A theory-based multi-component intervention to increase reactive balance measurement by physiotherapists in three rehabilitation hospitals: an uncontrolled single group study.

BACKGROUND: Most implementation interventions in rehabilitation, including physiotherapy, have used passive, non-theoretical approaches without demonstrated effectiveness. The goal of this study was to improve an important domain of physiotherapy practice - reactive balance measurement - with a targeted theory-based multi-component intervention developed using the Theoretical Domains Framework. The primary objective was to determine documented reactive balance measure use in a 12-month baseline, during, and for three months post- intervention. METHODS: An uncontrolled before-and-after study was completed with physiotherapists at three urban adult rehabilitation hospitals in Ontario, Canada. The 12-month intervention included group meetings, local champions, and health record modifications for a validated reactive balance measure. The primary outcome was the proportion of records with a documented reactive balance measure when balance was assessed pre-, during- and post-intervention. Secondary outcomes were changes in use, knowledge, and confidence post-intervention, differences across sites, and intervention satisfaction. RESULTS: Reactive balance was not measured in any of 211 eligible pre-intervention records. Thirty-three physiotherapists enrolled and 28 completed the study. Reactive balance was measured in 31% of 300 eligible records during-intervention, and in 19% of 90 eligible records post-intervention (p < 0.04). Knowledge and confidence significantly increased post-intervention (all p < 0.05). There were significant site differences in use during- and post-intervention (all p < 0.05). Most participants reported satisfaction with intervention content (71%) and delivery (68%). CONCLUSIONS: Reactive balance measurement was greater among participants during-intervention relative to the baseline, and use was partially sustained post-intervention. Continued study of intervention influences on clinical reasoning and exploration of site differences is warranted.

Discovery of an Anteriorly Deviated, Partially Ossified Xiphoid Process With a Large, Teardrop-Shaped Foramen in a Male Cadaver.

The sternum, or "breastbone," is a principal bony component of the anterior thoracic wall and comprises the manubrium of the sternum, the body of the sternum, and the xiphoid process. The xiphoid process is the most inferior of these elements and commonly presents as a small, solid bone shaped like an inverted triangle. However, clinical literature has reported numerous variations in its size, shape, and presentation, likely the result of its lengthy embryological development from cartilage into fully ossified bone. In this case report, a rare, anteriorly deviated, partially ossified xiphoid process with a large, teardrop-shaped foramen is presented that was discovered during a routine cadaveric dissection of a 75-year-old male within an undergraduate anatomy course. Although anatomical variations in the xiphoid process are often asymptomatic and often only found incidentally through CT or X-ray scans, healthcare professionals should be aware of such variations to avoid both misdiagnoses as well as iatrogenic complications.

Bilateral Sternalis Muscles: The Clinical Significance of This Rare Discovery.

This case report explores the physical characteristics and clinical significance of the sternalis muscle, an uncommon anatomical variation of the anterior thoracic wall. If present, the sternalis muscle may distort diagnostic images and can be associated with incorrect interpretation of such medical images, misdiagnoses, and even surgical complications. As such, enhancing clinicians' knowledge of this muscle and improving its recognition is of the utmost importance. In this case report, a rare bilateral sternalis muscle that was discovered during an educational human cadaveric dissection of a 73-year-old Black male is described. The right sternalis muscle fibres extended from the mid-sternal level to the right sternocostal arch, measuring 11.5 cm in length and 3.4 cm at its largest width. In contrast, the smaller left sternalis muscle fibres measured only 5.6 cm in length and 1.2 cm at its greatest width. This rare bilateral presentation of the sternalis muscle is documented in approximately one-third of all reported sternalis cases with an associated estimated prevalence as low as 1.7% among the general population. Serving as a reminder of the intricate anatomical complexities that continue to challenge and intrigue medical professionals, this report advocates for continued education of anatomical variations to enhance patient care and medical practices.

Atypically Taut Superior Polar Splenic Artery Discovered in a Human Cadaver.

