The aim of this study is to investigate the effect of clinical experience and educational background on clinical decision-making of dentists presented with two prosthodontic cases.
A questionnaire-based survey was performed among 66 prosthodontists who were divided into two groups. The first group included clinicians from Belgium, Germany, and the Netherlands covering a wide spectrum of dental experience. The second (specialized) group consisted of German dentists performing their last module of a 3-year postgraduate master program in prosthodontics. Two patient scenarios of different complexities were presented to the participants who were asked to make an educated choice among seven therapeutic options.
Sixty-six dentists participated. For case #1, 22 therapeutic suggestions were offered within the international group (variation 54%), while 17 options were chosen in the specialized group (variation 68%). For case #2, five (variation 12%) and four (variation 16%) different therapeutic options were planned in the groups, respectively. Treatment planning in combination with implants was clearly preferred by dentists with an experience of 20 years or less. Conversely, participants with more experience favored more conventional treatments. All differences were statistically significant (p < 0.05).
Clinicians' experience and educational background had a clinically relevant influence on decision-making and treatment planning. A clear preference for implant-free therapies was noted for dentists with more than two decades of professional experience.
In complex cases, clinicians with more than 20 years of professional experience tend to save questionable teeth rather than to resort to implants. This interindividual variation might less likely occur when more external evidence is taken into account during the decision-making process.
The aim of this study was to compare UV light and non-thermal plasma (NTP) treatment regarding the improvement of physical material characteristics and cell reaction on titanium surfaces in vitro after short-term functionalization.
Moderately rough (Ra 1.8–2.0 μm) sandblasted and acid-etched titanium disks were treated by UV light (0.05 mW/cm2 at λ = 360 nm and 2 mW/cm2 at λ = 250 nm) or by NTP (24 W, -0.5 mbar) of argon or oxygen for 12 min each. Surface structure was investigated by scanning electron microscopy, confocal microscopy and X-ray photoelectron spectroscopy (XPS). Hydrophilicity was assessed by dynamic contact angle measurement. Cell attachment, viability, cell proliferation and cytotoxicity were assessed in vitro using murine osteoblast-like cells.
UV irradiation or NTP treatment of titanium surfaces did not alter the surface structure. XPS analysis revealed a significantly increased oxidation of the surface and a decrease of carbon after the use of either method. NTP and UV light led to a significant better cell attachment of murine osteoblasts; significantly more osteoblasts grew on the treated surfaces at each time point (p < 0.001).
UV light as well as NTP modified the surface of titanium and significantly improved the conditions for murine osteoblast cells in vitro. However, results indicate a slight advantage for NTP of argon and oxygen in a short time interval of surface functionalization compared to UV.
UV light and NTP are able to improve surface conditions of dental implants made of titanium.
Particulate matter with size less than or equal to 2.5 μm (PM2.5) samples were collected from an urban site Pune, India, during April 2015 to April 2016. The samples were analyzed for various chemical constituents, including water soluble inorganic ions, organic carbon (OC), and elemental carbon (EC). The yearly mean total mass concentration of PM2.5 at Pune was 37.3 μg/m3, which is almost four times higher than the annual WHO standard (10 μg/m3), and almost equal to that recommended by the Central Pollution Control Board, India (40 μg/m3). Measured (OC, EC) and estimated organic matter (OM) were the dominant component (56 ± 11%) in the total particulate matter which play major role in the regional atmospheric chemistry. Total measured inorganic components formed about 35% of PM2.5. Major chemical contributors to PM2.5 mass were OC (30%), SO42− (13%), and Cl− and EC (9% each). The high ratios of OC/EC demonstrated the existence of secondary organic carbon. The air mass origin and correlations between the various components indicate that long range transport of pollutants from Indo-Gangetic Plain (IGP) and Southern part of the Arabian Peninsula might have contributed to the high aerosol mass during the dry and winter seasons. To our knowledge, this is the first systematic study that comprehensively explores the chemical characterization and source apportionment of PM2.5 aerosol speciation in Pune by applying multiple approaches based on a seasonal perspective. This study is broadly applicable to understanding the differences in anthropogenic and natural sources in the urban environment of particle air pollution over this region.
Publication date: Available online 20 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Kimberley A. Wattchow, Michelle N. McDonnell, Susan L. Hillier
ObjectiveTo investigate the therapeutic interventions reported in the research literature, and synthesize their effectiveness in improving upper limb (UL) function in the first four weeks post-stroke.Data sourcesElectronic databases, trial registries and hand searching was conducted, from inception until June 2016.Study selectionRandomised controlled trials (RCTs), controlled trials and interventional studies with pre/post-test design were included for adults within four weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared to usual care, sham or another technique.Data extractionTwo reviewers independently assessed eligibility of full texts, and methodologic quality of included studies using the Cochrane 'Risk of bias tool'.Data synthesis104 trials (83 RCTs, 21 non-randomised studies) were included (n=5,225 participants). Meta-analyses of RCTs only (20 comparisons), and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardised mean difference, SMD 1.09, 95% confidence intervals, CI 0.21, 1.97) and task-specific training (SMD 0.37, 95% CI 0.05 to 0.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported.ConclusionsUse of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase post-stroke. Further high quality studies into the initial four weeks post-stroke are needed to determine therapies for targeted functional UL outcomes.
http://ift.tt/2uL8ZNf
Publication date: Available online 19 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Carly S. Rivers, Nader Fallah, Vanessa K. Noonan, David GT. Whitehurst, Carolyn Schwartz, Joel Finkelstein, B. Catharine Craven, Karen Ethans, Colleen O'Connell, Catherine Truchon, Chester Ho, A. Gary Linassi, Christine Short, Eve Tsai, Brian Drew, Henry Ahn, Marcel F. Dvorak, Jérôme Paquet, Michael G. Fehlings, Luc Noreau
ObjectiveTo analyze relationships among injury, demographic and environmental factors on function, HRQoL and life satisfaction in individuals with traumatic SCI.Designprospective observational registry cohort studySetting31 acute and rehabilitation SCI centresParticipantsParticipants (N=340) from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) who were prospectively recruited from 2004-2014 were included. The model cohort included 340 participants: 79.1% were male; mean age was 41.6 (±17.3SD); and 34.7% were motor/sensory complete (AIS A).InterventionsnoneMain Outcome MeasuresPath analysis was used to determine relationships among SCI severity [ASIA Impairment Score (AIS) and anatomical level (cervical/thoracolumbar)], age at injury, education, number of HCs, functional independence [Functional Independence Measure (FIM) motor score], HRQoL [Short Form-36V2 physical (PCS) and mental (MCS) component scores], and life satisfaction [Life Satisfaction-11 (LiSat-11)]. The analysis was conducted using Mplus version 7.1; model fit was assessed using recommended published indices.ResultsGood model fit was supported by all indices, indicating the model results closely matched the RHSCIR data. Higher age, higher severity injuries, cervical injuries, and more HCs negatively affected FIM motor, while employment had a positive effect. Higher age, less education, more severe injuries (AIS A-C), and more HCs negatively correlated with PCS (worse physical health). More HCs were negatively correlated with a lower MCS (worse mental health), however were positively associated with reduced function. Being married and higher function positively affected Lisat-11, but more HCs had a negative effect.ConclusionsComplex interactions and enduring impacts of HCs following SCI have a negative impact on function, HRQoL and life satisfaction. Modeling relationships among these types of concepts will inform clinicians how to positively impact outcomes following SCI; for example, development of screening tools and protocols for managing individuals with traumatic SCI who have multiple HCs.
