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Une femme de 35 ans (2 gestations nullipares, 1 fausse couche) a consulte a notre clinique d'obstetrique a 30 semaines et 1 jour d'une gestation par fecondation in vitro, pour [...]

As the modernization of clinical research through digital and decentralized solutions continues to take research into local communities, reduce patient and site burden, and increase diversity, it will lead to [...]

Today, clinical trial data collection faces increased complexity due to data duplication between research systems and electronic health records (EHRs), particularly in oncology studies. Manual processes, such as data entry, [...]

The idea that we should always look on the bright side has gone too far and may now by damaging our well-being, finds Conor Feehly ARE you struggling with low [...]

Chances are, right now, you're in some sort of pain. Maybe your back aches, or arthritis is hurting your hands or knee pain is hobbling your walk. Maybe you're dealing [...]

May 3-6, 2024 NADOFARAGENE FIRADENOVEC SUSTAINS EFFICACY IN NMIBC AT 5-YEAR FOLLOW-UP The gene therapy nadofaragene firadenovec-vncg (Adstiladrin) continued to demonstrate durable clinical activity in patients with high-risk, BCG-unresponsive non-muscle-invasive [...]

Industry leaders discuss the progress and path forward for the clinical trials enterprise in meeting its environmental mandate. On May 16, 2024, Applied Clinical Trials held a roundtable event focused [...]

A 35-year-old woman (gravida 2, para 0, miscarriage 1) at 30 weeks and 1 day gestation via in vitro fertilization was seen in consultation in our obstetric medicine clinic for [...]

Background: Emergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as 'socially admitted' patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as 'social admissions.' Methods: This qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre. From October 2022 to July 2023, we interviewed eligible participants, including any health care clinician or administrator who worked directly with 'socially admitted' patients. Virtual or in-person individual interviews were audio-recorded and transcribed, then independently and iteratively coded. We mapped themes on the 5 domains of the Quintuple Aim conceptual framework. Results: We interviewed 20 nurses, physicians, administrators, and social workers. Most identified as female (n = 11) and White (n = 13), and were in their mid to late career (n = 13). We categorized 9 themes into 5 domains: patient experience (patient description, provision of care); care team well-being (moral distress, hierarchy of care); health equity (stigma and missed opportunities, prejudices); cost of care (wait-lists and scarcity of alternatives); and population health (factors leading to vulnerability, system changes). Participants described experiences caring for 'socially admitted' patients, perceptions and assumptions underlying 'social' presentations, system barriers to care delivery, and suggestions of potential solutions. Interpretation: Health care providers viewed 'socially admitted' patients as needing enhanced care but identified individual, institutional, and system challenges that impeded its realization. Examining perceptions of the people who care for 'socially admitted' patients offers insights to guide clinicians and policy-makers in caring for socially vulnerable patients., Emergency departments have become a destination of last resort for some patients who are made vulnerable by social circumstances, resulting in their occupying hospital beds typically designated for people with [...]

Objective. The recent publication of the Physical Therapy Evaluation and Treatment After Concussion Clinical Practice Guideline is intended to assist clinicians in their decision-making specific to evaluation and intervention. Clinical practice guidelines are supported by best available evidence, though it is unknown what other factors drive clinical decision-making in the realm of concussion management. The purpose of this study was to explore factors related to the process of clinical decision-making of experienced physical therapists who treat individuals with concussion. Methods. This grounded theory approach used semi-structured interviews of physical therapists who have practiced concussion management [greater than or equal to]3 years and have treated [greater than or equal to]15 individuals for postconcussion symptoms in the last year. Following the inductive approach, deductive qualitative methodology was used to explore alignment with recent guidelines. Member checking was used to ensure trustworthiness. Results. Ten therapists' experience in treating concussion ranged from 5 to 20 years. Four overarching themes were identified that contribute to clinical decision-making: expert practice behaviors through use of reflection in action, clinical reasoning, collaboration, and evidenced informed practice; therapeutic alliance building using individualized education, reassurance, and relationship building; adaptability in prioritizing, assessing, and responding to patients' needs; and listening and observing. Clinician decision-making statements showed alignment with clinical practice guideline recommendations. Conclusion. Experienced therapists demonstrate a consistent approach that parallels the current clinical practice guideline while building off clinical experience to tailor individualized care focusing on patient centeredness. These factors may assist more novice clinicians to develop and improve their management strategies for optimal outcomes. Impact. Identified themes may broaden frameworks and guidelines for the management of individuals postconcussion specific to the field of physical therapy. Keywords: Concussion, Decision-Making: Clinical, Physical Therapists, Introduction The lifetime prevalence of self-reported concussion is approximately 29% in adults (1) and 25% in adolescents. (2) Recent updates to the definition of concussion include an injury that occurs [...]

