Gender-Specific Effects on Muscle Activation During Incline Treadmill Walking: A Virtual Perturbation Study For Future Astronauts

Introduction Microgravity-induced muscle atrophy is a critical issue for astronauts in spaceflight [1]. To overcome neuromuscular deconditioning, combining virtual reality (VR) with treadmill training protocol could be a promising countermeasure for astronauts to enhance muscle activities and maximize the training effect [2]. Our previous study [3] found the presence of visual perturbation significantly increased muscle activation while walking on incline treadmill, compared with no visual perturbation; surprisingly, we found females had more pronounced muscle responses than males. Based upon these findings, this study aimed to investigate the effects of different visual rotation speeds and different types of visual perturbation on muscle activation during incline treadmill walking, and how those effects were different between males and females. Methods A total of 20 healthy young adults (10 males and 10 females) participated this study. The normal VR scene was a virtual moving corridor, and its direction and speed were in accordance with the walking speed of the participant on the 9-degree incline treadmill; the participant would feel like walking through an endless corridor. Visual perturbation was created by adding clockwise rotation of the VR in constant or random angular speed. For the constant speed rotation, there were four different rotation speeds at 10°/s, 20°/s, 30°/s, and 60°/s respectively. For the random speed rotation, the rotation speed would change every 360° and was randomly selected at the range of 10°/s and 60°/s. The participant walked in each condition for two minutes. The wireless electromyography sensors were placed at the vastus lateralis (VL), medial hamstring (MH), tibialis anteriors (TA) and lateral gastrocnemius (LG) of the right leg. Multivariate Analysis of Variance (MANOVA) was applied, with the RMS values of VL, MH, TA and LG as the four dependent variables. The analysis was conducted separately for the total gait cycle, and during stance phase and swing phase. Results Increased visual rotation speed of visual perturbation induced higher VL and LG activation; gender had different responses to increased visual rotation speed in VL. The effect of different types of visual perturbation was more pronounced in female, as random speed rotation visual perturbation induced higher MH activation than not only normal VR but also constant speed rotation visual perturbation. Conclusion Integrating visual perturbation into regular treadmill exercise could magnify the training effects to reduce muscle deconditioning for astronauts during spaceflight. The visual rotation speed of visual perturbation should be taken into consideration based on the expected outcome of training. The gender effects revealed different muscle responses between males and females to visual perturbation, which need to be considered and furtherly explored to identify the optimal training countermeasure for astronauts

Using active learning strategies to teach DPT students how to assertively address inappropriate patient sexual behavior (IPSB)

PURPOSE/HYPOTHESIS Inappropriate sexual behavior is defined as a “verbal or physical act of an explicit, or perceived, sexual nature, which is unacceptable within the social context in which it is carried out.” In a survey of U.S. PTs, 86% of the respondents reported experiencing at least one type of IPSB. PT education programs are required to teach concepts of professional duty, communication skills, and cultural competency, however, management techniques of IPSB in the clinic are not uniformly taught in schools. The use of active learning methods such as role play simulation and small group discussion has been successful with other healthcare professionals allowing students to practice behaviors in a safe place. The aim of this study was to use flipped and active learning methods to effectively teach DPT students assertive approaches to managing IPSB. This study describes the effects on students’ knowledge and attitudes pre- and post-instruction. NUMBER OF SUBJECTS Forty-five first-year DPT students participated as part of a course on psychosocial issues. MATERIALS/METHODS Faculty developed eight case scenarios for the in-class discussion and role play. Students completed pre- and post-class paper surveys about their beliefs and knowledge on IPSB. The flipped model involved reading an assigned article on the topic prior to the class, brief instruction by faculty, interactive small-group discussion, role play, and a large group debrief in class. RESULTS: Forty-three students reported reading the preparatory article prior to class. Significant improvements were observed in students’ perceptions including: 1) the ability to address sexuality with young patients (p CONCLUSIONS The students responded well to the learning experience and believed they improved their ability to address IPSB. There was an interaction between males and females on the self-efficacy question. Females perceived their abilities to be lower than the males initially, but they scored higher post-instruction. While both groups’ perceptions changed, we observed that the females gained more from the experience. We recommend using the flipped classroom model and simulation methods to instruct DPT students in assertive behaviors. CLINICAL RELEVANCE PT’s may encounter IPSB in the clinic. Practicing strategies for these situations could lead to more appropriate therapist-patient interactions and fewer adverse effects. FUNDING SOURCE UNMC Division of Physical Therapy Educatio

Health Related Quality of Life in Persons with Type 2 Diabetes in a Rural Community Served by a Critical Access Hospital

