Preparatory Time Research Articles

Rhythmic Physical Activity Intervention: Exploring Feasibility and Effectiveness in Improving Motor and Executive Function Skills in Children.

IntroductionIncreasing literature has emerged investigating the importance of considering the qualitative characteristics of physical activity (PA) interventions and sports as well as considering the role of motor competence in the exercise–cognition interplay. The purpose of this pilot study was to examine the feasibility and effectiveness of a rhythmic PA intervention compared to a standard physical education program, on motor and hot and cool executive function (EF) skills.MethodsChildren ages 6–11 were enrolled in one of the two programs: a rhythmic program (n = 22) and a physical education program (n = 17), both meeting for 30 min, twice per week, for 7 weeks. The rhythmic program emphasized moving to the beat of music and moving in various rhythmic patterns with whole body movements, clapping, and drumsticks. The children also created their own rhythmic patterns and socially engaged with other children by working in pairs and sharing their routines with the group. The physical education group engaged in ball skills, locomotor patterns, team sports, and moving through stations in small groups, with no emphasis on rhythm. Pretest and posttest measurements included measurement of balance (Movement ABC-2), cool and hot EF (Flanker, SWAN), and social factors, whereas throughout the implementation period data on affective valence, enjoyment, cognitive engagement, perceived exertion, and PA levels were collected at every lesson in both groups.ResultsThe rhythmic program used in this study was feasible, scalable, affordable, and able to be implemented with minimal preparatory time. Children in both groups (rhythmic and physical education) engaged in a similar level of PA and had similar positive experiences from the programs. Both groups improved in balance and cool EF, and there were significant correlations in the change scores between balance and cool EF, as well as between cool EF with hot EF and socio-emotional factors.DiscussionThis study contributes to the literature by exploring the potential value of rhythmic programs as a vehicle in helping children develop motor and EF skills while deriving joy and positive social interactions from the program.

Shared leadership in tertiary care: design of a simulation for patient safety decision-making in healthcare management teams

IntroductionSimulation-based training (SBT) on shared leadership (SL) and group decision-making (GDM) can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into healthcare...

The \u201cPPI Hawker\u201d: an innovative method for patient and public involvement (PPI) in health research

BackgroundPatient and Public Involvement (PPI) in health research entails doing research ‘with’ the public. Successful PPI requires a diversity of patients’ perspectives and experiences. In Singapore, including the public’s voice in research is still in its infancy and different ways of involving the public have to be explored.Our aims were to describe a PPI initiative that enables members of the public to share their ideas and opinions about health research, and to assess the feasibility, accessibility and utility of the initiative.MethodsBuilding on the concept of the PPI Café used in the west we designed a “PPI Hawker” for Singapore. Here Hawker Centres rather than cafes are used frequently for eating and socialising, providing a one-stop destination for a wide section of society. The PPI facilitators approached people sitting at tables and joined them to discuss questions of relevance to a local research study. Observations and reflexive field notes were used to evaluate the “PPI Hawker’s” feasibility, acceptability and utility in the Singaporean community.ResultsIn three “PPI Hawkers” we approached 96 people and 72 (75%) engaged in discussions about the design of a population-based research study. The majority (75%) of participants willingly discussed all of the questions posed to them by the researchers, indicating the feasibility of PPI. The PPI participants came from the three major ethnic groups in Singapore and appeared to be broad in age, suggesting “PPI Hawkers” are easily accessible. Both participants and researchers recognised the utility of the “PPI Hawker”, reflecting on people’s willingness to talk about the research issues, engaging in informative conversations and posing relevant questions.ConclusionThe “PPI Hawkers” succeeded in engaging the public in conversations about a local population-based study. The public brought to the researchers’ attention a variety of previously unheard perspectives about the research. Each event fostered connectivity between professionals and the public, generating among researchers a more positive perception of the power of public involvement.“PPI Hawkers” provide an opportunity for co-informed conduct of research studies with diverse members of the public. They create a focus within a community setting for researchers to engage with the public. The resources needed (costs and preparatory time) are relatively few. Not only do “PPI Hawkers” have potential in Singapore, but also for the rest of Asia.

