The effect of cycling using active-passive trainers on spasticity, cardiovascular fitness, function and quality of life in people with moderate to severe Multiple Sclerosis (MS); a feasibility study.

BACKGROUND: Exercise options for those with moderate to high levels of disability are limited. The aim of the study was to evaluate the feasibility of a progressive, four week lower limb cycling programme using active-passive trainers (APT's) on spasticity, cardiovascular fitness, function and quality of life in people with moderate to severe MS. METHODS: Participants were in-patients in the Physical Disability Rehabilitation Unit, Queen Elizabeth University Hospital, Glasgow, UK and randomised to APT + usual care or usual care only. The APT group received 30 min of APT (2 min passive warm up, 26 min active cycling, 2 min passive cool down), five days per week for 4 weeks. Outcome measures; Oxygen Uptake Efficiency Slope, Modified Ashworth Scale, Multiple Sclerosis Spasticity Scale, Functional Independence Measure, Timed 25 foot walk test and the MSQOL-54, were taken before and after the intervention period. Symmetry, distance cycled and active participation were also recorded for each cycling session. RESULTS: 24 participants were recruited, 15 to the intervention and 9 to the control group. There was a 100% adherence to the intervention and a significant increase in average speed, power output and distance cycled (p < 0.001 for each) over the four weeks. There were no adverse events and both groups improved in average scores for all outcome measures. CONCLUSIONS: APT cycling was well tolerated, while the cycling parameters improved it was difficult to separate the effects of the therapy programme and APT cycling. A longer duration, fully powered trial in a community setting is merited.

Evaluation of the prototype Anaesthetic Non-technical Skills for Anaesthetic Practitioners (ANTS-AP) system: a behavioural rating system to assess the non-technical skills used by staff assisting the anaesthetist.

This study tested the reliability, validity and usability of a prototype behavioural rating system for the non-technical skills of assistants working with the anaesthetist. Anaesthetic nurses and operating department practitioners (n = 48) used the prototype Anaesthetic Non-technical Skills for Anaesthetic Practitioners (ANTS-AP) system to rate the non-technical skills of anaesthetic assistants in 12 videos of simulated theatre work. Test-retest reliability was assessed with a sub-sample (n = 12). The skill categories assessed were 'situation awareness', 'teamwork and communication' and 'task management'. The internal consistency for the ratings of elements in categories was acceptable (Cronbach's α of 0.78, 0.77 and 0.69, respectively), with more modest inter-rater reliability (intraclass correlations for categories 0.54, 0.70, 0.86), test-retest reliability (intraclass correlations 0.68, 0.58, 0.38) and accuracy (weighted kappa 0.39). Most participants considered the system complete (n = 42, 87%), the wording clear (n = 48, 100%) and the system useful for structuring observation (n = 48, 100%).

The effects of a 12-week leisure centre-based, group exercise intervention for people moderately affected with multiple sclerosis: a randomized controlled pilot study.

OBJECTIVE: To establish the effects of a 12-week, community-based group exercise intervention for people moderately affected with multiple sclerosis. DESIGN: Randomized controlled pilot trial. SETTING: Two community leisure centres. PARTICIPANTS: Thirty-two participants with multiple sclerosis randomized into intervention or control groups. INTERVENTION: The intervention group received 12 weeks of twice weekly, 60-minute group exercise sessions, including mobility, balance and resistance exercises. The control group received usual care. MAIN OUTCOME MEASURES: An assessor blinded to group allocation assessed participants at baseline, after eight weeks and after 12 weeks. The primary outcome measure was 25-foot (7.6 m) walk time, secondary outcomes assessed walking endurance, balance, physical function, leg strength, body mass index, activity levels, fatigue, anxiety and depression, quality of life and goal attainment. RESULTS: The intervention made no statistically significant difference to the results of participants' 25-foot walk time. However the intervention led to many improvements. In the intervention group levels of physical activity improved statistically between baseline and week 8 (P < 0.001) and baseline and week 12 (P = 0.005). Balance confidence results showed a significant difference between baseline and week 12 (P = 0.013). Good effect sizes were found for dynamic balance (d = 0.80), leg strength (d = 1.33), activity levels (d = 1.05) and perceived balance (d = 0.94). CONCLUSION: The results of the study suggest that community-based group exercise classes are a feasible option for people moderately affected with multiple sclerosis, and offer benefits such as improved physical activity levels, balance and leg strength.