The splenic artery is the largest branch of the celiac trunk and frequently presents with anatomical variability. These variations relate to its origin, trajectory, location relative to the pancreas, terminal branching pattern, and the potential presence of polar arteries. Knowledge of the splenic artery's variability may inform gastrointestinal surgeons as they plan and execute surgical interventions, resulting in improved success rates while minimizing both operative complications and procedural time. The case presentation of a splenic artery dissected from an elderly male cadaver initially demonstrated normal anatomical arrangement. The artery branched off the celiac trunk of the abdominal aorta and followed a tortuous suprapancreatic route to split into two lobar arteries terminating in the spleen. However, upon closer inspection, a superior polar splenic artery was uncovered with two unique characteristics. Firstly, the presented polar artery lacked branching gastric arteries, a rare variation with a prevalence of only 3.27%. Secondly, the distance between the origin of the superior polar splenic artery and the splenic hilum was greater than what is often reported in clinical literature. While similar previous case reports have observed arterial origins of greater distance, these have often been accompanied by a compensatory arterial length. Interestingly, the case presented in this report contained a superior polar splenic artery with an arterial length shorter than its distance to the splenic hilum, resulting in an atypically taut vessel. This bears clinical importance, as this arterial presentation may be susceptible to a surgical rupture if neglected. By including this anatomical variation in the expanding library of splenic artery variations, surgeons and their collaborative healthcare teams may broaden their understanding of splenic artery anatomy as they conceptualize new techniques for pancreatomy and splenectomy procedures that consider arterial variations while minimizing surgical complications, operative time, and patient blood loss.

Education of the clinical embryology laboratory professional: development of a novel program delivered in a laboratory medicine department.

Clinical embryologists are responsible for the handling, evaluation, and care of human gametes and preimplantation embryos within the context of an assisted reproductive technology laboratory. They are integral members of a team of professionals who provide care for fertility patients. Despite the increasing recognition of clinical embryologists as professionals, training requirements, continuing professional development, and appropriate credentialing have lagged in several countries. In many cases, individuals enter the profession with training limited to technical aspects provided by individual laboratory directors through an apprenticeship model. In this article, we present the rationale for rigorous formal training in clinical embryology, introduce CanEMB competencies for practicing professional clinical embryologists that are founded on CanMEDs role principles, and present a nascent Masters of Health Sciences degree program in Laboratory Medicine with a specialization in clinical embryology. This 2-year program has unique features including a Clinical Embryology Skills Development Laboratory, research capstone project, and 200-hour placement within a practicing assisted reproductive technology laboratory. Importantly, this program is delivered through a university-based Department of Laboratory Medicine and Pathobiology in partnership with a Department of Obstetrics and Gynecology. Thus, this program represents a formal acceptance of clinical embryology as a clinical laboratory science. It can be adopted elsewhere to provide a relevant, robust education that will meet current and future needs of the profession.

An analysis of anatomy education before and during Covid-19: August-December 2020.

Coronavirus disease-2019 (Covid-19) disrupted the in-person teaching format of anatomy. To study changes in gross anatomy education that occurred during August-December, 2020 compared to before the pandemic, an online survey was distributed to anatomy educators. The 191 responses received were analyzed in total and by academic program, geographic region, and institution type. Cadaver use decreased overall (before: 74.1 ± 34.1%, during: 50.3 ± 43.0%, P < 0.0001), as well as across allopathic and osteopathic medicine, therapy, undergraduate, and veterinary programs (P < 0.05), but remained unchanged for other programs (P > 0.05). Cadaver use decreased internationally and in the US (P < 0.0001), at public and private (P < 0.0001) institutions, and among allopathic medical programs in Northeastern, Central, and Southern (P < 0.05), but not Western, US geographical regions. Laboratories during Covid-19 were delivered through synchronous (59%), asynchronous (4%), or mixed (37%) formats (P < 0.0001) and utilized digital resources (47%), dissection (32%), and/or prosection (21%) (P < 0.0001). The practical laboratory examination persisted during Covid-19 (P = 0.419); however, the setting and materials shifted to computer-based (P < 0.0001) and image-based (P < 0.0001), respectively. In-person lecture decreased during Covid-19 (before: 88%, during: 24%, P = 0.003). When anatomy digital resources were categorized, dissection media, interactive software, and open-access content increased (P ≤ 0.008), with specific increases in BlueLink, Acland's Videos, and Complete Anatomy (P < 0.05). This study provided evidence of how gross anatomy educators continued to adapt their courses past the early stages of the pandemic.

A brief experimental examination of post-exercise hypotension and the impact of calculation method.

