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Gray SM, Nettlefold L, Mackey D, Gould JS, McKay HA. Feasibility of a Virtual Health-Promoting Intervention (Choose to Move) for Older Adults: A Rapid Adaptation in Response to COVID-19. J Aging Phys Act 2023; 31:1003-1015. [PMID: 37536680 DOI: 10.1123/japa.2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/19/2023] [Accepted: 05/13/2023] [Indexed: 08/05/2023]
Abstract
To support older adults during the first wave of COVID-19, we rapidly adapted our effective health-promoting intervention (Choose to Move [CTM]) for virtual delivery in British Columbia, Canada. The intervention was delivered (April-October 2020) to 33 groups of older adults ("programs") who were a convenience sample (had previously completed CTM in person; n = 153; 86% female; 73 [6] years). We compared implementation outcomes (recruitment, dose received, retention, and completion of virtual data collection) to predetermined feasibility targets. We assessed mobility, physical activity, and social health outcomes pre- and postintervention (3 months) with validated surveys. We met most (dose received, retention, and virtual data collection), but not all (recruitment), feasibility targets. Approximately two thirds of older adults maintained or improved mobility, physical activity, and social health outcomes at 3 months. It was feasible to implement and evaluate CTM virtually. In future, virtual CTM could help us reach homebound older adults and/or serve as support during public health emergencies.
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Affiliation(s)
- Samantha M Gray
- Department of Biomedical Physiology and Kinesiology, Aging and Population Health Lab, Simon Fraser University, Burnaby, BC,Canada
- Active Aging Research Team, The University of British Columbia, Vancouver, BC,Canada
| | - Lindsay Nettlefold
- Active Aging Research Team, The University of British Columbia, Vancouver, BC,Canada
| | - Dawn Mackey
- Department of Biomedical Physiology and Kinesiology, Aging and Population Health Lab, Simon Fraser University, Burnaby, BC,Canada
| | - Joanie Sims Gould
- Active Aging Research Team, The University of British Columbia, Vancouver, BC,Canada
- Department of Family Practice, The University of British Columbia, Vancouver, BC,Canada
| | - Heather A McKay
- Active Aging Research Team, The University of British Columbia, Vancouver, BC,Canada
- Department of Family Practice, The University of British Columbia, Vancouver, BC,Canada
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Elliott J, van Wyk P, Butler R, Giosa JL, Sims Gould J, Tong CE, Taabazuing MM, Johnson H, Coyne P, Mitchell F, Whate A, Callon A, Carson J, Stolee P. Developing an in-depth understanding of patient and caregiver engagement across care transitions from hospital: protocol for a qualitative study exploring experiences in Canada. BMJ Open 2023; 13:e077436. [PMID: 37479510 PMCID: PMC10364181 DOI: 10.1136/bmjopen-2023-077436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Patient and caregiver engagement is critical, and often compromised, at points of transition between care settings, which are more common, and more challenging, for patients with complex medical problems. The consequences of poor care transitions are well-documented, both for patients and caregivers, and for the healthcare system. With an ageing population, there is greater need to focus on care transition experiences of older adults, who are often more medically complex, and more likely to require care from multiple providers across settings. The overall goal of this study is to understand what factors facilitate or hinder patient and caregiver engagement through transitions in care, and how these current engagement practices align with a previously developed engagement framework (CHOICE Framework). This study also aims to co-develop resources needed to support engagement and identify how these resources and materials should be implemented in practice. METHODS AND ANALYSIS This study uses ethnographic approaches to explore the dynamics of patient and caregiver engagement, or lack thereof, during care transitions across three regions within Ontario. With the help of a front-line champion, patients (n=18-24), caregivers (n=18-24) and healthcare providers (n=36-54) are recruited from an acute care hospital unit (or similar) and followed through their care journey. Data are collected using in-depth semi-structured interviews. Workshops will be held to co-develop strategies and a plan for future implementation of resources and materials. Analysis of the data will use inductive and deductive coding techniques. ETHICS AND DISSEMINATION Ethics clearance was obtained through the Western University Research Ethics Board, University of Windsor Research Ethics Board and the University of Waterloo Office of Research Ethics. The findings from this study are intended to contribute valuable evidence to further bridge the knowledge to practice gap in patient and caregiver engagement through care transitions. Findings will be disseminated through publications, conference presentations and reports.
