Global Health Perspectives in Physical Therapy Education: A Qualitative Report on a Service Learning Experience in Guatemala

Authors: Winter F Wildt-Bailey, SPT; Adriana Sandoval, SPT; Holly J Roberts, PT, DPT, GCS, NCS Global Health Perspectives in Physical Therapy Education: A Qualitative Report on a Service Learning Experience in Guatemala Purpose: Doctor of physical therapy (DPT) students at the University of Puget Sound traveled to Zacapa, Guatemala to deliver physical therapy services for 5 days as part of an elective course introducing students to physical therapy and health care delivery from a global health perspective. Participants journaled about their experiences, responding to prompts provided by the course professor/clinical instructor. The purpose of this research was to explore the impact of the experience by identifying common themes among the journal entries. Methods: Ten student physical therapists (SPT), 9 females, 1 male, mean age 29yrs (range 25-40) at the end of their second year of a three-year DPT program consented to allow their journals to be included in this report. Two SPTs noted recurring themes that emerged in the de-identified journal entries. Results: Five common themes emerged among the journal entries: 1) Cultural Bias: recognizing cultural biases, the impact they have on patient care, and identifying strategies for addressing them; 2) Healthcare Disparities: recognizing disparities in access to healthcare, patient education, and resources between the U.S. and Guatemala; 3) Confidence and Competency: overcoming feelings of inadequacy as novice clinicians and appreciating the extent of knowledge and skill gained through didactic coursework; 4) Identity: reaffirming one\u27s decision to pursue a physical therapy career and that it aligns with one\u27s values and identity; and 5) Skills Development: adapting to working with limited resources, and developing effective communication skills with a language barrier. Conclusions: Reflection is a central tenet of service learning. The personal reflections of DPT students participating in a short-term service learning trip to Guatemala as part of an elective course in global health perspectives revealed the experience allowed students to recognize and address cultural biases, recognize healthcare disparities, build professional confidence and competence, reaffirm professional goals, and develop important skills in communication and healthcare delivery. Clinical Relevance: The results of this qualitative report are consistent with literature examining the benefits of experiential learning in healthcare education. They demonstrate the potential for an international service learning experience to facilitate development of cultural competence, clinical reasoning skills, communication skills, and confidence in one\u27s knowledge and abilities. Keywords: global health, service learning, experiential learning References: Benson JD, Provident I, Szucs KA. An experiential learning lab embedded in a didactic course: outcomes from a pediatric intervention course. Occ Ther Health Care. 2013; 27:46-57. Knecht-Sabres LJ. Experiential learning in occupational therapy: can it enhance readiness for clinical practice? J Exp Educ. 2013; 36:22-36. Paterson C, Chapman J. Enhancing skills of critical reflection to evidence learning in professional practice. Phys Ther Sport. 2013; 14:133-138. Seif G, Coker-Bolt P, Kraft S, Gonsalves W, Simpson K, Johnson E. The development of clinical reasoning and interprofessional behaviors: service-learning at a student-run free clinic. J Interprof Care. 2014; 28(6):559-564. Smith S, Crocker A. Experiential learning in physical therapy education. Adv Med Educ Pract. 2017; 8:427-433. Village D, Clouten N, Millar AL, Geigle A, et al. Comparison of the use of service learning, volunteer, and pro bono activities in physical therapy curricula. J Phys Ther Educ St Louis. 2004;18(1):22-28

International Service Learning: An Overview

International Service Learning: An Overview Kaitlynn McKirgan, SPT; Daniel Murty, SPT; Dr. Holly Roberts, PT, DPT, GCS, NCS Affiliation: 1. The School of Physical Therapy, University of Puget Sound Abstract Purpose A wide range of healthcare disciplines including nursing, public health, occupational therapy, and physical therapy (PT) now recognize global health participation and education as a necessary component of healthcare education. Increasingly, students applying to and choosing which PT program to attend must now consider the design, purpose, benefits, and potential drawbacks of such a program in their education. The purpose of this report is to provide an overview of International Service Learning (ISL) structure, its proposed benefits and concerns, and to briefly compare how the University of Puget Sound’s (UPS) pilot ISL program compared to recommendations found within the literature in order to define possible areas of improvement. Methods Literature search was performed using PubMed, Google Scholar, ProQuest, Academic Search Premiere, and Cochrane. Search terms used were: Global health, international service learning, physical therapy, experiential learning. Programs described in the literature were compared to the course structure outlined in the UPS Global Health Perspectives Course PT677 Syllabus. The course instructor was interviewed to gain any knowledge not available within the syllabus regarding program structure. Results Pechak and Thompson recommend 7 components to create a program with positive outcomes: 1. A partner that understands the role of PT; 2. Community identified needs; 3. Explicit service and learning objectives; 4. Reflection; 5. Preparations; 6. Risk Management; 7. Service learning outcome measure. Benefits to students participating in ISL programs include: increased confidence, improved communication skills, self- empowerment, independence, increased student self-assessment scores, increased experiential learning opportunities and increased understanding and confidence in professional roles when ISL project includes cooperation with other professions.  Ethical concerns are inherent and individual programs must pay close attention to the impact they have on the communities they seek to serve. Common ethical dilemmas that should be considered include the power dynamic between the community and those rendering services, the quality of care being provided, sustainability at the community and individual levels, and community need. Conclusion The UPS pilot ISL program met 6/7 components for optimal ISL outlined by Pechak and Thompson: Use of an outcome measure to evaluate the service learning experience should be applied in future programs. Other recommended improvements to the program include incorporating instruction to local care providers to increase service community self-efficacy. Finally, increased medical Spanish education in the months leading up to the ISL program is advised. Works cited Pechak CM, Thompson M. A Conceptual Model of Optimal International Service-Learning and Its Application to Global Health Initiatives in Rehabilitation. Physical Therapy. 2009;89(11):1192-1204. Smith SN, Crocker AF. Experiential learning in physical therapy education. Adv Med Educ Pract. 2017;8:427-433. doi:10.2147/AMEP.S140373. Reisch RA. International Service Learning Programs: Ethical Issues and Recommendations. Developing World Bioethics. 2011;11(2):93-98. doi:10.1111/j.1471-8847.2011.00299.x. Pechak C, Gonzalez E, Summers C, Capshaw S. Interprofessional Education: A Pilot Study of Rehabilitation Sciences Students Participating in Interdisciplinary International Service-Learning. Journal of Allied Health; Washington. 2013;42(3):e61-6. Fries KS, Bowers DM, Gross M, Frost L. Service learning in Guatemala: using qualitative content analysis to explore an interdisciplinary learning experience among students in health care professional programs. J Multidiscip Healthc. 2013;6:45-52. doi:10.2147/JMDH.S35867

