This document outlines a study protocol to evaluate the feasibility of implementing grip strength measurement into routine clinical practice for hospitalized older patients. The study will take place in five acute medical wards for older people in one hospital. It will have three phases: 1) Define current practices for identifying at-risk patients and their nutrition/mobility care through interviews and record reviews. 2) Develop and implement staff training on grip strength measurement using Normalization Process Theory. 3) Evaluate the acceptability, adoption, coverage, and basic costs of routine grip strength measurement through interviews, record reviews, and focus groups with staff and patients. The results will inform how grip strength can be translated from a research tool into clinical practice to improve identification of at-
Three studies found that direct access to physical therapists significantly reduced waiting times for treatment compared to referral through consultants. Direct access also reduced pressure on consultant outpatient clinics by decreasing unnecessary referrals in two studies. One randomized controlled trial found slightly better patient recovery times and higher patient assessments of progress with direct access. However, most studies found no significant differences in the number of treatment sessions, recovery time, or return to work between direct access models and consultant referral models of physical therapy.
Nejm journal watch practice changing articles 2014Jaime dehais
This document provides a compilation of summaries of the latest practice-changing articles from NEJM Journal Watch. It includes summaries of articles on topics such as delayed or no antibiotic prescriptions for respiratory infections, physical therapy being beneficial for knee osteoarthritis, low-dose steroids being better than high-dose for COPD exacerbations, a diagnostic algorithm for upper-extremity deep vein thrombosis, evidence that meniscal tears may not require surgery, improvements in mental health with smoking cessation, doubts cast on flu drugs by meta-analyses, the 2014 recommended childhood immunization schedule, sentinel lymph node biopsies for thin melanomas, age-specific d-dimer cutoffs for pulmonary embolism, evidence that FOD
- The researchers modified a validated Patient Reported Experience Measure (PREM) tool originally developed for rheumatoid arthritis (RA) patients to be used for patients with other rheumatic conditions. [1]
- They administered the modified PREM across 11 UK sites to 110 patients with various rheumatic conditions other than RA. The modified PREM demonstrated good construct validity and reliably captured patient experiences across different rheumatic conditions. [2]
- Some domains like needs/preferences and emotional support had higher agreement with patients' overall experience ratings. Both the original RA PREM and modified versions are valid tools for measuring patient experience in rheumatology. [3]
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
home based pulmonaRY REHABILITATION IN COPDSurendra Ojha
This randomized study evaluated the impact of a home-based pulmonary rehabilitation program for subjects with COPD compared to a control group. The home-based program consisted of walking, stair climbing, and arm exercises performed 3 times per week for 24 sessions. The home-based group showed significant improvements in the 6-minute walk test distance (65m increase) and treadmill endurance time (316m increase) compared to no significant changes in the control group. The home-based group also had improvements in all domains of a quality of life questionnaire, while the control group did not change. The study demonstrates that a simple, low-cost home-based pulmonary rehabilitation program can improve exercise capacity and quality of life for subjects with COPD
This systematic review evaluated the effectiveness of Pilates exercise for chronic low back pain through 14 randomized controlled trials. The quality of studies ranged from poor to excellent. Pilates provided statistically significant improvements in pain and function compared to usual care and physical activity from 4 to 15 weeks, but not at 24 weeks. Pilates did not consistently show statistically significant differences in pain or function improvement compared to massage therapy or other exercises. Pilates may offer short-term benefits for pain and function over usual care/activity, but equivalence to other interventions. Future research should explore optimal Pilates protocols and which individuals may benefit most.
This document contains summaries of multiple studies related to value-based healthcare for inflammatory bowel diseases. The first study found that a coordinated care program for IBD patients led to less corticosteroid use, more immunomodulator and biologic use, fewer hospitalizations and ER visits, and more biomarker testing compared to matched controls. The second study quantified patients' preferences for disease control, quality of life, and productivity outcomes using a choice-based survey. The third study evaluated a value-based healthcare program for IBD and found less corticosteroid use and trends toward more appropriate medication use and decreased utilization compared to matched controls.
Three studies found that direct access to physical therapists significantly reduced waiting times for treatment compared to referral through consultants. Direct access also reduced pressure on consultant outpatient clinics by decreasing unnecessary referrals in two studies. One randomized controlled trial found slightly better patient recovery times and higher patient assessments of progress with direct access. However, most studies found no significant differences in the number of treatment sessions, recovery time, or return to work between direct access models and consultant referral models of physical therapy.
Nejm journal watch practice changing articles 2014Jaime dehais
This document provides a compilation of summaries of the latest practice-changing articles from NEJM Journal Watch. It includes summaries of articles on topics such as delayed or no antibiotic prescriptions for respiratory infections, physical therapy being beneficial for knee osteoarthritis, low-dose steroids being better than high-dose for COPD exacerbations, a diagnostic algorithm for upper-extremity deep vein thrombosis, evidence that meniscal tears may not require surgery, improvements in mental health with smoking cessation, doubts cast on flu drugs by meta-analyses, the 2014 recommended childhood immunization schedule, sentinel lymph node biopsies for thin melanomas, age-specific d-dimer cutoffs for pulmonary embolism, evidence that FOD
- The researchers modified a validated Patient Reported Experience Measure (PREM) tool originally developed for rheumatoid arthritis (RA) patients to be used for patients with other rheumatic conditions. [1]
- They administered the modified PREM across 11 UK sites to 110 patients with various rheumatic conditions other than RA. The modified PREM demonstrated good construct validity and reliably captured patient experiences across different rheumatic conditions. [2]
- Some domains like needs/preferences and emotional support had higher agreement with patients' overall experience ratings. Both the original RA PREM and modified versions are valid tools for measuring patient experience in rheumatology. [3]
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
home based pulmonaRY REHABILITATION IN COPDSurendra Ojha
This randomized study evaluated the impact of a home-based pulmonary rehabilitation program for subjects with COPD compared to a control group. The home-based program consisted of walking, stair climbing, and arm exercises performed 3 times per week for 24 sessions. The home-based group showed significant improvements in the 6-minute walk test distance (65m increase) and treadmill endurance time (316m increase) compared to no significant changes in the control group. The home-based group also had improvements in all domains of a quality of life questionnaire, while the control group did not change. The study demonstrates that a simple, low-cost home-based pulmonary rehabilitation program can improve exercise capacity and quality of life for subjects with COPD
This systematic review evaluated the effectiveness of Pilates exercise for chronic low back pain through 14 randomized controlled trials. The quality of studies ranged from poor to excellent. Pilates provided statistically significant improvements in pain and function compared to usual care and physical activity from 4 to 15 weeks, but not at 24 weeks. Pilates did not consistently show statistically significant differences in pain or function improvement compared to massage therapy or other exercises. Pilates may offer short-term benefits for pain and function over usual care/activity, but equivalence to other interventions. Future research should explore optimal Pilates protocols and which individuals may benefit most.
This document contains summaries of multiple studies related to value-based healthcare for inflammatory bowel diseases. The first study found that a coordinated care program for IBD patients led to less corticosteroid use, more immunomodulator and biologic use, fewer hospitalizations and ER visits, and more biomarker testing compared to matched controls. The second study quantified patients' preferences for disease control, quality of life, and productivity outcomes using a choice-based survey. The third study evaluated a value-based healthcare program for IBD and found less corticosteroid use and trends toward more appropriate medication use and decreased utilization compared to matched controls.
This document summarizes a DNP project that evaluated the implementation of a sedation vacation protocol in a medical intensive care unit (MICU). The purpose was to determine if the protocol reduced pneumonia incidence, intubation duration, and ICU length of stay. A literature review found support for daily sedation vacations, spontaneous breathing trials, and ventilator bundle care. Chart reviews of 33 patients in 2014 found the protocol was ordered for all patients but only documented for 67% of patients. Results were inconclusive on outcomes. Barriers to full protocol compliance were identified.
The study assessed adherence to cardiovascular medications in rural patients attending a tertiary hospital in India. It found that adherence was lowest in hypertension patients at 20.83% and highest in ischemic heart disease patients at 32%. The most common reason for non-adherence was carelessness. The study concluded that rural Indians adhere poorly to cardiovascular medications and that more efforts are needed to address this issue.
This document summarizes a study assessing performance measures at a tertiary hospital in central India over a one-month period. Key findings include:
- Bed occupancy rate was 71.07%, meeting WHO standards. ICUs like SICU and MICU had high occupancy.
- Average length of stay was 4.02 days, matching WHO guidelines.
- Bed turnover ratio was 5 patients per bed, higher than WHO standards and indicating more bed needs.
- ICU mortality rate was 40.27%, much higher than the WHO 1-15% standard. Overall hospital mortality rate was also higher at 11.89%.
This document presents the introduction and background for a study evaluating the effectiveness of a self-instructional module on knowledge of renal diet among chronic renal failure patients undergoing hemodialysis. The study aims to assess knowledge before and after providing the module, and to compare knowledge in patients who receive the module versus a control group. The document outlines the need for the study, objectives, hypotheses, methodology including a pre-test/post-test quasi-experimental design, and lists references to be used.
ChiropracticAndManualTherapies.ArticleDr. Zara Ali
This survey of chiropractors in Saskatchewan found that:
1) All respondents provide nutritional advice to patients and nearly all (99%) provide dietary supplement recommendations.
2) The most commonly recommended supplements were glucosamine sulfate, multivitamins, vitamin C, vitamin D, calcium, omega-3 fatty acids, and probiotics.