Effectiveness of breeding guidelines for reducing the prevalence of syringomyelia.

Several toy breed dogs are predisposed to syringomyelia (SM), a spinal cord disorder, characterised by fluid-filled cavitation. SM is a complex trait with a moderately high heritability. Selective breeding against SM is confounded by its complex inheritance, its late onset nature and high prevalence in some breeds. This study investigated the early outcome of existing SM breeding guidelines. Six hundred and forty-three dogs, 550 Cavalier King Charles spaniels (CKCS) and 93 Griffon Bruxellois (GB), were identified as having either one (454 dogs) or both parents (189 dogs) with MRI-determined SM status. Offspring without SM were more common when the parents were both clear of SM (SM-free; CKCS 70 per cent, GB 73 per cent). Conversely, offspring with SM were more likely when both parents had SM (SM-affected; CKCS 92 per cent, GB 100 per cent). A mating of one SM-free parent with an SM-affected parent was risky for SM affectedness with 77 per cent of CKCS and 46 per cent of GB offspring being SM-affected. It is recommended that all breeding dogs from breeds susceptible to SM be MRI screened; that the SM status at five years old is established; and all results submitted to a central database that can be used by dog breeders to better enable mate selection based on estimated breeding values.

Interprofessional attitudes and perceptions: Results from a longitudinal controlled trial of pre-registration health and social care students in Scotland.

This study made use of a controlled longitudinal design to assess the impact on pre-registration health and social care students of an interprofessional intervention on the attitudes to and perceptions of interprofessional ideals. Evaluation, over four years, of Nursing, Occupational Therapy, Podiatry, Prosthetics and Orthotics, Physiotherapy and Radiography students was performed using the adapted versions of the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS). Baseline samples of the control and experimental groups were 260 and 313 respectively. Support for Interprofessional Education (IPE) appears high but possibly idealistically so initially. Restricted Maximum Likelihood (REML) models were used to assess intervention effects as well as any possible profession or time effects. The intervention was found to have had a significant effect on five of the measured sub-scales and the professions were found to react in a significantly different way on four of the sub-scales. The inclusion of a control group has confirmed previous findings from other studies but also highlights the possible effects of the general learning and teaching methodologies employed within various professions as well as the need for research into the influence of the timing, duration, style and content of clinical placement periods.

Chiari-like malformation in the Griffon Bruxellois.

OBJECTIVES: This study describes Chiari-like malformation and syringomyelia in the Griffon Bruxellois and establishes if skull radiographs are useful for disease prediction. METHODS: Magnetic resonance imaging from 56 Griffon Bruxellois dogs was assessed for Chiari-like malformation and cerebrospinal fluid pathway abnormalities. Skull radiographs were obtained in 33 dogs. Two rostrocaudal and two ventrodorsal measurements were made, and ratios of one length to another were compared. RESULTS: In this selected sample, 60.7 per cent had Chiari-like malformation. Syringomyelia occurred with and without Chiari-like malformation (37.5 and 8.9 per cent study population, respectively). The radiographic study demonstrated that one measurement ratio could be used to predict Chiari-like malformation (sensitivity of 87 per cent and specificity of 78 per cent) and that there were significant interaction factors between sex and syringomyelia for two measurement ratios. CLINICAL SIGNIFICANCE: The study suggests that Chiari-like malformation is characterised by a shortening of the basicranium and supra-occipital bone with a compensatory lengthening of the cranial vault, especially the parietal bone. We described a simple radiographic technique, which may be useful as a screening test until a more definite genetic test for Chiari-like malformation is available.

The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy.

AIMS: To compare gait parameters of older people with diabetes and no peripheral neuropathy (DM) and people with diabetes and diabetic peripheral neuropathy (DPN) and to investigate the effect of a secondary motor or cognitive task on their gait. METHODS: Thirty subjects were recruited: 15 with DPN (mean age 69 +/- 3.0 years) and 15 with diabetes and no neuropathy (70 +/- 2.9 years). The temporal and spatial parameters of gait were determined using the GAITRite walkway. Subjects undertook four walks: under normal walking conditions (single task); four times while simultaneously undertaking an additional motor task, carrying a tray with cups of water (dual task); and four times whilst undertaking a cognitive dual task, counting backwards in sevens. This arithmetic task was also completed sitting. RESULTS: For all gait variables, there was a statistically significant difference between the groups. Subjects with DPN walked more slowly and with smaller steps compared with those with DM. In general, the secondary task had a significant and adverse effect on the gait parameters and this effect was greater for those with DPN in both absolute and relative terms. Both groups had poorer arithmetic ability when walking compared with sitting. DISCUSSION: Patients with DPN have different gait parameters to diabetic patients without neuropathy. Problems with divided attention when walking were more evident in the DPN group and may increase their risk of falls.

