Category: Nevin Manimala

J Phys Ther Educ. 2023 Jun 1;37(2):94-101. doi: 10.1097/JTE.0000000000000270. Epub 2023 Jan 30.

ABSTRACT

INTRODUCTION: The COVID-19 pandemic saw physical therapist (PT) education programs in 2020 add virtual options to prepare students for hands-on clinical skills. The purpose of this research was to investigate student confidence, preparation, and clinical performance based on their choice of virtual or in-person laboratory immersion. Secondary analysis compared 2020 cohort outcomes with the previous cohort in 2019 (prepandemic).

REVIEW OF LITERATURE: Virtual skill acquisition has been studied with support for effectiveness in didactic and psychomotor skill acquisition. The impact on clinical education performance is unknown.

SUBJECTS: Student records from an accelerated hybrid, PT education program in 2020 (n = 91) and 2019 (n = 86).

METHODS: In this mixed-method observational study, researchers analyzed a Qualtrics survey and the PT Clinical Performance Instrument (CPI) to compare student outcomes. Statistical analyses included chi-square, two-way multivariate analysis of variance (MANOVA), and Mann-Whitney U test. MAXQDA software was used to code student and clinical instructor narrative responses from the CPI related to strengths and areas for further development.

RESULTS: All students in 2020 attended laboratory virtually for 9 full days, and 24% of students chose virtual laboratory for the remaining 8.5 days; 97% of students reported feeling confident going into their clinical experience (66% inpatient). No statistically significant differences were found based on instructional method (virtual or in-person) or clinical practice setting (inpatient or outpatient) for confidence, preparation, or CPI performance. Themes of wanting more time to prepare and more confidence in clinical decision making emerged from the qualitative analysis.

DISCUSSION AND CONCLUSION: Results indicate no statistically significant difference for virtual versus in-person laboratory and no difference compared with the 2019 cohort. Virtual instruction effectively prepared students for their clinical experiences across all settings. Although an in-person laboratory experience may be preferred, it is possible to deliver effective experiences in a virtual setting without compromising student performance. Further research is needed to confirm findings.

PMID:38478822 | DOI:10.1097/JTE.0000000000000270

J Phys Ther Educ. 2023 Sep 1;37(3):250-256. doi: 10.1097/JTE.0000000000000279. Epub 2023 Apr 21.

ABSTRACT

INTRODUCTION: All Doctor of Physical Therapy (DPT) programs in the United States prepare students to demonstrate entry-level clinical performance upon graduation. Clinical residency programs are an option for DPT graduates seeking to specialize in a practice area.

REVIEW OF LITERATURE: There is little research published on why DPT graduates decide to pursue residency education (RE) or not. This study aimed to determine factors influencing a Physical Therapist’s (PT) decision-making process in choosing to pursue a postgraduate residency.

SUBJECTS: PTs within 3 years of graduation and third-year DPT program students were surveyed. Most respondents were from DPT programs in the northeastern United States.

METHODS: A survey was created, piloted, and disseminated to various DPT programs. The survey asked participants their perceptions of motivating factors or barriers to pursuing a RE using multiple choice questions and Likert items. Descriptive statistics and frequencies were reported. One-way analysis of variances, chi-square analysis, and unpaired t tests were used.

RESULTS: Students who considered residency in their second year are 26.5× more likely to apply for a residency (P < .001). Participants strongly agreed with the statements that residency will increase confidence when practicing in their specialty area (1.39 ± 0.48), expand their knowledge as clinicians (1.39 ± 0.051), and expedite proficient practice (1.72 ± 0.057). Participants considered student burnout, the cost of residency, student loan debt, and geographical relocation as the top barriers to pursuing residency. Men were significantly more confident in their ability to apply to residency (F = 8.219, P = .005). Married individuals perceived loans or financial obligations (F = 3.607, P = .029), family obligations (F = 17.170, P < .001), and geographical limitations (F = 3.825, P = .024) as barriers more than single individuals.

