The simulated early learning of cervical spine manipulation technique utilising mannequins

Background Trivial pain or minor soreness commonly follows neck manipulation and has been estimated at one in three treatments. In addition, rare catastrophic events can occur. Some of these incidents have been ascribed to poor technique where the neck is rotated too far. The aims of this study were to design an instrument to measure competency of neck manipulation in beginning students when using a simulation mannequin, and then examine the suitability of using a simulation mannequin to teach the early psychomotor skills for neck chiropractic manipulative therapy. Methods We developed an initial set of questionnaire items and then used an expert panel to assess an instrument for neck manipulation competency among chiropractic students. The study sample comprised all 41 fourth year 2014 chiropractic students at Murdoch University. Students were randomly allocated into either a usual learning or mannequin group. All participants crossed over to undertake the alternative learning method after four weeks. A chi-square test was used to examine differences between groups in the proportion of students achieving an overall pass mark at baseline, four weeks, and eight weeks. Results This study was conducted between January and March 2014. We successfully developed an instrument of measurement to assess neck manipulation competency in chiropractic students. We then randomised 41 participants to first undertake either “usual learning” (n = 19) or “mannequin learning” (n = 22) for early neck manipulation training. There were no significant differences between groups in the overall pass rate at baseline (χ2 = 0.10, p = 0.75), four weeks (χ2 = 0.40, p = 0.53), and eight weeks (χ2 = 0.07, p = 0.79). Conclusions This study demonstrates that the use of a mannequin does not affect the manipulation competency grades of early learning students at short term follow up. Our findings have potentially important safety implications as the results indicate that students could initially gain competence in neck manipulation by using mannequins before proceeding to perform neck manipulation on each other

Exploring 1st- and 2nd-year chiropractic students' willingness and attitudes toward peer physical examination

Objective This study aimed to explore chiropractic students' perceptions and attitudes about the appropriateness of peer physical examination as a teaching tool and their willingness and comfort with it. Methods A modified version of a validated questionnaire was used. First- and 2nd-year chiropractic students at Murdoch University were approached during their practical sessions. The responses were analyzed using descriptive statistics reporting frequencies and percentages. Comparison between classes, age, and sex was evaluated by cross-tabulation. Results A total of 184 questionnaires were completed with a response rate of 76.6%. Our results demonstrated that most students were comfortable with and willing to participate in peer physical examination as well as trusted it as an appropriate part of their training and a valuable learning experience. Nevertheless, a small percentage were uncomfortable with peer physical examination and regarded it as an unprofessional activity. In addition, it was revealed that younger females (≤20 years) reported feeling unnecessarily exposed and therefore significantly less comfortable with peer physical examination. They were also less comfortable when examined in the inguinal area by a student of the opposite sex. Conclusion Although peer physical examination appears to be a very popular training tool, it still has a few areas of concern that need to be investigated and addressed to improve students' attitude, perception, and comfort with this teaching technique. Further studies could investigate how other factors such as religious beliefs contribute toward students' perception and attitudes regarding peer physical examination

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate´s phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.J.T.S. holds a research contract from the Fundación para la Formación e Investigación de los Profesionales de la Salud de Extremadura (FundeSalud), Instituto de Salud Carlos III. M.F.R. holds a clinical research contract “Juan Rodés” (JR14/00036) from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III

The effect of manual therapy on pulmonary function in healthy adults

Manual therapy is suggested as a potentially therapeutic intervention that may improve pulmonary function. However, this form of therapy is largely based on clinical observations and hypothetical models rather than mechanistic knowledge. This study examined the influence of a single session of manual therapy applied to the thoracic spine and thorax on dynamic pulmonary function over an extended time frame in healthy adults. 21 healthy individuals (14 males) aged 19-35 (mean [SD] age = 23 [3.9], BMI [SD] = 22.97 [2.41]) completed one experimental testing session consisting of five pulmonary function tests and the delivery of a manual therapy intervention. Pulmonary function was measured at baseline and 1 minute, 10 minutes, 20 minutes and 30 minutes following the intervention. Baseline mean (SD) forced vital capacity (FVC), forced expired volume in 1 second (FEV 1) and maximal voluntary ventilation (MVV) were 5.55(1.23 L), 4.64(0.92 L) and 165.7(40.0L min â '1) respectively. The mean (SD) FEV 1 /FVC ratio was 0.84(0.07). There were no statistically significant changes in any of the pulmonary function measures following the manual therapy intervention. Our findings do not support the use of manual therapy to provide a short-term benefit in respiratory function to healthy adults

Factors influencing student performance on the carpal bone test as a preliminary evaluation of anatomical knowledge retention

It has been demonstrated that a positive correlation exists between clinical knowledge and retained concepts in basic sciences. Studies have demonstrated a modest attrition of anatomy knowledge over time, which may be influenced by students' perceived importance of the basic sciences and the learning styles adopted. The aims of this study were to: (1) conduct a cross-sectional evaluation of the retention of anatomical knowledge in preclinical (second-year) and clinical (fifth-year) chiropractic students at Murdoch University; and (2) examine students' perceptions of factors that may influence their anatomy knowledge retention. Second- and fifth-year chiropractic students at Murdoch University were invited to participate in the study. Ninety-one students voluntarily participated. The Carpal Bone Test, previously utilized to determine the retention of anatomical knowledge, was utilized to determine the extent to which participants retained gross anatomy knowledge. Participants also completed a questionnaire specifically designed to identify the factors that may have influenced their retention of gross anatomy knowledge. A two-sided Pearson chi-square test of association was used to ascertain statistically significant differences in carpal bone retention and students' responses between the two cohorts. Seventy percent of the fifth-year (clinical) chiropractic students correctly identified all eight carpal bones compared to only six percent of second-year chiropractic students. The majority of participants in both cohorts believed that gross anatomy knowledge is of clinical importance. The use of mnemonics and the clinical application of anatomy knowledge were identified as factors that significantly influenced participants' gross anatomy knowledge retention within this study

