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The objective of this study is to determine the physical evaluations and assessment tools used by a group of Canadian healthcare professionals treating adults with spasticity.
Methods:
A cross-sectional web-based 19-question survey was developed to determine the types of physical evaluations, tone-related impairment measurements, and assessment tools used in the management of adults with spasticity. The survey was distributed to healthcare professionals from the Canadian Advances in Neuro-Orthopedics for Spasticity Congress database.
Results:
Eighty study participants (61 physiatrists and 19 other healthcare professionals) completed the survey and were included. Nearly half (46.3%, 37/80) of the participants reported having an inter- or trans-disciplinary team managing individuals with spasticity. Visual observation of movement, available range of motion determination, tone during velocity-dependent passive range of motion looking for a spastic catch, spasticity, and clonus, and evaluation of gait were the most frequently used physical evaluations. The most frequently used spasticity tools were the Modified Ashworth Scale, goniometer, and Goal Attainment Scale. Results were similar in brain- and spinal cord-predominant etiologies. To evaluate goals, qualitative description was used most (37.5%).
Conclusion:
Our findings provide a better understanding of the spasticity management landscape in Canada with respect to staffing, physical evaluations, and outcome measurements used in clinical practice. For all etiologies of spasticity, visual observation of patient movement, Modified Ashworth Scale, and qualitative goal outcomes descriptions were most commonly used to guide treatment and optimize outcomes. Understanding the current practice of spasticity assessment will help provide guidance for clinical evaluation and management of spasticity.
Sowerby's beaked whale is a deep-diving cetacean species specialized to live in the deep waters of the North Atlantic, including offshore Irish waters. Sightings of Sowerby's beaked whales in this area are infrequent and a substantial increase in our knowledge of their presence comes from recent static acoustic monitoring (SAM) and passive acoustic monitoring (PAM). However, most information on this species has been derived from stranding records, which provide opportunistic insights into this elusive species' cryptic life history. Here we report on the live stranding of a 1200 mm long neonate and an adult 5 m female Sowerby's beaked whale in July 2015 and on the stranding of a 4.9 m pregnant female in September 2020 with a 495 mm long male foetus in the south-west of Ireland. These stranding events provide an important insight into the reproductive life history of this species and provide further evidence that Sowerby's beaked whales calve in offshore Irish waters.
In 1969 R.T.É.'s 7 Days dealt with the issue of illegal moneylending, claiming that Dublin was ‘a city of fear’ where 500 unlicensed moneylenders used violence as a tool to collect debts. The Fianna Fáil government rejected the suggestion that loan sharking was widespread and that Gardaí responses to it were ineffectual; a tribunal of inquiry was established to investigate 7 Days. Previous analyses situated these events within the context of government concerns over the influence of television journalism. This article takes a different approach, analysing moneylending ― rather than 7 Days ― within the context of the rediscovery of poverty during the 1960s. It examines how social and economic changes, including the growth of consumer credit and the re-housing of large numbers of Dubliners, combined to make illegal moneylending more visible. Historical accounts of Ireland in the 1960s have had a top down focus on economic policy and growth. Here, the focus is shifted to personal rather state finances to offer a more nuanced portrayal of a decade often understood as a boom one. Moreover, analysing the nature and conclusions of the tribunal lays bare the contemporary resistance to those attempting to reframe the problem of poverty.
Spinal muscular atrophy (SMA) is a devastating rare disease that affects individuals regardless of ethnicity, gender, and age. The first-approved disease-modifying therapy for SMA, nusinursen, was approved by Health Canada, as well as by American and European regulatory agencies following positive clinical trial outcomes. The trials were conducted in a narrow pediatric population defined by age, severity, and genotype. Broad approval of therapy necessitates close follow-up of potential rare adverse events and effectiveness in the larger real-world population.
Methods:
The Canadian Neuromuscular Disease Registry (CNDR) undertook an iterative multi-stakeholder process to expand the existing SMA dataset to capture items relevant to patient outcomes in a post-marketing environment. The CNDR SMA expanded registry is a longitudinal, prospective, observational study of patients with SMA in Canada designed to evaluate the safety and effectiveness of novel therapies and provide practical information unattainable in trials.