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Affiliation(s)
- Jacobi Elliott
- Lawson Health Research Institute, London, Ontario, Canada
- Specialized Geriatric Services, St. Joseph's Health Care London, London, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paula van Wyk
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Roy Butler
- Senior Leadership, St. Joseph's Health Care London, London, Ontario, Canada
| | - Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, Toronto, Ontario, Canada
| | | | - Catherine E Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary Margaret Taabazuing
- Department of Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Helen Johnson
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paige Coyne
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
- Henry Ford Health System, Detroit, Michigan, USA
| | - Fallon Mitchell
- Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Alexandra Whate
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne Callon
- Patient and Caregiver Partner, London, Ontario, Canada
| | - Judith Carson
- Patient and Caregiver Partner, Waterloo, Ontario, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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McKay HA, Macdonald HM, Nettlefold L, Weatherson K, Gray SM, Bauman A, Khan KM, Sims Gould J. What is the 'voltage drop' when an effective health promoting intervention for older adults-Choose to Move (Phase 3)-Is implemented at broad scale? PLoS One 2023; 18:e0268164. [PMID: 37146002 PMCID: PMC10162521 DOI: 10.1371/journal.pone.0268164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/30/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Choose to Move (CTM), an effective health-promoting intervention for older adults, was scaled-up across British Columbia, Canada. Adaptations that enable implementation at scale may lead to 'voltage drop'-diminished positive effects of the intervention. For CTM Phase 3 we assessed: i. implementation; ii. impact on physical activity, mobility, social isolation, loneliness and health-related quality of life (impact outcomes); iii. whether intervention effects were maintained; iv) voltage drop, compared with previous CTM phases. METHODS We conducted a type 2 hybrid effectiveness-implementation pre-post study of CTM; older adult participants (n = 1012; mean age 72.9, SD = 6.3 years; 80.6% female) were recruited by community delivery partners. We assessed CTM implementation indicators and impact outcomes via survey at 0 (baseline), 3 (mid-intervention), 6 (end-intervention) and 18 (12-month follow-up) months. We fitted mixed-effects models to describe change in impact outcomes in younger (60-74 years) and older (≥ 75 years) participants. We quantified voltage drop as percent of effect size (change from baseline to 3- and 6-months) retained in Phase 3 compared with Phases 1-2. RESULTS Adaptation did not compromise fidelity of CTM Phase 3 as program components were delivered as intended. PA increased during the first 3 months in younger (+1 days/week) and older (+0.9 days/week) participants (p<0.001), and was maintained at 6- and 18-months. In all participants, social isolation and loneliness decreased during the intervention, but increased during follow-up. Mobility improved during the intervention in younger participants only. Health-related quality of life according to EQ-5D-5L score did not change significantly in younger or older participants. However, EQ-5D-5L visual analog scale score increased during the intervention in younger participants (p<0.001), and this increase was maintained during follow-up. Across all outcomes, the median difference in effect size, or voltage drop, between Phase 3 and Phases 1-2 was 52.6%. However, declines in social isolation were almost two times greater in Phase 3, compared with Phases 1-2. CONCLUSION Benefits of health-promoting interventions-like CTM-can be retained when implemented at broad scale. Diminished social isolation in Phase 3 reflects how CTM was adapted to enhance opportunities for older adults to socially connect. Thus, although intervention effects may be reduced at scale-up, voltage drop is not inevitable.
