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Abstract Introduction Point-of-care ultrasonography (POCUS) is a portable imaging technology used in clinical settings. There is a need for valid tools to assess clinical competency in POCUS in medical students. The primary aim of this study was to use Kane’s framework to evaluate an interpretation-use argument (IUA) for an undergraduate POCUS assessment tool. Methods Participants from Memorial University of Newfoundland, the University of Calgary, and the University of Ottawa were recruited between 2014 and 2018. A total of 86 participants and seven expert raters were recruited. The participants performed abdominal, sub-xiphoid cardiac, and aorta POCUS scans on a volunteer patient after watching an instruction video. The participant-generated POCUS images were assessed by the raters using a checklist and a global rating scale. Kane’s framework was used to determine validity evidence for the scoring inference. Fleiss’ kappa was used to measure agreement between seven raters on five questions that reflected clinical competence. The descriptive comments collected from the raters were systematically coded and analyzed. Results The overall agreement between the seven raters on five questions on clinical competency ranged from fair to moderate (κ = 0.32 to 0.55). The themes from the qualitative data were poor image generation and interpretation (22%), items not applicable (20%), poor audio and video quality (20%), poor probe handling (10%), and participant did not verbalize findings (14%). Conclusion The POCUS assessment tool requires further modification and testing prior before it can be used for reliable undergraduate POCUS assessment.

Objective Communication is a key competency for medical education and comprehensive patient care. In rural environments, communication between rural family physicians and urban specialists is an essential pathway for clinical decision making. The aim of this study was to explore rural physicians’ perspectives on communication with urban specialists during consultations and referrals.Setting Newfoundland and Labrador, Canada.Participants This qualitative study involved semistructured, one-on-one interviews with rural family physicians (n=11) with varied career stages, geographical regions, and community sizes.Results Four themes specific to communication in rural practice were identified. The themes included: (1) understanding the contexts of rural care; (2) geographical isolation and patient transfer; and (3) respectful discourse; and (4) overcoming communication challenges in referrals and consultations.Conclusions Communication between rural family physicians and urban specialists is a critical task in providing care for rural patients. Rural physicians see value in conveying unique aspects of rural clinical practice during communication with urban specialists, including context and the complexities of patient transfers.

The coronavirus 2019 (COVID-19) disease has affected millions of lives, forcing most of us to stay at home and work. However, there is an immediate need to conduct research on potential drugs against COVID-19. In this article, the extent to which major publishers have provided access for the public to read research articles relevant to potential drug candidates for the COVID-19 disease are presented. A systematic search of five electronic databases (Elsevier’s ScienceDirect, Taylor & Francis, SpringerLink, Wiley, and New England Journal of Medicine (NEJM)) was conducted on April 12-17, 2020. The total number of research articles containing terms ‘Ribavirin’, ‘Remdesivir’, ‘Hydroxychloroquine OR Chloroquine’, ‘Favipiravir’, ‘Lopinavir OR Ritonavir’, ‘Sarilumab’, and ‘Tocilizumab’, available for the public to read for free were determined. In this study, there was a lack of full access to research articles related to potential drugs of COVID-19 in commercial academic databases, except for ‘Remdesivir’ and ‘Favipiravir’ from NEJM.

