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A deepened understanding of patients' perspectives is essential in order to improve medical communication. By changing focus from patient satisfaction to patient experiences, more immediate, personal and affective responses may be captured.

Antifungal therapy has been claimed to be effective in polysymptomatic patients with diffuse symptoms from multiple body systems and even well defined diseases, traditionally not related to fungi. Hypersensitivity to fungus proteins and mycotoxins has been proposed as the cause.

The objective of this study was to measure patient satisfaction and to investigate the practical implications of monitoring the quality of care at four radiology procedures. A survey was conducted immediately after the examinations in eight radiology departments: 550 patients attending for mammography, 110 for double-contrast barium enema (DCBE), 97 for abdominal ultrasonography and 90 for vaginal ultrasonography. Outcome measures were seven questionnaire scales: pain, emotional distress, information received, staff's punctuality and technical ability, facilities, and general satisfaction. Response rate was 87 %. Multivariate regression analysis showed significant differences between procedures on all scales (p < 0.001). Differences considered to be of practical importance, i. e. 7 scale points, were detected on five of the scales. Mammography and DCBE caused the most pain, and vaginal US and DCBE caused the most distress. The US procedures entailed dissatisfaction with information about the procedures. The DCBE patients recorded dissatisfaction with the staff's lack of punctuality, and these and the mammography patients recorded dissatisfaction with the facilities. The findings indicate a potential for improving patients' experiences. Several aspects of care, i. e. pain management, attention to the patient's emotional concerns, explanation of procedures, punctuality and quality of the facilities, can be improved.

Steine S, Stordahl A, Laerum F, Lsrum E. Referrals for double-contrast barium examination. Factors influencing the probability of finding polyps or cancer. Scand J Gastroenterol 1994;29:260-264.Predictors of the radiologic detection of colorectal polyps or cancer were studied in 1852 patients referred from primary health care for a double-contrast barium enema. Significant polyp predictors were age 40-79 years (odds ratio (OR), 2.4-5.0) and rectal bleeding (OR, 1.8). Previous colorectal neoplasm, familial history of cancer in general, and male sex were nearly significant predictors of polyps. Significant cancer predictors were age > 60 years (OR, 8.6-27.8), rectal bleeding (OR, 2.7), loss of weight (OR, 2.6), and male sex (OR, 2.2). Fatigue and abdominal pain were nearly significant negative predictors for cancer. No association was found between patient delay and the detection of polyps or cancer. Physician delay was significantly shorter in patients with cancer than in cancer-free patients. Age was the most important predictor for the detection of both polyps and cancer, more important than symptoms and history, including family history.

The aims of this present study were firstly to examine whether diet compliance and blood pressure effect could be enhanced by self monitoring with a titrator strip (Quantab 1176) measuring the urine chloride concentration. This was achieved by an open, randomized parallel group design. The study also sought to evaluate the blood pressure effect of a moderately salt restricted diet by using a pre-test-post-test design with a run-in period and controlling for relevant confounding factors (weight, training and alcohol consumption). Furthermore, the study aims were to validate the measurement of chloride concentration in the morning urine by the Quantab titrator strip. We compared Quantab 1176 measurement of chloride concentration in the morning urine with 24 h sodium excretion, determined by the clinical chemical laboratory, was performed.Twenty men and 14 women (mean age 53 years) with essential hypertension (mean: 165/96 mmHg) were observed during a run-in period of 4 weeks before randomization to either dietary advice combined with self monitoring of morning urine chloride concentration for 12 weeks, or dietary advice alone.The reduction in diastolic blood pressure of 6 mmHg was not different in the two groups (between groups p = 0.44). Within group changes of systolic blood pressure were 10 mmHg and 6 mmHg (p = 0.006 and p = 0.04) in the diet plus Quantab group, and the diet only group respectively (between groups p = 0.30). No significant difference in 24 h sodium excretion could be detected between the groups. The morning urine chloride concentration correlated moderately to the 24 h urine sodium excretion (r = 0.66, p < 0.001).It is concluded that self monitoring was not effective either to enhance the salt restriction diet compliance or the blood pressure effect in this study. A diastolic blood pressure reduction of 6 mmHg was attained by simple dietary advice.

The present study was performed to evaluate glucose metabolism, serum lipids and sympathetic activity during 12 weeks of a moderate salt restricted diet in hypertensive patients. The study was designed as a pre-test-post-test study. All patients from a controlled trial evaluating self-monitoring of urine chloride concentration as a remedy for enhancing diet compliance and blood pressure effect were included.Twenty male patients and 14 female patients with essential hypertension (mean age 53 years) were randomized to a self monitoring diet group and a diet only group. They were exposed to a moderately salt restricted diet during 12 weeks. Fasting serum insulin C-peptide, glucose, HbAlc, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were measured along with 24 h urine excretion of adrenaline, noradrenaline and vanillylmandelic acid (VMA).As a result, insulin C-peptide increased by 40% (p = 0.0001) whereas glucose rose by 6% (p = 0.02). Total cholesterol, LDL-cholesterol and HDL-cholesterol concentration were reduced by 6% (p = 0.001), 12% (p = 0.008) and 11% (p = 0.004) respectively. HbAlc, serum triglycerides, total/HDL-cholesterol ratio, urine catecholamines and VMA were unchanged during the trial. It is concluded that salt restriction may increase insulin resistance in hypertensive patients.

