Evidence-Based Practice in Clinical Athletic Training Education

Evidence-Based Practice (EBP) concepts are becoming more prevalent in the educational curricula of nursing, medicine, physical therapy, and athletic training. The infusion of EBP in the clinical education experience of students has been slow especially in athletic training. The aim of Project I was to investigate approved clinical instructors (ACIs) experience and implementation of EBP with students through emergent design qualitative interviews. Project II was designed to develop and establish the reliability of the Evidence-Based Concepts Assessment (EBCA) to assess athletic trainers\u27 perceived importance, attitudes & beliefs, knowledge, confidence, accessibility, and barriers of EBP. Project III investigated the importance, knowledge, and confidence of athletic trainers in EBP concepts using the EBCA. The sixteen approved clinical instructors (ACIs) interviewed identified strategies of discovery, promotion of critical thinking, and sharing of information in how they implemented EBP with students. ACIs also expressed the need to model the EBP behavior for students to appreciate and implement in their clinical practice. Barriers of limited resources, personnel, academic program constraints, and personal knowledge were reported. Strategies to integrate didactic and clinical collaboration of EBP were identified. Project II demonstrated that each of the sub-scales of the EBCA were reliable. In addition, factors within each sub-scale were established to allow for further analysis of the data. The EBCA was utilized to assess the perceived importance, attitudes & beliefs, knowledge, confidence, accessibility, and barriers to EBP in individuals with a variety of athletic training roles. Athletic training clinicians, undergraduate athletic training education program directors, approved clinical instructors, post-professional educators, and post-professional students were contacted to participate in completing the EBCA. Overall participants demonstrated a high level (3.49/4.0 ± .41) of perceived importance for EBP. Despite the high level of importance, participants\u27 overall total knowledge scores were low (64.2% ± 1.29) and they reported that they were only mildly to moderately confident in their knowledge (2.71/4.0 ± .55). Athletic training clinicians demonstrated significantly lower knowledge and confidence scores than all other participants. Individuals with a terminal degree demonstrated significantly higher knowledge scores and confidence in knowledge than all other participants

Feasibility of ultra-performance liquid chromatography-ion mobility-time-of-flight mass spectrometry in analyzing oxysterols

Oxysterols are oxygenated cholesterols that are important in many cell functions and they may also be indicative of certain diseases. The purpose of this work was to study the feasibility of ultra-performance liquid chromatography-ion mobility-time-of-flight mass spectrometry (UPLC-IM-TOFMS) using traveling wave cell in analyzing oxysterols and especially their isomers in biological samples. Oxysterols were analyzed as their p-toluenesulfonyl isocyanate derivatives, which improved the separation of isomeric oxysterols by ion mobility and ionization efficiency in the electrospray ionization step. The UPLC-IM-TOFMS method was shown to be fast and to provide good quantitative performance. The feasibility of the method was demonstrated in the analyses of oxysterols in fibroblast cell samples. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe

Phaseguide assisted liquid lamination for magnetic particle-based assays

We have developed a magnetic particle-based assay platform in which functionalised magnetic particles are transferred sequentially through laminated volumes of reagents and washing buffers. Lamination of aqueous liquids is achieved via the use of phaseguide technology; microstructures that control the advancing air–liquid interface of solutions as they enter a microfluidic chamber. This allows manual filling of the device, eliminating the need for external pumping systems, and preparation of the system requires only a few minutes. Here, we apply the platform to two on-chip strategies: (i) a one-step streptavidin–biotin binding assay, and (ii) a two-step C-reactive protein immunoassay. With these, we demonstrate how condensing multiple reaction and washing processes into a single step significantly reduces procedural times, with both assay procedures requiring less than 8 seconds

Perceptions of Approved Clinical Instructors: Barriers in the Implementation of Evidence-Based Practice

Context: As evidence-based practice (EBP) becomes prevalent in athletic training education, the barriers that Approved Clinical Instructors (ACIs) experience in implementing it with students need to be understood. Objective: To investigate barriers ACIs face when implementing EBP concepts in clinical practice and in teaching EBP to professional athletic training students and to investigate the educational emphases to improve the barriers. Design: Qualitative study. Setting: Telephone interviews. Patients or Other Participants: Sixteen ACIs (11 men, 5 women; experience as an athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.81 ± 3.9 years) were interviewed. Data Collection and Analysis: We interviewed each participant by telephone. Interview data were analyzed and coded for common themes and subthemes regarding barriers and educational emphases. Themes were triangulated through multiple-analyst triangulation and interpretive verification. Results: Barriers to EBP incorporation and educational emphasis placed on EBP were the main themes reported. Resources, personnel, and student characteristics were subthemes identified as barriers. Resource barriers included time, equipment, access to current literature, and knowledge. Coworkers, clinicians, and coaches who were unwilling to accept evidence regarding advancements in treatment were identified as personnel barriers. Programmatic improvement and communication improvement were subthemes of the educational emphasis placed on EBP theme. The ACIs reported the need for better integration between the clinical setting and the classroom and expressed the need for EBP to be integrated throughout the athletic training education program. Conclusions: Integration of the classroom and clinical experience is important in advancing ACIs\u27 use of EBP with their students. Collaborative efforts within the clinical and academic program could help address the barriers ACIs face when implementing EBP. This collaboration could positively affect the ability of ACIs to implement EBP within their clinical practices

