Moderate Confidence Research Articles

Oral language comprehension interventions in school-age children and adolescents with developmental language disorder: A systematic scoping review.

Difficulties understanding spoken language are associated with several social and academic risks in school-age children and adolescents with developmental language disorder (DLD). Still, interventions for this group have received little attention, and there are no reviews focusing on oral language comprehension interventions in school-age children and adolescents. The objective of this systematic scoping review was to identify interventions targeting oral language comprehension in school-age children and adolescents with DLD. Further, the aim was to examine the focus of intervention, efficacy, and level of evidence of the identified interventions. The present review is the second part of a larger search on oral language comprehension interventions. The first review examined the same factors in children 8 years and younger. A systematic scoping review of eight databases was conducted. Of the 2399 sourced articles, 12 met the inclusion criteria. Another 8 articles were identified through reference lists of sourced articles. In these 20 articles, containing 21 studies, 1661 children aged 5-16 years participated. The data were extracted and analysed, and the intervention focus, efficacy, and level of evidence were examined.Main contribution: In the interventions intended for school-age children and adolescents with DLD, three intervention foci were identified that targeted aspects of language and language processing, as well as modifying the communicative environment. Of the included studies, 57% reported positive results, 14% reported mixed results, and 29% reported no effects on oral language comprehension. The level of evidence varied. One can have high confidence in the results of 19%, moderate in 38%, and indicative confidence in 43% of the included studies. Results of the present review suggest that there are a few interventions providing high confidence on the efficacy of improving oral language comprehension difficulties in school-age children and adolescents with DLD. Most interventions indicating efficacy provide moderate or indicative confidence in the results. More research with a high level of evidence is urgently needed. Most of the interventions indicating efficacy focused directly on language skills or modified the communicative environment. The results suggest that the therapy techniques focusing on improving language processing skills indicate efficacy only when they aim at compensating current language processing skills, not trying to improve them.Implications: The findings on different therapy techniques, their focus of intervention, efficacy, and level of evidence provide information for clinical practice and direct future investigations in this sparsely researched topic.

Vitamin D in patients with Hashimoto's disease: a systematic review and meta-analysis

One of the most common thyroid dysfunctions is Hashimoto's disease (HD), characterized by the production of specific antibodies against thyroid gland antigens (Anti-Tg and Anti-TPO). Recent studies have suggested that vitamin D supplementation, associated with levothyroxine, may contribute to the control of this autoimmune disease. However, secondary studies on this topic, such as systematic reviews and meta-analyses, are still scarce. Thus, the present study aimed to evaluate the efficacy and safety of vitamin D in patients with HD through a systematic review with meta-analysis. Randomized clinical trials were selected on the Pubmed, Scopus, and Web of Science databases. Studies comparing groups of HD patients supplemented with vitamin D and non-supplemented HD patients were included. The following outcomes were considered: TSH, T3, T4, Anti-Tg, Anti-TPO, and adverse drug reactions. The risk of bias was performed according to the Cochrane recommendations (RoB v. 2.0), and the quality of evidence was evaluated by the GRADE system. A total of 766 studies were identified in the databases, of which 7 met the eligibility criteria. None of the studies indicated the occurrence of adverse reactions with vitamin D supplementation in any administered dosage. Supplemented patients had a significant reduction in serum TSH levels compared to the control group (mean difference = -0.180 (95% CI [-0.316 to -0.045]), p = 0.009), suggesting that thyroid function was more controlled in the intervention group. However, for the other outcomes, no statistically significant differences were observed between the groups. Additionally, most of included articles (n=5/7) had some concerns or high risk of bias, and the quality of evidence revealed a moderate confidence for almost all outcomes; so the results must be interpreted with caution. Thus, more consistent, and robust clinical trials need to be carried out to confirm the efficacy of vitamin D supplementation in patients with HD.