Objective. The purpose of this study was to describe the experiences of individuals with post-coronavirus 19 (COVID-19) condition symptoms who underwent a supervised telerehabilitation and home-based respiratory muscle training (TSHB-RMT) program. Methods. A qualitative descriptive study was conducted. Participants were recruited using purposeful sampling. The inclusion criteria consisted of: patients aged over 18 years who presented persistent COVID-19 symptoms of fatigue and dyspnea for at least 3 months after the COVID-19 diagnosis. In total, 28 patients were included. In-depth interviews and researcher field notes were used to collect the data. A thematic analysis was performed. Results. Three themes reflect the patients' perspective on the TSHB-RMT before the program (reasons for participating), during the treatment program, and upon completion of the study. Among the reasons for participation, participants highlighted the absence of improvement and treatment, and feeling abandoned and forgotten by the health system. The treatment required discipline on behalf of the patients. Mondays and Tuesdays were the most difficult days for performing the therapy, and the physical therapist was perceived as a tool for adherence, change, and a source of validated information. The patients perceived positive effects quite soon; however, it was necessary to extend the follow-up after completing the program because they abandoned the program due to the lack of guidance for exercise supervision. Conclusion. This study described relevant aspects that physical therapist professionals should consider when providing TSHB-RMT treatment. Impact. TSHB-RMT requires discipline, perseverance, effort, and a commitment to the group. The physical therapist is perceived as the tool that facilitates adherence and participation. The effects are rapidly perceived, leading to improved self-confidence and autonomy; however, it is necessary to increase the follow-up time. Keywords: (MeSH): Breathing Exercises, Physical Therapists, Postacute COVID-19 Syndrome, Qualitative Research, SARS-CoV-2, Telerehabilitation, Introduction After COVID-19 infection, between 2.3% and 60% of survivors experience symptoms that are unexplained by an alternative diagnosis. (1,2) These individuals are considered to have post-COVID-19 condition (PCC) when [...]

Objective. The objective of this study was to perform a meta-analysis of the minimal clinically important difference (MCID) of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and its shortened version (ie, the QuickDASH). Methods. MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Scopus were searched up to July 2022. Studies on people with upper limb musculoskeletal disorders that calculated the MCID by anchor-based methods were included. Descriptive and quantitative synthesis was used for the MCID and the minimal detectable change with 90% confidence ([MDC.sub.90]). Fixed-effects models and random-effect models were used for the meta-analysis. [I.sup.2] statistics was computed to assess heterogeneity. The methodological quality of studies was assessed with the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist for measurement error and an adaptation of the checklist for the studies on MCID proposed by Bohannon and Glenney. Results. Twelve studies (1677 patients) were included, producing 17 MCID estimates ranging from 8.3 to 18.0 DASH points and 8.0 to 18.1 QuickDASH points. The pooled MCIDs were 11.00 DASH points (95% CI = 8.59-13.41; [I.sup.2] = 0%) and 11.97 QuickDASH points (95% CI = 9.60-14.33; [I.sup.2] = 0%). The pooled [MDC.sub.90]s were 9.04 DASH points (95% CI = 6.46-11.62; [I.sup.2] = 0%) and 9.03 QuickDASH points (95% CI = 6.36-11.71; [I.sup.2] = 18%). Great methodological heterogeneity in the calculation of the MCID was identified among the primary studies. Conclusion. Reasonable MCID ranges of 12 to 14 DASH points and 12 to 15 QuickDASH points were established. The lower boundaries represent the first available measure above the pooled [MDC.sub.90], and the upper limits represent the upper 95% CI of the pooled MCID. Impact. Reasonable ranges for the MCID of 12 to 14 DASH points and 12 to 15 QuickDASH points were proposed. The lower boundaries represent the first available measure above the pooled [MDC.sub.90], and the upper limits represent the upper 95% CI of the pooled MCID. Information regarding the interpretability of the 2 questionnaires was derived from very different methodologies, making it difficult to identify reliable thresholds. Now clinicians and researchers can rely on more credible data. The proposed MCIDs should be used to assess people with musculoskeletal disorders. Heterogeneity was found related particularly to the anchor levels used in the primary studies. To promote comparability of MCID values, shared rules defining the most appropriate types of anchoring will be needed in the near future. Keywords: Clinical Relevance, Minimal Detectable Change, Patient Reported Outcome Measures, Psychometrics, Responsiveness, Upper Extremity, Introduction Health outcome measures are relevant to clinicians to select the most suitable treatment option, establish customized goals, and examine the effectiveness of an intervention. Patient-reported outcome measures (PROMs) are [...]

