Assistance Scores Research Articles

Managing Chronic Headache Disorders.

Headaches are a very common disorder, more common than asthma and diabetes combined. Migraine is the most common headache disorder, but it remains underdiagnosed and therefore undertreated. The treatment of migraines is divided into acute and prophylaxis. Patients who are experiencing 8 or more headaches a month or those who experience disability with their headaches as determined by the Migraine Disability Assistance Score or MIDAS should be placed on prophylaxis.

First-Year Library Student Assistants Have Better Information Literacy Skills, and Demonstrate a Larger Increase in these Skills, Compared to Their First-Year Peers

A Review of:
 Folk, A. L. (2014). How well are we preparing them?: An assessment of first-year library student assistants’ information literacy skills. College & Undergraduate Libraries, 21(2), 177-192. http://dx.doi.org/10.1080/10691316.2013.829377
 
 Objective – To examine the information literacy skills of first year library student assistants, in comparison to first year students who are not library assistants. Additionally, the study investigates whether information literacy skills of library student assistants increased more than those of the general student population during their first semester at college. 
 
 Design – Pretest/posttest.
 
 Setting – Two regional campuses of a research university in the United States of America. 
 
 Subjects – First-year students, including library student assistants and students in the Freshman Seminar course. At one regional campus, 103 first-year students, including 5 library student assistants, completed the pretest. At the same campus, 75 first year students, including 5 library student assistants, completed the posttest. At the other campus, 30 first-year students, including 3 library student assistants, completed the pretest, and 26 first-year students, including 2 library student assistants, completed the posttest.
 
 Methods – The researcher distributed a pretest and posttest that included demographic questions and 11 items related to information literacy to first-year students. The pretest was given within the first two weeks of the fall semester, before the students attended library instructional sessions. At one campus, the library student assistants took the pretest at the beginning of their first shift, while at the second campus, the library student assistants completed the pretest within the first two weeks of the semester. The posttest was given to participants within the last two weeks of classes during the fall semester. 
 
 Main Results – On the pretest, the library student assistant scores ranged from 6 to 10, out of a maximum of 11 points. For the posttest, these students had scores that ranged from 8 to 11. Both of these score ranges were higher than the mean score of the general first-year students. 
 
 The mean of the pretest scores of the general first-year students was 5.95 points out of 11 points with a mean score of 54.1%, while the mean of the pretest scores for the library student assistants was 8.13, or 73.9%. The mean of the posttest scores for the general first-year students was 7.29, or 66.3%, while the mean of the posttest scores for the library student assistants was 9.43, or 85.7%. No students earned a perfect score on the pretest. On the posttest, 29% of the library student assistants scored a perfect 11 points, while only 4% of the general first-year students earned a perfect score.
 
 In comparing pretest to posttest scores, the general first-year students’ mean score increased 1.34 points, while the mean score of the library student assistants increased by 1.3 points. The library student assistants scored higher than the general first-year students on both the pretest and posttest; these numbers are statistically significant. The author reports that the increase in the mean scores from the pretest to the posttest for the library student assistants is not statistically significant. On the other hand, the increase of the mean scores from the pretest to the posttest for the general first-year students is statistically significant (p. 186).
 
 Conclusions – The author concludes that the information literacy skills of first-year library student assistants are better than general first-year students. This information is valuable to librarians who wish to gauge how well they are doing in regards to teaching information literacy skills to library student assistants. Additionally, librarians can better understand how their instruction is contributing to the library student assistants’ educational experiences in general as well as their future as lifelong learners.

Screening, brief intervention and referral of emergency department patients with unhealthy drug use: efficacious or not?

ABSTRACT FROM: Bogenschutz MP, Donovan DM, Mandler RN, et al . Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial. JAMA Intern Med...

Screening and concurrent brief intervention of conjoint hazardous or harmful alcohol and tobacco use in hospital out-patients in Thailand: a randomized controlled trial.