Feasibility of skin-friction field measurements in a transonic wind tunnel using a global luminescent oil film

The feasibility of skin-friction field measurements using the global luminescent oil-film skin-friction field estimation method was evaluated for a challenging case of a supercritical airfoil model under transonic wind-tunnel conditions (freestream Mach number of 0.72) at a high Reynolds number (10 million, based on the model chord length). The oil-film thickness and skin-friction coefficient distributions were estimated over the airfoil model upper surface for a range of angles of attack (from -0.4^{circ } to 2.0^{circ }), thus enabling the study of different boundary-layer stability situations with laminar–turbulent transition, including cases with shock-wave/boundary-layer interaction. Conventional pressure measurements on the surface and in the wake of the model as well as Schlieren flow visualizations were conducted to support the oil-film based investigations. In the laminar-flow regions, the oil-film thickness could be generally kept below the critical limit of roughness that would induce premature boundary-layer transition. The skin friction in this region could be estimated with a moderate confidence level, as confirmed for portions of the chord by the reasonable agreement with numerical data obtained via laminar boundary-layer computations. Moreover, the location of transition onset was evaluated from the skin-friction estimations with relatively low uncertainty, thus enabling the examination of the transition location evolution with varying angle of attack. The estimated locations of transition onset were shown to be in general agreement with reference transition locations measured via temperature-sensitive paint. On the other hand, the oil-film thickness in the turbulent-flow regions was larger than the height of the viscous sublayer, which led to an hydraulically rough surface with increased skin friction, as compared to the clean configuration. For this reason, quantitative skin-friction estimations were not feasible in the turbulent-flow regions. The global effects of the oil-film setup on the flow around the airfoil were evaluated from the estimations of the aerodynamic coefficients. In particular, it was shown that the presence of the specific base coat used for the application of the oil film already induced a significant increase in airfoil drag, as compared to the clean configuration, whereas a thin oil film led to negligible or small additional increases in drag. Based on the present observations, considerations for the further improvement of the global luminescent oil-film skin-friction field estimation method in transonic flow experiments at high Reynolds numbers are elucidated.Graphic abstract

The Correlation of Online Health Information-Seeking Experience With Health-Related Quality of Life: Cross-Sectional Study Among Non-English-Speaking Female Students in a Religious Community.

BackgroundGiven the increasing availability of the internet, it has become a common source of health information. However, the effect of this increased access on health needs to be further studied.ObjectiveThis study aimed to investigate the correlation between online health information–seeking behavior and general health dimensions in a sample of high school students in Iran.MethodsA cross-sectional study was conducted in 2019. A total of 295 female students participated in the study. The data were collected using two validated questionnaires: the e-Health Impact Questionnaire and the 36-Item Short Form Health Survey. The collected data were analyzed through descriptive statistics and Pearson correlation coefficients using SPSS version 23 (IBM Corp).ResultsThe participants moderately used online information in their health-related decisions, and they thought that the internet helped people in health-related decision making. They also thought that the internet could be used to share health experiences with others. Participants had moderate confidence in online health information and stated that the information provided by health websites was moderately understandable and reliable and moderately encouraged and motivated them to play an active role in their health promotion. Nevertheless, the results showed that online health information–seeking experience had no significant correlation with health-related quality of life.ConclusionsThis study provides insights into the effect of using internet information on the health of adolescents. It has important implications for researchers and policy makers to build appropriate policies to maximize the benefit of internet access for health.

Long-term evaluation of a train-the-trainer workshop for pharmacy faculty using the RE-AIM framework.