http://ift.tt/2u9VvHY
Publication date: Available online 20 July 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jennifer H. Marwitz, Adam P. Sima, Jeffrey S. Kreutzer, Laura E. Dreer, Thomas F. Bergquist, Ross Zafonte, Douglas Johnson-Greene, Elizabeth R. Felix
ObjectiveTo evaluate the trajectory of resilience during the first year following a moderate-severe TBI, factors associated with resilience at 3, 6 and 12-months post-injury, and changing relationships over time between resilience and other factors.DesignLongitudinal analysis of an observational cohort.SettingFive inpatient rehabilitation centers.ParticipantsPatients with TBI (N = 195) enrolled in the resilience module of the TBI Model Systems study with data collected at 3, 6, and 12-month follow-up.InterventionsNot applicable.Main Outcome MeasureConnor-Davidson Resilience Scale.ResultsInitially, resilience levels appeared to be stable during the first year post-injury. Individual growth curve models were used to examine resilience over time in relation to demographic, psychosocial, and injury characteristics. After adjusting for these characteristics, resilience actually declined over time. Higher levels of resilience were related to non-minority status, absence of pre-injury substance abuse, lower anxiety and disability level, and greater life satisfaction.ConclusionsResilience is a construct that is relevant to understanding brain injury outcomes and has potential value in planning clinical interventions.
http://ift.tt/2uKQc4P
Publication date: Available online 30 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Mehdi Jafari, Farid Bahrpeyma, Manijhe Mokhtari-Dizaji, Azadeh Nasiri
IntroductionMyofascial trigger points (MTrPs) are one of the most common and important causes of musculoskeletal pain. Ultrasound is a useful modality in examining musculoskeletal disorders. By applying compressive stress and observing changes in ultrasound images, the elastic modulus (Young's modulus) can be calculated. Our objective was to develop a novel method to distinguish MTrPs from normal tissues.MethodsA total of 29 subjects with MTrP in the sternocleidomastoid muscle were assessed. A force gauge was attached to a transducer to obtain stress levels. To obtain strain, images were recorded in both with stress and without stress states. By dividing the stress level by the measured strain, the elastic modulus was determined.ResultsElastic modulus in MTrPs and the normal part of the muscle were measured to be 13379.57 ± 1069.75Pa and 7078.24 ± 482.92Pa, respectively (P = 0.001). This indicated that MTrPs were stiffer than normal parts of the muscle.ConclusionThis study presents a new method for the quantitative measurement of the elastic modulus of MTrP, thereby distinguishing MTrPs from normal adjacent muscular tissue, with more simplicity and lower cost, compared to other ultrasound methods.
http://ift.tt/2uw4aDE
Publication date: Available online 27 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Rasool Bagheri, Mohammad Reza Pourahmadi, Ali Reza Sarmadi, Ismail Ebrahimi Takamjani, Giti Torkaman, Sayyed Hamed Fazeli
ObjectiveThis study aimed to evaluate the effects of kinesiology tape, anesthesia, and kinesiology tape along with anesthesia, on motor neuron excitability.ParticipantsParticipants included 20 healthy men aged 20–35 years, who were examined over 5 sessions.InterventionThe five experimental sessions included: control without applying the kinesiology tape or Eutectic Mixture of Local Anesthetics (EMLA); treatment only with EMLA; only kinesiology tape application; only sham tape application; and treatment with kinesiology tape and EMLA.Main outcome measuresThe H-reflex recruitment curve of the soleus and lateral gastrocnemius was recorded by a blinded assessor in the 5 separate sessions randomly assigned with 48 h washout periods. The major H-reflex parameters include: the Hmax/Mmax ratio, the H-reflex threshold stimulation intensity (Hth), the intensity of maximum H-reflex (IntensityHmax), the H-reflex ascending slope (Hslp), and the H-reflex ascending slope fixed into the first three points (first Hslp).ResultsThe H-reflex parameters (H slope, first Hslp, Hth, and IntensityHmax) were facilitated by application of the kinesiology tape with and without EMLA; however, EMLA inhibited the H-reflex parameters (Hmax/Mmax ratio, Hslp, first Hslp, and Hth) in both the soleus and lateral gastrocnemius. The sham tape did not alter the H-reflex recruitment curve parameters. The statistical model revealed a significant difference between the kinesiology tape and the sham tape and control sessions, between kinesiology tape–EMLA and EMLA, and between kinesiology tape–EMLA and control session.ConclusionsResults suggest that the kinesiology tape facilitates the muscle activity and the underlying mechanism on the gastrosoleus motor neuron pool involves the cutaneous receptors.