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Affiliation(s)
- Heather A McKay
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Heather M Macdonald
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay Nettlefold
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Katie Weatherson
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
| | - Samantha M Gray
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Aging and Population Health Lab, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Adrian Bauman
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Karim M Khan
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Joanie Sims Gould
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
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Stolee P, Elliott J, Giguere AM, Mallinson S, Rockwood K, Sims Gould J, Baker R, Boscart V, Burns C, Byrne K, Carson J, Cook RJ, Costa AP, Giosa J, Grindrod K, Hajizadeh M, Hanson HM, Hastings S, Heckman G, Holroyd-Leduc J, Isaranuwatchai W, Kuspinar A, Meyer S, McMurray J, Puchyr P, Puchyr P, Theou O, Witteman H. Transforming primary care for older Canadians living with frailty: mixed methods study protocol for a complex primary care intervention. BMJ Open 2021; 11:e042911. [PMID: 33986044 PMCID: PMC8126280 DOI: 10.1136/bmjopen-2020-042911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Older Canadians living with frailty are high users of healthcare services; however, the healthcare system is not well designed to meet the complex needs of many older adults. Older persons look to their primary care practitioners to assess their needs and coordinate their care. They may need care from a variety of providers and services, but often this care is not well coordinated. Older adults and their family caregivers are the experts in their own needs and preferences, but often do not have a chance to participate fully in treatment decisions or care planning. As a result, older adults may have health problems that are not properly assessed, managed or treated, resulting in poorer health outcomes and higher economic and social costs. We will be implementing enhanced primary healthcare approaches for older patients, including risk screening, patient engagement and shared decision making and care coordination. These interventions will be tailored to the needs and circumstances of the primary care study sites. In this article, we describe our study protocol for implementing and testing these approaches. METHODS AND ANALYSIS Nine primary care sites in three Canadian provinces will participate in a multi-phase mixed methods study. In phase 1, baseline information will be collected through questionnaires and interviews with patients and healthcare providers (HCPs). In phase 2, HCPs and patients will be consulted to tailor the evidence-based interventions to site-specific needs and circumstances. In phase 3, sites will implement the tailored care model. Evaluation of the care model will include measures of patient and provider experience, a quality of life measure, qualitative interviews and economic evaluation. ETHICS AND DISSEMINATION This study has received ethics clearance from the host academic institutions: University of Calgary (REB17-0617), University of Waterloo (ORE#22446) and Université Laval (#MP-13-2019-1500 and 2017-2018-12-MP). Results will be disseminated through traditional means, including peer-reviewed publications and conferences and through an extensive network of knowledge user partners. TRIAL REGISTRATION NUMBER NCT03442426;Pre-results.
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Affiliation(s)
- Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Anik Mc Giguere
- Department of Family Medicine and Emergency Medicine, Universite Laval, Laval, Quebec, Canada
| | - Sara Mallinson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joanie Sims Gould
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Veronique Boscart
- School of Health and Life Sciences, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Catherine Burns
- Faculty of Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Kerry Byrne
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Judith Carson
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Justine Giosa
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heather M Hanson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Stephanie Hastings
- Alberta Health Services, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - George Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | | | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for exceLlence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Samantha Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Josephine McMurray
- School of Business and Economics/Health Studies, Wilfred Laurier University, Waterloo, Ontario, Canada
| | - Phyllis Puchyr
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Peter Puchyr
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Holly Witteman
- Department of Family Medicine and Emergency Medicine, Universite Laval, Laval, Quebec, Canada
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Abstract
Primary care may be the best place within the health system to coordinate care for older persons, but at present, it is poorly equipped to do so. Effective models for complex patients require appropriate targeting, patient/caregiver engagement, and care coordination. A large national project aims to co-design and implement a model in primary care that includes risk-stratification, patient engagement and care coordination techniques for older adults. This presentation focuses on the process of implementation in primary care. Grounded in the Consolidated Framework for Implementation Research, researchers worked with nine primary care sites in three Canadian provinces. Project implementation was completed in two phases. Pre-implementation: Interviews with providers (n=25) and older adults (n=8) were conducted to understand current practices and plan for implementation. Implementation: Researchers worked with sites to train staff and support implementation. Monitoring of the implementation process included Interviews with providers (n=20) and field notes. Data were analyzed using directed coding, following the framework. A number of learnings emerged: buy-in was required from the entire team, teams provided meaningful information to guide implementation, contributing to a sense of ownership, and it was important that intervention components were tailored to the needs at each site. Ongoing and frequent discussions with the team was necessary. Scheduling meetings and training sessions for providers was challenging due to the length of time away from direct patient care. A new primary care model for older adults living with frailty was implemented. Lessons from this project will be used to guide future implementation and spread.
