The influence of jump-landing direction on dynamic postural stability following anterior cruciate ligament reconstruction.

BACKGROUND: Traditional testing prior to return to sport following anterior cruciate ligament reconstruction typically involves jump-landing tasks in the forward direction. As injury is most likely the result of multiplanar neuromuscular control deficits, assessment of dynamic postural stability using landing tasks that require multiplanar stabilization may be more appropriate. The purpose of this study was to examine how dynamic postural stability is affected when performing jump-landing tasks in three different directions. METHODS: Fifteen athletes [11 females (18.0 ± 3.0 years) and 4 males (18.5 ± 3.1 years)] following anterior cruciate ligament reconstruction performed a series of single-limb jump-landing tasks in 3 directions. Individual directional stability indices and a composite dynamic postural stability index were calculated using ground reaction force data and were compared using separate one-way repeated measures ANOVAs. FINDINGS: All directional stability indices demonstrated a significant main effect for jump-landing direction (medial-lateral P < 0.001, η2p = 0.95; anterior-posterior P < 0.001, η2p = 0.97; vertical P = 0.021, η2p = 0.24). The diagonal jump-landing direction produced increased medial-lateral stability and vertical stability scores, while the forward and diagonal jump-landing directions produced increased anterior-posterior stability scores. There was no significant effect for the composite dynamic stability index score. INTERPRETATION: Jump-landing direction affects dynamic postural stability in all 3 planes of movement in athletes following anterior cruciate ligament reconstruction. Results indicate the potential need to incorporate multiple jump-landing directions to better assess dynamic postural stability prior to return to sport.

Instructional Approaches: Anatomy Education of Physical Therapists.

The profession of physical therapy has undergone an evolution since its inception. Since the early 1900s it has grown from a technical training program to a doctorate level degree. Human anatomy courses remain a requirement for physical therapist educational curricula. However, changes in anatomy pedagogy have been trending within health profession educational models, leading to questions regarding which method is best for student learning. The objective of this study was to determine if anatomy instructional method used within physical therapist educational curricula impacted current anatomy knowledge. Licensed physical therapists were recruited to complete a demographic survey and a questionnaire to demonstrate their knowledge of anatomy topics. Anatomy topics included six regional components: (1) upper limb; (2) lower limb; (3) thorax and abdomen; (4) pelvis; (5) spine; and (6) head. Each regional component contained five questions regarding systemic subsets related to joints and osteology, muscles, nervous system, vasculature, and special areas (e.g., spatial orientations, structures within spaces, pathways of nerves). Within the thorax and abdominal region, data analysis indicated that the dissection instruction method, when compared to no laboratory instruction, led to statistically significant greater anatomical knowledge (P = 0.02). Dissection also showed greater means when compared to the no laboratory method (P = 0.02) and the prosection method in the head region (P = 0.01). However, the variance explained by instructional method was small. This study adds empirical evidence regarding current anatomy knowledge exhibited by physical therapists as the level of anatomical knowledge exhibited small differences based on instructional methods.

A taste of nursing research: an interactive program introducing evidence-based practice and research to clinical nurses.

Developing and implementing a program to introduce clinical nurses to research and evidence-based practice (EBP) should spark interest and participation. In this article, the authors describe and evaluate a staff development initiative not only to introduce the principles of EBP and research but also to give nurses the opportunity to participate in the research process and development of EBP questions.

Substance Use Screening Protocol: Implementation of a System for Patients With Cancer.

BACKGROUND: Substance use by patients with a cancer diagnosis may have a detrimental effect on short- and long-term outcomes. Screening, brief intervention, and referral to treatment (SBIRT) has been recommended for all patients in primary care and emergency medicine. OBJECTIVES: The purpose of this quality improvement project was to train clinical providers and to implement an effective SBIRT program in a radiation oncology clinic in a comprehensive cancer center. METHODS: An interprofessional task force developed a staff training protocol that incorporated oncology-specific content. The team then piloted an SBIRT program in the outpatient clinic. FINDINGS: Staff training results were mixed, with only a few evaluation items showing significant improvement. Despite these results, staff training and the implementation of an SBIRT may be valuable in improving substance use screening in this vulnerable population.

