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We assessed the impact of an HIV care mentorship intervention on knowledge, attitudes, and practices with nurses and people living with HIV (PLWH) in Canada. We implemented the intervention in two urban and two rural sites with 16 mentors (eight experienced HIV nurses and eight PLWH) and 40 mentees (nurses with limited HIV experience). The 6- to 12-month intervention included face-to-face workshops and monthly meetings. Using a mixed-methods approach, participants completed pre- and postintervention questionnaires and engaged in semistructured interviews at intervention initiation, mid-point, and completion. Data from 28 mentees (70%) and 14 mentors (87%) were included in the quantitative analysis. We analyzed questionnaire data using McNemar test, and interview data using content analysis. Results indicated positive changes in knowledge, attitudes, and practices among nurse mentees, with qualitative interviews highlighting mechanisms by which change occurred. Mentorship interventions have the potential to engage and educate nurses in HIV treatment and care.

The purpose of this narrative review was to describe and compare the characteristics and episodic nature of disability among three chronic illnesses: multiple sclerosis (MS), HIV and fibromyalgia (FM). Searches were performed in electronic databases using a combination of keywords including episodic, relapse, remission, and fluctuation. We included articles published between 2004–2014 that described health challenges and the episodic nature of the illness. Data were extracted from selected articles, including the authors, date of publication, study population, the aims of the study, outcome measures and main study findings, and then were charted and collated to the dimensions of disability in the episodic disability framework. The descriptive words about symptoms/impairments, difficulty in day to day functioning, challenges to social inclusion and uncertainty were compared across illnesses to identify similarities and differences. We reported findings as a narrative summation. Forty-seven articles were included in this review. The comparison of the three chronic illnesses demonstrated that some of the symptoms/impairments such as pain, fatigue, sleep disturbance, depression, stress, and anxiety were reported commonly across illnesses. Similarly, difficulty with day to day functioning, challenges to social inclusion and uncertainty were reported across illnesses. On the other hand, factors influencing the symptoms, difficulties in daily functioning, challenges to social inclusion and uncertainty were found to be different. The episodic nature of the illness was identified among the three chronic conditions. People living with FM or MS or HIV, experience some common dimensions of disability that may be similarly experienced as episodic in nature. These similarities may not be exclusive to these three chronic illnesses, but could apply to individuals living with other chronic and episodic illnesses. Pursuing ways to enhance rehabilitation services among the conditions that experience similar episodic disability may help collectively to address disability and improve the overall health of people living with chronic illnesses.

We describe salient individual and organizational factors that influenced engagement of registered nurses in a 12-month clinical mentorship intervention on HIV care in Canada. The intervention included 48 nurses and 8 people living with HIV (PLWH) who were involved in group-based and one-on-one informal mentorship informed by transformative learning theory. We evaluated the process of implementing the mentorship intervention using qualitative content analysis. The inclusion of PLWH as mentors, the opportunities for reciprocal learning, and the long-term commitment of individual nurses and partner organizations in HIV care were major strengths. Challenges included the need for multiple ethical approvals, the lack of organizational support at some clinical sites, and the time commitment required by participants. We recommend that clinical mentorship interventions in HIV care consider organizational support, adhere to the Greater Involvement of People Living with HIV/AIDS principles, and explore questions of professional obligations.

This qualitative longitudinal study examined the experiences of people living with HIV who engaged in a structured community-based exercise (CBE) program under the supervision of a fitness coach. Twenty people living with HIV were invited to participate in 3 semi-structured interviews over time. Participants engaged in exercise 3 times per week for 6 months with one weekly session supervised by a coach. Interviews were audio-recorded, transcribed verbatim and underwent longitudinal thematic analyses. Eleven participants were included representing a total of 30 interviews. Participants valued their experiences with the CBE program, particularly the motivation provided by the coach. Concerns about the environment, stigma and episodic health challenges affected their overall experience. To foster independence and promote self-management, health providers should consider these findings when encouraging CBE with people living with HIV. It is important to understand their goals and offer a variety of exercise options to meet their needs.

This paper describes the design and novel features of an evidence- and theory-informed client activation intervention to increase the capacity of people living with HIV to: 1) self-manage their health-related challenges using rehabilitation strategies, and 2) communicate their rehabilitation needs to their healthcare providers to improve access to rehabilitation. Building on social-cognitive theory and evidence, the intervention is a community-based workshop to develop knowledge and skills of people living with HIV to advocate for rehabilitation services. Novel features include engagement of community-based organisations in a train-the-trainer delivery model, a problem-based learning design to promote problem-solving and application, and a focus on client-centred practice. The intervention is flexible and adaptable. Health providers in other countries and contexts could use the pedagogical features to develop a workshop to meet their local needs. Given that most knowledge transfer interventions aim to change health provider behaviour, the focus on teaching people living with HIV to advocate for referral to rehabilitation is unique. The workshop model may be of interest to those in communities where access to rehabilitation for people living with HIV can be limited due to a lack of knowledge of the potential role of rehabilitation.

Author(s): Montoya, Jessica L; Jankowski, Catherine M; O'Brien, Kelly K; Webel, Allison R; Oursler, Krisann K; Henry, Brook L; Moore, David J; Erlandson, Kristine M

Background This objective of this umbrella review was to summarize the evidence on safety, efficacy, and effectiveness of human papillomavirus (HPV) vaccines in the general population. Methods The authors conducted a literature search and selected systematic reviews if they were published from January 2006 through November 2018, included randomized controlled trials or observational studies, related to the general population, and evaluated HPV vaccine–related clinical outcomes. The authors independently and in duplicate screened literature, extracted data, and appraised reviews using AMSTAR 2, a critical appraisal tool for systematic reviews. Results The authors selected 30 systematic reviews that included male and female participants aged 9 through 76 years from multiple countries. Reviews evaluated postvaccine seroconversion, HPV infection rates, precancerous or benign lesions, and adverse events; none of the researchers reported on oral or oropharyngeal lesions. Results from the reviews showed that, compared with those who received a placebo or non–HPV-type vaccine, HPV-vaccinated participants had statistically significantly higher rates of seroconversion and local adverse events, statistically significantly lower rates of HPV infection and condylomata lesions, and decreased rates of HPV-related precancerous lesions, which did not always attain statistical significance. Conclusions Systematic reviews have found evidence that the available HPV vaccines are safe, effective, and efficacious against vaccine-type HPV infection and HPV-associated cellular changes, including precancerous and benign lesions. Practical Implications Dentists may use this resource to better understand the literature on the potential harms and benefits of HPV vaccination.

Objective: To examine the type and frequency of living strategies used by adults living with HIV. Methods: We conducted a cross-sectional web-based survey that included 51 living strategies: maintaining sense of control, attitudes and beliefs, blocking HIV out of the mind, and social interaction. We examined the frequency of use and compared the proportion of respondents who engaged in strategies across 3 age-groups (Results: Of the 935 participants, the majority were men (79%) and most (≥60%) engaged “most” or “all of the time” in healthy lifestyle strategies and maintained a positive outlook living with HIV. Compared to younger participants, a higher proportion of older adults (≥50 years) engaged “most” or “all the time” in strategies that involved maintaining control over health and adopting positive attitudes and outlook living with HIV. Conclusions: Findings can help to inform the role of self-management to enhance successful aging with HIV.