Fasting is an effective treatment for rheumatoid arthritis, but most patients relapse on reintroduction of food. The effect of fasting followed by one year of a vegetarian diet was assessed in a randomised, single-blind controlled trial. 27 patients were allocated to a four-week stay at a health farm. After an initial 7-10 day subtotal fast, they were put on an individually adjusted gluten-free vegan diet for 3·5 months. The food was then gradually changed to a lactovegetarian diet for the remainder of the study. A control group of 26 patients stayed for four weeks at a convalescent home, but ate an ordinary diet throughout the whole study period. After four weeks at the health farm the diet group showed a significant improvement in number of tender joints, Ritchie's articular index, number of swollen joints, pain score, duration of morning stiffness, grip strength, erythrocyte sedimentation rate, C-reactive protein, white blood cell count, and a health assessment questionnaire score. In the control group, only pain score improved significantly. The benefits in the diet group were still present after one year, and evaluation of the whole course showed significant advantages for the diet group in all measured indices. This dietary regimen seems to be a useful supplement to conventional medical treatment of rheumatoid arthritis.

The objectives of this study were to: (1) study if an opportunistic screening of coronary heart disease (CHD) risk factors among male attenders in general practice (GP) influenced the overall subjective satisfaction with life of persons labelled ‘high risk’ compared to other screened persons; (2) compare psychological well-being and patient satisfaction in a patient centred and self-directive (PCSD) intervention with conventional care (CC); and (3) evaluate patient satisfaction and psychological well-being among subjects with high CHD risk during a one year intervention study. Effects of ‘labelling’ were evaluated in 115 subjects with high CHD risk in comparison with a low risk reference population. The 22 participating GP centres were randomly allocated to follow either a PCSD intervention or a CC approach. An overall satisfaction with life question was employed and psychological well-being were measured using the General Health Questionnaire (20 item version). Satisfaction measures on health care aspects were also included. No difference of change between the high risk and the reference population was found concerning satisfaction with life after screening. No significant difference of change was found within or between the PCSD and the CC group concerning emotional well-being or overall satisfaction with life during one year intervention. Satisfaction with the care received was significantly better in the CC group as compared with the PCSD group (p=0.02). Satisfaction with own efforts for improving health was, however, more pronounced in the PCSD group (p=0.01). A substantial number (n=61) of the participants reported distaste of being reminded of the risk of heart disease and no more than 60 of the participants were satisfied with their own efforts for improving health. Although no significant change of satisfaction with life and emotional well-being due to screening or intervention could be detected, clinicians should be aware that encouraging patients to change life style may lead to patients' annoyance of being reminded of the risk of disease and dissatisfaction with their own efforts. Increasing patient responsibility and self-determination may improve their satisfaction with their own efforts, but reduce satisfaction with medical care.

Purpose: To study CT findings in general practice patients with a clinical diagnosis of acute sinusitis, and to examine the interobserver variation between 2 radiologists with regard to their CT evaluation.Material and Methods: Two hundred and one patients were examined with coronal CT images of the paranasal sinuses within 2 days of the clinical diagnosis. Patients with chronic sinusitis were excluded. Fluid level or total opacification of any sinus were used as evidence of sinusitis.Results: One hundred and twenty-seven (63%) patients had fluid level or total opacification in a sinus region, most in more than one region. One hundred and fifteen had CT signs of sinusitis in the ethmoid region, 84 in the maxillary, 18 in the frontal, and 10 in the sphenoid. Forty-nine patients had a negative CT. In the evaluation of interobserver agreement, the overall assessment of the CT yielded a kappa value of 0.70.Conclusion: The study demonstrated great variation in the CT findings in general practice patients with suspected acute sinusitis. More than one sinus region was affected in most patients in whom sinusitis was confirmed by CT imaging; the most common combination was ethmoid and maxillary sinuses. The interobserver agreement was substantial.

To investigate how departmental practice and women's characteristics are related to low patient satisfaction with mammography.

Thiazide induced metabolic effects reflected in serum and 24 h urine excretions were investigated in general practice in 48 recurrent urinary calcium stone formers on prophylaxis with 50 mg hydrochlorothiazide or placebo (average duration of treatment 3 years). After 10 months of treatment, there was a significantly greater decrease in urinary calcium excretion among patients receiving thiazide than in patients given placebo (p<0.05). There was a significant increase in urinary magnesium in the thiazide group (p0.02), while there was no significant alteration in urinary uric acid. An increase was observed in the 24 h urine volume of 400 ml in the placebo group in contrast to a decrease in the thiazide group. The effects on serum calcium, potassium and uric acid were in accordance with previous reports. Few and only mild side effects were observed except for one attack of gout. The necessity of having adequate control groups in such studies is emphasized.

The object of the study was to evaluate blood pressure, insulin and glucose metabolism, and serum lipids in hypertensive patients, during 8 weeks on a moderately salt-restricted diet.A double-blind, cross-over study was conducted with hypertensive patients following a moderately salt-restricted diet. Patients were randomised to sodium capsules in one period and placebo capsules during the other period. After a 1-month run-in period, 13 males and three females with mild to moderate essential hypertension (mean age 50 years) complied with a salt-reduced diet. They were randomized to a salt-supplemented group (5 capsules of 10 mmol sodium per capsule) or a salt reduced diet group (5 capsules of placebo) with cross-over after 8 weeks. Serum insulin, insulin C-peptide, and glucose were measured, fasting and 30 min after a 75-g glucose load. Serum lipids and lipoproteins constituting an atherogenic index were measured, along with blood pressure and 24-h urine excretion of sodium and chloride.Non-significant reductions of systolic and diastolic blood pressure (4 mmHg, p=0.06, and 2 mmHg, p=0.13, respectively) were observed during the reduced-salt period. The changes observed for fasting insulin, insulin C-peptide, glucose, serum lipids and the atherogenic index were also nonsignificant.It is concluded that moderate salt restriction seems not to adversely influence insulin resistance or serum lipids in hypertensive patients.

The relation between chronic musculoskeletal complaints and serum uric acid was examined in 737 men and 771 women (40-42 years old). The study is cross - sectional and part of the National Health Screening Service county studies in Norway. Both men and women with chronic musculoskeletal complaints had significantly higher s-urate means than persons without such complaints. Moreover, the prevalence of chronic musculoskeletal complaints (gout excluded) changed significantly across increasing s-urate levels also within the normal distribution of s-urate. Multivariate logistic regression analysis showed that the s-urate odds ratio for chronic complaints rose in a linear manner across these s-urate levels (adjusted for 12 other independent variables that may interfere with uric acid). Such a relation has not to our knowledge been previously described.

