Persons with type 2 diabetes (T2D) are believed to have reduced exercise tolerance; this may be p... more 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 (fCF impulse ) test as a measure of exercise tolerance (10-min intermittent maximal effort forearm contractions; the average contraction impulse in the last 30 sec quantified fCF impulse ). Forearm blood flow (FBF; ultrasound) and mean arterial pressure (MAP; finger photoplethysmography) were measured; forearm vascular conductance (FVK) was calculated. Data are means AE SD, T2D versus Control. fCF impulse was not different between groups (136.9 AE 47.3 NÁsec vs. 163.1 AE 49.7 NÁsec, P = 0.371) nor was the ΔFBF from rest to during exercise at fCF impulse (502.9 AE 144.6 vs. 709.1 AE 289.2 mL/min, P = 0.092), or its determinants ΔFVK and ΔMAP (both P > 0.05), although there was considerable interindividual variability. ΔFBF was strongly related to fCF impulse (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.
Background: Interprofessional collaboration in healthcare contributes to patient well-being. The ... more Background: Interprofessional collaboration in healthcare contributes to patient well-being. The purpose of this action research study was to evaluate an innovative interprofessional simulation educational module for pre-licensure healthcare students on adult suctioning skills.
We tested the hypothesis that type 2 diabetes (T2D), when present in the characteristic constella... more 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-trans...
North American journal of sports physical therapy : NAJSPT, 2006
Although acute myocardial infarction and sudden cardiac death are relatively rare occurrences in ... more 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.
Cardiac rehabilitation (CR) is a proven intervention that substantially improves physical health ... more 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). 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. 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 grou...
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013
ABSTRACT Introduction/Background: Both interprofessional collaboration and adherence to evidence ... more ABSTRACT Introduction/Background: Both interprofessional collaboration and adherence to evidence based infection control practices contribute to patient safety, improved patient outcomes and decreased healthcare costs. Hence, an interprofessional education (IPE) simulation module on infection control skills for intermediate-level health professions students using standardized patients (SPs) was developed and trialed in 2012. Feedback from the 2012 module was incorporated into the 2013 trial and evaluated. Our innovative approach to interprofessional infection control education using SPs aims to prepare prelicensure physiotherapy, nursing and medical students for collaborative, patient-centred practice to enhance patient safety. Methods: Prior to attending the IPE sessions, students completed three online modules on chain of transmission, hand hygiene and routine practices. The two hour IPE session included an interactive plenary session with an infection control practitioner (ICP) and four brief simulated clinical scenarios using SPs: 1) Patient with R-sided stroke wants to get up in wheelchair that has roommate&#39;s housecoat is draped on it; 2) Stable patient with HIV is attending clinic for routine checkup. Healthcare worker enters wearing gloves &amp; gown; 3) Patient with dementia and MRSA is ready for discharge post hospitalization fractured ankle; 4) Person with undiagnosed TB in ER reports recent weight loss, coughing for four weeks with greenish sputum, fatigue, fever etc. Interprofessional teams of students interacted with the SPs and were expected to select and utilize supplies and protective equipment appropriate to the level of infection control practices dictated by each unique clinical scenario. Debriefing focused on both infection control skills and interprofessional collaboration. The major changes implemented in 2013 to improve the module were: 1) Session offered earlier in term to avoid conflicts with midterms, assignments and other IPE initiatives; 2) Majority of facilitators were Infection Control Practitioners (ICPs); 3) Formal orientation session was provided to facilitators over lunch and included: 4) Orientation to specific scenarios and debriefing guides; 5) General orientation to facilitating a simulation session; 5) Facilitators also attended the didactic session; 6) Individual scenarios tweaked based on feedback; 7) More extensive instructions provided to students prior to sessions, including expectations for dressing professionally; 8) Perceived learning, interprofessional collaboration and the organization and content of the new learning module were evaluated by feedback from learners through a satisfaction survey and focus groups. Learning outcomes were assessed through an online survey administered before and after the sessions. Informal feedback was also provided by faculty observers and ICP facilitators. Learners reported high satisfaction with the module and its components. Feedback supported the value of the clinical scenarios with SPs in contributing to learning of infection control skills and providing opportunities for learning from and about other health professionals. Learners also identified areas for improvement of the module including providing more practical information and demonstrations during the interactive lecture component. Learner knowledge of infection control practices increased significantly (p&lt;0.03). Participants were least knowledgeable about the minimum time needed to properly wash hands with soap and water, and employing routine practices. Learner confidence performing all infection control skills except for hand hygiene increased significantly following participation in the sessions (p&lt;0.05). Participants were least confident utilizing enhanced precautions and adapting infection control practices to patients&#39; homes, longterm care and private practice settings. Results: Conclusion: Despite having previous education related to infection control practices, intermediate level learners continue to have knowledge gaps and lack of confidence applying these skills. Evaluation Results support the need for intermittent reinforcement of infection control knowledge and skills, with a particular emphasis on the clinical context. Identified knowledge gaps and suggestions for further improvement will be incorporated into future sessions as the IPE infection control module becomes fully integrated within the curricula of the three schools. Disclosures: None.
