Development of a low resource exercise rehabilitation application for musculoskeletal disorders to help underserved patients in a primary care setting.

Objective: We set out to create a Family Medicine EHR (electronic health record) embedded exercise application. This was done to evaluate the utility of the exercise app for providers and to understand the usefulness of the exercise app from the perspective of patients. Methods: This exercise application was developed through an iterative process with repeated pre-testing and feedback from an interprofessional team and embedded into the EHR at an academic family medicine clinic. Anecdotal feedback from patients was used to inform pre-testing adaptations. Results: The application required six iterations prior to clinical utility. It had several features that clinicians and patients felt were beneficial. These features involved a customizable exercise directory with pre-made templated plans which could be further modified. To overcome accessibility barriers, the application was developed to include digital and printable copies with an integrated direct email option for ease of remote sharing with patients. Conclusion: A customizable, open-source exercise application was developed to facilitate provider exercise prescription and support patient self-management. This project may be useful for other providers interested in developing similar programs to address musculoskeletal conditions in their patients. Next steps are to undertake pilot testing of the app with broader provider and patient feedback.

Objectif: Concevoir une application d'exercices intégrés au DES (dossier de santé électronique) de la médecine familiale. Cela visait à évaluer l'utilité de l'application d'exercices pour les prestataires et à en comprendre l'utilité du point de vue des patients. Méthodologie: Cette application d'exercices a été élaborée au moyen d'un processus itératif mettant en oeuvre une mise à l'essai répétée et une rétroaction d'une équipe interprofessionnelle et intégrée dans le DES d'une clinique universitaire de médecine familiale. Une rétroaction secondaire de patients a contribué aux adaptations de mise à l'essai. Résultats: L'application a dû être répétée six fois avant l'utilité clinique. Selon les cliniciens et les patients, plusieurs fonctions ont présenté un avantage. Il s'agissait notamment d'un répertoire d'exercices personnalisable assorti de modèles de plans préconçus et modifiables par la suite. Afin de surmonter les obstacles d'accessibilité, l'application était conçue pour comprendre des versions numériques et imprimables dotées d'une option de courriel direct intégré pour faciliter le partage à distance avec les patients. Conclusion: Une application d'exercices personnalisable et ouverte visait à faciliter la prescription d'exercices par les prestataires et à soutenir le traitement autonome des patients. Ce projet peut être utile à d'autres prestataires souhaitant élaborer des programmes semblables pour traiter les problèmes musculosquelettiques de leurs patients. Les étapes suivantes consistent à entreprendre des mises à l'essai de l'application avec un retour d'information plus large de la part des prestataires et des patients.

Do as I say, not as I do: a survey of public impressions of queue-jumping and preferential access.

OBJECTIVES: The Canada Health Act legislates that Canadian citizens have access to healthcare that is publicly administered, universal, comprehensive, portable, and accessible (i.e. unimpeded by financial, clinical, or social factors). We surveyed public impressions and practices regarding preferential access to healthcare and queue jumping. METHODS: Households were randomly selected from the Toronto telephone directory. English speakers aged 18 years or older were solicited for a standardized telephone survey. Statistical analysis was performed using SPSS and SAS. RESULTS: Fifteen percent (n=101) of 668 solicited were surveyed. Ninety-five percent advocated equal access based on need. Support for queue jumping in the emergency department (ED) was strong for cases of emergency, severe pain, and pediatrics, equivocal for police, and minimal for the homeless, doctors, hospital administrators, and government officials. To improve a position on a waiting list, approximately half surveyed would call a friend who is a doctor, works for a doctor, or is a hospital administrator. Sixteen percent reported having done this. The likelihoods of offering material inducement for preferential access were 30 and 51% for low and high-impact medical scenarios, respectively. The likelihoods of offering nonmaterial inducement were 56 and 71%, respectively. Responses were not associated with sex, occupation, or education. CONCLUSIONS: Respondents expressed support for equal access based on need. Policy and scenario-type questions elicited different responses. Expressed beliefs may vary from personal practice. Clearly defined and enforced policies at the hospital and provincial level might enhance principles of fairness in the ED queue.