The Interdisciplinary Education Perception Scale (IEPS): an alternative remodelled sub-scale structure and its reliability.

The original 4 sub-scale version of the Interdisciplinary Education Perception Scale (IEPS) was published by Luecht et al. (1990, Journal of Allied Health, 181 - 191). There appears however to be a lack of evidence of the stability of the original instrument and of the test-retest reliability of the items and sub-scales when used with undergraduates. Given that during its development only 143 subjects completed the questionnaire which contained 18 items the generalizability of the instrument should perhaps have been investigated further. The Interprofessional Learning Group (IPL) at Glasgow Caledonian University has been using both the IEPS and the Readiness for Interprofessional Learning Scale (RIPLS) (Parsell & Bligh, 1999, Medical Education, 33, 95 - 100) to monitor changes in attitudes and perceptions of undergraduate students from eight different health and social care programmes. This paper reports the development of an alternative sub-scale model for the IEPS based on a sample of 308 students. Various aspects of the reliability of this revised model based on a subsequent data set of 247 students are also reported. This revised model appears to be stable for use with undergraduate students yielding Cronbach Alpha values for two of the sub-scales greater than 0.80 and test-retest weighted kappa values for items being fair to moderate.

The influence of HRT on technical recall in the UK Breast Screening Programme: are pain, compression force, and compressed breast thickness contributing factors?

AIM: To investigate recall for technical reasons within the UK Breast Screening Programme, and to determine whether differences exist in those women using hormone replacement therapy (HRT), considering potential associations with reported pain, compression force used and compressed breast thickness (CBT) obtained. MATERIALS AND METHOD: A prospective cohort study of 2765 women attending for incident round breast screening appointments who were either HRT users, with a minimum of 1 year duration (n=1077), or had never used HRT (n=1688). Data were collected using technical recall records, a radiographer data-collection sheet, and a self-administered participant questionnaire. RESULTS: Sixty-eight (2.5%) participants were recalled for technical reasons of whom 28 (2.6%) were HRT and 40 (2.4%) non-HRT users. This difference was not statistically significant (p=0.80). Significant differences were found for CBT between those HRT users who were and were not recalled for technical reasons (p<0.01) and for the similar categories of non-HRT users (p=0.03). No significant differences were found for force between those HRT users who were recalled or not (p=0.73) and for the similar categories of non-HRT users (p=0.07). Similarly no significant differences were found for pain between those HRT users who were recalled or not (p=0.75) and for the similar categories of non-HRT users (p=0.73). CONCLUSION: CBT was the only variable to have both a statistically and a clinically significant relationship with technical recall.

The test-retest reliability of a revised version of the Readiness for Interprofessional Learning Scale (RIPLS).

The original version of the Readiness for Interprofessional Learning Scale (RIPLS) was published by Parsell and Bligh in 1999. The only aspect of reliability considered by the authors was the internal consistency. A revised version for use with undergraduate students was published in 2005 (McFadyen et al., 2005). That paper also reported internal consistency of the revised version. Subsequently a sample from one professional group (n = 65) was used to assess test-retest reliability, over a one week period, of each of the 19 items and of the sub-scale totals, using Weighted Kappa and the intra-class correlation (ICC) respectively, and these results are reported in the present paper. The test-retest reliability of the individual items using Weighted Kappa was satisfactory, with the exception of two items (Items 11 and 12). The ICC results for the sub-scale totals were all in excess of 0.60 with the exception of sub-scale two. This revised version of RIPLS would appear to have good reliability in three of its sub-scales but further research, with larger samples, is required before the fourth sub-scale can be reliably assessed.

The Readiness for Interprofessional Learning Scale: a possible more stable sub-scale model for the original version of RIPLS.