Objective. The long-term effects of the unilateral muscle-sparing pedicled transverse rectus abdominis myocutaneous (TRAMmsp) flap procedure on trunk muscle performances and core stability were investigated in women with breast cancer. Methods. Forty women (mean age = 42.6 years) who had received breast reconstruction with the unilateral TRAMmsp flap procedure no less than 6 months earlier (mean = 10.3 [standard deviation, SD = 4.9] months) (TRAM group) participated, and 30 women who were healthy and matched for age (mean age = 41.2 years) served as controls (control group). Their abdominal and back muscle strength was assessed using the curl-up and prone extension tests, respectively, and their static abdominal muscle endurance and back extensor endurance were assessed using the sit-up endurance test in the crook-lying position and the Biering-Sorensen test, respectively. Core stability strength was assessed using a 4-level limb-lowering test (abdominal muscle test), and core stability endurance was assessed while lying supine with both flexed legs 1 inch off the mat while keeping the pelvis in a neutral position with a pressure biofeedback unit. Results. Compared with the control group, trunk muscles of the TRAM group were weaker, showing less endurance, as were their core stability strength and endurance. Static trunk muscle endurances and trunk flexion strength were associated with core stability in both groups. Conclusions. Women exhibit trunk flexor and extensor weakness along with poor endurance and impaired core stability even after an average of 10 months from receiving the TRAMmsp flap procedure. Immobilization after surgery, with possible systemic inflammatory effects from surgery and chemotherapy, might have further contributed to the generalized weakness subsequent to the partial harvesting of the rectus abdominis. Impact. Women after breast reconstruction with the TRAMmsp flap procedure show long-lasting deficits of strength and endurance in abdominal muscles, back extensors, and core stability. Proactive measures including early detection and evaluation of impairments as well as timely intervention targeting these clients are important to minimize the dysfunction and support their return to community participation. Keywords: Core Stability, Muscle-Sparing Pedicled TRAM Flap Breast Reconstruction, Rectus Abdominis, Trunk Muscle Function, Introduction Pedicled transverse rectus abdominis myocutaneous (TRAM) flap surgery is a popular surgical option for autologous breast reconstruction in women with breast cancer, (1-3) involving transecting the rectus abdominis at [...]

Objective. The goal of this study was to explore the patient-physical therapist interaction and the physical therapist's experience of the introductory session for mechanical insufflation-exsufflation (Ml-E) device treatment for patients with progressive neurological disease. Methods. Qualitative content analysis of participant's observation of interaction between patients and physical therapists during 9 Ml-E introduction sessions in different clinical care settings and 10 follow-up interviews with 6 physical therapists. Results. The introduction of Ml-E emerged as a process of instilling a sense of security in the patient. The process can be described in 4 steps: (1) gain understanding by being responsive to the person's whole life situation; (2) share knowledge and expectations in a respectful and permissive way; (3) introduce the device in a gentle and reciprocal interactivity; and (4) adapt to home use in an inclusive dialog with the patient and their significant others. Physical therapists described a need for assurance to instill a sense of security in the patient, implying a need for confidence, competent peers, guiding yet flexible routines, and emotional support. Conclusion. Physical therapists have a need to foster assurance in employing a person-centered approach to make a patient feel secure in the process of introducing Ml-E treatment. Multiple modes of professional knowledge were used together with action-based and relational-based ethics to facilitate a person-centered care approach. This seems to be a promising approach for providing good care when introducing Ml-E to patients. Further research is needed to explore this from the patient's perspective. Impact. This study added to the body of knowledge regarding Ml-E treatment in relation to patients. This has direct implication, particularly for inexperienced physical therapists, for informed care for the patient during introduction. Our study also supports that person-centered care should be implemented at all levels of health care to make it possible for physical therapists to practice person-centered care. Keywords: Mechanical Insufflation--Exsufflation, Neuromuscular Disease, Physical Therapy, Qualitative, Introduction Patients affected by progressive neurological disease in the later stages are prone to pulmonary complications, (1) characterized by impaired ventilation and cough, which can increase morbidity and mortality. (2) [...]

