Manual Protocol Research Articles

Assessment of the ForenSeq mtDNA control region kit and comparison of orthogonal technologies

The ForenSeq® mtDNA Control Region Kit, MiSeq FGx®, and Universal Analysis Software (UAS) were assessed to better define the performance and limitations of the system with forensically relevant samples to provide data for its transition into practice. A total of six MiSeq FGx sequencing runs of ForenSeq mtDNA Control Region kit, three runs of additional orthogonal sequencing chemistries, and Sanger sequencing results for 14 samples were used to test for concordance. Sensitivity, reproducibility, mixture detection studies, as well as studies to measure the performance of amplification and sequencing controls were performed. The use and reliability of the UAS for data analysis was also examined. With a variety of sample types and controls representing many mitochondrial haplotypes, the recently developed mtDNA Control Region Kit, with the MiSeq FGx and UAS, was found to be fit for purpose as reliable, reproducible, and robust. Sensitivity down to 1 pg of input genomic DNA was demonstrated, which allows the system to offer low limits of detection for better interrogation of potential heteroplasmy in samples. Concerns for implementing next generation sequencing (NGS) for mtDNA in laboratories were addressed in this research, including initial template quantification and confirmation of haplotypes generated by UAS software regarding length-based polymorphisms. To improve performance with forensic samples, laboratories could implement mitochondrial-specific qPCR assays for quantification and perform the optional manual normalization protocol. Additional optimization on sample multiplexing can provide methods that either increase sensitivity or cost efficiency of the assay.

Semi and fully automated immunostaining sample preparation platforms improve live leukocyte recovery, reproducibility, and flow cytometry data quality

Abstract Limited innovation in automated cell and organelle sample preparation methodology limits the effectiveness of modern analytical methods, such as single-cell ‘omics, flow and mass cytometry. These techniques traditionally rely on manual centrifugation-based protocols for cell washing and suspension preparation, hampering researchers’ access to the reproducibility and scalability benefits of automation. We have developed a suite of cell suspension preparation systems that enable semi and full automation of cell washing protocols. These Laminar Wash™ technologies robustly, gently, and efficiently remove debris, dead cells, and unbound reagent using laminar flow and liquid handling robotics, rather than turbulent and harsh pelleting-plus-pipetting methods. Adaptation of standard protocols to Laminar Wash automation typically improves repetitive immunostaining processes and workflows, in terms of reduced hands-on time and inter- and intra-operator variability. We demonstrate the superior live cell retention and reproducibility of Laminar Wash over centrifugation in processing murine and humanized mouse peripheral blood mononuclear cells (PBMCs) and tumor infiltrating lymphocytes (TILs) for flow cytometry. Furthermore, we show how Laminar Wash improves flow cytometry data quality, in terms of debris removal and separation of immune cell subsets for both PBMCs and TILs. Overall, these results show how Laminar Wash methodology assists in standardizing sample preparation for cytometric analysis, an important and unmet need in cancer immunotherapy discovery and manufacturing workflows.

Manual Therapy Intervention in Men With Chronic Pelvic Pain Syndrome or Chronic Prostatitis: An Exploratory Prospective Case-Series.

