The Effectiveness of Exercise on Cognitive Performance in Individuals with Known Vascular Disease: A Systematic Review.

Patients with known vascular disease are at increased risk for cognitive impairments. Exercise has been shown to improve cognition in healthy elderly populations and those with mild cognitive impairments. We explored the literature to understand exercise as a modality to improve cognition in those with vascular disease, focusing on dose-responses. A systematic review was conducted through 2017 using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Ovid Embase, and Ovid MEDLINE databases. Eligible studies examined effects of exercise on memory and cognition in cardiovascular (CVD) or cerebrovascular disease (CBVD). Data extracted included group characteristics, exercise dosage and outcomes measures employed. Twenty-two studies (12 CVD, 10 CBVD) met the inclusion criteria. Interventions included aerobic, resistance, or mixed training, with neuropsychological test batteries assessing cognition. In CVD populations, five studies demonstrated improved cardiovascular fitness and cognition with aerobic training, and another seven studies suggested a dose-response. In CBVD trials, four studies reported improved cognition, with no effects observed in the fifth study. Another study found enhanced cognition with resistance training and four demonstrated a positive association between functional capacity and cognition following combined aerobic and resistance training. Exercise is able to positively affect cognitive performance in those with known vascular disease. There is evidence to suggest a dose⁻response relationship. Further research is required to optimize prescription.

Development and Evaluation of an Epidural Analgesia Workshop for Senior Nursing Students.

BACKGROUND: Most prelicensure nursing students receive little to no training in providing care for patients who receive epidural analgesia, despite exposure in clinical settings and the potential for devastating adverse effects. To develop and pilot an epidural workshop for senior nursing students using standardized patients (SPs), and to evaluate feasibility and learner outcomes. METHOD: A 4-hour epidural workshop consisted of a large group lecture and demonstration, small-group practice scenarios, and individual learner evaluation with SPs. Learning outcomes were evaluated using a performance checklist and critical thinking rubric, and pre- and posttests. RESULTS: Participants scored well on the performance-based evaluation (mean score of 86% items performed correctly) and rated the workshop highly. However, learners and instructors made several recommendations for improving the learning module for future sessions. CONCLUSION: This pilot project demonstrated that an epidural analgesia workshop using SPs is feasible and results in positive learning outcomes and high satisfaction with senior nursing students. [J Nurs Educ. 2018;57(6):359-365.].

Lack of independent effect of type 2 diabetes beyond characteristic comorbidities and medications on small muscle mass exercising muscle blood flow and exercise tolerance.

Persons with type 2 diabetes (T2D) are believed to have reduced exercise tolerance; this may be partly due to impaired exercising muscle blood flow (MBF). Whether there is an impact of T2D on exercising MBF within the typical constellation of comorbidities (hypertension, dyslipidemia, obesity) and their associated medications has not been investigated. We tested the hypothesis that small muscle mass exercise tolerance is reduced in persons with T2D versus Controls (matched for age, body mass index, fitness, comorbidities, non-T2D medications) and that this is related to blunted MBF. Eight persons with T2D and eight controls completed a forearm critical force (fCFimpulse) test as a measure of exercise tolerance (10-min intermittent maximal effort forearm contractions; the average contraction impulse in the last 30 sec quantified fCFimpulse). Forearm blood flow (FBF; ultrasound) and mean arterial pressure (MAP; finger photoplethysmography) were measured; forearm vascular conductance (FVK) was calculated. Data are means ± SD, T2D versus Control. fCFimpulse was not different between groups (136.9 ± 47.3  N·sec vs. 163.1 ± 49.7 N·sec, P = 0.371) nor was the ∆FBF from rest to during exercise at fCFimpulse (502.9 ± 144.6 vs. 709.1 ± 289.2 mL/min, P = 0.092), or its determinants ∆FVK and ∆MAP (both P > 0.05), although there was considerable interindividual variability. ∆FBF was strongly related to fCFimpulse (r = 0.727, P = 0.002), providing support for the relationship between oxygen delivery and exercise tolerance. We conclude that small muscle mass exercising MBF and exercise tolerance are not impaired in representative persons with T2D versus appropriately matched controls. This suggests that peripheral vascular control impairment does not contribute to reduced exercise tolerance in this population.

Independent effect of type 2 diabetes beyond characteristic comorbidities and medications on immediate but not continued knee extensor exercise hyperemia.