3) Respondents generally recommend supplements for conditions related to bone, joint, and muscle health like arthritis, as well as for general health and wellness.
This document discusses a proposed project to increase the utilization of prone positioning for ARDS patients at a hospital. It begins with reviewing evidence that prone positioning can reduce mortality and improve oxygenation for ARDS patients. It then outlines a plan to develop a prone positioning protocol, educate staff, and implement the protocol. Evaluation of outcomes will occur after 90 days to determine if the protocol was successful in reducing mortality and improving oxygenation for ARDS patients. The goal is to implement an evidence-based intervention that can improve patient outcomes.
This document reviews interventions for improving outcomes following total hip or knee arthroplasty. It finds that pre-operative patient education, nutrition management, and pain management can help reduce hospital stays and aid recovery. Specifically, education improves expectations and anxiety, while addressing malnutrition and anemia. Neuromuscular electrical stimulation pre-operatively may also enhance muscle strength and early mobility.
The document discusses different types of epidemiological study designs used to assess whether an exposure is associated with a particular health outcome. It describes experimental (intervention) studies, where investigators allocate subjects to exposure and control groups, and observational studies, where investigators observe naturally occurring exposure and outcome groups. Two main types of intervention studies are clinical trials, which test new treatments among diseased individuals, and field trials, which assess disease prevention among non-diseased individuals. Examples provided examine low-fat diet interventions to reduce breast cancer recurrence and incidence.
This document presents a research synopsis on assessing the knowledge of renal diet among primary caregivers of renal failure patients. The study aims to evaluate the existing knowledge of primary caregivers regarding renal diet using a questionnaire and to develop a self-instructional module on renal diet. It will recruit 60 primary caregiver samples using non-probability purposive sampling from selected hospitals. Data will be collected using a demographic section and knowledge assessment questionnaire, and analyzed using frequency, percentage, mean and chi-square tests. Findings will be disseminated through publications and workshops.
This document discusses the rise of evidence-based health care over the last decade. Key points:
- Evidence-based health care aims to minimize problems like overuse, underuse and misuse of treatments by basing clinical practice closely on scientific research evidence.
- During the 1990s, the concepts of evidence-based health care spread widely and began influencing health policymakers, providers and researchers.
- Advances have been made in managing and disseminating research findings through initiatives like the Cochrane Collaboration and clinical practice guidelines.
- However, integrating research evidence into everyday clinical practice remains a challenge and some critics argue evidence-based practice could stifle innovation.
This study evaluated a nurse-led telephone intervention to support patients with chronic obstructive pulmonary disease (COPD) in managing their condition. 73 patients were randomly assigned to either receive standard care including a self-management plan, or to receive the self-management plan plus two telephone calls from a nurse over six weeks. The telephone calls provided education on using their self-management plan and managing exacerbations. The primary outcome was COPD symptom severity assessed before and after with the COPD Assessment Tool (CAT). Secondary outcomes included self-reported exacerbations and healthcare utilization. CAT scores significantly improved in the intervention group but not the control group. There were no significant differences in exacerbations between groups. Patient satisfaction did not differ significantly between groups
Poster: Test-Retest Reliability and Equivalence of PRO MeasuresCRF Health
This literature review examined administration intervals used in test-retest reliability and equivalence studies for patient-reported outcome measures. The review found a large variance in intervals, ranging from immediate to 7 years for test-retest studies and from immediate to 1 month for equivalence studies. The most common intervals were 2 weeks for test-retest studies and 1 hour or less for equivalence studies. Intervals varied depending on the medical condition and type of study, with shorter intervals used for equivalence studies compared to test-retest studies for the same conditions.
The document provides clinical guidelines from the American College of Physicians on the pharmacologic and surgical management of obesity in primary care. It summarizes the evidence from several studies.
The guidelines include 5 recommendations:
1) Counsel all obese patients on lifestyle changes like diet and exercise, and set individualized weight loss goals.
2) Pharmacologic therapy can be offered to patients who have failed to achieve goals through diet and exercise alone, after discussing side effects and lack of long-term safety data.
3) Acceptable drug options include sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion, choosing based on side effect profiles
This document reviews the evidence for different types of exercise as a treatment for Parkinson's disease. It finds that cardiovascular exercise, balance training, and resistance training can all provide benefits. Cardiovascular exercise may improve gait, balance, quality of life, and reduce mortality risk. Balance training can improve gait, balance, and reduce falls, especially when combined with resistance training. Resistance training can increase muscle strength, endurance, and mobility. The review develops a suggested home-based exercise regimen combining these modalities to maximize benefits for patients with mild to moderate Parkinson's disease.
This document summarizes a study that assessed current practices in teaching life support competencies in healthcare. The study conducted surveys to: 1) Identify life support courses provided in UK hospitals and required by professional bodies, 2) Describe curriculum content and teaching methods of popular in-hospital courses, 3) Examine fidelity of implementation of courses in England. The study found that most NHS hospitals provide adult life support courses, with the Resuscitation Council UK Advanced Life Support course most common. Many hospitals also provide in-house courses. Recognition and management of pre-arrest deterioration are now widely taught. While life support training is provided in all medical schools, approaches vary and pre-arrest management courses are less common. Only a
A Quasi Experimental Study to Assess the Effectiveness of Selected Nursing In...iosrjce
A study to assess the effectiveness of selected nursing interventions on health related quality of life
and activities of daily living among COPD patients in selected tertiary hospital, Chennai, Tamilnadu, India.
The aim of the study was to impart the selected nursing interventions applied to the COPD patients in medical
and pulmonary wards. The conceptual framework used in this study was Widenbach’s Helping art Theory. An
Evaluative approach was used for the present study. Using purposive sampling technique 50 samples were
selected from Chettinad Hospital and Research Institute, Tamil Nadu, India. The tool used was self
administered questionnaire. The collected data was analyzed using descriptive and inferential statistics. The
findings of the study revealed a significantly increase in the COPD patients health related quality of life and
activities of daily living after given the selected nursing interventions. The mean pre test score was 1867 and
the mean post test score was 1861 and the difference between pre test and post test knowledge score was 5.54.
Based on the objectives of the study the findings of the level of health related quality of life and activities of
daily living among COPD patients shows that increased health related quality of life and activities of daily
living. The study shows that the COPD patients in post test were having post score1861 mean difference
5.54.standard deviation 2.35.p value (0.02). Selected nursing interventions are effective in increasing the health
related qualityof life and activities of daily living among COPD patients.. The findings of the study revealed that
a significantly increased in the post test health related quality of life and activities of daily living after given the
selected nursing interventions
Chiropractic and CAM Utilization: A Descriptive Reviewhome
Studies looking at chiropractic utilization demonstrate that the rates vary, but
generally fall into a range from around 6% to 12% of the population, most of whom seek
chiropractic care for low back pain and not for organic disease or visceral dysfunction. CAM is itself
used by people suffering from a variety of conditions, though it is often used not as a primary
intervention, but rather as an additional form of care. CAM and chiropractic often offer lower costs
for comparable results compared to conventional medicine
This document summarizes the results of a systematic review of 6 randomized controlled trials involving 296 patients that examined the effect of inhaled magnesium sulfate (MgSO4) in the treatment of acute asthma exacerbations. The review found that treatment with nebulized MgSO4, particularly in addition to a beta-2 agonist, was associated with a statistically significant improvement in pulmonary function compared to beta-2 agonists alone. There was also a non-significant trend toward fewer hospital admissions among patients who received nebulized MgSO4. Subgroup analyses showed similar improvements in lung function for both adult patients and those with more severe asthma.
La inflación económica se refiere al aumento sostenido y generalizado del nivel de precios de bienes y servicios medido frente al poder adquisitivo. Se causa principalmente por aumentos en los costos de producción debidos a un incremento en la demanda o los costos de producción, así como por escasez de productos. Además, la inflación reportada por el DANE para Colombia refleja promedios ponderados a nivel nacional, por lo que los ciudadanos deberían considerar la inflación de su región e ingreso particular.
This document summarizes a DNP project that evaluated the implementation of a sedation vacation protocol in a medical intensive care unit (MICU). The purpose was to determine if the protocol reduced pneumonia incidence, intubation duration, and ICU length of stay. A literature review found support for daily sedation vacations, spontaneous breathing trials, and ventilator bundle care. Chart reviews of 33 patients in 2014 found the protocol was ordered for all patients but only documented for 67% of patients. Results were inconclusive on outcomes. Barriers to full protocol compliance were identified.
The study assessed adherence to cardiovascular medications in rural patients attending a tertiary hospital in India. It found that adherence was lowest in hypertension patients at 20.83% and highest in ischemic heart disease patients at 32%. The most common reason for non-adherence was carelessness. The study concluded that rural Indians adhere poorly to cardiovascular medications and that more efforts are needed to address this issue.
This document summarizes a study assessing performance measures at a tertiary hospital in central India over a one-month period. Key findings include:
- Bed occupancy rate was 71.07%, meeting WHO standards. ICUs like SICU and MICU had high occupancy.
- Average length of stay was 4.02 days, matching WHO guidelines.
- Bed turnover ratio was 5 patients per bed, higher than WHO standards and indicating more bed needs.
- ICU mortality rate was 40.27%, much higher than the WHO 1-15% standard. Overall hospital mortality rate was also higher at 11.89%.