ABSTRACT Introduction Poor adherence to infection control standards among health care professiona... more ABSTRACT Introduction Poor adherence to infection control standards among health care professionals is widespread, putting patients at substantial risk. Basic infection control skills are typically learned uniprofessionally outside the clinical environment. In real clinical settings, the cognitive load associated with simultaneously managing challenging clinical problems as part of an interprofessional team compounds difficulties in applying infection control standards. This mixed methods study evaluated an interprofessional education infection control module as part of a larger action research project aimed at developing interprofessional health education using simulation. Methods Students from medicine, nursing, and physiotherapy (N = 24) participated in a pilot infection control simulation. Participants completed a survey regarding confidence performing infection control skills, perceptions of interprofessional communication and collaboration, and satisfaction with the module. Qualitative feedback was obtained from facilitators and participants. Results Participants reported confidence with all skills except enhanced precautions and found the interprofessional simulation-based training valuable. Observers identified instances where infection control practices were not appropriately followed within the clinical context but noted strong teamwork and collaboration amongst team members. Several barriers to learning were identified. The majority of participants indicated that the interprofessional infection control module should be mandatory for health sciences students. Qualitative analysis revealed recommendations on ways to make this type of session more effective. Conclusions This pilot project demonstrated the feasibility of using high-fidelity patient simulation to reinforce infection control skills and promote interprofessional communication and teamwork. Study results support the need for senior health professional students to learn and practice infection control skills in an interprofessional manner and to incorporate complex clinical scenarios in the training.
Focal transcranial magnetic stimulation was used to map the motor cortical representations of the... more Focal transcranial magnetic stimulation was used to map the motor cortical representations of the relaxed and gently contracted biceps brachii, deltoid and triceps muscles in 22 subjects comprised of 12 controls, ®ve subjects with complete and ®ve with incomplete cervical spinal cord lesions (SCI). Motor evoked potentials (MEPs) were rarely observed during the resting condition (3/30 muscles tested; SCI group) which precluded detailed analysis of these data. With background facilitation, the mean number of scalp stimulation sites producing MEPs varied according to muscle (P50.001); biceps yielded the largest maps and triceps the smallest. The cortical representations of proximal upper extremity muscles were largest for the control group and smallest for the incomplete SCI group although dierences were not signi®cant (P40.09). The optimal site of stimulation (that which produced the largest MEP) was always surrounded by an area producing submaximal MEPs, but was variable across subjects and groups. There was extensive overlap in the motor cortical representation areas corresponding to the three muscles of interest. Following maximal intensity stimulation at the optimal site, the mean MEP amplitudes (normalized) were largest for the biceps muscle and smallest or absent in triceps (P50.02). No dierences were detected between groups (P40.50). The threshold stimulus intensity was highest for those with incomplete SCI and lowest amongst control subjects (P50.05), with biceps then deltoid muscles generally having lower thresholds than triceps (P50.001). The ®ndings suggest that cortical map areas and MEP characteristics are not signi®cantly altered in gently contracting muscles innervated by nerve roots rostral to the lesion. Only activation thresholds are higher following SCI, particularly incomplete lesions, although there is no apparent association with sensorimotor function. The inability to elicit MEPs in the relaxed muscles of patients with SCI fail to support previous reports of expanded motor cortical representations associated with muscles innervated by roots rostral to the lesion.
To determine the perceptions of educators and students in Canadian entry-level professional physi... more 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. 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. 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. 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: The purposes of this article are (1) to list key messages from the 2003 chronic obstruct... more Purpose: The purposes of this article are (1) to list key messages from the 2003 chronic obstructive pulmonary disease (COPD) guidelines of the Canadian Thoracic Society (CTS) and associated implications and responsibilities for physiotherapists and (2) to compare ...
Journal of Cardiopulmonary Rehabilitation and Prevention, 2014
To prospectively assess whether the Risk of Activity Related Events (RARE) Score accurately ident... more 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. Individuals screened for entry into cardiac rehabilitation were classified as high-risk (RARE Score ≥ 4) or low-risk (RARE Score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 4) using the RARE Score. Patients were followed until program completion or withdrawal, and adverse events were documented. 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. 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.
Title. Simulation in interprofessional education for patient-centred collaborative care. Aim. Thi... more Title. 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.
