ObjectiveTo evaluate the effectiveness of conservative management (except drug therapy) for acute Whiplash Associated Disorder (WAD) II.DesignSystematic review and meta-analysis of Randomised Controlled Trials (RCTs) using a pre-defined protocol. Two independent reviewers searched information sources, decided eligibility of studies, and assessed risk of bias (RoB) of included trials. Data were extracted by one reviewer and checked by the other. A third reviewer mediated any disagreements throughout. Qualitative trial and RoB data were summarised descriptively. Quantitative syntheses were conducted across trials for comparable interventions, outcome measures and assessment points. Meta-analyses compared effect sizes with random effects, using STATA version 12.Data SourcesPEDro, Medline, Embase, AMED, CINAHL, PsycINFO, and Cochrane Library with manual searching in key journals, reference lists, British National Bibliography for Report Literature, Center for International Rehabilitation Research Information & Exchange, and National Technical Information Service were searched from inception to 15th April 2015. Active researchers in the field were contacted to determine relevant studies.Eligibility Criteria for Selecting StudiesRCTs evaluating acute (<4 weeks) WADII, any conservative intervention, with outcome measures important to the International Classification of Function, Disability and Health.ResultsFifteen RCTs all assessed as high RoB (n=1676 participants) across 9 countries were included. Meta-analyses enabled 4 intervention comparisons: conservative versus standard/control, active versus passive, behavioural versus standard/control, and early versus late. Conservative intervention was more effective for pain reduction at 6 months (95%CI: -20.14 to -3.38) and 1-3 years (-25.44 to -3.19), and improvement in cervical mobility in the horizontal plane at <3 months (0.43 to 5.60) compared with standard/control intervention. Active intervention was effective for pain alleviation at 6 months (-17.19 to -3.23) and 1-3 years (-26.39 to -10.08) compared with passive intervention. Behavioural intervention was more effective than standard/control intervention for pain reduction at 6 months (-15.37 to -1.55), and improvement in cervical movement in the coronal (0.93 to 4.38) and horizontal planes at 3-6 months (0.43 to 5.46). For early (<4 days) versus late (>10 days) interventions, there were no statistically significant differences in all outcome measures between interventions at any time.ConclusionsConservative and active interventions may be useful for pain reduction in patients with acute WADII. Additionally, cervical horizontal mobility could be improved by conservative intervention. The employment of a behavioural intervention (e.g. act-as-usual, education and self-care including regularly exercise) could have benefits for pain reduction and improvement in cervical movement in the coronal and horizontal planes. The evidence was evaluated as low/very low level according to the Grading of Recommendations Assessment, ...
Background Masters-level education is a key pathway of professional development for healthcare practitioners. Whilst there is evidence that Masters-level education leads to career enhancement, it is unclear how the programme pedagogy contributes to this. The objective was to: (1) examine the programme pedagogies and context that supports learning, and (2) synthesise the outputs, outcomes and impact of Masters-level healthcare programmes. Methods A systematic review was conducted according to the Cochrane Collaboration handbook and is reported in line with PRISMA. Using pre-defined key terms and eligibility criteria, two reviewers independently searched Medline, ERIC, Web of Science, ProQuest, and CINAHL Plus databases from inception to 14th November 2016, reference lists of retrieved articles and selected websites. Data were extracted independently. The Mixed Methods Appraisal Tool was used to assess methodological quality. A Weight of Evidence Framework enabled evaluation of the overall quality of evidence. Data were synthesised using thematic qualitative analysis. Results Thirty-five studies were included. All studies were retrospective, evaluated programmes in nursing ( n = 19), physiotherapy ( n = 6), general and family medicine ( n = 4), public health ( n = 3), dentistry ( n = 1), interdisciplinary ( n = 1), and occupational therapy ( n = 1). Most studies were rated low in methodological quality, with an overall low to moderate weight of evidence for programmes’ outcomes and impact. Pedagogies that promote social participation and knowledge co-construction, reflection, learner-centred approach, relevance and authenticity influenced outcomes and impact. Conclusion(s) Notwithstanding the low to moderate weight of evidence, the review identified multiple positive outcomes of Master-level education for healthcare practitioners. Whilst the pedagogies that contributed to such positive outcomes were examined in some studies, there is a need to further explore links between programme pedagogy, outputs, outcomes and impact. A cultural approach to evaluation may capture how M-level education drives changes. Electronic supplementary material The online version of this article (10.1186/s12909-019-1768-7) contains supplementary material, which is available to authorized users.
