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The pitting qualities of lymphoedema tissue change with disease progression. However, little is known about the underlying tissue response to the pitting test or the tissue characteristics that enhance or resist indentation. The pitting test is currently unstandardised, and the influence of test technique on pitting outcomes is unknown. Understanding how tissue reacts to applied pressure will build evidence for the standardisation of the pitting test. Ninety pitting test sites from fifteen women with unilateral breast cancer-related lymphoedema were evaluated using high-frequency ultrasound (HFUS), bioelectrical impedance spectroscopy (BIS), and limb volume measures. Three sites on each lymphoedema and non-lymphoedema arm were subject to a 60-s (s) staged pitting test, with changes in tissue features captured with ultrasound imaging before, throughout, and after the pitting test. Pitting qualities of tissues varied greatly, with lymphoedema sites pitting more frequently (p < 0.001) with greater depth (p < 0.001) and requiring a longer recovery time (p = 0.002) than contralateral unaffected tissue. Pitting is not solely attributable to oedema volume. Non-structural and structural characteristics of dermal and subcutaneous layers also influence tissue responses to sustained pressure. To enhance the validity and reliability of pitting assessment, a 60 s staged pitting test with an observation of tissue recovery is recommended for lymphoedema presentations. [ABSTRACT FROM AUTHOR]

Lymphoedema tissue is characterised by excess free fluid and structural changes to the extracellular matrix (ECM) in the form of fibrotic and fatty deposition. These tissue characteristics are integral to the assessment of lymphoedema progression; however, clinicians and researchers often focus on changes in the free fluid, volume and function of lymphatic vasculature to inform practice. Subsequently, little is known about the effect of clinical interventions on lymphoedema tissue composition. This article presents a novel approach to classify lymphoedema tissue. The Localised Objective Characterisation Assessment of Lymphoedema (LOCAL) classification combines diagnostic and clinically meaningful objective assessment thresholds to infer lymphoedema pathophysiological changes in tissue layers. The LOCAL classification method was verified using data from fifteen women with unilateral breast cancer-related lymphoedema who were evaluated at three sites on each arm using high-frequency ultrasound (HFUS), bio-electrical impedance spectroscopy (BIS) and volume measurements. Participants exhibited an uneven distribution of volume between the proximal and distal segments of the arm (p = 0.023), with multiple tissue compositional categories observed across sites on the same limb (p < 0.001). The LOCAL method demonstrated utility in categorising a diverse range of lymphoedema tissue layer changes beyond what can be ascertained from whole-limb measures. [ABSTRACT FROM AUTHOR]

Whilst the benefits of telehealth were identified during the COVID-19 pandemic, we noted barriers to its use at a vital time. Through a health service improvement approach, we sought to increase allied health professional capability in telehealth, but we also sought to understand if there were risks associated with its use. We designed and implemented tools to evaluate allied health professional competence and confidence in using telehealth with private and public patients in a metropolitan teaching hospital setting. With an emphasis on technology capability, we undertook audits over three consecutive years (2020 to 2022) of allied health professional telehealth occasions of service reporting on compliance with the audit criteria and investigating staff confidence in undertaking telehealth sessions using a co-designed survey. The audit tool and confidence survey results were used to identify risk factors to telehealth service delivery using a Modified Health Failure Modes, Effects Analysis. Although confidence levels were relatively high among staff, confidence in managing safety factors and technology risks associated with telehealth were not initially verified by the audit findings. Remedial efforts resulted in service improvements in many identified risk factors, yet technology performance and its troubleshooting remained a primary variable in the ability of staff to comply with the requirements of the real-time audits. Health workers using telehealth should have training to engage safely and effectively in telehealth care and the technology. [ABSTRACT FROM AUTHOR]

Objectives: To examine workload, thermal discomfort and heat‐related symptoms among healthcare workers (HCWs) in an Australian ED during the COVID‐19 pandemic. Methods: A cross‐sectional study design was employed among HCWs in an ED at a metropolitan hospital in Brisbane, Australia. Respondents provided demographic information including their self‐reported age, sex, height, weight, role (e.g. doctor, nurse), and whether they wore personal protective equipment (PPE) during their shift, rated as either Full PPE, Partial PPE, or usual uniform or scrubs. The workload of HCWs was assessed with the National Aeronautics and Space Administration's task load index (NASA‐TLX). Thermal discomfort was evaluated using scales from the International Organisation for Standardisation. Responders rated their subjective heat illness using the Environmental Symptoms Questionnaire. Results: Fifty‐nine HCWs completed the survey (27 male, 31 female, one prefer not to answer). Overall workload from the NASA‐TLX was 64.6 (interquartile range [IQR] 56.5–73.3) for doctors, 72.5 (IQR 63.3–83.3) for nurses and 66.7 (IQR 58.3–74.17) for other staff, representing moderate to high ratings. Eighty‐one percent reported thermal sensation to be slightly warm, warm, or hot, and 88% reported being uncomfortable, ranging from slightly to extremely. Ninety‐seven percent reported at least one heat‐strain symptom. More than 50% reported light‐headedness or headache and approximately 30% reported feeling dizzy, faint, or weak. Conclusions: ED HCWs experience thermal discomfort when wearing PPE. Combined with their workloads, HCWs experienced symptoms related to heat strain. Therefore, careful consideration should be given to managing heat strain among HCWs when wearing PPE in an ED. [ABSTRACT FROM AUTHOR]

