Effects of activity repetition training with Salat (prayer) versus task oriented training on functional outcomes of stroke.

Stroke is one of most disabling condition which directly affects quality of life. The objective of this study was to compare the effect of activity repetition training with salat (prayer) versus task oriented training on functional outcomes of stroke. The study design was randomized control trial and 32 patients were randomly assigned into two groups'. The stroke including infarction or haemorrhagic, age bracket 30-70 years was included. The demographics were recorded and standardized assessment tool included Berg Balance Scale (BBS), Motor assessment scale (MAS) and Time Up and Go Test (TUG). The measurements were obtained at baseline, after four and six weeks. The mean age of the patients was 54.44±10.59 years with 16 (59%) male and 11(41%) female patients. Activity Repetition Training group showed significant improvement (p<0.05) and is effective in enhancing the functional status as compare to task oriented training group. The repetition with motivation and concentration is the key in re-learning process of neural plasticity.

The impact of the learning contract on self-directed learning and satisfaction in nursing students in a clinical setting.

Background: The most important responsibilities of an education system are to create self-directed learning opportunities and develop the required skills for taking the responsibility for change. The present study aimed at determining the impact of a learning contract on self-directed learning and satisfaction of nursing students. Methods: A total of 59 nursing students participated in this experimental study. They were divided into six 10-member groups. To control the communications among the groups, the first 3 groups were trained using conventional learning methods and the second 3 groups using learning contract method. In the first session, a pretest was performed based on educational objectives. At the end of the training, the students in each group completed the questionnaires of self-directed learning and satisfaction. The results of descriptive and inferential statistical methods (dependent and independent t tests) were presented using SPSS. Results: There were no significant differences between the 2 groups in gender, grade point average of previous years, and interest toward nursing. However, the results revealed a significant difference between the 2 groups in the total score of self-directed learning (p= 0.019). Although the mean satisfaction score was higher in the intervention group, the difference was not statistically significant. Conclusion: This study suggested that the use of learning contract method in clinical settings enhances self-directed learning among nursing students. Because this model focuses on individual differences, the researcher highly recommends the application of this new method to educators.

A heutagogical approach to building the residential aged care workforce capability and capacity.

OBJECTIVE: This paper reports on the design and implementation of an interactive online education package for the diverse Australian residential aged care workforce, in response to the findings of the Royal Commission into Aged Care Quality and Safety. A decade of reports has consistently highlighted the need for an educated workforce to care for the increasingly frail older people with complex care needs living in residential aged care. Cost, availability and timing of education have been identified as barriers to uptake of education for this workforce. METHODS: A heutagogical approach was used to design an evidence-based, modular, online education package for nurses, care workers and allied health practitioners working in the residential aged care sector. The subject matter was developed by experts and the education divided into modules. A key challenge was to design a package that was inclusive of the diversity of educational needs in this workforce. The package does not provide assessments on completion of the modules, relying solely on the motivation of the individual learner. RESULTS: This online education package provides choice and self-determination for users in their learning journey. Collaborating with experts to develop an online education program that is learner-driven, challenges the conventions of education. Users can navigate the package at their pace; choose the modules they have identified as knowledge gaps or are of interest; and complete the education in their own time. CONCLUSION: As expected, most users are care workers and nurses and the five modules of the Dementia program are the most popular.

Evaluating the Impact of a Training Program in Shared Decision-Making for Neurologists Treating People with Migraine.

