Eight critical skill sets required for manual therapy competency: a Delphi study and factor analysis of physical therapy educators of manual therapy.

Erudition of clinical "skills" used by manually trained physical therapists involves the complex domain of cognitive, affective, and psychomotor concepts. The purpose of the study was to obtain consensus among manual therapy educators regarding stand-alone skills required during competent application of manual therapy and to distill these stand-alone skills into smaller but more homogeneous skill sets. Eighty manual therapy educators in entry-level and post-entry-level educational programs completed a three-round Delphi survey aimed at developing consensus among experts in the field regarding the stand-alone skills that are important to a learners' development of manual therapy competencies. From the Delphi outcomes, a principal component factor analysis distilled eight component skill sets that were associated with orthopedic manual therapy (OMT) proficiency: (1) manual joint assessment, (2) proficiency of fine sensorimotor characteristics, (3) manual patient management, (4) bilateral hand-eye coordination, (5) manual gross characteristics of the upper extremity, (6) manual gross characteristics of the lower extremity, (7) control of self and patient movement, and (8) discriminate touch. Manual joint assessment comprised 46% of the factor analysis variance and contained the majority of stand-alone descriptor statements from a Delphi survey. This study found that despite the disparate backgrounds among respondents, the eight skill sets were identified as important to OMT competency and application. By identifying the key skill sets required for OMT competency and application, OMT educators may more effectively identify teaching methods associated with improved educational outcomes.

Restoration of normal embryogenesis by mitochondrial supplementation in pig oocytes exhibiting mitochondrial DNA deficiency.

An increasing number of women fail to achieve pregnancy due to either failed fertilization or embryo arrest during preimplantation development. This often results from decreased oocyte quality. Indeed, reduced mitochondrial DNA copy number (mitochondrial DNA deficiency) may disrupt oocyte quality in some women. To overcome mitochondrial DNA deficiency, whilst maintaining genetic identity, we supplemented pig oocytes selected for mitochondrial DNA deficiency, reduced cytoplasmic maturation and lower developmental competence, with autologous populations of mitochondrial isolate at fertilization. Supplementation increased development to blastocyst, the final stage of preimplantation development, and promoted mitochondrial DNA replication prior to embryonic genome activation in mitochondrial DNA deficient oocytes but not in oocytes with normal levels of mitochondrial DNA. Blastocysts exhibited transcriptome profiles more closely resembling those of blastocysts from developmentally competent oocytes. Furthermore, mitochondrial supplementation reduced gene expression patterns associated with metabolic disorders that were identified in blastocysts from mitochondrial DNA deficient oocytes. These results demonstrate the importance of the oocyte's mitochondrial DNA investment in fertilization outcome and subsequent embryo development to mitochondrial DNA deficient oocytes.

Middle ear electromagnetic semi-implantable hearing device: results of the phase II SOUNDTEC direct system clinical trial.

OBJECTIVE: To assess the safety and efficacy of the SOUNDTEC Direct System, a partially implantable electromagnetic middle ear hearing device. STUDY DESIGN: Food and Drug Administration Phase II clinical trial of 103 patients at 10 sites across the United States. SETTING: Tertiary referral medical centers. PATIENTS: Individuals with bilateral moderate to moderately severe sensorineural hearing impairment who had worn optimally fit hearing aids for at least 45 days. INTERVENTIONS: Therapeutic intervention included implantation of a 27-mg neodymium iron boron magnet encased in a laser-welded titanium canister onto the incudostapedial joint, followed, after a 10-week healing period, by fitting with a deep earmold coil assembly and activation of the sound processor. MAIN OUTCOME MEASURES: Functional gain, speech recognition in quiet and noise, articulation index scores, perceived aided benefit, sound quality judgments, satisfaction, and presence of feedback and occlusion with the Direct System were compared with those of the patients' optimally fit hearing aid. RESULTS: The results of this multicenter clinical trial were submitted to the Food and Drug Administration on April 13, 2001, and are presented here. The results with the use of the SOUNDTEC Direct System compared with an optimally fit hearing aid provided an average 7.9-dB increase in functional gain in the speech frequencies (500-4,000 Hz) and a 9.6 dB gain in high frequencies (2,000, 3,000, and 4,000 Hz). There was a statistically significant average increase of 5.3% in speech discrimination. The mean speech perception in noise test score was improved, but the improvement was not statistically significant. Subjective tests using abbreviated profile of hearing aid benefit and the Hough Ear Institute Profile demonstrated scores statistically improved over the hearing aid condition. These subjective tests measured areas such as the presence of occlusion and feedback, speech quality judgments, device preference, and perceived aided benefit. CONCLUSIONS: The results of this Phase II clinical trial demonstrate that the SOUNDTEC Direct System provided statistically significant reduction in feedback and occlusive effect as well as a statistically significant improvement in all the following categories: functional gain, articulation index scores, speech discrimination in quiet, perceived aided benefit, patient satisfaction and device preference over the patient's optimally fit hearing aid.

Case management information systems: how to put the pieces together now and beyond year 2000.

The case management process is a critical management and operational component in the delivery of customer services across the patient care continuum. Case management has transcended time and will continue to be a viable infrastructure process for successful organizations in the future. A key component of the case management infrastructure is information systems and technology support. Case management challenges include effective deployment and use of systems and technology. As more sophisticated, integrated systems are made available, case managers can use these tools to continue to expand effectively beyond the patient's episodic event to provide greater levels of cradle-to-grave management of healthcare. This article explores methods for defining case management system needs and identifying automation options available to the case manager.