BackgroundThe aim of this study was to conduct a cluster randomized control trial to assess the efficacy of screening and brief intervention (SBI) for conjoint alcohol and tobacco use among hospital out-patients.MethodIn all 620 hospital out-patients who screened positive for both tobacco and alcohol moderate risk in four hospitals were randomized into 2 control and 1 intervention condition using the hospital as a unit of randomization (2 intervention and 2 control hospitals) to 405 patients in the two control groups (tobacco only intervention, n = 199, and alcohol only intervention, n = 206) and 215 in the intervention group. The intervention or control consisted of three counselling sessions.ResultsResults of the interaction (Group × Time) effects using GEE indicated that there were statistically significant differences between the three study groups over the 6-month follow-up on the ASSIST tobacco score (Wald χ2 = 8.43, P = 0.004), and past week tobacco use abstinence (Wald χ2 = 7.34, P = 0.007). Although there were no significant interaction effects on the other outcomes (Alcohol ASSIST score, low alcohol risk score, past week tobacco abstinence or low alcohol risk score, and past week tobacco abstinence and low alcohol risk score), the scores in all of the six outcome measures showed consistent improvements. For past week tobacco abstinence the tobacco only intervention was more effective than the alcohol only intervention and the integrated alcohol and tobacco intervention. For the outcome of low alcohol risk, the alcohol only intervention and the integrated alcohol and tobacco intervention was more effective than the tobacco only or alcohol only intervention.ConclusionsThe study found that for past week tobacco abstinence the tobacco only intervention was more effective than the alcohol only intervention and the polydrug use (alcohol and tobacco) integrated intervention.

Addressing Substance Use within Primary Health Care Settings in South Africa: Opportunities and Challenges

Traditionally, substance use services have not been provided by South African primary health care facilities, limiting access to treatment. A lack of mental health workers has slowed plans to integrate these services into the primary health care system. This has prompted calls for the task-shifting of some treatment responsibilities from mental health specialists to non-specialty health workers. We present findings from three projects that used a task-shifting approach to integrate brief interventions (BIs) for substance use into primary care. The first involved the horizontal integration of nurse-led BI services. In our three-month evaluation, we found significant reductions in substance use (p < 0.001). The second involved the vertical integration of a community health worker-delivered BI within emergency services. In a randomized controlled trial, participants were assigned to a session of motivational interviewing (MI), a five-session blended MI and problem-solving therapy (PST) intervention, or a control group. At three months, ASSIST scores were significantly lower in the MI-PST group than in the other groups (p < 0.001). In the third, we horizontally integrated a nurse-delivered BI intervention into an antenatal clinic. There was low detection of alcohol use; however, tobacco use decreased significantly following the intervention (p < 0.001). Through task-shifting, it is feasible to provide substance use services in primary health care in lowand middle-income countries. It remains unclear whether it is more feasible, acceptable, and effective to integrate these services into primary care using horizontally or vertically integrated approaches. These questions need to be answered in order to guide the implementation of these new health services.

Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial.

The United States has invested substantially in screening and brief intervention for illicit drug use and prescription drug misuse, based in part on evidence of efficacy for unhealthy alcohol use. However, it is not a recommended universal preventive service in primary care because of lack of evidence of efficacy. To test the efficacy of 2 brief counseling interventions for unhealthy drug use (any illicit drug use or prescription drug misuse)-a brief negotiated interview (BNI) and an adaptation of motivational interviewing (MOTIV)-compared with no brief intervention. This 3-group randomized trial took place at an urban hospital-based primary care internal medicine practice; 528 adult primary care patients with drug use (Alcohol, Smoking, and Substance Involvement Screening Test [ASSIST] substance-specific scores of ≥4) were identified by screening between June 2009 and January 2012 in Boston, Massachusetts. Two interventions were tested: the BNI is a 10- to 15-minute structured interview conducted by health educators; the MOTIV is a 30- to 45-minute intervention based on motivational interviewing with a 20- to 30-minute booster conducted by master's-level counselors. All study participants received a written list of substance use disorder treatment and mutual help resources. Primary outcome was number of days of use in the past 30 days of the self-identified main drug as determined by a validated calendar method at 6 months. Secondary outcomes included other self-reported measures of drug use, drug use according to hair testing, ASSIST scores (severity), drug use consequences, unsafe sex, mutual help meeting attendance, and health care utilization. At baseline, 63% of participants reported their main drug was marijuana, 19% cocaine, and 17% opioids. At 6 months, 98% completed follow-up. Mean adjusted number of days using the main drug at 6 months was 12 for no brief intervention vs 11 for the BNI group (incidence rate ratio [IRR], 0.97; 95% CI, 0.77-1.22) and 12 for the MOTIV group (IRR, 1.05; 95% CI, 0.84-1.32; P = .81 for both comparisons vs no brief intervention). There were also no significant effects of BNI or MOTIV on any other outcome or in analyses stratified by main drug or drug use severity. Brief intervention did not have efficacy for decreasing unhealthy drug use in primary care patients identified by screening. These results do not support widespread implementation of illicit drug use and prescription drug misuse screening and brief intervention. clinicaltrials.gov Identifier: NCT00876941.

