Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092)

Effectiveness of brief/minimal contact self-activation interventions that encourage participation in physical activity (PA) for chronic low back pain (CLBP >12 weeks) is unproven. The primary objective of this assessor-blinded randomized controlled trial was to investigate the difference between an individualized walking programme (WP), group exercise class (EC), and usual physiotherapy (UP, control) in mean change in functional disability at 6 months. A sample of 246 participants with CLBP aged 18 to 65 years (79 men and 167 women; mean age ± SD: 45.4 ± 11.4 years) were recruited from 5 outpatient physiotherapy departments in Dublin, Ireland. Consenting participants completed self-report measures of functional disability, pain, quality of life, psychosocial beliefs, and PA were randomly allocated to the WP (n = 82), EC (n = 83), or UP (n = 81) and followed up at 3 (81%; n = 200), 6 (80.1%; n = 197), and 12 months (76.4%; n = 188). Cost diaries were completed at all follow-ups. An intention-to-treat analysis using a mixed between-within repeated-measures analysis of covariance found significant improvements over time on the Oswestry Disability Index (Primary Outcome), the Numerical Rating Scale, Fear Avoidance-PA scale, and the EuroQol EQ-5D-3L Weighted Health Index (P < 0.05), but no significant between-group differences and small between-group effect sizes (WP: mean difference at 6 months, 6.89 Oswestry Disability Index points, 95% confidence interval [CI] -3.64 to -10.15; EC: -5.91, CI: -2.68 to -9.15; UP: -5.09, CI: -1.93 to -8.24). The WP had the lowest mean costs and the highest level of adherence. Supervised walking provides an effective alternative to current forms of CLBP management.

Preserving arteriovenous fistula outcomes during surgical training

PURPOSE: Arteriovenous fistulae (AVFs) are the preferred option for vascular access, as they are associated with lower mortality in hemodialysis patients than in those patients with arteriovenous grafts (AVGs) or central venous catheters (CVCs). We sought to assess whether vascular access outcomes for surgical trainees are comparable to fully trained surgeons.

METHODS: A prospectively collected database of patients was created and information recorded regarding patient demographics, past medical history, preoperative investigations, grade of operating surgeon, type of AVF formed, primary AVF function, cumulative AVF survival and functional patency.

RESULTS: One hundred and sixty-two patients were identified as having had vascular access procedures during the 6 month study period and 143 were included in the final analysis. Secondary AVF patency was established in 123 (86%) of these AVFs and 89 (62.2%) were used for dialysis. There was no significant difference in survival of AVFs according to training status of surgeon (log rank x2 0.506 p=0.477) or type of AVF (log rank x2 0.341 p=0.559). Patency rates of successful AVFs at 1 and 2 years were 60.9% and 47.9%, respectively.

CONCLUSION: We have demonstrated in this prospective study that there are no significant differences in outcomes of primary AVFs formed by fully trained surgeons versus surgical trainees. Creation of a primary AVF represents an excellent training platform for intermediate stage surgeons across general and vascular surgical specialties.

Attitudes of Irish dental graduates to vocational training

INTRODUCTION: Vocational training (VT) is a mandatory 12 month period for UK dental graduates after graduation. Graduates of Irish Dental Schools are eligible to enter the general dental service in Ireland or obtain an NHS performers list number in the UK immediately after qualification. Reports would suggest that some graduates of Irish Dental Schools are choosing to take part in VT in the UK and find the experience beneficial. This study aimed to record the uptake of VT amongst recent graduates from University College Cork and to document their experiences. It was designed to compare the attitudes and experiences of graduates of Irish Dental Schools who undertook VT compared with those who entered the general dental service.

METHOD: A self-completion questionnaire was distributed by e-mail to dental graduates from University College Cork who had graduated 2001-2007. Responses were returned by e-mail or post.

RESULTS: The response rate was 68.9%. There has been an increase in the numbers of graduates taking part in VT each year since 2004. 92.5% of Vocational Dental Practitioners (VDPs) found their experience beneficial as they received a guaranteed source of income, had a supportive peer network and worked in a positive learning environment. However, some felt that they earned a lower income than their associate colleagues, others found the pace of practice slow and that the duration of the training period was excessive. Eighty-five per cent of VDPs would choose the same position again after graduation as compared with 61.8% of associates (P < 0.001). Ninety per cent of VDPs would advise current undergraduates to take part in VT as compared with 51% of associates (P < 0.001). A larger proportion of VDPs had taken part in postgraduate studies but there was no significant difference between the two groups.

CONCLUSIONS: Larger proportions of recent graduates are undertaking vocational training.--The majority of VDPs and associates find their initial employment position beneficial.--VDPs benefit from a guaranteed source of income, a supportive peer network and a positive learning environment.--Some associates suffered from a lack of support, feeling isolated and overwhelmed with patients.--The majority of previous VDPs and associates would recommend VT to current undergraduates.--Almost 40% of associates would now choose to take part in VT if given the opportunity.

