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Biomedical subjects

Jeff Blackmer

Publications and source records attributed to Jeff Blackmer.

8 recordsLinked to original sources
PubMed2006

Concordance in goal setting between patients with multiple sclerosis and their rehabilitation team.

OBJECTIVE: To determine the concordance between patients with multiple sclerosis and their clinical team members on the identification of goals for an inpatient rehabilitation stay. DESIGN: Prospective cohort study of patients admitted for rehabilitation in an adult inpatient neurospinal unit at a Rehabilitation Centre in Ottawa, Canada. Twenty-seven patients (11 men and 16 women, mean age of 45.3 yrs) with either a laboratory or a clinically supported diagnosis of multiple sclerosis. Patients rated 55 goals from a preexisting list, indicating the importance of each goal to be addressed during the inpatient stay. The goals fell into five broad domains of health/medical issues, daily activities, mobility, community life, and personal well-being. Patients also identified their five most important individual goals. In a separate session, the clinical team also rated the 55 goals in relation to each patient and identified an independent list of the five most important rehabilitation goals. Main outcome measures included concordance between patient and team ratings in the identification of goals, ratings of the likelihood of success of achieving each goal, and ratings of the amount of change required to realize a minimal clinically important difference. RESULTS: The patients and the team agreed on an average of 1.7 of the patient's five top-rated goals. Compared with the team, patients gave higher importance ratings to goals within the health/medical, mobility, and daily activities domains. They also considered that a greater average improvement would be required to achieve a meaningful benefit, and they gave higher ratings of the likelihood of success in achieving their selected goals. CONCLUSION: Patients with multiple sclerosis and clinical team members do not necessarily agree on specific goals for a rehabilitation stay. Patients may also have greater expectations than clinicians with respect to the amount of improvement and the likelihood of achieving their goals.

Activities of Daily Living↗
PubMed2006

Autonomic dysreflexia and telehealth.

With the rapid expansion of telehealth lines in the United States and the establishment of provincially funded lines in Canada, a growing number of people use this convenient approach to establish their initial health needs and to pursue self-care. Telehealth providers, for the most part, rely on electronic protocols to offer triaging and advice. Unfortunately, standard protocols are misleading when a premorbid health condition such as a spinal cord injury is present. Symptoms such as a headache, diaphoresis or an elevated blood pressure, which are common occurrences in the general population, may indicate an emergency situation, namely autonomic dysreflexia (AD), when a mid-thoracic and higher spinal cord lesion is present. Since there is no available electronic protocol on AD, this emergency health condition is not recognized by the telehealth provider and may put the caller at risk of serious morbidity or even death. In this article, the authors present the clinical features of AD, the precipitating factors and the nursing management of an episode. The merits and pitfalls of electronic protocols are reviewed and an algorithm is presented to assist telehealth providers in recognizing AD.

Algorithms↗
PubMed2003

Rehabilitation medicine: 1. Autonomic dysreflexia.

Autonomic dysreflexia is an acute syndrome of excessive, uncontrolled sympathetic output that can occur in patients who have had an injury to the spinal cord (generally at or above the sixth thoracic neurologic level). It is caused by spinal reflex mechanisms that remain intact despite the patient's injury, leading to hypertension. This review describes the clinical features of autonomic dysreflexia, its common causes (most frequently stimulation of the lower urinary tract) and a recommended approach to treatment. The condition can nearly always be managed successfully, but prompt recognition is essential--without treatment there may be dire consequences, including death.

Adult↗
PubMed2003

The unique ethical challenges of conducting research in the rehabilitation medicine population.

BACKGROUND: The broad topic of research ethics is one which has been relatively well-investigated and discussed. Unique ethical issues have been identified for such populations as pediatrics, where the issues of consent and assent have received much attention, and obstetrics, with concerns such as the potential for research to cause harm to the fetus. However, little has been written about ethical concerns which are relatively unique to the population of patients seen by the practitioner of rehabilitation medicine. DISCUSSION: This paper reviews unique ethical concerns in conducting research in this population, including decision-making capacity, communication, the potential for subject overuse, the timing of recruitment, hope for a cure and therapeutic misconception and the nature of the health care provider-research subject relationship. SUMMARY: Researchers in the area of rehabilitation medicine should be aware of some of the unique ethical challenges posed by this patient population and should take steps to address any potential concerns in order to optimize subject safety and ensure that studies meet current ethical guidelines and standards.

Brain Injuries↗
PubMed2002

The use of alternative therapies in the Saskatchewan stroke rehabilitation population.

BACKGROUND: Many patients use alternative therapies. The purpose of this study was to determine the percentage of stroke rehabilitation patients in Saskatchewan using alternative therapies, whether patients found these therapies effective in alleviating stroke-related symptoms, how often those patients who used alternative therapies discuss this fact with their primary care doctor and the main reason why patients might not do so. METHODS: Telephone questionnaire surveys were conducted with 117 patients who had suffered a stroke and undergone inpatient or outpatient rehabilitation at Saskatoon City Hospital. RESULTS: The study revealed that 26.5% of 117 stroke rehabilitation patients visited alternative practitioners at least once or used some form of unconventional therapy. Only 16.1% of patients found that alternative therapy made them feel much better. Of those who used alternative therapy, 61.3% did not discuss this fact with their primary physician. Many of the respondents (47.3%) who did not inform their physician stated that they did not see the necessity of talking about these treatments and 21.1% did not discuss the issue with their physician because they felt that he or she might disapprove of alternative therapies. CONCLUSION: A relatively small percentage of stroke patients found alternative therapies beneficial. Doctors should be aware that a significant number of patients will try alternative treatment without discussion with their primary care physician or specialist. The current study suggests that after completing routine questioning, doctors should also ask their patients about their use of alternative therapies and, when appropriate, review issues of safety and efficacy.

Adult↗
PubMed2002

Medical-ethics teaching in Canadian physical medicine and rehabilitation residency training programs.

BACKGROUND: Medical-ethics education is a required component of all Royal College residency training programs in Canada. There have been no studies to determine how and to what extent this teaching is done in physical medicine and rehabilitation training programs. OBJECTIVE: To assess the state of medical-ethics teaching in Canadian physical medicine and rehabilitation residency training programs. METHODS: A six-question survey was faxed to the program directors of the 10 physiatry residency training programs in Canada. We asked whether medical-ethics teaching is being done, who is doing the teaching, which pedagogic methods is used, how many hours are dedicated to the topic, which topics are taught, and what evaluation method is used. RESULTS: The response rate was 90 per cent. The study confirmed that medical-ethics teaching is done in all Canadian physiatry training programs. However, the person doing the teaching, the number of hours allocated to ethics education, the pedagogic method used, and the topics being taught vary from program to program. CONCLUSION: Although medical-ethics teaching is done in all programs, there is a need for more standardization in the curriculum and in evaluation. The curriculum should focus on ethical issues that are most likely to be encountered in daily physiatric practice. Small-group, case-based teaching should be used for maximum effectiveness. Whenever possible, teaching should be done by a physiatrist.

Bioethics↗