Persons with type 2 diabetes (T2D) are believed to have reduced exercise tolerance; this may be p... more 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 (fCF impulse ) test as a measure of exercise tolerance (10-min intermittent maximal effort forearm contractions; the average contraction impulse in the last 30 sec quantified fCF impulse ). Forearm blood flow (FBF; ultrasound) and mean arterial pressure (MAP; finger photoplethysmography) were measured; forearm vascular conductance (FVK) was calculated. Data are means AE SD, T2D versus Control. fCF impulse was not different between groups (136.9 AE 47.3 NÁsec vs. 163.1 AE 49.7 NÁsec, P = 0.371) nor was the ΔFBF from rest to during exercise at fCF impulse (502.9 AE 144.6 vs. 709.1 AE 289.2 mL/min, P = 0.092), or its determinants ΔFVK and ΔMAP (both P > 0.05), although there was considerable interindividual variability. ΔFBF was strongly related to fCF impulse (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.
Background: Interprofessional collaboration in healthcare contributes to patient well-being. The ... more Background: Interprofessional collaboration in healthcare contributes to patient well-being. The purpose of this action research study was to evaluate an innovative interprofessional simulation educational module for pre-licensure healthcare students on adult suctioning skills.
We tested the hypothesis that type 2 diabetes (T2D), when present in the characteristic constella... more 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-trans...
North American journal of sports physical therapy : NAJSPT, 2006
Although acute myocardial infarction and sudden cardiac death are relatively rare occurrences in ... more 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.
Cardiac rehabilitation (CR) is a proven intervention that substantially improves physical health ... more 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). 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. 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 grou...
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013
ABSTRACT Introduction/Background: Both interprofessional collaboration and adherence to evidence ... more ABSTRACT Introduction/Background: Both interprofessional collaboration and adherence to evidence based infection control practices contribute to patient safety, improved patient outcomes and decreased healthcare costs. Hence, an interprofessional education (IPE) simulation module on infection control skills for intermediate-level health professions students using standardized patients (SPs) was developed and trialed in 2012. Feedback from the 2012 module was incorporated into the 2013 trial and evaluated. Our innovative approach to interprofessional infection control education using SPs aims to prepare prelicensure physiotherapy, nursing and medical students for collaborative, patient-centred practice to enhance patient safety. Methods: Prior to attending the IPE sessions, students completed three online modules on chain of transmission, hand hygiene and routine practices. The two hour IPE session included an interactive plenary session with an infection control practitioner (ICP) and four brief simulated clinical scenarios using SPs: 1) Patient with R-sided stroke wants to get up in wheelchair that has roommate&#39;s housecoat is draped on it; 2) Stable patient with HIV is attending clinic for routine checkup. Healthcare worker enters wearing gloves &amp; gown; 3) Patient with dementia and MRSA is ready for discharge post hospitalization fractured ankle; 4) Person with undiagnosed TB in ER reports recent weight loss, coughing for four weeks with greenish sputum, fatigue, fever etc. Interprofessional teams of students interacted with the SPs and were expected to select and utilize supplies and protective equipment appropriate to the level of infection control practices dictated by each unique clinical scenario. Debriefing focused on both infection control skills and interprofessional collaboration. The major changes implemented in 2013 to improve the module were: 1) Session offered earlier in term to avoid conflicts with midterms, assignments and other IPE initiatives; 2) Majority of facilitators were Infection Control Practitioners (ICPs); 3) Formal orientation session was provided to facilitators over lunch and included: 4) Orientation to specific scenarios and debriefing guides; 5) General orientation to facilitating a simulation session; 5) Facilitators also attended the didactic session; 6) Individual scenarios tweaked based on feedback; 7) More extensive instructions provided to students prior to sessions, including expectations for dressing professionally; 8) Perceived learning, interprofessional collaboration and the organization and content of the new learning module were evaluated by feedback from learners through a satisfaction survey and focus groups. Learning outcomes were assessed through an online survey administered before and after the sessions. Informal feedback was also provided by faculty observers and ICP facilitators. Learners reported high satisfaction with the module and its components. Feedback supported the value of the clinical scenarios with SPs in contributing to learning of infection control skills and providing opportunities for learning from and about other health professionals. Learners also identified areas for improvement of the module including providing more practical information and demonstrations during the interactive lecture component. Learner knowledge of infection control practices increased significantly (p&lt;0.03). Participants were least knowledgeable about the minimum time needed to properly wash hands with soap and water, and employing routine practices. Learner confidence performing all infection control skills except for hand hygiene increased significantly following participation in the sessions (p&lt;0.05). Participants were least confident utilizing enhanced precautions and adapting infection control practices to patients&#39; homes, longterm care and private practice settings. Results: Conclusion: Despite having previous education related to infection control practices, intermediate level learners continue to have knowledge gaps and lack of confidence applying these skills. Evaluation Results support the need for intermittent reinforcement of infection control knowledge and skills, with a particular emphasis on the clinical context. Identified knowledge gaps and suggestions for further improvement will be incorporated into future sessions as the IPE infection control module becomes fully integrated within the curricula of the three schools. Disclosures: None.