DISCUSSION AND CONCLUSION: There are many variables DPT students and recent graduates consider when deciding whether to pursue RE. RPs and entry-level DPT programs should consider these factors to promote increased participation in postprofessional RE.

PMID:38478818 | DOI:10.1097/JTE.0000000000000279

J Phys Ther Educ. 2023 Sep 1;37(3):227-234. doi: 10.1097/JTE.0000000000000284. Epub 2023 May 10.

ABSTRACT

INTRODUCTION: Faculty development has been identified as an important initiative in Doctor of Physical Therapy (DPT) education. However, little is known about opportunities available for associated faculty (AF). These unique educators who make notable contributions to physical therapist education often lack formal preparation for teaching. The purpose of this study was to explore AF development opportunities across physical therapist education programs nationally.

REVIEW OF LITERATURE: Formal faculty development programs have been successful in medical and nursing education programs to enhance educator identity, skill, and retention in both core and clinical faculty. No evidence of faculty development programs for AF in physical therapy education was found in the literature.

SUBJECTS: Participants were program directors or identified faculty development leads from CAPTE accredited and in-candidacy physical therapist education programs. Seventy participants completed an anonymous survey and 10 participated in semistructured interviews following the completion of the survey.

METHODS: A parallel, convergent, mixed methods approach was used to assess the national state of formal AF development opportunities. A survey was developed to assess development opportunities available to AF. Descriptive statistics and Chi square analyses were performed to analyze quantitative data. An instrumental collective case study further explored development opportunities. Deductive and inductive thematic analysis techniques were used to analyze qualitative data from interview transcripts. Quantitative and qualitative approaches were integrated in the data analysis.

RESULTS: Survey data, aligned with interview outcomes, suggest that despite ideologic support for faculty development, low percentages of AF have access to formal development activities, and even fewer are receiving adequate breadth of educational content related to proficiency in their role.

DISCUSSION AND CONCLUSION: A lack of formal development opportunities exists for AF. Excellence in DPT education requires deeper development across all levels of faculty, including opportunities tailored specifically to the unique needs and role of AF.

PMID:38478815 | DOI:10.1097/JTE.0000000000000284

J Phys Ther Educ. 2023 Sep 1;37(3):220-226. doi: 10.1097/JTE.0000000000000286. Epub 2023 Jun 1.

ABSTRACT

INTRODUCTION: Full-time clinical education experiences (CEEs) constitute a significant component of entry-level physical therapy education. COVID-19 challenged clinical education throughout the country by affecting the availability of CEEs.

REVIEW OF LITERATURE: Research suggested that the number of clinical education spots available would stay the same. By contrast, the number of students enrolling in physical therapist (PT) and physical therapist assistant (PTA) education programs continues to rise. In response to the COVID-19 pandemic, students and faculty expressed concerns about the lack of student readiness and the availability of CEEs. The purpose of this study was to examine prepandemic factors that influenced the number of CEE slots available in Florida and the impact that the COVID-19 pandemic had on slot availability. Furthermore, researchers sought to identify factors that prevented a return to prepandemic levels of CEE spot offerings and recognize solutions to overcome those barriers. Finally, the researchers aimed to pinpoint suggestions to enhance collaborations between the clinical sites and physical therapy education programs.

SUBJECTS: Forty-eight site coordinators of clinical education (SCCEs) from various settings and regions in Florida completed the survey.

METHODS: An online survey was distributed to Florida SCCEs to ascertain their perceptions on how COVID-19 influenced clinical education. The researchers used descriptive and inferential statistics to analyze the data.

RESULTS: Clinical instructor (CI) volunteerism was the primary determinant of CEE spots available before the COVID-19 pandemic. The number of CEE spots was reduced for both PT and PTA education programs during the COVID-19 pandemic. Although the PTA slots returned to their baseline from 2019, the PT placements remained significantly lower in 2021. Social distancing and CI availability had the most considerable impact on CEE offerings. Site coordinators of clinical education also suggested that the greatest supports needed from the academic institutions were educating students on COVID-19 prevention and providing personal protective equipment (PPE) to students for their CEEs. This article also offers suggested incentives that academic sites can provide their clinical partners, such as in-services earning continuing education units, to enhance their participation in clinical education.

