Under-investigation of older people with abnormal chest radiographs

Background: Whilst many authors have previously suggested that older people are under-represented in the investigation and management of lung cancer, few data are available as to the effect of age on the subsequent investigation and management of a patient with an abnormal chest radiograph. Methods: During a 3-month period in a university teaching hospital, all abnormal chest radiographs suggestive of a possible diagnosis of lung cancer were identified, and patients subsequently followed to determine investigation, management and date of death over a 5-year period. Results: Thirty-seven younger (less than or equal to69 years, median age 62 years) and 43 older patients ( 670 years, median age 80 years) were identified. Of the 80 patients with a possible bronchial carcinoma only 59% had a further chest radiograph performed. Bronchoscopy was performed in 34% of patients, but a biopsy of the lesion was undertaken in only 24% of patients. Sixteen of the 80 patients, irrespective of what investigations had been undertaken, were referred for an oncological or surgical opinion. During the study period ( 3 months), 24% of the patients died. At 6, 24 and 60 months, respectively, the total deaths were 40, 78 and 88%. Conclusion: Older patients compared with those aged less than 70 years were less likely to be investigated, further, were more likely to be managed differently (i.e., less aggressively) and more likely to die within each time interval. In more of the older group a presumed death certificate diagnosis of pneumonia was made. When an abnormal chest radiograph raises the possibility of an underlying bronchial carcinoma, the finding of this study suggests that an ageist attitude influences the subsequent management of some patients. Copyright (C) 2005 S. Karger AG, Basel.

The sport Injury Rehabilitation Adherence Scale : a reliable scale for use in clinical physiotherapy

Objective
To evaluate, through two studies, the factor structure, inter-rater agreement, and test–retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design
Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting
University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants
Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention
In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure
The SIRAS.

Results
In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test–retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36–0.82) to 0.76 (95% CI 0.55–0.88), respectively.

Conclusion
The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.

The normative distribution of chest tube drainage volume after coronary artery bypass grafting

Background
Little evidence exists to describe expected volumes of chest tube (CT) drainage after coronary artery bypass grafting (CABG).

Objectives
The study objective was to map the trajectory of CT drainage volumes from insertion to removal after CABG.

Design

This was a retrospective, descriptive study.
Patients
The study included 239 patients who underwent CABG at a single metropolitan hospital in Melbourne, Australia.

Results
The sample (N = 234), aged 68.7 years (standard deviation [SD] 9.9), was predominantly male (N = 185, 79.1%). The mean duration of CT insertion was 45.2 hours (SD 26.7), and total drainage volume was 1300.6 mL (SD 763.8). Drainage volumes plateau to 31 mL per hour, 8 hours after surgery. From 24 to 48 hours, the mean drainage was 21 mL per hour. Drainage volumes varied between genders.

Conclusions
Evidence of similar drainage patterns in other populations is difficult to locate. If the pattern of drainage shown in this study is consistent, experimental intervention studies comparing standard removal time and earlier removal are recommended. If not, prospective collection of relevant preoperative, intraoperative, and postoperative factors across multiple sites is necessary to determine which patient or practice variations influence CT drainage patterns after CABG.

Perceptions of health, illness and physiotherapy of Maori identifying with Ngati Tama iwi

The purpose of this study was to explore the perceptions of health, illness and the delivery of physiotherapy amongst a group of contemporary Maori. The methodology was established in collaboration with Kaumatua of the Ngati iwi. This resulted in the data collection consisting of semi-structured interviews, which used open-ended questions. As with other studies of cultural health issues both quantitative and qualitative data were collected. Nineteen people identifying with this iwi volunteered to participate. The majority of participants had some involvement in the Maori culture. All participants had used the western orthodox health system, with approximately 50% of them having also used traditional Maori methods of healing. Their perceptions of health and illness beliefs reflected a mixture of western orthodox medicine theories and traditional Maori beliefs. Despite only 10 participants having experienced physiotherapy, the majority had a good understanding of what physiotherapy is. While those who had received physiotherapy regarded it positively, there was a general feeling amongst the participants that it could be delivered in a more culturally sensitive manner. This did not necessarily mean that Maori people wanted to be treated at a clinic on the Marae or by Maori physiotherapists.