Although two thirds of tobacco users express interest in quitting, few pharmacists address tobacco use as part of routine practice. Historically, pharmacy schools provided inadequate tobacco cessation training for students. To address this educational gap, train-the-trainer workshops were conducted between 2003 and 2005 to train pharmacy faculty (n=191) to teach a shared, national tobacco cessation curriculum at their academic institutions. To characterize faculty perceptions of the train-the-trainer workshops and estimate the long-term reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of the shared curriculum at pharmacy schools. This study is the second phase of a sequential mixed methods study. Results from Phase 1, a qualitative study, informed the development of survey items for Phase 2. Applying the RE-AIM framework, a web-based survey was developed and administered to train-the-trainer participants. Of 191 trainees, 137 were locatable; of these, 111 completed a survey (81.0%). Most (n=87; 78.4%) reported current employment in academia. The most highly rated reason for attending a workshop was to improve teaching of tobacco cessation content, and 98.1% reported moderate or high confidence for teaching tobacco cessation. Among those who practice in a clinical setting, 70.6% reported asking their patients about tobacco use all or almost all the time. Just over three fourths of faculty respondents who work in academia believe that shared curricula should be more broadly considered for use in pharmacy schools, and 79.0% agreed that shared curricula are a cost-effective approach to teaching. Evidence is provided for long-term reach, effectiveness, adoption, implementation, and maintenance of the Rx for Change shared tobacco cessation training program. Participants perceived that the workshop resulted in long-term, positive effects on their careers as well as their teaching and clinical practice.

Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis

ObjectiveTo determine the most effective interventions in recently detoxified, alcohol dependent patients for implementation in primary care.DesignSystematic review and network meta-analysis.Data sourcesMedline, Embase, PsycINFO, Cochrane CENTRAL, ClinicalTrials.gov, and the World...

Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review.

Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review.

Barriers and Facilitators to the Use of Medications for Opioid Use Disorder: a Rapid Review.

Despite evidence that medications to treat opioid use disorder (OUD) are effective, most people who could benefit from this treatment do not receive it. This rapid review synthesizes evidence on current barriers and facilitators to buprenorphine/naloxone and naltrexone at the patient, provider, and system levels to inform future interventions aimed at expanding treatment. We systematically searched numerous bibliographic databases through May 2020 and selected studies published since 2014. Study selection, data abstraction, coding of barriers and facilitators, and quality assessment were first completed by one reviewer and checked by a second. We included 40 studies of buprenorphine (5 also discussed naltrexone). Four types of patient and provider-level barriers to OUD medication use emerged-stigma related to OUD medications, treatment experiences and beliefs (positive or negative), logistical issues (time and costs as well as insurance and regulatory requirements), and knowledge (high or low) of OUD and the role of medications. Stigma was the most common barrier among patients, while logistical issues were the most common barriers among providers. Facilitators for both patients and providers included peer supports. Most administrator-identified or system-level barriers and facilitators fit into the category of logistical issues. We have moderate confidence in buprenorphine findings but low confidence in naltrexone findings due to the small number of studies. Stigma, treatment experiences, logistical issues, and knowledge gaps are the main barriers associated with low utilization of OUD medications. These barriers can overlap and mutually reinforce each other, but given that, it is plausible that reducing one barrier may lead to reductions in others. The highest priority for future research is to evaluate interventions to reduce stigma. Other priorities for future research include better identification of barriers and facilitators for specific populations, such as those with OUD related to prescription opioids, and for naltrexone use. PROSPERO; CRD42019133394.

Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis

ObjectiveTo explore the acceptability of different bisphosphonate regimens for the treatment of osteoporosis among patients, clinicians and managers, payers and academics.DesignA systematic review of primary qualitative studies. Seven databases were...

Light at night exposure and cancer: A cancer hazard evaluation

Background: Modern electric lighting practices have transformed our society into one in which people work, sleep, and receive goods and services 24/7. As the light-dark cycle is the major stimulus for coordinating the circadian system, exposure to light at night (LAN) can lead to circadian disruption (CD) and potential adverse health effects.Methods: The U.S. National Toxicology Program (NTP) conducted a cancer hazard evaluation of exposure to LAN that included a systematic review of epidemiology studies of female breast cancer. The human studies assessed LAN exposure in the sleeping area (i.e., “indoor light”) or from outdoor light, mostly by using satellite imaging methods (e.g., “environmental LAN”). We characterized all identified studies as low or moderate quality based on our bias and sensitivity evaluation.Results and discussion: The 10 studies of indoor LAN provided inconsistent findings due to heterogeneity in methods used to measure LAN levels and the lack of specificity regarding LAN levels. Cohort or case-control studies of environmental LAN consistently found an increased risk of breast cancer among women in the highest category of overall LAN or blue-light LAN exposure. Whether these measurements provide a relevant direct measure of light or are surrogates for other activities enabled by light is not clear. Furthermore, whether low light levels observed in these studies are sufficient to disrupt circadian rhythms remains a question. NTP concluded the epidemiological database was inadequate to evaluate the relationship between exposure to LAN and female breast cancer.Conclusions: Mechanistic and toxicological data studies provide strong evidence that certain lighting conditions (excessive LAN and insufficient daylight) can cause CD, biological effects characteristic of carcinogens, and promote breast or mammary tumor growth, thus providing moderate confidence of carcinogenicity in humans. Additional studies precisely measuring exposure to all sources of LAN and characterizing LAN intensities and spectral characteristics are needed.

