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Postural stability helps maintain the position of the body within the support area to maintain control, but this postural stability is affected in children with cerebral palsy during static or dynamic activities. However, the practical application of postural stability exercises combined with muscle strengthening has not been studied in spastic diplegia cerebral palsy children with gait difficulties. Purpose: To study the effect of postural stability exercises on the gait and posture of children with spastic diplegia cerebral palsy. Materials & Methods. 23 subjects with spastic diplegia cerebral palsy within the age group of 8 to 15 years, both male and female were randomly allocated into two groups Group A (Experimental) n=12 and Group B (Control) n=11, voluntarily participated and EVGS and DGI were used to assess the posture, gait, and functional capacity as outcome measures. Pre-test and post-test values were used for the interpretation of data. Results: The mean difference of 3.25 with a t-value of 8.74 at a significance of 0.000 (p

In this research paper, we investigate the variables that impact the behavioural intention of cryptocurrency investors in India. The analysis of the data was done using smart partial least square-structural equation modelling. The study was carried out in India using purposive sampling and included investors who had a fundamental understanding of cryptocurrency. It has been established that factors such as financial literacy, facilitating conditions, social influence, effort expectancy and performance expectancy have a significant influence on the investment behaviour of these individuals. The study looks at how the Unified Theory of Acceptance and Use of Technology model with financial literacy affects the behaviour of cryptocurrency investment.

Purpose: the purpose of this study was to evaluate the effect of diclofenac sodium gel phonophoresis in grade -l ankle sprain. Materials & Methods: 54 patients were randomly included in this study and allocated equally into two groups. Group-1 was managed with therapeutic ultrasound (digital ultrasound machine, a product of HMS marketed in India with frequency of 1 MHz and 3MHz) with diclofenac sodium gel and group-2 was managed with therapeutic ultrasound with aquasonic gel. Therapeutic ultrasound with diclofenac sodium gel, marketed under the name of Voltaren, was administered at a frequency of 1MHz, an intensity of 0.8 W/cm2 with continuous mode (1:1) for five times a week for 2 weeks. The patients were examined by using Numeric Pain Rating Scale (NPRS) and Foot and Ankle Disability Index (FADI). They were assessed on the baseline, after 1st week, and after 2nd week of treatment. Results: one way ANOVA test was used to determine the significant difference at the 0.05 level of significance. There was reduction in NPRS and FADI p-value 0.000 after 2nd week of treatment in group-1 and group-2. But on the basis of mean difference score of NPRS and FADI, group-1 was better effective in terms of reduction of pain and improvement of function periodical manner (Table 3). Conclusion: significant dose-dependently relief was observed in NPRS and FADI for pain in disability for each group treated with diclofenac sodium gel compared with aquasonic gel using ultrasound. Acoustic streaming increased these benefits significantly when used after topical application of diclofenac sodium gel, and the dose-dependent effects of diclofenac sodium gel using therapeutic ultrasound.

Abstract Objective: To determine the reach, adoption, implementation and effectiveness of an intervention to increase children’s vegetable intake in long day care (LDC). Design: A 12-week pragmatic cluster randomised controlled trial, informed by the multiphase optimisation strategy (MOST), targeting the mealtime environment and curriculum. Children’s vegetable intake and variety was measured at follow-up using a modified Short Food Survey for early childhood education and care and analysed using a two-part mixed model for non-vegetable and vegetable consumers. Outcome measures were based on the RE-AIM framework. Setting: Australian LDC centres. Participants: Thirty-nine centres, 120 educators and 719 children at follow-up. Results: There was no difference between intervention and waitlist control groups in the likelihood of consuming any vegetables when compared with non-vegetable consumers for intake (OR = 0·70, (95 % CI 0·34–1·43), P = 0·32) or variety (OR = 0·73 (95 % CI 0·40–1·32), P = 0·29). Among vegetable consumers (n 652), there was no difference between groups in vegetable variety (exp(b): 1·07 (95 % CI:0·88–1·32, P = 0·49) or vegetable intake (exp(b): 1·06 (95 % CI: 0·78, 1·43)), P = 0·71) with an average of 1·51 (95 % CI 1·20–1·82) and 1·40 (95 % CI 1·08–1·72) serves of vegetables per day in the intervention and control group, respectively. Intervention educators reported higher skills for promoting vegetables at mealtimes, and knowledge and skills for teaching the curriculum, than control (all P < 0·001). Intervention fidelity was moderate (n 16/20 and n 15/16 centres used the Mealtime environment and Curriculum, respectively) with good acceptability among educators. The intervention reached 307/8556 centres nationally and was adopted by 22 % eligible centres. Conclusions: The pragmatic self-delivered online intervention positively impacted educator’s knowledge and skills and was considered acceptable and feasible. Intervention adaptations, using the MOST cyclic approach, could improve intervention impact on children’ vegetable intake.

