2024-03-28T15:56:53Z
http://ir.lib.uwo.ca/do/oai/
oai:ir.lib.uwo.ca:physmedpub-1000
2011-04-25T23:32:47Z
publication:rwkex
publication:physmed
publication:physmedpub
publication:faculties
publication:rwkex_researcharticles
Clinical Education of Ethicists: The Role of a Clinical Ethics Fellowship
Chidwick, Paula
Faith, Karen
Godkin, Dianne
Hardingham, Laurie
Article
2004-11-08T08:00:00Z
Clinical education
Clinical ethics
BMC Medical Ethics
BMC Medical Ethics
5
6
http://dx.doi.org/10.1186/1472-6939-5-6
Medicine and Health Sciences
Rehabilitation and Therapy
<p>Background: Although clinical ethicists are becoming more prevalent in healthcare settings, their required training and education have not been clearly delineated. Most agree that training and education are important, but their nature and delivery remain topics of debate. One option is through completion of a clinical ethics fellowship.</p>
<p>Method: In this paper, the first four fellows to complete a newly developed fellowship program discuss their experiences. They describe the goals, structure, participants and activities of the fellowship. They identify key elements for succeeding as a clinical ethicist and sustaining a clinical ethics program. They critically reflect upon the challenges faced in the program.</p>
<p>Results: The one-year fellowship provided real-time clinical opportunities that helped them to develop the necessary knowledge and skills, gain insight into the role and scope of practice of clinical ethicists and hone valuable character traits.</p>
<p>Conclusion: The fellowship enabled each of the fellows to assume confidently and competently a position as a clinical ethicist upon completion.</p>
https://ir.lib.uwo.ca/physmedpub/1
oai:ir.lib.uwo.ca:fammedpub-1001
2009-09-23T22:46:19Z
publication:kin
publication:rwkex
publication:kinpub
publication:fammedpub
publication:physmed
publication:fammed
publication:physmedpub
publication:rwkex_researcharticles
publication:pmid
publication:faculties
16684358
Do Patients Receive Recommended Treatment of Osteoporosis Following Hip Fracture in Primary Care?
Petrella, Robert J.
Jones, Tim J.
Article
2006-05-09T07:00:00Z
Aftercare
Aged
Aged
80 and over
Bone Density Conservation Agents
Calcitonin
Calcium
Dietary Supplements
Diphosphonates
Drug Utilization
Estrogen Replacement Therapy
Family Practice
Female
Guideline Adherence
Hip Fractures
Humans
Male
Ontario
Osteoporosis
Primary Health Care
Rehabilitation Centers
Treatment Outcome
Vitamin D
BMC Family Practice
BMC Family Practice
7
31
Kinesiology
Medicine and Health Sciences
Rehabilitation and Therapy
Background: Osteoporosis results in fractures and treatment of osteoporosis has been shown to reduce risk of fracture particularly in those who have had a history of fracture.
Methods: A prospective study was conducted using patients admitted to a hip fracture rehabilitation program at a large referral center to evaluate the use of treatments recommended for secondary prevention of osteoporotic fracture between September 1, 2001 and September 30, 2003. The frequency of medication use for the treatment of osteoporosis including estrogen replacement therapy, bisphosponates, calcitonin, calcium and vitamin D therapy was determined on admission, at 6 weeks post discharge and one year following discharge. All patients were discharged to the care of their family physician. All family physicians in the referral region received a copy of the Canadian Consensus recommendations for osteoporosis management 1-3 months prior to the study.
Results: During the study period, 174 patients were enrolled and 121 completed all assessments. Fifty-seven family physicians were identified as caring for 1 or more of the study patients. Only 7 patients had previous BMD, only 5 patients had previously been prescribed a bisphosponate and 14 patients were taking calcium and/or vitamin D. All patients were prescribed 2500 mg calcium, 400 IU vitamin D and 5 mg residronate daily during rehabilitation and at discharge.Following discharge, a significant improvement was seen in all clinical indices of functional mobility, including the functional independence measure (FIM), walking distance, fear of falling score (FFS), and the Berg balance score (BBS). At six weeks a significant (p < 0.01) decrease in calcium and vitamin D use was observed. All patients remained compliant with residronate therapy. At twelve months 71 patients remained on residronate (p < 0.01), 10 were now taking alternate bisphosphonate therapy and few were taking calcium and/or vitamin D (p < 0.001). FIM, FFS and Berg scores were significantly decreased from discharge (p < 0.001) while walking distance was unchanged.
