Opportunities and Challenges in The Use of an External Interprofessional Reviewing Body in a Curricular Review Process in a Doctor of Physical Therapy Curriculum

Purpose: The purpose of this article is to describe the opportunities and challenges of a curricular review process in an entry-level doctor of physical therapy geriatric curriculum. The curricular review process utilized an external interprofessional reviewing body, in conjunction with an established internal curricular reviewing body, to determine inclusion of Essential Competencies in order to prepare students for best clinical practice in the care of the older adult. Method: The methodology of our curricular review process included both internal and external reviewing bodies but the intent of this article is to highlight how the review process was implemented including an external interprofessional reviewing body. The internal reviewing body involved two faculty members with expertise in geriatrics, the Program Curriculum Committee members, and the faculty members within the entry-level doctor of physical therapy program. The external reviewing body was comprised of the 2012-2014 members of the Faculty Development Collaborative Program in Geriatrics (FDCPG), a national interprofessional learning community representing multiple disciplines involved in the care of older adults. Results: The outcomes of including an external interprofessional reviewing body in the geriatric curricular review process were: the FDCPG justified the need for the review of the Essential Competencies, deemed their role as important in healthcare education, and reported a greater understanding of the role of physical therapists as part of an interprofessional healthcare team. The Program Curriculum Committee created a policy for consideration of other published competencies, including a recommendation for “other necessary consultation” based on our use of an external reviewing body, noting its value. The outcomes of the overall curricular review process included: 53/61 Essential Competencies were identified as already in the curriculum and the remaining 8/61 Essential Competencies were added. Conclusions and Recommendations: The addition of an external interprofessional reviewing body to an already established internal reviewing body within the geriatric curricular review process in an entry-level doctor of physical therapy program produced a curriculum that will hopefully prepare students for best clinical practice in the care of the older adult. This comprehensive curricular review process involved opportunities and challenges yet still can be used across multiple disciplines, across multiple curricular structures, and is in line with the current state of healthcare practice

Fostering PT-PTA Student Relationships, Pilot Study

Purpose: The purpose of this study was to assess physical therapist (PT) and physical therapist assistant (PTA) students\u27 attitudes toward working in a team, direction and supervision, preparation for effective communication, and respect for and the value of physical therapist/physical therapist assistant (PT/PTA) teams following an interactive classroom session via a brief online questionnaire. Methods: PT students in the second year of their doctor of physical therapy graduate studies in St Louis, MO and PTA students in the second year of their associate’s degree program in St Louis, MO were involved. A questionnaire was completed prior to and after attending an interactive classroom session. The interactive session included four stations; curriculum and education, communication and documentation, PT/PTA teamwork scenarios in different practice settings, and social interaction. The questionnaire consisted of six questions asking students to indicate their level of agreement or disagreement. Results: Attendance status at the interactive session was related to student responses on the questionnaire for both PT and PTA students. Among PTA students, responses on three of six questionnaire items were found not to be independent of attendance status. PTA students indicated they felt more prepared for PT/PTA communication, had more respect for the similarities in roles of PTs and PTAs, and felt more strongly that effective PT/PTA teams were essential to optimal patient care. Among the PT student population, the only questionnaire item found to be independent of interactive session attendance status was the belief in effective PT/PTA teams. Generally, students’ responses tended to be more positive after attending the interactive session, with “Strongly agree” responses increasing by as much as 24 percent on some questionnaire items. Increases in weighted means for PTA students were not found to be statistically significant; however, among PT students these increases were significant across three questionnaire items. Conclusions: The findings suggest that both PT and PTA students experienced increased comfort with the idea of working as part of a PT/PTA team after the interactive event where communication was the focus. The affective behavior of “comfort” in working as part of a PT/PTA team increased in our study among both PT and PTA students. The interactive session was easy to implement and had no cost associated with it. Follow-up study or methodologies could provide more robust results to further support these findings. This activity could also be replicated across healthcare professions that utilize professional and paraprofessional assistant relationships

A comparison of the efficacy of digital versus Hydra-Mat II cleaning methods

An in vitro comparison of the cleaning efficacy of the BARNESHIND ® Hydra-Mat® II system with the traditional digital massage method was performed using fifty Fluoroperm 60 lenses coated with a simulated tear mixture. This artificial tear film consisted of human albumin, lactoferrin, and lysozyme, and other constituents determined using FDA guidelines and other research describing human tear composition. Twenty four lenses were cleaned with the Hydra-Mat II system; and 24 using digital massage. Cleaning efficacy was measured by having masked observers rate both the cleaned lenses and photos of the same lenses. The digitally cleaned lenses were judged to be significantly cleaner than the lenses cleaned by the Hydra-Mat II (p=0.0075), although there appeared to be qualitative differences in the types of deposits left behind by the two methods