This document presents the introduction and background for a study evaluating the effectiveness of a self-instructional module on knowledge of renal diet among chronic renal failure patients undergoing hemodialysis. The study aims to assess knowledge before and after providing the module, and to compare knowledge in patients who receive the module versus a control group. The document outlines the need for the study, objectives, hypotheses, methodology including a pre-test/post-test quasi-experimental design, and lists references to be used.
ChiropracticAndManualTherapies.ArticleDr. Zara Ali
This survey of chiropractors in Saskatchewan found that:
1) All respondents provide nutritional advice to patients and nearly all (99%) provide dietary supplement recommendations.
2) The most commonly recommended supplements were glucosamine sulfate, multivitamins, vitamin C, vitamin D, calcium, omega-3 fatty acids, and probiotics.
3) Respondents generally recommend supplements for conditions related to bone, joint, and muscle health like arthritis, as well as for general health and wellness.
This document discusses a proposed project to increase the utilization of prone positioning for ARDS patients at a hospital. It begins with reviewing evidence that prone positioning can reduce mortality and improve oxygenation for ARDS patients. It then outlines a plan to develop a prone positioning protocol, educate staff, and implement the protocol. Evaluation of outcomes will occur after 90 days to determine if the protocol was successful in reducing mortality and improving oxygenation for ARDS patients. The goal is to implement an evidence-based intervention that can improve patient outcomes.
This document reviews interventions for improving outcomes following total hip or knee arthroplasty. It finds that pre-operative patient education, nutrition management, and pain management can help reduce hospital stays and aid recovery. Specifically, education improves expectations and anxiety, while addressing malnutrition and anemia. Neuromuscular electrical stimulation pre-operatively may also enhance muscle strength and early mobility.
The document discusses different types of epidemiological study designs used to assess whether an exposure is associated with a particular health outcome. It describes experimental (intervention) studies, where investigators allocate subjects to exposure and control groups, and observational studies, where investigators observe naturally occurring exposure and outcome groups. Two main types of intervention studies are clinical trials, which test new treatments among diseased individuals, and field trials, which assess disease prevention among non-diseased individuals. Examples provided examine low-fat diet interventions to reduce breast cancer recurrence and incidence.
This document presents a research synopsis on assessing the knowledge of renal diet among primary caregivers of renal failure patients. The study aims to evaluate the existing knowledge of primary caregivers regarding renal diet using a questionnaire and to develop a self-instructional module on renal diet. It will recruit 60 primary caregiver samples using non-probability purposive sampling from selected hospitals. Data will be collected using a demographic section and knowledge assessment questionnaire, and analyzed using frequency, percentage, mean and chi-square tests. Findings will be disseminated through publications and workshops.
This document discusses the rise of evidence-based health care over the last decade. Key points:
- Evidence-based health care aims to minimize problems like overuse, underuse and misuse of treatments by basing clinical practice closely on scientific research evidence.
- During the 1990s, the concepts of evidence-based health care spread widely and began influencing health policymakers, providers and researchers.
- Advances have been made in managing and disseminating research findings through initiatives like the Cochrane Collaboration and clinical practice guidelines.
- However, integrating research evidence into everyday clinical practice remains a challenge and some critics argue evidence-based practice could stifle innovation.
This study evaluated a nurse-led telephone intervention to support patients with chronic obstructive pulmonary disease (COPD) in managing their condition. 73 patients were randomly assigned to either receive standard care including a self-management plan, or to receive the self-management plan plus two telephone calls from a nurse over six weeks. The telephone calls provided education on using their self-management plan and managing exacerbations. The primary outcome was COPD symptom severity assessed before and after with the COPD Assessment Tool (CAT). Secondary outcomes included self-reported exacerbations and healthcare utilization. CAT scores significantly improved in the intervention group but not the control group. There were no significant differences in exacerbations between groups. Patient satisfaction did not differ significantly between groups
Poster: Test-Retest Reliability and Equivalence of PRO MeasuresCRF Health
This literature review examined administration intervals used in test-retest reliability and equivalence studies for patient-reported outcome measures. The review found a large variance in intervals, ranging from immediate to 7 years for test-retest studies and from immediate to 1 month for equivalence studies. The most common intervals were 2 weeks for test-retest studies and 1 hour or less for equivalence studies. Intervals varied depending on the medical condition and type of study, with shorter intervals used for equivalence studies compared to test-retest studies for the same conditions.
The document provides clinical guidelines from the American College of Physicians on the pharmacologic and surgical management of obesity in primary care. It summarizes the evidence from several studies.
The guidelines include 5 recommendations:
1) Counsel all obese patients on lifestyle changes like diet and exercise, and set individualized weight loss goals.
2) Pharmacologic therapy can be offered to patients who have failed to achieve goals through diet and exercise alone, after discussing side effects and lack of long-term safety data.
3) Acceptable drug options include sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion, choosing based on side effect profiles
This document reviews the evidence for different types of exercise as a treatment for Parkinson's disease. It finds that cardiovascular exercise, balance training, and resistance training can all provide benefits. Cardiovascular exercise may improve gait, balance, quality of life, and reduce mortality risk. Balance training can improve gait, balance, and reduce falls, especially when combined with resistance training. Resistance training can increase muscle strength, endurance, and mobility. The review develops a suggested home-based exercise regimen combining these modalities to maximize benefits for patients with mild to moderate Parkinson's disease.
This document summarizes a study that assessed current practices in teaching life support competencies in healthcare. The study conducted surveys to: 1) Identify life support courses provided in UK hospitals and required by professional bodies, 2) Describe curriculum content and teaching methods of popular in-hospital courses, 3) Examine fidelity of implementation of courses in England. The study found that most NHS hospitals provide adult life support courses, with the Resuscitation Council UK Advanced Life Support course most common. Many hospitals also provide in-house courses. Recognition and management of pre-arrest deterioration are now widely taught. While life support training is provided in all medical schools, approaches vary and pre-arrest management courses are less common. Only a
A Quasi Experimental Study to Assess the Effectiveness of Selected Nursing In...iosrjce
A study to assess the effectiveness of selected nursing interventions on health related quality of life
and activities of daily living among COPD patients in selected tertiary hospital, Chennai, Tamilnadu, India.
The aim of the study was to impart the selected nursing interventions applied to the COPD patients in medical
and pulmonary wards. The conceptual framework used in this study was Widenbach’s Helping art Theory. An
Evaluative approach was used for the present study. Using purposive sampling technique 50 samples were
selected from Chettinad Hospital and Research Institute, Tamil Nadu, India. The tool used was self
administered questionnaire. The collected data was analyzed using descriptive and inferential statistics. The
findings of the study revealed a significantly increase in the COPD patients health related quality of life and
activities of daily living after given the selected nursing interventions. The mean pre test score was 1867 and
the mean post test score was 1861 and the difference between pre test and post test knowledge score was 5.54.
Based on the objectives of the study the findings of the level of health related quality of life and activities of
daily living among COPD patients shows that increased health related quality of life and activities of daily
living. The study shows that the COPD patients in post test were having post score1861 mean difference
5.54.standard deviation 2.35.p value (0.02). Selected nursing interventions are effective in increasing the health
related qualityof life and activities of daily living among COPD patients.. The findings of the study revealed that
a significantly increased in the post test health related quality of life and activities of daily living after given the
selected nursing interventions
Chiropractic and CAM Utilization: A Descriptive Reviewhome
Studies looking at chiropractic utilization demonstrate that the rates vary, but
generally fall into a range from around 6% to 12% of the population, most of whom seek
chiropractic care for low back pain and not for organic disease or visceral dysfunction. CAM is itself
used by people suffering from a variety of conditions, though it is often used not as a primary
intervention, but rather as an additional form of care. CAM and chiropractic often offer lower costs
for comparable results compared to conventional medicine
This document summarizes the results of a systematic review of 6 randomized controlled trials involving 296 patients that examined the effect of inhaled magnesium sulfate (MgSO4) in the treatment of acute asthma exacerbations. The review found that treatment with nebulized MgSO4, particularly in addition to a beta-2 agonist, was associated with a statistically significant improvement in pulmonary function compared to beta-2 agonists alone. There was also a non-significant trend toward fewer hospital admissions among patients who received nebulized MgSO4. Subgroup analyses showed similar improvements in lung function for both adult patients and those with more severe asthma.
La inflación económica se refiere al aumento sostenido y generalizado del nivel de precios de bienes y servicios medido frente al poder adquisitivo. Se causa principalmente por aumentos en los costos de producción debidos a un incremento en la demanda o los costos de producción, así como por escasez de productos. Además, la inflación reportada por el DANE para Colombia refleja promedios ponderados a nivel nacional, por lo que los ciudadanos deberían considerar la inflación de su región e ingreso particular.
Rosario Sapienza is proposed to serve as a family name on a project. She holds a Bachelor's degree in Sociology and a Master's in Ethno-Anthropology from the University of Rome. She speaks English and French at an excellent level and has over 20 years of experience managing and evaluating development projects throughout Africa, the Middle East, and Europe funded by organizations like the EU, UN, and World Bank. Her areas of expertise include local development, governance, social inclusion, and monitoring and evaluation.
The document discusses how the media product, a magazine called "Smash Hits Vibe", uses conventions from real music magazines like Billboard, We Love Pop, and Top of the Pops. It focuses mainly on conventions from Top of the Pops, such as a big bold title, cover images with eye contact between artists and readers, images of other artists, and subheadings. These conventions help the magazine look professional and stylish like Top of the Pops. Specifically, it uses a large centered masthead like music magazines, and eye contact on cover images to create a relationship between artists and readers.