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Affiliation(s)
| | | | - Susie Gregg
- University of Waterloo, Waterloo, Ontario, Canada
| | | | - Paul Stolee
- University of Waterloo, Waterloo, Ontario, Canada
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Gould JS, McKay H, Gray S, Bauman A, Nettlefold L, Hoy C. CHOOSE TO MOVE: IMPLEMENTATION OF A PHYSICAL ACTIVITY INTERVENTION AT SCALE ACROSS BRITISH COLUMBIA, CANADA. Innov Aging 2019. [PMCID: PMC6846127 DOI: 10.1093/geroni/igz038.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Despite the many benefits of physical activity (PA), older adults remain among the least active Canadians. Regular PA effectively enhances social connectedness which in turn, is linked to positive health benefits. PA also promotes older adult’s physical mobility which is “the best guarantee of retaining independence and being able to cope” in later years. Although effective PA interventions exist, all but five were conducted at small scale. None were effectively scaled up and sustained over the longer term. To improve population health, effective interventions must be scaled-up. In 2015, BC Ministry of Health released a PA strategy and action plan--older adults were identified as one priority area. In partnership with government and community stakeholders we were entrusted to co-design, implement and evaluate a 6 month, evidence- and choice-based PA intervention (Choose to Move; CTM) across BC, Canada. Implementation and adaptation frameworks and processes we adopted were embedded within socioecological models. We evaluated CTM at scale-up in 26 communities with 458 low active older adults. Our implementation evaluation showed that relationships and infrastructure were key facilitators to delivering CTM at scale. Our impact evaluation showed that PA and social connectedness were enhanced; mental health (loneliness/happiness), grip strength and mobility all improved following participation in CTM. A flexible, adaptable PA model, designed with scalability in mind is key to enhance health indicators in low active older adults. Effectively engaging stakeholders at multiple levels in the implementation process is essential to success.
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Affiliation(s)
| | - Heather McKay
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Samantha Gray
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Christa Hoy
- University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
OBJECTIVE The prevalence of type 2 diabetes mellitus (T2DM) is increasing globally and there is critical need develop interventions to improve health outcomes among older people. The Group Appointments in Primary Care (GAP) study was a randomised controlled trial designed to test the efficacy of a group and team-based medical visit programme to lower haemoglobin A1c among patients with T2DM. We aimed to understand the barriers and facilitators to implement the GAP intervention within a primary care setting, with an emphasis on patient experience. RESEARCH DESIGN AND METHODS This was a qualitative exploratory study. Data were gathered from semistructured interviews conducted with the first cohort of GAP study participants (n=15) at baseline and intervention completion. GAP participants were aged >65, diagnosed with T2DM and from one primary care clinic. The interview questions identified the patient perspectives and factors relating to their attendance at seven group medical visits that were part of the intervention programme. Data were analysed using framework analysis. RESULTS We identified four themes that captured participants' experiences: (1) Education: learning with professionals, learning with one another; (2) Social Support: common interests, common problems; (3) Setting: ease of location, ease of conversation and (4) Impact: expectations met, empowerment gained. The GAP intervention increased participants' self-reported diabetes literacy and self-management skills. CONCLUSIONS We learnt that: accessible community centres, not primary care offices, were the ideal location for GAP; the consistent leadership of the primary care physician was valued by participants; and, the content related to exercise and healthy diet were viewed as impactful. Also, learning was achieved through content delivered by clinical experts, and by T2DM experts with lived experience-the GAP peers. Our findings highlight the important role of group learning. TRIAL REGISTRATION NUMBER NCT02002143.