Rationale, aims, and objectives A comprehensive electronic guide (e-module) describing an interprofessional, evidence-informed approach to HIV rehabilitation was developed as an education resource for rehabilitation professionals. We developed a guideline implementation tool, consisting of a 10-week, case-based education intervention delivered by email, that was perceived to increase rehabilitation professionals' (occupational therapists (OTs), physical therapists (PTs), and speech language pathologists (SLPs)) knowledge and confidence to apply best practices in HIV rehabilitation. This study aimed to increase understanding of how the design of the guideline implementation tool facilitated increased awareness of and access to the e-module among rehabilitation professionals. Methods We conducted a single group intervention study with rehabilitation professionals in Canada and the United Kingdom. Six case studies targeting HIV pathophysiology and associated conditions, an interprofessional approach to rehabilitation assessment and treatment, and psychosocial issues experienced by people living with HIV, were emailed to participants at 2-week intervals. Individual semi-structured interviews were conducted post-intervention. Interview transcripts were analysed using a descriptive qualitative approach. Results Twenty-six individuals (17 from Canada, and 9 from the UK; 16 PTs, 7 OTs, 3 SLPs) were interviewed. One main theme related to design features of the intervention that facilitated learning and access to the e-module emerged. Subthemes highlighted features of the case-based intervention, including technical feasibility, terminology, formatting and layout, hyperlinks, number and frequency of case studies, and diverse and realistic case scenarios relevant to the learner's practice, that participants described as facilitating access to information and learning. Conclusion Electronically administered case studies were perceived as complementary knowledge tools that increased access to an evidence-informed guide to HIV rehabilitation. Findings provide guidance on using case studies as a guideline implementation tool to facilitate access to information and related resources to optimize learning.

Objectives To examine the episodic disability experiences of older women living with HIV over time. Design Qualitative longitudinal study, conducting semistructured in-depth interviews on four occasions over a 20-month time frame. Inductive thematic analyses were conducted cross-sectionally and longitudinally. Setting Participants were recruited from HIV community organisations in Canada. Participants 10 women aged 50 years or older living with HIV for more than 6 years. Results Two major themes related to the episodic nature of the women’s disability. Women were living with multiple and complex sources of uncertainty over time including: unpredictable health challenges, worrying about cognition, unreliable weather, fearing stigma and the effects of disclosure, maintaining housing and adequate finances, and fulfilling gendered and family roles. Women describe strategies to deal with uncertainty over time including withdrawing and limiting activities and participation and engaging in meaningful activities. Conclusions This longitudinal study highlighted the disabling effects of HIV over time in which unpredictable fluctuations in illness and health resulted in uncertainty and worrying about the future. Environmental factors, such as stigma and weather, may put older women living with HIV at a greater risk for social isolation. Strategies to promote dealing with uncertainty and building resilience are warranted.

HIV-associated neurocognitive disorder (HAND) is common, but the lived experience of HAND is not well-understood. In this descriptive qualitative study, we explored how adults with HAND view, manage, and obtain support for cognitive difficulties. We interviewed 25 participants (20% female; median age = 51 years) who were diagnosed with HAND using neuropsychological assessment and a clinical interview. Semistructured interviews, co-developed with community members living with HIV, focused on how cognitive difficulties manifested and progressed, impacted well-being, and were discussed with others. We analyzed interview transcripts using a team-based, thematic approach. Participants described concentration, memory, and multitasking difficulties that fluctuated over time, as well as potential risk factors, management strategies, and psychosocial consequences. They reported they seldom discussed cognitive impairment with health care professionals, and that receiving a HAND diagnosis was validating, informative, yet somewhat disconcerting. Conversations between health care professionals and people living with HIV about HAND may provide opportunities for education, assessment, and support.

People living with HIV may experience disability which is episodic in nature, characterized by periods of wellness and illness. The purpose of this longitudinal qualitative study was to understand how the episodic nature of HIV and the associated uncertainty shape the disability experience of older adults living with HIV over time. Fourteen men and 10 women who were HIV positive and over 50 years (mean age: 57 years; range: 50-73) participated in 4 interviews over 20 months. Longitudinal analyses of the transcribed interviews identified 4 phenotypes of episodic disability over time: decreasing, increasing, stable, or significant fluctuations. Although all participants experienced uncertainty, acceptance and optimism were hallmarks of those whose phenotypes were stable or improved over time. Understanding a person’s episodic trajectory may help to tailor interventions to promote stability, mitigate an upward trajectory of increasing disability, and increase the time between episodes of illness.

Qualitative research methods are important tools that are frequently underused in medical research, particularly in systemic sclerosis (scleroderma, SSc) research. In this issue of The Journal , Nakayama, et al report a thematic synthesis of qualitative studies of patients’ perspectives and experiences living with SSc1. This editorial serves as a brief introduction to qualitative research, addressing the questions: What is it? How is it used? How is it different from quantitative research? What are key indicators of its rigor? Quantitative research is a form of study design that uses statistical methods or other means of quantification to address a research question. It involves deductive approaches and hypothesis testing to approximate the truth and handling of uncertainty2. Quantitative methods generally evaluate participants in settings removed from the natural environment (e.g., randomized controlled trials) and attempts are made to control for confounding factors. In contrast, qualitative research is a form of study design that uses systematic and reproducible methods to explore experiences, behaviors, and beliefs about a concept or phenomenon. Qualitative research commonly involves interpretative forms of analysis in which the unit of study is often a participant’s experienced reality3. Results are a representation of reality rather than an approximation of the truth (see Table 1). View this table: Table 1. Comparison of quantitative and qualitative methods. Qualitative methods may be preferable if one wishes to develop a new theory, explore an unknown phenomenon, evaluate the meaning of a concept, or understand a phenomenon. Qualitative research can provide more detailed descriptions and nuanced understanding of a concept, in contrast to a “cause and effect” relationship. A qualitative approach may facilitate a more in-depth understanding of quantitative results, answering “what … Address correspondence to Dr. S.R. Johnson, Division of Rheumatology, Ground Floor, East Wing, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada. E-mail: Sindhu.Johnson{at}uhn.on.ca

Since the advent of antiretrovirals, people with HIV are living longer and have improved quality of life. However, 30-60% of these individuals experience cognitive impairment. Fortunately, physical activity has emerged as a management strategy for cognitive impairment.To map the evidence on physical activity and cognition in HIV.We searched five databases using terms related to physical activity and HIV. Two authors independently reviewed titles and abstracts for studies that addressed physical activity/exercise and cognition in people with HIV. Authors reviewed full texts to identify articles that met our inclusion criteria. One author extracted the data, then we collated the results and summarized the characteristics of included studies.Sixteen studies from high-income countries were included; eight were interventional (five randomized controlled trials and three pre-post single group observational studies) and eight were non-interventional studies. The interventional studies included aerobic, resistive, and Tai Chi exercise for 8 weeks to 12 months in duration. Two of eight interventional studies found exercise to benefit self-reported cognition. All eight non-interventional studies showed a positive relationship between physical activity and cognitive function.Results of this study suggest that physical activity may preserve or improve cognition in people living with HIV. Implications for Rehabilitation Physical activity may play a role in preserving or improving cognition in the human immunodeficiency virus population. Exercise should be prescribed for people with human immunodeficiency virus based on the stage of infection. Rehabilitation professionals should follow current exercise guidelines when prescribing exercise for people living with human immunodeficiency virus.