INTRODUCTION: Migraine symptoms vary significantly between patients and within the same patient. Currently, an increasing number of therapeutic options are available for symptomatic and preventive treatment. Guidelines encourage physicians to use shared decision-making (SDM) in their practice, listening to patients' treatment preferences in order to select the most suitable and effective therapy. Although training for healthcare professionals could increase their awareness of SDM, results concerning its effectiveness are inconclusive. This study aimed to analyze the impact of a training activity to promote SDM in the context of migraine care. This was addressed by evaluating the impact on patients' decisional conflict (main objective), patient-physician relationship, neurologists' perceptions of the training and patient's perception of SDM. METHODS: A multicenter observational study was conducted in four highly specialized headache units. The participating neurologists received SDM training targeting people with migraine in clinical practice to provide techniques and tools to optimize physician-patient interactions and encourage patient involvement in SDM. The study was set up in three consecutive phases: control phase, in which neurologists were blind to the training activity and performed the consultation with the control group under routine clinical practice; training phase, when the same neurologists participated in the SDM training; and SDM phase, in which these neurologists performed the consultation with the intervention group after the training. Patients in both groups with a change of treatment assessment during the visit completed the Decisional conflict scale (DCS) after the consultation to measure the patient's decisional conflict. Also, patients answered the patient-doctor relationship questionnaire (CREM-P) and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). The mean ± SD scores obtained from the study questionnaires were calculated for both groups and compared to determine whether there were significant differences (p < 0.05). RESULTS: A total of 180 migraine patients (86.7% female, mean age of 38.5 ± 12.3 years) were included, of which 128 required a migraine treatment change assessment during the consultation (control group, n = 68; intervention group, n = 60). A low decisional conflict was found without significant differences between the intervention (25.6 ± 23.4) and control group (22.1 ± 17.9; p = 0.5597). No significant differences in the CREM-P and SDM-Q-9 scores were observed between groups. Physicians were satisfied with the training and showed greater agreement with the clarity, quality and selection of the contents. Moreover, physicians felt confident communicating with patients after the training, and they applied the techniques and SDM strategies learned. CONCLUSION: SDM is a model currently being actively used in clinical practice for headache consultation, with high patient involvement in the process. This SDM training, while useful from the physician's perspective, may be more effective at other levels of care where there is still room for optimization of patient involvement in decision-making.

Making lighting adjustments to establish new behavioral patterns in a child with autism: A follow-up study.

Acknowledging the importance of lighting adjustment (a less-studied aspect of the environmental modification), this study showed novel effects of black light conditions, where white objects became part of the foreground of a blackened environment to train a child with autism to master a series of self-care tasks. This follow-up study provided details about how training progressed under black light conditions to teach the child a second task called self-feeding. The process of training self-feeding for this child was undergone after the child mastered the self-care task of toothbrushing. Healthcare practitioners may want to illuminate overlooked aspects of the non-human environment, which may be ignored by children with autism, to stimulate interest in objects following lighting adjustments.

Changes in training activity post COVID-19 infection in recreational runners and cyclists.

Background: Anecdotal evidence suggests that athletes struggle to return to exercise post COVID-19 infection. However, studies evaluating the effect of COVID-19 on athletes' exercise activity are limited. Objectives: The objectives of this study were: (i) to describe the perceptions of recreational runners and cyclists recovering from COVID-19 on their training activity and general well-being, (ii) to compare device-measured training data in runners and cyclists pre- and post COVID-19, with non-infected controls that had a training interruption. Methods: Participants who were recruited via social media completed an online questionnaire (n=61), including demographic, health and COVID-19 descriptive data. In a sub-sample, device-measured training data (heart rate, time, distance and speed, n=27) were obtained from GPS devices for four weeks before infection and on resumption of training. Similar data were collected for the control group (n=9) whose training had been interrupted but by factors excluding COVID-19. Results: Most participants experienced a mild to moderate illness (91%) that was associated with a training interruption time of two-four weeks. Decreases in heart rate, relative exercise intensity, speed, time and distance were observed during the first week of returning to training for both groups, followed by an increase from Week two onwards. Discussion: Results failed to support a 'COVID-19 effect' on exercise activity as reductions in training variables occurred in both the COVID-19 and control groups. A possible explanation for the reductions observed is a deliberate gradual return to training by athletes post-COVID-19. Conclusion: More research is needed using device-measured training data prior to and post COVID-19 infection to better understand the impact of the SARS-CoV-2 virus on the exercise activity of athletes.

Serum sclerostin concentration is associated with specific adipose, muscle and bone tissue markers in lean adolescent females with increased physical activity.

OBJECTIVES: Sclerostin is an important regulator of bone mass involving the Wnt/ß-catenin signalling pathway. Relatively few studies have investigated the relationships of circulating sclerostin levels with adiposity-related and muscle-related biochemical factors in individuals with increased energy metabolism. The aim of this study was to investigate the associations of circulating sclerostin with adipokines, myokines, osteokines and body composition values in lean adolescent females with increased physical activity. METHODS: A total of 73 adolescent females who were physically active and aged 14-18 years old participated in the study. Sclerostin, leptin, resistin, tumour necrosis factor (TNF)-α, interleukin (IL)-6, irisin, osteocalcin, C-terminal telopeptide of type I collagen (CTx), insulin-like growth factor (IGF)-1 and insulin were obtained from fasting blood samples. Body composition was measured by dual-energy X-ray absorptiometry (DXA) and analyzed for body fat mass, lean body mass, bone mineral content and muscle mass. RESULTS: Serum sclerostin (117.9 ± 60.3 pg/mL) was correlated with age, age at menarche, body fat, muscle mass, training activity, leptin, TNF-α, irisin, osteocalcin, CTx and IGF-1. Multivariate linear regression analysis demonstrated that fat mass (ß = 0.434; p = 0.001), leptin (ß = -0.308; p = 0.015), irisin (ß = 0.227; p = 0.024) and CTx (ß = 0.290; p = 0.031) were the most important predictors of serum sclerostin concentration. CONCLUSIONS: Bone-derived sclerostin is associated with specific adipokine, myokine and osteokine values in lean adolescent females with increased physical activity. These results suggest that the interactions between bone, adipose and muscle tissues could also be associated with circulating sclerostin concentrations.