Approved Clinical Instructors\u27 Perspectives on Implementation Strategies in Evidence-Based Practices for Athletic Training Students

Context: Understanding implementation strategies of Approved Clinibal Instructors (ACIs) who use evidence-based practice (EBP) in clinical instruction will help promote the use of EBP in clinical practice. Objective: To examine the perspectives and experiences of ACIs using EBP concepts in undergraduate athletic training education programs to determine the importance of using these concepts in clinical practice, clinical EBP implementation strategies for students, and challenges of implementing EBP into clinical practice while mentoring and teaching their students. Design: Qualitative study. Setting: Telephone interviews. Patients or Other Participants: Sixteen ACIs (11 men, 5 women; experience as a certified athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.8 ± 3.9 years) were interviewed. Data Collection and Analysis: We interviewed each participant by telephone. Interview transcripts were analyzed and coded for common themes and subthemes regarding implementation strategies. Established themes were triangulated through peer review and member checking to verify the data. Results: The ACIs identified EBP implementation as important for validation of the profession, changing paradigm shift, improving patient care, and improving student educational experiences. They promoted 3 methods of implementing EBP concepts with their students: self-discovery, promoting critical thinking, and sharing information. They assisted students with the steps of EBP and often faced challenges in implementation of the first 3 steps of EBP: defining a clinical question, literature searching, and literature appraisal. Finally, ACIs indicated that modeling the behavior of making clinical decisions based on evidence was the best way to encourage students to continue using EBP. Conclusions: Athletic training education program directors should encourage and recommend specific techniques for EBP implementation in the clinical setting. The ACIs believed that role modeling is a strategy that can be used to promote the use of EBP with students. Training of ACIs should include methods by which to address the steps of the EBP process while still promoting critical thinking

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An Evidence-Based Practice Educational Intervention for Athletic Trainers: A Randomized Controlled Trial

Context: As evidence-based practice (EBP) becomes a necessity in athletic training, Web-based modules have been developed and made available to the National Athletic Trainers\u27 Association membership as a mechanism to educate athletic trainers (ATs) on concepts of EBP. Objective: To assess the effect of an educational intervention on enhancing knowledge of EBP among ATs. Design: Randomized controlled trial. Setting: Web-based modules and knowledge assessment. Patients or Other Participants: A total of 164 of 473 ATs (34.7% response rate), including professional athletic training students, graduate students, clinical preceptors, educators, and clinicians, were randomized into a control group (40 men, 42 women) or experimental group (33 men, 49 women). Intervention(s): Ten Web-based modules were developed that covered concepts involved in the EBP process. Both groups completed the Evidence-Based Practice Knowledge Assessment before and after the intervention phase. During the intervention phase, the experimental group had access to the Web-based modules for 4 weeks, whereas the control group had no direct responsibilities for the investigation. The knowledge assessment consisted of 60 multiple choice questions pertaining to concepts presented in the 10 modules. Test-retest reliability was determined to be good (intraclass correlation coefficient [2,1] = 0.726, 95% confidence interval = 0.605, 0.814). Main Outcome Measure(s): Independent variables consisted of group (control, experimental) and time (preassessment, postassessment). Knowledge scores were tabulated by awarding 1 point for each correct answer (maximum = 60). Between-group and within-group differences were calculated using a 2 × 2 repeated-measures analysis of variance (P ≤ .05), post hoc t tests, and Hedges g effect size with 95% confidence intervals. Results: We found a group × time interaction (F1,162 = 26.29, P \u3c .001). No differences were identified between the control (30.12 ± 5.73) and experimental (30.65 ± 5.93) groups during the preassessment (t162 = 0.58, P = .84). The experimental group (36.35 ± 8.58) obtained higher scores on the postassessment than the control group (30.99 ± 6.33; t162 = 4.55, P = .01). No differences were identified among time instances within the control group (t81 = 1.77, P = .08); however, the experimental group obtained higher scores on the postassessment than the preassessment (t81 = 7.07, P \u3c .001). Conclusions: An educational intervention consisting of 10 Web-based modules was an effective mechanism to increase knowledge of foundational EBP concepts among ATs. However, it is not known whether ATs are integrating EBP into daily clinical practice. Researchers should determine whether increased knowledge of EBP affects the daily clinical decision making of ATs