Incorporating cardiopulmonary resuscitation training into a cardiac rehabilitation programme: A feasibility study.

BACKGROUND: Patients with a cardiac history are at future risk of cardiac events, including out-of-hospital cardiac arrest. Targeting cardiopulmonary resuscitation (CPR) training to family members of cardiac patients has long been advocated, but is an area in need of contemporary research evidence. An environment yet to be investigated for targeted training is cardiac rehabilitation. AIM: To evaluate the feasibility of providing CPR training in a cardiac rehabilitation programme among patients, their family members and staff. METHODS: A prospective before and after study design was used. CPR training was delivered using video self-instruction CPR training kits, facilitated by a cardiac nurse. Data was collected pre-training, post-training and at one month. RESULTS: Cardiac patient participation rates in CPR classes were high ( n = 56, 72.7% of eligible patients) with a further 27 family members attending training. Patients were predominantly male (60.2%), family members were predominantly female (81.5%), both with a mean age of 65 years. Confidence to perform CPR and willingness to use skills significantly increased post-training (both p<0.001). Post training participants demonstrated a mean compression rate of 112 beats/min and a mean depth of 48 mm. Training reach was doubled as participants shared the video self-instruction kit with a further 87 people. Patients, family members and cardiac rehabilitation staff had positive feedback about the training. CONCLUSIONS: We demonstrated that cardiac rehabilitation is an effective and feasible environment to provide CPR training. Using video self-instruction CPR training kits enabled further training reach to the target population.

Cardiac Rehabilitation Online Pilot: Extending Reach of Cardiac Rehabilitation.

BACKGROUND: While cardiac rehabilitation (CR) is recommended for all patients after an acute cardiac event, limitations exist in reach. OBJECTIVE: The purpose of the current study was to develop and pilot a flexible online CR program based on self-management principles "Help Yourself Online." METHODS: The program was designed as an alternative to group-based CR as well as to complement traditional CR. The program was based on existing self-management resources developed previously by the Heart Research Centre. Twenty-one patients admitted to Cabrini Health for an acute cardiac event were recruited to test the program. The program was evaluated using qualitative and quantitative methods. RESULTS: Quantitative results demonstrated that patients believed the program would assist them in their self-management. Qualitative evaluation, using focus group and interview methods with 15 patients, showed that patients perceived the online CR approach to be a useful instrument for self-management. CONCLUSIONS: Broader implications of the data include the acceptability of the intervention, timing of intervention delivery, and patients' desire for additional online community support.

Working Memory in the Classroom: An Inside Look at the Central Executive.

This article provides a review of working memory and its application to educational settings. A discussion of the varying definitions of working memory is presented. Special attention is given to the various multidisciplinary professionals who work with students with working memory deficits, and their unique understanding of the construct. Definitions and theories of working memory are briefly summarized and provide the foundation for understanding practical applications of working memory to assessment and intervention. Although definitions and models of working memory abound, there is limited consensus regarding universally accepted definitions and models. Current research indicates that developing new models of working memory may be an appropriate paradigm shift at this time. The integration of individual practitioner's knowledge regarding academic achievement, working memory and processing speed could provide a foundation for the future development of new working memory models. Future directions for research should aim to explain how tasks and behaviors are supported by the substrates of the cortico-striatal and the cerebro-cerebellar systems. Translation of neurobiological information into educational contexts will be helpful to inform all practitioners' knowledge of working memory constructs. It will also allow for universally accepted definitions and models of working memory to arise and facilitate more effective collaboration between disciplines working in educational setting.

A behaviourally anchored rating scale for evaluating the use of the WHO surgical safety checklist: development and initial evaluation of the WHOBARS.

BACKGROUND: Realising the full potential of the WHO Surgical Safety Checklist (SSC) to reduce perioperative harm requires the constructive engagement of all operating room (OR) team members during its administration. To facilitate research on SSC implementation, a valid and reliable instrument is needed for measuring OR team behaviours during its administration. We developed a behaviourally anchored rating scale (BARS) for this purpose. METHODS: We used a modified Delphi process, involving 16 subject matter experts, to compile a BARS with behavioural domains applicable to all three phases of the SSC. We evaluated the instrument in 80 adult OR cases and 30 simulated cases using two medical student raters and seven expert raters, respectively. Intraclass correlation coefficients were calculated to assess inter-rater reliability. Internal consistency and instrument discrimination were explored. Sample size estimates for potential study designs using the instrument were calculated. RESULTS: The Delphi process resulted in a BARS instrument (the WHOBARS) with five behavioural domains. Intraclass correlation coefficients calculated from the OR cases exceeded 0.80 for 80% of the instrument's domains across the SSC phases. The WHOBARS showed high internal consistency across the three phases of the SSC and ability to discriminate among surgical cases in both clinical and simulated settings. Fewer than 20 cases per group would be required to show a difference of 1 point between groups in studies of the SSC, where α=0.05 and ß=0.8. CONCLUSION: We have developed a generic instrument for comprehensively rating the administration of the SSC and informing initiatives to realise its full potential. We have provided data supporting its capacity for discrimination, internal consistency and inter-rater reliability. Further psychometric evaluation is warranted.

Attention and other constructs: evolution or revolution?

This article provides a review of the construct of attention from a non-traditional standpoint. Attention is conceptualized by focusing on the categorical concept of the diagnosis of attention-deficit hyperactivity disorder, large-scale brain network models of functional neuroanatomy, and implications for understanding lateralized hemispheric brain organization. Cortical systems are multifunctional, with certain degrees of specialization, but no cortical region or network supports only one, specific, isolated cognitive process, such as attention. Future implications for clinical practice must focus on connectivity patterns rather than the idea of "domains" or "constructs" when considering attention and other cognitive processes. This has significant implications for the future of neuropsychological assessment and intervention.