Interobserver variations between three radiologists with different backgrounds (duration of practice, and departments) were studied in connection with the diagnosing of urolithiasis. Films from 152 consecutive patients (examined with conventional abdominal films, urography/tomography) were analyzed independently. With respect to the number of patients with or without calculi there was agreement between the three observers in 129 of the 152 cases, which was taken to represent very good agreement beyond chance. The total number of stones was interpreted as 832, 460 and 570 respectively, and the median stone size as 6, 9 and 11 mm2. There was a fair interobserver agreement rate regarding whether stones were localized to the renal parenchyma or calyces, and whether stenosis/stricture or hydronephrosis was present. Tomography appeared to reduce the interobserver variability significantly. Adequate bowel cleaning, oblique projections, and lack of clinical information apparently did not influence the agreement rate. It was concluded that such interobserver variations are factors of importance in the reliability of the radiologic evaluation of urolithiasis.

Many patients in general practice present with complex health problems. It is argued that the GP who is in a prime position to counsel patients with such problems, will, however, often perceive a lack of tools to manage them. The aim of the present study was to develop a novel instrument in terms of a patient-administered questionnaire, the Patient Perspective Survey (PPS), designed to enhance the quality of clinical communication in the consultation. It is based on a biopsychosocial patient perspective, patient centredness, patient resources, involvement and coping, and quality of life orientation.

Registration studies have shown great variations in prescribing volume and prescribing patterns of benzodiazepines (BZDs) and minor opiates among GPs.

The success of national breast screening programmes hinges on women's adherence. By monitoring patients' perceptions, potential barriers to attendance may be detected, measured and possibly alleviated. Consequently a new questionnaire MGQ, measuring patients' experience of and satisfaction with mammography, has been developed. As discomfort is a predictor of non-attendance, a dimension measuring physical and psychological discomfort was included.

Eighty-four male patients with a mean age of 56.4 years (range 34 to 65 years) were subjected to a semistructured interview 12–21 weeks after acute myocardial infarction in order to elucidate possible positive changes in family or spouse relationships induced by or following on from the disease. There were appreciable positive alterations in the love and caring domains and in communication, especially in those patients (one third of the total) who considered their total life situation to be improved after the myocardial infarction. A majority of the patients judged their familys adaptation to the myocardial infarction as good. The authors argue that it is important to discover, and reinforce, possible positive changes within the family after a myocardial infarction in one of its members and not merely to focus on negative effects.

Kidney stone formation or urolithiasis is a complex process that results from a succession of several physicochemical events including supersaturation, nucleation, growth, aggregation, and retention within the kidneys. Epidemiological data have shown that calcium oxalate is the predominant mineral in a majority of kidney stones. Among the treatments used are extracorporeal shock wave lithotripsy (ESWL) and drug treatment. Even improved and besides the high cost that imposes, compelling data now suggest that exposure to shock waves in therapeutic doses may cause acute renal injury, decrease in renal function and an increase in stone recurrence. In addition, persistent residual stone fragments and the possibility of infection after ESWL represent a serious problem in the treatment of stones. Furthermore, in spite of substantial progress in the study of the biological and physical manifestations of kidney stones, there is no satisfactory drug to use in clinical therapy. Data from IN VITRO, IN VIVO and clinical trials reveal that phytotherapeutic agents could be useful as either an alternative or an adjunctive therapy in the management of urolithiasis. The present review therefore critically evaluates the potential usefulness of herbal medicines in the management of urolithiasis. [ABSTRACT FROM AUTHOR]

Summary of Stuge B, Lærum E, Kirkesola G and Vøllestad N (2004): The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy. Arandomized controlled trial. Spine29: 351–359. [Prepared by Pierre Trudelle, Editor in Chief KinésithérapieMasson, France]

Introduction Neck pain is a prevalent condition and has a 1-year prevalence of 30% to 50% and a lifetime prevalence of 14.2% to 71% (.1-3) People with neck pain demonstrate [...], Objective. The purpose of this review was to evaluate the effects of sling exercise on pain intensity, disability, and health-related quality of life in adults with neck pain. Methods. The Cochrane Central Register of Controlled Trials, EMBASE, Physiotherapy Evidence Database (PEDro), and 6 other databases were searched from inception to July 2020. The reference lists of relevant articles to identify additional trials were also screened. Randomized controlled trials were included if they investigated the effects of sling suspension therapy in patients with neck pain, including mechanical neck disorders, cervicogenic headache, and neck disorders with radicular findings. Studies were required to be published in English or Chinese. The methodological quality and levels of evidence of studies were assessed using the PEDro scale and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. The random-effects model was used to perform meta-analyses. Results. Eleven randomized controlled trials were included (n = 595). The mean total PEDro score was 4.64 (SD =1.21) of 10, which indicated a fair methodological quality. The intervention groups showed significant improvements in pain intensity (SMD = -1.23; 95% CI = -1.8 8 t o -0.58) immediately postintervention compared with the control groups. No significant effects were found for disability, cervical range of motion, and health-related quality of life. However, sensitivity analyses revealed significant short-term improvements in pain intensity, disability, and cervical range of motion and sustained effects on disability at intermediate-term follow-up. Conclusion. Sling exercise appears to be beneficial for improvements in pain intensity (moderate- to low-level evidence) among patients with neck pain. However, no definitive conclusion could be made regarding the effect of sling exercise for neck pain due to methodological limitations and high heterogeneity in the included studies. Impact. This review provides overall moderate- to very low-level evidence for health care professionals who may consider including sling exercise in the intervention program for patients with neck pain. Keywords: Disability, Exercise Therapy, Neck Pain, Systematic Review, Sling Exercise