Wolf reintroduction to Scotland: public attitudes and consequences for red deer management.

Reintroductions are important tools for the conservation of individual species, but recently more attention has been paid to the restoration of ecosystem function, and to the importance of carrying out a full risk assessment prior to any reintroduction programme. In much of the Highlands of Scotland, wolves (Canis lupus) were eradicated by 1769, but there are currently proposals for them to be reintroduced. Their main wild prey if reintroduced would be red deer (Cervus elaphus). Red deer are themselves a contentious component of the Scottish landscape. They support a trophy hunting industry but are thought to be close to carrying capacity, and are believed to have a considerable economic and ecological impact. High deer densities hamper attempts to reforest, reduce bird densities and compete with livestock for grazing. Here, we examine the probable consequences for the red deer population of reintroducing wolves into the Scottish Highlands using a structured Markov predator-prey model. Our simulations suggest that reintroducing wolves is likely to generate conservation benefits by lowering deer densities. It would also free deer estates from the financial burden of costly hind culls, which are required in order to achieve the Deer Commission for Scotland's target deer densities. However, a reintroduced wolf population would also carry costs, particularly through increased livestock mortality. We investigated perceptions of the costs and benefits of wolf reintroductions among rural and urban communities in Scotland and found that the public are generally positive to the idea. Farmers hold more negative attitudes, but far less negative than the organizations that represent them.

Neuromuscular adaptations in human muscle following low intensity resistance training with vascular occlusion.

Low-intensity (approximately 50% of a single repetition maximum-1 RM) resistance training combined with vascular occlusion results in increases in muscle strength and cross-sectional area [Takarada et al. (2002) Eur J Appl Physiol 86:308-331]. The mechanisms responsible for this hypertrophy and strength gain remain elusive and no study has assessed the contribution of neuromuscular adaptations to these strength gains. We examined the effect of low-intensity training (8 weeks of unilateral elbow flexion at 50% 1 RM) both with (OCC) and without vascular occlusion (CON) on neuromuscular changes in the elbow flexors of eight previously untrained men [19.5 (0.4) years]. Following training, maximal voluntary dynamic strength increased (P<0.05) in OCC (22%) and CON (23%); however, isometric maximal voluntary contraction (MVC) strength increased in OCC only (8.3%, P<0.05). Motor unit activation, assessed by interpolated twitch, was high (approximately 98%) in OCC and CON both pre- and post-training. Evoked resting twitch torque decreased 21% in OCC (P<0.05) but was not altered in CON. Training resulted in a reduction in the twitch:MVC ratio in OCC only (29%, P<0.01). Post-activation potentiation (PAP) significantly increased by 51% in OCC (P<0.05) and was not changed in CON. We conclude that low-intensity resistance training in combination with vascular occlusion produces an adequate stimulus for increasing muscle strength and causes changes in indices of neuromuscular function, such as depressed resting twitch torque and enhanced PAP.

Resistance training with vascular occlusion: metabolic adaptations in human muscle.

UNLABELLED: Two recent studies have reported increases in strength and whole muscle cross-sectional area after low-intensity resistance training (LIT) with vascular occlusion (OCC) that are greater than LIT alone (e.g., 22, 25). The OCC stress might be expected to induce metabolic alterations that are consistent with compromised oxygen delivery rather than an increase in strength per se, but this has not been studied. PURPOSE: We examined the effect of LIT and LIT+OCC on resting metabolites in m. biceps brachii and elbow flexor strength. METHODS: Eight men (19.5 +/- 0.4 yr) performed 8 wk of LIT at approximately 50% of one-repetition maximum (2 sessions per week; 3-6 sets, 8-10 repetitions, final set to failure); one arm trained with OCC and the other without (CON). :Biopsies obtained before and 72 h after the final training bout revealed that resting [glycogen] was higher (P