From Classroom to Practice: Implementing the Core Set of Outcome Measures in a Student-Led Clinic

Background: Literature suggests that Clinical Practice Guidelines (CPGs) are insufficient for facilitating behavior change in clinicians. However, translating research to clinical practice is essential for evidence-based practice. Prior to publication of the Core Set of Outcome Measures (CSOMs) for Adults with Neurologic Conditions CPG, all recommended outcome measures (OMs) were included in the University of Puget Sound curriculum. Beginning Fall 2018, didactic instruction adjusted such that clinical decision-making for the CSOMs was instructed as outlined in the CPG. Purpose: To determine whether utilization of CSOMs in a student-led neurologic outpatient physical therapy clinic changed after students received intentional didactic instruction on CPG utilization. The secondary aim was to determine whether OM utilization frequency changed. Methods: Patient diagnosis, patient ambulatory status, and frequencies of OMs administered were collected for all patients who attended a student-led neurologic physical therapy clinic between 2017 and 2022. Descriptive and inferential statistical tests were conducted using non-parametric methods. Results: Utilization of the CSOMs increased by 41% overall and 59% for ambulatory patients. Prior to Fall 2018, the most frequently utilized OMs were the Timed Up and Go (TUG), 5 Times Sit to Stand (5xSTS), Dynamic Gait Index, and Four Square Step Test. Following publication and instruction of the CPG, the most frequently utilized OMs were the TUG, 5xSTS, Activities-Specific Balance Confidence Scale, and Functional Gait Assessment. The frequency of overall OM utilization did not change. Conclusion: Students increased utilization of CSOMs after intentional didactic instruction. Frequency of overall OM utilization remained unchanged

Evaluation of antimicrobial effectiveness of pimaricin-loaded thermosensitive nanohydrogels in grape juice

Pimaricin-loaded poly(N-isopropylacrylamide) nanohydrogels with and without acrylic acid, were evaluated as food-spoilage inhibitors in a model system and a real food product: grape juice. Pimaricin was proposed as a non-allergenic alternative to sulphites for protecting juices against recontamination. However, pimaricin may degrade under conditions and treatments (heating, acidification, lighting) commonly applied in producing fresh juices. Nanohydrogel encapsulation may be a feasible procedure to avoid pimaricin degradation, improving its antimicrobial activity. Pimaricin-free nanohydrogels did not affect the growth of the indicator yeast either in the food model system or in grape juice. Conversely, pimaricin-loaded nanohydrogels effectively inhibited the growth of the indicator yeast. In some cases, the inhibition was extended even further than using free pimaricin. For instance, in the food model system, pimaricin-loaded nanohydrogels with acrylic acid (NPPNIPA-20AA(5)) prevented the yeast growth for more than 81 h while free pimaricin was only effective for 12 h. Despite pimaricin-loaded nanohydrogels without acrylic acid (NPPNIPA(5)) were able to reduce maximum yeast growth, as in all treatments with pimaricin, the extent of the inhibitory effect was not significantly (p>0.05) different to that achieved with free pimaricin. In grape juice, both free pimaricin and NPPNIPA-20AA(5) treatment completely inhibited the growth of the indicator yeast until the end of the bioassay. However, the latter provided similar inhibition levels using a smaller amount of pimaricin due to PNIPA-20AA(5) protection and its controlled release from the nanohydrogel. Therefore, nanohydrogel encapsulation may help to optimise antifungal treatments and decrease the incidence of food allergies.Funded by grant (MAT 2006-11662-CO3-CO2-C01/MAT 2010-21509-C03-01/EUI 2008-00115) from the “Ministerio de Educación y Ciencia” (Spain). Grant (SFRH/BPD/87910/2012) from the Fundação para a Ciência e Tecnologia (FCT, Portugal). Marie Curie COFUND Postdoctoral Research Fellow