PURPOSE: There is great variability in the reported values of post-exercise hypotension (PEH), with inconsistent calculation methods employed across primary research. This study aimed to explore the influence of the mathematical calculation method on PEH variability, with the hypothesis that the method of identifying the lowest single reduction point (LSRP) would yield false-positive results. METHODS: Young, normotensive (108 ± 7/69 ± 5 mmHg), apparently healthy, male (n = 20) were included in this study. Participants completed three random-order experimental sessions, with blood pressure and heart rate measured before (10 min) and after (30 min) an acute bout of either isometric handgrip exercise, aerobic cycling, or a nonexercise control. Three PEH calculation methods were analyzed: LSRP, 30-min average across the full post-exercise recovery, and 15-min binned averages with two recovery windows (0-15 min, 15-30 min). RESULTS: The only calculation method to consistently identify PEH was the LSRP method, which identified PEH for SBP, DBP, and mean arterial pressure, across handgrip exercise, aerobic cycling, and even nonexercise control (P < 0.001). All other calculation methods inconsistently identified PEH across experimental sessions, supporting the hypothesis that LSRP inaccurately overreports PEH. CONCLUSION: Mathematical calculation method appears to be one source of variability contributing to the inconsistency in reported PEH among young, healthy males. This brief experimental examination reveals that the LSRP method should be avoided as it inaccurately overreports PEH. Alternatively, binned averages of smaller time windows across the recovery period may be a potentially advantageous approach and require further examination to determine to ideal level of granularity.

Two-stage collaborative group testing does not improve retention of anatomy among students studying medical radiation technology.

INTRODUCTION: Two-stage collaborative group testing is an assessment format where students first complete a summative assessment independently, and then immediately convene in a small group to complete the same assessment again. Research on two-stage collaborative group testing has shown that it increases immediate learning, improves communication and teamwork, and can lead to enhanced retention of course material; the latter of which is especially important for basic anatomical concepts among health care professionals such as medical radiation technologists. However, such previous research has often employed quasi-experimental designs that may limit both internal and external validity. METHODS: Using a randomized crossover design with both quantitative and qualitative data analyses including robust intra-individual statistical comparisons, this research compared the educational impact of the two-stage collaborative group testing format (the COL condition) to traditional independent testing (the IND condition). Students (n=196) from two successive renditions of an introductory anatomy course were randomly assigned into groups of 3-5 students. Groups worked together throughout the term on various course elements, including three in-class, non-cumulative term tests (TTs). After practicing the collaborative format during TT1, during TT2 half the groups were assigned to the COL condition while the other half were assigned to the IND condition. Groups crossed over for TT3. All students completed a cumulative final examination independently, with performance data from that examination coded and extracted according to previous TT condition. Educational impact was evaluated as both immediate learning (by comparing IND and COL performance on the associated TT) as well as retention (by comparing final examination performance for topics previously IND tested versus previously COL tested). Students' qualitative reflections were coded into categories and juxtaposed against quantitative Likert-style feedback to comprehensively explore students' perception of the testing format for evidence of enjoyment, acceptability, and influence on relevant CAMRT professional competencies. RESULTS: 167 students (85%) consented to data inclusion, with a final course grade of 75.5 ± 10.0%. On average, TT performance was 13.6 ± 11.6% greater on the COL test (90.4 ± 7.6%) than the IND test (76.7 ± 14.3%) (p<0.01, r = 0.76), results that support immediate learning. Contrary to expectations, final examination performance specific to the two experimental conditions was similar, with students earning an average of 69.6 ± 18.3% on questions that pertained to material they were previously IND tested on, and 67.4 ± 19.1% on questions they were previously COL tested on (ns). Students' overall perceptions of the two-stage collaborative group testing format were overwhelmingly positive, with 84% indicating a belief that the format was a constructive learning opportunity and 74% recommending continued use. Written reflections revealed that students believed that collaborative testing enhanced their learning by both clarifying previous mistakes and reinforcing correct knowledge. Relevant CAMRT professional competencies included oral communication and interprofessional skills, capacity for productive teamwork, and collaborative practice. SIGNIFICANCE: Although the results of this study do not support the use of two-stage collaborative group testing for retention of course material, they simultaneously reveal how the testing structure may be uniquely beneficial to students studying within the field of medical radiation sciences while also presenting a pragmatic example of how to implement this unique testing format.

An Analysis of Anatomy Education Before and During Covid-19: May-August 2020.

Coronavirus disease 2019 (Covid-19) created unparalleled challenges to anatomy education. Gross anatomy education has been particularly impacted given the traditional in-person format of didactic instruction and/or laboratory component(s). To assess the changes in gross anatomy lecture and laboratory instruction, assessment, and teaching resources utilized as a result of Covid-19, a survey was distributed to gross anatomy educators through professional associations and listservs. Of the 67 survey responses received for the May-August 2020 academic period, 84% were from United States (US) institutions, while 16% were internationally based. Respondents indicated that in-person lecture decreased during Covid-19 (before: 76%, during: 8%, P < 0.001) and use of cadaver materials declined (before: 76 ± 33%, during: 34 ± 43%, P < 0.001). The use of cadaver materials in laboratories decreased during Covid-19 across academic programs, stand-alone and integrated anatomy courses, and private and public institutions (P ≤ 0.004). Before Covid-19, cadaveric materials used in laboratories were greater among professional health programs relative to medical and undergraduate programs (P ≤ 0.03) and among stand-alone relative to integrated anatomy courses (P ≤ 0.03). Furthermore, computer-based assessment increased (P < 0.001) and assessment materials changed from cadaveric material to images (P < 0.03) during Covid-19, even though assessment structure was not different (P > 0.05). The use of digital teaching resources increased during Covid-19 (P < 0.001), with reports of increased use of in-house created content, BlueLink, and Complete Anatomy software (P < 0.05). While primarily representing US institutions, this study provided evidence of how anatomy educators adapted their courses, largely through virtual mediums, and modified laboratory protocols during the initial emergence of the Covid-19 pandemic.