The original version of the Readiness for Interprofessional Learning Scale (RIPLS) was published by Parsell and Bligh (1999). Three sub-scales with acceptable or high internal consistencies were suggested, however two publications suggested different sub-scales. An investigation into how to improve the reliability for use of the RIPLS instrument with undergraduate health-care students commenced. Content analysis on the original 19 items involving experienced health-care staff resulted in four sub-scales. These sub-scales were then used to formulate a possible model within a structural equation model. The goodness of fit was assessed using a sample (n = 308) of new first year undergraduate students from 8 different health and social care programmes. The same data was fitted to each of the two original sub-scale models suggested by Parsell and Bligh (1999) and the results compared. The fit of the new four sub-scale model appears superior to either of the original models. The new four factor model was then tested on subsequent data (n = 247) obtained from the same students at the end of their first year. The fit was seen to be even better at the end of the academic year.

Salicylate inhibition of Acanthamoeba attachment to contact lenses: a model to reduce risk of infection.

PURPOSE: Acanthamoeba attachment (adsorption) to hydrogel contact lenses is enhanced by Pseudomonas aeruginosa biofilm. The effect of sodium salicylate on Acanthamoeba attachment to biofilm-coated and uncoated hydrogel lenses was investigated. DESIGN: Experimental study. PARTICIPANTS AND CONTROLS: A minimum of 16 replicates were used for each test condition; a control condition using clean lenses without biofilm was included. METHODS: Four groups of hydrogel contact lenses (etafilcon A) were pretreated with P. aeruginosa to form a biofilm. In addition, two more groups remained untreated. Quartered lenses of all six groups were then incubated in a suspension of A. castellanii trophozoites. Two batches of lenses had either 3 or 30 mM sodium salicylate added to the bacterial suspension (stage 1 intervention). Two other batches of lenses had salicylate added to the amoebal suspension (stage 2 intervention). One of the batches, which had a stage 1 intervention, had salicylate added at the second stage as well. The remaining batches received no salicylate exposure and included lenses with and without biofilm coating. MAIN OUTCOME MEASURE: The outcome measure in this study was the number of Acanthamoeba trophozoites attached, per square centimeter, to the hydrogel surfaces. RESULTS: Biofilm coating from P. aeruginosa gave a significantly increased attachment of A. castellanii trophozoites to the contact lens. When introduced at a first (biofilm) stage, second (trophozoite attachment) stage, or with intervention at both stages, 30 mM sodium salicylate reduced amoebal attachment to the hydrogel lens. When applied to both stages and when applied at stage 2 to the biofilm coated contact lenses, 3 mM sodium salicylate reduced amoebal attachment. The 3 mM concentration was not effective for the lower level of amoebae attachment to uncoated (nonbiofilm) lenses. CONCLUSIONS: Sodium salicylate successfully reduced amoebal trophozoite attachment to hydrogel lenses. This was the result of one of the following possibilities or a combination thereof: inhibition of biofilm formation; a direct effect on the amoebae; an alteration in the biofilm-amoebal attachment and resulting modification of the hydrogel lens surface. The results of this study suggest the major action is at stage 2 (on amoebal attachment to lenses) and favors alteration of the biofilm-amoebal attachment mechanism. This study demonstrates salicylate's potential benefit as a component of contact lens care solutions, designed to reduce microbial attachment and the risk of infection.

Differential adherence of Acanthamoeba to contact lenses: effects of material characteristics.

BACKGROUND: Acanthamoeba-associated keratitis occurs most often in contact lens wearers. The contact lens material may affect its ability to act as a mechanical vector, permitting transfer of viable amoebae from the storage case to the corneal surface. The purpose of this study was to investigate the effects of ionicity and water content on the comparative quantitative adherence of Acanthamoeba trophozoites and cysts to new, unworn hydrogel contact lenses and rigid gas-permeable contact lens materials. METHODS: Sixteen quarter segments of each of 8 types of unworn hydrogel lenses representative of FDA groups 1 to 4 were exposed to freshly prepared cultures of either trophozoites or cysts of A. castellanii or A. polyphaga for 1.5 h, and then washed. Three types of rigid lens button were similarly exposed to A. castellanii trophozoites or cysts. Adherent trophozoites and cysts were then enumerated. RESULTS: All hydrogel lenses showed binding of both trophozoites and cysts, with the former predominating in every case. It was primarily the ionic nature of a lens surface and secondly its water content that was associated with increased quantitative adherence of Acanthamoeba. Neither form of the amoebae bound to any of the hard lens buttons. CONCLUSIONS: Greater relative potential exists for contamination of ionic and high-water content hydrogels by Acanthamoeba. This combination may influence mechanical transmission of the protozoon to the corneal surface. Adherence to hard lenses (as buttons) did not occur if a postincubation wash step was performed.