PurposeChronic pelvic pain syndrome (CPPS) is permanent pelvic pain of unknown etiology. Current theories suggest a multifactorial origin for CPPS, including urinary pathologies, psychosocial factors, prostate inflammation, infection, central sensitization of the nervous system, and muscular contractures or fibrosis. As there are no defined treatment protocols for CPPS, a multimodal approach is recommended. The objective of this study was to evaluate the impact of a manual therapy treatment protocol on pain, urinary symptoms, and overall quality of life.Materials and MethodsTwenty-three men aged 47.36 ± 10.11 years were recruited consecutively by urologists practicing at two hospitals. All men presented prostatic tenderness with no other positive clinical history, urine cultures, or echography studies. Patients underwent six manual therapy sessions (three during the first week and three every two weeks after that) performed by a single osteopath or physiotherapist. The intervention protocol addressed the treatment of muscle structures, fascial mechanics, vascularization, innervation, emotional factors, and the need for information. The questionnaires used to evaluate outcomes included the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptoms Score (IPSS), and a Visual Analog Scale (VAS) for pain, and the Hospital Anxiety and Depression Scale (HADS). Data were evaluated using Chi-squared or paired difference tests by an external researcher.ResultsThe mean NIH-CPSI scores recorded for our study cohort decreased by 7.69 points (30.92%; p<0.0005; 95% CI 4.02-10.52). IPSS measurements decreased by 3.20 points (22.18%; p=0.009; 95% CI 1.00-6.09), although the item addressing quality of life decreased by 1.67 points only (31.99%; p<0.0005; 95% CI 0.94-2.33). The VAS score also decreased by 2.20 points (38.6%; p<0.0005; 95% CI 1.45-2.73). Changes in HADS scores were not statistically significant.ConclusionsBased on patient responses, this case series revealed that manual therapy improved urinary symptoms, pain, and quality of life.

Protein detection by fluorescence of manually cleaned high-speed dental handpieces.

We analyzed the effectiveness of manual cleaning protocols performed on high-speed dental handpieces, using protein identification by fluorescence. Although one protocol was able to able to lower the amount of protein, >40% of the handpieces showed amounts of residual protein at unacceptable levels.

Outcome of Manual Traction in Patients with Cervicogenic Dizziness and Neck Pain

Objective: Symptoms of cervicogenic dizziness include instability, unsteadiness, confusion, neck soreness, and limited cervical range of motion (ROM). We evaluated the outcome of manual traction in patients presenting with dizziness and neck pain.&#x0D; Materials and Methods: 50 patients included who had dizziness and neck pain with a reduced range of cervical motion. Patients had sessions of manual traction after pre-treatment evaluation. Patients included in the study after history and physical examination were sent to the otorhinology department to rule out the vestibular cause of dizziness. Patients were sent to the Physiotherapy department for manual traction. Pain and dizziness were assessed from VAS and DHI scores.&#x0D; Results: There were 28 male and 22 female patients. The mean age of the patients was 23.92 ± 11.39 years. The mean VAS scores (dizziness) were 46, 31, and 14 before treatment, at one week, and at one month, respectively. The mean VAS scores (pain) were 40, 21, and 8 before treatment, at one week, and at one month, respectively. The mean DHI scores (for dizziness disability) were 47.5, 34, and 21, at one week and at one month, respectively. There existed a significant difference (p &lt; 0.00001) between the VAS and DHI scores before the treatment and post-treatment of follow-up at one week and at one month.&#x0D; Conclusion: Patients with cervicogenic dizziness who were treated with manual traction improved considerably in terms of dizziness severity, pain relief, and a low score on the dizziness handicap index, indicating better psychological and functional well-being.&#x0D; Keywords: Cervicogenic Dizziness (CGD), Dizziness Handicap Inventory (DHI), Manual Traction Protocol.

Adapting a Cognitive Dissonance-based Eating Disorders Prevention Program for Adolescent Girls with Type 1 Diabetes

ABSTRACT Adolescent girls with Type 1 diabetes (T1D) are at high risk for developing eating disorders (EDs), a comorbidity that undermines treatment adherence and contributes to serious medical complications. Despite these concerns, no teen prevention programs exist that address risk factors specific to T1D. This study aimed to adapt an existing, empirically supported cognitive dissonance-based ED prevention program (Body Project) for teen girls with T1D. Young women with T1D, parents, and multidisciplinary medical professionals participated in semi-structured focus groups and individual interviews centered on understanding T1D-specific factors that influence body image development and eating and gathering suggestions for modifying the program to address T1D-specific factors. Multiple themes were identified related to complicating factors: diabetes stereotypes and misinformation, illness non-acceptance, demands of T1D management, adolescent-doctor relations, and family factors. Three themes related to protective factors also emerged: illness acceptance, validation and normalization of experiences, and family factors. Stakeholder feedback on program structure was also gathered. The adapted manual protocol is described in detail in addition to how findings extend current theoretical models of ED development in young women with T1D. The adapted ED prevention program, Body Project (T1D Style), centers on promoting illness acceptance, encouraging self-affirmation, teaching effective communication skills, and enhancing social support in addition to the original program’s focus on challenging and resisting sociocultural appearance pressures.