Shoes with active insoles mitigate declines in balance after fatigue

Fatigue can induce postural instability and even lead to falls. However, most current methods to delay or reduce fatigue require long preparatory time, or large and expensive equipment. We propose a convenient method to alleviate postural instability due to fatigue. We paid attention to that fatigue and aging share similar neurophysiological deterioration of sensory-motor function. Considering that stochastic resonance via sub-sensory mechanical vibration increases postural stability in the elderly, we propose that sub-sensory insole vibration reduces the negative effect of fatigue on postural control. We performed experiments with 21 young and healthy adult participants, and demonstrated that insole vibration compensates for the loss of balance ability due to fatigue. The sub-sensory insole vibration restored both the area of center of pressure and the complexity of the time series of the motor output after fatigue to the pre-fatigue levels. The insole units generating the vibration were completely concealed in shoes and controlled by a smart phone. This compact implementation contrasts with the cumbersome procedure of current solutions to fatigue-induced postural instability.

Effect of Ramadan fasting: Association with time of day on time-motion, technical aspect and psychophysiological response to simulated karate competition in young amateur competitors

Ramadan is characterized by daily abstinence from food and fluid intake from dawn to sunset. The understanding of the Ramadan effects on the diurnal variations of athletic performance is crucial for practitioners, coach and researchers to prepare sport events and optimize performance. The aim of the present study was to reveal the effect of Ramadan on the performance aspect, heart rate and rating of perceived exertion during a karate match. In a randomized counterbalanced, 2 × 2 cross-over order, 22 male and female amateur karate athletes (age = 16.8 years, body mass = 59.1 kg, height = 168.3 cm) participated in simulated karate match at 8–10 a.m. and 5–7 p.m. on three different occasions: 1 week before Ramadan, the second week of Ramadan (during Ramadan), and 2 weeks after Ramadan. Performance aspects were analyzed, and heart rate and rating of perceived exertion were assessed before and immediately after the match at each visit. Our results demonstrated that Ramadan adversely affected time-motion variables (fighting time and preparatory time) and heart rate during simulated karate match (p < 0.05, all). However, heart rate pic response to karate match was higher during Ramadan when compared with before Ramadan and after Ramadan. However, rating of perceived exertion results did not show any variation during Ramadan phases. Concerning the interaction of Ramadan and time of day, fighting time and stoppage time were higher in the evening and in the morning before Ramadan and the inverse during Ramadan, respectively (p < 0.05). In conclusion, Ramadan altered the diurnal variation of performance aspect, in terms of fighting time and stoppage time, during simulated karate match.

A flipped classroom in graduate medical education.

The role of the flipped classroom model in graduate medical education (GME) is not yet defined. We set out to evaluate the feasibility, acceptability and outcomes of a flipped classroom instructional model in an internal medicine curriculum. This pilot study was carried out in an academic medical centre in the USA with 43 second-year internal medicine postgraduate trainees. Trainees watched videos on the pharmacological treatment of type 2 diabetes outside of the classroom, followed by an in-class session in which they engaged in case-based discussions. The intervention was evaluated using surveys and a knowledge test before, immediately after and 6 months after the intervention. The mean number of correct answers for a 10-question knowledge test was 5.25 before the intervention, 8.00 in the immediate post-intervention test, and 7.10 in the 6-month follow-up test (p<0.001). Six months after the intervention, 57.1% of participants reported prescribing an antidiabetic medication discussed at the session. In a focus group, trainees reported their preference for interactive, case-based learning, concern about the time required for preparation and interest in incorporating real patient cases. Trainees preferred the flipped classroom, which also resulted in increased knowledge and self-reported prescribing changes; however, the required preparatory time may limit its feasibility in GME.