In this paper, we report an investigation on the impact of large block Forward Error Correction (FEC) with Drop Tail (DT) and Random Early Detection (RED) queue policies on network performance and quality of video streaming. FEC is a technique that uses redundant packets to reconstruct dropped packets, while DT and RED are the most popular queue management policies used in network routers. DT mainly depends on the size of the queue buffer to decide on whether to drop a packet or not. RED monitors the average queue size and drops arriving packets probabilistically. The probability of dropping a packet increases as the estimated average queue size grows. In the investigation, we consider simulation settings with varying size of queue buffers. Results obtained from the simulation experiments show that large block FEC and queue size affect the performance the network. Consequently, the qualities of multimedia applications are also affected.
Aims: To report estimates of the reliability and agreement of a new method for measuring the femoral Neck-shaft angle in the Jordanian population. The neck-shaft angle is an important anatomical indicator in orthopedics of the hip. While there are different approaches to measuring the neck-shaft angle in the literature, there is no agreement on the best technique used for measurement. CT scout view was used in this study to provide a promising alternative. Study Design: Observational reliability and agreement study. Places and Duration of the Study: Department of physiotherapy, school of rehabilitation science, University of Jordan and University of Jordan Hospital between March 2014 and October 2015. Methodology: Two independent raters calculated the neck-shaft angle on each hip of 50 pelvic CT scout images of healthy adults to determine inter-rater reliability. One rater performed the measurement twice to determine the intra-rater reliability. Intra-class correlation coefficients were used to examine relative reliability. The standard error of measurement (SEM) and 95% minimal detectable change (MDC) were calculated to examine absolute reliability. Results: The mean value of all angle measurements was 131.3. Intra-class correlation coefficients were 0.726 and 0.63 for inter and intra-rater measurements respectively. SEM and MDC for inter-rater measurements were 2.69 and 7.46 respectively. For intra-rater measurements, they were 2.84 and 7.86 respectively. Conclusion: The new method proposed in this study for measuring the neck-shaft angle showed good reliability and small measurement error.
BACKGROUND: Myalgic encephalomyelitis (ME) is a complex, multi-system neurological condition. The defining feature of ME is post-exertional malaise (PEM) with over 30 symptoms triggered by physical, cognitive, emotional and social activity. The cause of PEM is unclear but one area of research using cardio-pulmonary exercise tests show a reduced ventilatory anaerobic threshold (VAT) with repeated tests leading to PEM. Pacing with heart rate monitoring (HRM) provides feedback to maintain activity intensity below the VAT. There is only one piece of research investigating the use of HRM although a number of guidelines recommend it. OBJECTIVE: To identify the experiences and attitudes of people with ME towards HRM. METHODS: A 40 question online survey was devised and released on ME websites, Twitter and Facebook pages. People with ME read the information sheet and followed an online link to the survey. The survey was open for three weeks and all answers were anonymous. RESULTS: 488 people with ME completed the survey. Most participants were female, 35-50 years and with a reported illness of greater than 5 years. Over 100 types of HR monitor used. Over 30 benefits and over 30 negatives identified. HRM reduced severity of ME and severity and duration of PEM. CONCLUSION: Although there are limitations, HRM has many benefits including helping PwME to understand and manage their PEM and support them to increase their activities, including work. There is a need for more research and education of healthcare professionals in the safe use of HRM.
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