As people living with HIV (PLWH) live longer, increased understanding of individuals’ values and perceptions of successful aging can assist health providers in working with PLWH to set meaningful goals as they age. The purpose of this qualitative study was to understand how PLWH define successful aging and their perceptions of contributors to successful aging. Fourteen men and ten women over the age of 50 years (mean age 57 years; mean time since diagnosis 18 years) participated in individual interviews. Interviews were analyzed using directed content analysis. Six themes emerged: accepting limitations, staying positive, maintaining social supports, taking responsibility, living a healthy lifestyle, and engaging in meaningful activities. The participants emphasized individual control. This highlights the importance of working with PLWH to understand their values and aspirations, and create patient-centered goals. From a research perspective this reinforces calls to include the subjective experiences of older adults in developing successful aging criteria.

The objective of this study is to describe the collaborative development of a rehabilitation guide for people living with human immunodeficiency virus (HIV) which was adapted from an online resource for clinicians.We adapted a comprehensive evidence-informed online clinical resource for people living with HIV using a three-phase participatory process. In Phase 1, we interviewed 26 clinicians and 16 people living with HIV to gather recommendations on how to adapt and format the content to benefit people living with HIV. In Phase 2, we adapted the patient education resource using the recommendations that emerged from Phase 1. Phase 3 consisted of comprehensive stakeholder review of the revised resource on the adaptability, usability, communicability, and relevance of the information. Stakeholders participated in an interview to obtain in-depth information on their perspectives. Transcribed interviews underwent qualitative content analysis.Stakeholders indicated that the e-guide had utility for people living with HIV, community HIV service organizations, and care providers.Engaging people living with HIV resulted in a more relevant and meaningful resource that incorporated patients' values, needs, and preferences.Involving multiple stakeholders and user groups in the adaptation and evaluation of online patient education resources can assist in meeting patients' needs through increasing the relevance, organization and presentation of the content, and incorporating patients' values and needs. Implications for Rehabilitation Online patient education resources should be adapted in order to maximize relevance and meaningfulness to patients. Involving multiple stakeholders in the adaptation and evaluation of online patient education resources can assist in meeting patients' needs. Involving multiple stakeholders increases the relevance, organization and presentation of the content and allows the incorporation of patient values and needs. This collaborative approach with an emphasis on meaningful participation of patients and community may be of interest to others interested in promoting knowledge translation.

Objective: To identify factors to consider for developing and implementing a community-based exercise (CBE) program for people living with HIV (PLWH). Methods: We conducted a qualitative descriptive study using semi-structured interviews with PLWH, rehabilitation professionals, and recreation providers from Canada and the United Kingdom. We asked participants to describe their experience with exercise, facilitators, and barriers to accessing and participating in exercise, and factors to consider in developing a CBE program for PLWH. Interviews were analyzed using content analytical techniques. Results: We developed a Framework of CBE in the Context of HIV that describes (1) exercise experiences of PLWH (nature of exercise, motivators for initiating or sustaining exercise, perceived benefits, and barriers and facilitators to exercise) and (2) 11 factors to consider in developing and implementing a CBE program for PLWH. Conclusion: Recommendations for the development and implementation of an accessible and feasible CBE program may enhance exercise participation among PLWH.

Background HIV is increasingly considered a chronic illness. More individuals are living longer and aging with the health-related consequences associated with HIV and multi-morbidity. Exercise is a self-management approach that can promote health for people aging with HIV. We examined the safety and effectiveness of progressive resistive exercise (PRE) interventions on immunological, virological, cardiorespiratory, strength, weight, body composition, and psychological outcomes in adults living with HIV. Methods We conducted a systematic review using the Cochrane Collaboration protocol. Searching databases up to April 2013, we included randomized controlled trials that compared PRE with no exercise or another intervention performed at least three times per week for at least four weeks with adults living with HIV. Two reviewers independently determined study eligibility. We extracted data from included studies and assessed risk of bias using the Cochrane Collaboration risk of bias tool. Meta-analyses were conducted using random effects models with Review Manager (RevMan) computer software. Results Twenty studies met inclusion criteria (n = 764 participants at study completion); the majority of participants were men (77%) taking antiretroviral therapy (14/20 included studies). Exercise interventions included PRE alone (8 studies) or a combination of resistive and aerobic exercise (12 studies) ranging from 6 to 52 weeks in duration. Thirty-four meta-analyses were performed. Results demonstrated statistically significant improvements in cardiorespiratory status (maximum oxygen consumption, exercise time), strength (chest press, knee flexion), weight, and body composition (arm and thigh girth, leg muscle area) among exercisers versus non-exercisers. We found no significant differences in change in CD4 count and viral load. We were unable to perform meta-analyses for psychological outcomes however results from individual studies demonstrated improvements in health-related quality of life with exercisers compared with non-exercisers. Conclusions Performing progressive resistive exercise (PRE) or a combination of resistive and aerobic exercise at least three times per week for at least six weeks is safe and can lead to improvements in cardiorespiratory fitness, strength, weight, and body composition for adults with HIV. Exercise may be considered a safe and beneficial for enhancing the health of medically stable adults aging with HIV. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2342-8) contains supplementary material, which is available to authorized users.

Objectives Our aim was to explore the experiences of engaging in a community-based exercise programme (CBEP) from the perspective of people living with HIV (PLWH). Design We conducted a descriptive qualitative study using semistructured interviews. Setting We recruited adults living with HIV who participated in a 16-week CBEP in Toronto, Canada. Participants 11 participants, the majority men (64%), with a median age of 52 years, and living with a median of 5 concurrent health conditions in addition to HIV participated in the study. Outcome measures We asked participants about their overall experiences: strengths, limitations and perceived benefits of the CBEP; factors influencing participation and current level of exercise after completion of the CBEP. We administered a self-reported demographic questionnaire followed by the Rapid Assessment of Physical Activity (RAPA) questionnaire. We analysed interview data using thematic analysis. Results We developed a framework that describes the experiences before, during and after the CBEP; and the perceived impact of the CBEP on health, which influenced the intent to, engagement in and sustainability of exercise among PLWH. Participants described the positive impact of the CBEP on their physical, mental and social health. Interviews were completed at a median of 6 months after the CBEP, when 9 participants reported ongoing engagement in exercise, but to a lesser extent than during the CBEP. Intrinsic and extrinsic factors facilitated or hindered engagement in exercise throughout all phases of the CBEP. The episodic nature of HIV and multimorbidity influenced engagement in exercise and posed challenges to re-engagement after periods of inactivity. Conclusions CBEPs provide an opportunity to enhance physical activity, perceived health outcomes and knowledge about exercise for PLWH. Community-based exercise is a strategy that may be used by health providers to promote engagement in sustained physical activity for PLWH.

