Objective To explore in depth how primary care clinicians (general practitioners and practice nurses) derive their individual and collective healthcare decisions. Design Ethnographic study using standard methods (non-participant observation, semistructured interviews, and documentary review) over two years to collect data, which were analysed thematically. Setting Two general practices, one in the south of England and the other in the north of England. Participants Nine doctors, three nurses, one phlebotomist, and associated medical staff in one practice provided the initial data; the emerging model was checked for transferability with general practitioners in the second practice. Results Clinicians rarely accessed and used explicit evidence from research or other sources directly, but relied on “mindlines”—collectively reinforced, internalised, tacit guidelines. These were informed by brief reading but mainly by their own and their colleagues9 experience, their interactions with each other and with opinion leaders, patients, and pharmaceutical representatives, and other sources of largely tacit knowledge. Mediated by organisational demands and constraints, mindlines were iteratively negotiated with a variety of key actors, often through a range of informal interactions in fluid “communities of practice,” resulting in socially constructed “knowledge in practice.” Conclusions These findings highlight the potential advantage of exploiting existing formal and informal networking as a key to conveying evidence to clinicians.

https://www.bmj.com/content/bmj/329/7473/1013.full.pdf

Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care

The term bracketing has increasingly been employed in qualitative research. Although this term proliferates in scientific studies and professional journals, its application and operationalization remains vague and, often, superficial. The growing disconnection of the practice of bracketing in research from its origins in phenomenology has resulted in its frequent reduction to a formless technique, value stance, or black-box term. Mapping the subtle theoretical and philosophical underpinnings of bracketing will facilitate identification and delineation of core elements that compose bracketing, and distinguish how different research approaches prioritize different bracketing elements. The author outlines a typology of six distinct forms of bracketing that encompasses the methodological rigor and evolution of bracketing within the richness of qualitative research.

Bracketing in Research: A Typology

Study Design Prospective, randomized, double-blinded, clinical trial using a repeated-measures design Objectives To determine the short-term clinical efficacy of Kinesio Tape (KT) when applied to college students with shoulder pain, as compared to a sham tape application Background Tape is commonly used as an adjunct for treatment and prevention of musculoskeletal injuries A majority of tape applications that are reported in the literature involve non-stretch tape The KT method has gained significant popularity in recent years, but there is a paucity of evidence on its use Methods and Measures Forty-two subjects clinically diagnosed with rotator cuff tendonitis/impingement were randomly assigned to 1 of 2 groups: therapeutic KT group or sham KT group Subjects wore the tape for 2 consecutive 3-day intervals Self-reported pain and disability and pain-free active range of motion (ROM) were measured at multiple intervals to assess for differences between groups Results The therapeutic KT group showed 

/pdf/the-clinical-efficacy-of-kinesio-tape-for-shoulder-pain-a-20vw3dv3xc.pdf

The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial.

The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome.

In a keynote address to the Teacher Training Agency Annual Conference, Professor David Hargreaves suggested that teaching could become an evidence-based profession if educational researchers were made more accountable to teachers. This systematic literature review set out to explore: how teachers use research; which features of research encourage teachers to use research findings in their own practice; whether medical practitioners make greater use of research findings than teachers; and approaches to dissemination. Two key ideas emerge from this review. First, there appear to be common barriers to research use in both medicine and in education. Findings suggest that there is a need to create a culture in the public sector which supports and values research. There are, however, a number of factors, which appear to be more specific to the education field. Key differences in the way that research knowledge is constructed in the social sciences has led to researchers being challenged about their findings, pa...

The use of research to improve professional practice: a systematic review of the literature

To ensure effective utilization of research in nursing more evidence is needed which illuminates the way nurses think about research, the value which they put on it, and how they envisage that it may help or hinder them in their everyday work. This English study aimed to meet these objectives by describing the research culture of practising nurses, health visitors and midwives, and their managers. It rests on two assumptions. Firstly that the reasons why practitioners do, or do not, base their practice on research are complex, and secondly, that interventions to increase research utilization must be grounded in an appreciation of this complex ‘whole’. Thus the study took a qualitative approach to exploring: what participants thought and felt about research; the current status of research based practice; and the opportunities and constraints to increasing research based practice. The results confirm the hypothesis that many factors, both individual and organizational affect research utilization. Furthermore, practitioners and managers hold differing perceptions regarding the nature of research, its role, and the opportunities and constraints which effect its dissemination and utilization. The implications of the results for education, policy and practice are discussed.

