RESUMEN

INTRODUCTION: Physical therapists (PTs) in all United States, DC, and the US Virgin Islands have first-contact direct access privileges to examine and treat patients. Evidence supports the value of PT services in reducing annual healthcare costs, decreasing the need for prescription pain medication, and decreasing the need for outpatient physician care. PTs can play an essential role in managing patient health needs in primary care health professional shortage areas (pcHPSAs), especially in rural areas, which are disproportionately affected by shortage-related health disparities. The current study examined values that differentiated PTs who accept and maintain employment in pcHPSAs and non-urban areas, as a means of advising health agencies within these designation areas. METHODS: A survey invitation was emailed to PTs in six states. The Determinants of Employment Acceptance Survey was used to survey the importance of six factors (attachment to place, community assets, practice environment, professional advancement, relationships, and remuneration) when considering employment. RESULTS: Respondents included 373 PTs (36% pcHPSA; 33% non-urban). Professional advancement was significantly more important to PTs intending to continue their employment in a pcHPSA. Community assets were more important to PTs in non-urban areas who planned to leave their employment within 5 years. The most valued factors for PTs, regardless of practice location, were practice environment and attachment to place. CONCLUSION: Employers in rural areas or pcHPSAs who are interested in recruiting and retaining PTs should consider the importance of professional advancement, practice environment, and workplace relationships, and should use strategic measures to fortify these assets within the workplace.

Asunto(s)

RESUMEN

Four acoustic Seagliders were deployed in the Philippine Sea November 2010 to April 2011 in the vicinity of an acoustic tomography array. The gliders recorded over 2000 broadband transmissions at ranges up to 700 km from moored acoustic sources as they transited between mooring sites. The precision of glider positioning at the time of acoustic reception is important to resolve the fundamental ambiguity between position and sound speed. The Seagliders utilized GPS at the surface and a kinematic model below for positioning. The gliders were typically underwater for about 6.4 h, diving to depths of 1000 m and traveling on average 3.6 km during a dive. Measured acoustic arrival peaks were unambiguously associated with predicted ray arrivals. Statistics of travel-time offsets between received arrivals and acoustic predictions were used to estimate range uncertainty. Range (travel time) uncertainty between the source and the glider position from the kinematic model is estimated to be 639 m (426 ms) rms. Least-squares solutions for glider position estimated from acoustically derived ranges from 5 sources differed by 914 m rms from modeled positions, with estimated uncertainty of 106 m rms in horizontal position. Error analysis included 70 ms rms of uncertainty due to oceanic sound-speed variability.

Asunto(s)

RESUMEN

BACKGROUND: Calcific deposits (CaDs) may be related to chronic postoperative pain and may affect function after patellar tendon surgery. STUDY DESIGN: Cross-sectional. HYPOTHESIS: We hypothesized that patients with CaDs (+CaDs) would rate lower than those without (-CaDs) on measures of knee function and quality of life. METHODS: Patients completed the Tegner Lysholm Knee Scoring Scale (Lysholm), Knee Injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Subjective Knee Form (IKDC), and the Tegner Activity Level Scale. Sixteen postsurgical and 16 age-matched controls were tested. Patients +CaDs were 5.6 years older than those patients -CaDs and had 4.2 years of longer elapse since surgery. Bilateral patellar tendons were examined for CaDs with musculoskeletal ultrasound imaging. One-way analysis of variance was used to determine if differences existed among patients +CaDs and -CaDs and healthy controls. Hierarchical logistic regressions were used to determine which variables best predicted the presence of CaDs. RESULTS: CaDs were found in 44% (7 of 16) of postsurgical patients, who scored lower than controls on all dimensions of the Lysholm, KOOS, and IKDC. Patients +CaD had lower KOOS scores than controls (symptoms, activities of daily living, and quality of life). Age and time since surgery were both moderately related to the presence of CaDs, and both correctly predicted 71% of patients +CaDs. CONCLUSION: Calcific deposits were found in the patellar tendon of 44% of postsurgical patients, who rated themselves lower on all subjective measures of knee function and quality of life following surgery. Age is an important factor for developing CaDs postsurgery. CLINICAL RELEVANCE: Calcific deposits may be present in patellar tendons following surgery, but their direct role in functional or clinical limitations remains unknown.

RESUMEN

BACKGROUND: When medical coverage does not exist at games and practices, coaches are often responsible for the management of acute conditions. The question that arises is whether they make proper medical decisions concerning the health and safety of their athletes. The purpose of this study was to assess high school head coaches' decision-making skills related to acute medical condition management through the use of case scenarios. METHODS: A cover letter/web link to the web-based survey was e-mailed to all 2008-2009 school year South Dakota high school head athletic coaches. RESULTS: Head coaches were found to be responsible for the immediate care of injured athletes at practice (87.2 percent) and home competitions (72.3 percent). Less than 75.0 percent of coaches reported feeling "prepared" or "somewhat prepared" to handle 11 of the 16 types of acute athletic injuries and medical conditions presented, with less than 75.0 percent of coaches giving "appropriate" or "overly cautious" responses to eight of the 17 cases. Little to no relationship was found between perceived level of preparedness for treating various conditions and appropriateness of responses. A significant difference was found in appropriateness of decisions based on level of athlete (68.9 percent starters, 79.3 percent non-starters) and event situation (66.5 percent important events, 76.6 percent non-important events). CONCLUSIONS: In South Dakota, high school coaches are most often responsible for the initial management of acute injuries; yet, a large percentage of coaches did not feel "prepared" to manage various conditions and/or gave "inappropriate" responses to multiple cases. Furthermore, the level of athlete and the event situation may influence coaches' decisions. Further education may include the proper management of head and neck injuries, multiple concussions, dislocations, heat emergencies, eye injuries and internal organ injuries. Health care workers can be an integral part of training coaches in the care of acute conditions, as well as providing practice and event coverage.

Asunto(s)

RESUMEN

BACKGROUND: A lack of health coverage at athletic competitions and practices poses concern over the knowledge coaches have in providing adequate health care to high school (HS) athletes. Therefore, the purpose of this study was to determine the need for education of coaches in the prevention, assessment and management of sports-related injuries in South Dakota (SD). METHODS: Survey link e-mailed to 1,050 HS athletic head coaches in SD; 247 (23.5 percent) completed the prospective, web-based survey. RESULTS: Of the respondents, 74.91 percent reported HS enrollments less than 300, with 79.36 percent in rural/frontier counties and 28.74 percent in medically underserved areas. Coaches from 14 sports responded. The majority indicated they were responsible for the immediate medical care of athletes at practices (89.07 percent) and competitions (74.90 percent); and 79.76 percent of coaches agreed or strongly agreed they needed more injury management education. Results also indicated less than 50.00 percent had current certifications in CPR/BLS (46.65 percent) and first aid (47.4 percent). CONCLUSIONS: Due to the demand placed on head coaches to be the initial caregivers for injured athletes, there is a need for increased education of SD coaches related to the management of acute sports injuries. Additionally, policy changes may be indicated to address the lack of medical personnel available during HS athletic competitions and practices.

Asunto(s)