Automation of high-throughput mRNA-seq library preparation: a robust, hands-free and time efficient methodology.

Over the last decade, whole transcriptome profiling, also known as RNA-sequencing (RNA-seq), has quickly gained traction as a reliable method for unbiased assessment of gene expression. Integration of RNA-seq expression data into other omics datasets (e.g., proteomics, metabolomics, or epigenetics) solidifies our understanding of cell-specific regulatory patterns, yielding pathways to investigate the key rules of gene regulation. A limitation to efficient, at-scale utilization of RNA-seq is the time-demanding library preparation workflows, which is a 2-day or longer endeavor per cohort/sample size. To tackle this bottleneck, we designed an automated workflow that increases throughput capacity, while minimizing human error to enhance reproducibility. To this end, we converted the manual protocol of the NEBNext Directional Ultra II RNA Library Prep Kit for Illumina on the Beckman Coulter liquid handler, Biomek i7 Hybrid workstation. A total of 84 RNA samples were isolated from two human cell lines and subjected to comparative manual and automated library preparation methods. Qualitative and quantitative results indicated a high degree of similarity between libraries generated manually or through automation. Yet, there was a significant reduction in both hands-on and assay time from a 2-day manual to a 9-hour automated workflow. Using linear regression analysis, we found the Pearson correlation coefficient between libraries generated manually or by automation to be almost identical to a sample being sequenced twice (R²= 0.985 vs 0.983). This demonstrates that high-throughput automated workflows can be of great benefit to genomic laboratories by enhancing efficiency of library preparation, reducing hands-on time and increasing throughput potential.

The Assessment and Treatment of Inpatient Cancer-Related Pain with Acupuncture: Development of a Manual.

Background and Objective: Pain is a highly prevalent and distressing experience of hospitalized patients with cancer, and undertreatment is a challenging issue. Adding nonpharmacologic treatments such as acupuncture to conventional pain management may help address a patient's total pain experience. A dearth of acupuncture treatment guidelines exists, leaving individual practitioners to develop treatments themselves. The aim of the work described in this report was to develop a standardized clinical reference manual for East Asian Medicine (EAM) assessment, diagnosis, and acupuncture treatment of cancer-related pain in hospitalized patients with cancer. Design: The acupuncture manual was developed based on: (1) a narrative review of existing literature on acupuncture and cancer pain; (2) a review of acupuncture charting notes of more than 200 treatments provided in an inpatient setting; and (3) meetings of an expert panel of senior acupuncturists to reach consensus on a manual protocol. Results: The resulting manual described diagnosis of patients based on EAM constitution, symptoms and signs, and channel location of the cancer-related pain symptoms. The resulting point selections for acupuncture treatment enables adaptability, reproducibility, and individualized acupuncture treatment of cancer-related pain in hospitalized patients with cancer. Conclusions: The manual fills a vital gap in the current literature, and supports community- and hospital-based acupuncturists as a standardized clinical reference. The manual provides guidance for cancer-related pain management, using EAM acupuncture in hospitalized patients.

The sensitivity of shoulder muscle fatigue to vertical hand location during complex manual force exertions

Occupational shoulder overexposures, including increased muscle activity and associated localized muscle fatigue, typically scale with manual exertion height during static or intermittent overhead work. It is unknown how this response is affected during complex (i.e. multi-directional and varying magnitude) manual force exertions, and how this work profile may attenuate task endurance. The purpose of this study was to evaluate the influence of manual exertion height on shoulder muscle fatigue responses during a multi-directional manual exertion protocol. Fourteen participants completed a shoulder fatiguing protocol by exerting manual forces (push up, down, left, and right) at three vertical hand location heights (low, shoulder and overhead). Decline in strength, myoelectric indicators of fatigue, ratings of perceived discomfort and endurance time were used to track the progression of fatigue at the different height conditions, and differential effects due to direction of exertion were also examined. The overhead and shoulder height conditions resulted in significantly increased muscle activation, discomfort and strength decline in comparison to the low condition. Fatigue responses between overhead and shoulder level work were generally similar, as no differences existed in endurance time, RPD and mean power frequency for these conditions, but the overhead condition resulted in a substantial 18% reduction in downwards strength. The downwards exertions seemed to elicit the greatest fatigue response, despite the upwards direction requiring the highest global muscle activity. These results add evidence that repetitive overhead work should be avoided when possible, but provides novel insight on how direction of force application can be further considered in design recommendations.