Functional characterisation and antimicrobial efficiency assessment of smart nanohydrogels containing natamycin incorporated into polysaccharide-based films

The potential application of polysaccharide-based films containing smart nanohydrogels for the controlled release of food preservatives is demonstrated here. Smart active packaging is the most promising alternative to traditional packaging as it provides a controlled antimicrobial effect, which allows reducing the amount of preservatives in the food bulk, releasing them only on demand. This work evaluates the usefulness of smart thermosensitive poly(N-isopropylacrylamide) (PNIPA) nanohydrogels with or without acrylic acid (AA) incorporated into polysaccharide-based films (GA) to transport natamycin and release it as a response to environmental triggers. Release kinetics in liquid medium from GA films containing PNIPA/AA nanohydrogels (GA-PNIPA(5) and GA-PNIPA-20AA(5)) presented a characteristic feature regarding the films without nanohydrogels that was the appearance of a lag time in natamycin release, able to reach values of around 35 h. Another important feature of natamycin release kinetics was the fact that the release from GA-PNIPA/AA films only occurred when temperature was increased, so that the natamycin release was restricted to when there is a risk of growth of microorganisms that cause food spoilage or the development of pathogenic microorganisms. Additionally, it could be observed that the relative fraction of natamycin released from GA-PNIPA/AA films was significantly (p<0.05) higher than that released from GA films loaded with the same amount of free natamycin. It can be hypothesised that the encapsulation of natamycin into nanohydrogels helped it to be released from GA films, creating reservoirs of natamycin into the films and, therefore, facilitating its diffusion through the film matrix when the nanohydrogel collapses. In a solid medium, the low water availability limited natamycin release from GA-PNIPA/AA films restricting the on/off release mechanism of PNIPA/AA nanohydrogels and favouring the hydrophobic interactions between natamycin and polymer chains at high temperatures. Despite the low natamycin release in solid media, antimicrobial efficiency of GA-PNIPA(5) films containing natamycin in acidified agar plates was higher than that obtained with GA films without natamycin and GA films with free natamycin, probably due to the protecting effect against degradation when natamycin was included in the nanohydrogels, allowing its release only when the temperature increased.Clara Fucinos and Miguel A. Cerqueira are recipients of a fellowship (SFRH/BPD/87910/2012 and SFRH/BPD/72753/2010, respectively) from the Fundacao para a Ciencia e Tecnologia (FCT, POPH-QREN, and FSE Portugal). The authors thank the FCT Strategic Project PEst-OE/EQB/LA0023/2013 and the project "BioInd - Biotechnology and Bioengineering for improved Industrial and Agro-Food processes", Ref. NORTE-07-0124-FEDER-000028 co-funded by the Programa Operacional Regional do Norte (ON.2 - O Novo Norte), QREN, FEDER and the project from the "Ministerio de Educacion y Ciencia" (Spain) "Nanohidrogeles inteligentes sensibles a cambios de pH y Temperatura: Diseno, sintesis y aplicacion en terapia del cancer y el envasado activo de alimentos", Ref. MAT2010-21509-C03-01

Head-Shake Sensory Organization Test Performance in Concussed Military Service Members.

Title: Head-Shake Sensory Organization Test Performance in Concussed Military Service Members. Purpose: The purpose of the study was to describe performance on the Sensory Organization Test (SOT) and Head-Shake SOT (HS-SOT) in military service members with concussions. Subjects: Seventeen military service members (16 men, mean 32.47 +/-8.01 years) who sustained a concussion within the past 24 months. Methods: Participants completed the SOT and HS-SOT, Activities-specific Balance Confidence scale (ABC), and Dizziness Handicap Inventory (DHI). Separate analyses were performed with subjects divided into groups based on concussion history(\u3e3), and DHI score (\u3e13). Results: Participants had a mean DHI score of 23.53 (+/-18.42), ABC of 85.43% (+/-14.15), SOT composite score of 71.53 (+/-16.58), HS-SOT/fixed surface (FS) and sway-referenced surface (SR) ratios of .98 (+/-1.13) and .74 (+/-.34), respectively. There were no differences in outcomes when groups were stratified by DHI score or concussion history, with the exception of a higher equilibrium ratio on HS-SOT/SR in participants with a concussion history of \u3e3 than participants with fewer than 3 concussions (1.02, .60, respectively, p =.017). Conclusions: Our results suggest that despite evidence of imbalance and dizziness on validated patient-reported outcome measures, the SOT and HS-SOT did not detect differences in balance performance.These results highlight the need to identify objective performance-based measures to quantify post-concussive balance deficits. Clinical Relevance: SOT composite scores may not be sensitive to measure balance deficits following concussion in this population, despite evidence of imbalance and dizziness. Further research is needed to determine whether the HS-SOT is a valid measure to guide clinical decision making