Purpose: To explore communication-related experiences with accessing and participating in community-based exercise programmes from the perspective of adults with post-stroke aphasia. Methods: Adults with mild to severe post-stroke aphasia were recruited from the Aphasia Institute (AI), Toronto, Canada, for a qualitative descriptive study using semi-structured, in-depth one-on-one interviews. Participants were asked to identify facilitators of, barriers to, and strategies for joining and participating in exercise programmes. Interview data were analyzed using conventional content analysis. Results: Ten adults with mild (40%), moderate (40%), or severe (20%) aphasia participated in this study. The majority of participants were men (60%) aged 60–69 years (40%). Participants experienced a combination of communication, environmental, and personal facilitators of and barriers to accessing and participating in community-based exercise programmes. Strategies to enhance participation can be applied at both programme and individual levels. Conclusions: Findings may inform clinical practice and programming to optimize access to and participation in community-based exercise programmes for adults with post-stroke aphasia.

Diamond Blackfan anemia (DBA), a syndrome primarily characterized by anemia and physical abnormalities, is one among a group of related inherited bone marrow failure syndromes (IBMFS) which share overlapping clinical features. Heterozygous mutations or single-copy deletions have been identified in 12 ribosomal protein genes in approximately 60% of DBA cases, with the genetic etiology unexplained in most remaining patients. Unlike many IBMFS, for which functional screening assays complement clinical and genetic findings, suspected DBA in the absence of typical alterations of the known genes must frequently be diagnosed after exclusion of other IBMFS. We report here a novel deletion in a child that presented such a diagnostic challenge and prompted development of a novel functional assay that can assist in the diagnosis of a significant fraction of patients with DBA. The ribosomal proteins affected in DBA are required for pre-rRNA processing, a process which can be interrogated to monitor steps in the maturation of 40S and 60S ribosomal subunits. In contrast to prior methods used to assess pre-rRNA processing, the assay reported here, based on capillary electrophoresis measurement of the maturation of rRNA in pre-60S ribosomal subunits, would be readily amenable to use in diagnostic laboratories. In addition to utility as a diagnostic tool, we applied this technique to gene discovery in DBA, resulting in the identification of RPL31 as a novel DBA gene.

Background An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated clinical recommendations for the urgent management of symptomatic irreversible pulpitis with or without symptomatic apical periodontitis, pulp necrosis and symptomatic apical periodontitis, or pulp necrosis and localized acute apical abscess using antibiotics, either alone or as adjuncts to definitive, conservative dental treatment (DCDT) in immunocompetent adults. Types of Studies Reviewed The authors conducted a search of the literature in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to retrieve evidence on benefits and harms associated with antibiotic use. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and the Evidence-to-Decision framework. Results The panel formulated 5 clinical recommendations and 2 good practice statements, each specific to the target conditions, for settings in which DCDT is and is not immediately available. With likely negligible benefits and potentially large harms, the panel recommended against using antibiotics in most clinical scenarios, irrespective of DCDT availability. They recommended antibiotics in patients with systemic involvement (for example, malaise or fever) due to the dental conditions or when the risk of experiencing progression to systemic involvement is high. Conclusion and Practical Implications Evidence suggests that antibiotics for the target conditions may provide negligible benefits and probably contribute to large harms. The expert panel suggests that antibiotics for target conditions be used only when systemic involvement is present and that immediate DCDT should be prioritized in all cases.

Background The purpose of this systematic review was to determine the potential effect of dental treatment before cardiac valve surgery (CVS) or left ventricular assist device (LVAD) implantation on morbidity and mortality. Types of Studies Reviewed The authors included relevant studies from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, including randomized controlled trials and cohort studies, published from 1998 through 2019 and involving adults who received dental treatment before CVS or LVAD implantation. The authors assessed bias by using the Newcastle-Ottawa Quality Assessment Scale and evidence certainty by using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors used a meta-analysis with a random-effects model to estimate dichotomous and continuous outcomes, expressed as relative risk (RR) and weighted mean difference. Results Six studies met the inclusion criteria for CVS but none for LVAD implantation. Very low certainty in the evidence suggested uncertainty as to whether health outcomes for patients undergoing dental treatment before CVS differed from those who did not. Postsurgical outcomes included all-cause mortality (RR, 1.00; 95% confidence interval [CI], 0.53 to 1.91), infective endocarditis (RR, 1.30; 95% CI, 0.51 to 3.35), postsurgical infection (RR, 1.01; 95% CI, 0.76 to 1.33), and length of stay in the hospital (weighted mean difference, 2.9; 95% CI, −2.3 to 8.1). Conclusions and Practical Implications From the available evidence, it is unclear whether postoperative outcomes differ in patients receiving dental treatment before CVS compared with outcomes in those who do not. Dentists and medical care professionals should collaborate on an appropriate course of action for each patient, weighing any potentially relevant care considerations.

ObjectivesTo examine the living strategies used by older men living with HIV to deal with the episodic nature of disability and associated uncertainty, over time.DesignQualitative longitudinal study in which men living with HIV were interviewed on four occasions over 20 months.SettingMen were recruited from HIV community organisations in Canada.Participants14 men with a median age of 57.5 years and median time since diagnosis of 21.5 years.ResultsFive themes depict the living strategies used to deal with the episodic nature of disability and uncertainty over time. Actively engaging in problem-solving by prioritising and modifying activities and avoiding stress, advocating for support, being positive and future oriented, engaging in healthy pursuits and providing social support to others helped men to mitigate their disability. By following participants over time, we were able to gather insights into triggers of episodes of disability, and perceptions of the success of implementing their living strategies and avoiding uncertainty.ConclusionsParticipants used living strategies to deal with uncertainty and mitigate episodes of disability over time. This study supports the importance of programmes that promote self-management for older men living with HIV through helping them identify triggers of disability, set realistic goals and problem-solve. These may help build self-efficacy, increase sense of control, and decrease feelings of uncertainty and episodes of disability.