According to the Institute of Medicine, clinical practice guidelines (CPGs) are defined as 'statements that include recommendations intended to optimize patient care that are informed by a systematic review of [...], Objective. Clinical practice guidelines (CPGs) can be characterized to the extent that they specifically address physical therapists and mainly contain recommendations for physical therapist interventions. The primary aim of this study was to identify existing physical therapy CPGs regardless of medical condition, with a secondary aim of assessing their methodological quality to determine whether they are potentially suitable for adaptation. Methods. Systematic searches of the Medline and Physiotherapy Evidence Database were performed (August 2019), and the websites of World Confederation for Physical Therapy members were screened (September 2019). Only CPGs published in German or English were included. Two independent reviewers screened records according to previously defined inclusion criteria. Information was extracted regarding country of origin, year of publication, and clinical subject area addressed. Four independent reviewers assessed the quality of physical therapy CPGs using the Appraisal of Guidelines Research and Evaluation instrument. A descriptive data analysis was performed. Results. Thirty-five CPGs met the inclusion criteria; 46% (16/35) of the included CPGs were from the United States, and 31% (11/35) were from the Netherlands. Assessment using the Appraisal of Guidelines Research and Evaluation tool resulted in the following domain scores, presented as median percentage (interquartile range): domain 1 (scope and purpose), 76 (63-92); domain 2 (stakeholder involvement), 63 (55-76); domain 3 (rigor of development), 67 (53-75); domain 4 (clarity of presentation), 74 (67-77); domain 5 (applicability), 44 (30-57); and domain 6 (editorial independence), 52 (35-66). Conclusions. In general, the methodological quality of the included CPGs was moderate to good. Possibilities of adapting recommendations from existing CPGs should be considered with the development of new physical therapy CPGs. Impact Statement. This study can raise awareness of existing physical therapy CPGs and can support their application by physical therapists. Further, the study can support decisions on adapting existing CPGs with the planning of new physical therapy CPGs.

1 | INTRODUCTION Patient-reported experience measures (PREMs) are tools that capture 'what' happened during an episode of care, and 'how' it happened from the perspective of the patient. (1-3) PREMs [...], Objectives: To identify patient-reported experience measures (PREMs), assess their validity and reliability, and assess any bias in the study design of PREM validity and reliability testing. Data Sources/Study Setting: Articles reporting on PREM development and testing sourced from MEDLINE, CINAHL and Scopus databases up to March 13, 2018. Study Design: Systematic review. Data Collection/Extraction Methods: Critical appraisal of PREM study design was undertaken using the Appraisal tool for Cross-Sectional Studies (AXIS). Critical appraisal of PREM validity and reliability was undertaken using a revised version of the COSMIN checklist. Principal Findings: Eighty-eight PREMs were identified, spanning across four main health care contexts. PREM validity and reliability was supported by appropriate study designs. Internal consistency (n = 58, 65.2 percent), structural validity (n = 49, 55.1 percent), and content validity (n = 34, 38.2 percent) were the most frequently reported validity and reliability tests. Conclusions: Careful consideration should be given when selecting PREMs, particularly as seven of the 10 validity and reliability criteria were not undertaken in >50 percent of the PREMs. Testing PREM responsiveness should be prioritized for the application of PREMs where the end user is measuring change over time. Assessing measurement error/agreement of PREMs is important to understand the clinical relevancy of PREM scores used in a health care evaluation capacity. KEYWORDS health care organization and systems, reliability, survey research and questionnaire design, systematic reviews/meta-analyses, validity

The traditional biomedical view of low back pain (LBP) as a purely structural or biomechanical disorder has been greatly challenged over the past 2 decades. (1,2) There is now a [...], Background. The Pain Attitudes and Beliefs Scale (PABS) for Physical Therapists aims to measure clinicians&apos; biomedical and biopsychosocial treatment orientations regarding nonspecific low back pain. Objective. The objective of this study was to assess whether the PABS can differentiate between subgroups of physical therapists hypothesized to differ in treatment orientations. Design. This study was a cross-sectional survey. Methods. The PABS was completed by 662 Norwegian physical therapists with a diversity of professional backgrounds. Twenty-four a priori hypotheses on expected differences in PABS scores were formulated. Sufficient discriminative ability was defined as a minimum of 75% confirmed hypotheses. Hypotheses on differences in scores were tested for the biomedical and biopsychosocial subscales separately as well as for combinations of the 2 subscales, representing responders with high biomedical and low biopsychosocial PABS scores and vice versa. Results. Of the 24 hypotheses, only 15 (62.5%) were confirmed. Between-group differences concerning the separate subscales were small, varying from -0.63 to 1.70 scale points, representing values up to 6.0% of the total subscale ranges. Between-group differences were larger when combined subscales were used, varying from 1.80 to 6.70 points, representing values up to 25.1% of the total subscale ranges. Despite little spread in scores, 24% of respondents demonstrated extreme attitudes. Limitations. The lack of convincing scientific evidence from previous research on differences in attitudes and beliefs between physical therapists was a limitation for the formulation of hypotheses. Conclusions. Discriminative validity of separate subscales of the PABS was not supported. Combining the 2 subscales into global treatment attitudes enabled better discrimination. Little spread in biomedical and biopsychosocial orientations explains why more than one-third of the hypotheses were not confirmed. Either Norwegian physical therapists are basically similar in their treatment orientation or the PABS is not able to detect any differences between them.

Which therapies should you recommend for chronic low back pain, osteoarthritis, or fibromyalgia? This review--with 3 handy tables--summarizes the evidence. PRACTICE RECOMMENDATION! * Recommend tai chi as an exercise modality [...]