Plug-and-play advanced magnetic resonance spectroscopy.

Advanced MRS protocols improve data quality and reproducibility relative to vendor-provided protocols; however, they are challenging to incorporate into the clinical workflow and require local MRS expertise for successful implementation. Here, we developed an automated advanced MRS acquisition protocol at 3T to facilitate acquisition of high-quality spectroscopic data without local MRS expertise. First, a B0 shimming protocol was selected for automation by comparing 3 widely used B0 algorithms (2 vendor protocols and FAST(EST)MAP). Next, voxel-based B0 and B1 calibrations were incorporated into the consensus-recommended semi-LASER sequence and combined with an automated VOI prescription tool, a recently developed method for automated voxel prescription. The efficiency of collecting single-voxel data from a clinical cohort (N = 40) with the automated protocol (calibration time and fraction of usable datasets) was compared with the nonautomated semi-LASER protocol (N = 35) whereby all prescan calibrations were executed manually in the academic hospital setting with rotating MR technologists in the neuroradiology unit. A multi-iteration FAST(EST)MAP protocol resulted in narrower water linewidths than vendor's B0 shim protocols for data acquired from 6 brain locations (p < 1e-5) and was selected for automation. The automated B0 and B1 calibrations resulted in a time saving of ~4.5 minutes per voxel relative to the same advanced protocol executed manually. All spectra acquired with the automated protocol were usable, whereas only 86% of those collected with the manual protocol were usable and spectral quality was more variable. The plug-and-play advanced MRS protocol allows automated acquisition of high-quality MRS data with high success rate and consistency on a clinical 3T platform.

Automated lightless cytometry on a microchip with adaptive immunomagnetic manipulation

Surface expression of cell populations are often sought as diagnostic and prognostic biomarkers in hematology-oncology and infectious diseases, making flow cytometry an invaluable technique for both clinical and basic research applications. On the other hand, the reliance of flow cytometry on manual input parameters and user protocols for operation introduces variation between analyses while potentially leading to errors in measurements. In this work, we introduce an integrated flow cytometry microchip that automatically adapts to the sample it interrogates. Our device measures the antigen expression in a sample by automatically analyzing the response of immunomagnetically labeled cells to an external magnetic field through integrated electrical sensors and by continuously modulating the time the cells are subjected to the field for optimal sensitivity and dynamic range. Furthermore, the lack of optical illumination and fluorescence detectors enables automated analysis to be carried on a fully integrated platform that is particularly well suited for translation into point-of-care testing and mobile screening. We applied our automated cytometry chip on both pure and mixed cell populations and validated its operation by benchmarking against a conventional flow cytometer. By transforming the utility-proven flow cytometry, a technique that has long been dependent on an operator in centralized laboratories, into a standardized disposable test for bedside or home testing, the automated flow cytometry microchip introduced here has the potential to enable self-screening for telemedicine and wellness.