http://ift.tt/2tpwStd
Publication date: Available online 24 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Warrick McNeill
http://ift.tt/2tIaAzF
Publication date: Available online 24 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Lucy Whyte Ferguson
This article reports on an observational and treatment case series involving 22 adolescents and preadolescents treated over a 15 year period who had or appeared to be developing idiopathic scoliosis (IS). Common patterns of muscle and fascial asymmetry were observed and treated. Most of these individuals had spinal area pain and the trigger points (TrPs) apparently responsible for this pain were located in muscles at some distance from the spine, yet referred pain to locations throughout the thoracolumbar spine. Asymmetries in tension in these muscles appear to tether the spine in such a way as to contribute to scoliotic curvatures. The most common pattern of asymmetrical muscle tension found in these individuals follows a particular spiral fascial plane and as the fascia in this spiral plane tightened, the scoliotic curvature appeared to increase. Evaluation also showed that 21 of 22 of these individuals have major ligamentous laxity and this may also have contributed to the development of scoliotic curvatures. Furthermore, each of these individuals has marked overpronation of the ankles, with arches that totally collapse when weight-bearing. Based on observation during the care of these 22 subjects, it appears that asymmetry in the degree of pronation may, in some individuals, be a contributing factor in the development of the spiral body organization involved in the development of scoliosis. Common patterns of joint dysfunction were also observed in many of these individuals. There were also some findings of significant muscle weaknesses that appeared to contribute to the development of the spiraling body organization. Treatment of the tethering of the spine from myofascial asymmetries and related joint dysfunction not only resulted in elimination of pain in almost all cases but also, in many cases resulted in significant reduction of scoliotic curvatures including reductions of rib humps. In other cases, it resulted in stabilization of scoliotic curvatures, and in some cases it may have slowed the rate of progression of curvatures. Stretching and strengthening exercises appeared to contribute to the stability of treatment gains. A segment of the treated population had atypical scoliotic curvatures that did not follow the typical spiral pattern. Even in these individuals, there were significant patterns of fascial restriction and joint dysfunction accompanying the curvatures. Prior traumatic injury was a common factor in almost all of these atypical cases. Treatment of myofascial TrPs and asymmetrical fascial tension and accompanying joint dysfunction is proposed as a useful approach to treating pain in adolescents who have or who appear to be developing scoliosis and to treating and controlling and/or decreasing many scoliotic curvatures. This case series is presented as a way to illuminate possible factors in the development of scoliosis and promising treatment strategies to address these factors and to eliminate pain and stabilize or decrease curvatures so that further research can more systematically evaluate the role of these factors. An addendum of two more cases is also included, because of the information that these cases add to the discussion and to treatment approaches. Including the addendum cases, 8 of the subjects had scoliosis as documented by x-rays. The other 16 appeared to be developing scoliosis according to criteria stated below.
http://ift.tt/2t8mDsX
Publication date: Available online 23 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Warrick McNeill
This short practical article suggests that for those unused to ground living, increasing their time spent in sitting or kneeling postures may improve their adaptation of their passive and active joint structures by using low stools, mats, blocks, yoga bricks, bolsters/cushions, and rolled towels. A very slow approach to adaptation and a deliberate reduction of extremes of available lower limb joint range, in the beginning of the process, is likely to reduce possible tissue overload injury risk.
http://ift.tt/2tCEtBl
Publication date: Available online 4 July 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): G. Shankar Ganesh, Mamata Manjari Sahu, Pramod Tigga
BackgroundThe etiopathogenesis of orofacial pain remains complex and a number of pain referral patterns for this region have been reported in the literature. The purpose of this report is to describe the assessment and successful clinical management of orofacial pain possibly attributable to cervical origin.Case descriptionA 55-year-old male teacher with a 3-year history of pain in the right lower jaw, radiating to the ear, consulted our institute for assessment and management. The patient was unsuccessfully treated for dental pain and trigeminal neuralgia. The patient's functioning was grossly limited and the patient was unable to sleep because of severe pain. Current and previous medical and physical examinations revealed no infection, malignancies, or sinusitis. Palpation revealed no temporomandibular disorder, tenderness or myofascial trigger points. Examination of the cervical range of motion showed a reduction in rotation to the right side. The patient was treated for upper cervical joint dysfunction involving mobilization of the first three cervical vertebrae and motor control exercises. The patient had an almost complete resolution of symptoms and reported significant improvement in the Patient Specific Functional Scale (PSFS) and the Global Rating of Change (GRC) scale.ConclusionThis case study demonstrates the importance of considering, assessing and treating the cervical spine as a possible source of orofacial pain, and the positive role of cervical mobilization on these disorders.
http://ift.tt/2tJjIXV
Publication date: Available online 23 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Clarissa Matheis, Thomas Stöggl
Study designRandomized controlled trial.ObjectivesTo improve hip function by an additional targeted mobilization and strength training of the hip muscles within the first postoperative week following a total hip arthroplasty (THA) in contrast to standard physiotherapy.BackgroundThe aim of early postoperative physiotherapy is to improve the functioning of the artificial hip joint as well as the restoration of mobility and independence of the patient. Minimally invasive surgical techniques allow early mobilization with immediate full weight-bearing.Methods39 patients were divided into an intervention (IG) and control group (CG). After implantation of THA the CG completed standard physiotherapy, while the IG had an intensified active treatment with additional mobilization and strength training. Passive range of motion (flexion, extension, abduction), thigh circumference, holding force of the gluteal muscles, one-leg stance, covered distance walked in 6-min and subjective parameters were tested one day before and six days after surgery.ResultsImprovements in IG compared to CG were recorded in range of motion (flexion p < 0.01, extension p < 0.001, abduction p < 0.01) and gait performance (p < 0.001). No differences between groups were detected as regard thigh circumference, holding force of the gluteal muscles, one-leg stance and subjective parameters. Deterioration in IG compared to CG did not occur.ConclusionAn additional, targeted mobilization and strength training of the hip muscles with full weight-bearing, which begins at the 3rd day after implantation of a THA is tolerated well and improves within one week hip range of motion and gait performance compared to standard physiotherapy.
http://ift.tt/2tHThyJ
Publication date: Available online 21 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Lucas Ithamar, Alberto Galvão de Moura Filho, Marco Aurélio Benedetti Rodrigues, Kelly Cristina Duque Cortez, Vinícius Gomes Machado, Claudia Regina Oliveira de Paiva Lima, Eduarda Moretti, Andrea Lemos
IntroductionAbdominal hypopressive gymnastics appeared as an alternative to traditional abdominal exercises to promote abdominal muscles strength without overloading the pelvic floor muscles (PFM). To determine the activation level of abdominal muscles and PFM and the posture influence in the level of activation in these muscles during abdominal hypopressive gymnastics, we used surface electromyography in young and healthy multipara women.MethodsThis is an observational study with eutrophic nulliparous women aged between 18 and 35 years, with abdominal skinfold less than or equal to 3 cm and active or irregularly active physical activity. Surface electromyography was used for rectus abdominis, external oblique, transversus abdominal/internal oblique (TrA/IO) and PFM assessment in the supine, quadruped and orthostatic (upright standing) positions during abdominal hypopressive gymnastics using normalized electromyographic (%EMG) data. We also analyzed the difference in activation between each muscle and between muscles and positions.ResultsThirty women were evaluated and the mean age was 25.77 years (SD 3.29). The group formed by the TrA/IO muscles and the PFM showed higher %EMG in all the positions assessed, followed by the external oblique and rectus abdominis muscles. A comparison of %EMG of each muscle between the different positions showed differences only in rectus abdominis between the supine and quadruped (p = 0.001) and supine and orthostatic positions (p = 0.004), and in TrA/IO between the supine and orthostatic (p = 0.023) and orthostatic and quadruped positions (p = 0.019).ConclusionsThe results suggest that abdominal hypopressive gymnastics can activate the abdominal muscles and PFM and the position do not have influence on electromyographic activation level of the PFM and external oblique.
