-intensity activities (>13 km/h). The referees' highest mobility was achieved in the initial 15 min of the match, covering greater distance and performing more intense exercise (P
OBJECTIVE: The purpose of this investigation was to study lateral pharyngeal wall adduction relative to pharyngeal flaps of different widths. The hypothesis to be tested was that pharyngeal wall adduction does not increase postoperatively but may decrease due to the mechanical hindrance of a wide flap. DESIGN: In this prospective study, adaptation of lateral pharyngeal wall adduction during speech was studied relative to pharyngeal flaps of different widths utilizing videoradiography. Flap width was determined nasopharyngoscopically. SETTING: All patients were treated by the Stockholm Cleft Palate Team, Sweden. PATIENTS: Fifty-three patients were strictly selected by discarding conditions known to exert uncontrolled influence on velopharyngeal sphincter function. RESULTS: The results revealed a potential for adaptation of pharyngeal wall adduction to different flap widths. The magnitude and character (increase or decrease) of change in adduction was significantly correlated with the degree of preoperative adduction and with the width of the flap. In patients with limited preoperative adduction, pharyngeal wall activity increased, more in the presence of a narrow flap while less if the flap was wide. When preoperative adduction was pronounced, the postoperative activity decreased because of mechanical hindrance by the flap, and the degree of impediment was correlated to the width of the flap. CONCLUSION: A potential for increased lateral pharyngeal wall adduction after pharyngeal flap surgery was verified, but the result cannot be interpreted as generally applicable because of the strict selection of patients.
Sibling supervision has been shown to increase the risk of supervisee's unintentional injury in the home. Both poorer supervision by the older sibling and noncompliance by the younger sibling have been shown to contribute to this risk. Previous studies have shown that informing older siblings that they are responsible for the behavior of their younger sibling improves their supervision. The present study, conducted in Canada, examined whether informing both children the older child is in charge would improve both older sibling supervisory practices and compliance by the younger child. Younger and older siblings were initially placed in a room containing contrived hazards, and their interactions were unobtrusively recorded. In a second contrived hazards room, both children were then informed that the older sibling was in charge, and the supervisor was privately told not to let the supervisee touch hazardous objects. Results revealed that sibling supervisors showed improved supervision but supervisee behavior did not vary across conditions. Implications for injury prevention and future research directions are discussed.
Patient transfers have been implicated as a contributing factor in the high work-related musculoskeletal disorder (MSD) rate in nursing. However, documenting how much time is spent doing such tasks, compared to other less biomechanically stressful tasks in the workplace, has been limited, and not performed to date using a video-based approach. Therefore, the purpose of this study was to determine the feasibility of documenting all job-related nursing tasks performed during a typical shift in a hospital setting using video.
Ten female nurses from an acute care hospital who worked in different units and during all three shifts.
Nurses working in different units of the hospital were videotaped performing their normal job-related tasks for a 2 hour period. Video records were subsequently analyzed to identify and categorize all tasks performed by each nurse.
Overall, nurses spent less than 7% of their time during patient moving and transfer activities. One third of their time was spent walking, standing and sitting, 19.8% charting, 14.7% in patient care, 13.9% preparing medicines, 9.5% in housekeeping, and about 3% in self-care.
This study showed that video-based methods are feasible for documenting what nurses do in the workplace. It also highlighted the diversity and non-repetitive nature of the workplace tasks nurses perform and suggests that ergonomic assessments of the cumulative effects of work on nurses in the field should focus on more than just patient handling activities.
The aim of the current study was to find out how the measures of chairs and desks match with the anthropometrics of schoolchildren and how schoolchildren sit during a lesson in their classroom. This paper reports the baseline measurements of an intervention study. Participants of this study were 6th and 8th grade (12 and 14 year old) schoolchildren from two comprehensive schools in Finland (N = 101, 57 girls and 44 boys). The main outcome measures were the differences between desk height and elbow-floor height, and chair height and popliteal height. Forty-three participants were randomized for sitting posture analysis by video recordings. The study showed that desks were on average 13 cm above elbow-floor height and chairs 2 cm below popliteal height. For 56% of time participants sat with their backs flexed >20 degrees and/or rotated >45 degrees . For 70% of time they sat with their necks flexed >20 degrees or rotated >45 degrees. The results indicate that there is a mismatch between school furniture and the anthropometrics of schoolchildren. Schoolchildren sit in disadvantaged postures for a substantial part of school lessons.
