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Biomedical subjects

N E Foster

Publications and source records attributed to N E Foster.

15 recordsLinked to original sources
PubMed2007

Acupuncture treatment for chronic knee pain: a systematic review.

OBJECTIVES: To evaluate the effects of acupuncture on pain and function in patients with chronic knee pain. METHODS: Systematic review and meta-analysis of randomized controlled trials of adequate acupuncture. Computerized databases and reference lists of articles were searched in June 2006. Studies were selected in which adults with chronic knee pain or osteoarthritis of the knee were randomized to receive either acupuncture treatment or a control consisting of sham (placebo) acupuncture, other sham treatments, no additional intervention (usual care), or an active intervention. The main outcome measures were short-term pain and function, and study validity was assessed using a modification of a previously published instrument. RESULTS: Thirteen RCTs were included, of which eight used adequate acupuncture and provided WOMAC outcomes, so were combined in meta-analyses. Six of these had validity scores of more than 50%. Combining five studies in 1334 patients, acupuncture was superior to sham acupuncture for both pain (weighted mean difference in WOMAC pain subscale score = 2.0, 95% CI 0.57-3.40) and for WOMAC function subscale (4.32, 0.60-8.05). The differences were still significant at long-term follow-up. Acupuncture was also significantly superior to no additional intervention. There were insufficient studies to compare acupuncture with other sham or active interventions. CONCLUSIONS: Acupuncture that meets criteria for adequate treatment is significantly superior to sham acupuncture and to no additional intervention in improving pain and function in patients with chronic knee pain. Due to the heterogeneity in the results, however, further research is required to confirm these findings and provide more information on long-term effects.

Acupuncture Analgesia↗
PubMed2004

Being a parent or grandparent with back pain, ankylosing spondylitis or rheumatoid arthritis: a descriptive postal survey.

Research that explores being a parent or grandparent with musculoskeletal problems has been fairly limited to date. The aim of this study was to describe the experience of parenting in the context of back pain (BP), ankylosing spondylitis (AS) and rheumatoid arthritis (RA), with a particular focus on the extent and nature of childcare experiences and to compare these experiences across the three groups. In addition, the possible reasons for these reported experiences, the availability of advice and support and the development of strategies for coping were explored using a cross-sectional descriptive survey. A total of 448 participants was recruited from relevant charitable organizations and the National Health Service (280 with BP, 106 with AS and 62 with RA). A combination of opportunistic and random sampling was used. Quantitative data were analysed with appropriate descriptive and inferential statistics using Statistical Package for the Social Sciences (SPSS version 10). Qualitative data were analysed using content analysis. Results indicate that a high proportion of all groups experienced a wide range of difficulties with parenting (81% BP, 77% AS, 97% RA). The most prevalent problems were similar for all three groups: lifting baby/child from the floor or cot, encouraging children/grandchildren to help with domestic chores and keeping up (in terms of energy) with children/grandchildren. However, the RA group reported having greater difficulties than the other two groups. Very little advice was offered to participants with parenting difficulties which may indicate a gap in service provision. However, a wide range of strategies for coping were described by respondents. The study highlighted a need for healthcare professionals to develop a greater awareness of parenting issues and to provide opportunities for these issues to be addressed.

Journal Article↗
PubMed2003

Reproducibility and repeatability: errors of three groups of physiotherapists in locating spinal levels by palpation.

Location of spinal levels by palpation is an essential part of physiotherapy assessment and treatment of spinal musculoskeletal conditions. This study aimed to (i) investigate the reproducibility and repeatability of three groups of physiotherapists in locating three randomly selected spinal levels by palpation, (ii) explore whether these groups were palpating similar points at each level, and (iii) investigate whether there were differences in palpation across the spinal levels tested. Reproducibility was estimated using a convenience sample of 30 physiotherapists: 13 undergraduate students, 10 clinicians, and seven manual therapists (MTs). Repeatability was investigated using six physiotherapists (two students, two clinicians and two MTs). Each therapist palpated the spinous processes (C5, T6, L5) once for reproducibility, and 10 times for repeatability, on each asymptomatic model. The skin overlying the spinal levels was marked with an invisible pen. Using an ultra-violet light, marks were transcribed onto transparent plastic strips for analysis, and the distances were measured with an electronic caliper. Repeated measures analyses of variance (ANOVA) indicated poor reproducibility across therapists at all spinal levels (F=18.43, P=0.001), but good repeatability within therapists (F=2.09, P=0.161). Students produced different mean locations of their palpatory marks from the other two groups in two spinal levels. Clinicians and MTs were more reproducible than students, and located similar levels. Palpation of L5 spinous process presented the most difficulty, for all groups. Further research is needed to compare different methods of palpation and explore whether reproducibility can be improved.