This systematic review describes difference in patient‐relevant outcomes between comprehensive cancers (CCCs) versus non‐CCCs. Studies were identified in PubMed, Cochrane CENTRAL, Epistemonikos, and gray literature from January 2002 to May 2024. Data were extracted and appraised by two authors. Results were narratively synthesized, and meta‐analyzed where appropriate. Of 2272 records screened, 36 observational studies were included, predominantly from the United States, and focused on adults with solid cancers. Compared to non‐CCCs, studies consistently or predominantly reported superior outcomes at CCCs relating to mortality and survival, quality of peri‐ and postoperative care, rates of cancer recurrence or progression, and impact on symptoms and health‐related quality of life. Meta‐analysis showed a significantly lower overall mortality risk of 23% in CCCs compared to non‐CCCs (hazard ratio, 0.77; 95% confidence interval, 0.74–0.81, p <.001), with medium heterogeneity (I2 = 64.61%; Q‐test = 36.29, p <.01) observed between the studies. Studies reporting on health equity and costs outcomes consistently or predominantly favored non‐CCCs over CCCs. Mixed results were reported for outcomes relating to time to care, palliative and end‐of‐life care, and health care utilization. The literature reports CCCs are associated with superior outcomes in many areas, especially around mortality and survival. Greater focus is needed to explore outcomes that are important to people with cancer including health‐related quality of life, symptoms, and treatment experience, and economic evaluation. Rather than aiming for superior outcomes, CCCs should be striving to enable equitable, high value, patient‐centered outcomes for all people affected by cancer. Literature demonstrates comprehensive cancers (CCCs) are associated with superior outcomes in many areas, especially around mortality and survival—despite CCCs being called to address health equity for all people with cancer. In addition to mortality and survival outcomes, greater focus is needed exploring other concerns that are important to people with cancer including health‐related quality‐of‐life, symptom burden, treatment experience, and economic evaluation. [ABSTRACT FROM AUTHOR]

When human beings are targeted as a class with adverse consequences, whether personally or professionally, it amounts to the victimisation of that class. During the ongoing pandemic, every individual, every class, or even every state has suffered so much. One class that has tried to save us from the pandemic and yet have been the targets of violent attacks, stigmatisation, trauma, and even social exclusion, is that of health care workers. The paper examines the extent of their victimisation and the law or policies enacted to rescue them. The major conclusions are that the scarcity of the facilities and the uncertainties of the disease created anxiety amongst people, and they targeted nurses and also doctors and many of the attacks went violent. Not only were the health care workers victimised by the public, but they also had to suffer at the hands of the administration.

Abstract Background Presently, for patients presenting with suspected Normal Pressure Hydrocephalus (NPH) who undergo temporary drainage of cerebrospinal fluid (CSF) there is no defined model to differentiate chance improvement form clinical significance change at the individual patient level. To address this lack of information we computed standard regression based clinical change models for the 10 Meter Walk Test, Timed Up & Go, Dual Timed Up & Go, 6-Minute Walk Test, Mini-Balance Evaluation Systems Test, Montreal Cognitive Assessment, and Symbol Digit Modalities using data from patients with suspected NPH that underwent temporary drainage of CSF. These clinically significant change modes can classify clinically significant improvement following temporary drainage of CSF at the individual patient level. This allows for physicians to differentiate a clinically significant improvement in symptoms from chance improvement. Methods Data was collected from 323 patients, over the age of 60, with suspected NPH that underwent temporary drainage of CSF with corresponding gait and cognitive testing. McSweeney Standardized Regression Based Clinical Change Models were computed for standard gait and cognitive measures: Timed Up & Go, Dual Timed Up & Go, 10 Meter Walk Test, MiniBESTest, 6-Minute Walk Test, Montreal Cognitive Assessment, and Symbol Digit Modalities Test. To assess the discriminate validity of the measures we used correlations, Chi2, and regression analyses. Results The clinical change models explained 69–91.8% of the variability in post-drain performance (p