Conclusion: Few patients admitted for hip fracture had previously taken recommended osteoporosis therapy including bisphosphonates. While compliance with Canadian Consensus recommendations was observed at six weeks, this was not the case at twelve months post hip fracture rehabilitation. Interventions to improve not only the detection and treatment of osteoporosis but also the ongoing treatment and management post-fracture need to be developed and implemented.
Published in: BMC Family Practice, 2006, 7:31. doi: 10.1186/1471-2296-7-31
https://ir.lib.uwo.ca/fammedpub/2
oai:ir.lib.uwo.ca:kinpub-1004
2012-02-11T23:57:13Z
publication:kin
publication:fammedpub
publication:fammed
publication:rwkex_researcharticles
publication:physpharmpub
publication:pmid
publication:faculties
publication:medpub
publication:kinpub
publication:rwkex
publication:healthstudies
publication:physpharm
publication:med
publication:physmed
publication:physmedpub
publication:healthstudiespub
19646259
The Use of Group Dynamics Strategies to Enhance Cohesion in a Lifestyle Intervention Program for Obese Children
Martin, Luc J.
Burke, Shauna M.
Shapiro, Sheree
Carron, Albert V.
Irwin, Jennifer D.
Petrella, Robert
Prapavessis, Harry
Shoemaker, Kevin
Article
2009-07-31T07:00:00Z
Group dynamics
Obesity
Children
Lifestyle intervention
BMC Public Health
BMC Public Health
9
277
http://dx.doi.org/10.1186/1471-2458-9-277
Kinesiology
Public Health
<p>Background: Most research pertaining to childhood obesity has assessed the effectiveness of preventative interventions, while relatively little has been done to advance knowledge in the treatment of obesity. Thus, a 4-week family- and group-based intervention utilizing group dynamics strategies designed to increase cohesion was implemented to influence the lifestyles and physical activity levels of obese children.</p>
<p>Methods/Design: This paper provides an overview of the rationale for and implementation of the intervention for obese children and their families. Objectives of the intervention included the modification of health behaviors and cohesion levels through the use of group dynamics strategies. To date, a total of 15 children (7 boys and 8 girls, mean age = 10.5) and their families have completed the intervention (during the month of August 2008). Physiological and psychological outcomes were assessed throughout the 4-week intervention and at 3-, 6-, and 12-month follow-up periods.</p>
<p>Discussion: It is believed that the information provided will help researchers and health professionals develop similar obesity treatment interventions through the use of evidence-based group dynamics strategies. There is also a need for continued research in this area, and it is our hope that the Children's Health and Activity Modification Program (C.H.A.M.P.) will provide a strong base from which others may build.</p>
https://ir.lib.uwo.ca/kinpub/5
oai:ir.lib.uwo.ca:physmedpub-1001
2010-03-11T23:36:21Z
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:rwkex
publication:physmed
publication:physmedpub
20053273
Study Protocol of the YOU CALL--WE CALL TRIAL: Impact of a Multimodal Support Intervention after a "Mild" Stroke
Rochette, Annie
Korner-Bitensky, Nicol
Bishop, Duane
Teasell, Robert
White, Carole
Bravo, Gina
Côté, Robert
Lachaine, Jean
Green, Teri
Lebrun, Louise-Hélène
Lanthier, Sylvain
Kapral, Moira
Wood-Dauphinee, Sharon
Article
2010-01-06T08:00:00Z
multimodal support intervention
stroke
BMC Neurology
BMC Neurology
10
3
http://dx.doi.org/10.1186/1471-2377-10-3
Medicine and Health Sciences
Rehabilitation and Therapy
BACKGROUND: More than 60% of new strokes each year are "mild" in severity and this proportion is expected to rise in the years to come. Within our current health care system those with "mild" stroke are typically discharged home within days, without further referral to health or rehabilitation services other than advice to see their family physician. Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention, community reintegration, medication counselling and problem solving with regard to specific concerns that arise. Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization.The purpose of this study is to assess the effectiveness, for individuals who experience a first "mild" stroke, of a sustainable, low cost, multimodal support intervention (comprising information, education and telephone support)--"WE CALL" compared to a passive intervention (providing the name and phone number of a resource person available if they feel the need to)--"YOU CALL", on two primary outcomes: unplanned-use of health services for negative events and quality of life.
