Possible Duration of WISH-type Hip Brace Use: Prognostic Value of Timed Up and Go Test.

Objectives: The WISH-type S-form hip brace (WISH brace) has significantly improved hip function and functional mobility in patients with hip osteoarthritis (OA). However, most patients later undergo surgery. The main purpose of this study was to evaluate how long the orthosis can be effectively used by patients with hip OA, and to reveal the associated prognostic factors. Methods: This prospective study examined the survival curve of the equipment by using surgery as an endpoint and investigated how the duration of use affects patients. Harris Hip Score, muscle strength, and the Timed Up and Go test (TUG) were evaluated as prognostic factors. Results: By drawing the survival curves of 26 patients, approximately one third were expected to be still using the brace after 7 years. A rapid decrease in use was observed at around 1 year. A significant difference between patients with and without bracing at 1 year was found for the TUG result with the unaffected leg inside (ULI) at the start of bracing. A cut-off value of 9.5 s for the TUG with ULI significantly differentiated patients with and without bracing at 1 year, suggesting a possible predictor of brace survivorship in the early phase. Conclusions: The TUG with ULI with a cut-off value of 9.5 s, or at most 10 s, may be a possible predictor of persistence of brace use in the early phase.

Muscle activity of the vastus medialis obliquus during squat motion after static stretching of the tensor fasciae latae.

[Purpose] The purpose of this study was to investigate the changes of muscle activity during squat motion after stretching the tensor fasciae latae muscle. [Participants and Methods] The participants comprised 19 healthy males. The test muscles were the vastus medialis obliquus and vastus lateralis. The participants performed the squat motion before and after stretching the tensor fasciae latae. We measured the muscle activities and the onset timing of the vastus medialis obliquus relative to that of the vastus lateralis during squat motions. [Results] The onset timing of the vastus medialis obliquus relative to that of the vastus lateralis was decreased, and the vastus medialis obliquus activity and vastus medialis obliquus/vastus lateralis activity ratio were increased after stretching the tensor fasciae latae. [Conclusion] This study revealed that stretching of the tensor fasciae latae increases the relative vastus medialis obliquus muscle activity.

Key factors affecting the integration of interprofessional education into human resources for health reform: a Lao People's Democratic Republic case study.

Lao People's Democratic Republic (Lao PDR) with a population of 6.8 million is a low middle-income country in Southeast Asia. Despite economic development, Lao PDR is still characterized by a weak health system. The Ministry of Health has launched health reforms to provide better health services and University of Health Sciences (UHS) plays an essential role in Human Resources for Health (HRH) reform. Especially, the importance of its role in training health professionals from entry-level to continuing education has been increased. In 2016, the UHS embedded an Interprofessional Education (IPE) concept into a pre-qualifying course, in collaboration with the World Health Organization and the Gunma University Centre for Research and Training on IPE. As a pilot study, some students from faculties of Medicine, Pharmacy, Dentistry, Nursing, and Medical Technology participated in a community-based IPE program. Results suggested that students participating in the IPE program showed more positive attitudes toward collaborative practice than students who did not participate in the IPE program. Based on the results, the UHS is planning to develop an IPE program for health workers. In this article, we describe the strategic international collaboration and discuss the keys to successful IPE planning and implementation in line with HRH reform.

Changes in attitudes of undergraduate students learning interprofessional education in the absence of patient safety modules: evaluation with a modified T-TAQ instrument.

Communication underpinning well-functioning teamwork is a key mechanism for patient safety. Undergraduate interprofessional education (IPE) provides students with a basic understanding of the psychological factors contributing to teamwork. To develop IPE fostering a collaborative mindset for patient safety, attitudinal changes of students for patient safety were evaluated. Changes in the scores of the modified attitudes toward health care teams scale (ATHCTS) and the modified teamwork attitudes questionnaire (T-TAQ) of students pre- and post-IPE program were evaluated in the 2017 academic year. One hundred and fifty-one students (n=151) of five health professions (medicine, nursing, laboratory science, physiotherapy and occupational therapy) and 125 students of a possible 167 completed the survey before and after the IPE program, respectively. In the modified ATHCTS, 11 out of 14 items showed a significant change. The "quality of care delivery" and "patient-centered care" subscales showed significant increases in the regression factor score. In contrast, only 7 out of 30 items showed a significant increase in the modified T-TAQ. Four out of five categories, however, showed a significant increase, although the factor structure did not correspond to the T-TAQ category structure. The IPE program may have significant capacity to cultivate competencies to collaborate for patient safety. However, development of IPE may require preceding subjects providing concrete knowledge for patient safety, especially for communication and leadership.

