Cardiac Rehabilitation and Exercise Prescription in Symptomatic Patients with Non-Obstructive Coronary Artery Disease-a Systematic Review.

PURPOSE OF REVIEW: Non-obstructive coronary artery disease (NOCAD) on coronary angiography is a common finding in patients with stable angina. Angina in NOCAD patients is thought to be caused by endothelial dysfunction of the epicardial coronary arteries and/or the microvasculature. Treatment is empiric, and 30% of patients remain symptomatic in spite of therapy. It is well known that physical exercise can improve endothelial function. The goal of this review was to assess the current literature on effects of physical exercise in NOCAD patients with angina. Therefore, a literature search was conducted to March 13, 2018 using the following search terms: syndrome X, microvascular angina, non-obstructive coronary artery disease and exercise training, cardiac rehabilitation, endothelial function. All original publications were included which examined the effect of a cardiac rehabilitation (CR) program or exercise training (ET) on patients with angina and NOCAD. RECENT FINDINGS: Eight studies, of which four were randomized controlled studies, examined 218 participants, 162 in an intervention and 56 in control groups. Most patients were women (97.7%). Exercise programs varied from 8 weeks to 4 months at moderate intensity and some included relaxation therapy. The studies examined the effect of CR on exercise capacity, quality of life (QoL), and perfusion defects. CR increased exercise capacity, oxygen uptake, symptom severity, and QoL. Myocardial perfusion improved. CR appears to be beneficial in symptomatic patients with NOCAD, improving exercise capacity and QoL and reducing severity of symptoms and myocardial perfusion defects. Data is limited to a small number of predominantly female patients. Further larger trials are warranted to determine the optimal rehabilitation protocols and define its long-term benefits

The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study.

Objective To develop a scoring system to measure physical morbidity in critical care – the Chelsea Critical Care Physical Assessment Tool (CPAx). Method The development process was iterative involving content validity indices (CVI), a focus group and an observational study of 33 patients to test construct validity against the Medical Research Council score for muscle strength, peak cough flow, Australian Therapy Outcome Measures score, Glasgow Coma Scale score, Bloomsbury sedation score, Sequential Organ Failure Assessment score, Short Form 36 (SF-36) score, days of mechanical ventilation and inter-rater reliability. Participants Trauma and general critical care patients from two London teaching hospitals. Results Users of the CPAx felt that it possessed content validity, giving a final CVI of 1.00 (P < 0.05). Construct validation data showed moderate to strong significant correlations between the CPAx score and all secondary measures, apart from the mental component of the SF-36 which demonstrated weak correlation with the CPAx score (r = 0.024, P = 0.720). Reliability testing showed internal consistency of α = 0.798 and inter-rater reliability of κ = 0.988 (95% confidence interval 0.791 to 1.000) between five raters. Conclusion This pilot work supports proof of concept of the CPAx as a measure of physical morbidity in the critical care population, and is a cogent argument for further investigation of the scoring system

A ‘person-in-context relational’ approach to understanding students’ willingness to communicate in an additional language in higher education in Greece: only the tip of an iceberg

Cultivating language learners’ willingness to communicate in a second language (L2 WTC) has been seen as the ultimate goal of L2 education and empirical inquiry into students’ intention to engage in L2 communication given the opportunity has gained momentum in applied linguistics research over the past decade or so. This strand of inquiry has seen a major shift from treating WTC as a relatively stable and fixed personality trait to taking a more context-sensitive perspective. In line with this shift, the present study set out to investigate the situated and emerging nature of L2 learners’ WTC in the English as a Foreign Language (EFL) classroom in the Greek higher education setting. Adopting a ‘person-in context relational’ view of L2 motivation (Ushioda, 2009) as a theoretical and methodological lens for researching WTC, this qualitative multiple case study conducted over the period of one academic semester investigated L2 WTC of a diverse group of five first-year undergraduate students studying at a specific private higher education institution in Greece. Data came from ethnographic classroom observations, stimulated recall interviews, life story narratives, and follow-up interviews. While the findings have confirmed L2 WTC as a dynamic and complex construct, they have also added crucial new insights. The key amongst these is the notion that WTC must be understood as part of people’s larger meaning making practices. These unravel across lifespans and lifeworlds, occur in relationships with others, and, while not necessarily visible in the WTC moment, are always present in it. Thus, the present study has laid bare the consequences of adopting a person-in-context relational view of WTC in terms of what can be learned and what should be done about it in both research and practice

Giving hope, ticking boxes or securing services? A qualitative study of respiratory physiotherapists' views on goal-setting with people with chronic obstructive pulmonary disease.

OBJECTIVE: To explore respiratory physiotherapists' views and experiences of using goal-setting with people with chronic obstructive pulmonary disease in rehabilitation settings. PARTICIPANTS: A total of 17 respiratory physiotherapists with ⩾12 months current or previous experience of working with patients with chronic obstructive pulmonary disease in a non-acute setting. Participants were diverse in relation to age (25-49 years), sex (13 women), experience (Agenda for Change bands 6-8) and geographic location. METHOD: Data were collected via face-to-face qualitative in-depth interviews (40-70 minutes) using a semi-structured interview guide. Interview locations were selected by participants (included participants' homes, public places and University). Interviews followed an interview guide, were audio-recorded and transcribed verbatim. DATA ANALYSIS: Data were analysed using thematic analysis; constant comparison was made within and between accounts, and negative case analysis was used. RESULTS: Three themes emerged through the process of analysis: (1) 'Explaining goal-setting'; (2) 'Working with goals'; and (3) 'Influences on collaborative goal-setting'. Goal-setting practices among respiratory physiotherapists varied considerably. Collaborative goal-setting was described as challenging and was sometimes driven by service need rather than patient values. Lack of training in collaborative goal-setting at both undergraduate and postgraduate level was also seen as an issue. CONCLUSION: Respiratory physiotherapists reflected uncertainties around the use of goal-setting in their practice, and conflict between patients' goals and organisational demands. This work highlights a need for wider discussion to clarify the purpose and implementation of goal-setting in respiratory rehabilitation

Rationale and Design of an Online Educational Program Using Game-Based Learning to Improve Nutrition and Physical Activity Outcomes Among University Students in the United Kingdom.