Background Despite lower mortality rates due to combination antiretroviral therapy, people living with HIV (PLWH) are grappling with increasingly complex health issues, including cognitive impairments in areas such as memory, attention, processing speed, and motor function. Yoga has been shown to be an effective form of exercise and mindfulness-based stress reduction for many clinical populations. However, no randomized trials have evaluated the impact of yoga on cognitive and physical function among PLWH. Objective The aim of this pilot randomized trial was to determine the feasibility of a yoga intervention to lay the groundwork for a full-scale, multisite, community-based trial for PLWH. Specific objectives are to (1) assess the feasibility of study protocol and procedures, (2) compare cognition in the yoga group with the usual care control group after 12 weeks of the intervention in PLWH, and (3) compare the effects of the 12-week yoga intervention versus control on balance, walking speed, physical activity, mental health, medication adherence, and quality of life among PLWH. Methods We propose a pilot randomized trial with 2 parallel groups (yoga versus control). We will recruit 25 PLWH (>35 years) from community and health organizations in Halifax, Canada. After baseline assessment with blinded assessors, participants will be randomly assigned to the yoga or control group, using a random computer generator. Participants in the yoga group will engage in supervised 60-min group-based yoga sessions 3 times a week for 12 weeks at a yoga studio. Participants in the control group will maintain their current physical activity levels throughout the study. Results As per the Consolidated Standards of Reporting Trials extension for pilot studies, means of all outcomes, mean change, and 95% CIs will be calculated for each group separately. Two-tailed independent t tests and Fisher exact tests will be used to compare groups at baseline. We will analyze quantitative postintervention questionnaire responses using Chi-square tests, and open-ended responses will be analyzed thematically. Intention-to-treat and per-protocol analyses will be used to analyze secondary variables. Changes in outcome variables will be examined between groups and within groups. Effect sizes will be reported for each outcome. A priori adherence and satisfaction criteria will be met if participants attend >70% of the yoga sessions and if >70% of the participants are satisfied with the intervention as determined by a postparticipation questionnaire. Study enrollment began in January 2018, with results expected for October 2019. Conclusions This pilot randomized trial will be the first to investigate the feasibility and effect of a yoga intervention on cognitive and physical outcomes among PLWH. This work will inform the feasibility of further investigations in terms of capacity building, participant recruitment and retention, and assessment and intervention protocols. Trial registration ClinicalTrials.gov NCT03071562; https://clinicaltrials.gov/ct2/show/NCT03071562 (Archived by WebCite at http://www.webcitation.org/785sfhWkw). International registered report identifier (irrid) DERR1-10.2196/13818.

Integrins have a critical role in thrombosis and haemostasis. Antagonists of the platelet integrin αIIbβ3 are potent anti-thrombotic drugs, but also have the life-threatening adverse effect of causing bleeding. It is therefore desirable to develop new antagonists that do not cause bleeding. Integrins transmit signals bidirectionally. Inside-out signalling activates integrins through a talin-dependent mechanism. Integrin ligation mediates thrombus formation and outside-in signalling, which requires Gα13 and greatly expands thrombi. Here we show that Gα13 and talin bind to mutually exclusive but distinct sites within the integrin β3 cytoplasmic domain in opposing waves. The first talin-binding wave mediates inside-out signalling and also ligand-induced integrin activation, but is not required for outside-in signalling. Integrin ligation induces transient talin dissociation and Gα13 binding to an EXE motif (in which X denotes any residue), which selectively mediates outside-in signalling and platelet spreading. The second talin-binding wave is associated with clot retraction. An EXE-motif-based inhibitor of Gα13-integrin interaction selectively abolishes outside-in signalling without affecting integrin ligation, and suppresses occlusive arterial thrombosis without affecting bleeding time. Thus, we have discovered a new mechanism for the directional switch of integrin signalling and, on the basis of this mechanism, designed a potent new anti-thrombotic drug that does not cause bleeding.

It has been shown that belonging has a significant impact on a range of factors associated with wellbeing. These factors include general life satisfaction, cognitive performance, academic work and physical health. These associations have been demonstrated across a range of settings, including secondary schools. This paper provides an overview of belonging and its importance in secondary schools.

Background. As adults age with human immunodeficiency virus (HIV), the role for rehabilitation continues to emerge. Understanding how social participation is affected among women aging with HIV can inform occupational therapy assessment and treatment. Purpose. Our purpose was to develop a theoretical model that describes the experiences of social participation from the perspective of older women living with HIV. Method. A grounded theory methodological approach was utilized. We conducted interviews with 20 women living with HIV, age 50 or older, to explore various aspects of social participation, including self-care, relationships with others, and access to health and social services. Emergent themes informed the theoretical model. Findings. The theoretical model comprises four concepts related to social participation: social engagement, social isolation, contrasting perceptions about factors variably influencing participation, and contextual influences that may enhance or hinder social participation. Implications. Women aging with HIV experience social participation as a dynamic process involving social engagement and isolation. Contextual influences may promote and impede social participation.

Diamond-Blackfan anemia (DBA) is a congenital bone marrow failure syndrome characterized by erythroid hypoplasia, usually without perturbation of other hematopoietic lineages. Approximately 65% of DBA patients with autosomal dominant inheritance have heterozygous mutations or deletions in ribosomal protein (RP) genes while

Introduction Our aim was to evaluate a community-based exercise (CBE) intervention with the goal of reducing disability and enhancing health for community-dwelling people living with HIV (PLWH). Methods and analysis We will use a mixed-methods implementation science study design, including a prospective longitudinal interrupted time series study, to evaluate a CBE intervention with PLWH in Toronto, Canada. We will recruit PLWH who consider themselves medically stable and safe to participate in exercise. In the baseline phase (0–8 months), participants will be monitored bimonthly. In the intervention phase (8–14 months), participants will take part in a 24-week CBE intervention that includes aerobic, resistance, balance and flexibility exercise at the YMCA 3 times per week, with weekly supervision by a fitness instructor, and monthly educational sessions. In the follow-up phase (14–22 months), participants will be encouraged to continue to engage in unsupervised exercise 3 times per week. Quantitative assessment: We will assess cardiopulmonary fitness, strength, weight, body composition and flexibility outcomes followed by the administration of self-reported questionnaires to assess disability and contextual factor outcomes (coping, mastery, stigma, social support) bimonthly. We will use time series regression analysis to determine the level and trend of outcomes across each phase in relation to the intervention. Qualitative assessment: We will conduct a series of face-to-face interviews with a subsample of participants and recreation providers at initiation, midpoint and completion of the 24-week CBE intervention. We will explore experiences and anticipated benefits with exercise, perceived impact of CBE for PLWH and the strengths and challenges of implementing a CBE intervention. Interviews will be audio recorded and analysed thematically. Ethics and dissemination Protocol approved by the University of Toronto HIV/AIDS Research Ethics Board. Knowledge translation will occur with stakeholders in the form of presentations and publications in open access peer-reviewed journals. Trial registration number NCT02794415; Pre-results.

Background Scoping studies (or reviews) are a method used to comprehensively map evidence across a range of study designs in an area, with the aim of informing future research practice, programs and policy. However, no universal agreement exists on terminology, definition or methodological steps. Our aim was to understand the experiences of, and considerations for conducting scoping studies from the perspective of academic and community partners. Primary objectives were to 1) describe experiences conducting scoping studies including strengths and challenges; and 2) describe perspectives on terminology, definition, and methodological steps. Methods We conducted a cross-sectional web-based survey with clinicians, educators, researchers, knowledge users, representatives from community-based organizations, graduate students, and policy stakeholders with experience and/or interest in conducting scoping studies to gain an understanding of experiences and perspectives on the conduct and reporting of scoping studies. We administered an electronic self-reported questionnaire comprised of 22 items related to experiences with scoping studies, strengths and challenges, opinions on terminology, and methodological steps. We analyzed questionnaire data using descriptive statistics and content analytical techniques. Survey results were discussed during a multi-stakeholder consultation to identify key considerations in the conduct and reporting of scoping studies. Results Of the 83 invitations, 54 individuals (65 %) completed the scoping questionnaire, and 48 (58 %) attended the scoping study meeting from Canada, the United Kingdom and United States. Many scoping study strengths were dually identified as challenges including breadth of scope, and iterative process. No consensus on terminology emerged, however key defining features that comprised a working definition of scoping studies included the exploratory mapping of literature in a field; iterative process, inclusion of grey literature; no quality assessment of included studies, and an optional consultation phase. We offer considerations for the conduct and reporting of scoping studies for researchers, clinicians and knowledge users engaging in this methodology. Conclusions Lack of consensus on scoping terminology, definition and methodological steps persists. Reasons for this may be attributed to diversity of disciplines adopting this methodology for differing purposes. Further work is needed to establish guidelines on the reporting and methodological quality assessment of scoping studies. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1579-z) contains supplementary material, which is available to authorized users.