DISCUSSION AND CONCLUSION: All clinical education stakeholders must collaborate to provide students with the required clinical educational opportunities. Academic sites should continue to provide support, training, and incentives to CIs to enhance participation from clinical education sites. Educational programs must add content about COVID-19 to their curriculum and consider providing students with PPE during their rotations to restore the number of CEEs post-COVID-19 pandemic.

PMID:38478814 | DOI:10.1097/JTE.0000000000000286

J Phys Ther Educ. 2023 Sep 1;37(3):202-210. doi: 10.1097/JTE.0000000000000288. Epub 2023 May 17.

ABSTRACT

INTRODUCTION: Video, phone, or in-person site visits are used to assess clinical education in entry-level physical therapy education programs. The perspectives of students and clinical instructors (CIs) related to site visits were examined in this article using 2 consecutive surveys. The first included items related to in-person and phone call site visits. The second added video calls. The research purpose was to assess the CI and student perspectives on the effectiveness of site visits and explore the differences between in-person, video, and phone visits.

REVIEW OF LITERATURE: Published literature about the effectiveness of site visits is scarce. Two recent articles explored the director of clinical education and student perspectives of site visits. Future research concentrating on the clinician perspective of site visits was recommended.

SUBJECTS: A convenience sample of 104 CIs and 97 doctor of physical therapy students were recruited by email for the 2 surveys.

METHODS: A mixed-methods, triangular, validating, quantitative data model was used. Respondents answered open-ended questions and rated items on 5-point Likert scales. Descriptive and chi-square statistics were calculated, and themes were developed using qualitative analysis.

RESULTS: No significant difference was found in preference of site visit method between students and CIs. CIs rated the effectiveness of site visits similarly for all methods. Students rated in-person site visits as the most effective in the first survey and video calls as the most effective in the second survey. Qualitative analysis showed that CIs and students preferred in-person visits when the student was struggling. Considering closed-ended and open-ended questions on both surveys, CIs and students would rather meet individually with the faculty member.

DISCUSSION AND CONCLUSION: The results of this study suggest that any type of site visit can be effective; in-person visits should be considered when students are struggling, and the site visitor should meet privately with the student and CI.

PMID:38478812 | DOI:10.1097/JTE.0000000000000288

Genet Test Mol Biomarkers. 2024 Mar 13. doi: 10.1089/gtmb.2023.0457. Online ahead of print.

ABSTRACT

Aim: The matrix metalloproteinases (MMPs) inhibit tissue inhibitors of metalloproteinases (TIMPs), playing a notable role in various biological processes, and mutations in TIMP2 genes impact a variety of urinary cancers. In this study, we analyze and evaluate the potential involvement of the TIMP2 418 G/C and MMP gene polymorphism in the etiology of urinary cancer. Methodology: For suitable case-control studies, a literature search was undertaken from various database sources such as PubMed, EMBASE, and Google Scholar. Incorporated into the analysis were case-control or cohort studies that documented the correlation between TIMP2 418 G/C and urological cancers. MetaGenyo served as the tool for conducting the meta-analysis, employing a fixed-effects model. The collective odds ratios, along with their corresponding 95% confidence intervals, were calculated and presented to assess the robustness of the observed associations. Results: A total of seven studies involving controls and cases out of recorded 1265 controls and 1154 cases were analyzed to ascertain the significant association of the TIMP2 gene with urologic cancer. No statistically significant correlation was observed between allelic, recessive, dominant, and overdominant models for the genetic variant under investigation. A 95% confidence interval (CI) and odds ratio (OR) were computed for each model, considering p-values <0.05. The OR and 95% CI for the allelic model were 0.99 and 0.77-1.27, respectively, whereas the respective values were 1.00 and 0.76-1.32 for the recessive model. In the dominant contrast model, OR and 95% CI were 1.09 and 0.62-1.90, while the same were 0.93 and 0.77-1.12 for the overdominant model. A funnel plot was used to reanalyze and detect the results as statically satisfactory. Conclusions: As a result of the data obtained, the TIMP2 gene polymorphism does not correlate statistically with cancer risk. The significance of this finding can only be confirmed using a large population, extensive epidemiological research, a comprehensive survey, and a better understanding of the molecular pathways associated.

PMID:38478803 | DOI:10.1089/gtmb.2023.0457

J Phys Ther Educ. 2023 Dec 1;37(4):342-350. doi: 10.1097/JTE.0000000000000310. Epub 2023 Oct 5.

ABSTRACT

INTRODUCTION: Physical therapy professional education program directors (PDs) face stress associated with work roles and responsibilities, which can cause burnout and job turnover.

REVIEW OF LITERATURE: Burnout and turnover in physical therapy education PD positions are influenced by inexperience, insufficient compensation, decreased support, heavy workloads, difficulty hiring and retaining faculty, and internal conflict. Program directors also receive insufficient training in their roles. Individuals with greater resilience, or the ability to face adversity with positive outcomes, may be more resistant to stress, burnout, and turnover. Therefore, this study’s purpose was to explore the relationships among leadership behaviors, demographic and program factors, and resilience in physical therapy PDs.

SUBJECTS: Of the 600 physical therapy PDs invited to participate in the study, 126 directors completed the survey (21% response rate).

METHODS: The survey included demographic questions, the Multifactor Leadership Questionnaire (MLQ-5X), and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). Correlational analyses were used to investigate relationships among leadership behaviors, demographic and program factors, and resilience.

RESULTS: Participants included 43 physical therapist and 82 physical therapist assistant PDs (79.4% female and 20.6% male participants; mean age, 52.0 ± 8.3 years; mean years in role, 7.3 ± 6.9 years). Mean MLQ-5X scores showed that participants primarily used transformational leadership (TFL) behaviors. The mean CD-RISC-10 score for participants was 33.06 (±4.10). Analysis revealed statistically significant positive relationships between all TFL behaviors and resilience. Exploratory regression analysis revealed that 3 leadership behaviors and one demographic factor may contribute to resilience in participants, although the proportion of variance was modest (39%).

DISCUSSION AND CONCLUSION: This is the first study to offer insight regarding the relationships between leadership behaviors and resilience in physical therapy PDs. These results may help lay the foundation for future research in this area, with the goal of decreasing burnout and job turnover through increased resilience.

PMID:38478790 | DOI:10.1097/JTE.0000000000000310

Cornea. 2024 Mar 13. doi: 10.1097/ICO.0000000000003515. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to investigate the associations between central corneal endothelial cell density (ECD), endothelial morphology, and corneal thickness (central corneal thickness) with the anterior chamber depth, corneal volume (CV), white-to-white (WTW) distance, mean anterior chamber angle (CAmean), and gender in healthy individuals.

METHODS: This observational study included 136 healthy volunteers. The ECD, coefficient of variation of cell area, and hexagonal cell appearance ratio (%Hex) were measured by means of specular microscopy. The central corneal thickness, anterior chamber depth, CV, WTW distance, and the angle width of 12 points were taken by the Pentacam HR Scheimpflug anterior segment imaging. The arithmetical mean of the 12 points was considered as the CAmean. We used mixed effect linear regression model for the statistical analysis of the data.

RESULTS: ECD was positively correlated with CV (P = 0.028), while after adjusting for age, it was negatively correlated with age (P < 0.001). Coefficient of variation of cell area was positively correlated with CAmean (P = 0.036), while after adjusting for age, it was positively correlated with age (P < 0.001) and CAmean (P = 0.005). Hex was negatively correlated with WTW (P = 0.023) and CAmean (P = 0.025), and after adjusting for age, this correlation remained the same (P = 0.029 when correlated with WTW and P = 0.035 with CAmean).

CONCLUSIONS: There were significant changes in the morphology of the corneal endothelial cells in eyes with wider anterior chamber angle. Greater pleomorphism and polymegethism of the corneal endothelium was observed in healthy patients with wider CAmean. Deepening of the anterior chamber as myopia progresses could render the corneal endothelium more fragile and susceptible to mechanical stress, which is an area worthy of further study.

PMID:38478761 | DOI:10.1097/ICO.0000000000003515

Hepatology. 2024 Mar 13. doi: 10.1097/HEP.0000000000000779. Online ahead of print.

ABSTRACT

BACKGROUND AIMS: Despite the availability of highly effective direct-acting antiviral therapy, chronic hepatitis C (CHC) continues to cause a major public health burden. In many high-income countries, treatment rates have been declining, which was exacerbated by the impact of the COVID-19 pandemic, threatening the ability to meet the World Health Organization (WHO)’s targets for eliminating hepatitis C virus (HCV) as a public health threat by 2030. We sought to model the impact of CHC in Canada, a resource-rich country with ongoing immigration from HCV-endemic regions; which relies exclusively on risk-based screening for case identification.

APPROACH RESULTS: We developed an agent-based model to characterize the HCV epidemic in a high-income country with ongoing immigration. Combinations of prevention such as harm-reduction, screening, and treatment strategies were considered. Model parameters were estimated from the literature and calibrated against historical HCV data. Sensitivity analyses were performed to assess uncertainty. Under the current status quo of risk-based screening, we predict the incidence of CHC-induced decompensated cirrhosis, hepatocellular carcinoma, and liver-related deaths would decrease by 79.4%, 76.1%, and 62.1%, respectively, between 2015-2030, but CHC incidence would only decrease by 11.1%. Results were sensitive to HCV transmission rate and annual number of people initiating treatment.

CONCLUSIONS: Current risk-based screening, and subsequent treatment, will be inadequate to achieve WHO goals. With extensive scale-up in screening, and treatment, the mortality target may be achievable, but the target for preventing new CHC cases is unlikely reachable, highlighting the importance of developing enhanced harm-reduction strategies for HCV elimination.

PMID:38478751 | DOI:10.1097/HEP.0000000000000779

Vascular. 2024 Mar 13:17085381241239428. doi: 10.1177/17085381241239428. Online ahead of print.

ABSTRACT

INTRODUCTION: Ruptured abdominal aortic aneurysms (AAA) presenting with hostile neck anatomy can represent a challenge in surgical decision-making. We hypothesized that, patients who require reinterventions have higher rates of compromised neck anatomy at initial presentation and may indicate a need for altered surveillance paradigm.

METHODS: Patients presenting with ruptured AAA to a single tertiary care institution from 2014 to 2021 were retrospectively reviewed. Those treated with infrarenal EVAR, with no prior aortic surgeries, and with available pre-operative computed tomography (CT) scans were included. Demographics, timing and type of reintervention, follow-up, and survival were collected. CT scans were assessed for hostile neck anatomy via measurements of diameter, length, angle, taper, bulge, calcification, and thrombus. Demographics, comorbidities, and neck anatomy of those with and without reintervention were compared using Fischer’s Exact and Student’s T-test. Survival was analyzed via Kaplan-Meier and log-rank test.

RESULTS: Eighty-nine patients were available for analysis, 37 of which met inclusion criteria. Intraoperative death occurred in 3 patients (8.1%) and 1 patient (2.7%) was intraoperatively converted to an open repair. Thirty-day and 1-year survival were 97% and 91%, respectively. The reintervention rate was 30% (n = 10), occurring at a median of 200 days (18-2053 days) after the index operation. All patients requiring reintervention met hostile neck criteria (p = .002) and had a statistically higher number of hostile neck criteria (1.80 vs 0.87, p = .03). Thirty percent (n = 3) of patients that received a reintervention had neck diameter greater than 3 cm, compared to zero patients in the non-reintervention group (p = .022). Proximal reinterventions (n = 5) had statistically higher neck diameters and neck angle compared to the non-reintervention group.

CONCLUSION: Infrarenal rEVAR is effective at preventing acute mortality despite specific anatomic considerations that may contribute to the higher reintervention rates, and therefore those parameters ought to be considered when following patients in the post-intervention period.

PMID:38478714 | DOI:10.1177/17085381241239428