A proposed framework for point of care musculoskeletal ultrasound and ultrasound image-guided interventions by physiotherapists: scope of practice, education and governance.

BACKGROUND: The use of point of care ultrasound (PoCUS) in the management of musculoskeletal (MSK) disorders is a diverse area of PoCUS practice. Its use by clinicians, such as physiotherapists, can occur across a wide range of roles and care pathway configurations; however, professional, educational and regulatory uncertainties can leave clinicians, managers and patients at risk. MAIN BODY: A PoCUS framework approach (previously applied to support PoCUS consolidation and expansion) is used to frame these proposals. Central to this is the defining of (clinical and sonographic) scope of practice (ScoP). A number of indicative ScoPs are described to both (i) illustrate application of the principles and (ii) provide templates for ScoP derivations for individual services or clinicians. Image-guided MSK interventions are increasingly an aspect of MSK physiotherapy PoCUS. Given the utility of physiotherapists drawing upon their imaging to fully inform the selection (and performance) of such techniques, we present a rationale for competency in undertaking sonographic differentials as a pre-cursor to performing ultrasound image-guided MSK interventions. Alignment of ScoP with the relevant education and formal competency assessments are a cornerstone of the PoCUS framework approach; as such, key aspects of MSK PoCUS education and competency assessment are outlined. Strategies for addressing such requirements in healthcare settings where formal provision is not accessible, are also presented. Governance considerations are aligned with the regulatory environment, including those pertaining to professional guidance and insurance considerations. In addition, generic quality assurance elements are emphasised, as core aspects of high-quality service provision. Whilst the paper clarifies the situation for MSK physiotherapists using PoCUS in the UK, prompts are provided to support other professional groups working in MSK services in the United Kingdom (UK) and MSK physiotherapists/physical therapists in other countries-to facilitate their application of the principles. CONCLUSION: Acknowledging the breadth of MSK physiotherapy PoCUS practice, this paper draws upon a framework approach to provide integrated ScoP, education/competency and governance solutions, along with mechanisms for other professions working with MSK PoCUS-and physiotherapists/physical therapists outside of the UK-to consolidate and expand their practice.

Effectiveness of non-surgical interventions for rotator cuff calcific tendinopathy: A systematic review.

OBJECTIVE: To evaluate the effectiveness of non-surgical interventions for rotator cuff calcific tendinopathy. DATA SOURCES: Medline, EMBASE, CINAHL, Cochrane Register of Clinical Trials, PEDro and SPORTDiscus from inception to March 2018, and accompanying reference lists. Peer-reviewed randomized clinical trials of non-surgical interventions for adults with rotator cuff calcific tendinopathy were included. DATA EXTRACTION: The same 2 reviewers independently evaluated eligibility, extracted data and evaluated risk of bias of the included randomized clinical trials. A system to resolve any disagreements was established a priori. Short-term, medium-term and long-term outcomes for pain, shoulder function and calcific morphology related to rotator cuff calcific tendinopathy were extracted. Due to diversity in outcome measures a meta-analyses was not conducted. DATA SYNTHESIS: Of the 2,085 articles identified, 18 met the inclusion criteria, all of which had high risk of bias. Five non-surgical interventions were identified (extracorporeal shockwave therapy, ultrasound-guided percutaneous intervention, pulsed ultrasound, acetic acid iontophoresis, and transcutaneous electrical nerve stimulation). CONCLUSION: There was moderate evidence for high-energy extracorporeal shockwave therapy over low-energy extracorporeal shockwave therapy for pain and function between 3 and 6 months, and over placebo for function in the first 6 months. There was moderate evidence for ultrasound-guided percutaneous intervention over medium/high-energy extracorporeal shockwave therapy for reduced pain and calcific morphology over a 1-year period. Methodological concerns preclude definitive recommendations.

'We are doing our best': African and African-Caribbean fatherhood, health and preventive primary care services, in England.

Recent policy pronouncements emphasise the importance of engaging fathers with preventive primary care services. However, in England, there is a paucity of literature which examines African and African-Caribbean fathers' experiences of service provision. This paper reports a study that investigated African and African-Caribbean fathers' beliefs about fatherhood, health and preventive primary care services, with the aim of addressing the deficit in the literature. Nine focus groups involving 46 African and African-Caribbean fathers, recruited using purposive sampling, were undertaken between October 2008-January 2009. Fatherhood was seen as a core aspect of the participants' identities. The fathers enacted these identities in a number of ways, such as caring for and protecting children, which were influenced by spirituality, relationships with women, paid work and racism. The fathers had concerns about their bodies, medical conditions, physical activity and forms of consumption. However, their primary focus was on maintaining and improving the well-being of their children. This resulted in them neglecting their own health needs as they had to meet the obligations of family life and paid work. The fathers reported limited contact with preventive primary care services and were unaware of their purpose, function and availability. They identified ethnicity as a positive asset, and felt their families and communities had particular strengths. However they acknowledged that structural constraints, including racism, influenced their perceptions of and access to local health services. The engagement of African and African-Caribbean fathers needs to be addressed more specifically in policy as part of a broader programme of action to tackle health inequalities. In addition, child health services could build on fathers' commitment to children's well-being through practice that addresses fathers' as well as mothers' needs in families.

Rediscovering a history of nursing management: from Nightingale to the modern matron.

OBJECTIVES: This paper presents an examination of distinct periods in the development of nursing in order to rediscover a history of nursing management in England. The overall purpose is to demonstrate that uncritical accounts written in the past have not adequately explained the complex factors that have shaped nursing management in England. It is also suggested that the approach taken may be usefully applied to other national contexts. DESIGN: This is a review article which first establishes the value of historical perspectives in increasing understanding of nursing and then goes on to analyse the professional, social and political forces that contributed to the development of nursing management. DATA SOURCES: A range of historical and contemporary sources is accessed to support the review. REVIEW METHODS: The review is informed by an historical approach which also seeks recourse to current literature to develop a critical narrative analysis which has an international dimension. CONCLUSIONS: The history of nursing management has been 'lost' in celebratory and uncritical accounts of nursing as a whole. The important influence of key figures other than Nightingale has been overlooked and it emerges that nursing management has a longer and more complex history than is generally accepted.

Nursing and the issue of 'party' in the Church of England: the case of the Lichfield Diocesan Nursing Association.

In recent years, there has been increased interest in the role of religion in the reform of nursing during the mid-nineteenth century. However, less is known about how 'party' disputes between evangelicals and followers of the 'Oxford Movement' may have affected nursing. This study examines a proposal to create a nursing association for the Diocese of Lichfield in 1864, which leads to a public dispute concerning the 'ecclesiastical' nature of the organisation. Leading evangelicals in Derby campaigned against the idea of nurses belonging to a 'sisterhood'. This resulted in two rival organisations being created in 1865. This paper reports upon the nature and origins of the dispute within the diocese, unsuccessful attempts to draw Florence Nightingale into the dispute and the relative success of the two institutions. The results of this research indicate that the importance of context and of place must be recognised when studying the history of nursing. This research is based mainly, upon newspaper reports, correspondence and miscellaneous sources, including biographies as there are few surviving records from the two organisations under scrutiny.

The development of nurse training in the Birmingham Teaching Hospitals, 1869-1957.

This paper is based upon research undertaken in the Birmingham City Archives in which the development of nurse training and education is traced from its beginnings in 1869 to the creation of a central school for the Teaching Hospitals in 1957. The results from this research are discussed in the context of national developments in training and as such developments in Birmingham can be seen as typical of many towns and cities in provincial England, during the period under study.