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Affiliation(s)
- Joanie Sims Gould
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Tong
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Ly
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara Vazirian
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adriaan Windt
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim Khan
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Chudyk AM, Winters M, Moniruzzaman M, Ashe MC, Gould JS, McKay H. Destinations matter: The association between where older adults live and their travel behavior. J Transp Health 2015; 2:50-57. [PMID: 27104147 PMCID: PMC4835227 DOI: 10.1016/j.jth.2014.09.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The positive effect of physical activity in the prevention and treatment of many chronic diseases and age-related disabilities, such as mobility-disability, are widely accepted. Mobility is broadly defined as the ability of individuals to move themselves within community environments. These two concepts -physical activity and mobility - are closely linked and together contribute to older adults living healthy, independent lives. Neighborhood destinations may encourage mobility, as older adults typically leave their homes to travel to specific destinations. Thus, neighborhoods with a high prevalence of destinations may provide older adults an attractive opportunity to walk, instead of drive, and thereby obtain incidental physical activity. We know surprisingly little about the specific types of destinations older adults deem relevant and even less about destinations that support the mobility of older adults with low income. Accessible neighborhood destinations may be especially important to older adults with low income as they are more likely to walk as a primary travel mode. Conversely, this population may also be at increased risk of functional impairments that negatively affect their ability to walk. As a means to fill this information gap we aimed to better understand the mobility habits of older adults with low income. Thus, our specific objectives were to: (1) describe the types of destinations older adults with low income most commonly travel to in one week; and (2) determine the association between the prevalence of neighborhood destinations and the number of transportation walking trips these individuals make (average per day). We conducted a cross-sectional study of community-dwelling older adults with low income residing within Metro Vancouver, Canada. We assessed participant travel behavior (frequency, purpose, mode, destination) using seven-day travel diaries and measured the prevalence of neighborhood destinations using the Street Smart Walk Score. We also assessed participants' sociodemographic characteristics and mobility (physical function, car access, confidence walking). We used a negative binomial model to determine the association between Street Smart Walk Score and number of transportation walking trips (average per day). Our sample was comprised of 150 participants (median age 74 years; 51 men) from who we acquired at least one day of travel diary data (range = 1-7 days). Participants made three trips per day (2, 5; median P25, P75) and travelled to six different destination types per week (5, 9; median P25, P75). Destinations most relevant to older adults were grocery stores, malls, and restaurants/cafés. Each 10-point increase in Street Smart Walk Score was associated with a 20% increase in the number of transportation walking trips (average per day, incidence rate ratio = 1.20, 95% CI = 1.12, 1.29). Our findings provide preliminary evidence regarding destinations that may be most relevant to older adults. They also suggest that the prevalence of these neighborhood destinations may encourage walking. As we approach a new era of healthy city benchmarks, our findings guide policy makers and developers to retrofit and develop communities that support the mobility, health, and independence of older adults.
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Affiliation(s)
- Anna M Chudyk
- Centre for Hip Health and Mobility and Department of Medicine, University of British Columbia, 2635 Laurel Street, Vancouver, BC, Canada V5Z 1M9
| | - Meghan Winters
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6
| | - Md Moniruzzaman
- Business School, The University of Western Australia, 35 Stirling Highway, Crawley, WA, Australia
| | - Maureen C Ashe
- Centre for Hip Health and Mobility and Department of Family Practice, University of British Columbia, 2635 Laurel Street, Vancouver, BC, Canada V5Z 1M9
| | - Joanie Sims Gould
- Centre for Hip Health and Mobility and Department of Family Practice, University of British Columbia, 2635 Laurel Street, Vancouver, BC, Canada V5Z 1M9
| | - Heather McKay
- Centre for Hip Health and Mobility and Department of Family Practice, University of British Columbia, 2635 Laurel Street, Vancouver, BC, Canada V5Z 1M9
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Gould JS. Thanksgiving. Am J Orthop (Belle Mead NJ) 2001; 30:846. [PMID: 11771796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Gould JS. Who are the humanitarians? Am J Orthop (Belle Mead NJ) 2001; 30:792. [PMID: 11757856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Gould JS. September 11, 2001. AMERICAN JOURNAL OF ORTHOPEDICS (BELLE MEAD, N.J.) 2001; 30:737. [PMID: 11683445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Gould JS. Privacy. Am J Orthop (Belle Mead NJ) 2001; 30:528. [PMID: 11482507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Chi TD, McWilliam J, Gould JS. Lateral plate-washer technique for revision tibiocalcaneal fusion. Am J Orthop (Belle Mead NJ) 2001; 30:588-90. [PMID: 11482515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Tibiocalcaneal fusion using intramedullary rods for severe end-stage Charcot deformity is challenging. Complications such as nonunion, delayed union, recurrent deformity, wound problems, and infection are common. Revision cases present the additional obstacle of obtaining bony purchase in the calcaneal screws. We present a technique using readily available instrumentation to obtain reliable calcaneal fixation.