Extraction of DNA from face mask recovered from a kidnapping scene

Deoxyribonucleic acid (DNA) extraction has considerably evolved since it was initially performed back in 1869. It is the first step required for many of the available downstream applications used in the field of molecular biology and forensic science. Blood samples is one of the main body fluid used to obtain DNA. This experiment used other body fluids such as saliva, sweat tears and mucus. There are many different protocols available to perform nucleic acid extraction on such samples. These methods vary from very basic manual protocols to more sophisticated methods included in automated DNA extraction protocols. This experiment used extraction kit (Zymo research). The DNA result from isolated saliva samples on the facemask range from 133.7, 213.6, 599.1 and 209.1 mg/ml. theoretically; such DNA is of much quantity and quality and can be used for forensic investigation when recovered from a crime scene. The DNA from isolated tears samples on the face mask ranges from 707.7, 202.5, 99.2, and 62.6 mg/ml. Theoretically, such DNA is of much quantity and quality and can be used for forensic investigation when recovered from a crime scene. The DNA from isolated tears samples on the face mask ranges from 615.3, 66.2, 78.5, and 68.2 mg/ml. theoretically, such DNA is of much quantity and quality and can be used for forensic investigation when recovered from a crime scene. Extracted DNA from saliva and sweat produced visible bands on agarose gel, mucous stain produce obscure band on agarose gel and the tears stain produce invisible bands. DNA from sweat satin, saliva stain, mucus stain and tears stain in face mask can be used as alternative for forensic investigation.

Parent-child interaction therapy (PCIT) with families of children with autism spectrum disorder.

Parent-child interaction therapy (PCIT) is an evidence-based behavioral parent training program designed for preschool-age children that emphasizes supporting parent-child interaction patterns to improve child behavior and enhance the quality of parent-child relationships. PCIT has been deemed efficacious in treating children with disruptive behavior disorders, and recent studies have shown promising results utilizing aspects of PCIT with children with autism spectrum disorder (ASD), but none of these studies applied the entire PCIT intervention per manual protocol. The present study is the first to test the efficacy of PCIT, without modification, with families of preschool-age children with ASD without comorbid behavioral difficulties. This study employed a single-subject multiple-probe design to evaluate the efficacy of PCIT with four families with children with ASD between the ages of 2 and 4 years old (M = 40 months) over a 4-month period. PCIT was effective in increasing positive parenting behavior, decreasing negative parenting behavior, and increasing child compliance to parental commands. Parents reported greater confidence in parenting abilities post-treatment and significant improvement in the core areas of autism symptomatology. Parents endorsed significant improvement in aspects of the parent-child relationship, such as attachment and involvement. Parents of children with ASD demonstrated more positive and effective parenting behavior and reported enhancements in the parent-child relationship after participating in PCIT. Children were more compliant to parental commands and exhibited improvements in social and behavioral functioning. Increases in positive parenting behaviors and child compliance to parental requests were maintained 1 month after treatment and outside the clinic setting during generalization sessions. Parents of children with ASD reported a high degree of satisfaction with PCIT. The present study provides initial evidence of the efficacy of utilizing PCIT with families of preschool-age children with ASD and supports the continued investigation of the efficacy of PCIT with this population.

Effects of Joint Mobilization Versus Acupuncture on Pain and Functional Ability in People with Chronic Neck Pain: A Randomized Controlled Trial of Comparative Effectiveness.

Chronic Neck Pain (CNP) is one of the main contributing factors to disability in people of working age. The aim of this randomized clinical trial was to compare the efficacy between acupuncture and joint mobilization on pain and disability in patients with CNP. The study involved 45 men and women with CNP, divided into three groups of 15 each. The first group followed a manual therapy protocol with joint mobilization for eight weeks three times per week. The second group followed an acupuncture protocol of equal duration and frequency, while the third group did not follow any treatment. Pain with the Visual Analog Scale (VAS) for pain and functional limitations with the Neck Disability Index (NDI) questionnaire were assessed before and after an 8-week intervention. Analysis of variance was applied while post-hoc comparisons were made to determine the differences among the groups at each time of measurement. Both intervention groups showed statistically significant differences compared to the control group after the end of the intervention in both the VAS and the NDI scores (p< .001). Furthermore, the acupuncture group showed a statistically significant improvement compared to the joint mobilization team after the end of the intervention in the VAS score (p< .001) and the NDI score (p< .05). Both joint mobilization and acupuncture appear to be effective interventions in reducing pain and improving functional ability in people with CNP. However, acupuncture appears to have a greater analgesic effect than joint mobilization.