Introduction: New estimated glomerular filtration rate (eGFR) equations using serum creatinine and/or cystatin C have been derived to eliminate adjustment by perceived Black ancestry. We sought to analyze the performance of newer eGFR equations among Black living kidney donor candidates. Methods: Black candidates (n = 64) who had measured iothalamate GFR between January 2015 and October 2021 were included, and eGFR was calculated using race adjusted (eGFRcr2009 and eGFRcr‐cys2012) and race unadjusted (eGFRcys2012, eGFRcr2021, and eGFRcr‐cys2021) CKD‐EPI equations. Bias and accuracy were calculated. Results: The eGFRcr2021 equation had a negative bias of 9 mL/min/1.73 m2, while other equations showed a modest positive bias. Accuracy within 10% and 30% was greatest using the eGFRcr‐cys2021 equation. With the eGFRcr2021 equation, 9.4% of donors with an mGFR > 80 mL/min/1.73 m2 were misclassified as having an eGFR < 80 mL/min/1.73 m2. eGFR was also compared among 18 kidney donors at 6–24 months post‐donation. Post‐donation, the percentage of donors with an eGFR < 60 mL/min/1.73 m2 was 44% using the eGFRcr2021 equation compared to 11% using the eGFRcr‐cys2021 equation. Conclusion: The CKD‐EPICr2021 equation appears to underestimate true GFR in Black living donor candidates. Alternatively, compared to CKD‐EPICr2021, the CKD‐EPICr‐CysC2021 equation appears to perform with less bias and improved accuracy. [ABSTRACT FROM AUTHOR]

Physical sedentarism is linked to elevated levels of circulating cytokines, whereas exercise upregulates growth-promoting proteins such as brain-derived neurotrophic factor (BDNF). The shift towards a ‘repair’ phenotype could protect against neurodegeneration, especially in diseases such as multiple sclerosis (MS). We investigated whether having higher fitness or participating in an acute bout of maximal exercise would shift the balance of BDNF and interleukin-6 (IL-6) in serum samples of people with progressive MS (n = 14), compared to matched controls (n = 8). Participants performed a maximal graded exercise test on a recumbent stepper, and blood samples were collected at rest and after the test. We assessed walking speed, fatigue, and maximal oxygen consumption (V·O2max). People with MS achieved about 50% lower V·O2max (p = 0.003) than controls. At rest, there were no differences in BDNF between MS and controls; however, IL-6 was significantly higher in MS. Higher V·O2max was associated with a shift in BDNF/IL-6 ratio from inflammation to repair (R = 0.7, p = 0.001) when considering both groups together. In the MS group, greater ability to upregulate BDNF was associated with faster walking speed and lower vitality. We present evidence that higher fitness indicates a shift in the balance of blood biomarkers towards a repair phenotype in progressive MS.

Introduction. Walking is of high priority for people with multiple sclerosis (PwMS). It remains unclear whether aerobic exercise can improve walking ability and upregulate neurotrophins. This review aims to consolidate evidence to develop optimal aerobic training parameters to enhance walking outcomes and neuroplasticity in PwMS. Methods. Clinical studies examining aerobic exercise for ≥3 weeks, having outcomes on walking with or without neurotrophic markers, were included. Studies utilizing animal models of MS were included if they employed aerobic exercise with outcomes on neurological recovery and neurotrophins. From a total of 1783 articles, 12 clinical and 5 animal studies were included. Results. Eleven clinical studies reported improvements in walking ability. Only two clinical studies evaluated both walking and neurotrophins, and neither found an increase in neurotrophins despite improvements in walking. Patients with significant walking impairments were underrepresented. Long-term follow-up revealed mixed results. Two animal studies reported a positive change in both neurological recovery and neurotrophins. Conclusion. Aerobic exercise improves walking ability in PwMS. Gains are not consistently maintained at 2- to 9-month follow-up. Studies examining levels of neurotrophins are inconclusive, necessitating further research. Aerobic exercise enhances both neurological recovery and neurotrophins in animal studies when started 2 weeks before induction of MS.