Purpose Type 2 diabetes poses significant health concerns and severe complications can result. The prevalence of type 2 diabetes is greater in rural than urban areas with rural populations exhibiting higher blood glucose (A1C). The purpose of this study was to determine whether health related quality of life (QOL) varies by gender and diabetes control (A1C) in rural persons with type 2 diabetes. Subjects We surveyed 615 persons with type 2 diabetes who receive care at a critical access hospital that serves a seven county rural area in a Midwestern state. Methods This study was a cross-sectional mail survey including a questionnaire assessing demographic characteristics, health related quality of life (QOL) using the diabetes specific QOL tool, D-39, which covers five dimensions of a persons’ life: energy and mobility, diabetes control, anxiety and worry, social burden, and sexual functioning. We analyzed associations between A1C levels and survey responses using descriptive statistics and Spearman correlations. Results We received a 42% response rate with an even distribution of males and females. The median age for females was 76 years, males was 72 years and the majority were white (95%). The average years since diagnosis was 13.4 years (11 years for males and 9.5 for females). Spearman correlations were computed for D-39 subscales, overall perceived severity and QOL, and A1C. Positive correlations exist between overall perceived severity and the QOL dimensions of diabetes control (p\u3c.001), anxiety and worry (p\u3c.001), social burden (p\u3c.001), sexual functioning (p\u3c.001), and energy and mobility (p\u3c.001). Overall QOL rating is positively correlated with anxiety and worry (p=.011), social burden (p=.002) and energy and mobility (p\u3c.001). Hemoglobin A1C is positively correlated with the dimensions of diabetes control (p\u3c.001), anxiety and worry (p=.006), social burden (p\u3c.001), and sexual functioning (p=.030). When comparing the subscale dimension means between gender there is a significant difference only in reports of the sexual functioning dimension (p\u3c.001). Additional gender differences are related to perceived severity. When at low perceived severity females have a lower A1C and at high values of perceived severity males have a lower A1C. Conclusions Since diabetes control is largely due to self-management, it is important to consider the associations between the QOL dimensions, diabetes control (A1C) and gender. These results could be important for implementing successful intervention strategies for glycemic control (a potential mediator between diabetes and QOL) in rural critical access hospitals. Clinical Relevance Although gender is commonly reported in published studies about diabetes, differences have not been routinely analyzed. A better understanding of the relationship of perceived QOL and the impact on diabetes control and gender differences can assist the physical therapist in their role in providing optimal care for older adults with type 2 diabetes in rural communities

Filling the gap. Clinical skill acquisition with interactive online modules to supplement traditional instruction