Effects of the WISH-type S-form Hip Brace on Muscle Strength in Patients with Osteoarthritis of the Hip: A Short-term Longitudinal Study.

BACKGROUND: The WISH-type S-form hip brace (WISH brace) has been shown to significantly improve hip function, functional mobility, and gait biomechanics in patients with hip osteoarthritis. The aim of the current study was to evaluate the effects of the WISH brace over time on the strength of muscles around the hip and knee joints. METHODS: A prospective short-term longitudinal study with a 6-month follow-up was conducted. Muscle strengths were measured using a handheld dynamometer. RESULTS: The muscle strengths of hip flexion, hip abduction, and knee extension were lower in the affected limb than in the unaffected limb, whereas hip adduction muscle strength was reduced to the same extent in both the affected and unaffected limbs. This short-term longitudinal study revealed that only hip adduction and knee extension exhibited significant interaction between legs and time when measurement was performed without the WISH brace. Furthermore, the inherent hip abduction muscle strength of the affected limb was improved by the WISH brace so that the strength became the same as the unaffected limb. CONCLUSIONS: Improvement in abduction muscle strength of the affected limb by daily walking exercise with the WISH brace, which occurred with little interaction with the unaffected limb, may improve hip function.

Correlation of upper limb joint load withsimultaneous throwing mechanics including acceleration parameters in amateur baseball pitchers.

[Purpose] The purpose of this study was to provide information regarding the knowledge of mechanical principles related to the load applied to the shoulder and elbow during the pitching motion. [Subjects and Methods] The three-dimensional kinematics of body segments were measured in 19 amateur baseball players with a VICON motion capture system. The correlation between maximum shoulder internal torque, maximum elbow varus torque, and simultaneous kinematic parameters including joint angular acceleration and ball acceleration was investigated. [Results] Peak shoulder internal rotation torque and elbow varus torque averaged 31 Nm and 26 Nm, respectively. Ball acceleration had the strongest influence on shoulder internal rotational torque (standardized partial regression coefficient 0.69). During previous maximum external rotation (pre-MER), the main cause parameter of elbow varus torque was shoulder horizontal adduction velocity (r=0.672). On the other hand, after MER (post-MER), the main cause was ball acceleration (r=0.745). [Conclusion] Results of our study suggest that one of the main mechanical principles of joint load during the baseball pitching motion may be the 'inertia' yielded on the segment distal to the certain joint.

Health science students' attitudes towards healthcare teams: A comparison between two universities.

There have been few studies comparing the attitudes towards healthcare teams between different universities. This study analysed the differences in attitudes towards healthcare teams between health science students at Gunma University, Japan, which implements a comprehensive interprofessional education (IPE) programme, and Kanazawa University, a similar national university. Study populations were first- and third-year students at the Gunma University School of Health Sciences and the Kanazawa University School of Health Sciences. The present study was performed just after the IPE and multi-professional education subjects at Gunma University in the first term of the 2012 academic year. The first-year students were different cohort from the third-year students. The modified Attitudes Toward Health Care Teams Scale (ATHCTS) was used to measure attitudes towards healthcare teams. The overall mean score on the modified ATHCTS of students at Gunma University was significantly higher than that of those at Kanazawa University. In both first- and third-year students, the regression factor score of "patient-centred care" was significantly higher at Gunma University than at Kanazawa University. Based on the present study, it can be stated that IPE may foster the value of collaborative practice (CP) among health science students.

Muscle activation patterns in acceleration-based phases during reach-to-grasp movement.

[Purpose] An earlier study divided reaching activity into characteristic phases based on hand velocity profiles. By synchronizing muscle activities and the acceleration profile, a phasing approach for reaching movement, based on hand acceleration profiles, was attempted in order to elucidate the roles of individual muscle activities in the different phases of the acceleration profile in reaching movements. [Subjects and Methods] Ten healthy volunteer subjects participated in this study. The aim was to electromyographically evaluate muscles around the shoulder, the upper trapezius, the anterior deltoid, the biceps brachii, and the triceps brachii, most of which have been used to evaluate arm motion, as well as the acceleration of the upper limb during simple reaching movement in the reach-to-grasp task. [Results] Analysis showed the kinematic trajectories of the acceleration during a simple biphasic profile of the reaching movement could be divided into four phases: increasing acceleration (IA), decreasing acceleration (DA), increasing deceleration (ID), and decreasing deceleration (DD). Muscles around the shoulder showed different activity patterns, which were closely associated with these acceleration phases. [Conclusion] These results suggest the important role of the four phases, derived from the acceleration trajectory, in the elucidation of the muscular mechanisms which regulate and coordinate the muscles around the shoulder in reaching movements.

