Does on-site computed tomography matter? A cross-sectional study of stroke patients' door-to-scan-time in rural hospitals.

PURPOSE: Many rural Australian hospitals lack on-site computed tomography (CT). These hospitals often refer patients to local off-site private radiology clinics or to central hospitals, challenging the achievement of time-sensitive scans. For stroke patients, timely access to CT affects treatment options. This study questions whether on-site CT matters in rural hospitals by investigating stroke patients' door-to-scan-time (DTST) and CT scan sequence referrals. METHOD: A retrospective chart audit was completed across four rural hospitals; two with on-site CT and two without. Adult emergency stroke presentations were randomly sampled. Comparisons between on-site and off-site CT hospitals were made for DTST and CT sequence referrals using Mann-Whitney U-tests and Fisher's exact tests. RESULTS: A total of 120 charts were audited (on-site CT, n = 60; off-site CT, n = 60). DTST was longer for off-site vs. on-site CT hospitals (median = 4.30 h vs. median = 0.70 h; U = 338, p < 0.001) regardless of whether presentations occurred in business hours or out of hours (p < 0.001). Off-site CT hospitals ordered less CT angiography or perfusion scanning (32% vs. 85%, p < 0.001). CONCLUSIONS: Off-site CT hospital patients had longer DTST and received less angiography or perfusion scanning. These findings suggest that on-site CT matters to rural stroke patients by improving equitable access to CT and appropriate scan referrals.

Beyond the Written Reflection: A Systematic Review and Qualitative Synthesis of Creative Approaches to Reflective Learning Amongst Medical Students.

Introduction: In medical curricula, reflective learning (RL) mostly consists of writing and small-group discussion, yet accommodating diverse learning preferences is a key factor in developing lifelong reflective practitioners. Medical education uses a number of creative approaches to RL which cater to more diverse learning preferences; however, the overarching benefits of creative RL to students' development is unknown. To understand how creative RL approaches contribute to students' holistic development we performed a qualitative systematic review and synthesis. Methods: Systematic searches of PubMed, PsycINFO, and EMBASE databases identified 4986 unique records, with 15 studies meeting inclusion criteria. Included studies specifically assessed the impact of RL on medical students and utilized creative approaches to RL. Creative approaches were defined as those not predominantly focused on reflective writing or group discussion. Studies were appraised using the Critical Appraisal Skills Programme and the Checklist for Quasi-Experimental Studies. Results: We identified five distinctive RL methods: viewing, performing, creating, imagining, and mind-body. Thematic analysis generated three themes: building and maintaining relationships, personal development, and sense of belonging. These themes incorporated eight sub-themes: recognizing multiple perspectives, empathizing with others, two-way communication skills, patient centered care, processing thoughts and emotions, self-care, interacting positively with peers, and developing trust and commonality. Discussion: Creative RL approaches may foster students' sense of belonging and support interpersonal skills and personal development. In addition, creative RL activities may contribute to medical graduate's holistic development, while providing opportunities to address diverse student needs using innovative, non-conventional methods.

Aspire2Health and COVID-19: the impact of the pandemic on outcomes from an outreach program to increase high school student interest in rural health careers.

