Digital dashboards: a speech pathology case study.

The introduction of electronic medical records has created vast opportunities in relation to data storage, visibility and extraction. In Allied Health the collection, storage, display and reporting of service statistics is a key opportunity to utilise the capabilities of the electronic medical record to reduce clinician time completing data entry, improve accuracy and visibility of available data and maximise opportunities to view and utilise service statistic information in clinical and operational decision making. This case study describes service statistic capture and extraction for a speech pathology department, pre- and post- the introduction of a digital dashboard. A new Allied Health digital dashboard was created via clinicians and informaticians working collaboratively to define service delivery elements for data extraction and design dashboard functionality. Descriptive comparison of data capture pre- and post- dashboard implementation was undertaken. The integration of service statistic information into a digital dashboard was found to support service statistic reporting, improve ease of access, and provide greater visibility and timeliness of service information.

Increased physical activity post-exacerbation is associated with decreased systemic inflammation in cystic fibrosis - An observational study.

Background and Objective: We assessed whether measured physical activity in adults with cystic fibrosis (CF) following in-hospital treatment for an acute exacerbation was impacted by levels of systemic and airway inflammation, and whether physical activity post-discharge predicted for time to next pulmonary exacerbation. Methods: Adults with CF were included following hospitalization for a pulmonary exacerbation, and were followed for 12 months. Inflammatory markers and physical activity were measured immediately post-discharge via sputum and plasma concentrations of interleukin-6, interleukin-8, and tumor necrosis factor-α. Physical activity was monitored for 7 days via a Sensewear Armband. Statistical analyses included Shapiro-Wilk's test and Q-Q plots to determine normal distribution, t-tests, Pearson's correlational analyses, and one-way MANOVAs. Results: Thirty-one adults with CF (13 females, 28.8 ± 8.8 years, forced expiratory volume in 1 s (FEV1) 59.4 ± 23.0% predicted) were prospectively recruited. Physical activity negatively correlated with plasma inflammation (r = -0.48, p < 0.01), and positively with FEV1 (r = 0.45, p < 0.05) and body mass index (r = 0.39, p < 0.05). There was no significant relationship between time to re-exacerbation and any inflammatory markers or measurement of physical activity (all p > 0.05). Conclusion: Increased physical activity following exacerbation in CF is associated with lower levels of systemic inflammation. Time to re-exacerbation is not related to post-discharge inflammation or physical activity levels.

Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline.

Physiotherapy management is a key element of care for people with cystic fibrosis (CF) throughout the lifespan. Although considerable evidence exists to support physiotherapy management of CF, there is documented variation in practice. The aim of this guideline is to optimize the physiotherapy management of people with CF in Australia and New Zealand. A systematic review of the literature in key areas of physiotherapy practice for CF was undertaken. Recommendations were formulated based on National Health and Medical Research Council (Australia) guidelines and considered the quality, quantity and level of the evidence; the consistency of the body of evidence; the likely clinical impact; and applicability to physiotherapy practice in Australia and New Zealand. A total of 30 recommendations were made for airway clearance therapy, inhalation therapy, exercise assessment and training, musculoskeletal management, management of urinary incontinence, managing the newly diagnosed patient with CF, delivery of non-invasive ventilation, and physiotherapy management before and after lung transplantation. These recommendations can be used to underpin the provision of evidence-based physiotherapy care to people with CF in Australia and New Zealand.

Defining the tumour and target volumes for radiotherapy.

Radiotherapy is a localised treatment. The definition of tumour and target volumes for radiotherapy is vital to its successful execution. This requires the best possible characterisation of the location and extent of tumour. Diagnostic imaging, including help and advice from diagnostic specialists, is therefore essential for radiotherapy planning. There are three main volumes in radiotherapy planning. The first is the position and extent of gross tumour, i.e. what can be seen, palpated or imaged; this is known as the gross tumour volume (GTV). Developments in imaging have contributed to the definition of the GTV. The second volume contains the GTV, plus a margin for sub-clinical disease spread which therefore cannot be fully imaged; this is known as the clinical target volume (CTV). It is the most difficult because it cannot be accurately defined for an individual patient, but future developments in imaging, especially towards the molecular level, should allow more specific delineation of the CTV. The CTV is important because this volume must be adequately treated to achieve cure. The third volume, the planning target volume (PTV), allows for uncertainties in planning or treatment delivery. It is a geometric concept designed to ensure that the radiotherapy dose is actually delivered to the CTV. Radiotherapy planning must always consider critical normal tissue structures, known as organs at risk (ORs). In some specific circumstances, it is necessary to add a margin analogous to the PTV margin around an OR to ensure that the organ cannot receive a higher-than-safe dose; this gives a planning organ at risk volume. This applies to an organ such as the spinal cord, where damage to a small amount of normal tissue would produce a severe clinical manifestation. The concepts of GTV, CTV and PTV have been enormously helpful in developing modern radiotherapy. Attention to detail in radiotherapy planning is vital, and does affect outcomes: 'the devil is in the detail'. Radiotherapy planning is also dependent on high quality imaging, and the better the imaging the better will be the outcomes from radiotherapy.