Effects of wheels and tires on high-strength lightweight wheelchair propulsion cost using a robotic wheelchair tester

Purpose This study was designed to investigate the effect of wheel and tire selections on the propulsion characteristics of a high-strength lightweight manual wheelchair using robotic wheelchair propulsion. Materials and methods Four configurations were compared with differing combinations of drive wheel tires and casters, with the baseline reflecting the manufacturer configuration of a solid mag drive wheel and 8"×1" caster. The robotic wheelchair tester propelled the chair using pre-generated straight and curvilinear manoeuvres using repeatable and reliable cyclic torque profiles. Additionally, energy loss of the components was measured using coast-down deceleration tests to approximate the system-level rolling resistance of each configuration. Results Results indicate a significant decrease in propulsion cost, increased distance travelled and increased manoeuvrability across all configurations, with upgraded casters and tires. Conclusions These results indicated that with better casters and drive wheel tires, the performance of high strength lightweight wheelchairs can be improved and better meet the mobility needs of users. Implications for rehabilitation Wheel and tire selection can have a demonstrable impact on the propulsion efficiency of manual wheelchairs Coast-down test protocols can be used as a simple and cost-effective means of assessing representative energy losses across various surfaces Wheelchair configurations can be optimized with proper knowledge of the main energetic loss contributions and the environments and contexts of use

Pinot noir Crop Estimation Method Allows Growers to Estimate Yields Earlier than Lag Phase

<h3>Summary</h3> <h3>Goals:</h3> Winegrape growers must estimate yields to prepare for harvest operations and winery processing. Standard practice requires waiting until the lag phase of berry development, which is late for making decisions related to crop thinning, fruit sales, winery inventory, and ordering wine production supplies. Because producers desire improved methods for accurate crop estimation, we evaluated the following questions over six growing seasons for Oregon <i>Vitis vinifera</i> Pinot noir: 1) When does lag phase occur? 2) What cluster weight increase factor should be used with lag phase crop estimation? and 3) Can crop estimation be conducted earlier in the growing season? <h3>Key Findings:</h3> The Pinot noir berry development curve was consistent across six years when based on days post-full bloom (50% capfall). The mid-point of lag phase, the most common time to estimate crop yields, was at 55 days post 50% capfall. Lag phase duration was 12 days. Mean cluster weight increase factor during the entire lag phase over the six-year period was 2.1. Cluster weight increase factor equations were developed based on post-budbreak and bloom thermal times and day counts to allow growers flexibility in timing of crop estimation. <h3>Impact and Significance:</h3> Data was used to improve upon manual lag phase crop estimation protocols commonly used by winegrape producers, including methods to identify berry lag phase occurrence and developing equations for cluster weight increase factors based on berry development. These modifications may improve the accuracy of manual yield estimates and allow growers to obtain yield estimates earlier in the growing season than previously allowed by standard practice. This methodology may be useful in testing increase factors for other grape cultivars.

COVID-19 outbreak: Should dental and medical practices consider uv-c technology to enhance disinfection on surfaces? – A systematic review

AimsDuring the COVID-19 pandemic the search for complementary methods to enhance manual disinfection in dental and medical practices raised relevance. We sought evidence for the addition of ultraviolet-C (UV-C) disinfection to manual cleaning protocols –and whether it improves the logarithmic (log) reduction of surface pathogen colonies. MethodsThis review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD420200193961. Six electronic sources were consulted looking for clinical trials performed in healthcare environments in which pathogens were quantified by colony-forming unit (CFU)-enumeration before and after interventions, all databases were last consulted on May 2021. We assessed the risk of bias using an adapted Revised Cochrane Risk of Bias Tool (RoB 2). The certainty of the evidence was qualified according to the Classification of Recommendations, Evaluation, Development, and Evaluation (GRADE) approach. ResultsWe identified 1012 records and 12 studies fulfilled the inclusion criteria. All included studies reported enhanced disinfection in the UV-C arm; most of them reported 1-log to 2-log reduction in approximately 10 to 25 min. Only three studies reached a 5-log and 6-log reduction. When manual cleaning was performed alone, only two studies reported a 1-log reduction using a chlorine-based disinfectant. We detected a high risk of bias in 1 study. Certainty of evidence was classified as moderate and low. ConclusionsThe evidence points out the effectiveness of UV-C technology in reducing manual cleaning failures, enhancing the logarithmic reduction of surface pathogen colonies. However, the safety and success of these devices will depend on several physical and biological factors. A judicious project must precede their use in clinical and medical offices under the supervision of a physicist or other trained professional.