INTRODUCTION: Rural health career outreach programs promote health careers to secondary school students and aim to address rural health workforce shortages. This study analyses student feedback data from Aspire2Health, a multidisciplinary rural health career outreach program conducted in Queensland Australia before COVID in 2019, and during COVID lockdown and isolation periods during 2020-2021. The study aims were to assess the suitability of the program and its elements, the program's short-term impact on students' interest in health careers and whether COVID restrictions on program delivery affected students' program experience and outcomes. METHODS: We conducted statistical and semantic analysis of data collected pre- and peri-COVID from participating secondary school students living in regional, rural and remote Australian communities. Data validity was established by triangulating quantitative results from items using a five-point Likert scales, qualitative themes from short-response items and frequency analysis of themes. Data were collected pre-COVID (2019, n=125) and peri-COVID (2020-21, n=248). RESULTS: Student responses to the program remained extremely positive despite COVID-imposed restrictions. Feedback scores indicated quite strong agreement in pre- and peri-COVID periods that the program motivated students to pursue a career in health (mean (M)=4.6 pre-COVID v M=4.5 peri-COVID) and that students would recommend the program to a friend (M=4.8 pre-COVID v M=4.7 peri-COVID). Overall ratings of the event were high, although a drop occurred during the peri-COVID period (M=4.8 pre-COVID v M=4.7 peri-COVID; p=0.043). Activity interest rankings indicated that, irrespective of the pandemic, clinical skills sessions, meeting health professionals and watching the emergency scenario were more interesting to students than ambulance and hospital tours (p<0.001). Four themes were generated from analysing qualitative data. In response to the item 'What did you enjoy the most?' the themes were 'clinical skills' (n=203, 55% of respondents) and 'interacting with professionals' (n=146, 39% of respondents). Responses to 'Is there anything we could do differently?' produced the themes 'no changes required' (n=158, 58% of respondents) and 'variety and duration' (n=40, 11% of respondents). 'Variety and duration' described students' desire for more variety, more professionals and more time to engage in activities. The themes and their frequency among student responses indicate strong support for the validity of the results. CONCLUSION: This study found that the Aspire2Heath program continued to motivate rural students to pursue health careers during the COVID-19 pandemic and that student interest is greatest during activities with hands-on clinical skills and student-professional interactions. These results suggests that rural health career outreach programs can be run under challenging social circumstances with confidence that students can be successfully encouraged to pursue health careers. Furthermore, program design should emphasise hands-on clinical skills and interactions with professions. These findings have practical implications for rural health career outreach programs, particularly those faced with restricted financing or external circumstances that limit their access to external healthcare resources.

The effects of age on dyspnea and respiratory mechanical and neural responses to exercise in healthy men.

The respiratory muscle pressure generation and inspiratory and expiratory neuromuscular recruitment patterns in younger and older men were compared during exercise, alongside descriptors of dyspnea. Healthy younger (n = 8, 28 ± 5 years) and older (n = 8, 68 ± 4 years) men completed a maximal incremental cycling test. Esophageal, gastric (Pga ) and transdiaphragmatic pressures, and electromyography (EMG) of the crural diaphragm were measured using a micro-transducer and EMG catheter. EMG of the parasternal intercostals, sternocleidomastoids, and rectus abdominis were measured using skin surface electrodes. After the exercise test, participants completed a questionnaire to evaluate descriptors of dyspnea. Pga at end-expiration, Pga expiratory tidal swings, and the gastric pressure-time product (PTPga ) at absolute and relative minute ventilation were higher (p < 0.05) for older compared to younger men. There were no differences in EMG responses between older and younger men. Younger men were more likely to report shallow breathing (p = 0.005) than older men. Our findings showed younger and older men had similar respiratory neuromuscular activation patterns and reported different dyspnea descriptors, and that older men had greater expiratory muscle pressure generation during exercise. Greater expiratory muscle pressures in older men may be due to compensatory mechanisms designed to offset increasing airway resistance due to aging. These results may have implications for exercise-induced expiratory muscle fatigue in older men.

Finding what works-Patients' long-term experiences of weight maintenance post bariatric surgery: A systematic review and thematic synthesis of qualitative studies.

Individuals with obesity can attain significant weight loss in a relatively short timeframe following bariatric surgery; however, new healthy behaviors must be sustained in perpetuity to maintain weight loss. This study investigates patients' views on the facilitators and barriers to long-term weight loss maintenance following bariatric surgery. Systematic searches of Medline, PsycINFO, and CINAHL databases identified 403 studies with 15 fitting the study inclusion criteria. Included studies were independently appraised using Critical Appraisal Skills Program (CASP). Data extraction and thematic synthesis generated three themes: changing food relationships, navigating inter- and intrapersonal influences, and caring health professionals. These appeared across six organizing sub-themes: building new food relationships, creating healthy habits, relationships with others, internalized stressors, finding and defining success, and ongoing patient education. Patients experienced a variety of barriers and facilitators to weight loss maintenance, with some facilitators diminishing over time. The findings demonstrate the importance of considering patients' perspectives and individual contexts to assist them to negotiate and overcome challenges to long-term weight loss maintenance post-bariatric surgery.

Assessing health literacy of Aboriginal and Torres Strait Islander peoples presenting to general practice.