Characterizing and Comparing Acute Responses of Blood Pressure, Heart Rate, and Forearm Blood Flow to 2 Handgrip Protocols.

PURPOSE: Growing evidence supports handgrip exercise training for reducing resting blood pressure (BP), with inconsistent exercise protocols reported throughout the literature. To verify safety of such protocols, real-time cardiovascular responses must be assessed. Consequently, this research sought to evaluate the acute impact of dissimilar handgrip protocols on the cardiovascular responses of BP, heart rate (HR), and forearm blood flow. METHODS: Using a randomized intraindividual crossover design, 20 post-menopausal women completed 2 distinct handgrip protocols compared with a nonexercise control: 4 × 2-min sustained grips at 30% moderate intensity with 1-min rest between sets (ZONA), and 32 × 5-sec intermittent grips at maximal intensity with 5-sec rest between sets (MINT). Cardiovascular responses were measured throughout exercise and post-exercise recovery. RESULTS: Compared to ZONA, the MINT protocol required less time and less exercise effort, yet caused greater average BP perturbations (systolic, MINT: 16.9 ± 12.9 mm Hg, ZONA: 7.9 ± 11.6 mm Hg; diastolic, MINT: 8.7 ± 7.2 mm Hg, ZONA: 4.5 ± 4.9 mm Hg) (P < .05), with peak BP changes far below published safety guidelines. Average HR responses were similarly elevated between protocols (MINT: 5.4 ± 4.9 beats/min, ZONA: 3.4 ± 3.6 beats/min). Post-exercise recovery of BP and HR occurred swiftly following MINT while remaining elevated following ZONA. CONCLUSIONS: Handgrip exercise protocols with distinct design features (ie, grip intensity, grip strategy, and exercise duration) cause dissimilar acute cardiovascular responses. Careful and controlled attention should be directed toward determining how such acute dissimilarities influence corresponding training outcomes. Given the confirmed safety of acute BP perturbations, future researchers can have confidence in prescribing even the high-intensity MINT protocol for at-home, unsupervised activity.

Resting blood pressure reductions following handgrip exercise training and the impact of age and sex: a systematic review and narrative synthesis.

BACKGROUND: The risk of developing cardiovascular disease can be directly correlated to one's resting blood pressure (BP), age, and biological sex. Resting BP may be successfully reduced using handgrip exercise training, although the impact of age and sex on training effectiveness has yet to be systematically evaluated. The objective of this systematic review is to determine this impact of age and sex on handgrip-induced changes to resting BP. METHODS: Data sources included MEDLINE, Embase, Cochrane Reviews, CINAHL, SPORTDiscus, Web of Science, AMED, PubMed, and Scopus through May 2018. Eligibility criteria were those with prospective handgrip exercise training of ≥ 4 weeks with reported impact on resting systolic BP (SBP). Screening of articles, data extraction, and quality appraisal were completed in duplicate. When necessary, the corresponding authors were contacted to provide segregated data based on age (younger, 18-54 years; aged, > 55 years) and sex (men, women) categories. SBP was primarily explored with numerous secondary outcomes of interest summarized as a narrative synthesis. RESULTS: After screening 1789 articles, 26 full texts were reviewed. Eight studies reported data in a way that facilitated age and sex comparisons of primary outcomes, while 7 of 18 studies reporting pooled data (men and women) provided segregated results. Research spans 1992-2018 and represents 466 participants; at least 43.1% of whom are women. Although weighted mean differences reveal that handgrip training-induced SBP reductions are similar when merely comparing sexes (women; - 5.6 mmHg, men; - 4.4 mmHg) or ages (younger; - 5.7 mmHg, aged; - 4.4 mmHg), when the impact of sex and age is simultaneously evaluated, aged women experience the largest reduction in SBP (- 6.5 mmHg). Many factors were explored for their impact on resting BP reductions and have been summarized in the corresponding narrative synthesis. CONCLUSIONS: Handgrip exercise is an effective modality for resting BP reduction resulting in clinically significant reductions for men and women of all ages. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015019792.

