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The aim of this study is to analyze the biomechanical performance of the kinematic and dynamic structures of key elements of sports techniques of basic exercises performed gymnasts aged 12 - 14 years to the vaulting and on the bars of different heights, on the basis of the method of postural orientation movements. The study involved 11 gymnasts doing exercises on the vaulting and 9 gymnasts - on the boards of various heights. It is shown that the method of video - computer analysis of the type Yurchenko vault and dismount from the bars of varying heights, in conjunction with the method of postural orientation movements possible to isolate and identify the node elements. The indicators characterizing the node elements of sports equipment movements gymnasts in the phase structure of the vault and dismount from the bars of different heights have specific features and characteristics. Learned node elements sports equipment is the basis for the measurement, analysis and evaluation of the kinematic and dynamic structures and other types of exercises all-around gymnastics.

Background: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk for hospitalization and death from gastrointestinal bleeding and perforation.Objectives: To 1) estimate the extent to which NSAIDs are prescribed unnecessarily and NSAID-related side effects are inaccurately diagnosed and inappropriately managed and 2) identify the physician and visit characteristics associated with suboptimal use of NSAIDs.Design: Prospective cohort study.Setting: Montreal, Canada.Participants: 112 physicians representing academically affilliated general practitioners, community-based general practitioners, and residents in family medicine and internal medicine.Interventions: Blinded, office-based assessment of the management of two clinical cases (chronic hip pain due to early osteoarthritis and NSAID-related gastropathy) using elderly standardized patients.Measurements: Quality of drug management and potential predictors of suboptimal drug management.Results: Unnecessary prescriptions for NSAIDs or other drugs were written during 41.7% of visits. Gastropathy related to NSAID use was correctly diagnosed in 93.4% of visits and was acceptably managed in 77.4% of visits. The risk for an unnecessary NSAID prescription was greater when the contraindications to NSAID therapy were incompletely assessed (odds ratio, 2.3 [95% CI, 1.0 to 5.2]) and when the case was managed by residents in internal medicine (odds ratio, 4.1 [CI, 1.2 to 14.7]). The risk for suboptimal management of NSAID-related side effects was increased by incorrect diagnosis (odds ratio, 16.6 [CI, 3.6 to 76.5]) and shorter visits.Conclusions: Unnecessary NSAID prescribing and suboptimal management of NSAID-related side effects were sufficiently common to raise questions about the appropriateness of NSAID use in the general population. If these results reflect current practice, prescribing patterns may contribute to avoidable gastrointestinal morbidity in elderly persons. [ABSTRACT FROM AUTHOR]

In 2011, through regular surveillance of more than 100 English-language research journals, a group of seven clinicians identified approximately 250 studies with the potential to improve the practice of primary care physicians and the outcomes of patients (designated as POEMs [patient-oriented evidence that matters]). Using a validated tool, Canadian primary care physicians have been rating the relevance of each POEM as they receive it in their e-mail. This article summarizes 20 of the most relevant, practice-changing POEMs from 2011 as determined by these raters. We believe this approach has greater relevance and validity than a subjective list of studies selected by experts or editors, because it is based on the actual ratings of practicing primary care physicians. These POEMs address topics that include how to best measure blood pressure, the lack of benefit of intensive glucose control, quantification of the benefit of statins for prevention of cardiac events, treatments for functional abdominal disorders, and management of low back pain. [ABSTRACT FROM AUTHOR]

Background: In a prospective study to explore connections between clinical information delivery and information retrieval, 41 Canadian family physicians searched an electronic knowledge resource (EKR) as needed for practice. Research software, called the Information Assessment Method (IAM), prompted family physicians to report on the situational relevance, perceived cognitive impact and application of their retrieved information hits. Both the IAM and the EKR needed periodic updating to properly address our research questions. Objective: To determine the frequency of software updating when manual or semi-automatic approaches are used by family physicians. Methods: Each family physician received a handheld computer (PDA) that ran the Windows Mobile 6 operating system. For technical reasons, both the IAM and the EKR were accessed offline on PDA. To update the EKR and the IAM, family physicians were asked to synchronise their PDA to their PC. Updating the IAM was a manual process, whereas updating the EKR was semi-automatic. Results: We found: (1) about 25% of family physicians never or rarely updated PDA software on their own, (2) a large number of software updates were never installed and (3) the semi-automatic method was associated with a small increase in the proportion of installed software updates (58.9% versus 48.6% for the manual method). Conclusions: When a wireless internet connection is not used to update PDA software, sociotechnical issues complicate mobile data collection and data transfer. [ABSTRACT FROM AUTHOR]