ABSTRACT Introduction Poor adherence to infection control standards among health care professiona... more ABSTRACT Introduction Poor adherence to infection control standards among health care professionals is widespread, putting patients at substantial risk. Basic infection control skills are typically learned uniprofessionally outside the clinical environment. In real clinical settings, the cognitive load associated with simultaneously managing challenging clinical problems as part of an interprofessional team compounds difficulties in applying infection control standards. This mixed methods study evaluated an interprofessional education infection control module as part of a larger action research project aimed at developing interprofessional health education using simulation. Methods Students from medicine, nursing, and physiotherapy (N = 24) participated in a pilot infection control simulation. Participants completed a survey regarding confidence performing infection control skills, perceptions of interprofessional communication and collaboration, and satisfaction with the module. Qualitative feedback was obtained from facilitators and participants. Results Participants reported confidence with all skills except enhanced precautions and found the interprofessional simulation-based training valuable. Observers identified instances where infection control practices were not appropriately followed within the clinical context but noted strong teamwork and collaboration amongst team members. Several barriers to learning were identified. The majority of participants indicated that the interprofessional infection control module should be mandatory for health sciences students. Qualitative analysis revealed recommendations on ways to make this type of session more effective. Conclusions This pilot project demonstrated the feasibility of using high-fidelity patient simulation to reinforce infection control skills and promote interprofessional communication and teamwork. Study results support the need for senior health professional students to learn and practice infection control skills in an interprofessional manner and to incorporate complex clinical scenarios in the training.
Focal transcranial magnetic stimulation was used to map the motor cortical representations of the... more Focal transcranial magnetic stimulation was used to map the motor cortical representations of the relaxed and gently contracted biceps brachii, deltoid and triceps muscles in 22 subjects comprised of 12 controls, ®ve subjects with complete and ®ve with incomplete cervical spinal cord lesions (SCI). Motor evoked potentials (MEPs) were rarely observed during the resting condition (3/30 muscles tested; SCI group) which precluded detailed analysis of these data. With background facilitation, the mean number of scalp stimulation sites producing MEPs varied according to muscle (P50.001); biceps yielded the largest maps and triceps the smallest. The cortical representations of proximal upper extremity muscles were largest for the control group and smallest for the incomplete SCI group although dierences were not signi®cant (P40.09). The optimal site of stimulation (that which produced the largest MEP) was always surrounded by an area producing submaximal MEPs, but was variable across subjects and groups. There was extensive overlap in the motor cortical representation areas corresponding to the three muscles of interest. Following maximal intensity stimulation at the optimal site, the mean MEP amplitudes (normalized) were largest for the biceps muscle and smallest or absent in triceps (P50.02). No dierences were detected between groups (P40.50). The threshold stimulus intensity was highest for those with incomplete SCI and lowest amongst control subjects (P50.05), with biceps then deltoid muscles generally having lower thresholds than triceps (P50.001). The ®ndings suggest that cortical map areas and MEP characteristics are not signi®cantly altered in gently contracting muscles innervated by nerve roots rostral to the lesion. Only activation thresholds are higher following SCI, particularly incomplete lesions, although there is no apparent association with sensorimotor function. The inability to elicit MEPs in the relaxed muscles of patients with SCI fail to support previous reports of expanded motor cortical representations associated with muscles innervated by roots rostral to the lesion.
To determine the perceptions of educators and students in Canadian entry-level professional physi... more 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. 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. 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. 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: The purposes of this article are (1) to list key messages from the 2003 chronic obstruct... more Purpose: The purposes of this article are (1) to list key messages from the 2003 chronic obstructive pulmonary disease (COPD) guidelines of the Canadian Thoracic Society (CTS) and associated implications and responsibilities for physiotherapists and (2) to compare ...
Journal of Cardiopulmonary Rehabilitation and Prevention, 2014
To prospectively assess whether the Risk of Activity Related Events (RARE) Score accurately ident... more 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. Individuals screened for entry into cardiac rehabilitation were classified as high-risk (RARE Score ≥ 4) or low-risk (RARE Score &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 4) using the RARE Score. Patients were followed until program completion or withdrawal, and adverse events were documented. 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. 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.
Title. Simulation in interprofessional education for patient-centred collaborative care. Aim. Thi... more Title. 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.
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