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Affiliation(s)
- T D Chi
- American Sports Medicine Institute, Birmingham, Alabama, USA
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Gould JS. When will they go away? Am J Orthop (Belle Mead NJ) 2001; 30:372. [PMID: 11370942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Gould JS. Care of older patients. Am J Orthop (Belle Mead NJ) 2001; 30:276. [PMID: 11334449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Gould JS. Visiting professors. Am J Orthop (Belle Mead NJ) 2001; 30:90. [PMID: 11234946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Gould JS. Victory! Am J Orthop (Belle Mead NJ) 2001; 30:13. [PMID: 11198826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Gould JS. Christmas cheer. Am J Orthop (Belle Mead NJ) 2000; 29:920. [PMID: 11140346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Gould JS. AV: show or substance? Am J Orthop (Belle Mead NJ) 2000; 29:749-50. [PMID: 11043957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Gould JS, Alvine FG, Mann RA, Sanders RW, Walling AK. Total ankle replacement: a surgical discussion. Part II. The clinical and surgical experience. Am J Orthop (Belle Mead NJ) 2000; 29:675-82. [PMID: 11008864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- J S Gould
- University of Virginia, Charlottesville, USA
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Gould JS, Alvine FG, Mann RA, Sanders RW, Walling AK. Total ankle replacement: a surgical discussion. Part I. Replacement systems, indications, and contraindications. Am J Orthop (Belle Mead NJ) 2000; 29:604-9. [PMID: 10955464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Affiliation(s)
- J S Gould
- University of Virginia, Charlottesville, USA
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Gould JS. Tax one orthopedists. Am J Orthop (Belle Mead NJ) 2000; 29:504. [PMID: 10926400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Gould JS. The learning laboratory. Am J Orthop (Belle Mead NJ) 2000; 29:422. [PMID: 10890455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Gould JS. The master's touch. Am J Orthop (Belle Mead NJ) 2000; 29:346, 348. [PMID: 10868434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Gould JS. Medicine's secrets. Am J Orthop (Belle Mead NJ) 2000; 29:142. [PMID: 10746465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Gould JS. Academic medicine careers. Am J Orthop (Belle Mead NJ) 2000; 29:70. [PMID: 10695857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Gould JS. The menace of cyberspace. Am J Orthop (Belle Mead NJ) 1999; 28:682. [PMID: 10614758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Gould JS. The asymptomatic patient. Am J Orthop (Belle Mead NJ) 1999; 28:614. [PMID: 10588468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Gould JS. Leaders of the pack. Am J Orthop (Belle Mead NJ) 1999; 28:551-2. [PMID: 10541139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Gould JS. Knowing your patients. Am J Orthop (Belle Mead NJ) 1999; 28:439. [PMID: 10470665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Gould JS. Madman in the OR. Am J Orthop (Belle Mead NJ) 1999; 28:384. [PMID: 10426434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Gould JS. Orthopedic fellowships. Am J Orthop (Belle Mead NJ) 1999; 28:331, 335. [PMID: 10401897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Gould JS. Blaming the patient. Am J Orthop (Belle Mead NJ) 1999; 28:144. [PMID: 10195835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Gould JS. Between rubbish and the magnum opus. Am J Orthop (Belle Mead NJ) 1999; 28:82, 87. [PMID: 10067710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Gould JS. Basking in the glory. Am J Orthop (Belle Mead NJ) 1999; 28:12. [PMID: 10048353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Gould JS. Blaming the other guy. Am J Orthop (Belle Mead NJ) 1998; 27:778. [PMID: 9880093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Abstract