Su1571 A Randomized Trial of Endoscopic Simulator Training in First Year Gastroenterology Fellows

tablet application with an additional observer resulted in a 10.2% increase in the polyp detection rate, increasing the number of detected polyps by an average of 1.7 0.9 per procedure. Conclusions: Using the tablet software to increase the number of qualified participants is a valid approach to increasing the polyp detection rate for decreasing the incidence of colorectal cancer. The approach additionally allows for more effective medical training by enabling experienced physicians to more effectively highlight lesions and polyps using the endoscopic video. The proposed platform can be easily integrated into existing infrastructure for colonoscopy without interfering with the standard of care, and additionally be used for other types of endoscopy. Su1571 A Randomized Trial of Endoscopic Simulator Training in First Year Gastroenterology Fellows Pichamol Jirapinyo*, Vicki Bing, Nitin Kumar, Michele B. Ryan, Hiroyuki Aihara, Avlin B. Imaeda, Christopher C. Thompson Yale-New Haven Hospital, New Haven, CT; Division of Gastroenterology, Brigham & Women’s Hospital, Boston, MA Background: Training in endoscopy has traditionally relied upon clinical hands-on experience. Simulators may now allow the development of endoscopic skills in a non-clinical environment. Aim: To assess the effect of an endoscopic part-task simulator on trainees’ endoscopic performance. Methods: Simulator An endoscopic part-task training box consisting of 5 modules (snare polypectomy, retroflexion, torque, knob control and loop reduction/navigation) and a validated scoring system. Subjects: First year gastroenterology fellows from 2 academic institutions. Design: Fellows were randomized into 2 arms. The study arm practiced on the simulator for at least 45 minutes per week for the first 3 months of training, in addition to receiving traditional hands-on clinical training. The control arm received only hands-on clinical training. Outcomes: All fellows were assessed for their endoscopic skill performance using the Mayo Colonoscopy Skills Assessment Tool (MCSAT) and the simulator at month 0, 1 and 3. MCSAT scores, training box scores and the numbers of esophagoduodenoscopies (EGDs) and colonoscopies performed were collected. Statistical Analysis: Training box scores from the 2 arms were compared using a linear regression model adjusting for the numbers of EGDs and colonoscopies. Results: Ten first year gastroenterology fellows from 2 academic institutions participated in the study. Five were randomized into the study arm and 5 into the control arm. No participants had used the simulator prior to the study. Average numbers of prior EGDs and colonoscopies are shown in Table 1. There was no difference in total MCSAT hands-on skill scores between the 2 groups at month 1 (pO0.05), however, there was a trend for fellows in the simulator group taking less time (pZ0.09) to reach a farther landmark (hepatic flexure in simulator group vs. splenic flexure in control group (pZ0.22). Additionally, fellows in the study arm performed significantly better on the simulator at month 1 (Table 2; p!0.01), and showed significant improvement in training box performance from month 0 to month 1, compared to the control group (Table 2; p!0.05). At month 3, the control group eliminated this difference as reflected by similar MCSAT hands-on skill scores, time spent reaching the maximal insertion site, location of the farthest landmark reached without assistance and absolute simulator scores, compared to the simulator group (pO0.05 in all variables). Conclusion: The part-task endoscopic simulator provides a non-clinical environment for trainees to practice fundamental endoscopic maneuvers and become familiar with accessories prior to initiation of clinical cases, and during ongoing clinical training. This small sample size suggests that routine use of the simulator may improve technical endoscopic performance during the early phases of training, and larger studies are now needed. Table 1. Average numbers of esophagoduodenoscopies (EGDs) and colonoscopies (colons) performed www.giejournal.org Month 0 Month 1 Month 3 EGDs Colons EGDs Colons EGDs Colons Study arm (n [ 5) 4 4 31 21 62 38 Control arm (n [ 5) 4 1 24 20 51 25 Table 2. Average simulator scores