Anterior cruciate ligament reconstruction and dynamic stability at time of release for return to sport.

OBJECTIVE: Examine dynamic stability using Dynamic Postural Stability Index (DPSI) in athletes following anterior cruciate ligament reconstruction (ACLR) at time of release for return-to-sport (RTS), compared to matched controls. DESIGN: Cross-sectional case-control study. SETTING: Sports medicine clinic. SUBJECTS: Fifteen ACLR athletes who had completed post-operative rehabilitation and were within 6 weeks following release to RTS were age-, gender-, and activity-matched to 15 healthy controls. MAIN OUTCOME MEASURES: Ground reaction forces (GRFs) were collected using a portable force plate during stabilization from three different single-leg landing tasks. A composite DPSI was calculated using GRFs. RESULTS: Compared to matched controls, ACLR athletes within 6 weeks of release for RTS did not significantly differ in dynamic postural stability and there were no significant differences between the involved and uninvolved limbs in the ACLR group. CONCLUSION: Current findings indicate that dynamic postural stability, as measured using the DPSI, is not significantly different in ACLR subjects at time of release for RTS compared to matched controls. In addition, the DPSI was not significantly different between the involved and uninvolved limbs in the ACLR subjects. The results suggest that the post-ACLR rehabilitation program utilized may have adequately restored postural stability in this particular sample.

Professional Values Are Implicit in Written Reflections by DPT Students in a Short-Term International Service Learning Course.

International service learning (ISL) courses within physical therapy (PT) education programs are designed, in part, to promote the development of professional values. Assessment of students' professional values, however, is a challenge for educators. METHODS: This study focused on the reflective learning component of an elective 10-day ISL course, evaluated whether PT professional values were manifested in students' written reflections, and characterized the level of student reflections using Bradley's criteria. Twenty-one third-year PT students participated. A qualitative content analysis of each student's written assignments was conducted. RESULTS: Although explicit instruction on PT values was not provided, reflections on professional values were identified in 97% of assignments. All three of Bradley's levels were found in all three written assignments, with the highest proportion of level 2 and 3 reflections being found in unstructured journals. CONCLUSION: Although no instruction specific to PT professional values was provided, values were implicit in student written assignments during this ISL course.

Ethnicity and vasomotor symptoms in postmenopausal women.

OBJECTIVE: To determine if there is a difference in the prevalence of vasomotor symptoms between African American and white postmenopausal women. METHODS: We conducted a cross-sectional study to evaluate baseline vasomotor symptoms in postmenopausal women enrolled in a randomized, placebo-controlled trial of dietary soy supplements. The Menopause-Specific Quality of Life Questionnaire (MENQOL) vasomotor subscale was used to measure vasomotor symptoms, including hot flashes and night sweats. RESULTS: In total, 104 African American and 112 white postmenopausal women (mean age 56.8 +/- 5.6 years) were studied. A multiple linear regression analysis, which controlled for differences in body mass index (BMI) and dietary fat intake, showed that race and age were significantly and independently associated with vasomotor symptoms, explaining 10% of the variance (p < 0.001). Being African American and younger age were associated with increased vasomotor symptoms. CONCLUSIONS: The most prevalent postmenopausal symptoms were vasomotor symptoms, which were more bothersome in African American women compared with white women. Factors associated with vasomotor symptoms included race, BMI, and dietary intake of fat calories. Implications for practice include increasing provider awareness to discuss vasomotor symptoms and the need for treatment in postmenopausal African American women. Further research to increase our understanding of racial differences and associated factors that influence the duration and intensity of vasomotor symptoms experienced by postmenopausal women is needed.

Prevalence of Substance Use in Patients With Cancer Receiving Radiation Therapy.