La academia de danza Mentes Brillantes y Talentosas tiene como misión fortalecer las habilidades de baile de los niños y desarrollar valores como la responsabilidad y el amor por la danza. Su visión es expandirse en los próximos 4-5 años para enseñar danzas folclóricas y mantener las culturas de los antepasados. Uno de los problemas de la comunidad es la iniciación de drogas a temprana edad debido a la falta de actividades sanas, por lo que la academia ofrece baile y teatro como altern
Immediate Media Company would be the publisher for the magazine because they are an award-winning UK media company and the fourth largest magazine publisher. They reach millions of educated readers across 50 websites, 34 magazines and over 70 brands each month. Using such a large, well-known publisher would provide advertising opportunities and help distribute the magazine more widely and cheaply. The magazine would be distributed physically in popular retail stores like newsagents and WHSmith as well as supermarkets like Asda and Tesco, which are common places for people to buy magazines. It would also be distributed online with digital copies to reach younger audiences who prefer finding magazines online and to keep up with competitors also offering online versions.
Una encuesta mostró que el 73% de los participantes sintieron que exploraron diferentes posibilidades en cursos aplicados, mientras que solo el 8% sintieron lo mismo en cursos no aplicados. La mayoría (70%+) sintió que los cursos aplicados fueron innovadores, en comparación con una minoría (30%-) para los cursos no aplicados.
Crude Oil for Natural Gas: Prospects for Iran-Saudi Reconciliationatlanticcouncil
Despite the sectarian barbs traded between Saudi Arabia and Iran, Iran's unique ability to meet the kingdom's fast growing demand for electricity may help spur a reconciliation, according to the Atlantic Council's Jean-François Seznec. In his report Crude Oil for Natural Gas: Prospects for Iran-Saudi Reconciliation, Seznec argues that the two dominant energy producers do not necessarily need to see their energy production as competition.
Saudi Arabia's currently fuels its stunning 8 percent annual rise in demand for electricity with precious crude oil due to little low cost domestic natural dry gas reserves. Iran's vast gas reserves could be used to meet the kingdom's growing needs, but after decades of punishing sanctions its dilapidated gas fields need an estimated $250 billion in repairs. If Saudi Arabia used its investment power or buying power to help revitalize Iran's gas industry, it would both secure the energy it needs to meet its citizens' demands and free up its crude oil for export. While the sectarian rhetoric hurled back and forth may seem unstoppable and the timeline for reconciliation may be long, Seznec contends that both sides are rational at heart and highlights that that the benefit of economic cooperation on energy issues could open up better relations on a range of issues.
The document discusses the progression made in magazine cover and contents page design between a preliminary task and finished product. For the cover, improvements included using brighter colors that fit the target audience and genre, adding more graphics and photos to make the text stand out, and simplifying the language. For the contents page, key progressions involved adding structure with columns, including more detailed descriptions, using easier to read font colors and sizes, and incorporating more varied photos. The finished pieces employed consistent color schemes and magazine design elements like multiple photos to engage readers.
The document is an interview transcript of Abhinav Patel, who has a diploma in civil architecture. The interviewer is Hardik Patel, who is asking Abhinav questions about his education and career. Abhinav provides brief answers about obtaining his diploma in civil architecture.
Impact of a designed nursing intervention protocol on myocardial infarction p...Alexander Decker
This study examined the impact of a designed nursing intervention protocol on myocardial infarction patients' outcomes at a university hospital in Egypt. Forty adult myocardial infarction patients were included. The study found that after exposure to the nursing intervention protocol, patients had significantly higher total mean knowledge scores and total mean practice scores. It also found that patients had medium to high levels of compliance to lifelong instructions. The results support the hypotheses that the nursing intervention protocol improved patients' knowledge, practices, and compliance. The study concluded that a nursing intervention protocol can have a positive impact on myocardial infarction patient outcomes.
Alt PDFThe Journal of the CanadianChiropractic Associati.docxdaniahendric
Alt PDF
The Journal of the Canadian
Chiropractic Association
The Canadian Chiropractic Association
What is your research question?
An introduction to the PICOT
format for clinicians
John J. Riva, BA, DC, Keshena M.P. Malik, BSc,
DC, [...], and Jason W. Busse, DC, PhD
Additional article information
Introduction
Clinicians often witness impressive treatment
results in practice and may wish to pursue
research to formally explore their anecdotal
experiences. The potential to further new
knowledge both within the profession and to the
greater healthcare system is compelling. An
obvious next step for a practitioner considering
research is to connect with experienced
researchers to convey their idea for a study, who
may in turn ask, “What is your research
question?” With limited understanding of how to
respond, this interaction may result in the first
and last experience these clinicians will have with
the research community.
It has been estimated that between 1% and 7% of
the chiropractic profession in Canada is engaged
in research. Arguably, this low engagement
could be the result of practitioners’ perceived
importance of research and levels of research
literacy and capacity. However, increasing
demands for evidence-based approaches across
the health system puts pressure on all clinicians to
base their decisions on the best available
scientific evidence. Lack of clinician
representation in research has the probable effect
of limiting growth and new developments for the
profession. Furthermore, lack of clinician
involvement in research complicates the transfer
of study findings into practical settings.
The Canadian Institutes of Health Research
describes integrated knowledge translation as a
process that involves collaboration between
researchers and knowledge users at all stages of a
research project. This necessitates involvement
of clinicians to help in forming a research
question, interpreting the results, and moving
research findings into practice. This shared effort
between clinicians and researchers increases the
likelihood that research initiatives will be relevant
to practice. Conversely, it has been reported that
there is a growing communication gap between
clinicians and academics in chiropractic.
Clinicians have important practice-related
questions to ask, but many may lack the ability to
map out their research strategy, specifically in
communicating their question in a manner
required to develop a research protocol.
David L. Sackett, Officer of the Order of Canada
and the founding Chair of Canada’s first
Department of Clinical Epidemiology &
Biostatistics at McMaster University, highlights
the importance of mapping one’s research
strategy in exploration of the research question:
“one-third of a trial’s time between the germ of
your idea and its publication in the New England
Journal of Medicine should be spent fighting
about the research question.” (personal
communicat ...
Brough et al perspectives on the effects and mechanisms of CST a qualitative ...Nicola Brough
This document summarizes a qualitative study on the effects and mechanisms of craniosacral therapy according to users' views. 29 participants were interviewed about their experiences with craniosacral therapy. Most participants reported improvements in at least two dimensions of holistic wellbeing: body, mind and spirit. Experiences during therapy included altered perceptual states and specific sensations and emotions. Participants emphasized the importance of the therapeutic relationship. The emerging theory from the study suggests that the trusting relationship in craniosacral therapy allows clients to experience altered states of awareness, which facilitates a new understanding of the interrelatedness of body, mind and spirit and an enhanced ability to care for oneself and manage health problems.
The final protocol (v5.3). Notable changes include:
1) Confirmation of audit standard (Page 6).
2) Refinement of inclusion and exclusion criteria (Page 7)
3) Confirmation of audit status (Appendix C)
4) Refinement of required data fields (Page 19) including definitions (Pages 20-25)
Scheduling Of Nursing Staff in Hospitals - A Case Studyinventionjournals
This document summarizes a study that developed a goal programming algorithm to schedule 11 nurses across a two-week period at a hospital. The goals were to satisfy each nurse's contracted time, ensure minimum nurse requirements by role each day, give full-time nurses a weekend off while avoiding more than two consecutive days off, and honor nurses' weekend preference when possible. The algorithm solved the 154-variable, 120-constraint scheduling problem in under 30 seconds. The results showed schedules that met goals for minimum nurse levels each day and individual nurses' two-week schedules.
This document summarizes three studies that evaluated the effectiveness of repositioning schedules for preventing pressure ulcers in hospitalized patients. A systematic review by Gillespie et al. found insufficient evidence from three randomized controlled trials to determine whether particular repositioning positions or frequencies reduced pressure ulcer development. A study by Bergquist-Beringer et al. found that patients who were routinely repositioned every 24 hours had a 14% lower risk of pressure ulcers. A systematic review by Moore et al. did not identify any randomized controlled trials comparing different repositioning techniques or frequencies.
To Determine Preference of Shoulder Pain Management by General Physicians in ...suppubs1pubs1
Rotator cuff muscles are functionally active and provide stability to the shoulder joint and also thereby allow the full Range of Motion (ROM) by moving the head of humerus in the glenoid cavity. Any tear or fragility of the rotator cuff muscles can cause the dislocation or instability and hence damaging other muscles specially the long head of biceps muscle. The diseases related to the supraspinatus tendon are frequently linked with the long head of the biceps tendon. Other cause of chronic shoulder pain is the adhesive capsulitis with large prevalence rates of more than 5.3% in the general target population [3].
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
This document discusses factors that contribute to readmissions of stroke patients and interventions to reduce readmissions. It notes that readmissions account for 20.5% of hospital admissions and reviews reasons for readmissions like medication issues, lack of follow-up care, and unhealthy lifestyles. The document outlines programs like TRACS, COMPASS and MISTT that provide post-discharge support through nurse coaching, medication management support and lifestyle counseling to reduce readmissions.
s it all in the Wrist? The Potential of Activity Trackers to Rise Physical Ac...CrimsonpublishersCancer
A growing body of evidence suggests that higher levels of physical activity are inversely associated with treatment side-effects and mortality in cancer survivors. Conversely, a limited percentage of cancer patients achieve physical activity goals and fitness compared with age-matched peers or other chronic medical conditions. In the last years, the next generation of activity trackers has integrated several parameters of physical fitness and mobility measurements. These multi-task devices go beyond objective physical activity measurements. Due to its functioning based on integrated platforms, clinicians may experience a unique opportunity to incorporate more active behaviors into their patients’ lives. This mini-review will discuss the advantages, challenges and future directions of most recent activity trackers in oncology.