Introduction Monitoring of joint replacement (JR) data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has reduced revision rates and improved surgical practice. Outcome assessment post-arthroplasty is limited however, to revision (reoperation) surgery and mortality outcomes. The AOANJRR National Data Linkage project seeks to broaden the scope of outcomes investigation in Australia by linking registry and health administrative datasets. Objectives and Approach Using linked registry and administrative data, the project seeks to describe and quantify national/regional trends and variation in major complications (infection, dislocation, arthrofibrosis, chronic pain, venous thromboembolism, cardiac events), malignancy and health service utilisation (readmissions, emergency encounters and inpatient rehabilitation) following hip, knee and shoulder joint replacement surgery. Evidence will be generated on how these outcomes are associated with and vary according to patient, surgical, implant, hospital and pharmacological factors. As Australia lacks a national identifier, seven linkage agencies are probabilistically linking AOANJRR hip, knee and shoulder replacement data (1999-2017) with 20 datasets. Datasets include government-subsidised health services, procedural and prescription data. Hospital separations and emergency attendance data from Australia’s eight jurisdictions together with national cancer registry and rehabilitation service data are also planned for linkage. Linked data are maintained in a secure remote access computing environment. Results To date, national Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and the Australian Cancer Database data have been linked with >900,000 AOANJRR patients, representing 607.6 million health service records (1999-2018), 467.7 million prescriptions (2002-2018) and 184,000 cancer records, respectively. Remaining linked data will be available in mid-2020. Some initial summary results across a selected range of studies will be presented. Conclusion / Implications This national data-linkage program will identify areas for improvement in joint replacement surgery and modifiable risk factors contributing to poor patient outcomes.

Introduction Patient comobidity at time of primary joint replacement (JR) impacts on outcomes including revision and mortality. Understanding changes in comorbidity profiles is important when assessing change in outcomes over time. Most arthroplasty registries have limited comorbidity information due to their minimum dataset. One approach to obtaining additional comorbidity data is linking registry data with national administrative data. Objectives and Approach Objectives were to quantify pre-operative comorbidity profile of patients undergoing primary total hip replacement (THR) and total knee replacement (TKR) for osteoarthritis. Also, to examine temporal trends in individual comorbidities for THR and TKR patients. National pharmaceutical dispensing data were linked with THR and TKR arthroplasty patients. Medication dispensing histories in 12-months preceding JR (2003-2017) for 237,333 THR and 394,965 TKR patients, were mapped to 47 comorbidity classes using the Rx-Risk-V measure - a pharmacy-based measure of comorbidity. Comorbidity scores were calculated by summing comorbidity categories for individual patients. Trends in comorbidity scores/categories were described, with comorbidity information presented by PBS beneficiary category (concessional/general), stratified by age (

Introduction Infection is a major complication following joint replacement (JR) surgery. However, little data exist on baseline use of antibiotics following primary JR and how use changes with subsequent revision surgery. Objectives & Approach Our study objectives were to describe community use of antibiotics before and after primary total hip replacement (THR) and change in use pre and post revision procedure. Registry data were linked with national medication dispensing data using probabilistic record linkage. Patients with THR for osteoarthritis in a private hospital between 1999 and 2017 were included. Three groups were analysed: patients with primary procedures revised for infection, revised for non-infection reasons and those not revised. Rate of antibiotic dispensing/month was calculated as number of patients dispensed at least one antibiotic in a given month divided by number of patients at-risk. Results There were 102,577 patients included in the non-revised group, 3,156 revised for non-infection and 520 revised for infection. Prior to primary THR, baseline antibiotic dispensing rate was 9-11%/month in all groups. Post-primary rates were similar (10-11%) for non-revised and revised non-infection patients but higher (16-17%) for revised-infection patients. In 1, 6 and 12 months preceding revision for infection, antibiotic use was 55%, 27% and 22%, respectively. For patients revised for non-infection, antibiotic use was 21%, 14%, 13%, respectively. One-month following revision for infection, 82% of patients were dispensed antibiotics, remaining high (38%) at 6-months and 28% at 12-months. In the revision non-infection group, antibiotic use was 48% first month post-surgery, reducing rapidly to 15% at 6-months. Conclusion / Implications Non-revision and revision non-infection patients had similar antibiotic dispensing before and after surgery. Revision infection patients however, maintained higher antibiotic dispensing post-primary, pre and post revision. This may reflect either ongoing infection, need for long-term suppressive therapy or reluctance of treating physicians to terminate treatment.