http://ift.tt/2swt1ZJ
Publication date: Available online 21 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Sarah Orner, Wolfgang Kratzer, Julian Schmidberger, Beate Grüner
ObjectiveThe aim of the study was to examine the quantitative tissue properties of the Achilles tendon and plantar fascia using a handheld, non-invasive MyotonPRO device, in order to generate normal values and examine the biomechanical relationship of both structures.DesignProspective study of a large, healthy sample population.ParticipantsThe study sample included 207 healthy subjects (87 males and 120 females) for the Achilles tendon and 176 healthy subjects (73 males and 103 females) for the plantar fascia. For the correlations of the tissue parameters of the Achilles tendon and plantar fascia an intersection of both groups was formed which included 150 healthy subjects (65 males and 85 females).InterventionsAll participants were measured in a prone position. Consecutive measurements of the Achilles tendon and plantar fascia were performed by MyotonPRO device at defined sites.ResultsFor the left and right Achilles tendons and plantar fasciae all five MyotonPRO parameters (Frequency [Hz], Decrement, Stiffness [N/m], Creep and Relaxation Time [ms]) were calculated of healthy males and females. The correlation of the tissue parameters of the Achilles tendon and plantar fascia showed a significant positive correlation of all parameters on the left as well as on the right side.ConclusionsThe MyotonPRO is a feasible device for easy measurement of passive tissue properties of the Achilles tendon and plantar fascia in a clinical setting. The generated normal values of the Achilles tendon and plantar fascia are important for detecting abnormalities in patients with Achilles tendinopathy or plantar fasciitis in the future. Biomechanically, both structures are positively correlated. This may provide new aspects in the diagnostics and therapy of plantar fasciitis and Achilles tendinopathy.
http://ift.tt/2s10sjz
Publication date: Available online 21 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Hamid Reza Bokaeian, Amir Hoshang Bakhtiary, Majid Mirmohammadkhani, Jamileh Moghimi
It is believed that Quadriceps strength training may reduce pain and improve functional activity in patients with knee osteoarthritis (OA). This improvement is generally attributed to an increase in quadriceps strength. This study investigated whether quadriceps muscle strength increases with decreasing pain, improving functional activity in knee OA. Twenty-four patients with knee OA participated in an 8-week treatment protocol including traditional physical therapy and strength training 3 sessions per week. Measurements were conducted before and after the intervention and included the peak torque of quadriceps muscle, pain by visual analogue scale (VAS), short Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and functional activity by the 2 minute walking test (2MWT) and time up & go test (TUGT). After the intervention, analysis of data illustrated that changes in quadriceps muscle strength correlated with changes in VAS (r2 = 0.310, p = 0.005), WOMAC (r2 < 0.278, p < 0.008) and 2MWT (r2 < 0.275, p < 0.009) significantly, although the correlation slope was negligible. No correlation was found between muscle strength and TUGT. However, the strength training significantly improved quadriceps muscle strength (p = 0.013), pain and functional activity (p = 0.000). This study showed that reduction in pain and improvement in functional activity occurs independently from an increase in quadriceps muscle strength in knee OA. It seems that increased quadriceps muscle strength may not be a cause of improvement in pain and functional activity in knee OA.
http://ift.tt/2stqK1e
Publication date: Available online 21 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Vanessa Sanders Curi, Helder Miguel Fernandes, José Vilaça, Aline Nogueira Haas
The aim of this study was to determine the effects of Pilates-based mat exercises on functional autonomy and life satisfaction among elderly women. A randomized controlled trial was conducted in Caxias do Sul, Brazil in 2015, in which 61 healthy older women were randomized into two groups (experimental group, EG = 31 participants with 64.25 mean years of age, SD = 0.14, and a control group, CG = 30 participants, 63.75 mean years of age; SD = 0.08). The EG participants performed the mat Pilates twice per week, 60-minutes per session. The same measurements were performed at baseline and after 16 weeks. No significant differences were found between groups at baseline (p > 0.05). In the EG, the following factors were increased after the 16-weeks training period: flexibility of lower limbs, flexibility of upper limbs, strength in lower and upper limbs, aerobic endurance and dynamic balance. This study revealed significant improvements on the life satisfaction scale's score for the EG when compared to the CG, after 16 weeks of intervention. No differences were found between baseline and after 16 weeks on the functional autonomy and life satisfaction scores for the CG. According to the results of this study, it was found that functional autonomy and life satisfaction for elderly women was improved after exposure to 16 weeks of the PM, suggesting this practice helps with healthy aging.
http://ift.tt/2rYGFkG
Publication date: Available online 19 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): D. Origo, A.G. Tarantino, A. Nonis, L. Vismara
BackgroundCoccydynia is a disorder associated with pain/discomfort at the base of the spine. The role of osteopathic manipulative treatment (OMT) in chronic coccydynia as well as for low back pain (LBP) and radicular pain (RP) associated with coccydynia, has not previously been investigated. This study seeks to analyse the effects of OMT on chronic coccydynia compared to physical therapy and pharmacological treatment (PTPT). The secondary objective is to analyse the effect of OMT on LBP and RP associated with coccydynia.MethodsClinical records of 50 patients were examined. These patients (aged 39.94 ± 15.34 years, BMI 21.22 ± 3.15) who complained of chronic coccydynia were assessed 3 times: before any treatment (t0), after PTPT (t1) and after OMT (t2). Patients were treated with PTPT during the first 3 months and then referred by physicians to osteopaths to receive 3 sessions of OMT over a period of 5 weeks. The outcome measurements were made by a visual analogue scale (VAS 0–10 cm) and the Oswestry Low Back Pain Disability Questionnaire.ResultsBefore starting OMT treatment, patients showed a stable condition of coccydynia (mean VAS values from 7.1 to 6.5 p = 0.065) and a slight but significant reduction in disability (mean OD values from 17.7 to 14.5 p = 0.017) after PTPT. After the 3 sessions of OMT, all subjects gained a successful reduction in pain (mean VAS values from 6.5 to 1.2, p ≤ 0.001) and demonstrated a higher significant reduction in disability (mean Oswestry scale values from 14.5 to 2.5, p < 0.001).ConclusionsThis case series shows that OMT elicits a positive benefit for pain relief and reduction in disability in patients complaining of coccydynia (with or without LBP and RP associated with coccydynia). Therefore, OMT could be considered as a valid therapeutic approach for treating chronic coccydynia. Nevertheless, further research is required to test the hypothesis and to better determine the benefits of OMT.