A plan for embedding an interprofessional education initiative into an existing programme in a Southeast Asian university.

An interprofessional education (IPE) initiative was recently launched at the University of Health Sciences in the Lao People's Democratic Republic, a country located in southeast Asia. During the process of reviewing the current curriculum, it was realised that the university has been providing a kind of IPE programme for more than a decade. Medical, pharmacy, dentistry, and nursing students were participating together in a community education programme. After identifying the programme's strengths and challenges, a 4-year plan for embedding the IPE concept into the programme was developed. The plan was divided into four phases-sharing the key concepts of IPE, designing the programme, organising the interprofessional programme committee, and evaluating the effectiveness of the programme. In this short article, we describe the process that led to the plan's creation and the experiences from the first two phases already completed.

Professional identity acquisition process model in interprofessional education using structural equation modelling: 10-year initiative survey.

The mandatory interprofessional education (IPE) programme at Gunma University, Japan, was initiated in 1999. A questionnaire of 10 items to assess the students' understanding of the IPE training programme has been distributed since then, and the factor analysis of the responses revealed that it was categorised into four subscales, i.e. "professional identity", "structure and function of training facilities", "teamwork and collaboration", and "role and responsibilities", and suggested that these may take into account the development of IPE programme with clinical training. The purpose of this study was to examine the professional identity acquisition process (PIAP) model in IPE using structural equation modelling (SEM). Overall, 1,581 respondents of a possible 1,809 students from the departments of nursing, laboratory sciences, physical therapy, and occupational therapy completed the questionnaire. The SEM technique was utilised to construct a PIAP model on the relationships among four factors. The original PIAP model showed that "professional identity" was predicted by two factors, namely "role and responsibilities" and "teamwork and collaboration". These two factors were predicted by the factor "structure and function of training facilities". The same structure was observed in nursing and physical therapy students' PIAP models, but it was not completely the same in laboratory sciences and occupational therapy students' PIAP models. A parallel but not isolated curriculum on expertise unique to the profession, which may help to understand their professional identity in combination with learning the collaboration, may be necessary.

Attitudes of nursing school deans toward interprofessional education in Western Pacific Region countries.

A previous survey distributed to medical school deans in the Western Pacific Region (WPR) showed positive attitudes toward collaborative practice and interprofessional education (IPE). This study aimed to clarify the present state of IPE and the attitudes of nursing school deans in the WPR. The modified Attitudes Toward Health Care Teams Scale (ATHCTS) and the modified Readiness of healthcare students for Interprofessional Learning Scale (RIPLS) were used. Unexpectedly, the response rate was less than 20%. Deans of nursing schools with IPE courses showed significantly more positive attitudes than those of schools without IPE courses. The mean score of the modified ATHCTS and RIPLS of deans of nursing schools in rural areas were significantly higher than those in urban areas. Compared with medical schools, nursing schools in the WPR pay less attention to IPE and this may be one of the present characteristics of the region.

Trunk kinematics and muscle activities during arm elevation.

BACKGROUND: While trunk movement accompanies arm elevation, trunk muscle activities during arm elevation at different speeds are unclear. The purpose of this study was to examine the trunk muscle activities at various speeds of arm elevation and then to evaluate their roles in trunk kinematics. METHODS: Twenty-two healthy subjects participated. The participants performed right shoulder flexion at three different speeds. Surface electromyography was used to measure the activities of bilateral external oblique muscles (EO), internal oblique muscles (IO), rectus abdominis muscles (RA) and lumber erector spinae muscles (ES). A three-dimensional motion analyzer was used to measure arm and trunk movements. RESULTS: In natural and slow movements, the muscle activities of left ES, right EO and left IO were significantly augmented compared with those of the contralateral muscles, in the relatively late phase. In fast movement, the muscle activities of both ES were significantly augmented during the early phase compared with later in the action. The muscle activities of the left ES and the right EO were significantly augmented compared with those of the contralateral muscles. There was a consistent pattern of trunk extension, lateral flexion and rotation during arm elevation, irrespective of the speed. CONCLUSIONS: Bilateral ES activity may be required for back-extension torques, especially for the early phase of rapid elevating motion. The anterior muscles' activity may contribute to the production of anterior force against the backward movement of the center of mass of the upper limb in the late phase. Trunk rotation, controlled by the trunk muscles in harmony, may assist the scapular movement to align the scapular plane in the arm elevating plane.