Introduction To enhance the value of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) we recently linked these data with administrative datasets including, Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Understanding the validity of administrative data is important in establishing the reliability of these data for informing clinical practice and policy. Objectives & Approach The study objective was to determine the validity of MBS data for capturing the occurrence of a joint replacement procedure. Using the AOANJRR procedures as the gold standard, we determined the sensitivity of the MBS data in correctly identifying hip joint replacement procedures. Results Of the 178,047 patients with a single primary total hip replacement occurring in a private hospital setting and recorded in the AOANJRR, 76% had a same-day MBS service claim indicative of that procedure, 2% had MBS procedures within +/- 7 days of the procedure while 18% had no MBS procedure codes indicative of a total hip joint replacement procedure. Of the procedures with no total hip MBS codes, 2% had MBS procedures codes indicating a total knee procedure, 1.7% had MBS procedure codes indicating a revision hip on that day and 13% of procedures had an in-hospital MBS hip anaesthetic administration code claimed on that day. Conclusion / Implications Given the increasing application of MBS data to describe health service use it is important to understand the validity of these data for identifying procedures undertaken in the private hospital setting. Using validated, gold standard data captured by the AOANJRR we identified that MBS data likely underestimate the occurrence of total hip replacement procedures. In addition, some MBS procedure codes are misattributed to other procedure types such as knee procedures and revision procedures.

Introduction Achieving parenthood is challenging in individuals receiving renal replacement therapy (RRT; dialysis or kidney transplantation) for end-stage kidney disease. Decision-making regarding parenthood in RRT recipients should be underpinned by robust data, yet there is limited data on parental factors that drive adverse health outcomes. Therefore, we aim to investigate the perinatal risks and outcomes in parents receiving RRT.Methods and analysis This is a multijurisdictional probabilistic data linkage study of perinatal, hospital, birth, death and renal registers from 1991 to 2013 from New South Wales, Western Australia, South Australia and the Australian Capital Territory. This study includes all babies born ≥20 weeks’ gestation or 400 g birth weight captured through mandated data collection in the perinatal data sets. Through linkage with the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, babies exposed to RRT (and their parents) will be compared with babies who have not been exposed to RRT (and their parents) to determine obstetric and fetal outcomes, birth rates and fertility rates. One of the novel aspects of this study is the method that will be used to link fathers receiving RRT to the mothers and their babies within the perinatal data sets, using the birth register, enabling the identification of family units. The linked data set will be used to validate the parenthood events directly reported to ANZDATA.Ethics and dissemination Ethics approval was obtained from Human Research Ethics Committees (HREC) and Aboriginal HREC in each jurisdiction. Findings of this study will be disseminated at scientific conferences and in peer-reviewed journals in tabular and aggregated forms. De-identified data will be presented and individual patients will not be identified. We will aim to present findings to relevant stakeholders (eg, patients, clinicians and policymakers) to maximise translational impact of research findings.

Aim: Kidney transplantation remains the preferred standard of care for patients with kidney failure. Most patients do not access this treatment and wide variations exist in which patients access transplantation. We sought to develop a model to estimate post‐kidney transplant survival to inform more accurate comparisons of access to kidney transplantation. Methods: Development and validation of prediction models using demographic and clinical data from the Australia and New Zealand Dialysis and Transplant Registry. Adult deceased donor kidney only transplant recipients between 2000 and 2020 were included. Cox proportional hazards regression methods were used with a primary outcome of patient survival. Models were evaluated using Harrell's C‐statistic for discrimination, and calibration plots, predicted survival probabilities and Akaike Information Criterion for goodness‐of‐fit. Results: The model development and validation cohorts included 11 302 participants. Most participants were male (62.8%) and Caucasian (79.2%). Glomerulonephritis was the most common cause of kidney disease (45.6%). The final model included recipient, donor, and transplant related variables. The model had good discrimination (C‐statistic, 0.72; 95% confidence interval (CI) 0.70–0.74 in the development cohort, 0.70; 95% CI 0.67–0.73 in the validation cohort and 0.72; 95% CI 0.69–0.75 in the temporal cohort) and was well calibrated. Conclusion: We developed a statistical model that predicts post‐kidney transplant survival in Australian kidney failure patients. This model will aid in assessing the suitability of kidney transplantation for patients with kidney failure. Survival estimates can be used to make more informed comparisons of access to transplantation between units to better measure equity of access to organ transplantation. [ABSTRACT FROM AUTHOR]