PURPOSE The purpose of this study was to assess the effectiveness of interactive e-learning modules to supplement traditional instruction for range of motion (ROM) clinical skill acquisition in a doctor of physical therapy(DPT) curriculum. BACKGROUNDS/SIGNIFICANCE Online resources have become highly favored to augment learning especially by millennials for convenience, self-paced content, and versatility in learning styles. It has been reported that elearning platforms are as effective as traditional face-to-face instruction, but may be best utilized as an adjunctive resource for teaching psychomotor skills. Student confidence has also been analyzed with reports of increased self-efficacy with use of online learning materials. There are deficiencies in the literature related to the use of e-learning and student outcomes. There are no studies investigating the use of online technologies to supplement ROM skill acquisition and an overall deficiency regarding interactive learning platforms in DPT curriculum. During the last two years at one institution, only about half of the class passed the ROM lab practical on the first attempt. Requests by students for a supplemental resource beyond the textbook as well as faculty searching for an option that would appeal to the millennial generation and address common errors lead to the development of interactive e-learning modules to fill in the gap. This study aims serve as a comprehensive evaluation of modules by analyzing pass rates, confidence, usage, and student satisfaction. We hypothesized the modules would be highly regarded, utilized by students, and result in increased lab practical pass rates. SUBJECTS 52/53 first-year DPT students consented to participate. METHODS AND MATERIALS This was prospective cohort study about supplemental modules created by a faculty-student team to be highly-engaging and media rich where the learner decides the pace and order of content delivered. Embedded quizzes provided immediate feedback for the learner to reflect on their understanding. Modules supplemented 4 labs with faculty demonstrations, peer practice and lab assistant feedback. Students were assessed by a high-stakes lab practical of ROM measurements on a standardized patient: upper extremity (UE), lower extremity(LE) and spine. At the beginning of the semester, students were randomly divided into 2 groups with 1 group receiving access to the UE modules and the other having access to the LE modules. To reduce the crossover effect between the groups and maintain the integrity of the study, students were educated on the importance of only viewing the modules they had access to and faculty were blinded to group assignment. Mid-way through the semester all students had the option to choose if they wanted access to the last set of modules focused on the spine. Students rated confidence on a 10-point Likert scale and self-reported module usage was confirmed by the learning management system. Student satisfaction was assessed by an end of semester course evaluation. ANALYSES Chi-square tests were used to determine associations between groups for lab practical pass rates. Logistic regression was used to analyze differences between cohorts by year (α= 0.05). RESULTS Data was analyzed from 44/52 students. 8 students were excluded (6 for not using modules, 1 had previously taken the class, 1 viewed modules not of their assigned group). There were 34 females and 10 males with a mean age of 23 years (21-28), who reported race as Caucasian (n=41), Asian (n=2) and Hispanic (n=1). There were no significant differences between groups for gender, age or race. The average module usage per person was 2.4hours (10 min-7 hours). The average self-reported confidence for both groups combined increased from 4.3/10 to9.0/10 at the end of the semester. There was no significant difference between groups in the first time lab practical pass rate (p=0.30) and no significant differences in passing the UE (p=0.23) or LE (p=0.66) measurement. The first time lab practical pass rate for all students in 2015 was 71%. Without modules available, first time pass rates were 63% in 2013 and 47% in 2014.Individual year effects show a significant difference between 2015 and 2014 (p=0.02), but no difference for 2015 and2013 (p=0.40).All students requested access to the spine modules. Student satisfaction results of the modules: 78% reported appropriate interactivity, 80% wanted access beyond the semester, 76% said it helped them learn, and 85%recommended using them in the future. CONCLUSIONS The results support the use of interactive e-learning modules to supplement ROM clinical skill acquisition in a DPT curriculum. It appears that the interactive modules were well utilized by the students, increased confidence, and had a high rate of satisfaction as indicated by the course evaluation and students wanting access to the spine modules. Additionally, there were significant improvements in first time pass rates from the previous year when the modules were not available. Our results are congruent with previous studies that reported online technologies are best used to supplement traditional instruction. Limitations include a small sample size from a single institution and the inherent inaccuracies in students’ recall of self-reported data. Strengths include outcomes that went beyond student satisfaction. Furthermore, this interactive module served as a readily accessible resource and allowed students to study at their own pace and learning style. This platform for supplemental materials should be strongly considered for attainment of ROM psychomotor skills and could be valuable for instruction of other foundational clinical skills in physical therapy. FUNDING SOURCE University of Nebraska Medical Center College of Allied Health Professions and the Office of the Vice Chancellor for Academic Affairs

A Theory-Driven, Longitudinal Evaluation of the Impact of Team Training on Safety Culture in 24 Hospitals

Effective teamwork facilitates collective learning, which is integral to safety culture. There are no rigorous evaluations of the impact of team training on the four components of safety culture—reporting, just, flexible and learning cultures. We evaluated the impact of a year-long team training programme on safety culture in 24 hospitals using two theoretical frameworks

The Clinical Relevance of Cement Volume in Percutaneous Vertebral Augmentation

Introduction: Vertebroplasty and Kyphoplasty are two forms of percutaneous vertebral augmentation (PVA), in which polymethylmethacrylate cement is used to stabilize vertebral compression fractures (VCF). This study sought to evaluate the relationship between cement volume and clinical outcomes, including pain reduction, opioid use, and complication rate. Methods: Retrospective chart review produced 88 patients who received PVA at a tertiary care outpatient pain clinic. Cement volume, type of PVA, gender, level (thoracic vs lumbar) were collected, as well as clinical outcomes of numeric pain score (NPS) reduction, opioid percent change (OPC), and complications. Both pre-procedure and post-procedure (between 2-4 weeks) data were collected. Results: Sixty-four patients (72.7%) had statistically significant NPS reduction of ≥50% pain (p Conclusion: Cement volume does not correlate with clinical outcomes of NPS reduction or OPC. Furthermore, our study reinforced PVA as a beneficial treatment for reducing pain and opioid consumption in patients with painful VCF

Pediatric Acute Lymphoblastic Leukemia Patients and Potential Risk for Vincristine Side Effects with Concomitant Fluconazole