Pregnancy-related pelvic girdle pain (PGP) is a significant problem worldwide. (1-4) Pelvic girdle pain is described as a disorder which differs from low back pain (LBP) and other musculoskeletal ailments, [...], Background. The Pelvic Girdle Questionnaire (PGQ) is a condition-specific measure for women with pelvic girdle pain (PGP). The PGQ includes items relating to activity/partici-pation and bodily symptoms and has reliability, validity, and feasibility for use in research and clinical practice. Objective. The purposes of this study were to examine the responsiveness of the PGQ, to determine the minimal important change (MIC) for the PGQ, and to compare the PGQ with other outcome measures. Design. This study used a prospective cohort design. Methods. A total of 801 women responded to a booklet of questionnaires in the last trimester of their pregnancy and within 3 months post partum. Responsiveness analyses followed recommendations from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. The responsiveness of the PGQ was tested by examining correlations between the change scores of the total PGQ and the other patient-reported outcome measures. Results. A total of 606 women (76%) reported PGP, low back pain, or both. Of these women, 441 (73%) responded to the follow-up questionnaire post partum. The PGQ (both subscale and total scores) discriminated most accurately between participants who improved and those who did not improve, with an area under the receiver operator characteristic curve of 72%. The MIC values indicated that a change score smaller than 25 for the total score and activity subscale score and a change score of 20 for the symptom subscale score should be regarded as insignificant. Baseline PGQ scores had a large impact on the MIC estimates for the absolute change scores but not on the relative percentage change scores. Five of 6 hypotheses were supported (83%). Limitations. The type of anchor and definition of important change used might be weaknesses in women whose status is changing from pregnant to post partum. Conclusions. The PGQ showed acceptable responsiveness in women with PGP, low back pain, or both.

Patients with musculoskeletal pain are commonly treated by physical therapists, yet the mechanisms by which physical therapy interventions influence clinically relevant outcomes such as pain and disability are complex. (1-3) [...], Background. Musculoskeletal physical therapy involves both specific and nonspecific effects. Nonspecific variables associated with the patient, therapist, and setting may influence clinical outcomes. Recent quantitative research has shown that nonspecific factors, including patient-therapist interactions, can influence treatment outcomes. It remains unclear, however, what factors influence patient-therapist interaction. Purpose. This qualitative systematic review and meta-synthesis investigated patients' and physical therapists' perceptions of factors that influence patient-therapist interactions. Data Sources. Eleven databases were searched independently. Study Selection. Qualitative studies examining physical therapists' and patients' perceptions of factors that influence patient-therapist interactions in musculoskeletal settings were included. Data Extraction. Two reviewers independently selected articles, assessed methodological quality using the Critical Appraisal Skills Programme (CASP), and performed the 3 stages of analysis: extraction of findings, grouping of findings (codes), and abstraction of findings. Data Synthesis. Thirteen studies were included. Four themes were perceived to influence patient-therapist interactions: (1) physical therapist interpersonal and communication skills (ie, presence of skills such as listening, encouragement, confidence, being empathetic and friendly, and nonverbal communication), (2) physical therapist practical skills (ie, physical therapist expertise and level of training, although the ability to provide good education was considered as important only by patients), (3) individualized patient-centered care (ie, individualizing the treatment to the patient and taking patient's opinions into account), and (4) organizational and environmental factors (ie, time and flexibility with care and appointments). Limitations. Only studies published in English were included. Conclusions. A mix of interpersonal, clinical, and organizational factors are perceived to influence patient-therapist interactions, although research is needed to identify which of these factors actually influence patient-therapist interactions. Physical therapists' awareness of these factors could enhance patient interactions and treatment outcomes. Mechanisms to best enhance these factors in clinical practice warrant further study.

In many clinical settings with physical therapist services, people are routinely asked for feedback about the care that they have received. (1-3) Such surveys have primarily elicited information about satisfaction [...], Background. Patient feedback surveys are increasingly seen as a key component of health care quality monitoring and improvement. Objective. The study objective was to describe the development and initial psychometric evaluation of a fixed-length questionnaire about the experiences of patients receiving physical therapist treatment in postacute outpatient settings. Design. This was an instrument development study with validity and reliability testing. Methods. A total of 465 participants attending 3 rehabilitation centers for musculoskeletal conditions completed the questionnaire. A cognitive pretest was applied to the draft version (n=94), and a revised version was evaluated for test-retest reliability (n=90). Analyses to evaluate variance and nonresponse rates for items, the factor structure of the questionnaire, and the metric properties of multi-item scales were conducted. Results. Exploratory factor analyses yielded evidence for a 7-factor structure of the questionnaire, with 3 factors that may be conceptually viewed as professionals&apos; attitudes and behavior (providing information and education, sensitivity to patients&apos; changes, and emotional support) and 4 factors that conceptually reflect organizational environment (duration of attendance, interruptions during care delivery, waiting times, and patient safety). Item-scale correlations ranged from .70 to .93. The percentage of scaling success was 100% for all of the scales. Cronbach alpha coefficients ranged from .70 to .87. Intraclass correlation coefficients ranged from .57 to .80 (median=.68). Limitations. Generalization to other patients is not known. Conclusions. The questionnaire has test-retest reliability, and the scales have internal consistency and convergent and discriminant validity. All of the scales are distinct and unidimensional.

Systemic mycoses can cause a tremendous variety of health problems, including digestive difficulties (diarrhea, bloating, discomfort, flatulence, constipation, colitis, etc.), skin problems (rashes, eczema, psoriasis, dry skin patches, intense itching, [...]