Is it all in the Wrist? The Potential of Activity Trackers to Rise Physical A...CrimsonpublishersCancer
A growing body of evidence suggests that higher levels of physical activity are inversely associated with treatment side-effects and mortality in cancer survivors. Conversely, a limited percentage of cancer patients achieve physical activity goals and fitness compared with age-matched peers or other chronic medical conditions. In the last years, the next generation of activity trackers has integrated several parameters of physical fitness and mobility measurements. These multi-task devices go beyond objective physical activity measurements. Due to its functioning based on integrated platforms, clinicians may experience a unique opportunity to incorporate more active behaviors into their patients’ lives. This mini-review will discuss the advantages, challenges and future directions of most recent activity trackers in oncology.
This systematic review evaluated 14 randomized controlled trials assessing prehabilitation programs involving exercise prior to non-bariatric abdominal surgery. The trials included a total of 982 patients, with 502 undergoing prehabilitation programs consisting of various combinations of supervised and unsupervised exercise sessions including walking, cycling, and resistance training, conducted from 2 weeks to 6 months preoperatively. Thirteen of the 14 studies found benefits of prehabilitation such as improved functional capacity and reduced postoperative complications, though results were not uniformly statistically significant between groups. Overall complication rates ranged from 9-80% across studies, with some studies finding reduced pulmonary complications and overall complication rates with prehabilitation. Length of stay was unchanged in most studies.
This randomized controlled trial examined the effects of a goal setting intervention on self-efficacy, treatment efficacy, adherence, and treatment outcomes in patients undergoing low back pain rehabilitation. 48 military personnel with low back pain were randomly assigned to an experimental goal setting group, a therapist-led exercise group, or a non-therapist led exercise group. Adherence was higher in the experimental goal setting group compared to the non-therapist led group. Self-efficacy was also higher in the experimental group compared to the other two groups. However, treatment outcomes did not differ significantly between the groups. The findings provide partial support for using goal setting to enhance adherence in clinical rehabilitation.
This document describes a study protocol to evaluate the effectiveness of a planned teaching program for preventing pressure ulcers among fracture patients in a selected hospital in Bangalore. The study aims to provide patients and their family members with health education to improve knowledge on preventing pressure ulcers. A literature review found that pressure ulcer incidence is high for immobile patients like those with orthopedic fractures. Studies show prevention is better than treatment and nurses play a key role in educating patients and monitoring skin integrity. The planned teaching program aims to reduce pressure ulcer rates by empowering patients with knowledge on prevention.
This study examined the impact of resident duty hour reform on hospital readmission rates using an observational study with interrupted time series analysis of Medicare patients admitted to hospitals from 2003 to 2010. The study found no evidence that readmission rates improved or worsened after duty hour reform when comparing hospitals of different teaching intensities. Readmission rates neither improved nor worsened in association with duty hour reform, and these findings were robust across composite measures of readmission and mortality. The results provide evidence that duty hour reform did not generally impact patient outcomes.
Does shortened length of hospital stay affect total knee arthroplasty rehabil...FUAD HAZIME
The study compared rehabilitation outcomes for patients who participated in a hospital joint arthroplasty program designed to decrease length of stay ("Joint Camp") to outcomes for patients before the program was implemented. The program reduced average length of stay by 1.3 days but resulted in decreased range of motion at discharge. No significant differences were found between the groups at 3, 6, and 12 month follow ups for range of motion or Knee Society scores, suggesting primary knee arthroplasty rehabilitation outcomes were not compromised by the reduced hospital stay.
This document proposes a research study to evaluate the impact of implementing a Rapid Response Team (RRT) at a Magnet-designated urban hospital. The purpose would be to determine if an RRT improves patient outcomes on medical-surgical units. The study would compare outcomes for at-risk patients, such as shorter hospital stays, fewer transfers to higher levels of care, and improved functionality at discharge, between patients where an RRT was activated and those where a "code white" was called in a crisis. The Iowa Model of Evidence-Based Practice and Abdallah's Theory of Nursing would provide the framework, focusing on relevant nursing problems. The research question asks if RRT implementation would improve outcomes for at-risk patients.
This document describes a doubly randomized delayed-start design for clinical trials. The design consists of two periods. In the first period, patients are randomized to receive either a new drug or placebo. In the second period, patients who received placebo in the first period and meet certain enrichment criteria can be rerandomized to receive either the new drug or continue on placebo. The design aims to reduce bias from high placebo responses and more efficiently study maintenance effects. It is naturally adaptive as aspects of the second period can be modified based on interim analysis of the first period. Efficacy data from both periods are combined for the overall analysis. This design offers greater efficiency for clinical development compared to traditional parallel designs.
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...semualkaira
The patient experiences post-operative complications after colorectal surgery. To reduce these complications,
the ERAS protocol was developed. The current study assesses the
impact of ERAS on the post-operative complications after colorectal surgery.
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...semualkaira
The patient experiences post-operative complications after colorectal surgery. To reduce these complications,
the ERAS protocol was developed. The current study assesses the
impact of ERAS on the post-operative complications after colorectal surgery
RESEARCH Open AccessTelecoaching plus a portion control pl.docxsyreetamacaulay
RESEARCH Open Access
Telecoaching plus a portion control plate
for weight care management: a
randomized trial
Jill M. Huber1, Joshua S. Shapiro2, Mark L. Wieland1, Ivana T. Croghan1, Kristen S. Vickers Douglas3,
Darrell R. Schroeder4, Julie C. Hathaway5 and Jon O. Ebbert1,6*
Abstract
Background: Obesity is a leading preventable cause of death and disability and is associated with a lower health-
related quality of life. We evaluated the impact of telecoaching conducted by a counselor trained in motivational
interviewing paired with a portion control plate for obese patients in a primary care setting.
Methods: We conducted a randomized, clinical trial among patients in a primary care practice in the midwestern
United States. Patients were randomized to either usual care or an intervention including telecoaching with a
portion control plate. The intervention was provided during a 3-month period with follow-up of all patients
through 6 months after randomization. The primary outcomes were weight, body mass index (BMI),waist
circumference, and waist to hip ratio measured at baseline, 6, 12, 18, and 24 weeks. Secondary outcomes included
measures assessing eating behaviors, self-efficacy, and physical activity at baseline and at 12 and 24 weeks.
Results: A total of 1,101 subjects were pre-screened, and 90 were randomly assigned to telecoaching plus portion
control plate (n = 45) or usual care (n = 45). Using last-value carried forward without adjustment for baseline
demographics, significant reductions in BMI (estimated treatment effect -0.4 kg/m2, P = .038) and waist to hip ratio
(estimated treatment effect -.02, P = .037) at 3 months were observed in the telecoaching plus portion control plate
group compared to usual care. These differences were not statistically significant at 6 months. In females, the
telecoaching plus portion control plate intervention was associated with significant reductions in weight and BMI
at both 3 months (estimated treatment effect -1.6 kg, P = .016 and -0.6 kg/m2, P = .020) and 6 months (estimated
treatment effect -2.3 kg, P = .013 and -0.8 kg/m2, P = .025). In males, the telecoaching plus portion control
intervention was associated with a significant reduction in waist to hip ratio at 3 months (estimated treatment
effect -0.04, P = .017), but failed to show a significant difference in weight and BMI.
Conclusion: Telecoaching with a portion control plate can produce positive change in body habitus among obese
primary care patients; however, changes depend upon sex.
Trial registration: ClinicalTrials.gov NCT02373878, 13 February 2015. https://clinicaltrials.gov/ct2/show/
NCT02373878.
Keywords: Obesity, Telecoaching, Portion control plate, Primary care, Patient-centered medical home
* Correspondence: [email protected]
1Division of Primary Care Internal Medicine, Department of Medicine,
Rochester, MN 55905, USA
6Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
Full list of author information is ...
2. of life in older people [18]. Grip strength cutoff points
to identify those at risk have been proposed. For ex-
ample, the European Working Group on Sarcopenia in
Older People (EWGSOP) originally defined the cutoff
points for identifying older people with sarcopenia to
be < 30 kg for men and < 20 kg for women [19]. The
Foundation for the National Institutes of Health (FNIH)
Sarcopenia project reported that grip strength cutoff
points which were associated with functional weakness
were lower at < 26 kg for men and < 16 kg for women
[20]. Recently, a meta-analysis of data from 12 UK co-
horts has defined low grip strength as at least 2.5 SDs
below the gender-specific peak mean [21]. From this
study, low grip strength for people over 80 years old is
defined as less than 27 kg for men and less than 16 kg
for women, and these cutoff points will be used in our
study.
Grip strength can be improved through physical exer-
cise and nutritional supplements [22]. A Cochrane
Review showed that progressive resistance training in
particular could improve the strength, physical per-
formance, and physical abilities of older community-
dwelling people with no reported harmful side-effects
[23]. Resistance training in older people with moderate
dementia has also proved to be feasible leading to an
increase in grip strength within 6 weeks [24]. Moreover,
a 10-week programme of three times weekly progres-
sive resistance training to regain muscle strength has
been reported to be safe and effective among frail hos-
pitalised older patients [25]. Nutritional interventions
may also be beneficial to older adults with low grip
strength. The prevention and treatment of sarcopenia
require a sufficient amino acid and caloric supply [22].