Impact of Enhanced Recovery in Cesarean Patients

Enhanced recovery (ER) programs have been shown to improve postoperative outcomes, including cesarean births. Our clinical goal was to determine the impact of the ER protocol for scheduled, elective cesarean patients on lengths of stay (LOS), opiate consumption, antiemetic consumption, readmission rates, and exclusive breastfeeding rates. In addition, we wanted to determine whether any of the patients’ demographic variables (smoker, diabetes, anemia, age, or prior cesarean) resulted in increased LOS, despite ER-protocol implementation. The study consisted of a quasi-experimental, nonequivalent control group, pretest–posttest design. For the pretest–control group, 90 random elective cesarean charts were reviewed from August 2017 through August 2018. For the posttest or experimental group, 90 random elective cesarean charts will be reviewed from August 2018 through August 2019. A magnet-designated hospital in a Midwestern rural community with a population of approximately 18,500. The hospital has a 12-bed maternity unit staffed with 17 nurses (RNs) and averages 400 births/year with an average cesarean rate of 120/year. All multiparous, elective cesarean patients. The study is a quasi-experimental, nonequivalent control group, pretest–posttest design. A paired t test is used to determine the impact of the new ER protocol for scheduled cesarean patients' lengths of stay, opiate consumption, antiemetic consumption, readmission rates, and exclusive breastfeeding rates. Logistic regression is used to determine if any of women’s demographic factors (smoker, diabetic, anemic, previous cesarean, age) influence lengths of stay, despite ER implementation. Emergency cesareams are excluded from the data due to the lack of preparatory time for the ER protocol to be fully implemented. The following trends have been observed (n-19Pre/n-19Post): decreased LOS, decreased length of Foley catheter use, decreased length of bedrest, decreased length of intravenous fluid administration, decreased opiate use, and increased times of breastfeeding in the first 24 hours. There was a significant decrease in postoperative opioid consumption with an increase in exclusive breastfeeding rates.

Improving the Quality of Patient Data Capture in Breast Radiotherapy Peer-Review

The importance of multidisciplinary peer-review rounds is widely recognized. Peer-review rounds ensure the quality and safety of individual radiation therapy (RT) treatment plans. At our institution, breast cancer RT peer-review rounds are conducted weekly over 1-hour session, with attendance from radiation oncology, therapy, physics staff and trainees. All newly diagnosed breast cancer patients undergoing radical RT are scheduled for peer-review approximately 1 week prior to their treatment start date. One challenge in conducting peer-review for a large disease site is the ability to systematically review all patients within the limited time constraints. Our objective is to develop a comprehensive patient list with essential patient, tumour, and treatment factors for peer-review and to evaluate its feasibility. A standardized list of patient information essential for peer-review were identified by the site group. The core patient clinicopathologic parameters were entered into the RT Electronic Medical Record (RT-EMR) by the clinician at the time of radiotherapy prescription. Patient information included: age, clinical/pathological stage, surgery type, chemotherapy sequence, tumour size, histology, tumour grade, lympho-vascular invasion, margin status, nodal positivity, ER, PR, and HER2 status, and a comment section. Aside from tumour size, margins, nodal status and comments, all data inputs used dropdown menus, which ensured data consistency and reduced free-text entries. Standard RT prescription selections were templated in accordance with our institutional practice guidelines to facilitate uniformity. All patient parameters extracted from the RT-EMR were transferred to a spreadsheet and evaluated for completeness by a Clinical Specialist Radiation Therapist (CSRT) prior to rounds. For patients with insufficient data for peer-review, missing data were retrieved manually and entered by the CSRT through review of dictated clinic notes. The rate of completion and time required to retrieve missing information were captured following the implementation of the automated data extraction process. RT-EMR data were collected over 40 weeks between April 2015-April 2016. The average patient data completion during the first month of implementation was 64% (SD10) and increased significantly over time to 86% (SD4) in the final month (p<0.001). The time required to ensure data completion was inversely correlated with the overall data completion rate (Pearson r=-0.702;p<0.001). An average of 18 (SD4) patients were peer-reviewed weekly in rounds. The standardization of RT prescription selection and clinicopathologic data streamlined the peer-review process in rounds and significantly decreased preparatory time; mean reduction from 2hr:40mins (first month) to 1hr:15mins in the final month (p=0.005). The standardization and consistent entry of patient’s clinical-pathology data decreased time required for review of transcribed notes for missing patient information. The use of a comprehensive peer-review list is feasible and supports peer-review of all radical breast RT plans, even in the absence of the attending radiation oncologist. Direct entry of patient information at the time of RT decision-making enhances efficiency and allows prospective data capture, reduction of human resources, and avoidance of manually reviewing transcribed clinical notes.