Objective. The objective of this study was to evaluate the efficacy of electrotherapy and manual therapy for the treatment of women with primary dysmenorrhea. Methods. Systematic searches were conducted in Scopus, Web of Science, PubMed, CINAHL, and MEDLINE. The articles must have been published in the last 10 years, had a sample exclusively of women with primary dysmenorrhea, had a randomized controlled trial design, and used interventions that included some form of manual therapy and/or electrotherapy techniques. Two reviewers independently screened articles for eligibility and extracted data. Difference in mean differences and their 95% CIs were calculated as the between-group difference in means divided by the pooled standard deviation. The [I.sup.2] statistic was used to determine the degree of heterogeneity. Results. Twelve selected studies evaluated interventions, with 5 evaluating electrotherapy techniques and 7 evaluating manual therapy techniques. All studies analyzed identified improvements in pain intensity and meta-analysis confirmed their strong effect. Conclusions. Manual therapy and electrotherapy are effective for the treatment of women with primary dysmenorrhea. Transcutaneous electrical nerve stimulation combined with thermotherapy and effleurage massage stands out for its effects on the intensity and duration of pain with the application of a few sessions and their long-term effects. Impact. Manual therapy techniques and electrotherapy methods reduce the pain intensity of women with primary dysmenorrhea. Quality of life and degree of anxiety improved significantly with manual therapy interventions. Transcutaneous electrical nerve stimulation combined with thermotherapy and effleurage massage are the interventions with which positive effects were achieved with fewer sessions. Keywords: Dysmenorrhea, Electric Stimulation Therapy, Manual Therapy, Physical Therapy Modalities, Physical Therapy Specialty, Introduction Dysmenorrhea is a menstrual disorder characterized by suprapubic cramping of uterine origin and pain occurring a few hours before or after the onset of menstruation. (1) Dysmenorrhea is classified, [...]

In the following pages, you'll see how the latest discoveries from the University of Florida are moving Florida forward. UF's scientists and scholars will share creative approaches to the python [...]

IN THE 1960s, viewers of TV's Star Trek were amazed when Dr. Leonard 'Bones' McCoy scanned a patient's body using a handheld 'tricorder' device whose artificial intelligence (AI) quickly generated [...]

L'oesophagite a eosinophiles est une maladie chronique qui peut affecter autant les enfants que les adultes et qui englobe divers problemes, car il s'agit d'une cause frequente de dysphagie oesophagienne, [...]

Background: People with opioid use disorder (OUD) are at risk of premature death and can benefit from palliative care. We sought to compare palliative care provision for decedents with and without OUD. Methods: We conducted a cohort study using health administrative databases in Ontario, Canada, to identify people who died between July 1, 2015, and Dec. 31, 2021. The exposure was OUD, defined as having emergency department visits, hospital admissions, or pharmacologic treatments suggestive of OUD within 3 years of death. Our primary outcome was receipt of 1 or more palliative care services during the last 90 days before death. Secondary outcomes included setting, initiation, and intensity of palliative care. We conducted a secondary analysis excluding sudden deaths (e.g., opioid toxicity, injury). Results: Of 679 840 decedents, 11 200 (1.6%) had OUD. Compared with people without OUD, those with OUD died at a younger age and were more likely to live in neighbourhoods with high marginalization indices. We found people with OUD were less likely to receive palliative care at the end of their lives (adjusted relative risk [RR] 0.84, 95% confidence interval [CI] 0.82-0.86), but this difference did not exist after excluding people who died suddenly (adjusted RR 0.99, 95% CI 0.96-1.01). People with OUD were less likely to receive palliative care in clinics and their homes regardless of cause of death. Interpretation: Opioid use disorder can be a chronic, life-limiting illness, and people with OUD are less likely to receive palliative care in communities during the 90 days before death. Health care providers should receive training in palliative care and addiction medicine to support people with OUD., Between 1990 and 2016, the number of people with opioid use disorder (OUD) worldwide increased from 18.2 million to 26.8 million people. (1,2) As this population ages, more people with [...]

Omega fatty acids are an important part of a healthy diet, but could too much of one type actually be harmful? And if so, how do we get the ratio [...]

Jill Sommerville Senior Director Lauren Flood Associate Director Matthew Ryan Associate Director All with the digital and decentralized solutions for the PPD clinical research business of Thermo Fisher Scientific It's [...]

Introduction Infertility is a common disease: worldwide, an estimated 17.5% of couples experience infertility. (1-3) The definition of infertility, failure to achieve pregnancy after at least 12 months of sexual [...]