Reliability/validity of the Fortius trainer

This study examined the reliability/validity of power output measured using the Fortius Virtual Reality cycle trainer. 10 cyclists (age: 28 +/- 6 years; (V) over dotO(2)max: 60.9 +/- 7.2 ml . kg(-1) . min(-1); peak power: 393 +/- 82 W) completed three 20 km time trials on a Fortius cycle trainer. During each time trial, power output was measured at 1 Hz using the Fortius internal software and a PowerTap power monitor. Validity calculated for the Fortius trainer; Pearson correlation coefficient (r = 0.99; 95 % CI: 0.98-0.99; p < 0.01) and typical error of estimate (3.5 %; 95 % CI: 3.2-3.9 %), was similar to other established laboratory ergometers. No differences (F-2,F-16 = 0.32; p = 0.73) in mean 20 km power were observed between trial 1 (253 +/- 46 W), 2 (258 +/- 49 W), or 3 (255 +/- 50 W). Test-retest reliability (intraclass correlation coefficient (ICC) and coefficient of variation (CV)) was better between trial 2 and 3 (ICC = 1.00 (CI: 0.98-1.00); CV: 1.6 % (CI: 1.1-3.3 %)) compared with trial 1 and 2 (ICC = 0.98 (CI: 0.91-1.00); CV: 3.3% (CI: 2.2-6.4%)). The Fortius cycle trainer is a valid and reliable device for the measurement of power output in cyclists, thus providing an alternative to larger more expensive laboratory ergometers

‘Going Up-North’: Chiropractic undergraduate clinical immersion placements in country Western Australia

Aim: The aim of this study was to explore how clinical immersion placements (CIPs) in regional, rural and remote Western Australia impact undergraduate chiropractic student experience, attributes and employment destination. Methods: Ten cohorts of students in their final year of five-year Australian chiropractic undergraduate programs had undertaken a placement in regional, rural or remote Western Australia. Students from five of those cohorts were invited to complete the Service Experience Questionnaire (SEQ) and open-ended reflective feedback (Part A). The Australian Health Practitioner Regulation Agency/Chiropractic Board of Australia public register of chiropractors and the internet were also interrogated for data on graduate employment location (Part B). Results: All (n=67) invited students participated in the Part A study. All students agreed that the placement experience was educational, and should be retained in the undergraduate curriculum. Students also agreed that the placement enhanced respect for the individual and awareness of others in need (94.1%), highlighted the importance of respect for all people (94%), improved empathy for the disadvantaged (88.1%), and provided them with an opportunity to improve their communication skills (98.5%). A majority (56.7%) indicated that as a result of their placement, they would be more likely to practice in a country setting. Further, those who participated in a placement were significantly more likely to practice in a regional, rural or remote location of Western Australia after graduation. Conclusions: This study is the first in Australia to describe the extent to which CIPs impact the development of communication and interaction skills, social responsibility and a philosophy of caring in chiropractic students, and the decision to work in regional, rural or remote Australia. These results support the utility of clinical immersion placements to help meet the educational objectives of undergraduate chiropractic programs, and to address the mal-distribution of the chiropractic workforce in regional, rural and remote Australia

Urban planning and illegal building in Italy

The paper addresses illegal building and development activity, a phenomenon that substantially impacts the urban and regional system and influences land use and consumption. The paper begins by briefly describing the types and different meanings of informal settlements throughout the world, as well as in Italy. To explain what illegal building means in Italy, it is necessary to illustrate the country’s urban planning system, its regulations and the three laws that introduced building amnesty. The origins and causes of illegal building and urban planning practices are pointed out and precisely described. National data with particular focus on the Campania region illustrates the magnitude of the phenomenon. In fact, the largest part of illegal building volumes can be found in Southern Italian regions characterized by administrative inefficiency. The study concludes with some ideas on how to approach urban planning in territories marked by the presence of illegal development, whether compact or sprawled

Abusivismo urbanistico e rigenerazione urbana

Il presente paper propone una lettura dell’abusivismo e, in particolare, di quello urbanistico. Inquadra il fenomeno all’interno delle più ampie problematiche della pianificazione fisica nella consapevolezza del forte impatto territoriale che esso determina. L’abusivismo urbanistico ha una forte influenza sull’assetto del territorio, sul consumo, sull’uso e sulla tutela del suolo e condiziona pesantemente la rigenerazione di molte città meridionali. Il paper sarà organizzato in tre parti: la prima punterà al riconoscimento dell’abusivismo urbanistico, ovvero quello con effetti di tipo urbano/territoriale, distinguendolo da quello edilizio; la seconda proporrà una procedura, basata sulla tecnica dell’overlay-mapping, atta a rappresentare il fenomeno a scala urbanistica e la terza cercherà di chiarire cosa il piano urbanistico (o un altro strumento di pianificazione del territorio) potrebbe prevedere per incidere e/o avviare a soluzione la problematica della rigenerazione urbana delle città interessate da tale fenomeno