METHOD/DESIGN: We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites. Baseline measures will be taken within the first month after stroke onset. Participants will be stratified according to comorbidity level and randomised to one of two groups: YOU CALL or WE CALL. Both interventions will be offered over a six months period. Primary outcomes include unplanned use of heath services for negative event (frequency calendar) and quality of life (EQ-5D and Quality of Life Index). Secondary outcomes include participation level (LIFE-H), depression (Beck Depression Inventory II) and use of health services for health promotion or prevention (frequency calendar). Blind assessors will gather data at mid-intervention, end of intervention and one year follow up.
DISCUSSION: If effective, this multimodal intervention could be delivered in both urban and rural environments. For example, existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics, make this intervention, if effective, deliverable and sustainable.
TRIAL REGISTRATION: ISRCTN95662526.
https://ir.lib.uwo.ca/physmedpub/2
oai:ir.lib.uwo.ca:medpub-1036
2010-07-31T05:39:10Z
publication:kin
publication:fammedpub
publication:fammed
publication:rwkex_researcharticles
publication:pmid
publication:faculties
publication:medpub
publication:rwkex
publication:kinpub
publication:physmed
publication:med
publication:physmedpub
20205851
Management of Tennis Elbow with Sodium Hyaluronate Periarticular Injections
Petrella, Robert J.
Cogliano, Anthony
Decaria, Joseph
Mohamed, Naem
Lee, Robert
Article
2010-02-02T08:00:00Z
Tennis Elbow
Sodium hyaluronate
Periarticular injections
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology
2
4
http://dx.doi.org/10.1186/1758-2555-2-4
Kinesiology
Sports Sciences
OBJECTIVES: To determine the efficacy and safety of peri-articular hyaluronic acid injections in chronic lateral epicondylosis (tennis elbow).
DESIGN: Prospective randomized clinical trial in primary care sport medicine.
PATIENTS: Three hundred and thirty one consecutive competitive racquette sport athletes with chronic (>3 months) lateral epicondylosis were administered 2 injections (first injection at baseline) into the subcutaneous tissue and muscle 1 cm. from the lateral epicondyle toward the primary point of pain using a two-dimensional fanning technique. A second injection was administered 1 week later.
OUTCOMES MEASURES: Assessments were done at baseline, days 7, 14, 30, 90 and 356. Efficacy measures included patient's visual analogue scale (VAS) of pain at rest (0-100 mm) and following assessment of grip strength (0-100 mm). Grip strength was determined using a jamar hydraulic hand dynamometer. Other assessments included patients' global assessment of elbow injury (5 point categorical scale; 1 = no disability, 5 = maximal disability), patients' assessment of normal function/activity (5 point categorical scale), patients/physician satisfaction assessment (10 point categorical scale), time to return to pain-free and disability-free sport and adverse events as per WHO definition. Differences between groups were determined using an intent-to-treat ANOVA.
RESULTS: Average age of the study population was 49 years (+/- 12 years). One hundred and sixty-five patients were randomized to the HA and 166 were randomized to the control groups. The change in VAS pain was -6.7 (+/- 2.0) for HA vs -1.3 (+/- 1.5) for control (p < 0.001). The VAS post handgrip was -7.8 (+/- 1.3) vs +0.3 (+/- 2.0) (p < 0.001) which corresponded to a significant improvement in grip of 2.6 kg in the HA vs control groups (p < 0.01). Statistically significant improvement in patients' global assessment of elbow injury (p < 0.02), patients' assessment of normal function/activity (p < 0.05) and patients/physician satisfaction assessment (p < 0.05) were also observed favoring the HA group. Time to return to pain-free and disability-free sport was 18 (+/- 11) days in the HA group but was not achieved in the control group. VAS changes were maintained in the HA group at each followup while those in the control significantly declined from baseline. Assessment of patient and physician satisfaction continued to favor the HA group at subsequent followup.