We argue that willpower as well as its depletion may, in some circumstances, adversely impact on clinical decision‐making and patient care. This psychological phenomenon has been dubbed ego depletion in social psychology. Willpower and its depletion which is known as 'ego depletion' are well‐established and validated theoretical constructs in social psychology and have been studied across a range of experimental contexts. Willpower is closely related to the concept of self‐control, which refers to the ability to regulate one's own behaviour and actions in order to pursue and achieve either a short‐ or long‐term goal. We outline the clinical relevance of willpower and its depletion in relation to clinical case examples drawn from three of the authors' clinical experience with the view of developing a clinical‐research agenda for future research studies. We examine willpower and its depletion in the context of three clinical case examples, which include (i) doctor–patient interactions, (ii) willpower and its depletion in relation to challenging interpersonal interactions with clinical and non‐clinical work colleagues and (iii) willpower and its depletion in response to working within a challenging and unpredictable clinical environment. In contrast to the more widely recognised external resources (including space, staff allocations and night shifts), a greater understanding of how this important but under‐recognised internal resource can be depleted in response to a range of different factors within clinical settings has the potential to inform and improve patient care through a renewed focus on the developing interdisciplinary clinical studies which draw upon contemporary findings from social psychology. Future work aimed at developing evidence‐based interventions to help mitigate the negative impact of impaired self‐control and decision fatigue within healthcare systems may in turn lead to improved patient care as well as more effective healthcare service and delivery. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusion People living with Parkinson's disease (PD) commonly experience heat sensitivity—worsening symptoms and restricted daily activities in heat.This study aimed to develop a scale of heat sensitivity for people with PD.Through a search of the scientific literature and online forums, we developed 41 items relating to experiences of heat for people with PD to assess heat sensitivity. A panel of experts was then consulted to review the scale items critically. After two rounds of review, the scale was refined to 36 items with an overall scale content validity index of 0.89. Via an online survey, 247 people with PD responded to the items.The items were examined with exploratory factor analysis to determine the underlying factors therein. After several iterations, a simple structure was achieved with 29 items loading uniquely onto one of four factors: daily activities, sweating and exercise, heat‐related illness, and symptoms and medications. The model had acceptable to excellent fit statistics (root mean square error of approximation = 0.073 [90% confidence interval 0.067–0.081], root mean square of the residuals = 0.03, comparative fit index = 0.93, and Tucker‐Lewis index = 0.91), and each factor showed high reliability (Cronbach's α ≥0.89). Factor and total scale scores were significantly higher among those reporting sensitivity to heat and poor health status.This new heat sensitivity scale for people living with PD can enable health professionals and clients to assess the severity and impact of heat sensitivity. [ABSTRACT FROM AUTHOR]

Rationale: Spinal cord ischemia injury is a serious complication after intra-aortic surgery, with a low incidence but high disability rate. However, patients often do not receive comprehensive treatment in the early stages of the disease. Therefore, active neurological intervention is needed to protect and prevent spinal cord ischemia during and after surgery. In this paper, rehabilitation program and imaging data of 2 cases with spinal cord ischemic injury are presented and discussed regarding causes, prevention and acute treatment with this disease, which could be referred by clinicians., Patient Concerns: Case report 1: A 69-year-old male patient underwent aortic arch aneurysm and thoracic endovascular aortic repair (coated stent) was performed under general anesthesia. Complete paralysis of both lower limbs, constipation, and urinary retention occurred after surgery and was subsequently referred to our rehabilitation department. Case report 2: A man aged 41 years experienced sudden chest pain with no dizziness or headache. Weakness of both lower limbs gradually appeared over 30 minutes with subsequent loss of consciousness. He was diagnosed with aortic dissection and underwent aortic stent implantation. Inpatient rehabilitation began systematically 3 months after discharge., Diagnoses: The 2 patients were diagnosed with paraplegia and spinal cord ischemic injury., Interventions: The patients received strength and transfer training, sensory input, health mission, and activities of daily living., Outcomes: Patient 1 returned home without assistive devices and patient 2 returned home with wheelchair., Lessons: Perioperative spinal cord protection is directly related to postoperative quality of life. Once the symptoms of spinal cord ischemic injury occur, cerebrospinal fluid drainage should be performed as soon as possible to increase mean arterial pressure. At the same time, methylprednisolone, ganglioside, anticoagulation, vasodilator drugs, and symptomatic supportive treatments are required. Intercostal artery and subclavian artery are reconstructed if necessary. Symptom stability flags referral to commence rehabilitation. Repetitive functional training is necessary to help patients return to the family and society as soon as possible., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Beginning in 2018, Mater Health was enacting its next stage of strategic planning focusing on services designed around consumers and strengthening technology to improve access to care and information for delivering better outcomes. Telehealth was part of the strategy. Allied health services sought to meet future community needs by increasing the number of its offsite or virtual services without the need for expensive infrastructure. Our aim was to reinforce allied health professional capability in telehealth, as part of sustainable allied health telehealth delivery. We used a Model for Improvement that included use of the Plan, Do, Study, Act cycles, incorporating a community of practice and evaluation framework with strategies such as appreciative inquiry designed to enhance communication and understanding among team members. Telehealth has proven of great value to health services and consumers during the COVID-19 pandemic. Scaling up of telehealth during the pandemic resulted in recognition of multiple factors needing to be addressed for telehealth to be sustainable. Our work provides insights into staff and consumer perspectives of TH, forming a basis for future telehealth research.