Background
Currently the diagnosis of shoulder instability, particularly in children, is difficult and can take time. These diagnostic delays can lead to poorer outcome and long-term complications. A Diagnostic Decision Support System (DDSS) has the potential to reduce time to diagnosis and improve outcomes for patients. The aim of this study was to develop a concept map for a future DDSS in shoulder instability.
Methods
A modified nominal focus group technique, involving three clinical vignettes, was used to elicit physiotherapists decision-making processes.
Results
Twenty-five physiotherapists, (18F:7 M) from four separate clinical sites participated. The themes identified related to ‘Variability in diagnostic processes and lack of standardised practice’ and ‘Knowledge and attitudes towards novel technologies for facilitating assessment and clinical decision making’.
Conclusion
No common structured approach towards assessment and diagnosis was identified. Lack of knowledge, perceived usefulness, access and cost were identified as barriers to adoption of new technology. Based on the information elicited a conceptual design of a future DDSS has been proposed. Work to develop a systematic approach to assessment, classification and diagnosis is now proposed.
Trial Registraty This was not a clinical trial and so no clinical trial registry is needed.
In this study, the possibility of introducing an elevated platform to a piglet pen was explored as a way of increasing available space and creating functional areas. On the platform, nine different manipulable materials were offered. In four batches, 40 weaned piglets were kept for five weeks in the two-level pen. Video recordings were taken two days per week. In the afternoon, more piglets were on the platform than in the morning or at night (7.2 ± 0.1 vs. 4.9 ± 0.1 vs. 0.6 ± 0.1 piglets/5 minutes; p < .05). The area under the platform was preferred more in the morning and at night than in the afternoon (18.5 ± 0.1 vs. 21.6 ± 0.2 vs. 12.5 ± 0.1 piglets/5 minutes; p < .05). Up to 36 piglets were counted there simultaneously, mainly in the recumbent position. On and under the platform, air velocity and ammonia concentration were within the recommended ranges. The study concluded that a two-level pen is a feasible option to increase space allowance and to create functional areas in a piglet pen.
ObjectivesThe association between impaired digital provision, access and health outcomes has not been systematically studied. The Wolverhampton Digital ENablement programme (WODEN) is a multiagency collaborative approach to determine and address digital factors that may impact on health and social care in a single deprived multiethnic health economy. The objective of this study is to determine the association between measurable broadband provision and demographic and health outcomes in a defined population.DesignAn observational cross-sectional whole local population-level study with cohorts defined according to broadband provision.Setting/participantsData for all residents of the City of Wolverhampton, totalling 269 785 residents.Primary outcomesPoor broadband provision is associated with variation in demographics and with increased comorbidity and urgent care needs.ResultsBroadband provision was measured using the Broadband Infrastructure Index (BII) in 158 City localities housing a total of 269 785 residents. Lower broadband provision as determined by BII was associated with younger age (p<0.001), white ethnic status (p<0.001), lesser deprivation as measured by Index of Multiple Deprivation (p<0.001), a higher number of health comorbidities (p<0.001) and more non-elective urgent events over 12 months (p<0.001).ConclusionLocal municipal and health authorities are advised to consider the variations in broadband provision within their locality and determine equal distribution both on a geographical basis but also against demographic, health and social data to determine equitable distribution as a platform for equitable access to digital resources for their residents.
Highlights
More than 80% of patients with facioscapulohumeral muscular dystrophy (FSHD) report shoulder instability that affects daily life.
Despite this, only 44.4% engaged with exercises that target the upper body.
There is a lack of evidence to inform upper limb FSHD rehabilitation exercises.
Patients with FSHD support the need for further research in upper limb exercises.
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