http://ift.tt/2rSgHPT
Publication date: Available online 17 June 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): AmirAli Jafarnezhadgero, Morteza Madadi Shad, Mahdi Majlesi, Matteo Zago
ObjectiveTherapeutic lateral knee joint muscle taping potentially offers a low-risk, economical and effective alternative for the clinical treatment of light to moderate knee overload, due to misalignment in patients with genu varum. In this study, we aimed at investigating the immediate effect of lateral knee joint muscular kinesio taping on lower limb joint powers, during the stance phase of walking, in individuals with genu varum.MethodsFifteen male subjects with genu varum misalignment (age: 24.2±3.7 years) participated in the study. Subjects performed three walking trials without, and three with, biceps femoris and vastus lateralis kinesio taping. The three-dimensional position coordinate data of reflective markers were collected at 100 Hz using a six-cameras Vicon system (Motion Analysis Corp., UK). Additionally, two Kistler force plates (Kistler AG, Winterthur, Switzerland) were used to record the Ground Reaction Forces (GRF) components at 1000 Hz during stance phase of walking. A three-way ANOVA with post-hoc testing (using paired samples Student's t-test with Bonferroni correction) was performed to compare the power values of lower limb joints before and after the use of KT.ResultsWith kinesio taping, we observed that the average negative power increased at the ankle level in dominant limb, (P<0.05, 10-20% of gait cycle, GC), and at the knee level in both limbs (10-20% and 60-80% GC). Further, average negative power of the non-dominant knee joint (80-100% GC) and positive power of the non-dominant hip joint (60-80% GC) significantly reduced (P<0.05) in kinesio taping condition.ConclusionThe biomechanical analysis of joint power during walking using kinesio taping provided essential information about the possible mechanisms involved in gait analysis with this intervention in adults with genu varus.
http://ift.tt/2snCSAT
The aim of this study was to analyze the mechanisms, stoichiometry, and stability of 4-chlorophenol (4CP) biodegradation kinetics by phenol-acclimated activated sludge using open respirometry. While the removal of 4CP was higher than 98%, the removal of chemical oxygen demand (COD) ranged between 69 and 79% due to the accumulation of an intermediate metabolite. The value obtained from respirometric profiles for the stoichiometric ratio of O2 to 4CP (YO2/4CP) was 1.95 ± 0.04 mol of oxygen consumed per mol of 4CP removed. This YO2/4CP value reflected the action of the oxygenases responsible for the first steps of the aerobic oxidation of 4CP. The 4CP degradation activity decreased noticeably when successive pulses of 4CP were added to the respirometer. A mathematical model was developed to represent the aerobic biodegradation of 4CP. The fitted model adequately predicted the oxygen consumption rate, total phenols, and soluble COD concentrations as a function of time. The results presented could help to predict the dynamic of biodegradation of chlorophenols in a biological wastewater treatment system.
The reconstruction of soft tissue defects in the distal third of the leg and ankle joint remains a challenge for reconstructive surgeons. Presently, the distally based neurocutaneous flaps are the predominant surgical alternatives to free tissue transfer. In this article, we describe our experience with the distally based saphenous neurocutaneous flap for reconstructing soft tissue defects in this region.
A retrospective review of all patients who underwent reconstruction of the leg distal third and ankle joint at our department from January 1996 to June 2016 was carried out. Only patients who underwent reconstructive surgery for acute traumatic injuries were included. The fasciocutaneous pedicle was 3–4 cm wide, and the anatomical structures consisted of the superficial and deep fascia, saphenous nerve, greater saphenous vein and their accompanying vessels together with an islet of subcutaneous cellular tissue and skin. The size of skin islands ranged from 5–7 to 10–14 cm2.
A total of 170 patients (142 men and 28 women) were included in this study. The mean follow-up period was 3 months. All flaps survived with partial necrosis in three patients. Severe venous congestion occurred only in five patients. However, the flap was eventually salvaged after limb elevation and interrupted bloodletting. All donor sites were closed using split-skin grafting.
The reverse saphenous neurocutaneous flap proved to be a reliable and efficient method for reconstructing soft tissue defects in the distal third of the leg and ankle joint.
Level of Evidence: Level IV, therapeutic study
Publication date: December 2017
Source:Current Opinion in Neurobiology, Volume 47
Author(s): Lucy J Brooks, Simona Parrinello
Glioblastoma (GBM) are aggressive and therapy-resistant brain tumours driven by glioma stem-like cells (GSCs). GSC behaviour is controlled by the microenvironment, or niche, in which the cells reside. It is well-established that the vasculature is a key component of the GSC niche, which drives maintenance in the tumour bulk and invasion at the margin. Emerging evidence now indicates that the specific properties of the vasculature within these two regions impose different functional states on resident GSCs, generating distinct subpopulations. Here, we review these recent findings, focusing on the mechanisms that underlie GSC/vascular communication. We further discuss how plasticity enables GSCs to respond to vascular changes by interconverting bidirectionally between states, and address the therapeutic implications of this dynamic response.
http://ift.tt/2ucKAPk
Publication date: September 2017
Source:NeuroImage, Volume 158
Author(s): Michael M. Bannert, Andreas Bartels
A central problem in color vision is that the light reaching the eye from a given surface can vary dramatically depending on the illumination. Despite this, our color percept, the brain's estimate of surface reflectance, remains remarkably stable. This phenomenon is called color constancy. Here we investigated which human brain regions represent surface color in a way that is invariant with respect to illuminant changes. We used physically realistic rendering methods to display natural yet abstract 3D scenes that were displayed under three distinct illuminants. The scenes embedded, in different conditions, surfaces that differed in their surface color (i.e. in their reflectance property). We used multivariate fMRI pattern analysis to probe neural coding of surface reflectance and illuminant, respectively. While all visual regions encoded surface color when viewed under the same illuminant, we found that only in V1 and V4α surface color representations were invariant to illumination changes. Along the visual hierarchy there was a gradient from V1 to V4α to increasingly encode surface color rather than illumination. Finally, effects of a stimulus manipulation on individual behavioral color constancy indices correlated with neural encoding of the illuminant in hV4. This provides neural evidence for the Equivalent Illuminant Model. Our results provide a principled characterization of color constancy mechanisms across the visual hierarchy, and demonstrate complementary contributions in early and late processing stages.
http://ift.tt/2vlm8d8
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Characterization of Candidate probionts isolated from human breast milk.