BACKGROUND: Health literacy is a social determinant of health, with lower levels linked to suboptimal health outcomes. There is a gap in the literature regarding the value of health literacy assessment among Aboriginal and Torres Strait Islander peoples and best methods with which to perform such assessments in general practice. OBJECTIVE: Literature was reviewed to determine what is known regarding health literacy of Aboriginal and Torres Strait Islander peoples, the availability of assessment tools and the implications for general practice. DISCUSSION: Despite its effect on health outcomes, the health literacy of Aboriginal and Torres Strait Islander peoples is poorly understood, with no validated assessment tools specifically tailored to this population. Culturally insensitive screening of health literacy has potentiality to disaffect; thus, practitioners should consider assessments aligned with Indigenous methodologies such as conversational or yarning approaches or the use of a small number of screening questions. Practitioners are encouraged to adopt a universal precautions approach and use culturally appropriate conversational styles to optimise communication and healthcare outcomes.

The control of respiratory pressures and neuromuscular activation to increase force production in trained martial arts practitioners.

PURPOSE: The mechanisms that explain the ability of trained martial arts practitioners to produce and resist greater forces than untrained individuals to aid combat performance are not fully understood. We investigated whether the greater ability of trained martial arts practitioners to produce and resist forces was associated with an enhanced control of respiratory pressures and neuromuscular activation of the respiratory, abdominal, and pelvic floor musculature. METHODS: Nine trained martial arts practitioners and nine untrained controls were instrumented with skin-surface electromyography (EMG) on the sternocleidomastoid, rectus abdominis, and the group formed by the transverse abdominal and internal oblique muscles (EMGtra/io). A multipair oesophageal EMG electrode catheter measured gastric (Pg), transdiaphragmatic (Pdi), and oesophageal (Pe) pressures and EMG of the crural diaphragm (EMGdi). Participants performed Standing Isometric Unilateral Chest Press (1) and Standing Posture Control (2) tasks. RESULTS: The trained group produced higher forces normalised to body mass2/3 (0.033 ± 0.01 vs. 0.025 ± 0.007 N/kg2/3 mean force in Task 1), lower Pe, and higher Pdi in both tasks. Additionally, they produced higher Pg (73 ± 42 vs. 49 ± 19 cmH2O mean Pg) and EMGtra/io in Task 1 and higher EMGdi in Task 2. The onset of Pg with respect to the onset of force production was earlier, and the relative contributions of Pg/Pe and Pdi/Pe were higher in the trained group in both tasks. CONCLUSION: Our findings demonstrate that trained martial arts practitioners utilised a greater contribution of abdominal and diaphragm musculature to chest wall recruitment and higher Pdi to produce and resist higher forces.

Pressure measurement characteristics of a micro-transducer and balloon catheters.

Respiratory pressure responses to cervical magnetic stimulation are important measurements in monitoring the mechanical function of the respiratory muscles. Pressures can be measured using balloon catheters or a catheter containing integrated micro-transducers. However, no research has provided a comprehensive analysis of their pressure measurement characteristics. Accordingly, the aim of this study was to provide a comparative analysis of these characteristics in two separate experiments: (1) in vitro with a reference pressure transducer following a controlled pressurization; and (2) in vivo following cervical magnetic stimulations. In vitro the micro-transducer catheter recorded pressure amplitudes and areas which were in closer agreement to the reference pressure transducer than the balloon catheter. In vivo there was a main effect for stimulation power and catheter for esophageal (Pes ), gastric (Pga ), and transdiaphragmatic (Pdi ) pressure amplitudes (p < 0.001) with the micro-transducer catheter recording larger pressure amplitudes. There was a main effect of stimulation power (p < 0.001) and no main effect of catheter for esophageal (p = 0.481), gastric (p = 0.923), and transdiaphragmatic (p = 0.964) pressure areas. At 100% stimulator power agreement between catheters for Pdi amplitude (bias =6.9 cmH2 O and LOA -0.61 to 14.27 cmH2 O) and pressure areas (bias = -0.05 cmH2 O·s and LOA -1.22 to 1.11 cmH2 O·s) were assessed. At 100% stimulator power, and compared to the balloon catheters, the micro-transducer catheter displayed a shorter 10-90% rise time, contraction time, latency, and half-relaxation time, alongside greater maximal rates of change in pressure for esophageal, gastric, and transdiaphragmatic pressure amplitudes (p < 0.05). These results suggest that caution is warranted if comparing pressure amplitude results utilizing different catheter systems, or if micro-transducers are used in clinical settings while applying balloon catheter-derived normative values. However, pressure areas could be used as an alternative point of comparison between catheter systems.