BACKGROUND: Librarians often teach evidence-based practice (EBP) within health sciences curricula. It is not known what teaching methods are most effective. METHODS: A systematic review of the literature was conducted searching CINAHL, EMBASE, ERIC, LISTA, PubMed, Scopus, and others. Searches were completed through December 2014. No limits were applied. Hand searching of Medical Library Association annual meeting abstracts from 2009–2014 was also completed. Studies must be about EBP instruction by a librarian within undergraduate or graduate health sciences curricula and include skills assessment. Studies with no assessment, letters and comments, and veterinary education studies were excluded. Data extraction and critical appraisal were performed to determine the risk of bias of each study. RESULTS: Twenty-seven studies were included for analysis. Studies occurred in the United States (20), Canada (3), the United Kingdom (1), and Italy (1), with 22 in medicine and 5 in allied health. Teaching methods included lecture (20), small group or one-on-one instruction (16), computer lab practice (15), and online learning (6). Assessments were quizzes or tests, pretests and posttests, peer-review, search strategy evaluations, clinical scenario assignments, or a hybrid. Due to large variability across studies, meta-analysis was not conducted. DISCUSSION: Findings were weakly significant for positive change in search performance for most studies. Only one study compared teaching methods, and no one teaching method proved more effective. Future studies could conduct multisite interventions using randomized or quasi-randomized controlled trial study design and standardized assessment tools to measure outcomes. DATA FILES: In September 2017, the team was asked by the Journal of the Medical Library Association Editorial Board "if they would send [the JMLA Editorial Board] working group the data that would be needed to reproduce the results described in their articles" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886497/). The team identified the study data files, cleaned them, and sent them to JMLA. However, as this was simply a query and experiment by the Editorial Board, the files were not added to the published article. As these files are now prepared for sharing, they have been added to this study's VTechWorks institutional repository record in August, 2018.

Purpose The aim of this study was to conduct a preliminary investigation into parents' experiences of physical therapy and early mobility (EM) for their children in a pediatric critical care unit (PCCU). Methods We conducted a series of four qualitative case studies using in-depth semi-structured face-to-face interviews. We recruited parents of children who had undergone surgery and received at least one EM physical therapy intervention while intubated. We conducted a thematic analysis of transcribed interviews to illuminate the factors that influenced EM experiences. Results Four parents participated in the study. We developed an overview of Parental Experiences with Physical Therapy and Early Mobility in a PCCU, which includes four themes that parents believed influenced their experiences: (1) environmental factors; (2) awareness of physical therapist and health care professional (HCP) roles; (3) communication among parents and HCPs; and (4) parental participation in their child's EM, within the overarching parental experiences in the PCCU. Conclusion This study affords a preliminary understanding of parents' experiences with physical therapy and EM in a PCCU setting. Results provide an important foundation for future research on mobility in the context of pediatric critical care research and practice.

Objective: The purpose of this study was to investigate the relative effectiveness of three web-scale discovery (WSD) tools in answering health sciences search queries.Methods: Simple keyword searches, based on topics from six health sciences disciplines, were run at multiple real-world implementations of EBSCO Discovery Service (EDS), Ex Libris’s Primo, and ProQuest’s Summon. Each WSD tool was evaluated in its ability to retrieve relevant results and in its coverage of MEDLINE content.Results: All WSD tools returned between 50%–60% relevant results. Primo returned a higher number of duplicate results than the other 2WSD products. Summon results were more relevant when search terms were automatically mapped to controlled vocabulary. EDS indexed the largest number of MEDLINE citations, followed closely by Summon. Additionally, keyword searches in all 3 WSD tools retrieved relevant material that was not found with precision (Medical Subject Headings) searches in MEDLINE.Conclusions: None of the 3 WSD products studied was overwhelmingly more effective in returning relevant results. While difficult to place the figure of 50%–60% relevance in context, it implies a strong likelihood that the average user would be able to find satisfactory sources on the first page of search results using a rudimentary keyword search. The discovery of additional relevant material beyond that retrieved from MEDLINE indicates WSD tools’ value as a supplement to traditional resources for health sciences researchers.

Background : Involving community in development of clinical practice guidelines (CPGs) can decrease the gap between patient preferences and research evidence. Objective : To incorporate meaningful participation of people living with human immunodeficiency virus (HIV; people living with HIV [PHAs]) in the development of evidence informed recommendations for rehabilitation practice. Methods : PHAs were involved in a process to develop practice recommendations internally as members of a project team and externally through formal endorsement of the recommendations. Lessons Learned : Lessons learned include 1) providing time to develop as a team and understand the roles, biases, and expertise of each member, 2) engaging community in initial discussions to determine the most meaningful involvement, 3) realizing that participation in research may trigger anxiety and stress in community members, 4) developing terms of reference to clarify roles and expectations, 5) providing opportunities for skill development, and 6) conducting formal evaluation of the process and satisfaction of community. Conclusion : Meaningful inclusion of community can improve the quality of practice guidelines.

Objectives Our aim was to explore readiness to engage in exercise among people living with HIV and multimorbidity. Design We conducted a descriptive qualitative study using face-to-face semistructured interviews with adults living with HIV. Setting We recruited adults (18 years or older) who self-identified as living with HIV and 2 or more additional health-related conditions from a specialty hospital in Toronto, Canada. Participants 14 participants with a median age of 50 years and median number of 9 concurrent health-related conditions participated in the study. The majority of participants were men (64%) with an undetectable viral load (71%). Outcome measures We asked participants to describe their readiness to engage in exercise and explored how contextual factors influenced their readiness. We analysed interview transcripts using thematic analysis. Results We developed a framework to describe readiness to engage in exercise and the interplay of factors and their influence on readiness among adults with HIV and multimorbidity. Readiness was described as a diverse, dynamic and fluctuating spectrum ranging from not thinking about exercise to routinely engaging in daily exercise. Readiness was influenced by the complex and episodic nature of HIV and multimorbidity comprised of physical impairments, mental health challenges and uncertainty from HIV and concurrent health conditions. This key factor created a context within which 4 additional subfactors (social supports, perceptions and beliefs, past experience with exercise, and accessibility) may further hinder or facilitate an individual9s position along the spectrum of readiness to exercise. Conclusions Readiness to engage in exercise among people living with HIV is a dynamic and fluctuating construct that may be influenced by the episodic nature of HIV and multimorbidity and 4 subfactors. Strategies to facilitate readiness to exercise should consider the interplay of these factors in order to enhance physical activity and subsequently improve health outcomes of people with HIV and multimorbidity.