Consumer-directed health information resources hold great potential for improving public health and easing the demand on health systems. Their value, however, depends largely on the ability of their intended users to access and use them effectively. Little is known about whether British Columbia's ethnocultural communities are using the British Columbia (BC) Ministry of Health's BC HealthGuide (BCHG) program, and if so, when and for what purposes they use the services, as well as level of satisfaction with and users' perceptions of the resources. This study investigated attitudes toward and perceptions of the BCHG program, as well as use patterns and satisfaction levels, within the Iranian community of the Greater Vancouver Area (GVA)--among BC's largest and fastest-growing Middle Eastern immigrant communities--and explored a model for introducing the BCHG program to ethnic communities in the GVA and BC.
In a 2-stage quasi-experimental design, with a combination of quantitative and qualitative research methods, data obtained from structured telephone surveys, in-person interviews, and focus groups involving a randomly selected sample of the target population were analyzed before and after intervention with audiovisual health information: a series of culturally relevant informative video clips developed by direct participation of the community and aired on local television channels in the fall of 2004.
There was low awareness and low utilization of the BCHG program among participants at the beginning of this study. Furthermore, many participants in the initial stage of this study cautioned that self-care resources in general are unsuited to Iranian culture, due to widespread distrust of health advice received via telephone or the Internet, and due to the strong value placed on health advice received directly from a professional medical doctor. Nonetheless, attitudes, perceptions, and self-reported utilization rates of the BCHG program improved substantially among the participants of this study following the screening of culturally appropriate, targeted promotional videos. Participants almost unanimously reported that watching the videos had encouraged them to use the BCHG program, and that they intended to promote the resources to others. In addition, the majority of participants who had accessed at least one of the BCHG program resources reported being satisfied with the services that they had received, and improved utilization rates were maintained at the follow-up focus group stage. At the same time, participants cautioned that gaining the confidence of the wider Iranian community in BC and increasing service utilization will require considerable time and effort. In particular, they suggested using a variety of media and communication channels, carefully selecting the health messengers, and targeting messages to specific community subgroups.
The findings of this study strongly suggest that Iranians living in the GVA are open to alternatives to routine healthcare services, including the use of preventive and self-care resources. However, awareness levels and utilization rates of the BCHG program among the GVA's Iranian immigrant population have until now been low. The noticeable and sustained improvement to attitudes, perceptions, and self-reported utilization rates of the BCHG program among Iranian participants in this study after watching culturally appropriate promotional videos indicates the potential to modify cultural beliefs in regard to the delivery of preventive health information if the relevant messages are delivered appropriately. By carefully considering the demographic and cultural characteristics of the various ethnic communities living in BC, and by targeting promotional activities and services directly to these individual communities, the BCHG program could improve awareness and utilization rates within these communities.
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Capillary abnormalities, such as the enlargement and/or disappearance of capillary loops, occur early in the majority of patients with systemic sclerosis (SSc). The aim of this study was to compare three capillaroscopic methods of determining the capillary density in patients with SSc.
Two of the three methods involved stereo-zoom microscopy at a magnification of 20 times, used either for direct counting, or with a camera and imaging software for determination of the capillary density on coded images. The third method was computerised nailfold video capillaroscopy with 300 x magnification using coded images. The capillary density (loops/mm) was determined on the fourth finger of the non-dominant hand with all three methods in 40 patients, 32 with limited cutaneous SSc (lcSSc) and 8 with diffuse cutaneous SSc (dcSSc), and in 21 healthy control subjects.
The median values of capillary density assessed with the three methods were: 4.3, 5.4 and 6.1 loops/mm in lc-SSc patients, 4.5, 5.0 and 6.3 loops/mm in dcSSc patients, and 7.0, 7.0 and 6.9 loops/mm in the controls. Capillary density was thus lower in lcSSc and dcSSc patients than in the controls according to all three methods. Agreement between the three methods was good in the controls. In patients, direct counting resulted in lower values than in the two computer-based methods.
Assessment of capillary density with three different methods showed good agreement between methods. All methods could differentiate between SSc patients and controls.
To assess whether a video about infant immunization could inform parents as well as human counselling (oral presentation).
Core information for parents about infant immunization was identified and packaged in an instructional video and a scripted oral presentation. Volunteer prenatal classes were randomly assigned a video or oral presentation. Participants completed pre- and post-test questionnaires covering the same 16 items. Scores were compared for each question and as a group means, using Fisher's exact test, 2-sided.
227 subjects participated, including 102 men and 124 women. Groups were similar in terms of gender mix, parenting experience and recent reading about immunization. Pre-test knowledge scores were similarly low between groups. Post-test scores were much higher but did not differ significantly between groups.
In a prenatal classroom setting, video and oral presentations were equally effective in conveying key information about infant immunization.