Chronic low back pain (CLBP) remains a major health problem; it has a huge societal cost (1,2) and is a major source of sickness absence. (3) It has been described [...], Background. Beliefs, cognitions, and behaviors relating to pain can be associated with a range of negative outcomes. In patients, certain beliefs are associated with increased levels of pain and related disability. There are few data, however, showing the extent to which beliefs of patients differ from those of the general population. Objective. This study explored pain beliefs in a large nonclinical population and a chronic low back pain (CLBP) sample using the Pain Beliefs Questionnaire (PBQ) to identify differences in scores and factor structures between and within the samples. Design. This was a cross-sectional study. Methods. The samples comprised patients attending a rehabilitation program and respondents to a workplace survey. Pain beliefs were assessed using the PBQ, which incorporates 2 scales: organic and psychological. Exploratory factor analysis was used to explore variations in factor structure within and between samples. The relationship between the 2 scales also was examined. Results. Patients reported higher organic scores and lower psychological scores than the nonclinical sample. Within the nonclinical sample, those who reported frequent pain scored higher on the organic scale than those who did not. Factor analysis showed variations in relation to the presence of pain. The relationship between scales was stronger in those not reporting frequent pain. Limitations. This was a cross-sectional study; therefore, no causal inferences can be made. Conclusions. Patients experiencing CLBP adopt a more biomedical perspective on pain than nonpatients. The presence of pain is also associated with increased biomedical thinking in a nonclinical sample. However, the impact is not only on the strength of beliefs, but also on the relationship between elements of belief and the underlying belief structure.

Systematic reviews have demonstrated that exercise therapy reduces pain and improves function in individuals with chronic low back pain (LBP). (1,2) In addition, researchers have demonstrated that exercise therapy is [...], Background. Limited evidence exists on how strength and endurance exercises commonly used to prevent low back pain affect muscle morphometry and endurance. Objective. The purpose of this study was to analyze the effects of 2 exercise regimens on the morphometry and endurance of key trunk musculature in a healthy population. Design. The study was designed as a randomized controlled trial. Setting. The study was conducted in a military training setting. Participants. A random subsample (n=340; 72% men, 28% women; mean [[+ or -] SD] age=21.9 [+ or -] 4.2 years; mean [[+ or -] SD] body mass index=24.8 [+ or -] 2.8 kg/[m.sup.2]) from the larger Prevention of Low Back Pain in the Military trial (N = 4,325) was included. Intervention. The core stabilization exercise program (CSEP) included low-load/ low-repetition motor control exercises, whereas the traditional exercise program (TEP) included exercises conducted at a fast pace, with the use of high-load, high-repetition trunk strengthening exercises. Measurements. Baseline and follow-up examinations included ultrasound imaging of the trunk muscles and endurance tests. Linear mixed models were fitted to study the group and time effect and their interactions, accounting for the clustering effect. Results. Symmetry generally improved in the rest and contracted states, but there were no differences suggestive of muscle hypertrophy or improved ability to contract the trunk muscles between soldiers receiving the CSEP or the TEP. Total trunk endurance time decreased over the 12-week period, but endurance performance favored soldiers in the CSEP group. Endurance time was not associated with future episodes of low back pain. Limitations. The lack of morphological changes may not be detectable in an already-active cohort, or a more intensive dose was needed. Conclusions. Although improved symmetry was noted, neither the CSEP nor the TEP resulted in muscle hypertrophy. Longer endurance times were noted in individuals who completed the CSEP but were not strongly predictive of future low back pain episodes.

Communication is the act of giving, receiving, or exchanging information by speaking, writing, or other means. (1) Within health care, it affects every clinical encounter, and ensuring a positive experience [...], Background. Communication in clinical encounters is vital in ensuring a positive experience and outcome for both patient and clinician. Objective. The purpose of this study was to measure verbal communication between physical therapists and patients with back pain during their initial consultation and trial management of the data using a novel, Web-based application. Design. A cross-sectional study was conducted. Methods. Nine musculoskeletal physical therapists and 27 patients with back pain participated in this study. Twenty-five initial consultations were observed, audio recorded, and categorized using the Medical Communications Behavior System. Data were managed using Synote, a freely available application enabling synchronization of audio recordings with transcripts and coded notes. Results. In this sample, physical therapists spoke for 49.5% of the encounter and patients for 33.1%. Providers and patients spent little time overtly discussing emotions (1.4% and 0.9%, respectively). More-experienced clinicians used more 'history/ background probes,' more 'advice/suggestion,' and less 'restatement' than less-experienced staff, although they demonstrated a greater prevalence of talking concurrently and interrupting patients (7.6% compared with 2.6%). Limitations. Although studies measuring actual behavior are considered to be the gold standard, audio recordings do not enable nonverbal behaviors to be recorded. Conclusion. This study investigated a method for measuring the verbal content of clinical encounters in a physical therapy outpatient setting. The study has directly contributed to developing a research-friendly version of the application (ie, Synote Researcher). Given the pivotal role of communication in ensuring a positive experience and outcome for both patient and provider, investing time in further developing communication skills should be an on-going priority for providers. Further work is needed to explore affective behaviors and the prevalence of interrupting patients, considering differences in sex and provider experience.

Low back pain and pelvic girdle pain are widespread problems of pregnancy, but knowledge concerning primary and secondary prevention is scarce. Supervised group exercise and ergonomic advice did not reduce [...], Background. Many women have low back pain (LBP) or pelvic girdle pain (PGP) during pregnancy, but there is limited evidence of effective primary and secondary preventive strategies. Objective. The purpose of this study was to investigate whether a group-based exercise program can reduce the prevalence and severity of LBP and PGP in pregnant women. Design. An observer-blinded randomized controlled trial with equal assignments to a training group and a control group was conducted. Setting. The study was conducted in primary care maternity units in 2 suburban municipalities in the southeastern part of Norway. Patients. The participants were 257 pregnant women who were healthy and between 18 and 40 years of age before gestation week 20. Intervention. The training group received supervised exercises in groups once a week, and the control group received standard care. Measurements. The main outcome measures were self-reported LBP and self-reported PGP. Secondary outcome measures were pain intensity in the morning and evening, disability, and 8-Item Short-Form Health Survey (SF-8) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Follow-up measurements were performed at gestation weeks 24, 28, 32, and 36. Results. Overall, there was no effect of the program on the prevalence of PGP (odds ratio=1.03, 95% confidence interval [CI]=0.66 to 1.59) or LBP (odds ratio=0.77, 95% CI=0.50 to 1.19). For the secondary outcomes, the estimated mean differences between the groups were -0.4 (95% CI=-0.8 to 0.1) for pain intensity in the morning, -0.4 (95% CI= -1.0 to 0.2) for pain intensity in the evening, -1.0 (95% CI=-2.2 to 0.0) for disability, 1.8 (95% CI=0.0 to 3.7) for the SF-8 PCS, and -0.6 (95% CI=-2.2 to 1.4) for the SF-8 MCS. Limitations. Due to low statistical power, the estimates for the primary outcomes are imprecise. Conclusions. Supervised group exercise did not reduce the prevalence of LBP or PGP in pregnancy.