Bridging the research-practice gap: exploring the research cultures of practitioners and managers.

The application of tape to the skin overlying the lower fibres of trapezius is generally thought to facilitate this muscle. However, this facilitation has not been thoroughly investigated. In this study, the effect of tape upon trapezius motoneurone pool excitability was assessed using the trapezius H reflex. The amplitude of the H reflex was measured across four conditions: before tape application, with Endura Fix tape, with the addition of Endura Sports tape and finally with the tape removed. Instead of the expected facilitation of lower trapezius, this tape inhibited lower trapezius activity. On average, the application of Endura Fix tape inhibited trapezius by 4%. The application of Endura Sports tape overlaying the Endura Fix tape inhibited trapezius on average by 22%. This inhibition did not last once the tape was removed. This suggests that any change in shoulder girdle symptoms or movement, which occurs with the application of this particular tape is not explicable on the basis of the facilitation of the lower fibres of trapezius. r 2003 Elsevier Science Ltd. All rights reserved.

Original article: Does tape facilitate or inhibit the lower fibres of trapezius?

Does tape facilitate or inhibit the lower fibres of trapezius

What is the effect of taping along or across a muscle on motoneurone excitability? A study using triceps surae.

The control of the scapulothoracic muscles trapezius (Tr) and serratus anterior (SA) has been examined in normal human subjects. Electromyographic recordings were made from the SA and Tr muscles (upper trapezius UTr, lower trapezius LTr) using surface electrodes placed bilaterally. Magnetic stimulation of the motor cortex and electrical stimulation of peripheral nerves were used to examine their descending and reflex control. The average optimal site of cortical stimulation was found to be the same for SA, UTr and LTr (an approximate centre of gravity of −0.6 cm, 3.7 cm where the centre of gravity is expressed as the mean anterio-posterior position, the mean medio-lateral position). Some asymmetry in the cortical representation of UTr was found in each individual tested. Magnetic stimulation evoked bilateral MEPs in Tr (latency contralateral (c) UTr 8.5 ± 1.6 ms, ipsilateral (i) UTr 19.0 ± 2.7 ms) but only contralateral responses were evoked in SA (11.2 ± 2.6 ms). Electrical stimulation of the long thoracic nerve at two sites was used to examine homonymous and heteronymous reflexes of SA, while electrical stimulation of cervical nerve of C3/4 was used to examine the heteronymous reflexes of Tr. Ipsilateral SA H reflexes were evoked at a latency of 9.9 ± 0.8 ms (proximal site) and 10.8 ± 1.2 ms (distal site). No group I reflexes were evoked from SA to its contralateral homologue. No group I reflexes were evoked between Tr and SA. Finally, cross-correlation of activity from the Tr muscle pairs and the SA muscle pair revealed that the motoneurones of the Tr muscles share some common presynaptic input whereas there was no detectable common presynaptic input to the SA muscle pair. This study extends and consolidates knowledge regarding the neural control of trapezius and for the first time explores the neural control of SA. The study demonstrates a contrasting bilateral control of Tr and SA. These patterns of connections are discussed in relation to the contrasting bilateral functional roles of these muscles.

https://physoc.onlinelibrary.wiley.com/doi/pdf/10.1113/jphysiol.2006.126276

Caroline Alexander

Papers

Bridging the research-practice gap: exploring the research cultures of practitioners and managers.

Original article: Does tape facilitate or inhibit the lower fibres of trapezius?

Does tape facilitate or inhibit the lower fibres of trapezius

What is the effect of taping along or across a muscle on motoneurone excitability? A study using triceps surae.

Differential control of the scapulothoracic muscles in humans