An intensive physiotherapy program improves mobility for trauma patients

Physiotherapy is integral to modern trauma care. Early physiotherapy and mobility have been shown to improve outcomes in patients with isolated injuries; however, the optimal intensity of physiotherapy in the multitrauma patient population has not yet been examined. The primary aim of this study was to determine whether an intensive physiotherapy program resulted in improved inpatient mobility. We conducted a single-center prospective randomized controlled study of 90 consecutive patients admitted to the Alfred Hospital (a Level 1 trauma center) in Australia between October 2011 and June 2012 who could participate in ward-based physiotherapy. Participants were allocated to either usual care (daily physiotherapy treatment, approximately 30 minutes) or intensive physiotherapy (usual care plus two additional 30-minute treatments each day). The primary outcome measure was the modified Iowa Level of Assistance (mILOA) score, collected by a blinded assessor at Days 3 and 5 (or earlier if discharged). Secondary measures included physical readiness for discharge, hospital and rehabilitation length of stay, a patient confidence and satisfaction scale, and quality of life at 6 months. Groups were comparable at baseline. Participants in the intensive physiotherapy group achieved significantly improved mILOA scores on Day 3 (median, 7 points compared with 10 points; p = 0.02) and Day 5 (median, 7.5 points compared with 16 points; p = 0.04) and were more satisfied with their care (p = 0.01). There was no difference between groups in time to physical readiness, discharge destination, length of stay, or quality-of-life measures. Intensive physiotherapy resulted in improved mobility in trauma inpatients. Further studies are required to determine if specific groups benefit more from intensive physiotherapy and if this translates to long-term improvements in outcomes. Therapeutic study, level 1.

Measuring Physicians’ Productivity

To evaluate a new assessment tool measuring physicians' academic productivity and its use in a performance-based remuneration system. The authors developed an assessment tool based on existing tools to measure productivity. Yearly, from 2008 to 2011, physicians at the University of Western Ontario received a score of up to three points for each of four components (impact, application, scholarly activity, mentorship) in each of four domains (clinical practice, education, research, administration). Scores were weighted by the percentage of time physicians spent on tasks in each domain. Year 1 scores were a baseline. In Years 2 and 3, scores were tied to remuneration. The authors compared scores and associations, accounting for age and academic rank, across the three years. The 37 participating physicians included 11 assistant, 23 associate, and 4 full professors. The mean weighted total baseline score across all four domains was 7.44. Years 2 and 3 scores were highly correlated with Year 1 scores (r = 0.85, Years 1 and 2; r = 0.89, Years 1 and 3). Year 2 mean weighted scores did not differ significantly from Year 1 scores. Assistant professors' scores improved significantly between Years 1 and 2 (+1.08, P < .001). Lower Year 1 scores were correlated with a greater improvement in scores between Years 1 and 2, and age was negatively correlated with score changes between Years 2 and 3. Although the tool may be a robust measurement of physicians' productivity, performance-based remuneration had no effect on physicians' overall performance.

Relationship between static postural control and the level of functional abilities in children with cerebral palsy.