Introduction Candida albicans is without question the most significant fungal pathogen encountered by humans. (1) From birth, C. albicans is a normal commensal microbe colonizing the skin and mucosal surfaces [...]

The majority of adults will have low back pain (LBP) at some point in their life, and most of these cases will be nonspecific, that is, LBP where it is [...], Background. Physical therapists' management of patients with nonspecific low back pain (NSLBP) has been found to be associated with their beliefs and attitudes toward NSLBP, as well as with guideline recommendations. Greater knowledge of physical therapists' experiences and feelings of treating patients with NSLBP may help to explain these associations and increase our understanding of some of the challenges physical therapists face when treating patients with NSLBP in clinical practice. Objectives. The objective of this study was to understand more about how the personal experiences and feelings of physical therapists might influence their decision making when treating patients with NSLBP. Desigrl. This was a qualitative study using a phenomenological hermeneutical approach and practitioner-as-researcher model. Methods. Eleven semistructured interviews with physical therapists were conducted and analyzed using the hermeneutical circle to identify key themes relating to their experiences and feelings in treating patients with NSLBP. Results. Three linked themes emerged: (1) physical therapists believe that NSLBP has an underlying mechanical and recurring nature, (2) physical therapists' attitude toward managing NSLBP is to empower patients to exercise and self-manage their pain and functional problems, and (3) physical therapists experience feelings of tension between the advice and treatment they feel is best for their patient and the patient's own beliefs and attitudes. Conclusions. The experiences and feelings of physical therapists treating patients with NSLBP include conflict among their pain beliefs, attitudes, and working partnerships with patients. Treatment decisions may be influenced when physical therapists modify their beliefs and attitudes to reduce this sense of conflict. Improving physical therapist communication skills may help decrease feelings of conflict, enhance working relationships, and encourage a more consistent approach toward patients with NSLBP.

Pregnancy-related back and pelvic girdle pain is a common condition varying from self-limiting symptoms of short duration during pregnancy to great pain and disability both during and after pregnancy. (1) [...], Background. There is little evidence for the measurement properties of instruments commonly used for women with pelvic girdle pain. Objective. The aim of this study was to examine the internal consistency, testretest reliability, and construct validity of instruments used for women with pelvic girdle pain. Design. This was a cross-sectional methodology study, including test-retest reliability assessment. Methods. Women with pelvic girdle pain in pregnancy and after delivery participated in a postal survey that included the Pelvic Girdle Questionnaire (PGQ), Oswestry Disability Index (ODD, Disability Rating Index (DRD, Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), and 8-item version of the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire (SF-36). Test-retest reliability was assessed with a random subsample 1 week later. Internal consistency was assessed with the Cronbach alpha, and test-retest reliability was assessed with the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). Construct validity based on hypotheses was assessed by correlation analysis. Discriminant validity was assessed with the area under the receiver operating characteristic curve. Results. All participants responded to the main (N=87) and test-retest (n=42) surveys. Cronbach alpha values ranged from .88 to .94, and ICCs ranged from .78 to .94. The MDC at the individual level constituted about 7% to 14% of total scores for the 8-item version of the SF-36, ODI, and PGQ activity subscale; about 18% to 22% for the DRI, PGQ symptom subscale, and PCS; and about 25% for the FABQ. Hypotheses were mostly confirmed by correlations between the instruments. The PGQ was the only instrument that significantly discriminated participants who were pregnant from participants who were not pregnant as well as pain locations. Limitations. A comparison of responsiveness to change of the various instruments used in this study was not undertaken, but will be carried out in a future study. Conclusions. Serf-report instruments for assessing health showed good internal consistency, test-retest reliability, and construct validity for women with pelvic girdle pain. The PGQ was the only instrument with satisfactory discriminant validity, thus, it is recommended for evaluating symptoms and disability in patients with pelvic girdle pain.

Pregnancy-related back pain and pelvic girdle pain (PGP) are common across countries, irrespective of socioeconomic factors. (1) In general, the literature does not make a clear distinction between pregnancy-related low [...], Background. No appropriate measures have been specifically developed for pelvic girdle pain (PGP). There is a need for suitable outcome measures that are reliable and valid for people with PGP for use in research and clinical practice. Objective. The objective of this study was to develop a condition-specific measure, the Pelvic Girdle Questionnaire (PGQ), for use during pregnancy and postpartum. Design. This was a methodology study. Methods. Items were developed from a literature review and information from a focus group of people who consulted physical therapists for PGP. Face validity and content validity were assessed by classifying the items according to the World Health Organization's International Classification of Functioning, Disability and Health. After a pilot study, the PGQ was administered to participants with clinically verified PGP by means of a postal questionnaire in 2 surveys. The first survey included 94 participants (52 pregnant), and the second survey included 87 participants (43 pregnant). Rasch analysis was used for item reduction, and the PGQ was assessed for unidimensionality, item fit, redundancy, and differential item functioning. Test-retest reliability was assessed with a random sample of 42 participants. Results. The analysis resulted in a questionnaire consisting of 20 activity items and 5 symptom items on a 4-point response scale. The items in both subscales showed a good fit to the Rasch model, with acceptable internal consistency, satisfactory fit residuals, and no disordered threshold. Test-retest reliability showed high intraclass correlation coefficient estimates: .93 (95% confidence interval=0.86-0.96) for the PGQ activity subscale and .91 (95% confidence interval=0.84-0.95) for the PGQ symptom subscale. Limitations. The PGQ should be compared with low back pain questionnaires as part of a concurrent evaluation of measurement properties, including validity and responsiveness to change. Conclusions. The PGQ is the first condition-specific measure developed for people with PGP. The PGQ had acceptably high reliability and validity in people with PGP both during pregnancy and postpartum, it is simple to administer, and it is feasible for use in clinical practice.