Repeated cross-sectional study of the longitudinal changes in attitudes toward interprofessional health care teams amongst undergraduate students.

The interprofessional education (IPE) program at Gunma University, Maebashi, Japan, uses a lecture style for first-year students and a training style for third-year students. To investigate the comprehensive implications of IPE, the change pattern of attitudes toward health care teams was examined longitudinally in pre-qualified students. The modified Attitudes Toward Health Care Teams Scale (mATHCTS) was used. The overall mean score of the mATHCTS improved significantly after the training-style IPE in their third year. Two individual items in the factor "quality of care delivery" decreased significantly during the first year. In contrast, two individual items in the factor "patient-centered care" increased significantly during the third year. These changes over time were confirmed by analyses using regression factor scores. There are at least two independent attitudes toward collaborative practice (CP) or IPE in response to IPE interventions: the attitude toward "value of IPE for health care providers" may response negatively to IPE in the early stages, and the attitude toward "value of IPE for health care receivers" positively in the later stages. These findings suggest that the continuation of mandatory IPE, which must be designed on the basis of students' high expectations for IPE and CP on entry, may result in profound changes in attitudes amongst participating students.

Attitudes toward interprofessional healthcare teams: a comparison between undergraduate students and alumni.

The goal of effective interprofessional education (IPE) is high-quality patient-care delivery and attaining a high level of patient satisfaction in clinical settings. We aimed to examine if alumni who have studied in an IPE program at a pre-licensure stage maintain a positive attitude toward collaborative practice (CP) in the postgraduate clinical experience. This paper presents a cross-sectional descriptive study which employed the modified attitudes toward health care teams scale (ATHCTS) to examine the relationship between exposure to clinical practice and the attitudes toward interprofessional healthcare teams. Results indicated that the overall mean score of alumni was significantly lower than that of undergraduate students on the modified ATHCTS. Only "team efficacy" had a significantly lower regression factor score in alumni than undergraduate students. Our findings suggest that changes in professional identity in a team may be due to contact with patients after graduation in the postgraduate clinical healthcare experience. The reduction of attitudes toward healthcare teams in the postgraduate clinical experience may be related to "team efficacy". We emphasize the need for in-service IPE for sustaining attitudes and providing a useful CP, which results in good clinical outcome.

Hyperthermia reduces migration of osteosarcoma by suppression of autocrine motility factor.

Autocrine motility factor (AMF) plays an important role in the development of metastasis by regulating tumor cell motility. The expression of AMF is associated with metastasis in malignant musculoskeletal tumors including osteosarcoma. Recent studies indicated that hyperthermia contributes to the improvement of the prognosis of patients with soft tissue sarcomas; however, few reports have evaluated the impact of hyperthermia on tumor cell motility, which is an important factor of metastasis. The purpose of this study was to evaluate the effect of hyperthermia with or without heat shock protein (HSP) inhibitors on the motility and AMF expression in an osteosarcoma cell line. Hyperthermia was carried out at 41˚C for 24 h. According to microarray results, HSP90, HSP70 and HSP27 expression was upregulated in osteosarcoma cells under hyperthermia. The intracellular, secreted AMF, mRNA of AMF and cell motility were evaluated by western blotting, ELISA, RT-PCR, wound healing and phagokinetic track assays, respectively. The protein secretion and mRNA levels of AMF and tumor cell motility were significantly decreased by hyperthermia. Of note, the downregulated AMF expression and motility were recovered by the addition of an HSP27 inhibitor. By contrast, the HSP90 and HSP70/72/105 inhibitors had no effect on AMF expression and motility downregulated by hyperthermia. In conclusion, hyperthermia reduced AMF expression and tumor cell motility via HSP27 and may therefore be applied as osteosarcoma treatment.

Attitudes of medical school deans toward interprofessional education in Western Pacific Region countries.

To examine the attitudes of medical school deans toward interprofessional education (IPE) and collaborative practice (CP), we conducted survey research in the Western Pacific Region. This regional survey was conducted as a collaborative research project with the World Health Organization. A survey was distributed to the medical school deans in Malaysia, the Philippines, Republic of Korea and Japan. Thirty-five surveys were returned from four countries. The survey demonstrated that many medical school deans have positive attitudes toward IPE and CP. However, respondents also reported that it is not easy to introduce interprofessional learning in their academic settings. It is suggested that collaboration between education systems and health systems is needed to introduce IPE in the academic setting. The possible role of international organizations is mentioned. This information helps to identify local efforts on which global health organizations and national governments can build.