Adult↗
PubMed2001

Federal efforts to improve quality of care: the Quality Interagency Coordination Task Force (QuIC).

FORMATION OF THE QUIC: The Quality Interagency Coordination Task Force (QuIC) was established in 1998 to enable the participating federal agencies to coordinate their activities to study, measure, and improve the quality of care delivered by federal health programs; provide people with information to help them in making more informed choices about their care; and develop the research base and infrastructure needed to improve the health care system, including knowledgeable and empowered workers, well-designed systems of care, and useful information systems. STUDY, MEASURE, AND IMPROVE CARE: The QuIC's initial efforts to improve the care delivered in federal health care programs have focused on diabetes, depression, and the effect of working conditions on quality of care. More recently, patient safety efforts are under way to establish a coordinating center that will enable those who are testing methods of reducing errors to share information across their projects and with experts in error reduction. DEVELOP A RESEARCH BASE AND INFRASTRUCTURE: The QuIC has coordinated efforts in credentialing, information on measures of quality, a taxonomy of quality improvement methods, and errors data collection. PROVIDE INFORMATION TO AMERICANS ABOUT HEALTH CARE QUALITY: The QuIC agencies are developing products that will enhance their ability to communicate with the American people about their health care choices: improved gateways for consumer information available from federal agencies, a glossary of commonly used terms, and guidance for producing report cards on quality of care. MOVING THE QUALITY IMPROVEMENT AGENDA FORWARD: Federal efforts to improve quality of care are moving forward in a more integrated fashion on a wide number of fronts.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

Does a healthy health care workplace produce higher-quality care?

BACKGROUND: The multiagency Quality Interagency Coordination Task Force (QuIC) coordinates activities and plans for quality measurement and improvement across all the U.S. federal agencies involved in health care. One of its working groups focuses on the health care workforce and ways to improve the quality of care that it provides. In October 1999 four government agencies, under the aegis of the QuIC, convened a conference to examine how health care workplace quality influences the quality of care. A healthy workplace is one in which workers will be able to deliver higher-quality care and in which worker health and patients' high-quality care are mutually supportive. In October 2000 a follow-up conference was held to focus on a specific aspect of health care quality-patient safety. WHAT WE STILL NEED TO KNOW: Although enough is known to justify some initiatives to improve the quality of the health care workplace, participants in both meetings agreed that the evidence to prove these associations is weak and that there has been too little research to evaluate the impact of interventions intended to improve quality through improvements in the health care workplace. New evidence-based information is needed to test the theory of the nature of the relationship between working conditions and care quality. CONCLUSION: The tradition of evidence-based decision making needs to be applied to health care management as it has in medicine and nursing, to show how staffing, environment, organization, and culture can each can affect the quality of care.

Advisory Committees↗
PubMed1999

Management of nonspecific low back pain by physiotherapists in Britain and Ireland. A descriptive questionnaire of current clinical practice.

STUDY DESIGN: A descriptive questionnaire of chartered physiotherapists. OBJECTIVE: To investigate current physiotherapeutic management of low back pain throughout Britain and Ireland. SUMMARY OF BACKGROUND DATA: Physiotherapists play a key role in low back pain management. Although clinical guidelines for best practice have been developed recently, there has been no large-scale attempt to describe current physiotherapeutic treatment approaches within Britain or Ireland. METHODS: After semi-structured interviews (n = 6) and two pilot studies (n = 77) were done, postal questionnaires were distributed to four regional cluster samples of the membership of two physiotherapy professional organizations (n = 2654). After two mailings, a random sample of 90 nonresponders were followed up. Data were analyzed using the Statistical Package for the Social Sciences (SPSS Ltd., Woking, Surrey, UK), and precision of the survey estimates was assessed by calculation of sampling errors and intraclass correlation coefficients for cluster sampling. RESULTS: Results were received from 1548 therapists (total response rate, 58.3%); of these, 813 reported that they were practicing in settings in which they treated patients with low back pain. Analysis of the results indicated the overall popularity of the Maitland mobilization and McKenzie approaches among physiotherapists. Although exercise per se was mentioned frequently by respondents, a marked difference in opinion among therapists regarding the optimal type of exercise for low back pain was obvious. Little evidence was demonstrated of the use of manipulation, fitness programs, or multidisciplinary efforts involving behavioral and physical aspects of treatment. Commonly used methods of electrotherapy were interferential therapy, ultrasound, pulsed short-wave diathermy, and transcutaneous electrical nerve stimulation. CONCLUSIONS: The results of this study emphasize the need to evaluate further and improve the dissemination of findings regarding the effectiveness of specific physiotherapy approaches for low back pain management.