A Cochrane Review has reported that grip strength was
greater in those who received dietary advice and oral
nutritional supplements compared with those who re-
ceived dietary advice alone [26]. The PROT-AGE study
group recommended average daily protein intake in
older people of at least 1.0 to 1.2 g/kg body weight/day
to maintain muscle mass and strength [27]. Older people
with acute or chronic diseases require a higher dietary
protein intake (i.e. 1.2–1.5 g/kg body weight/day).
The routine measurement of grip strength in older pa-
tients admitted to hospital could identify those who are
at higher risk of functional decline and/or long length of
stay and would enable appropriate interventions such as
nutritional protein supplementation and resistance exer-
cises to be implemented. There is limited evidence that
trained clinical staff including nurses and physiotherapist
can measure patients’ grip strength [28, 29]. Thus, the
aim of this study is to assess the feasibility of implement-
ing grip strength measurement and its relevant care plan
into routine clinical practice and to identify factors that
promote or inhibit this process.
Study objectives
The specific objectives of this study are the following:
Objective 1: Define baseline practice in acute medical
wards for older people in one hospital in relation to the
identification of older inpatients at risk of poor health-
care outcomes and their current nutritional and mobil-
ity care.
Objective 2: Develop and deliver an educational train-
ing programme on grip strength measurement to clinical
staff.
Objective 3: Monitor and evaluate routine implemen-
tation of grip strength by assessing the acceptability,
adoption and coverage of routine GS measurement, and
the basic costs of implementation.
Objective 4: Identify facilitators and barriers to the im-
plementation process.
Methods/design
Study design
This feasibility study is a mixed methods design com-
bining qualitative, quantitative, and economic elements.
Our approach to intervention design and implementa-
tion evaluation will be informed by Normalisation
Process Theory (NPT), focusing primarily on practice
change, which addresses explicitly the issue of how in-
terventions are adopted, embedded, and integrated into
organisational routines [30]. NPT explains how inter-
ventions become routinely embedded in a context by
referencing to four mechanisms: coherence or sense-
making, cognitive participation, collective action, and
reflexive monitoring. We will focus on practice change
and how grip strength measurement is adopted and in-
tegrated into clinical routines [31]. This protocol com-
plies with the SPIRIT guideline of writing protocols
(see Additional file 1, SPIRIT 2013 Checklist).
The study will be conducted in five acute medical
wards for older people in one hospital in England with
120 beds in total. All five wards admit unselected emer-
gency medical patients aged 80 years and over and in-
clude two female wards, two male wards, and one
mixed sex ward. The study comprises three phases with
an explanatory sequential design, whereby the qualita-
tive data will be used to gain better understanding of
the quantitative findings (see the study flow chart in
Additional file 2). In order to understand the embed-
ding of a new practice into daily activities and to en-
hance coherence of the new practice, we will evaluate
what people actually do and how they work. Thus, the
first phase of the study will define the current practice
on the wards with regard to how patients at high risk of
poor healthcare outcomes are identified and their nutri-
tional care and management of their mobility. Imple-
mentation research often focuses on the strategies
necessary to deliver or implement interventions [32].
Ibrahim et al. Pilot and Feasibility Studies (2016) 2:27 Page 2 of 10
3. The intervention adopted in this research is “education
and training”. Therefore, the second phase of the study
involves developing and delivering an educational
training programme on grip strength measurement to
clinical staff. The findings from phase 1 and the NPT
components will inform the development of the train-
ing programme. The training will be designed to en-
able clinical staff to make sense of the new practice
(implementing grip strength measurement routinely),
promote their understanding of the importance of
measuring grip strength, and encourage their engage-
ment in planning and delivering the implementation of
grip strength measurement. The Collective action com-
ponent of NPT defines and organises the enacting of a
practice. This involves a review to ensure that the tasks
are performed as required and that the work is allo-
cated appropriately. In addition, any staff concerns
about the work required will be acknowledged and
they will be encouraged to share their ideas about how
these might be managed during the training and later
throughout the implementation process. The routine
implementation of grip strength measurement will
commence soon after completing the training. Partici-
pants’ reflexive monitoring, which defines and orga-
nises assessment of the outcomes of a practice, will be
evaluated during the implementation process. The
study period is summarised in Table 1.
Phase 1: Baseline practice (meeting objective 1)
The aim of this phase is to define current baseline prac-
tice in acute medical wards with regard to the identifica-
tion of patients at high risk of poor healthcare outcomes
and their nutritional care and mobility. For this purpose,
an ethnographic approach involving interviews, focus
groups, and audit of clinical records will be followed.
The central aim of ethnography is to provide rich, holis-
tic insights into people’s views and actions, as well as the
nature of the location they inhabit [33]. Understanding
how the healthcare system works will enable the integra-
tion of grip strength measurement into routine practice
in an effective way.
Semi-structured interviews or focus groups
Qualitative research studies usually involve a small
sample size compared to quantitative research, but the
data generated are substantial and detailed [34]. Some
researchers suggest that the sample size should be
around 20 to 30 [35] or the sampling should continue
until reaching saturation level when no new concepts
emerge from data analysis [36]. Following purposeful
sampling, there are often some pre-determined criteria
relating to sampling and participants are chosen based
on the fulfilment of these standards [36]. We will con-
duct in-depth semi-structured interviews/focus groups
with healthcare staff who are involved in the care of
older people working in the five study wards. Staff par-
ticipants will include those with different levels of expe-
riences and roles including consultants, junior doctors,
ward sisters, dieticians, physiotherapists, and therapy
assistants. We aim to gain the individual views of 20–
30 healthcare staff but will collect data until no new
concepts are emerging.
Open-ended questions will be used to collect data on
the current practice of staff with older inpatients, and
written informed consent will be obtained. Three semi-
structured interview/focus group schedules were devel-
oped to elicit information from relevant professional
groups (medical and nursing staff, therapy staff, and
dietetic staff) (Additional file 3). In general, questions
will elicit (1) information on the current positions and
professional backgrounds of each participant and their
main roles, (2) how older inpatients are assessed on ad-
mission to the ward, (3) how patients at risk of poor
healthcare outcomes are identified, and (4) what patient
Table 1 The study period according to SPIRIT figure
Description Study period
T0
(3 months)
T1
(3 months)
T2
(3 months)
T3
(3 months)
Phase 1: Define baseline practice (interviews/ focus groups). ✓
Phase 1: Define baseline practice (audit of patients’ medical records). ✓
Phase 2: Design the training program and finalise the care plan for low grip strength. ✓
Phase 2: Train staff on measuring grip strength and on the use of the care plan. ✓
Phase 2: Routine implementation of grip strength measurement. ✓ ✓
Phase 3: Assess outcomes of routine grip strength implementation (coverage). ✓ ✓
Phase 3: Assess outcomes of routine grip strength implementation (Patients’ acceptability). ✓
Phase 3: Assess outcomes of routine grip strength implementation (staff acceptability and adoption). ✓ ✓
Data analysis and dissemination. ✓ ✓ ✓ ✓
Ibrahim et al. Pilot and Feasibility Studies (2016) 2:27 Page 3 of 10
4. circumstances trigger dietetic or therapy input. At the
end of the conversation, clinical participants will be
introduced to grip strength measurement and we will
obtain their initial views about using grip strength in
clinical practice and identify any perceived potential
facilitators and barriers for routine implementation of
grip strength measurement. Focus groups will be pre-
ferred to gather shared information about the care pro-
vided to older patients, e.g. with nursing staff. However,
individual interviews will be suitable to illicit the individ-
ual experience and practice, e.g. of medical consultants.
Individual interviews will be used with participants who
prefer private discussions or those who could not attend
focus groups. The interviews/focus groups are antici-
pated to last less than 1 h and will take place in a private
room in the hospital.
Audit of clinical records
Audit of a sample of clinical records will provide further
evidence on whether the identification of patients at risk
of poor healthcare outcomes occurs explicitly, which is
documented and acted upon. Across the five study
wards, a random sample of the clinical notes of 60 pa-
tients who would be eligible for grip strength measure-
ment will be audited. All patients are considered eligible
unless those who are in their terminal phase of illness or
patients who have been at hospital for less than 3 days
at the time of data collection. Basic information about
each patient such as age, gender, date of admission,
domicile status, and reasons for admission will be ob-
tained. Information recorded within the first 3 days of
admission about likely risk factors for poor healthcare
outcomes including risk assessment measures applied to
patients will be collected. These will include dietetic and
therapy input, care plans in use, mobility level, history of
falls, Malnutrition Universal Screening Tool (MUST)
score, Do Not Resuscitate order (DNR), pressure ulcers
assessment, recognition of dementia or delirium, and
any other additional relevant information. Identifiable
patient information will not be collected.
The number of referrals each week to the dietetic
team from the study wards for the 3 months prior to
the start of the study as well as the number of pre-
scribed oral nutritional supplements (ONS) will be
obtained from the hospital E-referral system and the
hospital electronic prescribing system, respectively.
This data will allow comparison to assess changes in
routine practice following the implementation of the
care plan for grip strength measurement. Patients are
normally referred verbally and informally to the
physiotherapy team; thus, obtaining the number of re-
ferrals to physiotherapy from the study wards for
similar comparison is not currently possible.
