Jackie Campbell

Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners.

BACKGROUND We investigated the relationship between functional and static foot posture and medial tibial stress syndrome in distance runners. METHODS Twenty-eight runners with a clinical diagnosis of medial tibial stress syndrome and 12 asymptomatic runners were assessed with the Foot Posture Index to measure static overpronation. Range of motion was measured at the talocrural joint, with the knee extended and flexed as was range of motion at the first metatarsophalangeal joint and the angular difference between the neutral and relaxed calcaneal stance positions. Each participant was then videotaped while running on a treadmill shod and unshod. This videotape was analyzed using freeze frame to identify abnormal or mistimed pronation at each phase of gait. The results were analyzed using logistic regression to give the probability that a runner is likely to experience medial tibial stress syndrome, predicted from the static measurements and dynamic observations. RESULTS Variables identified as being significant predictors of medial tibial stress syndrome were the difference between the neutral and relaxed calcaneal stance positions, range of motion of the talocrural joint with the knee extended, early heel lift and abductory twist during gait, and apropulsive gait. CONCLUSION Runners with suspected symptoms of medial tibial stress syndrome should be assessed dynamically and statically for abnormal or mistimed pronation.

Building research capacity in the allied health professions

This article discusses research capacity building and its relevance for health practitioners using allied health professionals (AHPs) as a case example. Allied health professionals is a term used to represent a diverse group of health workers, each with a discrete clinical focus, whose needs for research capacity building are likely to be similar to one another and to other medical and nursing professionals. The work of AHPs challenges many current research paradigms being complex and multidisciplinary in nature, often delivered in community settings and focusing on holistic outcomes. This article examines some of the current drivers in the healthcare context and highlights tensions for AHPs in developing their research base in basic science and applied health research. The authors argue for a strategic approach to research capacity building and examine the implications of current policy initiatives for AHP roles and activity in research. The importance of a sustained approach to capacity building is underscored.

Balance features in Alzheimer's disease and amnestic mild cognitive impairment.

We evaluated alterations of balance by stabilometry in patients with amnestic mild cognitive impairment (aMCI) and with mild-moderate Alzheimers disease (AD). Fifteen patients with aMCI and 15 with mild AD were recruited according to the current diagnostic criteria. Fifteen healthy subjects of the same age range were recruited as controls. Stabilometry was carried out using a commercial 4 load cell platform. Statistical analysis of between group differences was performed using one-way analysis of variance for parametric data and Kruskal-Wallis tests for non-parametric data. Spearman correlation coefficients were used to investigate the association between cognitive test scores and stabilometric data. All stabilometry measures were significantly altered in mild AD patients compared to normal controls. Antero-posterior sway was found to be the most sensitive parameter, since it correlated with the ADAS-cog orientation subscale in AD patients, and also discriminated between aMCI and normal controls. Our study shows that impairment in balance is a feature not only of AD, but also of aMCI. The alterations found suggest that a progressive failure of the vestibular system, possibly linked to reduced hippocampal performance, may be responsible for such a feature. Further research must be focused on studying the predictive value of stabilometry in the conversion of aMCI.

The experiences of internationally recruited nurses in the UK (1995–2007): an integrative review

AIM This review explores the experiences of international nurses recently recruited to the UK nursing workforce (1995-2007) and the implications for retention. BACKGROUND An acute shortage of nurses in the mid 1990s, combined with policy initiatives to increase the number of qualified nurses working in the NHS, resulted in an active campaign to recruit nurses from overseas. Since 1997, approximately 100,000 international nurses have been admitted to the nursing register from more than 50 countries worldwide. Many practice areas are now dependent on overseas nurses as an essential part of their workforce. DESIGN An integrative review. METHOD The review was conducted using a range of electronic databases to capture the experiences of this cohort of migrant nurses. CONCLUSION Much literature has been generated over the past decade in relation to the experiences of international nurses recruited during this campaign. Five main themes emerged from the review: motivation for migration, adapting to British nursing, experiences of first world healthcare, feeling devalued and deskilled and vectors of racial discrimination. Although some positive experiences are described, significant numbers of nurses describe not feeling personally or professionally valued by the UK nursing establishment, common emotions expressed are disappointment and unmet expectations. This will have implications for job satisfaction and intention to leave or stay. RELEVANCE TO CLINICAL PRACTICE If overseas nurses choose to leave the UK in large numbers, the health services could face a severe staffing shortage. It is important that we listen carefully to their experiences to help identify priorities for policy and practice aimed at improving job satisfaction for migrant nurses and articulating the value that they bring to UK nursing.

Biomechanical consequences of total plantar fasciotomy: a review of the literature.