OBJECTIVE: To assess the impact of an online game-based educational program on nutrition knowledge and dietary and physical activity habits among university students in the United Kingdom. DESIGN: Randomized controlled trial with pre- and postintervention comparisons. SETTING: Two higher education settings in London, UK. SUBJECTS: Current undergraduate and postgraduate students of two universities (n = 88) aged 18-34 years are randomly allocated to an intervention (n = 44) or a control group (n = 44). INTERVENTION: The intervention group will receive access to an educational website and online quizzes with gamification elements, including information about healthy eating and physical activity. The control group will receive no information. Duration of the intervention will be 10 weeks. MEASURES OF OUTCOME: Primary outcome is nutrition knowledge. Secondary outcomes include dietary and activity habits. Nutrition knowledge and dietary and activity habits will be assessed using questionnaires. Weekly steps will be counted using pedometers. Assessment of anthropometric and metabolic risk factors will take place. ANALYSIS: Quantitative analysis will investigate changes in nutrition knowledge between the two groups of the study population. Linear regression analysis will be used, if the data follow the normal distribution (otherwise binomial regression analysis), to examine whether field of study, residence status, body mass index (BMI), and demographic factors affect nutrition knowledge. Associations between changes in knowledge and dietary and physical activity behavior will be assessed by correlations. CONCLUSIONS/IMPLICATIONS: The study will provide insights with regard to the design and use of online game-playing as a cost-effective approach to improve nutritional knowledge among university students

Supporting Ph.D. students' skills development: A three-stage doctoral program

Introduction: Sustainable development is increasingly recognized as a crucial component of education at all levels, including specialized academic work. As a result, the importance of Ph.D. training in producing highly skilled academics and professionals who can contribute to sustainable development has been acknowledged, leading to increased investments in doctoral training across Europe. However, the diversity in Ph.D. training across countries and universities suggests a lack of studies based on best practices for developing effective doctoral training programs. Methods: This study aimed to contribute to this discussion by combining the perspectives of 31 Ph.D. supervisors and directors from Portugal and England regarding the best practices for Ph.D. training. Participants from different disciplines were interviewed using semi-structured face-to-face interviews, and the data were analyzed using inductive thematic analysis. Results: The study found that, despite coming from different countries, the participants' perceptions regarding the challenges and strategies for improving doctoral education were similar. Based on these findings, the study proposes a three-stage program for structuring doctoral training, consisting of initial intensive training, assessment of individual needs, and tailored training. Discussion: The proposed program could prove valuable in developing or restructuring Ph.D. programs to address the main needs of Ph.D. students, optimize institutional resources, and promote on-time completion by enabling the timely development of necessary competencies for Ph.D. research. Furthermore, this approach could enhance the quality of Ph.D. education, broaden the spectrum and quality of graduates' competencies, and contribute to achieving sustainable development goals

Association of Real-Time Feedback and Cardiopulmonary-Resuscitation Quality Delivered by Ambulance Personnel for Out-of-Hospital Cardiac Arrest.

Background High-quality cardiopulmonary resuscitation (CPR) is associated with improved survival from out-of-hospital cardiac arrest and includes chest compression depth, chest compression rate, and chest compression fraction within international guideline recommendations. Previous studies have demonstrated divergent results of real-time feedback on CPR performance and patient outcomes. This study investigated the association between emergency medical service CPR quality and real-time CPR feedback for out-of-hospital cardiac arrest. Methods and Results This study collected out-of-hospital cardiac arrest data within the Capital Region of Denmark and compared CPR quality delivered by ambulance personnel. Data were collected in 2 consecutive phases from October 2018 to February 2020. Median chest compression depth was 6.0 cm (no feedback) and 5.9 cm (real-time feedback) (P=0.852). Corresponding proportion of guideline-compliant chest compressions for depth was 16.6% and 28.7%, respectively (P<0.001). Median chest compression rate per minute was 111 and 109 (P<0.001), respectively. Corresponding guideline adherence proportion for compression rate was 65.4% compared with 80.4% (P<0.001), respectively. Chest compression fraction was 78.9% compared with 81.9% (P<0.001), respectively. The combination of guideline-compliant chest compression depth and chest compression rate simultaneously was 8.5% (no feedback) versus 18.8% (feedback) (P<0.001). Improvements were not significant for return of spontaneous circulation (odds ratio [OR], 1.08 [95% CI, 0.84-1.39]), sustained return of spontaneous circulation (OR, 1.00 [95% CI, 0.77-1.31]), or survival to hospital discharge (OR, 0.91 [95% CI, 0.64-1.30]). Conclusions Real-time feedback was associated with improved guideline compliance for chest compression depth, rate, and fraction but not return of spontaneous circulation, sustained return of spontaneous circulation, or survival to hospital discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04152252