Integrating molecular diagnostics into histopathology training: the Belfast model

Molecular medicine is transforming modern clinical practice, from diagnostics to therapeutics. Discoveries in research are being incorporated into the clinical setting with increasing rapidity. This transformation is also deeply changing the way we practise pathology. The great advances in cell and molecular biology which have accelerated our understanding of the pathogenesis of solid tumours have been embraced with variable degrees of enthusiasm by diverse medical professional specialties. While histopathologists have not been prompt to adopt molecular diagnostics to date, the need to incorporate molecular pathology into the training of future histopathologists is imperative. Our goal is to create, within an existing 5-year histopathology training curriculum, the structure for formal substantial teaching of molecular diagnostics. This specialist training has two main goals: (1) to equip future practising histopathologists with basic knowledge of molecular diagnostics and (2) to create the option for those interested in a subspecialty experience in tissue molecular diagnostics to pursue this training. It is our belief that this training will help to maintain in future the role of the pathologist at the centre of patient care as the integrator of clinical, morphological and molecular information.

Double-breasting voice systems: an assessment of motives, arrangements and durability

This article explores employee voice within the specific institutional arrangement of double-breasting. Double-breasting is when multi-plant organizations recognize trade unions in some company sites, with non-union arrangements at other company plants, or where a unionized firm acquires a new site that it then operates on a non-union basis. We examine three research questions in four separate case study organizations that operate employee voice double-breasting arrangements across 16 workplace locations on the island of Ireland. These questions consider employer motives for double-breasting, the practices that characterize double-breasting employee voice, and the micro-political implications of double-breasting. The article contributes to knowledge on the emergence and impact of double-breasting and employee voice systems. We subsequently advance two theoretical propositions: the first theorizing employer motives for double-breasting, and the second explaining the extent to which the practice of double-breasting is durable over time.

“A quiet still voice that just touches”: music’s relevance for adults living with life-threatening cancer diagnoses.

Purpose
Music has historically aided health and loss-adaptation, however, cancer patients’ experience of music for self-care is not well understood. This study examines adult cancer patients’ views about music’s role before and after diagnosis.
Methods
Constructivist approach, with grounded theory informed design using convenience, snowball and theoretical sampling. Patients from Australian metropolitan cancer and hospice settings completed demographic questionnaires and participated in semi-structured interviews. Qualitative inter-rater reliability was applied.
Results
Fifty-two patients reported comparable time spent experiencing music pre-post diagnosis. Music may remain incidental; however, many patients adapt music usage to ameliorate cancer’s aversive effects. Patients often draw from their musical lives and explore unfamiliar music to: remain connected with pre-illness identities; strengthen capacity for enduring treatment, ongoing survival (even when knowing “you’re going to die”), or facing death; reframe upended worlds; and live enriched lives. Patients can ascribe human or physical properties to music when describing its transformative effects. Familiar lyrics maybe reinterpreted, and patients’ intensified emotional reactions to music can reflect their threatened mortality. Sometimes music becomes inaccessible, elusive, and/or intensifies distress and is avoided. Families’, friends’ and professionals’ recognition of patients’ altered musical lives and music-based suggestions can extend patients’ use of music for self-care.
Conclusion
Health professionals can support patients by inquiring about their music behaviours and recognising that altered music usage may signify vulnerability. Although commonly recommended, hospital concerts and music broadcasts need sensitive delivery. Patients’ preferred music should be available in diagnostic, treatment and palliative settings because it can promote endurance and life enrichment.

Introducing an obstetric emergency training strategy into a simulated environment

Midwifery educators are challenged to produce registrants who are fit for practice at the point of registration with competence at the heart of this expectation. In addition to achieving expertise in normal pregnancy, it is recognised that students need to have the skills of critical decision making where normal processes become adversely affected.
An evaluation was undertaken with final year direct entry midwifery students using questionnaires and focus group interviews to determine whether simulated learning, such as the Practical Obstetric Multi-Professional Training (PROMPT) package, for emergency obstetric training would enhance self-efficacy and confidence levels in preparation for post-registration practice. The main themes that emerged from the study indicate that this style of learning increased midwifery students’ feelings of self-efficacy; highlighted the importance of a safe learning environment; reduced their anxiety regarding their ability to make decisions in clinical practice and reinforced confidence in their level of knowledge.

Successful balance training is associated with improved multisensory function in fall-prone older adults

Balance maintenance relies on a complex interplay between many different sensory modalities. Although optimal multisensory processing is thought to decline with ageing, inefficient integration is particularly associated with falls in older adults. We investigated whether improved balance control, following a novel balance training intervention, was associated with more efficient multisensory integration in older adults, particularly those who have fallen in the past. Specifically, 76 healthy and fall-prone older adults were allocated to either a balance training programme conducted over 5 weeks or to a passive control condition. Balance training involved a VR display in which the on-screen position of a target object was controlled by shifts in postural balance on a Wii balance board. Susceptibility to the sound-induced flash illusion, before and after the intervention (or control condition), was used as a measure of multisensory function. Whilst balance and postural control improved for all participants assigned to the Intervention group, improved functional balance was correlated with more efficient multisensory processing in the fall-prone older adults only. Our findings add to growing evidence suggesting important links between balance control and multisensory interactions in the ageing brain and have implications for the development of interventions designed to reduce the risk of falls.