BACKGROUND Plantar fascia release for chronic plantar fasciitis has provided excellent pain relief and rapid return to activities with few reported complications. Cadaveric studies have led to the identification of some potential postoperative problems, most commonly weakness of the medial longitudinal arch and pain in the lateral midfoot. METHODS An electronic search was conducted of the MEDLINE, ScienceDirect, SportDiscus, EMBASE, CINAHL, Cochrane, and AMED databases. The keywords used to search these databases were plantar fasciotomy and medial longitudinal arch. Articles published between 1976 and 2008 were identified. RESULTS Collectively, results of cadaveric studies suggested that plantar fasciotomy leads to loss of integrity of the medial longitudinal arch and that total plantar fasciotomy is more detrimental to foot structure than is partial fasciotomy. In vivo studies, although limited in number, concluded that although clinical outcomes were satisfactory, medial longitudinal arch height decreased and the center of pressure of the weightbearing foot was excessively medially deviated postoperatively. CONCLUSIONS Plantar fasciotomy, in particular total plantar fasciotomy, may lead to loss of stability of the medial longitudinal arch and abnormalities in gait, in particular an excessively pronated foot. Further in vivo studies on the long-term biomechanical effects of plantar fasciotomy are required.

Extraction of short-latency evoked potentials using a combination of wavelets and evolutionary algorithms.

Somatosensory evoked potentials, recorded at the spine or scalp of a patient, are contaminated by noise. It is common practice to use ensemble averaging to remove the noise, which usually requires a large number of responses to produce one averaged signal. In this paper a post-processing technique is shown which uses a combination of wavelets and evolutionary algorithms to produce a representative waveform with fewer responses. The most suitable wavelets and a set of weights are selected by an evolutionary algorithm to form a filter bank, which enhances the extraction of evoked potentials from noisy recordings.

The ‘other participant’ in the room: The effect of significant adults in research with children

This article discusses the practical implications and ethical dilemmas of ‘other’ adults being present in a research setting where the participant is a child. The article focuses on three key issues in relation to this theme. First, the range of ways that ‘other’ adults (for example, parents or guardians, teachers or youth workers) may become involved in the process of research is discussed. Second, the article considers how the presence of ‘other’ adults may raise ethical challenges, impact on the research process, and ultimately affect the data collected. Finally, suggestions are offered for the range of strategies open to researchers in negotiating the involvement of ‘other’ adults within a research context.

Local health campaigns to reduce lung cancers induced by radon and smoking—Who responds?

The greatest risk factor for lung cancer is smoking, the second largest factor being raised radon levels at home. Initiatives to stop smoking and reduce domestic radon levels have met with some success, but in both cases a significant proportion of those affected have not taken action. The two risk factors combine, so that those who smoke and live in a house with high radon levels are at higher risk than if exposed to only one of the two threats. There is the potential for combined public health campaigns to better target those affected. Using postal questionnaires, we collected demographic information of those in Northamptonshire, UK, a radon Affected Area, who participated in Smoking Cessation Programmes, and compared these to a recent study by our group of those who had taken action to reduce radon. The comparison suggests that these two groups are significantly different, and in some cases differ from the general population. In addition, those who continue to quit smoking at 1 year were more likely to have children under 18 at home, and live with a parent or partner compared to those who had relapsed after the previous assessment at 4 weeks. There is merit in extending Smoking Cessation Programmes to include advice on reducing the risks from radon.

Incorporating cancer risk information into general practice: a qualitative study using focus groups with health professionals

Background It is estimated that approximately 40% of all cases of cancer are attributable to lifestyle factors. Providing people with personalised information about their future risk of cancer may help promote behaviour change. Aim To explore the views of health professionals on incorporating personalised cancer risk information, based on lifestyle factors, into general practice. Design and setting Qualitative study using data from six focus groups with a total of 24 general practice health professionals from the NHS Nene Clinical Commissioning Group in England. Method The focus groups were guided by a schedule covering current provision of lifestyle advice relating to cancer and views on incorporating personalised cancer risk information. Data were audiotaped, transcribed verbatim, and then analysed using thematic analysis. Results Providing lifestyle advice was viewed as a core activity within general practice but the influence of lifestyle on cancer risk was rarely discussed. The word ‘cancer’ was seen as a potentially powerful motivator for lifestyle change but the fact that it could generate health anxiety was also recognised. Most focus group participants felt that a numerical risk estimate was more likely to influence behaviour than generic advice. All felt that general practice should provide this information, but there was a clear need for additional resources for it to be offered widely. Conclusion Study participants were in support of providing personalised cancer risk information in general practice. The findings highlight a number of potential benefits and challenges that will inform the future development of interventions in general practice to promote behaviour change for cancer prevention.

Relationship Between Balance and Cognitive Performance in Older People

We investigated the relationship between balance and cognitive level in a group of 70 women with no definite Alzheimers disease or mild cognitive impairment diagnosis and no impairment of daily activity. Static stabilometry and the Montreal Cognitive Assessment (MoCA) test were performed. The antero-posterior sway component was demonstrated to be the best predictor of the MoCA overall score. As visual and proprioceptive components of balance could safely be excluded in our assessments, the vestibular system is to be considered as a putative link between balance and cognitive impairment.