Background: Pediatric Acute Lymphoblastic Leukemia (ALL) patients undergoing intensive treatment are considered at high risk for opportunistic infections. To prevent invasive fungal infection, some patients receive antifungal prophylaxis such as fluconazole. As a consequence, an increase in vincristine toxicity has been associated with the co-administration of antifungal prophylaxis. We analyzed whether the use of fluconazole prophylaxis impacts vincristine’s side effects during induction therapy. Method: We conducted a retrospective chart review of all pediatric (age 0-18 years) patients diagnosed with ALL at Children’s Hospital and Medical Center in Omaha, Nebraska from July 2013-May 2021. Patients were divided into two groups based on whether or not they received fluconazole. Incidence of fungal infection, rate and grade of peripheral neuropathy, and prescription for gabapentin (treatment for peripheral neuropathy) were collected for both groups. Results: We had 157 ALL patients, of which 72 patients received fluconazole, and 85 patients did not receive fluconazole. There was no significant difference between fluconazole use and increased incidence of peripheral neuropathy (p value= 0.28) or incidence of hyponatremia (p value =Conclusion: We did not find a statistically significant difference that the use of concomitant fluconazole with vincristine increased the risk of peripheral neuropathy or hyponatremia.https://digitalcommons.unmc.edu/surp2021/1037/thumbnail.jp

Vincristine Side Effects with Concomitant Fluconazole Use during Induction Chemotherapy in Pediatric Acute Lymphoblastic Leukemia

As a mainstay of treatment for acute lymphoblastic leukemia (ALL), vincristine’s side effect profile is well known. Parallel administration of the antifungal fluconazole has been shown to interfere with the metabolism of vincristine, potentially resulting in increased side effects. We conducted a retrospective chart review to determine whether concomitant administration of vincristine and fluconazole during pediatric ALL therapy impacted side effects of vincristine, namely, hyponatremia and peripheral neuropathy. We also evaluated whether the incidence of opportunistic fungal infections was impacted by fluconazole prophylaxis. Medical charts of all pediatric ALL patients treated with induction chemotherapy at Children’s Hospital and Medical Center in Omaha, NE from 2013-2021 were retrospectively reviewed. We found no correlation between fluconazole use and increased incidence of peripheral neuropathy or hyponatremia. Additionally, the rate of fungal infections was not impacted by fluconazole prophylaxis. Empiric fungal prophylaxis with fluconazole during pediatric ALL induction, although safe, may not be necessary.https://digitalcommons.unmc.edu/chri_forum/1039/thumbnail.jp

The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project

Background: Conducting post-fall huddles is considered an integral component of a fall-risk-reduction program. However, there is no evidence linking post-fall huddles to patient outcomes or perceptions of teamwork and safety culture. The purpose of this study is to determine associations between conducting post-fall huddles and repeat fall rates and between post-fall huddle participation and perceptions of teamwork and safety culture. Methods: During a two-year demonstration project, we developed a system for 16 small rural hospitals to report, benchmark, and learn from fall events, and we trained them to conduct post-fall huddles. To calculate a hospital’s repeat fall rate, we divided the total number of falls reported by the hospital by the number of unique medical record numbers associated with each fall. We used Spearman correlations with exact P values to determine the association between the proportion of falls followed by a huddle and the repeat fall rate. At study end, we used the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) to assess perceptions of teamwork support for fall-risk reduction and the Hospital Survey on Patient Safety Culture (HSOPS) to assess perceptions of safety culture. We added an item to the T-TPQ for respondents to indicate the number of post-fall huddles in which they had participated. We used a binary logistic regression with a logit link to examine the effect of participation in post-fall huddles on respondent-level percent positive T-TPQ and HSOPS scores. We accounted for clustering of respondents within hospitals with random effects using the GLIMMIX procedure in SAS/STAT. Result: Repeat fall rates were negatively associated with the proportion of falls followed by a huddle. As compared to hospital staff who did not participate in huddles, those who participated in huddles had more positive perceptions of four domains of safety culture and how team structure, team leadership, and situation monitoring supported fall-risk reduction. Conclusions: Post-fall huddles may reduce the risk of repeat falls. Staff who participate in post-fall huddles are likely to have positive perceptions of teamwork support for fall-risk reduction and safety culture because huddles are a team-based approach to reporting, adapting, and learnin

Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals

Objective To evaluate the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. Data Sources/Study Setting Fall-risk-reduction process and outcome measures from 16 small rural hospitals participating in a research demonstration and dissemination study from August 2012 to July 2014. Previously, these hospitals lacked a fall-event reporting system to drive improvement. Study Design A one-group pretest-posttest embedded in a participatory research framework. We required hospitals to implement MTSs, which we supported by conducting education, developing an online toolkit, and establishing a fall-event reporting system. Data Collection Hospitals used gap analyses to assess the presence of fall-risk-reduction processes at study beginning and their frequency and effectiveness at study end; they reported fall-event data throughout the study. Principal Findings The extent to which hospitals implemented 21 processes to coordinate the fall-risk-reduction program and trained staff specifically about the program predicted unassisted and injurious fall rates during the end-of-study period (January 2014-July 2014). Bedside fall-risk-reduction processes were not significant predictors of these outcomes. Conclusions Multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls