3103 research outputs found
Sort by
The effect of manual therapy on gastrocnemius muscle stiffness in healthy individuals
No full textStudy design: Randomized clinical trial.
Background: Muscle stiffness is a potential complication after injury and has been shown to be a risk factor for injury in healthy individuals.
Objectives: The primary purpose of this study was to assess the short-term effects of manual therapy (MT) on muscle stiffness of the gastrocnemius in both a relaxed and contracted state. The secondary purpose was to assess the reliability of a novel clinical tool (MyotonPRO) to measure muscle stiffness in the gastrocnemius in both a passive and contracted state.
Methods: Eighty-four consecutive healthy individuals were randomized to receive Manual Therapy (MT group) directed at the right-side ankle and foot or no treatment (CONTROL group). Muscle stiffness of the gastrocnemius was assessed bilaterally in all participants at baseline and then immediately after intervention in a relaxed and contracted state. Group (MT vs. CONTROL) by side (ipsilateral vs. contralateral) by time (pre vs. post) effects were compared through a 3-way interaction utilizing mixed model ANOVA. Reliability of the MyotonPRO was assessed with two-way mixed model intraclass correlation coefficients.
Results: There was a significant 3-way interaction for muscle stiffness of the gastrocnemius in a relaxed state (p\u3c0.01), but not contracted state (p=0.54). All conditions had increased resting muscle stiffness from pre to post measures except for the ipsilateral limb of the MT group. There was not a significant interaction for muscle stiffness in a contracted state. Reliability estimates (ICC) for muscle stiffness measures ranged between 0.898 and 0.986.
Conclusion: The change in muscle stiffness of the gastrocnemius in a relaxed state depended upon whether individuals received MT. Muscle stiffness measures were highly reliable based on single measurements.
Level of evidence: Therapy, level 2
Prediction of coronary thin-cap fibroatheroma by intravascular ultrasound-based machine learning
No full textBackground and aims: Although grayscale intravascular ultrasound (IVUS) is commonly used for assessing coronary lesion morphology and optimizing stent implantation, detection of vulnerable plaques by IVUS remains challenging. We aimed to develop machine learning (ML) models for predicting optical coherence tomography-derived thin-cap fibroatheromas (OCT-TCFAs). Methods: In 517 patients with angina, 414 and 103 coronary lesions were randomized into training vs. test sets. Each of the IVUS-OCT co-registered frames (including 32,807 for training and 8101 for test) was labeled according to the presence vs. absence of OCT-TCFA. Among 1449 computed IVUS features based on two-dimensional geometry and texture, 17 features were finally selected and used in supervised ML with artificial neural network (ANN), support vector machine (SVM), and naïve Bayes. Results: IVUS sections with (vs. without) OCT-TCFA showed a larger plaque burden, and a smaller and eccentric lumen. TCFA-containing sections were characterized by increased ratios of variance, entropy, and kurtosis; reduced ratio of homogeneity within the superficial to the deeper plaque; and decreased smoothness within the fibrous cap. In addition, OCT-TCFA was associated with low ratios of gamma-beta, Nakagami-μ and Nakagami-ω, and a high ratio of Rayleigh-b within the superficial to the deeper region. With a 5-fold cross-validation, the averaged accuracies were 81 ± 5% for ANN (area under the curve [AUC] = 0.80 ± 0.08), 77 ± 4% for SVM (AUC = 0.74 ± 0.05), and 78 ± 2% for naïve Bayes (AUC = 0.77 ± 0.04) for predicting OCT-TCFA. In the test set, ANN and naïve Bayes showed the overall accuracies of \u3e80%. Conclusions: Supervised ML algorithms with computed IVUS features predicted the presence of OCT-TCFA. This data-driven approach may help clinicians in recognizing high-risk coronary lesions
Dual Enrollment: Learning in an Accelerated 5 Week RN-BSN Hybrid Format
No full textThe accelerated RN-BSN dual-enrollment program model is minimally represented in the literature. Although they exist, the detail of their process and implementation strategies are often not shared. This article presents an accelerated dual-enrollment RN-BSN model offered using hybrid and flipped classroom strategies in a 5-week format. The case study of this model has shown student and faculty satisfaction and offered some ideas for refinement that the authors find useful for other RN-BSN programs to consider
Comparison of Disaster Preparedness between Urban and Rural Community Hospitals in New York State
No full textThe intent of this study was to determine whether there are differences in disaster preparedness between urban and rural community hospitals across New York State.Methods Descriptive and analytical cross-sectional survey study of 207 community hospitals; thirty-five questions evaluated 6 disaster preparedness elements: disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness.Results Completed surveys were received from 48 urban hospitals and 32 rural hospitals.There were differences in disaster preparedness between urban and rural hospitals with respect to disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, and perception of disaster preparedness. No difference was identified between these hospitals with respect to disaster preparedness funding levels.Conclusions The results of this study provide an assessment of the current state of disaster preparedness in urban and rural community hospitals in New York. Differences in preparedness between the two settings may reflect differing priorities with respect to perceived threats, as well as opportunities for improvement that may require additional advocacy and legislation
James aggrey and the African nation: Pan-africanism, public memory, and political imagination in colonial East Africa
No full textAlternatives to opioids for pain management in the emergency department decreases opioid usage and maintains patient satisfaction
No full textObjective: The objective of this study was to assess opioid use in an emergency department following the development and implementation of an alternative to opioids (ALTO)-first approach to pain management. The study also assessed how implementation affected patient satisfaction scores. Methods: This study compared data collected from October to December of 2015 (prior to implementation) to data collected between October and December of 2016 (after the intervention had been implemented). Emergency department visits during the study timeframe were included. Opioid reduction was measured in morphine equivalents (ME) administered per visit. Secondary outcomes on patient satisfaction were gathered using the Press Ganey survey. Results: Intravenous (IV) opioid administration during the study period decreased by \u3e20%. The predicted mean ME use in 2016 was 0.25 ME less when compared to 2015 (95% CI −0.27 to −0.23). Estimated use for patients in the pre-implementation period was 1.45 ME mgs (SD 0.88), and 1.13 ME mg (SD 0.69) for patients in the post-implementation period. Patient satisfaction scores using the Press Ganey Scale also were assessed. There was no significant difference in the scores between 2015 and 2016 when patients were asked “How well was you pain controlled?” (−0.94, 95% CI −5.29 to 3.4) and “How likely are you to recommend this emergency department?” (−1.55, 95% CI −5.26 to 2.14). Conclusion: In conclusion, by using an ALTO-first, multimodal treatment approach to pain management, participating clinicians were able to significantly decrease the use of IV opioids in the emergency department. Patient satisfaction scores remained unchanged following implementation