We tested the hypothesis that type 2 diabetes (T2D), when present in the characteristic constellation of comorbidities (obesity, hypertension, dyslipidemia) and medications, slows the dynamic adjustment of exercising muscle perfusion and blunts the steady state relative to that of controls matched for age, body mass index, fitness, comorbidities, and non-T2D medications. Thirteen persons with T2D and 11 who served as controls performed rhythmic single-leg isometric quadriceps exercise (rest-to-6 kg and 6-to-12 kg transitions, 5 min at each intensity). Measurements included leg blood flow (LBF, femoral artery ultrasound), mean arterial pressure (MAP, finger photoplethysmography), and leg vascular conductance (LVK, calculated). Dynamics were quantified using mean response time (MRT). Measures of amplitude were also used to compare response adjustment: the change from baseline to 1) the peak initial response (greatest 1-s average in the first 10 s; ΔLBFPIR, ΔLVKPIR) and 2) the on-transient (average from curve fit at 15, 45, and 75 s; ΔLBFON, ΔLVKON). ΔLBFPIR was significantly blunted in T2D vs. control individuals (P = 0.037); this was due to a tendency for reduced ΔLVKPIR (P = 0.063). In contrast, the overall response speed was not different between groups (MRT P = 0.856, ΔLBFON P = 0.150) nor was the change from baseline to steady state (P = 0.204). ΔLBFPIR, ΔLBFON, and LBF MRT did not differ between rest-to-6 kg and 6-to-12 kg workload transitions (all P > 0.05). Despite a transient amplitude impairment at the onset of exercise, there is no robust or consistent effect of T2D on top of the comorbidities and medications typical of this population on the overall dynamic adjustment of LBF, or the steady-state levels achieved during low- or moderate-intensity exercise.

Identifying patients at low risk for activity-related events: the RARE Score.

PURPOSE: To prospectively assess whether the Risk of Activity Related Events (RARE) Score accurately identifies patients who are at low risk of experiencing an adverse event while exercise training at cardiac rehabilitation. METHODS: Individuals screened for entry into cardiac rehabilitation were classified as high-risk (RARE Score ≥ 4) or low-risk (RARE Score < 4) using the RARE Score. Patients were followed until program completion or withdrawal, and adverse events were documented. RESULTS: Individuals (n = 656) were eligible for analysis (high risk: n = 260; low risk: n = 396). Eleven events (1 major, 10 minor) were recorded during the study, and the overall event rate was low (1 event per 1321 patient hours of exercise training). Individuals triaged as high-risk had significantly more events than the low-risk cohort (high risk: n = 8 vs low risk: n = 3; P = .024) and were 4 times more likely to experience an adverse event (OR: 4.2; 95% CI: 1.0-20.0). More than 99% of low-risk patients were event free (negative predictive value: 99.2%; 95% CI: 98.3-99.8), while participating in exercise at cardiac rehabilitation. CONCLUSION: The RARE Score accurately identifies patients who are at low risk of experiencing adverse events during exercise training at cardiac rehabilitation. The identification of low-risk patients allows for the possibility of reduced on-site supervision and monitoring, or the provision of alternative models of cardiac rehabilitation, including community- or home-based cardiac rehabilitation programs.

High and low contact frequency cardiac rehabilitation programmes elicit similar improvements in cardiorespiratory fitness and cardiovascular risk factors.

AIM: Cardiac rehabilitation (CR) is a proven intervention that substantially improves physical health and decreases death and disability following a cardiovascular event. Traditional CR typically involves 36 on-site exercise sessions spanning a 12-week period. To date, the optimal dose of CR has yet to be determined. This study compared a high contact frequency CR programme (HCF, 34 on-site sessions) with a low contact frequency CR programme (LCF, eight on-site sessions) of equal duration (4 months). METHODS: A total of 961 low-risk cardiac patients (RARE score <4) self-selected either a HCF (n = 469) or LCF (n = 492) CR programme. Cardiorespiratory fitness and cardiovascular risk factors were measured on admission and discharge. RESULTS: Similar proportions of patients completed HCF (n = 346) and LCF (n = 351) (p = 0.398). Patients who were less fit (<8 METs) were more likely to drop out of the LCF group, while younger patients (<60 years) were more likely to drop out of the HCF group. Both groups experienced similar reductions in weight (-2.3 vs. -2.4 kg; p = 0.779) and improvements in cardiorespiratory fitness (+1.5 vs. +1.4 METs; p = 0.418). CONCLUSIONS: Patients in the LCF programme achieved equivalent results to those in the HCF programme. Certain subgroups of patients, however, may benefit from participation in a HCF programme, including those patients who are predisposed to prematurely discontinuing the programme and those patients who would benefit from increased monitoring. The LCF model can be employed as an alternative option to widen access and participation for patients who are unable to attend HCF programmes due to distance or time limitations.

Draping education to promote patient dignity: canadian physiotherapy student and instructor perceptions.