Faculty and Student Perceptions of a Physical Therapy Professional Behavior Mentoring Program

Purpose: Mentoring is a process and a relationship between a novice and an expert that fosters intellectual, personal, and professional growth. The purposes and scope of this article are to describe 1) the structured professional development component of a comprehensive mentoring program for students in a physical therapy program; and 2) the perceptions of faculty and students regarding this mentoring program. Method: Faculty and students completed electronic questionnaires developed specifically for each group. Results: Return rate was 54.50% (N=286) for physical therapist students and 100% (N=18) for physical therapy faculty. Student positive ratings regarding the mentoring program exceeded 89.00%. Additionally, 76.75% of the students reported seeking feedback and advice from their faculty mentor to make informed decisions. Students perceived their mentors to be committed to helping them achieve their personal/professional goals (94.96%). Faculty mentors reported that they enjoy being mentors (94.12%), believe they have a responsibility to assist in the professional socialization of mentees (100.00%), and that mentees benefitted from meeting with them regarding professional behavior issues (92.86%). Conclusions: Faculty mentors and student mentees perceive that students benefit from mentoring regarding professional behavior issues and that the mentoring program is valuable and worth the time spent participating in it. We suggest that the process and documents developed by the Program in Physical Therapy may be used as a basis for critical dialogue within other academic units for the purpose of determining the desired professional behavior mentoring system for that particular academic entity

Protocol for the RT Prepare Trial: a multiple-baseline study of radiation therapists delivering education and support to women with breast cancer who are referred for radiotherapy

Introduction: There is limited evidence to guide the preparation of patients for radiotherapy. This paper describes the protocol for an evaluation of a radiation therapist led education intervention delivered to patients with breast cancer in order to reduce psychological distress. Methods: A multiple-baseline study is being used. Usual care data is being collected prior to the start of the intervention at each of three sites. The intervention is delivered by radiation therapists consulting with patients prior to their treatment planning and on the first day of treatment. The intervention focuses on providing sensory and procedural information to patients and reducing pretreatment anxiety. Recruitment is occurring in three states in Australia. Eligible participants are patients who have been referred for radiotherapy to treat breast cancer. 200 patients will be recruited during a usual care phase and, thereafter, 200 patients in the intervention phase. Measures will be collected on four occasions—after meeting with their radiation oncologist, prior to treatment planning, on the first day of treatment and after treatment completion. The primary hypothesis is that patients who receive the radiotherapy preparatory intervention will report a significantly greater decrease in psychological distress from baseline to prior to radiotherapy treatment planning in comparison with the usual care group. Secondary outcome measures include concerns about radiotherapy, patient knowledge of radiotherapy, patient preparedness and quality of life. Patient health system usage and costs will also be measured. Multilevel mixed effects regression models will be applied to test for intervention effects. Ethics Ethics approval has been gained from Curtin University and the three recruiting sites. Dissemination Results will be reported in international peer reviewed journals. Trial registration number Australian and New Zealand Clinical Trials Registration: ACTRN12611001000998

Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>In many healthcare systems, people with severe joint disease wait months to years for joint replacement surgery. There are little empirical data on the health consequences of this delay and it is unclear whether people with substantial morbidity at entry to the waiting list continue to deteriorate further while awaiting surgery. This study investigated changes in Health-Related Quality of Life (HRQoL), health status and psychological distress among people waiting for total hip (THR) and knee replacement (TKR) surgery at a major metropolitan Australian public hospital.</p> <p>Methods</p> <p>134 patients completed questionnaires including the Assessment of Quality of Life (AQoL) instrument, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kessler Psychological Distress Scale after entering an orthopaedic waiting list (baseline) and before surgery (preadmission). To quantify potential decline in wellbeing, we calculated the proportion of people experiencing clinically important deterioration using published guidelines and compared HRQoL and psychological distress outcomes with population norms.</p> <p>Results</p> <p>Most participants (69%) waited ≥6 months for surgery (median 286 days, IQR 169-375 days). Despite poor physical and psychological wellbeing at baseline, there was an overall deterioration in HRQoL during the waiting period (mean AQoL change -0.04, 95%CI -0.08 to -0.01), with 53% of participants experiencing decline in HRQoL (≥0.04 AQoL units). HRQoL prior to surgery remained substantially lower than Australian population norms (mean sample AQoL 0.37, 95%CI 0.33 to 0.42 vs mean population AQoL 0.83, 95%CI 0.82 to 0.84). Twenty-five per cent of participants showed decline in health status (≥9.6 WOMAC units) over the waiting period and prevalence of high psychological distress remained high at preadmission (RR 3.5, 95%CI 2.8 to 4.5). Most participants considered their pain (84%), fatigue (76%), quality of life (73%) and confidence in managing their health (55%) had worsened while waiting for surgery.</p> <p>Conclusions</p> <p>Despite substantial initial morbidity, over half of the participants awaiting joint replacement experienced deterioration in HRQoL during the waiting period. These data provide much-needed evidence to guide health professionals and policymakers in the design of care pathways and resource allocation for people who require joint replacement surgery.</p