Background: Postural control deficits can impair functional performance in children with cerebral palsy (CP) in daily living activities. Objective: To verify the relationship between standing static postural control and the functional ability level in children with CP. Method: The postural control of 10 children with CP (gross motor function levels I and II) was evaluated during static standing on a force platform for 30 seconds. The analyzed variables were the anteroposterior (AP) and mediolateral (ML) displacement of the center of pressure (CoP) and the area and velocity of the CoP oscillation. The functional abilities were evaluated using the mean Pediatric Evaluation of Disability Inventory (PEDI) scores, which evaluated self-care, mobility and social function in the domains of functional abilities and caregiver assistance. Results: Spearman's correlation test found a relationship between postural control and functional abilities. The results showed a strong negative correlation between the variables of ML displacement of CoP, the area and velocity of the CoP oscillation and the PEDI scores in the self-care and caregiver assistance domains. Additionally, a moderate negative correlation was found between the area of the CoP oscillation and the mobility scores in the caregiver assistance domain. We used a significance level of 5% (p <0.05). Conclusions:We observed that children with cerebral palsy with high CoP oscillation values had lower caregiver assistance scores for activities of daily living (ADL) and consequently higher levels of caregiver dependence. These results demonstrate the repercussions of impairments to the body structure and function in terms of the activity levels of children with CP such that postural control impairments in these children lead to higher requirements for caregiver assistance.

Functionality level and its relation to postural control during sitting-to-stand movement in children with cerebral palsy

In this study we studied functional performance and functional balance in children with cerebral palsy (CP) and typically developing (TD) children. The relationship between these components and postural control during sit-to-stand movement (STS) was also investigated. Ten children with CP (GMFCS I and II) and 27 TD children, ages 5-12 years, were included in the study. The Pediatric Evaluation of Disability Inventory (PEDI) and the Pediatric Balance Scale (PBS) were used to measure functional performance and functional balance, respectively. Postural control during STS was assessed by means of a force plate. Participants were asked to stand from a chair with feet over a force plate. Children with CP exhibited lower scores than TD children in the PBS and in the mobility Functional Skills and Caregiver Assistance domains of the PEDI (p≤0.05). In both groups postural control during STS movement was correlated with mobility Caregiver Assistance scores of the PEDI. The results demonstrate that although the participants had mild to moderate motor impairment, they exhibit deficits in their level of functional performance and functional balance compared to typical children. Moreover, it was observed that impairments in postural control during the STS movement are related to functional performance in both groups. This result demonstrates the importance of the structure and function components to the level of activity in children.

Household task participation of children and adolescents with cerebral palsy, Down syndrome and typical development

This cross-sectional study compared patterns of household task participation (e.g., performance, assistance and independence) of youth with cerebral palsy (CP), Down syndrome (DS) and typical development (TD). Parents of 75 children and adolescents were interviewed to report on their youths' active engagement in daily self-care and family-care tasks, using the children helping out: responsibilities, expectations and supports (CHORES) questionnaire. Groups were equivalent in age (mean=9.3 years; SD=2.2 years), sex (male=39; female=36), respondent education, presence of maid, and number of siblings at home, but differed on child cognitive function and family socioeconomic status, with the DS and the CP groups scoring lower than the TD group but not different from each other. ANOVA revealed group differences on CHORES performance of self-care tasks (p=0.004), on total participation score (p=0.04) and on assistance scores (p<0.02). Post hoc comparisons showed that TD group scored higher than CP and DS groups on performance and assistance in self-care tasks and total assistance; TD and CP groups were similar on total performance and assistance in family-care tasks. The groups also differed on independence indices; the TD index was greater than the CP and DS, and the CP index was greater than the DS. Parents from the three groups did not differ on ratings of importance regarding their children's household participation (p=0.416). In spite of observed differences, children and adolescents with CP and DS are actively engaged in daily self-care and family-care tasks; their participation at home is not prevented by the presence of their disabilities.

Desempenho de crianças com e sem necessidades especiais em provas assistidas e psicométricas