Cell Mol Biol (Noisy-le-grand). 2017 May 20;63(5):82-88
Authors: Khalkhali S, Mojgani N
Abstract
This study was designed to isolate and identify the potential probionts present in 32 healthy mothers' breast milk. Microbial culture media and 16SrRNA sequencing were used to isolate and identify the bacteria and all isolates were analyzed for their antagonistic potential, resistance to acidic pH, bile salts and survival under simulated gastric and intestinal conditions. The colonization potential was further assessed based on adherence to human enterocyte-like Caco-2 cell lines. The breast milk samples harbored significant numbers of Gram positive and catalase negative (85%) bacteria. Based on 16SrRNA sequencing, these isolates were identified as Lactobacillus casei, L.gasseri, L.fermentum, L.plantarum, Pediococcus acidilactici, and Enterococcus facieum. Among the isolates, P. acidilactici was the most frequent species (71%) present in these samples. Few Gram and catalase positive isolates, Staphylococcus aureus and S.hominiis were also observed. The isolates were viable and unviable in pH 3 and 1.5, respectively, while all isolates survived in 1.0% bile salt. As putative probionts, P.acidilactici 1C showed a significantly higher percentage of adhesion to Caco-2 cells (p< 0.05)than the other two isolates L.plantarum 7A and E.facieum 2C. Bacterial strains isolated from human breast milk were shown to have probiotic properties including anti-infective protection and may be considered as future therapeutics for infants.
PMID: 28719350 [PubMed - in process]
Exp Clin Endocrinol Diabetes 2017; 125: 478-484
DOI: 10.1055/s-0043-109699
Background Vitamin D deficiency represents a global health problem, affecting children and adolescents worldwide. Objects To confirm that vitamin D deficiency can present as a spectrum of clinical pictures. Methods We diagnosed nutritional rickets in a 10-month-old infant of Senegal origin with several risk factors for vitamin D deficiency. As many of these factors affected also his cohabitant relatives, we evaluate infant's family members (mother and 4 brothers) looking for other vitamin D deficiency-related comorbidities. Results 3 brothers had asymptomatic vitamin D deficiency and 2 of them (9.8 and 13.4 years-old) showed secondary hyperparathyroidism. The fourth brother (11.3 years-old) had nutritional rickets. Their mother was affected by osteomalacia. None of them received vitamin D supplementation. Conclusion Vitamin D deficiency may present as a spectrum of clinical pictures, representing a continuum ranging from asymptomatic/subtle conditions to overt rickets/osteomalacia. Immigrant families are at high risk for vitamin D deficiency at every age. If a case of symptomatic vitamin D deficiency is recognized, then the evaluation of the all family members is recommended, as they can have the same and/or other risk factors for vitamin D deficiency.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
Exp Clin Endocrinol Diabetes 2017; 125: 485-491
DOI: 10.1055/s-0043-103965
Reports on neuroprotective effects of Insulin-like growth factor-1 (IGF-1) and Insulin-like growth factor binding protein-3 (IGFBP-3) in ischemic brain tissue are inconsistent. The aim of this study was to determine if plasma levels of IGF-1 and IGFBP-3 in acute stroke patients are indicative of 3 months functional outcome. Plasma levels were measured via chemiluminescence immunoassay in heparin blood samples of patients included in the EARLY trial (NCT00562588). Plasma samples were drawn on admission and 8 days post-stroke. Neurological deficits were assessed via modified Rankin Scale (mRS) 3 months post-stroke, resulting in favorable (mRS=0–2) or unfavorable (mRS=3–6) outcome. A multiple binary logistic regression including IGF-1 and IGFBP-3 levels and confounders was conducted. Out of 404 included patients, 89 patients had an unfavorable outcome. Mean mRS on admission as well as 3 months post-stroke was 2 (±1). Low IGF-1 levels (day 8) were independently associated with a decreased risk of an unfavorable outcome (OR 0.61; 95%CI 0.37–0.99; p=0.044). Low IGFBP-3 levels (day 8) were independently associated with an unfavorable outcome (OR 2.75; 95%CI 1.56–4.84; p<0.001). Low IGFBP-3 levels and high IGF-1 levels in the subacute phase are predictive of unfavorable outcome 3 months after stroke.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
Exp Clin Endocrinol Diabetes 2017; 125: 419-435
DOI: 10.1055/s-0043-103969
For patients with type 2 diabetes mellitus, glucagon-like peptide-1 receptor agonists (GLP-1RAs) generally exert robust glucose-lowering effects that are at least as effective as insulin. As monotherapies, changes from baseline in HbA1c with GLP-1RAs ranged from –1.9 to –0.7% in phase 3 trials. In addition, GLP-1RAs confer a low risk of hypoglycaemia and have a body-weight advantage (changes from baseline ranging from –4.0 to –0.4 kg). There is also evidence of significant reductions in risk for cardiovascular events with some of these agents, with a number of other trials underway. Gastrointestinal adverse events typically increase with GLP-1RAs, although these are generally mild to moderate in intensity and rarely require treatment discontinuation. The GLP-1RAs that are commercially available or in development vary in structure and pharmacokinetics. These differences affect the frequency of administration and can also affect their relative efficacy and safety. This review summarizes the findings of phase 3 glycaemic control trials of available GLP-1RAs and considers them in the context of the distinct clinical needs of individual patients.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
Impaired sleep quality and quantity are associated with future morbidity and mortality. Exercise may be an effective non-pharmacological intervention to improve sleep, however, little is known on the effect of resistance exercise. Thus, we performed a systematic review of the literature to determine the acute and chronic effects of resistance exercise on sleep quantity and quality. Thirteen studies were included. Chronic resistance exercise improves all aspects of sleep, with the greatest benefit for sleep quality.
http://ift.tt/2trYLB9
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
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In order to assist and optimize the operation of a clean water diversion project for the medium-sized inland rivers in Chaohu, China, an integrated hydrodynamic and water quality model was used in this study. Sixteen diversion scenarios and five sewage interception scenarios were defined to assess the improvement of water quality parameters including ammonia nitrogen (NH3-N), total phosphorus (TP) and chemical oxygen demand (COD) under different diverted water flows, diverting times, diverting points, diverting routines and sewage interception proportions. An index of pollutant removal rate per unit diverted water flow (PRUWF) was proposed to evaluate the effect of the clean water diversion. Results show that operating conditions played important roles in water quality improvement of medium-sized inland rivers. The optimal clean water diversion was operated under the conditions of a flow rate of 5 m3/s for 48 h with an additional constructed bridge sluice. A global sensitivity analysis using the Latin Hypercube One-Factor-at-a-Time (LH-OAT) method was conducted to distinguish the contributions of various driving forces to inland river water restoration. Results show that sewage interception was more important than diverted water flow and diverting time with respect to water quality improvement, especially for COD.