BACKGROUND: Individuals with cancer and risky alcohol and illicit substance use (AISU) are more likely to suffer diminished quality of life and subpar treatment outcomes. The prevalence of AISU in patients with cancer is poorly understood. OBJECTIVES: This article reports on the results of a needs assessment to quantify AISU in individuals with cancer seeking care in the radiation oncology department of a large, academic medical center. METHODS: Medical records were reviewed for all patients seen in the radiation oncology department in a one-week (five-day) period in the fall of 2014 (N = 397). Demographic and prevalence data were analyzed. FINDINGS: The prevalence rates of AISU in this sample were slightly lower than estimates for the general population and inconsistency was noted in the documentation of relevant information. Despite the limitations, data analyses suggested that a significant percentage of patients receiving radiation therapy for cancer diagnoses exhibited substance use patterns that placed them at increased risk for negative short- and long-term outcomes. The findings support the need for systematic substance use screening, assessment, and risk-based interventions as an essential component of comprehensive cancer care.

Beyond student ratings: peer observation of classroom and clinical teaching.

Peer observation of classroom and clinical teaching has received increased attention over the past decade in schools of nursing to augment student ratings of teaching effectiveness. One essential ingredient is the scale used to evaluate performance. A five-step systematic procedure for adapting, writing, and building any peer observation scale is described. The differences between the development of a classroom observation scale and an appraisal scale to observe clinical instructors are examined. Psychometric issues peculiar to observation scales are discussed in terms of content validity, eight types of response bias, and interobserver reliability. The applications of the scales in one school of nursing as part of the triangulation of methods with student ratings and the teaching portfolio are illustrated. Copies of the scales are also provided.

Wire vascular closure device: evaluation of an evidence-based protocol for post-endovascular procedure patients.

Vascular closure devices (VCDs) can shorten the time to hemostasis, ambulation and discharge and improve patient comfort.(1) An evidence-based practice (EBP) project was initiated to assess impact of a shortened postoperative compression and bed rest protocol on patients undergoing arteriotomy using a wire vascular closure device (WVCD). Following protocol development, a post-implementation evaluation was initiated to assess selected outcomes including compression and bed rest time, complication rate and possible related variables. Following implementation of the new protocol, clinicians were able to shorten both compression and bed rest times by 50%, and Post-Anesthesia Care Unit (PACU) length of stay decreased to a maximum of 5 hours.

Fatigue in breast cancer survivors: the impact of a mind-body medicine intervention.

PURPOSE/OBJECTIVES: To evaluate a mind-body medicine (MBM) program for its impact on persistent fatigue following breast cancer treatment. DESIGN: Quasiexperimental. SETTING: An urban community hospital and a health department in a semirural county, both in Maryland. SAMPLE: 68 breast cancer survivors who were at least six months postadjuvant chemotherapy and/or radiation therapy and had a baseline fatigue score of 50 or lower per the vitality subscale of the SF-36® Health Survey. METHODS: A 10-week group-based MBM program for breast cancer survivors with persistent fatigue was evaluated using a pretest/post-test study design. MAIN RESEARCH VARIABLES: Sustained change in fatigue severity as measured by the Piper Fatigue Scale (PFS), SF-36 vitality subscale, and 10 cm visual analog scale (VAS). FINDINGS: Participants were 2.6 years post-treatment, with a mean age of 56.8 years. Overall, fatigue scores improved by 40%. The mean PFS improved from a score of 6 (SD = 1.6) at baseline to 4.2 (SD = 2) at the end of the program (p < 0.001), with additional improvement at two months and sustained at six months (X = 3.6, SD = 2, p < 0.001). Results from the SF-36 and VAS also showed significant improvement in fatigue (p < 0.001). CONCLUSIONS: The findings support the use of a holistic MBM intervention to reduce persistent fatigue in breast cancer survivors. Results should be confirmed with a randomized clinical trial. IMPLICATIONS FOR NURSING: Nurses and other healthcare team members can effectively impact persistent fatigue in breast cancer survivors through the use of a multipronged MBM program.