High-intensity handgrip training lowers blood pressure and increases heart rate complexity among postmenopausal women: a pilot study.

OBJECTIVE: Handgrip exercise is an emerging strategy for resting blood pressure (BP) reduction requiring minimal time and exercise effort. However, the research literature is currently limited to handgrip protocol designs predominantly prescribing sustained grip contractions, with little assessment of alternative options. Furthermore, our understanding of the utility of handgrip exercise would be strengthened by an evaluation of the physiological mechanisms driving BP reductions and an assessment of the interindividual response variability. As such, this research was designed to perform an initial evaluation of the pragmatic effectiveness of a novel at-home, high-intensity, unilateral (nondominant) handgrip exercise training program in reducing resting BP, while simultaneously exploring mediators of BP change including a neurocardiac index of autonomic nervous control [heart rate (HR) variability], measures of arterial stiffness (radial augmentation index and carotid-radial pulse wave velocity), and cardiovascular reactivity to psychophysiological stressors. METHODS: Postmenopausal women were recruited to complete 8 weeks of handgrip exercise training. Aforementioned measures of resting BP and mediators of BP change were acquired at the midway point and end of training. RESULTS: All participants (n=17) completed training with high self-reported adherence (96.9%) and improvement in grip strength (2.7±2.4kg, P<0.05). Handgrip training reduced resting systolic BP (-5.1±7.7 mmHg, P<0.05) and improved HR complexity (sample entropy: 0.24±0.31, P<0.05), without significant changes to resting diastolic BP, HR, or arterial stiffness (all P>0.05). CONCLUSION: This pilot study successfully shows the potential utility of high-intensity intermittent handgrip exercise for improvements in cardiovascular health among postmenopausal women, with additional research required to further explore the underlying physiological mechanisms driving such improvements.

Resting blood pressure reductions following isometric handgrip exercise training and the impact of age and sex: protocol for a systematic review.

BACKGROUND: The risk of developing cardiovascular disease is directly correlated to one's resting blood pressure (BP), age, and biological sex. Resting BP can be reduced using handgrip exercise training, but the impact of age and sex on the effectiveness of training is not well documented. METHODS/DESIGN: A systematic search of the literature will be conducted for all experimental studies (including randomized controlled trials and prospective experiments) that report the influence of isometric handgrip exercise training on resting systolic blood pressure. The databases Medline, Embase, Cochrane Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SPORTDiscus, Web of Science, Allied and Complementary Medicine (AMED), PubMed, and Scopus will be searched until 1 December 2015. Screening of potential articles, data abstraction, and quality appraisal will be completed in duplicate independently. When necessary, corresponding authors will be contacted in order to facilitate the separation of pooled data into age and sex categories. Methodological quality will be determined using the Quality Assessment Framework developed by the Cochrane Collaboration and the Newcastle-Ottawa Quality Assessment Scale as appropriate. Any discrepancies will be resolved by a third author. Findings will be presented in accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. DISCUSSION: This systematic review will determine the overall effectiveness of handgrip exercise training in improving resting blood pressure. A novel, focused assessment will contrast effectiveness of handgrip training based on the age (younger 18-54 years, older >55 years) and the sex (men, women) of study participants. This information is essential to consolidate before moving forward with the development and implementation of handgrip exercise training programmes which are designed to best meet the needs of particular cohorts. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015019792.

Yoga asanas as an effective form of experiential learning when teaching musculoskeletal anatomy of the lower limb.

Physical movement as a conduit for experiential learning within the academic context of anatomy is a strategy currently used in university dance education. This same approach can be applied to other movement-based practices, for example, yoga. The primary purpose of this study was to pilot a novel teaching curriculum to yoga practitioners, based on Bruner's Theory of Instruction, which incorporated the four adaptive modes of Kolb's Theory of Experiential Learning. The secondary purpose was to assess the applicability of anatomical knowledge within the participants' yoga practice. Following the development of a curriculum appropriate for a spectrum of academic backgrounds, participants were recruited to attend a 2-hour learning session within the Department of Anatomy at Queen's University in Kingston, Ontario, Canada. The learning session guided participants through the bones and muscles of the lower limb pertaining to five specific yoga poses. Based on participant feedback, the sessions were positively received and consistent. In addition, learning session participants were able to apply the anatomical information they were taught to their yoga practice 1-month later. Bruner and Kolb's independent theories on curriculum design and effective learning practice were successfully incorporated to create a 2-hour learning session. The potential use of experiential learning to compliment and/or enhance traditional didactic teaching in the academic context of anatomy should be further explored.