To examine whether patient flow factors in the ED such as prolonged length of stay are associated with hand hygiene (HH) compliance.We conducted a retrospective study at an urban district hospital utilising available data from January 2018 to December 2021. Compliance to the World Health Organization five moments of HH expressed as percentage of total moments observed were collated every 2 months. Patient flow measures including proportion of patients referred or discharged within 4 h (LOS4), proportion of patients with ED length of stay >24 h (LOS24) and total number of patient presentations, were obtained for each 2-month periods. The association between these patient flow measures and HH compliance was examined using Pearson's correlation (P < 0.05).The results showed a moderate and significant association between rates of HH compliance and LOS24 (r = -0.48, P = 0.025). That is, lower proportion of patients with ED length of stay >24 h was associated with improved HH compliance. There was no significant correlation between HH compliance and LOS4 (r = 0.38, P = 0.085) or total number of ED presentations (r = -0.30, P = 0.17).The findings show that prolonged ED length of stay may explain, at least partly, lower rates of HH compliance. Improvements in ED HH compliance should also include strategies that enhance patient flow.
Abstract In the multidisciplinary fields of pain medicine and rehabilitation, advancing techniques such as functional magnetic resonance imaging (fMRI) are used to enhance our understanding of the pain experience. Given that such measures, in some circles, are expected to help us understand the brain in pain, future research in pain measurement is undeniably rich with possibility. However, pain remains intensely personal and represents a multifaceted experience, unique to each individual; no single measure in isolation, fMRI included, can prove or quantify its magnitude beyond the patient self-report. Physical therapists should be aware of cutting-edge advances in measuring the patient's pain experience, and they should work closely with professionals in other disciplines (eg, magnetic resonance physicists, biomedical engineers, radiologists, psychologists) to guide the exploration and development of multimodal pain measurement and management on a patient-by-patient basis. The primary purpose of this perspective article is to provide a brief overview of fMRI and inform physical therapist clinicians of the pros and cons when utilized as a measure of the patient's perception of pain. A secondary purpose is to describe current known factors that influence the quality of fMRI data and its analyses, as well as the potential for future clinical applications relevant to physical therapist practice. Lastly, the interested reader is introduced and referred to existing guidelines and recommendations for reporting fMRI research.
Closed reduction of upper limb fractures and/or dislocations are common in the emergency department (ED), which involves physically re-aligning the injured part prior to immobilisation. As this is painful, numerous techniques are available to provide regional anaesthesia to ensure patient tolerance. A Bier block (BB) is typically performed as part of routine care. An alternative technique gaining interest in the ED is ultrasound-guided supraclavicular block (UGSCB), which involves injecting local anaesthetic around the brachial plexus at the supraclavicular fossa under ultrasound guidance. It is unclear whether UGSCB is effective and safe when performed in the ED.
Introduction: Deficits in motor control of the trunk muscles have been extensively reported in individuals with chronic low back pain (LBP). Recent evidence suggests that these deficits can be improved with motor training. However, whether these changes in motor control are mediated by changes in the motor cortex remains unclear. As deficits in postural activation of transversus abdominis (TrA) is consistently observed in individuals with LBP, the present study aimed to investigate the representation of TrA at the motor cortex in individuals with and without chronic LBP. The potential to change the cortical representation of TrA following motor training in individuals with chronic LBP was also examined. Methods: Eleven healthy volunteers and twenty individuals with chronic LBP participated. Chronic LBP individuals were randomly allocated into two training groups: specific motor control training that involved practice of skilled activation of TrA, or walking exercise, and trained twice per day for two weeks. Recordings of electromyographic activity (EMG) of TrA were made bilaterally with intramuscular fine-wire electrodes. Motor control of TrA was assessed as the postural activation of the muscle associated with repetitions of rapid arm flexion and extension movements. To evaluate the representation of TrA, transcranial magnetic stimulation (TMS) was delivered over pre-marked scalp sites. EMG amplitude of the responses to TMS at each site was superimposed over the grid to produce a map of response amplitude relative to scalp site. All procedures were repeated two weeks post-training for the chronic LBP group. Onset of TrA EMG relative to prime mover deltoid and the location of the centre of gravity (CoG) of TMS map were compared between individuals with and without chronic LBP, and between pre- and post-training in individuals with chronic LBP. Results: The CoG of the cortical representation of TrA was located 2 cm anterior and lateral to the vertex in healthy individuals. However, individuals with chronic LBP showed a posterior and lateral shift in the CoG. The shift in location of the CoG of the TrA representation was associated with timing of activation during rapid arm movement tasks. Following two weeks of skilled training of TrA, motor cortical representation shifted towards that observed in healthy individuals. Changes in representation were not observed for the walking exercise group. Discussion: These findings provide evidence of reorganisation of trunk muscle representation at the motor cortex in individuals with chronic LBP, and that cortical changes are associated with deficits in motor control. Furthermore, this study provides the first evidence that training can induce plasticity of the motor cortex in this group.
Abstract The sensory and motor systems can reorganise following injury and learning of new motor skills. Recently we observed adaptive changes in motor cortical organisation in patients with recurrent low back pain (LBP), which are linked to altered motor coordination. Although changes in motor coordination can be trained and are associated with improved symptoms and function, it remains unclear whether these training‐induced changes are related to reorganisation of the motor cortex. This was investigated using the model of a delay in postural activation of the deep abdominal muscle, transversus abdominis (TrA) in 20 individuals with recurrent LBP. Subjects were allocated to either motor skill training that involved isolated voluntary contractions of TrA, or a control intervention of self‐paced walking exercise for 2 weeks. Electromyographic (EMG) activity was recorded from TrA bilaterally using intramuscular fine‐wire electrodes. Motor cortical organisation using transcranial magnetic stimulation (TMS) and postural activation associated with single rapid arm movements were investigated before and after training. Motor skill training induced an anterior and medial shift in motor cortical representation of TrA, towards that observed in healthy individuals from our previous study. This shift was associated with earlier postural activation of TrA. Changes were not observed following unskilled walking exercise. This is the first observation that motor training can reverse reorganisation of neuronal networks of the motor cortex in people with recurrent pain. The observed relationship between cortical reorganisation and changes in motor coordination following motor training provides unique insight into potential mechanisms that underlie recovery.
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