Phase 2: Training and implementation
(meeting objective 2)
Develop and deliver a training programme
A training programme will be developed to provide
nursing, medical, and therapy staff with the necessary
knowledge and skills to implement grip strength meas-
urement. Baseline clinical practice defined in phase 1
and the published literature about grip strength meas-
urement will inform the training needs and the content
of the training programme. Date from phase 1 will help
us identify how best to integrate grip strength measure-
ment in routine practice, e.g., who could do the measure-
ment, how and where information about grip strength
measurement can be documented and stored, and on the
design and development of the training programme. In
collaboration with nursing staff, therapy, and dietetic
teams, we have developed a care plan for patients with low
grip strength (Additional file 4). The training programme
will be developed to match the constructs of the NPT (see
Table 2) and include the following:
1) A presentation about grip strength and the clinical
relevance of low grip strength values
2) An introduction to the care plan for managing
patients with low grip strength
3) A practical demonstration of grip strength
measurement using a Jamar dynamometer according
to a standardised protocol (see Appendix 1) [37]
As grip strength measurement will be part of nursing
admission procedures, nursing staff (n ≈ 150) across the
five study wards will be trained in grip strength meas-
urement in groups of two to six participants. The train-
ing sessions will be run daily for 4 weeks in each of the
five study wards. We anticipate that training sessions
will each last 20–30 min. Additional training sessions
will be scheduled in collaboration with ward managers
to train staff who could not attend during this period
and new staff. The training programme will also be in-
corporated in the induction days of new student nurses
and healthcare assistants. Additional training sessions
will be provided to junior doctors, consultants, and ther-
apy staff, incorporated into regular educational sessions
where possible. The time and date of the training ses-
sions will be agreed with the department training team
to minimise disruption to the daily tasks of the clinical
staff. At the end of each session, participants will be
asked to formally evaluate the training session and give
feedback.
Nurses attending the training session will be asked to
measure the grip strength of a colleague according to
the standard protocol as an assessment of their compe-
tency to measure grip strength of patients. Additionally,
ongoing ward observation will be carried out by the
Ibrahim et al. Pilot and Feasibility Studies (2016) 2:27 Page 4 of 10
5. research team and support will be offered to ensure
nurses remain competent. Competency will be assessed
in relation to positioning the patient correctly, giving
verbal instructions to the patient, taking four measure-
ments (two in each hand), recording the grip strength
values, and completing a care plan as needed. The num-
ber, grade, and ward base of nursing staff attending
training sessions and passing their competency assess-
ment will be recorded. Nursing staff in each training ses-
sion will be given the opportunity to express their initial
views and any concerns about the training and the use
of grip strength measurement in the routine assessment
of older inpatients. This will also inform the content of
subsequent training sessions.
Routine implementation of grip strength measurement
Implementation of routine grip strength measurement
will start soon after completing the training in each ward
with the aim that grip strength will be measured in all
patients within 3 days of admission to the study wards
as part of the admission procedure. If grip strength can-
not be measured, e.g. an inability to hold the dynamom-
eter in either hand (e.g. pain and/or severe arthritis), or
inability to understand the explanation given (e.g. severe
dementia or delirium), the reasons should be docu-
mented in the patient’s clinical records. Failure to
complete the measurement will be managed as if the pa-
tient had low grip strength on the care plan. Patients
who are in their terminal phase of illness will be ex-
cluded from the study.
Grip strength will be measured using a Jamar dyna-
mometer by asking the patient to squeeze the dyna-
mometer handle with each hand twice alternately,
starting with the right hand using a standardised proto-
col [37]. A brief break of approximately 1 min will be
allowed between each measurement, and the maximum
value will be recorded in kilogrammes (kg). We will use
two measurements with each hand instead of three
measurements since our previous research with inpa-
tients suggests that the third attempt is tiring and is
rarely the maximum value. Patients unable to sit on a
chair will still be included in the study and their grip
strength will be measured according to the protocol but
while the patient is sitting up in bed. The grip strength
dynamometer will be calibrated at the beginning and
end of the study and regularly every 2 months during
the study period. Any damaged or faulty dynamometer
will be replaced.
Patients who have low maximum GS values (men <
27 kg and women < 16 kg) or those who are unable to
perform the test will receive a care plan. The care plan
will focus on (1) dietary supplementation with oral nu-
tritional supplements and (2) review of mobility by a
physiotherapist to consider progressive resistance exer-
cises to increase muscle strength (Additional file 4). We
do not expect that measuring the patient’s grip strength
will impose any risk to inpatients. However, we will deal
with any complications resulted from study procedures
as adverse events, recording their details and reporting
them promptly.
Phase 3: Monitoring and evaluation of routine grip
strength implementation (meeting objectives 3 and 4)
Qualitative and audit data will be collected concurrently,
analysed in real time and will be fed back to the clinical
staff to inform ongoing change efforts. Monitoring and
evaluation of routine grip strength implementation will
involve assessing its acceptability, adoption, coverage,
and costs. A summary of the study implementation out-
come variables is presented in Table 3.
Semi-structured interviews/focus groups
We will collect qualitative data to assess the acceptability
of grip strength measurement to staff and patients and
adoption of routine grip strength measurement and
identify the facilitators and barriers of the routine use of
Table 2 Grip strength training programme based on Normalisation Process Theory (NPT)
NPT constructs Training components and topics Method
Coherence/sense-
making
Understand the relevance of implementing grip strength measurement routinely.
What are the cutoff points for grip strength, what to do with low grip strength levels.
Introduction to the care plan for patients with low grip strength and enhance
understanding the relevance of using the care plan for patients with low grip strength values.
Introduction to Jamar dynamometer + practically measuring grip strength according
to the standard protocol.
Present the paperwork that need to be completed in relation to grip strength measurement
and use of care plan.
Presentation
Practical demonstration + video
on grip strength measurement
Presentation
Cognitive
participation
Competence in grip strength measurement using the standardised protocol.
Discussion about how to initiate and adopt grip strength implementation, talk about staff’
initial concerns about implementing grip strength, engage staff in identifying the best way
to start and implement grip strength.
Supervised practical session
of measuring grip strength
of a colleague
Group discussion
Collective action Reaching a consensus about how to start and maintain implementation. Group discussion
Reflexive monitoring Discussion about how to engage staff in reflexive monitoring of grip strength
implementation via sharing experiences and providing continuous feedback.
Presentation + group
discussion
Ibrahim et al. Pilot and Feasibility Studies (2016) 2:27 Page 5 of 10
6. grip strength in clinical practice. Purposive sampling will
be used to select a range of participants who have ex-
perience of grip strength measurement including pa-
tients and staff members.
Patient interviews:
A purposive sample of 10–15 patients, to include
men and women with high and low grip strength across
the study wards, will be invited by a member of their
clinical team to take part in a short interview to assess
the acceptability of grip strength test. Interviews will be
conducted within 2 days of grip strength measurement
to maximise recall. Patients will receive an information
sheet describing the study and will have at least 24 h to
decide whether they wish to participate further. Pa-
tients who do not have the capacity to consent will not
be asked to participate in interviews. Interviews with
patients are anticipated to last for 15–20 min. Patients
will be asked open-ended questions about their views
and experience of grip strength measurement in a
semi-structured interview (Additional file 5).
Staff interviews/focus groups:
We will allow at least 4 weeks for the implementation
of grip strength measurement routinely in the study
wards prior to conducting interviews/focus groups.
This will help us understand the acceptability of its im-
plementation and how it was adopted and integrated in
everyday work. A purposive sample of 10–20 clinical
staff across the five study wards, including nursing staff,
therapy, and dietetic teams, is anticipated to give a deep
understanding of the experience of grip strength meas-
urement. The questions will use NPT constructs to gain
a view on how it has been operationalised and actioned
across the five study wards (Additional file 5). All po-
tential participants will receive an information sheet de-
scribing the study, and they will have at least 24 h to
decide whether they wish to participate in the study.
Prior to any interview/focus group, explicit written
consent will be obtained from each participant. The
interviews/focus groups are anticipated to last less than
1 h and will take place in a private room in the
hospital.
Audit of clinical records
Quantitative data will be collected over the period of
routine implementation to estimate reach or coverage of
the routine grip strength measurement. The patients’
clinical records on each ward will be audited at regular
intervals (at least every other week) to collect data on
(1) the number of patients who have their grip strength
measured and the range of values obtained, (2) the num-
ber of patients with low grip strength values, and (3) the
number of patients with low grip strength who have re-
ceived a grip strength care plan (see Table 4). These re-
sults should reveal the rate of progress of adopting grip
strength measurement in routine practice. Results will
be shared frequently with the study wards to encourage
subsequent uptake.
Once routine GS measurement is embedded in clin-
ical practice for at least three months, the number of
weekly referrals to the dietetic team and ONS prescrip-
tions for the preceding 3 months will be extracted from
the E-referrals and the electronic prescribing system
and will be compared to the numbers collected at
baseline.
Costs of implementation
The cost analysis will include the implementation costs
and National Health Service (NHS) resource utilisation.
The implementation costs will include the cost of equip-
ment, staff training, and note audits. Resource use infor-
mation will include nutritional prescriptions, referrals to
a dietician, length of stay, and discharge destination. The
results will be presented as the cost per patient and cost
per unit of 120 beds.