Provas cognitivas assistidas, que incluem auxílio do examinador, analisam o processo de resolução de problemas e o potencial de aprendizagem, complementando a avaliação psicométrica tradicional. São úteis especialmente para casos de necessidades educativas especiais (NEE). Este estudo analisou relações entre o desempenho de crianças, com e sem necessidades de educação especial (NEE), em três provas assistidas e duas psicométricas, entre o perfil de desempenho nas provas assistidas e variáveis de status (gênero, escolaridade e NEE). Foram analisados 256 resultados de provas assistidas e 228 psicométricas, obtidos em seis pesquisas, com 228 crianças (125 meninas), com 5-12 anos (M = 8 anos e 6 meses), cursando da Educação Infantil ao Ensino Fundamental (três em classe especial) e apresentando: dificuldade de aprendizagem (63), deficiência visual (6), nascidas prematuras e com baixo peso (38), prematuras e com muito baixo peso (30) e sem NEE (91); nas provas psicométricas, as classificações no Columbia-EMC (69 aplicações) concentraram-se em Média-Inferior (40,5%) e Média (33,3%) e no Raven-MPC (159 aplicações), nas faixas Intelectualmente na Média (45,2%) e Definidamente Acima da Média (23,9%). Quanto às provas assistidas (256 aplicações) - Jogos de Perguntas de Busca com Figuras Geométricas (154 aplicações) e com Figuras Diversas (34 aplicações) e Children's Analogical Thinking Modifiability Test (68 aplicações) predominou o perfil Ganhador (55,8%), seguido do perfil Ganhador Dependente da Assistência (16,8%), Não Mantenedor (14%) e Alto Escore (13,3%). Não houve associações significativas entre o desempenho nas provas assistidas e psicométricas, confirmando-se a proposição de complementaridade dessas metodologias avaliativas, especialmente para crianças com problemas no desenvolvimento.

Conséquences de la mise en place du programme Norwich de récupération accélérée après prothèse totale de hanche ou de genou

To report the analysis of the initial rehabilitation results of the Norwich Enhanced Recovery Programme (NERP), regime with increased postoperative physiotherapy input following total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed under spinal anaesthetic with wound catheter infiltration. A secondary analysis of a service improvement programme was undertaken from an acute national health service hospital in the United Kingdom. Ninety-five patients listed for THA ( n = 67) or TKA ( n = 28) were reviewed during the first six postoperative weeks. All received an enhanced postoperative programme including commencement of mobilisation 4 hours postoperatively and physiotherapy interventions a minimum of twice daily during hospital admission. The primary outcome measure was the Iowa Level of Assistance Score at discharge. Secondary outcomes included length of hospital stay (LOS), visual analogue scale pain at discharge and complications during the initial six postoperative weeks. The NERP is a successful rehabilitation regime for patients following THA and TKA, facilitating early safe discharge (mean LOS = 3.5 days) with minimal complications. Patients who commenced mobilisation on the day of the operation reported significantly reduced pain score ( p = 0.02) and length of stay ( p < 0.01) compared to those who did not. Thirty-four percent of patients were discharged with rollator frames. Whilst the early results of the NERP allow patients who have undergone THA or TKA surgery a short hospital length of stay, its demand on outreach physiotherapy suggests that the availability of such community services is imperative to ensure the appropriate progression of rehabilitation. Level IV – retrospective series.

Rehabilitation implications during the development of the Norwich Enhanced Recovery Programme (NERP) for patients following total knee and total hip arthroplasty

To report the analysis of the initial rehabilitation results of the Norwich Enhanced Recovery Programme (NERP), regime with increased post-operative physiotherapy input following total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed under spinal anaesthetic with wound catheter infiltration. A secondary analysis of a service improvement programme was undertaken from an acute National Health Service Hospital in the United Kingdom. Ninety-five patients listed for THA (n=67) or TKA (n=28) were reviewed during the first six post-operative weeks. All received an enhanced post-operative programme including commencement of mobilisation four hours post-operatively and physiotherapy interventions a minimum of twice daily during hospital admission. The primary outcome measure was the Iowa Level of Assistance Score at discharge. Secondary outcomes included length of hospital stay (LOS), visual analogue scale pain at discharge and complications during the initial six post-operative weeks. The NERP is a successful rehabilitation regime for patients following THA and TKA, facilitating early safe discharge (mean LOS=3.5days) with minimal complications. Patients who commenced mobilisation on the day of the operation reported significantly reduced pain score (p=0.02) and length of stay (p<0.01) compared to those who did not. Thirty-four percent of patients were discharged with rollator frames. Whilst the early results of the NERP allow patients who have undergone THA or TKA surgery a short hospital length of stay, its demand on out-reach physiotherapy suggests that the availability of such community services is imperative to ensure the appropriate progression of rehabilitation. Level IV-retrospective series.