BACKGROUND: Effective information transfer in primary care is becoming more difficult as the volume of medical information expands. Emailed research synopses are expected to raise awareness and thereby permit more effective information retrieval. OBJECTIVE: To identify key factors that influence physicians' self-reported cognitive impact of emailed research synopses. METHOD: In this prospective observational study, research synopses sent by email between 8 September 2006 and 30 May 2007 were analysed. Seven characteristics of synopses (number of characters, research design, study setting, number of types of patient populations studied, number of comparisons, number of outcomes, and number of results) were analysed. Each synopsis was classified as either positive or negative based on physician-reported impacts. Logistic regression analysis was used to evaluate the association between a negative impact and the synopsis' characteristics. RESULTS: A total of 1960 Canadian physicians submitted 159 442 ratings on 193 synopses. Each synopsis was assessed on average by 826.1 physicians. On average there were 28.3 negative ratings per research synopsis, 146.3 neutral, and 656.2 positive. Out of the seven characteristics analysed, only the number of comparisons (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.23-0.93) and the number of results (OR = 0.64, 95% CI = 0.44-0.93) had a statistically significant influence on physician ratings. An increase in the number of comparisons (P = 0.03) or the number of results (P = 0.02) decreased the likelihood of a negative impact. CONCLUSIONS: Characteristics of the synopses appear to influence cognitive impact, and there might be lexical patterns specific to these factors. Further research is recommended in order to understand the mechanism for the influence of these characteristics. [ABSTRACT FROM AUTHOR]

The aim of the research was to get information about pro-health behaviours and belief in oneself among 13-15-year old teenagers living in Biała Podlaska. The research included 229 pupils from three Grammar Schools (115 girls and 114 boys). The range of respondents’ age varied from 13 to 15 years old. The research tool was two anonymous questionnaires. The first questionnaire contained questions concerning teenagers’ belief in themselves and the efficacy of their activities (10 statements). The second questionnaire referred to the pro-health behaviours and it consisted of 14 situations described in the form of multiple choice questions. It was shown that Grammar School goers higly evaluated their own sense of efficacy (31,2 points). Girls (30,39 points) in comparison to boys (32,05) evaluated their efficacy lower by 1,66 points. Grammar School goers in 85,7% of cases choose healthy behaviours and girls are the group which reach for such behaviours more often.

Abstract Background This project engages patients and physicians in the development of Decision Boxes, short clinical topic summaries covering medical questions that have no single best answer. Decision Boxes aim to prepare the clinician to communicate the risks and benefits of the available options to the patient so they can make an informed decision together. Methods Seven researchers (including four practicing family physicians) selected 10 clinical topics relevant to primary care practice through a Delphi survey. We then developed two one-page prototypes on two of these topics: prostate cancer screening with the prostate-specific antigen test, and prenatal screening for trisomy 21 with the serum integrated test. We presented the prototypes to purposeful samples of family physicians distributed in two focus groups, and patients distributed in four focus groups. We used the User Experience Honeycomb to explore barriers and facilitators to the communication design used in Decision Boxes. All discussions were transcribed, and three researchers proceeded to thematic content analysis of the transcriptions. The coding scheme was first developed from the Honeycomb’s seven themes (valuable, usable, credible, useful, desirable, accessible, and findable), and included new themes suggested by the data. Prototypes were modified in light of our findings. Results Three rounds were necessary for a majority of researchers to select 10 clinical topics. Fifteen physicians and 33 patients participated in the focus groups. Following analyses, three sections were added to the Decision Boxes: introduction, patient counseling, and references. The information was spread to two pages to try to make the Decision Boxes less busy and improve users’ first impression. To try to improve credibility, we gave more visibility to the research institutions involved in development. A statement on the boxes’ purpose and a flow chart representing the shared decision-making process were added with the intent of clarifying the tool’s purpose. Information about the risks and benefits according to risk levels was added to the Decision Boxes, to try to ease the adaptation of the information to individual patients. Conclusion Results will guide the development of the eight remaining Decision Boxes. A future study will evaluate the effect of Decision Boxes on the integration of evidence-based and shared decision making principles in clinical practice.

Abstract Background Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the primary care practice environment. Methods/design A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians’ intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians’ access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs. Conclusions This project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.

Abstract Background Asthma is a prevalent and costly disease resulting in reduced quality of life for a large proportion of individuals. Effective patient self-management is critical for improving health outcomes. However, key aspects of self-management such as self-monitoring of behaviours and symptoms, coupled with regular feedback from the health care team, are rarely addressed or integrated into ongoing care. Health information technology (HIT) provides unique opportunities to facilitate this by providing a means for two way communication and exchange of information between the patient and care team, and access to their health information, presented in personalized ways that can alert them when there is a need for action. The objective of this study is to evaluate the acceptability and efficacy of using a web-based self-management system, My Asthma Portal (MAP), linked to a case-management system on asthma control, and asthma health-related quality of life. Methods The trial is a parallel multi-centered 2-arm pilot randomized controlled trial. Participants are randomly assigned to one of two conditions: a) MAP and usual care; or b) usual care alone. Individuals will be included if they are between 18 and 70, have a confirmed asthma diagnosis, and their asthma is classified as not well controlled by their physician. Asthma control will be evaluated by calculating the amount of fast acting beta agonists recorded as dispensed in the provincial drug database, and asthma quality of life using the Mini Asthma Related Quality of Life Questionnaire. Power calculations indicated a needed total sample size of 80 subjects. Data are collected at baseline, 3, 6, and 9 months post randomization. Recruitment started in March 2010 and the inclusion of patients in the trial in June 2010. Discussion Self-management support from the care team is critical for improving chronic disease outcomes. Given the high volume of patients and time constraints during clinical visits, primary care physicians have limited time to teach and reinforce use of proven self-management strategies. HIT has the potential to provide clinicians and a large number of patients with tools to support health behaviour change. Trial Registration Current Controlled Trials ISRCTN34326236.