Athletic Trainers' Perceptions of Responsibilities and Use of Psychosocial Interventions for Patients Following an ACL Injury.

Following an anterior cruciate ligament (ACL) injury, mental health challenges are often concomitant with the injury and rehabilitation process. Athletic trainers are essential components within the healthcare team who should be trained in recognizing, referring, and managing mental health issues. However, more research is needed on the athletic trainer's responsibility regarding psychosocial interventions and their role within ACL patients. Our descriptive study included 153 collegiate athletic trainers who reported on previous training and responsibilities related to mental health. Of these participants, 98% reported caring for an ACL patient within the last year. The participants were further asked to explore what behavioral responses were observed within ACL injury patients, the specific psychosocial interventions deployed, the frequency of integration, and whether a referral to another provider was utilized. We identified that athletic trainers share a strong understanding of their perceived roles, with 99.3% of participants stating the obligatory feeling to support ACL patients experiencing mental health challenges and implementing personalized rehabilitation (74%) and attainable goals (70%) while also keeping the athlete involved in the team (72%). Our data suggest that athletic trainers recognize their role and continue to integrate psychosocial strategies throughout the ACL injury process.

AMPATH surgical app: Low-cost simulator for the open appendectomy.

BACKGROUND: Due to a shortage and maldistribution of surgeons within Kenya, doctors with limited formal surgical training often perform emergency surgical procedures such as appendectomy. This lack of training can compromise patient outcomes and complicate care delivery. Our aim was to develop a low-cost simulator and skills curriculum to effectively teach open appendectomy. METHODS: Surgeons from 4 countries participated in semi-structured interviews to define the steps and technique of open appendectomy using cognitive task analysis. Using this input, our Academic Model Providing Access to Healthcare surgical team developed a curriculum, including a simulator and feedback mechanism. Surgeons and surgical trainees from Kenya and the United States tested the simulator prototype and provided feedback for its refinement based on clarity, utility, and realism. RESULTS: Instructions for a self-constructed simulator were developed at the cost of 70 Kenyan shillings (0.64 US dollars). Fifteen surgeons and surgical residents gave feedback on the simulator and curriculum, and each was presented with an updated version based on feedback. Overall, the curriculum was clear, with each sub-step receiving a median score of ≥83.5 out of 100 for clarity; however, through iterative design, the utility of sub-steps on the simulator improved. CONCLUSION: A comprehensive open appendectomy curriculum, including a low-cost appendectomy simulator model, was developed and refined using surgeon feedback. Such curricula may benefit trainees in low-resource settings who may otherwise have limited access to quality training material.

Effects of a multicomponent exercise program combined with calcium-vitamin D3-enriched milk on health-related quality of life and depressive symptoms in older men: secondary analysis of a randomized controlled trial.

PURPOSE: Osteoporosis is associated with both lower health-related quality of life and depression in older people. We examined the independent and combined effects of a multi-component exercise program and calcium-vitamin D3 fortified milk on health-related quality of life (HR-QoL) and depression in older men. METHODS: In this 12-month, factorial design randomized controlled trial, 180 healthy community-dwelling men aged 50-79 years with normal to below average bone mineral density were allocated into one of four groups: exercise + fortified milk; exercise; fortified milk; or controls. Exercise consisted of high-intensity resistance training with weight-bearing exercise (3 days per week; 60-75 min per session). Men assigned to fortified milk consumed 400 ml/day of low-fat milk containing 1000 mg/day calcium and 800IU/day vitamin D3. Questionnaires were used to assess HR-QoL (SF-36) and depressive symptoms (Center for Epidemiologic Studies Depression Scale) at baseline, and 6 and 12 months. A linear mixed model analysis was used to test whether there was a synergistic interaction between exercise and calcium-vitamin D3. If no significant interactions were detected, the main effects of exercise and fortified milk were examined. RESULTS: Mean adherence to the exercise program and fortified milk was 67% (95% CI 61, 73%) and 90% (95% CI 86, 93%), respectively. There were no exercise-by-fortified milk interactions nor main effects of exercise or calcium-vitamin D for any of the HR-QoL measures or depressive symptoms. CONCLUSION: In healthy community-dwelling older men, exercise training and/or calcium-vitamin D fortified milk did not improve HR-QoL or depressive symptoms.

Avstick: An Intravenous Catheter Insertion Simulator for Use with Standardized Patients.

An overwhelming majority of hospitalized patients undergo intravenous (IV) catheter insertion in order to receive hydration and necessary medication. Current IV insertion training techniques include manikins that are unable to react or give feedback to the trainee. The Avstick® is a realistic training device that can be worn by an actor, allowing a nurse trainee to perform an IV catheter insertion on a live patient without causing the person harm. The purpose of this study is to demonstrate the effectiveness of the Avstick in nursing education to increase nurse-patient communication and trainee self-efficacy.

Flexion-extension gap in cruciate-retaining versus posterior-stabilized total knee arthroplasty: a cadaveric study.

We re-examined experimental model results using half-body specimens with intact extensor mechanisms and navigation to evaluate cruciate-retaining (CR) and posterior stabilized (PS) total knee arthroplasty (TKA) component gaps through an entire range of motion. Six sequential testing regimens were conducted with the knee intact, with a CR TKA in place, and with a PS TKA in place, with and without 22 N traction in place at each stage. Each of 10 knees was taken through six full ranges of motion from 0° to 120° at every stage using a navigated knee system to record component gapping. No significant difference was found between loaded and unloaded component gaps, and no significant differences were found in component gapping between CR and PS TKAs throughout a full range of motion. Flexion-extension gap measurements were significantly different from previously published data (at 90° flexion). No difference was found in kinematics when comparing CR and PS TKA component designs. Our results suggest that intact extensor mechanisms may be required to perform proper kinematic studies of TKA. Our findings provide evidence that the extensor mechanism may play a major role in the flexion-extension gaps in cadaveric knees.

Optimizing referral practices for patients with non-traumatic intracerebral hemorrhage.

Because many cases of non-traumatic intracerebral hemorrhage (NTICH) do not require surgery, establishing the most appropriate referral and treatment algorithms to optimize patient outcome, including appropriate utilization of specialty physicians, such as neurosurgeons and neurologists, would be helpful. In this retrospective study based on census and billing records, the best referral model showed that medical therapy was the chosen treatment option if patients did not meet all of the following three criteria: GCS < or = 13, age < or = 70 and lesion volume > or = 40 cm3. These criteria may be helpful in predicting the need for surgery and improving referral practices for patients with NTICH.