Structure and function of large-scale brain systems.

This article introduces the functional neuroanatomy of large-scale brain systems. Both the structure and functions of these brain networks are presented. All human behavior is the result of interactions within and between these brain systems. This system of brain function completely changes our understanding of how cognition and behavior are organized within the brain, replacing the traditional lesion model. Understanding behavior within the context of brain network interactions has profound implications for modifying abstract constructs such as attention, learning, and memory. These constructs also must be understood within the framework of a paradigm shift, which emphasizes ongoing interactions within a dynamically changing environment.

The small-world organization of large-scale brain systems and relationships with subcortical structures.

Brain structure and function is characterized by large-scale brain systems. However, each system has its own "small-world" organization, with sub-regions, or "hubs," that have varying degrees of specialization for certain cognitive and behavioral processes. This article describes this small-world organization, and the concepts of functional specialization and functional integration are defined and explained through practical examples. We also describe the development of large-scale brain systems and this small-world organization as a sensitive, protracted process, vulnerable to a variety of influences that generate neurodevelopmental disorders.

Large-scale brain systems and subcortical relationships: the vertically organized brain.

This article reviews the vertical organization of the brain. The cortico-basal ganglia and the cerebro-cerebellar circuitry systems are described as fundamental to cognitive and behavioral control. The basal ganglia anticipate and guide implicitly learned behaviors on the basis of experienced reward outcomes. The cerebellar-cortical network anticipates sensorimotor outcomes, allowing behaviors to be adapted across changing settings and across contexts. These vertically organized systems, operating together, represent the underpinning of cognitive control. The medial temporal lobe system, and its development, is also reviewed in order to better understand how brain systems interact for both implicit and explicit cognitive control.

Large-scale brain systems and subcortical relationships: practical applications.

This article describes an interactive paradigm for understanding brain functioning. This model requires both explicit and implicit learning processes. This paradigm is illustrated through the interpretation of practical examples of behavior. Applications of current neuropsychological tests are presented within this interactive paradigm. The development of new neuropsychological tests is presented, as derived from experimental test paradigms that evaluate implicit learning processes.

Executive function treatment and intervention in schools.

This selective review article examines treatment and intervention strategies for executive function (EF) deficits within the school environment. We begin by providing a broad definition of EF. We then examine the scope of EF deficits within the school setting and identify profiles of special populations of students who present with such deficits. A focus is placed on the developmental trajectory that both EF and the frontal lobes follow and how this drives the selection and effectiveness of treatments and interventions at particular "critical periods" throughout a child's academic career. Direct and indirect school-based diagnostic assessment methods to identify EF deficits in students will be briefly reviewed. Against that background, various treatment methods and intervention strategies to remediate both cognitive and affective EF deficits within the confines of the school setting will be presented. Individual and group intervention strategies will be presented as will their current acceptance within the scientific community and applicability to the educational arena. The importance of incorporating school-based neuropsychological assessment methods that aid in the differential diagnosis of academic and behavioral difficulties directly related to EF will also be discussed, as the accurate identification of these impairments is necessary to facilitate data-based decision making when selecting the most appropriate interventions following a developmental model in educational settings. Topics addressing EF treatment modalities and research-based interventions for clinical and school-based practitioners to consider within educational settings will also be presented as suggestions for future research with pediatric populations.

Hypotonia, jaundice, and Chiari malformations: relationships to executive functions.

This article postulates that movement and action control are the underpinning of executive functioning. We selectively examine brain regions that have traditionally been almost exclusively understood as critical to the control and expression of movement-namely, the basal ganglia and the cerebellum. We first describe the relationship between movement and cognition. This is followed by a review of common developmental disorders that are known to exhibit abnormal executive functions and movement anomalies. Against that background, we examine hypotonia, neonatal jaundice, and Chiari I malformation, and we demonstrate why these are "at-risk" factors for neurodevelopmental disorders that can feature both motor control and executive function abnormalities. Our goal is to prepare the clinical neuropsychologist for gathering information about these features of a child's birth and developmental histories, while using this as a framework for interpreting test results and applying test data in a useful, practical way to guide descriptive diagnosis and treatment.

Digital infrared thermal imaging following anterior cruciate ligament reconstruction.

This case describes the selective use of digital infrared thermal imaging for a 48-year-old woman who was being treated by a physical therapist following left anterior cruciate ligament (ACL) reconstruction with a semitendinosus autograft.

Community rehabilitation: 'home versus centre' guidelines for choosing the optimal treatment location.

This study aimed to produce indicators and guidelines for clinician use in determining whether individual therapy sessions for community rehabilitation services should be delivered in a home/community-based setting or centre-based setting within a flexible service delivery model. Concept mapping techniques as described by Tochrim and Kane (2005) were utilized within two forums. The first forum consisted of 12 health professionals representing key community rehabilitation disciplines. The second forum consisted of seven clients or carers, who had been part of an active community rehabilitation admission. Each forum produced a concept map of ideas, a table indicating how these ideas tended to favour centre-based or home-based community rehabilitation and the importance of these ideas in choosing the location for community rehabilitation treatment. The five key themes generated were (1) service delivery issues, occupational health and safety; (2) interaction between the goals and the environment; (3) client physical and psychological considerations; (4) service delivery issues, efficiency and (5) service delivery issues, transport issues/logistics. From these themes, a series of specific indicators and associated guidelines were established to direct the decision-making process of staff. Through this research, we now have a tool that facilitates well-informed decisions about the most appropriate, physical environment for individual therapy sessions.