The aim of this study was to evaluate the effects of photobiomodulation (PBM) on cancellous bone in rat models of ovariectomized induced osteoporosis (OVX-D) and glucocorticoid-induced osteoporosis (GIOP). The experiment comprised of nine groups. A group of healthy rats was used for baseline evaluations. The OVX-D rats were further divided into groups as follows: control rats with osteoporosis, OVX-D rats that received alendronate (1 mg/kg 60 days), OVX-D rats treated with pulsed wave laser (890 nm, 80 Hz, 900 s, 0.0061 W/cm2, 5.5 J/cm2, three times a week, 60 days), and OVX-D rats treated with alendronate + pulsed laser. Dexamethasone was administered to the remaining rats that were split into four groups: control, alendronate-treated rats, laser-treated rats, and GIOP rats treated with alendronate + laser. T12, L1, L2, and L3 vertebrae were subjected to laser. Results of the current study demonstrated that OVX-D and GIOP significantly decreased some stereological parameters, and type 1 collagen gene expression compared to the healthy group. There was a significant increase in osteoclast number in both OVX-D and glucocorticoid administration compared to the healthy group. However, the detrimental effect of the OVX-D procedure on bone was more serious than glucocorticoid administration. Results showed that laser alone had a detrimental effect on trabecular bone volume, and cortical bone volume in groups GIOP and OVX-D compared to those in the healthy group. Alendronate significantly improved total vertebral bone volume, trabecular bone volume, and cortical bone volume, in GIOP and OVX-D groups compared to the laser-treated groups. Furthermore, the alendronate + laser in OVX-D rats and GIOP rats produced significantly increased osteoblast number and type 1 collagen gene expression and caused a significant decrease in osteoclast number compared to the controls.
Publication date: Available online 19 July 2017
Source:Magnetic Resonance Imaging
Author(s): Zongying Lai, Xiaobo Qu, Hengfa Lu, Xi Peng, Di Guo, Yu Yang, Gang Guo, Zhong Chen
Accelerating the imaging speed without sacrificing image structures plays an important role in magnetic resonance imaging. Under-sampling the k-space data and reconstructing the image with sparsity constraint is one efficient way to reduce the data acquisition time. However, achieving high acceleration factor is challenging since image structures may be lost or blurred when the acquired information is not sufficient. Therefore, incorporating extra knowledge to improve image reconstruction is expected for highly accelerated imaging. Fortunately, multi-contrast images in the same region of interest are usually acquired in magnetic resonance imaging protocols. In this work, we propose a new approach to reconstruct magnetic resonance images by learning the prior knowledge from these multi-contrast images with graph-based wavelet representations. We further formulate the reconstruction as a bi-level optimization problem to allow misalignment between these images. Experiments on realistic imaging datasets demonstrate that the proposed approach improves the image reconstruction significantly and is practical for real world application since patients are unnecessarily to stay still during successive reference image scans.
The present study was aimed to determine whether trefoil factor family (TFF) peptides which were generally considered to be resistant to proteolysis could be digested by gingipains, a major proteinases produced by Porphyromonas gingivalis.
Recombinant human TFF1, TFF2, and TFF3 peptides were used as substrates. Gingipains including arginine gingipain (RgpB) and lysine gingipain (Kgp) were used as enzymes. Trypsin was used as a control protease. Matrix-assisted laser desorption/ionization with time-of-flight/time-of-flight (MALDI-TOF/TOF) and liquid chromatography mass spectrometry (LC-MS) were used for analyzing peptide mass signals and amino acid sequences of digested TFF peptides.
MALDI-TOF/TOF analyses demonstrated that Kgp, RgpB, and trypsin were able to cleave TFF1 and TFF2 peptides, resulting in different patterns of digested fragments. However, impurity in recombinant TFF3 peptide substrates affected the interpretations of enzymatic reaction by MALDI-TOF/TOF. LC-MS analyses demonstrated that identified fragments of TFF1, TFF2, and TFF3 from digestion by gingipains were similar to those by trypsin.
Using MALDI-TOF/TOF and LC-MS, the present study provides new information that gingipains containing trypsin-like activities are able to digest TFF peptides.
The proteolytic effects of gingipains on TFF peptides may be responsible for reduction of salivary TFF peptides in chronic periodontitis patients. Further investigations to determine the pathological effects of gingipains on TFF peptides in saliva and periodontal tissues of patients with chronic periodontitis would be of interest.
Publication date: Available online 18 July 2017
Source:Clinical Imaging
Author(s): Shuko Mashimo, Shotaro Chubachi, Akihiro Tsutsumi, Naofumi Kameyama, Mamoru Sasaki, Masahiro Jinzaki, Hidetoshi Nakamura, Koichiro Asano, John J. Reilly, Tomoko Betuyaku
ObjectivesTo investigate the relationship between small pulmonary vessels and extent of emphysema on CT in individual lungs with chronic obstructive pulmonary disease (COPD).MethodsForty-nine patients were included. The percentage of cross-sectional area of vessels <5mm2 (%CSA <5) and extent of emphysema were assessed.ResultsLess than half of the COPD patients demonstrated an inverse correlation between %CSA <5 and percentage of low attenuation area (LAA%). In the remaining patients, %CSA <5 was homogeneously distributed.ConclusionNot all patients with COPD demonstrated an inverse correlation of the distributions between %CSA <5 and LAA% in individual lungs.