Use of Physiologically Based Pharmacokinetic (PBPK) Modeling for Predicting Drug-Food Interactions: an Industry Perspective

The effect of food on pharmacokinetic properties of drugs is a commonly observed occurrence affecting about 40% of orally administered drugs. Within the pharmaceutical industry, significant resources are invested to predict and characterize a clinically relevant food effect. Here, the predictive performance of physiologically based pharmacokinetic (PBPK) food effect models was assessed via de novo mechanistic absorption models for 30 compounds using controlled, pre-defined in vitro, and modeling methodology. Compounds for which absorption was known to be limited by intestinal transporters were excluded in this analysis. A decision tree for model verification and optimization was followed, leading to high, moderate, or low food effect prediction confidence. High (within 0.8- to 1.25-fold) to moderate confidence (within 0.5- to 2-fold) was achieved for most of the compounds (15 and 8, respectively). While for 7 compounds, prediction confidence was found to be low (> 2-fold). There was no clear difference in prediction success for positive or negative food effects and no clear relationship to the BCS category of tested drug molecules. However, an association could be demonstrated when the food effect was mainly related to changes in the gastrointestinal luminal fluids or physiology, including fluid volume, motility, pH, micellar entrapment, and bile salts. Considering these findings, it is recommended that appropriately verified mechanistic PBPK modeling can be leveraged with high to moderate confidence as a key approach to predicting potential food effect, especially related to mechanisms highlighted here.

85. A CLER PATH TO ONBOARDING TRAINING: A NOVEL APPROACH TO PREPARE PEDIATRIC FELLOWS TO WORK AT A CHILDREN'S HOSPITAL

Background Fellows need to be prepared for their clinical tasks to ensure safe and effective patient care. Many fellows graduate from residency and receive limited orientation for clinical learning at a new hospital. Using the ACGME's Clinical Learning Environment Review (CLER) program as a framework for instructional strategies can be an effective approach to prepare fellows for clinical work. Objective: To develop and evaluate a new interactive hospital onboarding program for pediatric fellows and to explore benefits to clinical practice 8 months after training. Design/Methods We implemented a novel Fellow Readiness Conference in alignment with CLER Pathways of Excellence to ensure fellows were well-prepared in domains of care transitions, patient safety, and physician wellness. A needs assessment evaluated the hospital's key elements of patient care for fellows, along with a review of 2018 CLER site visit data. Participants were 1st year fellows (n=64) who attended a didactic session. A post-session and 8-month follow-up survey were distributed. The Kirkpatrick Model was applied using descriptive statistics to assess Kirkpatrick Levels 1 (reaction) and 3(behavior) via means, frequencies, and histograms. Results Data from the 2 surveys are shown in Tables 1 and 2. All fellows completed the post-session survey, rating overall conference impressions as favorable (mean=3.6, SD=0.83) on a 5-point scale; 91% responded that it met or exceeded their expectations (exceeded, 41%). At 8-month follow-up 96% (26/27) of respondents indicated at least moderate confidence in applying skills learned in telephone consult communication;85% (23/27) evaluated the session as effective in helping them to apply safety practices in practice. Conclusion(s) The CLER Pathways are a valuable resource for developing a new orientation program. Our data showed benefits in several training areas, and a need to place a stronger emphasis on adverse event education. Escalation of care was added to the 2019 conference. Based on this program's success, we plan to expand the conference to add additional CLER pathways.