Molecular and Epidemiological Evaluation of Strain Replacement in Patients Previously Harboring Gentamicin-Resistant MRSA

Gentamicin-susceptible methicillin-resistant Staphylococcus aureus (GS-MRSA) clones have gradually replaced gentamicin-resistant MRSA (GR-MRSA) clones in many European countries. We studied molecular and epidemiological aspects of MRSA strain replacement in individual patients. All patients from whom at least 2 MRSA strains showing different gentamicin susceptibility patterns were isolated between 1996 and 2008 were retrospectively identified. Staphylococcal cassette chromosome mec (SCCmec) type and clonality between isolates were determined using molecular methods. Risk factors for individual GR-MRSA SCCmec I (prevalent clone) strain replacement with GS-MRSA non-SCCmec I types were studied in a nested case-crossover study (n = 55 patients). MRSA strain replacement was observed in 127 patients, 85 (67%) of whom were initially colonized with GR-MRSA replaced subsequently by GS-MRSA. Most GS-MRSA replacement strains (50; 59%) possessed SCCmec IV. All MRSA isolate pairs from the same patient that consisted of different gentamicin susceptibility and SCCmec types were also genotypically different. Exposure to domiciliary nursing assistance (odds ratio [OR], 8.1; 95% confidence interval [CI], 1.2 to 53.7) and high Charlson scores (OR, 7.1; 95% CI, 1.1 to 46.8) were associated with individual strain replacement. In individual patients, exogenous acquisition of a different MRSA strain was responsible for strain replacement in most cases. Domiciliary nursing assistance could be a target for specific control measures to prevent transmission of GS-MRSA in our setting.

Dyslexia, authorial identity, and approaches to learning and writing: A mixed methods study

Dyslexia may lead to difficulties with academic writing as well as reading. The authorial identity approach aims to help students improve their academic writing and avoid unintentional plagiarism, and could help to understand dyslexic students' approaches to writing. (1) To compare dyslexic and non-dyslexic students' authorial identity and approaches to learning and writing; (2) to compare correlations between approaches to writing and approaches to learning among dyslexic and non-dyslexic students; (3) to explore dyslexic students' understandings of authorship and beliefs about dyslexia, writing and plagiarism. Dyslexic (n= 31) and non-dyslexic (n= 31) university students. Questionnaire measures of self-rated confidence in writing, understanding of authorship, knowledge to avoid plagiarism, and top-down, bottom-up and pragmatic approaches to writing (Student Authorship Questionnaire; SAQ), and deep, surface and strategic approaches to learning (Approaches and Study Skills Inventory for Students; ASSIST), plus qualitative interviews with dyslexic students with high and low SAQ scores. Dyslexic students scored lower for confidence in writing, understanding authorship, and strategic approaches to learning, and higher for surface approaches to learning. Correlations among SAQ and ASSIST scores were larger and more frequently significant among non-dyslexic students. Self-rated knowledge to avoid plagiarism was associated with a top-down approach to writing among dyslexic students and with a bottom-up approach to writing among non-dyslexic students. All the dyslexic students interviewed described how dyslexia made writing more difficult and reduced their confidence in academic writing, but they had varying views about whether dyslexia increased the risk of plagiarism. Dyslexic students have less strong authorial identities, and less congruent approaches to learning and writing. Knowledge to avoid plagiarism may be more salient for dyslexic students, who may benefit from specific interventions to increase confidence in writing and understanding of authorship. Further research could investigate how dyslexic students develop approaches to academic writing, and how that could be affected by perceived knowledge to avoid plagiarism.

Development and validation of on-farm behavioural scoring systems to assess birth assistance and lamb vigour