Preparatory Time-Related Hand Surgery Operating Room Inefficiency: A Systems Analysis.

Background: No study exists on preparatory time-from patient's entrance into the operating room to skin incision-and its role in hand surgery operating room inefficiency. The purpose of this study was to investigate the length and variability of preparatory time and assess the relationship between several variables and preparatory time. Methods: Consecutive upper extremity cases performed for a period of 1 month by hand surgeons were reviewed at 3 surgical sites. Preparatory time was compared across locations. Cases at one location were further analyzed to assess the relationship between preparatory time and several variables. Both traditional statistical methods and Shewhart control charts, a quality control tool, were used for data analysis. Results: A total of 288 cases were performed. The mean preparatory times at the 3 sites were 25.1, 25.7, and 20.7 minutes, respectivley. Aggregated preparatory time averaged 24.4 (range 7-61) minutes, was 75% the length of the surgical time, and accounted for 34% of total operating room time. Control charts confirmed substantial variability at all locations, signifying a poorly defined process. At a single site, where 189 cases were performed by 14 different surgeons, there was no difference in preparatory time by case type, American Society of Anesthesiologists status, or case start time. Preparatory time varied by surgeon and anesthesia type. Conclusions: Preparatory time was found to be a source of inefficiency, independent of the surgical site. Control charts reinforced large variations, signifying a poorly designed process. Surgeon seemingly plays an important, albeit likely indirect, role. Efforts to improve operating room workflow should include preparatory time.

Technical-tactical ratios by round, genders and weight division of mixed martial arts for training

This study compared the technical–tactical analysis by time ratios between genders and weight divisions of female mixed martial arts (MMA) athletes competing in the Ultimate Fighting Championships. Eighty-two athletes (G1 = 21 male middleweights, G2 = 14 male lightweights, G3 = 21 female middleweights, G4 = 14 female lightweights), were evaluated using a time–motion and technical–tactical protocol. Four hundred eighty-four males and 205 female MMA rounds were analysed. Time–motion and technical–tactical variables were evaluated according to frequency of attempts and effective strikes, takedowns and submissions, as well as fighting activity time and preparatory of standing and groundwork combat. Comparing groundwork preparatory activity time G1 showed longer times than other groups (35:0 ± 1.8 s; p ≤ .002). For standing fighting activity time, G2 showed longer times than other groups (151.2 ± 72.9 s; p ≤ .001). G2 displayed longer times between actions during standing [p = .003; 1: 32.5 (17.8; 74.8)] and groundwork [p ≤ .003; 1: 30.0 (9.0; 52.0)] than G3. In conclusion, G1 and G2 showed longer groundwork and standing actions than G3 and G4. In standing and groundwork actions, G2 presented longer time between striking actions than G3.

Increased Complexities in Visual Search Behavior in Skilled Players for a Self-Paced Aiming Task.

The badminton serve is an important shot for winning a rally in a match. It combines good technique with the ability to accurately integrate visual information from the shuttle, racket, opponent, and intended landing point. Despite its importance and repercussive nature, to date no study has looked at the visual search behaviors during badminton service in the singles discipline. Unlike anticipatory tasks (e.g., shot returns), the serve presents an opportunity to explore the role of visual search behaviors in movement control for self-paced tasks. Accordingly, this study examined skill-related differences in visual behavior during the badminton singles serve. Skilled (n = 12) and less skilled (n = 12) participants performed 30 serves to a live opponent, while real-time eye movements were captured using a mobile gaze registration system. Frame-by-frame analyses of 662 serves were made and the skilled players took a longer preparatory time before serving. Visual behavior of the skilled players was characterized by significantly greater number of fixations on more areas of interest per trial than the less skilled. In addition, the skilled players spent a significantly longer time fixating on the court and net, whereas the less skilled players found the shuttle to be more informative. Quiet eye (QE) duration (indicative of superior sports performance) however, did not differ significantly between groups which has implications on the perceived importance of QE in the badminton serve. Moreover, while visual behavior differed by skill level, considerable individual differences were also observed especially within the skilled players. This augments the need for not just group-level analyses, but individualized analysis for a more accurate representation of visual behavior. Findings from this study thus provide an insight to the possible visual search strategies as players serve in net-barrier games. Moreover, this study highlighted an important aspect of badminton relating to deception and the implications of interpreting visual behavior of players.