Aromatherapy for dementia.

Medications licensed for the treatment of dementia have limited efficacy against cognitive impairment or against the distressed behaviours (behavioural and psychological symptoms, or behaviour that challenges) which are also often the most distressing aspect of the disorder for caregivers. Complementary therapies, including aromatherapy, are attractive to patients, practitioners and families, because they are perceived as being unlikely to cause adverse effects. Therefore there is interest in whether aromatherapy might offer a safe means of alleviating distressed behaviours in dementia. To assess the efficacy and safety of aromatherapy for people with dementia. We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register, on 5 May 2020 using the terms: aromatherapy, lemon, lavender, rose, aroma, alternative therapies, complementary therapies, essential oils. In addition, we searched MEDLINE, Embase, PsycINFO (all via Ovid SP), Web of Science Core Collection (via Thompson Web of Science), LILACS (via BIREME), CENTRAL (via the Cochrane Library), ClinicalTrials.gov and the World Health Organization (WHO) trials portal (ICTRP) on 5 May 2020. We included randomised controlled trials which compared fragrance from plants in an intervention defined as aromatherapy for people with dementia with placebo aromatherapy or with treatment as usual. All doses, frequencies and fragrances of aromatherapy were considered. Participants in the included studies had a diagnosis of dementia of any subtype and severity. Two reviewers independently selected studies for inclusion, extracted data and assessed risk of bias in included studies, involving other authors to reach consensus decisions where necessary. We did not perform any meta-analyses because of heterogeneity between studies, but presented a narrative synthesis of results from the included trials. Because of the heterogeneity of analysis methods and inadequate or absent reporting of data from some trials, we used statistical significance (P ≤ or > 0.5) as a summary metric when synthesising results across studies. As far as possible, we used GRADE methods to assess our confidence in the results of the trials, downgrading for risk of bias and imprecision. We included 13 studies with 708 participants. All participants had dementia and in the 12 trials which described the setting, all were resident in institutional care facilities. Nine trials recruited participants because they had significant agitation or other behavioural and psychological symptoms in dementia (BPSD) at baseline. The fragrances used were lavender (eight studies); lemon balm (four studies); lavender and lemon balm, lavender and orange, and cedar extracts (one study each). For six trials, assessment of risk of bias and extraction of results was hampered by poor reporting. Four of the other seven trials were at low risk of bias in all domains, but all were small (range 18 to 186 participants; median 66), reducing our confidence in the results. Our primary outcomes were agitation, overall behavioural and psychological symptoms, and adverse effects. Ten trials assessed agitation using various scales. Among the five trials for which our confidence in the results was moderate or low, four trials reported no significant effect on agitation and one trial reported a significant benefit of aromatherapy. The other five trials either reported no useable data or our confidence in the results was very low. Eight trials assessed overall BPSD using the Neuropsychiatric Inventory and we had moderate or low confidence in the results of five of them. Of these, four reported significant benefit from aromatherapy and one reported no significant effect. Adverse events were poorly reported or not reported at all in most trials. No more than two trials assessed each of our secondary outcomes of quality of life, mood, sleep, activities of daily living, caregiver burden. We did not find evidence of benefit on these outcomes. Three trials assessed cognition: one did not report any data and the other two trials reported no significant effect of aromatherapy on cognition. Our confidence in the results of these studies was low. We have not found any convincing evidence that aromatherapy (or exposure to fragrant plant oils) is beneficial for people with dementia although there are many limitations to the data. Conduct or reporting problems in half of the included studies meant that they could not contribute to the conclusions. Results from the other studies were inconsistent. Harms were very poorly reported in the included studies. In order for clear conclusions to be drawn, better design and reporting and consistency of outcome measurement in future trials would be needed.

The experience of health-related quality of life in extended and permanent cancer survivors: A qualitative systematic review.