The purpose of this study is to present the surgical and functional results of a total calcanectomy procedure as a foot salvage alternative in patients with extensive chronic osteomyelitis of the calcaneus. A retrospective review identified eight patients treated with a total calcanectomy for a chronic nonhealing plantar ulcer of the heel and osteomyelitis of the calcaneus. The primary diagnosis was insulin-dependent diabetes mellitus (six patients), pneumococcal septicemia (one patient), and an open calcaneal fracture (one patient). The average age of the patients was 52 years. Prior procedures included irrigation and debridement of the heel ulcer (seven patients), partial calcanectomy (three patients), and split thickness skin grafting (two patients). The vascular status of each limb was assessed preoperatively. Distal extremity bypass surgery was performed on two patients before calcanectomy. Osteomyelitis of the calcaneus was diagnosed by magnetic resonance imaging alone in three patients, and by technetium/indium scans and magnetic resonance imaging in five patients. The average follow-up duration was 27.3 months (range, 6-57 months). Infection at the plantar heel was controlled in all patients. In all eight cases the incisions were closed primarily. During a prolonged time of total contact casting to facilitate wound healing, one patient developed an anterior tibial ulcer that progressed to osteomyelitis and underwent below-knee amputation. Talonavicular subluxation occurred as a late complication in one patient. This was treated with a talonavicular arthrodesis and subsequent bracing for a nonunion. An assessment of functional ambulation was performed on all eight patients. Four patients maintained the same ambulation level postoperatively in a modified heel-containment orthosis. Two patients decreased one functional ambulation level, and one patient decreased two levels. One patient underwent below-knee amputation and is currently ambulatory with a prothesis. Assessment of ankle strength and range of motion of the surgical limb demonstrated decreased dorsiflexion and plantarflexion strength and a variable range of motion compared to the contralateral limb. Total calcanectomy is an alternative procedure to transtibial amputation in patients with chronic osteomyelitis of the calcaneus. Eradication of infection and preservation of the functional ambulation is achieved.
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Affiliation(s)
- J F Baumhauer
- Department of Orthopaedic Surgery, University of Rochester Medical Center, NY 14642, USA
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Gould JS. Staying at the peak. Am J Orthop (Belle Mead NJ) 1998; 27:720. [PMID: 9839954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Gould JS. When to refer. Am J Orthop (Belle Mead NJ) 1998; 27:596, 598. [PMID: 9758450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Gould JS. Caveat emptor. Am J Orthop (Belle Mead NJ) 1998; 27:545. [PMID: 9732076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Gould JS. Cultural literacy: is it important? Am J Orthop (Belle Mead NJ) 1998; 27:74. [PMID: 9574996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gould JS. Pain. Am J Orthop (Belle Mead NJ) 1997; 26:818. [PMID: 9413584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Gould JS. Failure. Am J Orthop (Belle Mead NJ) 1997; 26:732. [PMID: 9402207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
The immune mediated pathologic effects of rheumatoid arthritis on osteoarticular tissues are well delineated in the orthopaedic and medical literature. Less well explored are the extraosseous manifestations of rheumatoid arthritis. The rheumatoid disease process can affect virtually any organ system or tissue in the human body; from scleritis, arteritis, and splenomegaly to neuropathy, bursitis, and tendinopathy. The scope of this treatise is to define better for the clinician the extraosseous presentation of rheumatoid arthritis in the foot and ankle.
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Affiliation(s)
- T S O'Brien
- Department of Orthopaedics, Medical College of Wisconsin, Milwaukee, USA
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Gould JS. The independent medical examiner. Am J Orthop (Belle Mead NJ) 1997; 26:390. [PMID: 9193691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Gould JS. Macho man. Am J Orthop (Belle Mead NJ) 1997; 26:310. [PMID: 9181188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gould JS. Whither physician extenders? Am J Orthop (Belle Mead NJ) 1997; 26:245. [PMID: 9113290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gould JS. The bully pulpit. Am J Orthop (Belle Mead NJ) 1997; 26:184. [PMID: 9240786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gould JS. The acquisition of knowledge. Am J Orthop (Belle Mead NJ) 1996; 25:680. [PMID: 8922165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Gould JS. Ethics: a higher level? Am J Orthop (Belle Mead NJ) 1996; 25:470. [PMID: 8831887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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