Thrombotic Microangiopathy Team-Based Learning Module for Second-Year Medical Students.

Thrombotic microangiopathy (TMA) syndromes are a diverse group of disorders characterized by microangiopathic hemolytic anemia (intravascular hemolysis and presence of peripheral blood schistocytes) and thrombocytopenia. Prompt diagnosis is crucial to inform management and improve patient outcome. Clinical and laboratory manifestations of these various disorders overlap, making diagnosis difficult. My colleagues and I developed a team-based learning (TBL) module for second-year medical students in their hematology course block. Students attend a 1-hour lecture on hemolytic anemia in their standard course curriculum and are given two articles to read outside of class in preparation for the TBL. Total out-of-class preparatory time is 30 minutes. The TBL runs for 1 hour, and students participate in groups of eight. Materials associated with this TBL include the lecture on hemolytic anemia, individual and group readiness assurance test questions, and application exercises. Explanations for all answers are provided for instructors. Surveys indicated students enjoyed the TBL and felt that after participation, their ability to diagnose a TMA was improved. They felt that the number of questions in the session was appropriate to time allowed and that the preparatory articles provided a sufficient level of understanding to participate in the TBL. Some commented they would have liked more time to complete the application exercises, so instructors could consider increasing the allotted time to 1.5 hours. Based on the success of this TBL, we plan to develop additional modules for the course and investigate other measures of academic success after implementation.

Use of SkypeTM sessions with top cancer trial physicians to bring Interprofessional Education (IPE) into a didactic oncology course

ObjectiveTo incorporate meaningful Interprofessional Education (IPE) into a core didactic oncology course by bringing into the classroom a series of cancer specialist physicians, from around the United States, who instructed from and discussed their own clinical trials. MethodsThe instructor recruited physicians from selected nationwide cancer centers as well as from more regional institutions. Prior to each IPE session, students pre-read relevant trials or other materials. At an arranged time, an approximately 30-minute Skype™ session began which included student questions. Assessments of student learning included individual examinations and a group trial. Survey data was also collected on student views of interprofessionalism, cancer trial informatics and the role of pharmacists on trial teams. ResultsGroup clinical trials showed substantial student creativity and achievement of new skills in trial design. Essays indicated that students learned as individuals. Survey data showed that prior to the interprofessional sessions, students felt uncomfortable discussing trial designs/results with graduates of other health professions. Following the sessions and group trial assignment, students gained significant confidence discussing trials with physicians and felt increased recognition for the pharmacist’s role in the trial team and increased appreciation for the perspective of trial physicians. Students reported that they enjoyed the opportunity to talk with top cancer physicians. ConclusionsDidactic core courses can be modified to accommodate meaningful interprofessional team education. Considerable time was required to arrange external Skype™ speakers; however, this IPE oncology exercise was very highly rated by students indicating that this was preparatory time well-invested.

Tongue thickness evaluation using ultrasonography can predict swallowing function in amyotrophic lateral sclerosis patients

ObjectiveDysphagia is a critical issue in amyotrophic lateral sclerosis (ALS) patients. An evaluation of swallowing function is important for assessing the risk of aspiration. We investigated the validity of tongue sonography compared with videofluoroscopic examination for ALS patients. MethodsWe investigated 18 ALS patients. Nine subjects underwent repeated investigations. All of the subjects underwent tongue sonography and videofluoroscopic examination. Additionally, tongue sonography was evaluated in 18 age- and sex-matched healthy volunteers. To determine tongue thickness, we measured the vertical distance from the surface of the mylohyoid muscle to the tongue dorsum using ultrasonography. ResultsIn the ALS patients, the tongue was significantly thinner than in healthy subjects. Tongue thickness was associated with body mass index and onset type in the ALS patients (p=0.006). Temporal analyses of videofluoroscopy revealed that tongue thickness was associated with oral preparatory and transit time (p=0.032) but not with pharyngeal transit time. Repeated measurement data revealed a decrease in tongue thickness over the course of the measurements (p=0.002). ConclusionsIn ALS patients, reduced tongue thickness suggests disease progression and tongue dysfunction. SignificanceTongue sonography is a useful modality for the non-invasive and quantitative evaluation of tongue thickness and dysphagia in ALS patients.