Background: Pain alters the neuromuscular activation and results in altered movement adaptations. A new exercise prescription method proposes that we can restore the neuromuscular control by rehabilitating the deficient neural drive through Pilates exercises. This is done by identifying the postural control deficits using single-leg tests such as hopping, half squats and heel raises. The aim of this study was to find out if this method of prescribing exercises results in clinically relevant outcomes. Methods: Fifteen patients with chronic non-specific low back pain with unilateral musculoskeletal pain were recruited. Following consent, all patients were randomly assigned either to perform gym or Pilates-based individualised exercises once weekly for six weeks. The primary outcome was to measure the pain intensity using a 0–10 numerical rating scale. The secondary outcome measures were: the global perceived effect scale (GPE; 0–10), the patient-specific functional scale (PSFS; the patient-generated measure of disability) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; the condition-specific measure of disability). Results: There were statistically significant differences noted after intervention within the control group in the numerical rating scale ( P =0.041), GPE ( P =0.024), PSFS ( P =0.039) and within the experimental group in the WOMAC ( P =0.008), GPE ( P =0.007) and PSFS ( P =0.007). However, as there were clinically significant baseline differences, the within-group difference could be due to regression to the mean. There were no statistically significant results between the two groups after intervention. Conclusion: This new prescription method for Pilates-based exercises may improve disability and global perception of recovery. However, the outcomes are not different from a regular gym-based exercise programme.

Objective Reactive balance training (RBT) is an emerging approach to reducing falls risk in people with balance impairments. The purpose of this study was to determine the effect of RBT on falls in daily life among individuals at increased risk of falls and to document associated adverse events. Methods Databases searched were Ovid MEDLINE (1946 to March 2022), Embase Classic and Embase (1947 to March 2022), Cochrane Central Register of Controlled Trials (2014 to March 2022), and Physiotherapy Evidence Database (PEDro; searched on 22 March 2022). Randomized controlled trials of RBT were included. The literature search was limited to the English language. Records were screened by 2 investigators separately. Outcome measures were number of participants who reported falls after training, number of falls reported after training, and the nature, frequency, and severity of adverse events. Authors of included studies were contacted to obtain additional information. Results Twenty-nine trials were included, of which 17 reported falls and 21 monitored adverse events. Participants assigned to RBT groups were less likely to fall compared with control groups (fall risk ratio = 0.76; 95% CI = 0.63–0.92; I 2 = 32%) and reported fewer falls than control groups (rate ratio = 0.61; 95% CI = 0.45–0.83; I 2 = 81%). Prevalence of adverse events was higher in RBT (29%) compared with control groups (20%). Conclusion RBT reduced the likelihood of falls in daily life for older adults and people with balance impairments. More adverse events were reported in RBT than control groups. Impact Balance training that evokes balance reactions can reduce falls among people at increased risk of falls. Older adults and individuals with balance problems were less likely to fall in daily life after participating in RBT compared with traditional balance training. Lay summary If you are an older adult and/or have balance problems, your physical therapist may prescribe reactive balance training rather than traditional balance training in order to reduce your likelihood of falling in daily life. [ABSTRACT FROM AUTHOR]

Introduction: Chronic non-specific low back pain is a major health burden worldwide including Singapore. As literature shows inconclusive evidence on the benefit of various forms of exercises for chronic low back pain patients, we intended to investigate the efficacy of a four-week posture correction and movement re-education programme delivered through cognitive behavioural modification. Methods: A blinded randomised controlled pilot trial was conducted with the participants randomised into two different group exercise classes. The control group performed generic mat exercises. The experimental group performed functional back exercises and had training in activities like lifting, sitting, mopping to learn correct postures and body mechanics with proper ergonomics and activity pacing through cognitive behavioural modification. The following outcome measures were scored in this study: verbal numerical pain (VNP) scale, Roland Morris disability questionnaire (RMDQ), patient-specific functional scale (PSFS), and global perceived effect (GPE) score. Results: At baseline (n=15), the data was normally distributed between the control and the experimental groups, with the exception of BMI in the control group and VNP in the experimental group. In the experimental group, all outcome measures showed statistically significant difference between pre- and post-intervention scores, VNP (p=0.01), RMDQ (p=0.01), PSFS (p=0.01) and GPE (p=0.00). In the control group, a statistically significant difference between pre- and post-intervention was noted in the PSFS score (p=0.04). Conclusion: This pilot study demonstrated that an exercise class incorporating correction of postures and body mechanics in daily activities with a cognitive behavioural modification reduces pain and disability better than generic mat exercise class in patients with chronic non-specific low back pain.