CONCLUSION: Peri-articular HA treatment for tennis elbow was significantly better than control in improving pain at rest and after maximal grip testing. Further, HA treatment was highly satisfactory by patients and physicians and resulted in better return to pain free sport compared to control.
https://ir.lib.uwo.ca/medpub/29
oai:ir.lib.uwo.ca:cnspub-1003
2011-09-06T02:46:42Z
publication:rwkex_researcharticles
publication:pmid
publication:cns
publication:faculties
publication:cnspub
publication:rwkex
publication:physmed
publication:physmedpub
17912368
Creatine Monohydrate and Conjugated Linoleic Acid Improve Strength and Body Composition Following Resistance Exercise in Older Adults
Tarnopolsky, Mark
Zimmer, Andrew
Paikin, Jeremy
Safdar, Adeel
Aboud, Alissa
Pearce, Erin
Roy, Brian
Doherty, Timothy
Article
2007-10-03T07:00:00Z
Aging
Body Composition
Creatine
Exercise
Humans
Isometric Contraction
Linoleic Acid
Muscles
Nutritional Sciences
Physical Endurance
Weight Lifting
PLoS ONE
PLoS ONE
2
10
991
991
http://dx.doi.org/10.1371/journal.pone.0000991
Medical Nutrition
Medical Physiology
<p>Aging is associated with lower muscle mass and an increase in body fat. We examined whether creatine monohydrate (CrM) and conjugated linoleic acid (CLA) could enhance strength gains and improve body composition (i.e., increase fat-free mass (FFM); decrease body fat) following resistance exercise training in older adults (>65 y). Men (N = 19) and women (N = 20) completed six months of resistance exercise training with CrM (5g/d)+CLA (6g/d) or placebo with randomized, double blind, allocation. Outcomes included: strength and muscular endurance, functional tasks, body composition (DEXA scan), blood tests (lipids, liver function, CK, glucose, systemic inflammation markers (IL-6, C-reactive protein)), urinary markers of compliance (creatine/creatinine), oxidative stress (8-OH-2dG, 8-isoP) and bone resorption (Nu-telopeptides). Exercise training improved all measurements of functional capacity (P<0.05) and strength (P<0.001), with greater improvement for the CrM+CLA group in most measurements of muscular endurance, isokinetic knee extension strength, FFM, and lower fat mass (P<0.05). Plasma creatinine (P<0.05), but not creatinine clearance, increased for CrM+CLA, with no changes in serum CK activity or liver function tests. Together, this data confirms that supervised resistance exercise training is safe and effective for increasing strength in older adults and that a combination of CrM and CLA can enhance some of the beneficial effects of training over a six-month period. Trial Registration. ClinicalTrials.gov NCT00473902.</p>
https://ir.lib.uwo.ca/cnspub/4
oai:ir.lib.uwo.ca:kinpub-1010
2011-10-31T02:17:24Z
publication:kin
publication:rwkex_researcharticles
publication:surgerypub
publication:pmid
publication:cns
publication:faculties
publication:cnspub
publication:rwkex
publication:kinpub
publication:physmed
publication:physmedpub
publication:surgery
21910917
Vastus Medialis Motor Unit Properties in Knee Osteoarthritis
Berger, Michael J.
Chess, David G.
Doherty, Timothy J.
Article
2011-09-13T07:00:00Z
Vastus medialis motor unit
Knee
osteoarthritis
BMC Musculoskeletal Disorders
BMC Musculoskeletal Disorders
12
199
http://dx.doi.org/10.1186/1471-2474-12-199
Kinesiology
Medical Physiology
Musculoskeletal System
<p>BACKGROUND: Maximal isometric quadriceps strength deficits have been widely reported in studies of knee osteoarthritis (OA), however little is known about the effect of osteoarthritis knee pain on submaximal quadriceps neuromuscular function. The purpose of this study was to measure vastus medialis motor unit (MU) properties in participants with knee OA, during submaximal isometric contractions.</p>
<p>METHODS: Vastus medialis motor unit potential (MUP) parameters were assessed in 8 patients with knee OA and 8 healthy, sex and age-matched controls during submaximal isometric contractions (20% of maximum isometric torque). Unpaired t-tests were used to compare groups for demographic and muscle parameters.</p>
<p>RESULTS: Maximum knee extension torque was ~22% lower in the OA group, a difference that was not statistically significantly (p = 0.11). During submaximal contractions, size related parameters of the needle MUPs (e.g. negative peak duration and amplitude-to-area ratio) were greater in the OA group (p < 0.05), with a rightward shift in the frequency distribution of surface MUP negative peak amplitude. MUP firing rates were significantly lower in the OA group (p < 0.05).</p>
<p>CONCLUSIONS: Changes in MU recruitment and rate coding strategies in OA may reflect a chronic reinnervation process or a compensatory strategy in the presence of chronic knee pain associated with OA.</p>
https://ir.lib.uwo.ca/kinpub/11