Lamb mortality remains a significant welfare and economic issue for sheep production. Lamb survival is to a degree dependent upon an easy delivery and the expression of appropriate behaviours from both mother and offspring, such as rapid standing, udder seeking and sucking by the lamb. Genetic solutions have the potential to improve birth assistance and lamb behaviour but large amounts of data are needed. Therefore, to achieve this objective, simple, proxy methods (scoring systems) were developed to quantify the level of birth difficulties and lamb vigour on farm. In the first study, detailed historical behavioural data from 1156 lambs (Scottish Blackface and Suffolk (S)) were analysed to develop criteria for 3 scores: birth assistance, lamb vigour and sucking assistance. The birth assistance score was developed by analysing the relationships between birth presentation and intervention levels, and intervention level and labour length. Lambs with abnormal birth positions required more assistance than normally presented lambs and lambs with long labours required more and greater assistance than those with short labours. Lamb vigour score was developed by analysing the latencies for the lamb to first perform specific behaviours; more vigorous lambs reach landmark behaviours faster than low vigour lambs. The sucking assistance score was developed from the relationship between the latency to suck successfully and assistance level, where lambs that were slow to suck required more assistance than lambs that were quick to suck. In the second study, the behaviour scoring systems (5-point categorical scales) were validated using a commercial flock of 80 twin-bearing crossbred ewes mated with either Texel (T) or S sires by simultaneously recording scores and the latency to perform specific landmark behaviours (i.e. to stand, seek the udder and suck). The vigour scores (recorded at 5 min of age) were compared with the latency from birth to standing and showed that lambs with lower (better) vigour scores were faster to stand after birth than those with higher scores. The sucking assistance scores were compared with the latency from birth to sucking, and showed that lambs with lower sucking assistance scores are quicker to suck than those with high scores. These results showed that the scoring systems could provide a practical and reliable assessment of birth assistance and lamb behaviour on farm and were sufficiently sensitive to discriminate vigour levels between lambs sired by either S or T rams.

Effect of Multiple Physiotherapy Sessions on Functional Outcomes in the Initial Postoperative Period After Primary Total Hip Replacement: A Randomized Controlled Trial

Stockton KA, Mengersen KA. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial. Objective To determine whether increasing physiotherapy input from once to twice per day will result in earlier achievement of functional milestones (ie, independence in mobility and transfers) and decreased length of stay (LOS) in patients undergoing a primary total hip replacement. Design Randomized controlled trial. Setting Metropolitan private hospital. Participants Patients (N=57) with primary total hip replacement were randomly assigned to the twice daily (treatment, n=30) and once daily (control, n=27) groups. Patients who chose to attend hydrotherapy were excluded from the randomization process; however, they gave consent for outcome measures to be collected for comparison with the randomized groups. Interventions The control group received usual care, and the treatment group received twice-daily physiotherapy from day 1 after surgery to discharge. Main Outcome Measures The Iowa Level of Assistance at postoperative days 3 and 6 and LOS. Results This study demonstrates that patients who received twice-daily land-based physiotherapy after primary total hip replacement attained earlier achievement of functional milestones than patients that received once-daily physiotherapy. A statistically significant ( P=.041) but not clinically significant difference was evident in the Iowa Level of Assistance score at day 3. There was no difference between the groups in Iowa Level of Assistance measures on day 6 or on LOS. Conclusions Patients who received twice-daily physiotherapy showed a trend toward earlier achievement of functional milestones; however, this finding did not translate to decreased LOS.

The impact of curriculum change on health sciences first year students’ approaches to learning

This study aimed to use a learning inventory (the Approaches and Study Skills Inventory for Students, ASSIST) to measure the impact of a curriculum change on students’ approaches to learning in two large courses in a health sciences first year programme. The two new Human Body Systems (HUBS) courses were designed to encourage students to take a deep approach to learning. ASSIST was completed by 599 students enrolled in a biology class in 2006 that was part of the old curriculum, and by 705 students at the beginning and end of the new HUBS courses in 2007. Changes in students’ approaches to learning over time were examined. The ASSIST scores for both HUBS courses reflected the dominance of a surface approach, followed by a strategic and then a deep approach. However, by the end of the year, students were taking a deep and strategic approach to their studies to a greater extent, and a surface approach to a lesser extent. Moreover, students enrolled in the new course adopted a deep approach to their studies to a significantly greater degree than those studying the old curriculum. Despite the predominance of a surface approach, the results suggest that it is possible to bring about small but significant positive changes in students’ learning behaviour in a very large class through curriculum change. The proportion of students preferring a surface approach, and results showing that high performance on the final exam was significantly correlated with a surface approach, probably reflected contextual factors, including assessment, and is the focus of ongoing curriculum development.