Compassionate extubation for a peaceful death in the setting of a community hospital: a case-series study.

BackgroundThe use of compassionate extubation (CE) to alleviate suffering by terminating mechanical ventilation and withdrawing the endotracheal tube requires professional adherence and efficiency. The Hospice Palliative Care Act, amended on January 9, 2013, legalizes the CE procedure in Taiwan.MethodsFrom September 20, 2013 to September 2, 2014, the hospice palliative care team at a community hospital received 20 consultations for CE. Eight cases were excluded because of non-qualification. Following approval from the Ethics Committee, the medical records of the remaining 12 patients were reviewed and grouped by the underlying disease: A, “terminal-stage cancer”; B, “non-cancer out-of-hospital cardiac arrest”; and C, “non-cancer organ failure”. Time to extubation using a cut-off at 48 hours was assessed.ResultsThe mean ages of patients (standard deviation) in groups A, B, and C were 66.3 (14.9) years, 72 (19.1) years, and 80.3 (4.0) years, respectively. The mean number of days of intubation at consultation were 6.8 (4.9), 7.3 (4.9), and 179.3 (271.6), respectively. The mean total doses of opioids (as morphine-equivalent dose) in the 24 hours preceding CE were 76 (87.5) mg, 3.3 (5.8) mg, and 43.3 (15.3) mg. The median times from extubation (range) to death were 97 (0.2–245) hours, 0.3 (0.2–0.4) hours, and 6.1 (3.6–71.8) hours. Compared to those requiring <48-hour preparatory time, patients requiring >48 hours to the moment of CE were younger (62.8 years vs 75.5 years), required a mean time of 122 hours (vs 30 hours) to CE (P=0.004), had shorter length of stay (33.3 days vs 77.8 days), required specialist social worker intervention in 75% of cases (vs 37.5%), and had a median duration of intubation of 11.5 days (vs 5.5 days).ConclusionCE was carried out according to protocol, and the median time from extubation to death varies determined by the underlying disease which was 0.3 hour in patients admitted after out-of-hospital cardiac arrest and 97 hours in patients with advanced cancer.

Web-based teaching in point-of-care ultrasound: an alternative to the classroom?

ObjectivesTo evaluate two educational methods for point-of-care ultrasound (POC US) in order to: 1) determine participant test performance and attitudes in using POC US and 2) compare cost and preparation time to run the courses.MethodsThis was a pilot study conducted at a county teaching hospital. Subjects were assigned to participate in either a large group course with live classroom lectures (Group A) or a group asked to watch 4.5 hours of online prerecorded lectures (Group B). Both groups participated in small-group hands-on training after watching the lectures. Both groups took a pre- and post-course exam, and completed course surveys. Cost and time spent running the courses were also compared.ResultsForty-seven physicians participated in the study. The pre-test and post-test scores between the two groups did not differ significantly. Of those with prior ultrasound experience, the majority of both groups preferred to continue classroom-based teaching for future courses. Interestingly, in the groups who had no ultrasound experience prior to their course participation, there was a higher percentage who preferred web-based teaching. Lastly, Group B was shown to have the potential to take less preparatory time when compared to Group A.ConclusionA web-based curriculum in POC US appears to be a promising and potentially time saving alternative to live classroom lectures and seems to offer similar educational benefits for the postgraduate learner.

Impact of adapted team-based learning methods on student self-assessment of professionalism, teamwork, and skills in a self-care course

ObjectiveThe purpose of this study is to assess the impact of the introduction of an adapted team-based learning (TBL) pedagogy on student professionalism, teamwork skills, and perception of learning as well as resultant course evaluations. DesignAdapted TBL was implemented in a Patient Self-Care and Monitoring course. Following institutional review board (IRB) approval, third-year (P3) students enrolled in the course were administered a survey prior to introduction of TBL, and following the final exam. The Fall 2011 and Fall 2012 course evaluations were compared. ResultsA total of 109 (89%) and 116 (95%) students responded to the pre- and post-survey, respectively. Students responded that TBL significantly improved verbal communication and teamwork skills, his or her ability to convey ideas diplomatically. Students also felt more respected by team members than before TBL implementation. They were less likely to attend class following implementation of TBL compared to previous didactic lectures and did not feel that they learned more from TBL than from studying alone. Course evaluations were negatively impacted in some areas. Additional comments indicate that students and faculty found an increase in preparatory time for class meetings. ConclusionTeam-based learning improves student perception of some, but not all, areas of communication, teamwork, and professionalism.