Prebiotic effects: metabolic and health benefits

The different compartments of the gastrointestinal tract are inhabited by populations of micro-organisms. By far the most important predominant populations are in the colon where a true symbiosis with the host exists that is a key for well-being and health. For such a microbiota, 'normobiosis' characterises a composition of the gut 'ecosystem' in which micro-organisms with potential health benefits predominate in number over potentially harmful ones, in contrast to 'dysbiosis', in which one or a few potentially harmful micro-organisms are dominant, thus creating a disease-prone situation. The present document has been written by a group of both academic and industry experts (in the ILSI Europe Prebiotic Expert Group and Prebiotic Task Force, respectively). It does not aim to propose a new definition of a prebiotic nor to identify which food products are classified as prebiotic but rather to validate and expand the original idea of the prebiotic concept (that can be translated in 'prebiotic effects'), defined as: 'The selective stimulation of growth and/or activity(ies) of one or a limited number of microbial genus(era)/species in the gut microbiota that confer(s) health benefits to the host.' Thanks to the methodological and fundamental research of microbiologists, immense progress has very recently been made in our understanding of the gut microbiota. A large number of human intervention studies have been performed that have demonstrated that dietary consumption of certain food products can result in statistically significant changes in the composition of the gut microbiota in line with the prebiotic concept. Thus the prebiotic effect is now a well-established scientific fact. The more data are accumulating, the more it will be recognised that such changes in the microbiota's composition, especially increase in bifidobacteria, can be regarded as a marker of intestinal health. The review is divided in chapters that cover the major areas of nutrition research where a prebiotic effect has tentatively been investigated for potential health benefits. The prebiotic effect has been shown to associate with modulation of biomarkers and activity(ies) of the immune system. Confirming the studies in adults, it has been demonstrated that, in infant nutrition, the prebiotic effect includes a significant change of gut microbiota composition, especially an increase of faecal concentrations of bifidobacteria. This concomitantly improves stool quality (pH, SCFA, frequency and consistency), reduces the risk of gastroenteritis and infections, improves general well-being and reduces the incidence of allergic symptoms such as atopic eczema. Changes in the gut microbiota composition are classically considered as one of the many factors involved in the pathogenesis of either inflammatory bowel disease or irritable bowel syndrome. The use of particular food products with a prebiotic effect has thus been tested in clinical trials with the objective to improve the clinical activity and well-being of patients with such disorders. Promising beneficial effects have been demonstrated in some preliminary studies, including changes in gut microbiota composition (especially increase in bifidobacteria concentration). Often associated with toxic load and/or miscellaneous risk factors, colon cancer is another pathology for which a possible role of gut microbiota composition has been hypothesised. Numerous experimental studies have reported reduction in incidence of tumours and cancers after feeding specific food products with a prebiotic effect. Some of these studies (including one human trial) have also reported that, in such conditions, gut microbiota composition was modified (especially due to increased concentration of bifidobacteria). Dietary intake of particular food products with a prebiotic effect has been shown, especially in adolescents, but also tentatively in postmenopausal women, to increase Ca absorption as well as bone Ca accretion and bone mineral density. Recent data, both from experimental models and from human studies, support the beneficial effects of particular food products with prebiotic properties on energy homaeostasis, satiety regulation and body weight gain. Together, with data in obese animals and patients, these studies support the hypothesis that gut microbiota composition (especially the number of bifidobacteria) may contribute to modulate metabolic processes associated with syndrome X, especially obesity and diabetes type 2. It is plausible, even though not exclusive, that these effects are linked to the microbiota-induced changes and it is feasible to conclude that their mechanisms fit into the prebiotic effect. However, the role of such changes in these health benefits remains to be definitively proven. As a result of the research activity that followed the publication of the prebiotic concept 15 years ago, it has become clear that products that cause a selective modification in the gut microbiota's composition and/or activity(ies) and thus strengthens normobiosis could either induce beneficial physiological effects in the colon and also in extra-intestinal compartments or contribute towards reducing the risk of dysbiosis and associated intestinal and systemic pathologies