Results:
The consensus expanded dataset includes items that address therapy effectiveness and safety and is collected in a multicenter, prospective, observational study, including SMA patients regardless of therapeutic status. The expanded dataset is aligned with global datasets to facilitate collaboration. Additionally, consensus dataset development aimed to standardize appropriate outcome measures across the network and broader Canadian community. Prospective outcome studies, data use, and analyses are independent of the funding partner.
Conclusion:
Prospective outcome data collected will provide results on safety and effectiveness in a post-therapy approval era. These data are essential to inform improvements in care and access to therapy for all SMA patients.
Background: Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease resulting in muscle weakness, dysarthria and dysphagia, and ultimately respiratory failure leading to death. Half of the ALS patients survive less than 3 years, and 80% of the patients survive less than 5 years. Riluzole is the only approved medication in Canada with randomized controlled clinical trial evidence to slow the progression of ALS, albeit only to a modest degree. The Canadian Neuromuscular Disease Registry (CNDR) collects data on over 140 different neuromuscular diseases including ALS across ten academic institutions and 28 clinics including ten multidisciplinary ALS clinics. Methods: In this study, CNDR registry data were analyzed to examine potential differences in ALS care among provinces in time to diagnosis, riluzole and feeding tube use. Results: Significant differences were found among provinces, in time to diagnosis from symptom onset, in the use of riluzole and in feeding tube use. Conclusions: Future investigations should be undertaken to identify factors contributing to such differences, and to propose potential interventions to address the provincial differences reported.
This paper explores the risks and rewards involved in directing undergraduate students engaged on an oral history project in Belfast. It advocates the role of oral history as a tool through which to encourage students’ engagement with research-led teaching to produce reflective assignments on the nature of historical evidence, particularly autobiographical memory. The particular challenges of conducting oral history in a city beset by ethno-sectarian divisions are discussed. This factor has ensured that the historiography of Belfast has focused extensively on conflict and violence. The city's social history is poorly understood, but employing oral history enables the exploration of issues that take undergraduate historians beyond the Troubles as a starting point. This project probed what is called the troubles with a lower case t, via an analysis of deindustrialisation and urban redevelopment in Sailortown (Belfast's dockland district). It provided evidence with which to offer a new assessment on existing historiographical discussions about working-class nostalgic memory and urban social change, one that supports those scholars that problematize attempts to categorise such memory. The testimony also differed in significant ways from previous oral history research on post-war Northern Ireland.
Providing optimal healthcare for increasingly elderly hospital populations who have high rates of cognitive disorder is a great challenge. Using delirium as an example, we describe how improved management of acute cognitive problems through a multifaceted hospital-wide programme can promote cognitive-friendly hospital environments. A specific plan of action is described that spans interventions in day-to-day clinical care of individual patients all the way to wider organisational practices.
Learning Objectives
• Understand the concept of cognitive friendliness and how addressing the problem of delirium can contribute to this in our healthcare system.
• Become more aware of specific aspects of a cognitive-friendly programme and how these can be implemented in practice.
• Explore the key outstanding issues for research that can further enhance our awareness of cognitive-friendly practices.
This article explores the life and commemoration of Buck Alec Robinson. A feared loyalist killer in 1920s Belfast, in more recent times he has featured as a lion-keeping “character” on wall murals and in tourist guide books. Robinson is employed as a case study to investigate two separate but, in this case, interlinked historiographical debates. The first involves Norbert Elias's analysis of the decline of violence. The second relates to discussion of the analysis of social memory in working-class communities, with violence being placed therein. The article supports historical assessments suggesting that the “civilizing offensive” had an uneven impact. That point is usually made in the context of working-class men. This article extends it to political elites in Belfast and probes their flirtations with violent hard men. The case is made that it is a mistake to assume the “civilizing” dynamic is to be understood as a teleological or top-down process.