Nonspecific low back pain (LBP) is a major public health problem in industrialized societies, with lifetime prevalence between 60% and 85%. (1) Reviews point to beneficial effects of supervised exercises [...], Background. Exercise benefits patients with chronic nonspecific low back pain; however, the most effective type of exercise remains unknown. Objective. This study compared outcomes after motor control exercises, sling exercises, and general exercises for low back pain. Design. This was a randomized controlled trial with a 1-year follow-up. Setting. The study was conducted in a primary care setting in Norway. Patients. The participants were patients with chronic nonspecific low back pain (n=109). Interventions. The interventions in this study were low-load motor control exercises, high-load sling exercises, or general exercises, all delivered by experienced physical therapists, once a week for 8 weeks. Measurements. The primary outcome measure was pain reported on the Numeric Pain Rating Scale after treatment and at a 1-year follow-up. Secondary outcome measures were self-reported activity limitation (assessed with the Oswestry Disability Index), clinically examined function (assessed with the Fingertip-to-Floor Test), and fear-avoidance beliefs after intervention. Results. The postintervention assessment showed no significant differences among groups with respect to pain (overall group difference) or any of the outcome measures. Mean (95% confidence interval) group differences for pain reduction after treatment and after 1 year were 0.3 (-0.7 to 1.3) and 0.4 (-0.7 to 1.4) for motor control exercises versus sling exercises, 0.7 (-0.6 to 2.0) and 0.3 (-0.8 to 1.4) for sling exercises versus general exercises, and 1.0 (-0.1 to 2.0) and 0.7 (-0.3 to 1.7) for motor control exercises versus general exercises. Limitations. The nature of the interventions made blinding impossible. Conclusions. This study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain.

BACKGROUND Conceptualizations of access in the past decade have expanded the 1993 institute of medicine's definition of access, 'the timely use of personal health services to achieve the best possible [...], The specific aim of this study is to identify factors related to parental satisfaction with a child health provider&apos;s services among a sample of Head Start parents. This is a retrospective study with a sample of 250 consentedparents/guardians of registered Head Start children (3-5 years old), in South Los Angeles, California, USA. The study results showed that parents who were empowered or having a voice to demonstrate concerns about their child&apos;s health to the provider, negotiate a health care management plan, and ask questions, were nearly six times more likely to have reported receiving caring services from their child&apos;s providers (OR = 5.78; CI = 2.882-11.8, P [less than or equal to] .05). Also, parents who reported trusting their child&apos;s provider were eight times more likely to report receiving caring services from their child&apos;s providers (OR = 8.63; CI = 9.30-18.1, P [less than or equal to] .05). These results have implications for health provider training in patient-centered care and for patient empowerment during a medical encounter.

Introduction to Biofilm In the microbiology world, a revolution in how microorganisms are perceived has been occurring that is only now catching the attention of medical practitioners. Much of what [...]

Low back pain (LBP) is one of the main causes of disability, and, despite its high prevalence, the source of pain is not established in the majority of cases and [...], Background. Previous systematic reviews have concluded that the effectiveness of motor control exercise for persistent low back pain has not been clearly established. Objective. The objective of this study was to systematically review randomized controlled trials evaluating the effectiveness of motor control exercises for persistent low back pain. Methods. Electronic databases were searched to June 2008. Pain, disability, and quality-of-life outcomes were extracted and converted to a common 0 to 100 scale. Where possible, trials were pooled using Revman 4.2. Results. Fourteen trials were included. Seven trials compared motor control exercise with minimal intervention or evaluated it as a supplement to another treatment. Four trials compared motor control exercise with manual therapy. Five trials compared motor control exercise with another form of exercise. One trial compared motor control exercise with lumbar fusion surgery. The pooling revealed that motor control exercise was better than minimal intervention in reducing pain at short-term follow-up (weighted mean difference = -14.3 points, 95% confidence interval [CI] = -20.4 to -8.1), at intermediate follow-up (weighted mean difference = -13.6 points, 95% CI = -22.4 to -4.1), and at long-term follow-up (weighted mean difference = -14.4 points, 95% CI = -23.1 to -5.7) and in reducing disability at long-term follow-up (weighted mean difference = -10.8 points, 95% CI = -18.7 to -2.8). Motor control exercise was better than manual therapy for pain (weighted mean difference = -5.7 points, 95% CI = -10.7 to -0.8), disability (weighted mean difference = -4.0 points, 95% CI = -7.6 to -0.4), and quality-of-life outcomes (weighted mean difference = -6.0 points, 95% CI = -11.2 to -0.8) at intermediate follow-up and better than other forms of exercise in reducing disability at short-term follow-up (weighted mean difference = -5.1 points, 95% CI = -8.7 to -1.4). Conclusions. Motor control exercise is superior to minimal intervention and confers benefit when added to another therapy for pain at all time points and for disability at long-term follow-up. Motor control exercise is not more effective than manual therapy or other forms of exercise.

Background: An HIV-specific version of the QUOTE questionnaire was developed to measure the quality of care of patients infected with HIV from the patients' perspective. The consistency and validity of [...]

Objective: To investigate the efficacy of a Mediterranean diet (MD) versus an ordinary Western diet for suppression of disease activity in patients with rheumatoid arthritis (RA). Methods: Patients with well [...]