Risk of upper gastrointestinal bleeding and perforation associated with low-dose aspirin as plain and enteric-coated formulations

BACKGROUND: The use of low-dose aspirin has been reported to be associated with an increased risk of upper gastrointestinal complications (UGIC). The coating of aspirin has been proposed as an approach to reduce such a risk. To test this hypothesis, we carried out a population based case-control study. METHODS: We identified incident cases of UGIC (bleeding or perforation) aged 40 to 79 years between April 1993 to October 1998 registered in the General Practice Research Database. Controls were selected randomly from the source population. Adjusted estimates of relative risk (RR) associated with current use of aspirin as compared to non use were computed using unconditional logistic regression. RESULTS: We identified 2,105 cases of UGIC and selected 11,500 controls. Among them, 287 (13.6%) cases and 837 (7.3%) controls were exposed to aspirin, resulting in an adjusted RR of 2.0 (1.7-2.3). No clear dose-effect was found within the range of 75-300 mg. The RR associated with enteric-coated formulations (2.3, 1.6-3.2) was similar to the one of plain aspirin (1.9, 1.6-2.3), and no difference was observed depending on the site. The first two months of treatment was the period of greater risk (RR= 4.5, 2.9-7.1). The concomitant use of aspirin with high-dose NSAIDs greatly increased the risk of UGIC (13.3, 8.5-20.9) while no interaction was apparent with low-medium doses (2.2, 1.0-4.6). CONCLUSIONS: Low-dose aspirin increases by twofold the risk of UGIC in the general population and its coating does not modify the effect. Concomitant use of low-dose aspirin and NSAIDs at high doses put patients at a specially high risk of UGIC

Australia and New Zealand Islet and Pancreas Transplant Registry Annual Report 2018—Islet Donations, Islet Isolations, and Islet Transplants

Background. This is an excerpt from chapter 4 of the annual registry report from the Australia and New Zealand islet and pan- creas transplant registry. The full report is available at http://anziptr.org/reports/. Methods. We report data for all allogeneic islet isolation and transplant activity from 2002 to end 2017. Solid organ pancreas transplantation activity is reported separately. New Zealand does not have an islet transplant program. Data analysis was performed using Stata software version 14 (StataCorp, College Station, TX). Results. From 2002 to 2017, a total of 104 allogeneic islet transplants were performed in 62 recipients. Conclusions. The number of islet transplants performed in Australia was slightly lower in 2017 but continues to increase over time

From rehabilitation to recovery: protocol for a randomised controlled trial evaluating a goal-based intervention to reduce depression and facilitate participation post-stroke

<p>Abstract</p> <p>Background</p> <p>There is much discourse in healthcare about the importance of client-centred rehabilitation, however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal-directed practice that reflects patients' valued activities. In addition, the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear. In community based rehabilitation, interventions based on patients' perceived needs may be more likely to alter such outcomes. In this paper, we describe the methodology of a randomised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke. The effectiveness of this intervention in reducing the severity of post-stroke depression, improving participation status and health-related quality of life is examined. The impact on carers is also examined.</p> <p>Methods/Design</p> <p>Patients (and their primary carers, if available) are randomly allocated to an intervention or control arm of the study. The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities. Intervention methods include: telephone contacts, written information provision, home visitation, and contact with treating health professionals, with further relevant health service referrals as required. The control involves treatment as usual, as determined by inpatient and community rehabilitation treating teams. Formal blinded assessments are conducted at discharge from inpatient rehabilitation, and at six and twelve months post-stroke. The primary outcome is depression. Secondary outcome measures include participation and activity status, health-related quality of life, and self-efficacy.</p> <p>Discussion</p> <p>The results of this trial will assist with the development of a model for community-based rehabilitation management for stroke patients and their carers, with emphasis on goal-directed practice to enhance home and community participation status. Facilitation of participation in valued activities may be effective in reducing the incidence or severity of post-stroke depression, as well as enhancing the individual's perception of their health-related quality of life. The engagement of carers in the rehabilitation process will enable review of the influence of the broader social context on recovery.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12608000042347.aspx">ACTRN12608000042347</a></p