As individuals age with HIV it is increasingly important to consider the health-related consequences of HIV and multiple morbidities, known as disability. We assessed relationships between four dimensions of disability among adults living with HIV. We conducted a structural equation modeling analysis using data from 913 participants in the Ontario HIV Treatment Network Cohort Study to determine relationships between four latent variables of disability in the Episodic Disability Framework: physical symptoms and impairments, mental health symptoms and impairments, difficulties with day-to-day activities, and challenges to social inclusion. Results indicated that physical symptoms and impairments, mental health symptoms and impairments and difficulties with day-to-day activities directly or indirectly predicted challenges to social inclusion for adults living with HIV. Challenges to social inclusion were directly predicted by mental health symptoms and indirectly by physical health symptoms via (mediated by) having difficulties carrying out day-to-day activities and mental health symptoms and impairments. These findings provide a basis for conceptualizing disability experienced by people living with HIV.

Adults aged 65 and older constitute the “core business” of hospitals.1 Although they represent 13% of the population in the United States2 and 14% of the population in Canada,3 older adults account for 43% of inpatient hospital days in the United States4 and 40% in Canada.5 This trend is likely to continue given population aging.3 During hospitalization for an acute event such as illness or injury, older adults are at risk of experiencing functional decline and iatrogenic complications, including falls, pressure ulcers, and delirium, which further contribute to functional decline.6 Hospital-acquired functional decline is associated with greater hospital expenditures, institutionalization, and mortality in older adults7 even after controlling for comorbidity and illness severity.8 Therefore, early intervention (before an acute episode is resolved) is critical because of the short length of time during which older persons can recover functional losses, resume their former lives, and avoid institutionalization.9 Dedicated geriatric units, based on a prehabilitation10 and function-focused11 model of care called Acute Care for Elders (ACE), have been designed specifically to prevent functional decline and related complications in older adults admitted to the hospital for an acute event.12,13 In response to an increasingly older and complex hospital population, some service providers have adopted the ACE model on hospital units where older adults are admitted.13 However, the overall effect of acute geriatric unit care, based on all or part of the ACE model and introduced during the acute phase of illness or injury, is unclear and unquantified. Two systematic reviews of acute geriatric unit care based on the ACE model have been conducted,14,15 but the authors did not present results of meta-analyses, supporting the need for this current review. Three prior reviews combined data from studies conducted with individuals in the acute and subacute illness phases;14,16,17 the results have limited validity for individuals in the acute phase of an illness or injury. One meta-analysis18 imputed means for missing standard deviations for cost and length-of-stay outcomes in almost 30% of included studies,18 which may have resulted in an underestimation of the overall effect. Last, no meta-analysis of acute geriatric unit care included iatrogenic complications, which are critical indicators of quality hospital care.19 The purpose of this study was to determine the effectiveness of acute geriatric unit care, based on all or part of the ACE model components and introduced in the acute phase of illness or injury, in reducing iatrogenic complications, functional decline, length of hospital stay, poor discharge destination outcomes, mortality, costs, and hospital readmissions in older adults.

The Akt family of serine/threonine kinases includes Akt1, Akt2, and Akt3 isoforms. Prior studies have reported that Akt1 and Akt2, but not Akt3, are expressed in platelets. Here, we show that Akt3 is expressed in substantial amounts in platelets. Akt3−/− mouse platelets selectively exhibit impaired platelet aggregation and secretion in response to low concentrations of thrombin receptor agonists and thromboxane A2 (TXA2), but not collagen or VWF. In contrast, platelets from Akt1−/− or Akt2−/− mice are defective in platelet activation induced by thrombin, TXA2, and VWF, but only Akt1−/− platelets show significant defects in response to collagen, indicating differences among Akt isoforms. Akt3−/− platelets exhibit a significant reduction in thrombin-induced phosphorylation of glycogen synthase kinase 3β (GSK-3β) at Ser9, which is known to inhibit GSK-3β function. Thus, Akt3 is important in inhibiting GSK-3β. Accordingly, treatment of Akt3−/− platelets with a GSK-3β inhibitor rescued the defect of Akt3−/− platelets in thrombin-induced aggregation, suggesting that negatively regulating GSK-3β may be a mechanism by which Akt3 promotes platelet activation. Importantly, Akt3−/− mice showed retardation in FeCl3-induced carotid artery thrombosis in vivo. Thus, Akt3 plays an important and distinct role in platelet activation and in thrombosis.

Aims: This article describes a pilot programme aiming to identify the strengths and challenges associated with a human immunodeficiency virus (HIV) mentorship programme for rehabilitation professionals. Methods: This unique pilot programme incorporated elements of problem-based learning, interprofessionalism and multiple mentoring models. A group of five physiotherapy mentees met initially with three clinician mentors, and three mentors who were persons living with HIV, for a one day workshop to develop relationships, identify learning needs and engage in learning through discussion of case scenarios. Subsequently they met formally every month via teleconference, over a five-month period, followed by a final one-day workshop. Qualitative evaluation included interviews and focus group methodology. Transcripts from these were analyzed through qualitative content analyses. Findings: Participants viewed the mentorship programme positively, in particular the networks they were able to establish, and learning from the mentors living with HIV. However, barriers to participation were related to scheduling and lack of support to devote time to the programme from the mentees' clinical managers. Other challenges related to the mentees' limited opportunities to implement new knowledge, and to difficulties in engaging in informal mentorship activities. Conclusions: Lessons learned from this pilot programme are of value to those interested in developing HIV-related mentorship experiences for rehabilitation health professionals or for those in other emerging areas of practice.

Persons living with HIV (PLHIV) may experience disability. We compared disability among PLHIV in the United States and South Africa and investigated associations with health and demographic characteristics. Secondary analysis of cross-sectional data using medical records and questionnaires including the World Health Organization Disability Assessment Schedule (WHO-DAS) 2.0 12-item version (range: 0-36, with higher scores indicative of more severe disability). Between-country differences for the presence of disability were assessed with logistic regression and differences in severity using multiple regression. Eighty-six percent of US participants reported disability, compared to 51.3% in South Africa. The mean WHO-DAS score was higher in the United States (12.09 ± 6.96) compared to South Africa (8.3 ± 6.27). Participants with muscle pain, depression, or more years since HIV diagnosis were more likely to report disability. Being female or depressed was associated with more severity. Being adherent to anti-retroviral therapy (ART) and employed were associated with less severity. Because muscle pain and depression were predictive factors for disability, treatment of those problems may help mitigate disability in PLHIV.

In HIV clinical research, participants are typically sampled based on demographic and/or disease characteristics. As little is known about HIV-specific disability, we did not know whether this purposive type of sampling would be helpful and what characteristics (if any) should guide our sampling strategy. We describe using exploratory focus groups to determine a sampling strategy to investigate disability from the perspective of adults living with HIV. We conducted 4 focus groups with 23 men and women and asked participants to describe their health-related challenges and impact on their overall health. We analyzed data to determine whether health-related challenges differed based on age, gender, ethnocultural background, length of time since HIV diagnosis and antiretroviral use and if these characteristics should be considered when sampling. Participants described seven health-related challenges that appeared not to vary based on demographic or disease characteristics. Variations emerged in the way health-related challenges manifested and the strategies participants used to deal with these challenges. Consequently, we decided upon a broad theoretical sampling strategy for the subsequent interview phase. Exploratory focus groups may be a useful technique to determine a sampling strategy when exploring a new phenomenon in HIV qualitative research.