Improvement of Attention in Elementary School Students through Fixation Focus Training Activity.

The attentional problems of school children are a crucial topic due to abundant information in this digital era. There are five attention dimensions for children: focused attention, sustained attention, selective attention, alternating attention, and divided attention. Focused training is a traditional method of improving attention ability. Subjects are required to focus on a fixed point for an extensive period without blinking and to perceive small objects as large. This study investigates which types of attention indicators are influenced by focus training. Eighty-two grade five and six elementary school students (45 experiment group, 37 control group) were involved. The experiment group underwent focus training for 12 weeks. The training was conducted once per week, and the Attention Scales for Elementary School Children were used before and after the training to examine the children's attention. The percentile rank scores of five attention dimensions and the total attention scale were evaluated. The results gave difference data, defined as post-test results minus the pretest results, where significant differences occurred for the total scale (p < 0.05), focused attention (p < 0.05), and selective attention (p < 0.01). Participants also noted that the training helped them improve concentration during school lessons (54.15%), fall asleep (29.1%), and relax the body (8.4%).

La ciencia desde la asistencia médica

La formación académica sustenta las bases para el desempeño investigativo del egresado. No obstante, en el camino entre la proyección del pregrado y el rediseño del posgrado de los planes de estudio, persisten dificultades en el proceso investigativo. Se propone considerar la utilidad del vínculo asistencia-docencia-investigación, sustentado en la presencia de esta última en cada momento y espacio de la vida del profesional, en función de transformar su entorno y con ello, su desarrollo intelectual, según criterios y experiencia de los autores. Es reconocida, la importante y decisiva integración docente-asistencial-investigativa, elemento característico de las formas organizativas de la educación médica cubana. No es posible llevar a cabo una investigación de calidad, sin una práctica médica de excelencia La investigación clínica mejora la calidad de los médicos y debe fomentarse como actividad esencial. Se deben identificar las necesidades de aprendizaje, y entre ellas estar contenidos los problemas investigativos, en torno a los cuales se erigen las investigaciones científicas. Para un profesional, no es posible que se separen las 3 vertientes interrelacionadas: la asistencia, la docencia y la investigación. Por lo tanto, de su trabajo diario, justamente emerge la ciencia. La formación de recursos humanos en Cuba, en el contexto actual, es transformadora, revolucionaria y a favor del bienestar de la sociedad. El vínculo asistencia-docencia-investigación debe concebirse como un sistema articulado e integral presente en cada momento de actuación del sistema de salud que debe ser aprovechado por los profesionales, los directivos, en función de transformar su entorno, calidad y pertinencia.

Academic training supports the bases for the graduate's research performance. However, on the path between the undergraduate projection and the postgraduate redesign of the study plans, difficulties persist in the research process. It is proposed to consider the usefulness of the assistance-teaching-research link, supported by the presence of the latter in every moment and space of the professional's life, in terms of transforming their environment and with it, their intellectual development, according to criteria and experience of the authors. The important and decisive integration of teaching-care-research is recognized, a characteristic element of the organizational forms of Cuban medical education. It is not possible to carry out quality research without excellent medical practice. Clinical research improves the quality of doctors and should be promoted as an essential activity. Learning needs must be identified, and among them the research problems, around which scientific research is built, must be contained. For a professional, it is not possible to separate the 3 interrelated aspects: assistance, teaching and research. Therefore, science emerges from daily work. The training of human resources in Cuba, in the current context, is transformative, revolutionary and in favor of the well-being of society. The care-teaching-research link must be conceived as an articulated and integral system present at every moment of action of the health system that must be taken advantage of by professionals, managers, in order to transform its environment, quality and relevance.