This qualitative systematic review aims to synthesize qualitative evidence from primary studies on experiencing health-related quality of life (HRQoL) in extended and permanent cancer survivors. A systematic literature search was performed in PubMed, CINAHL, LILACS, PsycINFO, Scopus, and Web of Science. It followed guidelines from the statement in the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). A quality appraisal of each study was undertaken using the Critical Appraisal Skills Programme. Data synthesis was conducted according to the thematic synthesis approach. Confidence in each review finding was assessed using the Confidence in the Evidence from Reviews of Qualitative research (Grade-CERQual). Twenty-four studies from nine countries were selected for the final sample. Analysis of the studies' results allowed for the construction of nine descriptive themes that were interpreted into three analytical themes: "The body as a representation of HRQoL," "Living through and beyond cancer: the re-signification of HRQoL," and "Employing resources to improve HRQoL." According to the CERQual approach, moderate confidence estimations were achieved for the results. The themes reflect that the HRQoL experience is re-signified by survivors from the privilege of being alive. This process happens with the support of social resources, family, hope, and spirituality. Based on the findings, it is suggested that health staff should be able to recognize the impact that cancer survival has on HRQoL and develop a care plan that addresses needs to sustain health in these survivors.

Clinician and patient beliefs about diagnostic imaging for low back pain: a systematic qualitative evidence synthesis

ObjectiveOveruse of diagnostic imaging for patients with low back pain remains common. The underlying beliefs about diagnostic imaging that could drive overuse remain unclear. We synthesised qualitative research that has...

Perceptions and Practices of Providing Physical Activity Counselling and Exercise Prescriptions among Physiotherapists in Nova Scotia.

Purpose: We assessed the perceptions and practices of physical activity counselling and exercise prescription of physiotherapists in Nova Scotia. Method: A total of 146 physiotherapists in Nova Scotia completed an online self-reflection survey regarding their current practice of, confidence in, barriers to, and facilitators of providing physical activity and exercise (PAE) counselling to their patients. Results: Physiotherapists included physical activity counselling and exercise content in 85% of patient counselling appointments. They reported a high level of confidence (>90%) in providing PAE information and answering patients' PAE questions and moderate confidence in their patients' abilities to maintain PAE over the long term (73%) and to follow through on their PAE recommendations (66%). Patients' interest in PAE was the greatest barrier to providing PAE counselling. The physiotherapists reported being most comfortable when prescribing exercise for patients with musculoskeletal conditions and least comfortable with patients with cancer, insulin-dependent diabetes, and respiratory conditions. Most physiotherapists (71%) reported being interested in pursuing further education or training in PAE counselling and prescription. Conclusions: The physiotherapists frequently recommended PAE to their patients, had moderate confidence in their patients' ability to follow through on their advice, and experienced patients' disinterest in PAE as the greatest barrier to providing PAE counselling. The results of this study suggest a desire by physiotherapists for educational training opportunities, which we recommend be focused on providing behavioural strategies and further information to help overcome patient-focused barriers; this will help patients adopt and maintain physically active lifestyles.

Confidence is sexy and it can be trained: Examining male social confidence in initial, opposite-sex interactions.

We investigated whether men's social confidence in an initial, opposite-sex chatting context can be improved through a video tutorial and the extent to which being perceived as socially confident results in being seen as more romantically desirable and worthy of future contact. Women chatted with men who had received or not received a tutorial on how to handle speed-dating chats (Study 1: N=129; Study 2: N=60) or with male targets selected for having high versus moderate confidence in handling initial, opposite-sex encounters (Study 3: N=46). Tutorial-trained men felt more confident going into the chats and they, as well as male targets selected for their confidence, were perceived by female chat partners to be higher in social confidence, status, and dominance. However, only perceptions of social confidence were further associated with being perceived as more romantically desirable (as a short-term mate) and worthy of future contact. Findings indicate that social confidence is trainable and that other-perceived social confidence can impact the outcomes of social interactions.

Decision Tree Learning Algorithm for Classifying Knee Injury Status Using Return-to-Activity Criteria.

