Integrating interprofessional electronic medical record teaching in preregistration healthcare degrees: A case study.

BACKGROUND: Electronic medical record (EMR) adoption across healthcare necessitates a purposeful curriculum design to prepare graduates for the delivery of safe and effective patient care in digitally-enabled environments. OBJECTIVE: To describe the design and development of an Interprofessional Electronic Medical Record (iEMR) subject that introduces healthcare students to its utility in clinical settings. METHODS: A six-stage design-based educational research framework (Focus, Formulation, Contextualisation, Definition, Implementation, Evaluation) was used to instigate the iEMR design and development in nursing and five allied health graduate entry to practice (preregistration) degrees at an Australian university. RESULTS: In the Focus process, the concept and interdisciplinary partnerships were developed. The Formulation process secured grant support for subject design and development, including a rapid literature review to accommodate various course and curriculum structures. Discipline-specific subject themes were created through the Contextualisation process. During the Definition process, learning objectives and content resources were built. The Implementation process describes the pilot implementation in the nursing program, where assessment tasks were refined, and interdisciplinary clinical case studies originated. DISCUSSION: The design and development of an iEMR subject is underpinned by internal support for educational innovation and in alignment with digital health strategies in employer organisations. Identified barriers include faculty-level changes in strategic support for teaching innovation, managerial expectations of workload, the scope of work required by academics and learning designers, and the gap between the technology platform required to support online learning and the infrastructure needed to support simulated EMR use. A key discovery was the difficulty of finding EMR software, whether designed for teaching purposes or for clinical use, that could be adapted to meet the needs of this project. CONCLUSION: The lessons learned are relevant to educators and learning designers attempting a similar process. Issues remain surrounding the sustainability of the iEMR subject and maintaining academic responsibility for ongoing curriculum management.

Architectural anatomy of the quadriceps and the relationship with muscle strength: An observational study utilising real-time ultrasound in healthy adults.

Quadriceps atrophy and morphological change is a known phenomenon that can impact significantly on strength and functional performance in patients with acute or chronic presentations conditions. Real-time ultrasound (RTUS) imaging is a noninvasive valid and reliable method of quantifying quadriceps muscle anatomy and architecture. To date, there is a paucity of normative data on the architectural properties of superficial and deep components of the quadriceps muscle group to inform assessment and evaluation of intervention programs. The aims of this study were to (1) quantify the anatomical architectural properties of the quadriceps muscle group (rectus femoris, vastus intermedius, and vastus lateralis) using RTUS in healthy older adults and (2) to determine the relationship between RTUS muscle parameters and measures of quadriceps muscle strength. Thirty middle aged to older males and females (age range 55-79 years; mean age =59.9 ± 7.08 years) were recruited. Quadriceps muscle thickness, cross-sectional area, pennation angle, and echogenicity were measured using RTUS. Quadriceps strength was measured using hand-held dynamometry. For the RTUS-derived quadriceps morphological data, rectus femoris mean results; circumference 9.3 cm; CSA 4.6 cm2 ; thickness 1.5 cm; echogenicity 100.2 pixels. Vastus intermedius mean results; thickness 1.8 cm; echogenicity 99.1 pixels. Vastus lateralis thickness 1.9 cm; pennation angle 17.3°; fascicle length 7.0 cm. Quadriceps force was significantly correlated only with rectus femoris circumference (r = 0.48, p = 0.007), RF echogenicity (r = 0.38, p = 0.037), VI echogenicity (r = 0.43, p = 0.018), and VL fascicle length (r = 0.43, p = 0.019). Quadriceps force was best predicted by a three-variable model (adjusted R2  = 0.46, p < 0.001) which included rectus femoris echogenicity (B = 0.43, p = 0.005), vastus lateralis fascicle length (B = 0.33, p = 0.025) and rectus femoris circumference (B = 0.31, p = 0.041). Thus respectively, rectus femoris echogenicity explains 43%, vastus lateralis fascicle length explains 33% and rectus femoris circumference explains 31% of the variance of quadriceps force. The study findings suggest that RTUS measures were reliable and further research is warranted to establish whether these could be used as surrogate measures for quadriceps strength in adults to inform exercise and rehabilitation programs.

Quantifying the Burden of Shoulder and Hip Pain In Water Polo Players Across Different Playing Levels.

BACKGROUND: Water polo is characterised by unique skills and movements with high demands of both the upper and lower limb. There is growing recognition of the problems of shoulder and hip/groin symptoms in this population. PURPOSE: To quantify the prevalence of shoulder and hip/groin pain in water polo players, and to describe how performance and participation were impacted. Secondary aims investigated whether demographic or training variables were associated with levels of symptoms. DESIGN: In-season, cross-sectional questionnaire study. METHODS: An online questionnaire was distributed to all adult levels of the Australian water polo community. Participants were asked about demographic and playing history, and then specific injury history at both the shoulder and hip/groin. Each respondent completed an Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire for the shoulder and hip/groin. Point prevalence and past history were calculated, as well as a morbidity score from OSTRC responses. Risk ratios were used to determine differences between playing levels and sex. RESULTS: One hundred, fifty-three respondents completed the questionnaire (57% female). High rates of shoulder pain were reported (38.1% current, 81.2% past history), as well as hip/groin pain (33.1% current, 60.4% past history). Current shoulder pain was a risk factor for hip/groin pain (RR 1.99 (95%CI 1.27-3.12), and hip/groin pain was a risk factor for shoulder pain (RR 1.70 (95%CI 1.23-2.35). Elite-level athletes had higher prevalence (RR 1.87 [95%CI 1.01-3.46]) and past history of hip/groin pain (RR 1.76 [95%CI 1.32-2.36]). CONCLUSIONS: This is the first study to quantify high self-reported levels of hip/groin pain in water polo athletes. Such high levels may be explained by high amounts of eggbeater kick, especially during skeletal development in adolescence. Shoulder pain continues to be the most common source of injury burden in water polo. Future research should determine whether any modifiable risk factors exist that may reduce the burden of injury in this population. LEVEL OF EVIDENCE: 2b.

Shoulder pain in water polo: a systematic review of the literature.

The main aim of this systematic review is to synthesize and critically evaluate literature on the incidence and clinical presentation of shoulder pain in water polo. A secondary aim is to examine the contributing factors to shoulder pain in water polo. Medline, Cinahl, Embase, Ausport, Ovid, Sports Discus, Pubmed and Google Scholar data bases were electronically searched. Data were extracted regarding research design, injuries, pain, incidence, interventions and therapy outcomes. Of an initial yield of 23 papers, 11 fulfilled the inclusion criteria and were categorized into studies on incidence, shoulder pain, shoulder mobility, strength and throwing injuries. Methodological limitations included sampling and measurement biases, inadequate internal validity of measurement tools, poor specification of testing protocols and limitations in statistical analysis. The review found a high incidence of shoulder pain in water polo. Although there was limited evidence regarding causation, the repeated action of throwing was identified as a contributing factor to shoulder pain. Future studies need to explore the relative contributions of hyper-mobility and muscle strength imbalance to shoulder pain in water polo.