Data management and analysis
Qualitative data
All interviews and focus groups will be audio-recorded
on a digital voice recorder, transcribed verbatim, and
then anonymised. Each recording and transcript as
word documents will be password-protected. Data col-
lected will be analysed using thematic analysis to
Table 3 Outcome variables for routine implementation of grip strength based on [32]
Implementation
outcome variables
Definition Assessment methods
Qualitative methods
Interviews/focus groups
Quantitative methods
Clinical audit
Acceptability The extent to which the service is agreeable +
Adoption The intention to try the service +
Coverage The degree to which those with the greatest
need received the service
+
Appropriateness The relevance of the service +
Costs Total cost of service in context +
Ibrahim et al. Pilot and Feasibility Studies (2016) 2:27 Page 6 of 10
7. identify themes following the six phases proposed by
Braun and Clarke (2006) [38]. The phases are familiar-
isation with the data, coding, searching for themes,
reviewing themes, defining and naming themes, and
writing up. A descriptive coding scheme will be devel-
oped from transcripts and based on participants’ per-
ceptions and experiences. Two types of coding will be
used: “open coding” to locate themes followed by “fo-
cused coding” to determine which themes repeat often
and which represent unusual concerns. Coding will
proceed in an iterative way with detailed memos linking
emergent themes. The perceptions and views of differ-
ent stakeholder groups will be compared. The thematic
analysis for qualitative data collected in phase 3 of the
study will be more focused and based on the four con-
structs of NPT to identify facilitators and barriers for
implementing grip strength measurement, but the re-
searchers will remain sensitive to any new concepts not
covered by NPT that could emerge. A software pro-
gram for analysing qualitative data (e.g. NVivo 10) will
be used to facilitate data analysis.
Quantitative data
All data will be double entered into a password-protected
computer database and assigned a unique identification
number. Quantitative analysis will involve mainly descrip-
tive statistics using the statistical software package IBM
SPSS statistics 22. Descriptive statistics will be used to
Table 4 A grid to report weekly ward coverage of routine implementation of grip strength measurement
Bays/beds Grip strength
assessed
(yes or no)
Grip strength Has a Care plan been acted upon?
Maximum level Assessed within
3 days (yes or no)
Care plan completed
(yes or no)
ONS Prescribed
(yes or no)
Referral to physio
(yes or no)
Grip strength
magnets
(yes or no)
Bay 1
Bed 1
Bed 2
Bed 3
Bed 4
Bed 5
Bed 6
Bay 2
Bed 1
Bed 2
Bed 3
Bed 4
Bed 5
Bed 6
Bay 3
Bed 1
Bed 2
Bed 3
Bed 4
Bed 5
Bed 6
Bay 4
Bed 1
Bed 2
Bed 3
Bed 4
Bed 5
Bed 6
Ibrahim et al. Pilot and Feasibility Studies (2016) 2:27 Page 7 of 10
8. report the data abstracted from the clinical records, the
E-referral system, and the electronic prescribing system.
Descriptive data will be summarised using mean and
standard deviation (SD), median and inter-quartile
range (IQR), and/or number (percent) as appropriate
for the type of data (continuous, normally distributed
or not, categorical).
The feasibility of training the clinical staff will be re-
ported using descriptive statistics. This will include de-
scription of the trainees’ numbers, discipline, grade,
team or ward base, degree of competence to measure
grip strength, and their evaluation of the training re-
ceived allowing comparisons to be made between
trainees across the five study wards. Descriptive statis-
tics will also be used to describe the coverage of grip
strength implementation such as the number and pro-
portion of patients who had their grip measured, had
low grip strength values, received a care plan, the range
of grip strength values, and the participants’ character-
istics for each ward. This will allow comparisons to be
made of the practice and implementation of grip
strength measurement across the different wards. Chi-
squared tests will be used to assess the coverage of rou-
tine grip strength assessment across the five wards, the
number of referrals to the dietetic team, and the num-
ber of ONS prescription before and after the routine
implementation of grip strength measurement.
Overall mixed methods integration
The qualitative and quantitative results will be inte-
grated; we will consider each analysis (qualitative and
quantitative) on its own terms and how the two differ or
converge in their findings when presenting the overall
conclusion. Qualitative and quantitative data will be in-
tegrated through triangulation to examine (1) conver-
gence (so results provide the same answer to the same
questions), (2) expansion (are the findings collected from
one data explained by another), and 3) complementary
aspects (does embedding the results of one data within
the other data set help contextualise overall results) [39].
The implementation costs (e.g., the training costs and
costs of equipment) and NHS resource utilisation (e.g.
ONS prescriptions) will be integrated in the final ana-
lysis and reports alongside the qualitative and quantita-
tive data.
Trial status
At the time of submission, data collection has started for
phase 1. No data cleaning or analysis has been carried out.
Discussion
The purpose of this study is to evaluate the feasibility
and acceptability of implementing grip strength meas-
urement into routine clinical practice to identify older
patients at risk of poor healthcare outcomes. Many stud-
ies have demonstrated that older hospital patients with
low grip strength have an increased risk of functional
decline, long length of stay, admission to care homes,
and death. Early identification of patients with low grip
strength at admission to hospital will allow the possibil-
ity of appropriate early intervention. Translating this
evidence-based research tool into clinical practice has
the potential to improve the care of older patients. This
mixed methods study will provide a rich picture of bar-
riers and facilitators to the use of grip strength measure-
ment routinely in an acute medical setting. The inclusion
of purposive samples of clinicians and patients will cap-
ture the complexity of the roles and responsibilities that
influence the implementation process and user views and
experiences. If routine grip strength measurement is feas-
ible and acceptable, this study will inform the implemen-
tation of grip strength assessment routinely in clinical
practice in other hospitals and organisations.
Appendix
Standard protocol for measuring grip strength [32]
1- Sit the participant comfortably in the chair with
their forearms on the arms of the chair and
their wrist just over the end of the arm of
the chair—wrist in a neutral position, thumb
facing upwards. Feet flat on the floor.
2- Demonstrate how to use the dynamometer to show
that gripping very tightly registers the best score.
3- Starting with the right hand position, the thumb
around one side of the handle in position 2 and
the four fingers are around the other side.
The instrument should feel comfortable in the
hand: alter the position of the handle if necessary.
4- Rest the base of the dynamometer on the palm of
the observer’s hand as the participant holds
the dynamometer. The aim of this is to support
the weight of the dynamometer, but be careful
not to restrict the “movement” of the machine.
5- Encourage the participant to squeeze as long and
as tightly as possible or until the needle stops rising.
Use a standard encouragement “and squeeze
as tightly as you can”. Once the needle stops raising,
you can instruct the participant to stop squeezing as
they have achieved their peak.
6- The observer should read from the outside dial
which gives grip strength in kilogrammes.
Record the result to the nearest 1 kg on the
data entry form.
7- Repeat measurement in the left hand.
8- Do one further measurements at least 1 min apart
in each hand alternating sides to give two readings
in total for each side.
Ibrahim et al. Pilot and Feasibility Studies (2016) 2:27 Page 8 of 10
9. 9- For analysis, use the maximum grip score from
each hand.
10- Clean the dynamometer with an alcohol wipe
between patients and place the dynamometer
back in its case.
Additional files
Additional file 1: SPIRIT 2013 Checklist: Recommended items to address
in a clinical trial protocol and related documents*. (DOC 121 kb)
Additional file 2: The study flow chart to illustrate the three study
phases. (DOCX 25 kb)
Additional file 3: Semi-structure interview/focus group schedules for
phase 1: define baseline practice. (DOCX 16 kb)
Additional file 4: Care plan for grip strength measurement.
(PDF 350 kb)
Additional file 5: Semi-structured interview/focus group schedule for
phase 3: monitoring and evaluation of routine implementation of grip
strength measurement. (DOCX 18 kb)
Abbreviations
NPT: Normalisation Process Theory; ONS: oral nutritional supplements.
Acknowledgments
The authors would like to acknowledge the contributions of the clinical staff
to the protocol development, particularly Hannah Leach and Claire Woods
(dietetics), Linda Snook and Rachael Leyland (therapists), and the ward
managers.
Funding
This research is funded by the National Institute for Health Research (NIHR)
Collaboration for Leadership in Applied Health Research and Care Wessex at
the University Hospital Southampton NHS Foundation Trust. The views
expressed are those of the authors and not necessarily those of the NHS, the
NIHR, or the Department of Health. This study is supported by the Faculty of
Medicine and the Faculty of Health Sciences at the University of
Southampton. KI, CM, AAS, and HCR receive support from the National
Institute for Health Research (NIHR) Collaboration for Leadership in Applied
Health Research and Care (CLAHRC) Wessex. HCR, HPP, and AAS receive
support from the NIHR Southampton Biomedical research Centre.
Availability of data and material
See additional files.
Authors’ contributions
All authors were involved in the conception and design of the protocol. KI
and HR drafted the initial manuscript, and all authors were involved in the
critical revision of the paper for intellectual content and its final approval
before submission.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Not applicable.
Ethics approval and consent to participate
Full ethical approval was obtained from NRES Committee South West –
Frenchay (REC REFERENCE 15/SW/2012).
Author details
1
Academic Geriatric Medicine, Mailpoint 807, Southampton General Hospital,
Tremona Road, Southampton SO16 6YD, UK. 2
NIHR CLAHRC: Wessex, Faculty
of Health Sciences, University of Southampton, Highfield, Southampton SO17
1BJ, UK. 3
Medicine for Older People, Mailpoint 63, Southampton General
Hospital, Tremona Road, Southampton SO16 6YD, UK. 4
Institute of Ageing
and Institute of Health and Society, Campus for Ageing and Vitality,
Newcastle University, Newcastle NE4 5PL, UK.
Received: 11 March 2016 Accepted: 14 May 2016
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