Anterior cruciate ligament (ACL) injury rates in female adolescents are increasing. Irrespective of treatment options, approximately 1/3 will suffer secondary ACL injuries following their return to activity (RTA). Despite this, there are no evidence-informed RTA guidelines to aid clinicians in deciding when this should occur. The first step towards these guidelines is to identify relevant and feasible measures to assess the functional status of these patients. The purpose of this study was therefore to evaluate tests frequently used to assess functional capacity following surgery using a Reduced Error Pruning Tree (REPT). Thirty-six healthy and forty-two ACLinjured adolescent females performed a series of functional tasks. Motion analysis along with spatiotemporal measures were used to extract thirty clinically relevant variables. The REPT reduced these variables down to two limb symmetry measures (maximum anterior hop and maximum lateral hop), capable of classifying injury status between the healthy and ACL injured participants with a 69% sensitivity, 78% specificity and kappa statistic of 0.464. We, therefore, conclude that the REPT model was able to evaluate functional capacity as it relates to injury status in adolescent females. We also recommend considering these variables when developing RTA assessments and guidelines.Clinical Relevance- Our results indicate that spatiotemporal measures may differentiate ACL-injured and healthy female adolescents with moderate confidence using a REPT. The identified tests may reasonably be added to the clinical evaluation process when evaluating functional capacity and readiness to return to activity.

Physical Therapists' Falls Prevention Knowledge, Beliefs, and Practices in Osteoarthritis Care: A National Cross-Sectional Study.

To investigate physical therapists' knowledge, beliefs, and current practices around falls prevention in osteoarthritis (OA) care. Currently registered, practicing Australian physical therapists who care for patients with hip and/or knee OA were invited to participate in this cross-sectional study. A comprehensive online survey was used to collect data that were analyzed descriptively or using chi-square tests; free-text responses were classified into key themes for analysis. Complete responses were received from 370 eligible physical therapists, with broad representation across Australian states and practice settings. Participants worked in public and private hospitals, community health centers, private practices, and aged-care facilities. The sample ranged from new graduates to experienced physical therapists (47% had practiced ≥11 years). Despite the majority having specific training or access to educational resources, physical therapists reported only moderate confidence in assessing falls risk (median 7 [interquartile range (IQR) 6-8]; range 0 [not at all confident] to 10 [extremely confident]) and delivering falls prevention care (median 7 [IQR 6-8]). While most participants asked about falls history (88%), only 39% used falls-risk screening tools, and of these, relatively few used appropriate tools. Time constraints (including competing clinical priorities) were the most frequently perceived barrier to including falls prevention activities within OA care. This national snapshot of contemporary OA practice has revealed clear opportunities for optimizing clinician confidence and skills to facilitate the uptake of best-practice falls prevention strategies. Improving practice in this area may yield substantial benefits to patients and the health system if more falls can be prevented.

Knowledge, confidence and skills of midwives in maternal nutrition education during antenatal care

Background Maternal nutrition during pregnancy affects the health of the mother and baby. Midwives are suitably well placed to offer nutrition education to pregnant women, however they may not be equipped with the necessary skills to deliver nutrition education to pregnant women. The aim of this study was to explore the midwives knowledge, confidence and skills to conduct maternal nutrition education (MNE) in an antenatal care clinic, Kampala, Uganda. Methods The study employed an exploratory qualitative design. Six in depth interviews, 6 direct observations for group education, and 12 observations of one-on-one midwife- pregnant woman interaction were conducted. The transcribed interviews and field observation notes were analyzed using latent content analysis. Results The midwives demonstrated good communication/facilitation skills during the sessions, and highlighted the nutrient rich dietary sources, increased nutrient demand, as well as food safety and hygiene requirements. Overall midwives’ MNE knowledge and skills were limited and had moderate confidence in performing the MNE. Midwives were ignorant about the maternal nutrition guidelines. Relevance of appropriate weight gain during pregnancy, guidelines for healthy habits, avoidance of substance abuse and nutrition precautions in special circumstances were missing in MNE. Information given to the pregnant women, MNE resources, infrastructural, and health systems gaps were identified. Conclusions There is need for alternative innovative MNE delivery models, and strengthening capacity of midwives in MNE.