Vascular endothelial growth factor-D is a key molecule that enhances lymphatic metastasis of soft tissue sarcomas.

Studies on lymph node metastasis of soft tissue sarcomas are insufficient because of its rarity. In this study, we examined the expressions of vascular endothelial growth factor (VEGF)-C and VEGF-D in soft tissue sarcomas metastasized to lymph nodes. In addition, the effects of the two molecules on the barrier function of a lymphatic endothelial cell monolayer against sarcoma cells were analyzed. We examined 7 patients who had soft tissue sarcomas with lymph node metastases and who had undergone neither chemotherapy nor radiotherapy before lymphadenectomy. Immunohistochemistry revealed that 2 of 7 sarcomas that metastasized to lymph nodes expressed VEGF-C both in primary and metastatic lesions. On the other hand, VEGF-D expression was detected in 4 of 7 primary and 7 of 7 metastatic lesions, respectively. Interestingly, 3 cases that showed no VEGF-D expression at primary sites expressed VEGF-D in metastatic lesions. Recombinant VEGF-C at 10(-8) and VEGF-D at 10(-7)and 10(-8)g/ml significantly increased the random motility of lymphatic endothelial cells compared with controls. VEGF-D significantly increased the migration of sarcoma cells through lymphatic endothelial monolayers. The fact that VEGF-D induced the migration of fibrosarcomas through the lymphatic endothelial monolayer is the probable reason for the strong relationship between VEGF-D expression and lymph node metastasis in soft tissue sarcomas. The important propensities of this molecule for the increase of lymph node metastases are not only lymphangiogenesis but also down-regulation of the barrier function of lymphatic endothelial monolayers, which facilitates sarcoma cells entering the lymphatic circulation.

Changes in attitudes toward interprofessional health care teams and education in the first- and third-year undergraduate students.

The interprofessional education (IPE) program at Gunma University, Maebashi, Japan, implements a lecture style for the first-year students and a training style for the third-year students. Changes in the scores of modified Attitudes Toward Health Care Teams Scale (ATHCTS) and those of modified Readiness of health care students for Interprofessional Learning Scale (RIPLS) at the beginning and the end of the term were evaluated in the 2008 academic year. Two hundred and eighty-five respondents of a possible 364 completed the survey. In both the scales, the overall mean scores declined significantly after the lecture-style learning in the first-year students, while the scores improved significantly after the training-style learning in the third-year students. Exploratory factor analysis revealed that the modified ATHCTS was composed of three subscales, and the modified RIPLS two subscales. Analyses using regression factor scores revealed that the scores of "quality of care delivery" subscale in the modified ATHCTS and those of "expertise" subscale in the modified RIPLS declined significantly in the first-year students. Consequently, IPE programs may be introduced early in the undergraduate curriculum to prevent stereotyped perceptions for IPE, and comprehensive IPE curricula may result in profound changes in attitudes among participating students.

Effect of the WISH-type hip brace on functional mobility in patients with osteoarthritis of the hip: evaluation using the Timed Up & Go Test.

BACKGROUND: The WISH-type S-form brace, is considered to improve hip function and gait in patients presenting with painful hip osteoarthritis (OA). OBJECTIVES: To evaluate the effects of the brace on functional mobility. STUDY DESIGN: Cross sectional survey. METHODS: The Timed Up & Go Test (TUG) was performed with right and left turns separately in each subject. RESULTS: In the patients with the bilateral hip brace, the average time to complete the TUG (8.3 ± 1.7 seconds) was significantly shorter than in those without the brace (9.4 ± 2.9 seconds). On the other hand, for the patients with unilateral hip OA, the improvement of TUG with the hip brace was significant in turning the unbraced leg inside (7.4 ± 1.1 vs. 7.6 ± 1.2 seconds), while not turning the braced leg inside (7.5 ± 1.1 vs. 7.6 ± 1.2 seconds). Furthermore, significant improvement of TUG was found at three-month follow-up and maintained until the 12-month follow-up assessment. This improvement was independent of the application of the brace at the assessment. CONCLUSIONS: The direct effect of the hip brace may be related to the hip function in the turning phase of TUG. In addition, mechanical improvements due to daily exercise may provide an indirect, but essential, effect of the brace on TUG performance.