http://ift.tt/2uDZajq
Publication date: Available online 19 July 2017
Source:Journal of Surgical Education
Author(s): Hsin-Yi Chiu, Yi-No Kang, Wei-Lin Wang, Hung-Chang Huang, Chien-Chih Wu, Wayne Hsu, Yiu-Shun Tong, Po-Li Wei
ObjectiveTo evaluate the effectiveness of a simulation-based flipped classroom in gaining the laparoscopic skills in medical students.DesignAn intervention trial.SettingTaipei Medical University Hospital, an academic teaching hospital.Participants and MethodsFifty-nine medical students participating in a 1-hour laparoscopic skill training session were randomly assigned to a conventional classroom (n = 29) or a flipped classroom approach (n = 30) based on their registered order. At the end of the session, instructors assessed participants' performance in laparoscopic suturing and intracorporeal knot-tying using the assessment checklist based on a modified Objective Structured Assessment of Technical Skills tool.ResultsStudents in the flipped group completed more numbers of stitches (mean [M] = 0.47; standard deviation [SD] = 0.507) than those in the conventional group (M = 0.10; SD = 0.310) (mean difference: 0.37; 95% CI: 0.114-582; p = 0.002). Moreover, students in the flipped group also had higher stitch quality scores (M = 7.17; SD = 2.730) than those in the conventional group (M = 5.14; SD = 1.767) (mean difference = 2.03; 95% CI: 0.83-3.228; p = 0.001). Meanwhile, students in the flipped group had higher pass rates for the second throw (p < 0.001), third throw (p = 0.002), appropriate tissue reapproximation without loosening or strangulation (p < 0.001), needle cut from suture under direct visualization (p = 0.004), and needle safely removed under direct visualization (p = 0.018) than those in the conventional group.ConclusionsComparing with traditional approach, a simulation-based flipped classroom approach may improve laparoscopic intracorporeal knot-tying skill acquisition in medical students.
http://ift.tt/2uE1Xcf
Publication date: Available online 18 July 2017
Source:Journal of Surgical Education
Author(s): Minh-Bao Mundschenk, Elizabeth B. Odom, Trina D. Ghosh, Grant M. Kleiber, Andrew Yee, Kamlesh B. Patel, Susan E. Mackinnon, Marissa M. Tenenbaum, Donald W. Buck
ObjectiveIn surgical education, the areas of focus and evaluation are skewed toward technical skill and operative knowledge; less emphasized is familiarity with the patient's medical history. The purposes of this study were to characterize how surgical trainees prepare for cases and to determine the comprehensiveness of their preparation.DesignA 27-question survey was created through a web-based software program and distributed to all resident physicians and fellows in the Departments of Surgery, Neurosurgery, and Otolaryngology at our institution. Survey responses were collected anonymously and analyzed. Institutional review board exemption was obtained.SettingThis study was performed at Washington University in St. Louis, Missouri, at an institutional hospital setting.ParticipantsThe survey was distributed to current surgical trainees at Washington University in St. Louis in the Departments of Surgery, Neurosurgery, and Otolaryngology. Further, 130 of 169 surgical residents and fellows completed the survey.ResultsMost respondents (96%) taught themselves case preparation. Only 57% of respondents reviewed the patients medical record before every surgery. Although most respondents (83%) felt they were prepared or very prepared from a patient-specific standpoint, only 24% felt that their handoff of a patient to on-call colleagues was comprehensive enough to include all pertinent aspects of a patient's history and expected perioperative course. From a technical perspective, most residents (63%) felt they were prepared or very prepared, and this level of comfort increased with postgraduate year; 76% of respondents would not feel comfortable telling their attending they were not adequately prepared.ConclusionsAlthough most trainees feel prepared or very prepared for cases from a patient-specific regard, only half review the patient's medical record before every surgery. Furthermore, almost all trainees have taught themselves how to prepare for surgery. This represents a critical gap in residency education and an opportunity to improve patient safety and quality of care.
http://ift.tt/2u9evGB
Publication date: Available online 19 July 2017
Source:Journal of Surgical Education
Author(s): Shanley B. Deal, Heather Seabott, Lily Chang, Adnan A. Alseidi
ObjectiveTo evaluate the success of the annual program evaluation process and describe the experience of a Program Evaluation Committee for a General Surgery residency program.DesignWe conducted a retrospective review of the Program Evaluation Committee's meeting minutes, data inputs, and outcomes from 2014 to 2016. We identified top priorities by year, characterized supporting data, summarized the improvement plans and outcome measures, and evaluated whether the outcomes were achieved at 1 year.SettingVirginia Mason Medical Center General Surgery Residency Program.ParticipantsProgram Evaluation Committee members including the Program Director, 2 Associate Program Directors, 2 Senior Faculty Members, and 1 Resident.ResultsAll outcome measures were achieved or still in progress at 1 year. This included purchasing a GI mentor to improve endoscopic simulation training, establishing an outpatient surgery rotation to increase the volume of cases, and implementing a didactic course on adult learning principles for faculty development to improve intraoperative teaching. Primary reasons for slow progress were lack of follow-through by delegates or communication breakdown.ConclusionsThe annual program evaluation process has been successful in identifying top priorities, developing action plans, and achieving outcome measures using our systematic evaluation process.
http://ift.tt/2uDKn8z
Publication date: Available online 18 July 2017
Source:American Journal of Infection Control
Author(s): Wrechelle Ocampo, Rose Geransar, Nancy Clayden, Jessica Jones, Jill de Grood, Mark Joffe, Geoffrey Taylor, Bayan Missaghi, Craig Pearce, William Ghali, John Conly
BackgroundWard closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain.PurposeTo understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.MethodsA Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis.ResultsA total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak.DiscussionResults suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration.
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Publication date: Available online 18 July 2017
Source:American Journal of Infection Control
Author(s): T. Grimmond, L. Good
BackgroundNational blood exposure (BE) surveys are valuable to health care facilities striving to reduce percutaneous sharps injuries (SIs) or mucocutaneous (MC) exposures among their health care workers (HCWs). In the Exposure Survey of Trends in Occupational Practice (EXPO-S.T.O.P.) 2015 we surveyed hospital BE incidence among members of the Association of Occupational Health Professionals in Healthcare.MethodsA 23-item electronic survey requested 2015 data on total SI and MC; SI in nurses, doctors, and surgery; staffed beds; teaching status; full time equivalent staff (FTE), nurse FTE, average daily census (ADC), and adjusted patient days (APD).ResultsOne hundred eighty-one hospitals in 34 states reported 9,343 BE (71% SI and 29% MC exposures). SI rates were 25.2/100 ADC (17.5 in nonteaching hospitals and 30.4 in teaching hospitals), 2.1/100 FTE (significantly less than that in 2001), 3.2/100 nurse FTE, 0.36/1,000 APD, and 38% occurred during surgery. MC exposure incidence rates were 10.5/100 ADC (8.6 in nonteaching hospitals and 11.7 in teaching hospitals), 0.86/100 FTE, and 0.14/1000 APD.ConclusionsBE incidence rates have fallen slowly but significantly since 2001, but the reduction is far less than hoped. Occupied beds (ie, ADC) has become a less-useful denominator. We estimate more than 300,000 HCWs sustain SIs annually in hospital and nonhospital settings. Greater resources are needed for more frequent and correct use of safety devices, training to competency, and root-cause investigation of all SIs.
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