PURPOSE: To determine the perceptions of educators and students in Canadian entry-level professional physiotherapy programmes with respect to the current draping curriculum and the methods of delivery of that content and to determine if there is a need for additional draping education time and resources in these programmes. METHODS: Canadian university physiotherapy students (n=127) and educators (n=183) completed questionnaires designed by the authors. Data were collected via Survey Monkey, exported as Excel files, and analyzed using descriptive statistics and Pearson chi-square analysis. RESULTS: Students and educators agreed that dignity as a concept and draping as a skill to protect patient dignity are both important and should be included in Canadian physiotherapy curricula. Respondents also agreed that students often have difficulty with draping. Educators identified barriers to teaching draping while students identified components of an effective educational resource on draping. CONCLUSIONS: To enhance the development of effective draping skills among entry-level physiotherapists, draping education should be included in Canadian physiotherapy curricula. An effective draping educational resource should be developed for educators and students.Purpose: To determine the perceptions of educators and students in Canadian entry-level professional physiotherapy programmes with respect to the current draping curriculum and the methods of delivery of that content and to determine if there is a need for additional draping education time and resources in these programmes. Methods: Canadian university physiotherapy students (n=127) and educators (n=183) completed questionnaires designed by the authors. Data were collected via Survey Monkey, exported as Excel files, and analyzed using descriptive statistics and Pearson chi-square analysis. Results: Students and educators agreed that dignity as a concept and draping as a skill to protect patient dignity are both important and should be included in Canadian physiotherapy curricula. Respondents also agreed that students often have difficulty with draping. Educators identified barriers to teaching draping while students identified components of an effective educational resource on draping. Conclusions: To enhance the development of effective draping skills among entry-level physiotherapists, draping education should be included in Canadian physiotherapy curricula. An effective draping educational resource should be developed for educators and students.

RÉSUMÉ Objectif : Préciser les perceptions des éducateurs et des étudiants dans des programmes de niveau d'entrée en physiothérapie face au programme de cours en drapement et à la façon dont cette formation est enseignée afin de déterminer s'il serait nécessaire de consacrer plus de temps et plus de ressources à la formation en drapement des patients. Méthode : Des étudiants en physiothérapie canadiens (n=127) et des enseignants (n=183) ont rempli des questionnaires conçus par les auteurs. Les données ont été recueillies à l'aide de l'outil Survey Monkey, exportées sous forme de fichier Excel, puis ont fait l'objet d'une analyse en statistiques descriptives et d'une analyse du khi-carré de Pearson. Résultats : Les étudiants et les enseignants s'accordent pour dire que la notion de dignité et le drapement en tant que compétence ont tous deux leur importance et doivent être inclus dans les programmes de cours en physiothérapie au Canada. Les répondants se disent également d'accord sur le fait que les étudiants éprouvent souvent des difficultés avec le drapement. Les formateurs et les enseignants ont précisé les obstacles à l'enseignement du drapement et les étudiants ont identifié les composantes d'une ressource éducative efficace pour l'enseignement du drapement. Conclusions : Pour améliorer l'acquisition de techniques de drapement efficaces chez les étudiants débutants, une formation en drapement devrait être incluse dans les programmes de cours en physiothérapie au Canada. Une ressource éducative efficace sur ces techniques devrait également être produite à l'intention des éducateurs et des étudiants.

Simulation in interprofessional education for patient-centred collaborative care.

AIM: This paper is a report of preliminary evaluations of an interprofessional education through simulation project by focusing on learner and teacher reactions to the pilot modules. BACKGROUND: Approaches to interprofessional education vary widely. Studies indicate, however, that active, experiential learning facilitate it. Patient simulators require learners to incorporate knowing, being and doing in action. A theoretically based competency framework was developed to guide interprofessional education using simulation. The framework includes a typology of shared, complementary and profession-specific competencies. Each competency type is associated with an intraprofessional, multiprofessional, or interprofessional teaching modality and with the professional composition of learner groups. METHOD: The project is guided by an action research approach in which ongoing evaluation generates knowledge to modify and further develop it. Preliminary evaluations of the first pilot module, cardiac resuscitation rounds, among 101 nursing students, 42 medical students and 70 junior medical residents were conducted in 2005-2007 using a questionnaire with rating scales and open-ended questions. Another 20 medical students, 7 junior residents and 45 nursing students completed a questionnaire based on the Interdisciplinary Education Perception scale. FINDINGS: Simulation-based learning provided students with interprofessional activities they saw as relevant for their future as practitioners. They embraced both the interprofessional and simulation components enthusiastically. Attitudinal scores and responses were consistently positive among both medical and nursing students. CONCLUSION: Interprofessional education through simulation offers a promising approach to preparing future healthcare professionals for the collaborative models of healthcare delivery being developed internationally.

Cardiovascular prevention in a high risk sport, ice hockey: applications in wider sports physical therapy practice.

Although acute myocardial infarction and sudden cardiac death are relatively rare occurrences in athletics, cardiovascular accidents do occur. This manuscript presents information on the cardiovascular risks in athletics. In addition, information is provided on screening for cardiovascular risk - including history taking, chart review, physical examination - and the appropriate guidelines on the treatment of athletes found to be at risk. For the purpose of this article, the sport of ice hockey is used to illustrate the subject matter and highlight the behaviors in sport that carry cardiovascular risk. Physical therapists have ethical and legal responsibility to undertake the necessary screening procedures to recognize and respond to any signs of cardiovascular risk in their clients.