Expedited synthesis of mannose-6-phosphate containing oligosaccharides

Currently, the reaction toolbox for the functionalization of glycans assembled on solid-phase is quite limited. Automated (1 h) and manual (overnight) phosphorylation protocols that enable the solid-phase synthesis of oligosaccharides containing up to two mannose-6-phosphates are presented. Automated glycan assembly expedited access to substrates and facilitated the screening of experimental conditions.

An Evidence-Based Protocol for Manual Prone Positioning of Patients With ARDS.

Manual prone positioning has been shown to reduce mortality among patients with moderate to severe acute respiratory distress syndrome, but it is associated with a high incidence of pressure injuries and unplanned extubations. This study investigated the feasibility of safely implementing a manual prone positioning protocol that uses a dedicated device. A search of CINAHL and Medline identified multiple randomized controlled trials and meta-analyses that demonstrated both the reduction of mortality when prone positioning is used for more than 12 hours per day in patients with acute respiratory distress syndrome and the most common complications of this treatment. An existing safe patient-handling device was modified to enable staff to safely perform manual prone positioning with few complications for patients receiving mechanical ventilation. All staff received training on the protocol and use of the device before implementation. This study included 36 consecutive patients who were admitted to the medical intensive care unit at a large academic medical center because of hypoxemic respiratory failure/acute respiratory distress syndrome and received mechanical ventilation and prone positioning. Data were collected on clinical presentation, interventions, and complications. Using the robust protocol and the low-cost device, staff can safely perform a low-volume, high-risk maneuver. This method provides cost savings compared with other prone positioning methods. Implementing a prone positioning protocol with a dedicated device is feasible, with fewer complications and lower costs than anticipated.

Perspectives of inpatient rehabilitation clinicians on the state of manual wheelchair training: a qualitative analysis

Purpose The purpose of this study was to identify clinician knowledge regarding manual wheelchair (MWC) training in an inpatient rehabilitation (IPR) setting, identify current MWC education provided to new manual wheelchair users (MWUs), and determine how MWC training resources can be developed or modified to promote use among IPR clinicians. Methods Semi-structured interviews were conducted with 20 licenced IPR clinicians who work with MWUs. Using a traditional qualitative research design, researchers completed open, data-driven coding of interview transcripts. Overarching themes were determined through content analysis. Results Participants included 12 physical therapists, six occupational therapists, one physical therapy assistant, and one occupational therapy assistant. Five themes emerged from the interviews: (1) clinician knowledge, education, and experience (2) current training content (3) training environment, (4) desired programme components (5) barriers to implementation. Participants reported receiving minimal education in school and from their employers on training MWUs. While clinicians expressed the importance of MWU education, they used varying training approaches with little standardization. Participants identified that training protocols for IPR are beneficial if they are quick, straightforward, and flexible. Conclusions While MWC training occurs during IPR stays, it appears to be inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to evidence-based practices. This is likely due to limited feasibility and awareness of existing MWC training resources. Clinician input gathered from these interviews provides information for how to best integrate MWC training programmes into the rehabilitative process. Findings may inform the development and assessment of more clinically feasible MWC training protocols. Implications for Rehabilitation New manual wheelchair users must learn numerous wheelchair-related skills in order to participate in everyday life activities. Manual wheelchair education for new users during inpatient rehabilitation is often inconsistent across facilities, clinicians, and patients, with varying degrees of adherence to existing evidence-based practices. Systematic challenges often act as a barrier to the implementation of more comprehensive, structured manual wheelchair training protocols. Manual wheelchair training resources must be concise, flexible, customisable, and easy to follow in order to promote increased implementation among inpatient rehabilitation clinicians.