Adult↗
PubMed1999

Does arthritis influence perceived ability to fulfill a parenting role? Perceptions of mothers, fathers and grandparents.

The presence of a painful, disabling chronic disease may have implications for perceived ability to fulfill a parenting role. The purpose of this research was to examine the realities of parenting from the perspectives of mothers, fathers and grandparents with arthritis using a combination of methods: a cross sectional survey and in-depth focus group discussions. There was consensus that pain, fatigue and restricted physical functioning combined to interfere with the parenting role. Overall, approximately 35% of the sample had experienced difficulties attributed to arthritis. A gender difference emerged with women reporting more difficulties in relation to caring for babies and toddlers, whereas men reported more problems as children grew older. Key themes concerned: physical limitations; practical and caring issues; social factors; emotional response; hereditary risks and safety issues. Perceived inability to fulfill parenting roles resulted in feelings of frustration, guilt, anger and depression. A number of positive outcomes were mentioned including children's increased awareness of the needs of others. Limitations of the methodological approach adopted are discussed.

Activities of Daily Living↗
PubMed1996

Manipulation of transcutaneous electrical nerve stimulation variables has no effect on two models of experimental pain in humans.

Two separate studies investigated the hypoalgesic effect of manipulation of Transcutaneous Electrical Nerve Stimulation (TENS) parameters on two models of experimental pain: the Submaximal Effort Tourniquet Technique and cold-pressor pain. For the first study, 32 healthy subjects (16 male and 16 female) attended once for the purpose of cold-pressor pain induction that involved immersion of the nondominant hand in a water bath at 0 degree C. Subjects were allocated to Control, Placebo, or 1 of 2 treatment groups (110 or 4-Hz TENS). Pain threshold measurements (time to withdrawal of hand in seconds) were obtained over six standardised cold pain cycles (i.e., two before stimulation onset, three during stimulation, and one cycle after stimulation). In the second study, 48 healthy volunteers (24 male and 24 female) attended on two occasions, 48 h apart, for the purposes of ischaemic pain induction. On the first attendance, baseline data were obtained and on the second, subjects were randomly allocated to Control, Placebo, or one of four treatment groups with different combinations of stimulation frequencies and pulse durations (4 or 110 Hz and 50 or 200 microseconds). Measurements of "current pain intensity" and "worst pain experienced" were obtained via the Visual Analogue Scale (VAS) and the McGill Pain Questionnaire (MPQ), respectively. Analysis of variance performed on both sets of collected data revealed no significant differences between any of the groups, thus indicating no apparent relevance of manipulation of TENS parameters using these models of pain. Several hypotheses are suggested to explain these findings.

Adult↗
PubMed1995

Challenges to generalism: views from the delivery system.

The declining interest in primary care among U.S. medical students is an ominous trend for the national health system. The medical school environment, the powerful financial incentives promoting specialism, and the practice environment itself have contributed to the decline of generalism. During a day-long meeting sponsored by the Robert Wood Johnson Foundation, representatives of group practices, HMOs, community health centers, and military medicine noted the universal shortage of primary care physicians, the fact that medical education does not prepare physicians for the realities of practice, the concern that "burnout" is a significant problem for retention and physician satisfaction, and the problem that the optimal design of primary care practice is not yet known. To reverse these trends, concerted action must take place within academic medicine, by public policy makers, and by the delivery system itself.

Burnout, Professional↗
PubMedDate not supplied

Transcutaneous electrical nerve stimulation. Relevance of stimulation parameters to neurophysiological and hypoalgesic effects.

Although Transcutaneous Electrical Nerve Stimulation (TENS) has become a popular modality in pain management over the past 20 yr, there is still debate over its mechanisms of action and the precise relevance of stimulation parameters to its hypoalgesic effects. Thus, confusion still surrounds the selection of optimal stimulation parameters. Two separate studies (total n = 88) were carried out to investigate the effect of four combinations of TENS pulse durations (50 microseconds & 200 microseconds) and frequencies (4 Hz and 110 Hz) on nerve conduction in the human superficial radial nerve and on Mechanical Pain Threshold (MPT) within the associated sensory distribution of the nerve over the dorsum of the hand. Results showed that application of one combination of TENS parameters (110 Hz, 200 microseconds) directly over the course of the nerve produced a significant increase in both peripheral nerve conduction latency (P < or = 0.05; analysis of variance (ANOVA)) and MPT (P < or = 0.01). In addition, there was a high correlation (r = 0.9) between shifts in MPT and negative peak latency for the groups treated with this combination of TENS parameters. The results of this study thus illustrate that combinations of TENS parameters are important to the peripheral neurophysiological effects of this modality and, further, its associated hypoalgesic effects, at least on the model of pain used here.

Action Potentials↗