No difference in 1RM strength and muscle activation during the barbell chest press on a stable and unstable surface

Exercise or Swiss balls are increasingly being used with conventional resistance exercises. There is little evidence supporting the efficacy of this approach compared to traditional resistance training on a stable surface. Previous studies have shown that force output may be reduced with no change in muscle electromyography (EMG) activity while others have shown increased muscle EMG activity when performing resistance exercises on an unstable surface. This study compared 1RM strength, and upper body and trunk muscle EMG activity during the barbell chest press exercise on a stable (flat bench) and unstable surface (exercise ball). After familiarization, 13 subjects underwent testing for 1RM strength for the barbell chest press on both a stable bench and an exercise ball, each separated by at least 7 days. Surface EMG was recorded for 5 upper body muscles and one trunk muscle from which average root mean square of the muscle activity was calculated for the whole 1RM lift and the concentric and eccentric phases. Elbow angle during each lift was recorded to examine any range-of-motion differences between the two surfaces. The results show that there was no difference in 1RM strength or muscle EMG activity for the stable and unstable surfaces. In addition, there was no difference in elbow range-of-motion between the two surfaces. Taken together, these results indicate that there is no reduction in 1RM strength or any differences in muscle EMG activity for the barbell chest press exercise on an unstable exercise ball when compared to a stable flat surface. Moreover, these results do not support the notion that resistance exercises performed on an exercise ball are more efficacious than traditional stable exercises.

The presence of fungi on contact electrical stimulation electrodes and ultrasound transducers in physiotherapy clinics

Objectives To evaluate the presence of fungi on contact electrodes and ultrasound transducers from physiotherapy clinics.Design Quantitative study conducted at the Laboratory of Microbiology and Immunology, Faculty of Health Sciences and Technology of Piaui - NOVAFAPI, Teresina, Brazil.Setting Sample collection was performed in 10 clinics ( 20 ultrasound transducers and 20 contact electrodes).Main outcome measures Swabs were soaked with saline solution, inoculated in culture and incubated for filamentous fungi and yeast growth.Results Fourteen taxons were identified: Acremomium hyalinulum (Sacc.), Aspergillus terreus, Candida albicans, Cladosporium cladosporioides, Cladosporium elatum, Cladosporium oxysporum, Cladosporium sphaerospermum, Cladosphialophora bantiana, Curvularia clavata, Curvularia senegalensis, Fusarium oxysporum, Penicillium decumbens, Scopulariopsis candida and Sporothrix schenckii. Aspergillus terreus, Cladosporium oxysporum, Sporothrix shenckii and Candida albicans were found most often on contact electrodes, and Penicillium decumbens and Cladosporium cladosporioides were found most often on ultrasound transducers.Conclusion Fungi were found on all of the contact electrodes and ultrasound transducers. Physiotherapy professionals need to improve the disinfection procedures for this equipment. (C) 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Avaliação da cinemática do complexo tóracoabdominal durante repouso e endurance muscular respiratória em obesos

Background: Obesity may affect the respiratory system, causing changes in respiratory function and in the pulmonary volumes and flows. Objectives: To evaluate the influence of obesity in the movement of thoracoabdominal complex at rest and during maximal voluntary ventilation (MVV), and the contribution between the different compartments of this complex and the volume changes of chest wall between obese and non-obese patients. Materials and Methods: We studied 16 patients divided into two groups: the obese group (n = 8) and group non-obese (n = 8). The two groups were homogeneous in terms of spirometric characteristics (FVC mean: 4.97 ± 0.6 L - 92.91 ± 10.17% predicted, and 4.52 ± 0.6 L - 93.59 ± 8.05%), age 25.6 ± 5.0 and 26.8 ± 4.9 years, in non-obese and obese respectively. BMI was 24.93 ± 3.0 and 39.18 ± 4.3 kg/m2 in the groups investigated. All subjects performed breathing calm and slow and maneuver MVV, during registration for optoelectronic plethysmography. Statistical analysis: we used the unpaired t test and Mann-Whitney. Results: Obese individuals had a lower percentage contribution of the rib cage abdominal (RCa) during breathing at rest and VVM. The variation of end expiratory (EELV) and end inspiratory (EILV) lung volumes were lower in obese subjects. It has been found asynchrony and higher distortion between compartments of thoracoabdominal complex in obese subjects when compared to non-obese. Conclusions: Central obesity impairs the ventilation lung, reducing to adaptation efforts and increasing the ventilatory work

Development of phantom for radiographic image optimization of standard patient in the lateral view of chest and skull examination

We present the construction of a homogeneous phantom to be used in simulating the scattering and absorption of X-rays by a standard patient chest and skull when irradiated laterally. This phantom consisted of Incite and aluminium plates with their thickness determined by a tomographic exploratory method applied to the anthropomorphic phantom. Using this phantom, an optimized radiographic technique was established for chest and skull of standard sized patient in lateral view. Images generated with this optimized technique demonstrated improved image quality and reduced radiation doses. (c) 2006 Elsevier Ltd. All rights reserved.