Effect of Physical Therapy Training on Gait Initiation in Patients with Moderate Parkinson's Disease

The present study investigated the effects of physical therapy treatment on gait initiation in patients with Parkinson's disease (PD). Thirteen patients with PD were randomized into a treatment (n = 7) and control (n = 6) group. Participants were assessed for their severity level, using the Modified Hoehn and Yahr scale, and motor evaluation, using the Unified Parkinson's Disease Rating Scale (UPDRS), items III and IV. At pre- and post-assessments, gait initiation was assessed using a gait mat, synchronized with a video camera. The treatment group received a physical therapy training program based on the TrainingBIG™ technique and task-specific concepts, three times per week for four weeks. The control group received no physical therapy treatment. From analysis of the pre- and post-assessment variables, only the treatment group showed a significant decrease in preparatory phase time (p = 0.043) and increase in step length (p = 0.018). In addition, the treatment group had a significant increase in step length (p = .022) at post-assessment when compared to the control group. The present findings demonstrated that physical therapy treatment would be beneficial for patients with PD experiencing gait initiation problems.

The price of doing pediatric sinus procedures (a look at cost)

ObjectiveDisplay the cost savings of minimal sterile covers and preparatory time while still maintaining optimal outcomes for sinus procedures.In-office non-sterile endoscopic sinus procedures have not shown a difference in infections and complications. Institutions continue to employ more “traditional” sterile preparation with similar procedures in the operating room. Multiple studies have also shown no significant difference in postoperative course when preoperative antibiotics are administered for sinus procedures. MethodsEndoscopic sinus procedures were selected (58 patients) to analyze itemized sterile costs. Drapes, gloves, gowns, and antibiotics were then tallied and compared to the same items for cochlear implants (14 procedures). The “sterile-prep” time was also analyzed and compared between the two procedures. Cost difference was analyzed. ResultsComparing the supplies used for sinus procedures (56) and cochlear implants, our average sinus cost was $10.19, compared to $34.64, with a difference of $24.45. This equated to a savings of $1418.00 in sinus procedure supplies that year. The difference in draping and scrubbing time showed a difference of 20min between groups, equaling a value of $1760 difference/case. This calculated to a savings of $10,2080 for sinus operating room time. There was no difference in patient outcomes with this surgical preparatory approach. ConclusionOur analysis showed a large cost savings over a fiscal year in operative time and supplies. This did not compromise any patient outcomes given the already non-sterile nature of endoscopic sinus surgery. This practice can be adopted to greatly enhance efficiency without sacrificing surgical results.

Tracing the bilingual advantage in cognitive control: The role of flexibility in temporal preparation and category switching

The present study addressed the question whether bilinguals are characterised by increased cognitive flexibility. Mechanisms of cognitive flexibility were compared between a group of Hungarian-Polish bilinguals and a group of Hungarian monolinguals. The first task explored the effects of temporal orienting (ability to voluntarily orient attention to a certain point in time when a relevant event is expected) and the efficiency of switching between preparatory time intervals of different duration (sequential effects). The second task – the social category switching task – tapped into the mechanisms of switching between 2 types of categories (age and gender) and employed socially relevant stimuli (faces). The results of the first task revealed similar temporal orienting effects for both groups; however, the pattern of sequential effects differed between the groups, showing that bilinguals were less affected by the duration of the preceding preparatory interval. In the social category switching task, bilinguals showed reduced switch costs in the RT measure when categorising gender, and greater accuracy in the specific switch and no-switch conditions. We suggest that bilinguals are characterised by an enhanced mechanism of cognitive flexibility, which is applied to a temporal domain (efficient switching between preparatory intervals of different duration), and extends to the cognitive control processes in social categorisation tasks.