The purpose was to update an original systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). The original MEDLINE and CINAHL search to August 2003 was updated to January 2007 and EMBASE was searched from inception to January 2007. Randomized controlled trials, published in English, with adults with stable COPD, comparing IMT to sham IMT or no intervention, low versus high intensity IMT, and different modes of IMT were included. Nineteen of 274 articles in the original search met the inclusion criteria. The updated search revealed 17 additional articles; 6 met the inclusion criteria, all of which compared targeted, threshold or normocapneic hyperventilation IMT to sham IMT. An update of the sub-group analysis comparing IMT versus sham IMT was performed with 10 studies from original review and 6 from the update. Sixteen meta-analyses are reported. Results demonstrated significant improvements in inspiratory muscle strength (PI(max), PI(max) % predicted, peak inspiratory flow rate), inspiratory muscle endurance (RMET, inspiratory threshold loading, MVV), exercise capacity (Ve(max), Borg Score for Respiratory Effort, 6MWT), Transitional Dyspnea Index (focal score, functional impairment, magnitude of task, magnitude of effort), and the Chronic Respiratory Disease Questionnaire (quality of life). Results suggest that targeted, threshold or normocapneic hyperventilation IMT significantly increases inspiratory muscle strength and endurance, improves outcomes of exercise capacity and one measure of quality of life, and decreases dyspnea for adults with stable COPD.

The aim of this systematic review was to determine if eccentric exercise is superior to concentric exercise in stimulating gains in muscle strength and mass. Meta-analyses were performed for comparisons between eccentric and concentric training as means to improve muscle strength and mass. In order to determine the importance of different parameters of training, subgroup analyses of intensity of exercise, velocity of movement and mode of contraction were also performed. Twenty randomised controlled trials studies met the inclusion criteria. Meta-analyses showed that when eccentric exercise was performed at higher intensities compared with concentric training, total strength and eccentric strength increased more significantly. However, compared with concentric training, strength gains after eccentric training appeared more specific in terms of velocity and mode of contraction. Eccentric training performed at high intensities was shown to be more effective in promoting increases in muscle mass measured as muscle girth. In addition, eccentric training also showed a trend towards increased muscle cross-sectional area measured with magnetic resonance imaging or computerised tomography. Subgroup analyses suggest that the superiority of eccentric training to increase muscle strength and mass appears to be related to the higher loads developed during eccentric contractions. The specialised neural pattern of eccentric actions possibly explains the high specificity of strength gains after eccentric training. Further research is required to investigate the underlying mechanisms of this specificity and its functional significance in terms of transferability of strength gains to more complex human movements.

Purpose To determine the effect of inspiratory muscle training (IMT) (alone or combined with exercise and/or pulmonary rehabilitation) and compare with other rehabilitation interventions among adults with chronic obstructive pulmonary disease (COPD). Methods We conducted a systematic review, using Cochrane Collaboration protocol. We included randomized controlled trials, published in English, comparing IMT or combined IMT and exercise/pulmonary rehabilitation with other rehabilitation interventions among adults with COPD. Abstracts were reviewed independently by 2 investigators to determine study eligibility up to December 2005. Data were abstracted and methodological quality of included studies was assessed. Results A total of 156 additional articles were retrieved. Two new studies met the inclusion criteria and were included with 16 studies in the original review. Results highlight updated subgroup analyses comparing (1) IMT versus exercise and (2) combined IMT and exercise versus exercise alone. Fourteen meta-analyses were performed for outcomes of inspiratory muscle strength, exercise tolerance, and quality of life. Results showed significant improvements in maximum inspiratory pressure and maximum exercise tidal volume favoring combined IMT and exercise compared with exercise alone. Conclusions Performing a combination of IMT plus exercise may lead to significant improvements in inspiratory muscle strength and one outcome of exercise tolerance for individuals with COPD.

Purpose: This article provides an overview of factor analysis from the perspective of measurement in clinical research. Summary of Key Points: Factor analysis is a statistical technique that identifies interrelationships among a set of items in an instrument and/or questionnaire and groups them into homogeneous domains. Exploratory factor analysis can be used to reduce the number of items in a questionnaire and identify its underlying domains. Confirmatory factor analysis can be used to test a hypothesis about the domain structure of a questionnaire. Principal component analysis and common factor analysis are the most common techniques and differ based on the amount of variability that is analyzed among items. Steps of the factor analytical process include assessing correlation matrices, factor extraction, choosing the number of factors to retain, assessing the factor loading matrix, factor rotation and factor interpretation. Because no standardized method exists, factor analysis involves decision-making at each step. Conclusions: The different techniques and methods of factor analysis each have unique strengths and limitations. Clinicians and researchers reviewing articles on factor analysis should ensure that authors state a priori their purpose, conceptual approach, preferred technique and methods that will guide their decision-making.

Background : People with HIV face a variety of health-related challenges from HIV, concurrent health conditions, and side effects of treatment. These health-related challenges may be termed disability . Community involvement in conceptualizing and understanding disability is essential to developing appropriate measurement tools. Objective : To describe a community–academic partnership in the development of a new self-administered health status instrument, the HIV Disability Questionnaire (HDQ), using a community-engaged approach. Methods : With a Community Advisory Committee, we used categories from the Episodic Disability Framework , a conceptual framework developed in an earlier stage of research, as a foundation for item generation. Results : The purpose of the 70-item HDQ is to characterize the presence, severity, and episodic nature of disability experienced by adults with HIV. The Community Advisory Committee suggested items beyond those in the Episodic Disability Framework , refined item phrasing, order, response options, and questionnaire instructions to enhance feasibility and relevance of the HDQ to adults with HIV, advised on how to structure the questionnaire to capture the episodic nature of disability, and suggested next steps for testing and implementation. Conclusions : The HDQ is the first HIV-specific questionnaire to describe disability experienced by adults with HIV. Engaging community research partners in the development of the HDQ enhanced the questionnaire’s relevance, feasibility, and face and content validities. This approach may be considered by others interested in health status instrument development.

Purpose: The purpose of this article is to present the results of a systematic review that investigated the effects of aerobic exercise interventions in people living with HIV/AIDS and to discuss the implications for physical therapy practice, education, and research. Summary of Key Points: A systematic review was conducted based on the Cochrane Collaboration protocol. Eleven randomized trials of HIVpositive adults who performed aerobic exercise three times per week for at least four weeks were identified. Thirteen meta-analyses were performed. The main results indicated that aerobic exercise was associated with significant improvements in some outcomes of cardiopulmonary status (maximum oxygen consumption) and psychological status (depression-dejection symptoms). Conclusions: Performing continuous or interval aerobic exercise or a combination of continuous aerobic exercise and progressive resistive exercise for at least 24 minutes three times per week for at least five weeks appears to be safe and may be beneficial for adults living with HIV. These findings should be interpreted cautiously owing to small sample sizes and high withdrawal rates within individual studies. The results of this review support the role of exercise and, more broadly, the role of rehabilitation practice, education, and research in the care and treatment of persons living with HIV.