Creating Patient Context: Empathy and Attitudes Toward Diabetes Following Virtual Immersion.

BACKGROUND: Pandemic circumstances created challenges for doctor of physical therapy (DPT) students to understand social determinants of health (SDH) in clinical rotations. Instead of canceling clinical rotations, a virtual reality cinema (cine-VR) education series was implemented. The purpose of this project is to describe the effect of this simulated immersion on student empathy and attitudes toward diabetes. METHOD: The DPT students (n=59) participated in 12 cine-VR education modules, completing surveys at three time points as part of coursework. The students completed baseline measures of the Diabetes Attitude Scale-Version 3 (DAS-3) and Jefferson Empathy Scale (JES), and then were immersed in 12 cine-VR modules. One week after module completion, students participated in a class discussion about the modules. The students repeated the JES and DAS-3 scales at postclass and six weeks later. Three subscales from the Presence Questionnaire (PQ) were used to measure the virtual experience. RESULTS: Student scores on three DAS-3 subscales significantly improved on posttest: Attitude toward patient autonomy, Mean: 0.75, SD: 0.45; t(58) = 12.742, P < .001; Psychosocial impact of diabetes, Mean: -0.21, SD: 0.41; t(58) = -3.854, P < .001; and Seriousness of type 2 diabetes, Mean: -039, SD: 0.44; t(58) = -6.780, P < .001, with lower scores six weeks later. Student scores increased on the JES and remained high (P < .001). High subscale scores on the PQ demonstrated immersion and involvement in the virtual experience. DISCUSSION: These modules can allow for a shared student experience that improves diabetes attitudes, increases empathy, and fosters meaningful classroom discussion. The cine-VR experience is flexible, and modules allow students to engage in aspects of a patient's life that were not available otherwise.

Quantifying fear of falling by utilizing objective body sway measures: A 360° virtual video study.

BACKGROUND: Fear of falling (FOF) is a psychological condition that can lead to increased morbidity and mortality in the elderly population. However, the subjective and multidimensional nature of FOF results in limitations of existing FOF measurement tools, which could influence the generalization of the findings from various studies. An objective measure of FOF could address those limitations. The present study aimed to identify the feasibility of using center of pressure (COP) parameters to quantify FOF. RESEARCH QUESTION: (1) Are 360º roller coaster videos effective to induce FOF? And (2) Which COP parameter(s) is/are feasible to quantify FOF? METHODS: Nineteen young, healthy adults (24 ± 2.47 years) were recruited in the present study. Subjects were required to watch three 360º videos: one control video and two roller coaster videos, through virtual reality goggles during standing and sitting. Six trials (3 during standing and 3 during sitting) with video were performed. Subjects were required to rate their FOF on a visual analogue scale after watching each video. COP mean power frequency, COP root mean square, and COP range were measured. The Friedman test was used to assess differences in COP parameters under different video conditions, and Spearman's correlation analysis was used to assess the relationship between FOF and COP parameters. RESULTS: Similar COP changes were observed in sitting and standing conditions. With increased FOF, participants demonstrated decreased COP mean power frequency and increased COP root mean square in the medial-lateral direction during both sitting and standing. SIGNIFICANCE: Our study provided evidence that 360º roller coaster videos are effective tools to induce FOF and change in COP parameters. The relationship between FOF and COP parameters suggests that the measurement of body sway may be an objective way to quantify FOF. More research are needed to solidify the evidence.

A cross-sectional assessment of stroke rehabilitation in Nebraska hospitals.

OBJECTIVE: To assess the structure and process of stroke rehabilitation in Nebraska hospitals. DESIGN: Cross-sectional mail survey using the Dillman tailored-design method of administration. SETTING: Hospitals in Nebraska. PARTICIPANTS: Approximately 77% of the 84 Nebraska hospitals that provide stroke rehabilitation are critical access hospitals (CAHs) that are limited to 25 beds. Our study sample of hospitals (N=53) included the 19 hospitals licensed for 47 to 689 beds (non-CAHs) and a stratified random sample of 34 of the 65 CAHs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported stroke rehabilitation team structure and processes, purposes of and barriers to the use of evidence-based standardized assessments, specific assessments used, and access to specialized stroke rehabilitation services and community resources. RESULTS: Thirty-six (68%) of the 53 hospitals responded to the survey. Approximately 61% of the hospitals used an organized team to provide stroke rehabilitation; 8% of the hospitals-all non-CAHs-had a team dedicated to stroke rehabilitation. After adjusting for hospital size, having an organized team was significantly associated with the use of standardized assessments to improve communication, measure progress and outcomes, evaluate effectiveness of practice, and compare patient outcomes across conditions. Access to specialized stroke rehabilitation professionals and services was significantly greater in non-CAHs. CONCLUSIONS: Hospital size and the presence of a team are determinants of the structure and process of stroke rehabilitation in Nebraska hospitals. Further research is needed to determine (1) whether team structure is a determinant of stroke rehabilitation outcomes across the continuum of care settings, (2) the needs of rural stroke survivors, and (3) whether technology can facilitate the use of stroke rehabilitation standardized assessments by rural health care professionals.

Ice nucleation temperature influences recovery of activity of a model protein after freeze drying.

The objective of this study was to determine whether a relationship exists between ice nucleation temperature and recovery of activity of a model protein, lactate dehydrogenase, after freeze drying. Aqueous buffer systems containing 50 microg/mL of protein were frozen in vials with externally mounted thermocouples on the shelf of a freeze dryer, then freeze dried. Various methods were used to establish a wide range of ice nucleation temperatures. An inverse relationship was found between the extent of supercooling during freezing and recovery of activity in the reconstituted solution. The data are consistent with a mechanism of inactivation resulting from adsorption of protein at the ice/freeze-concentrate interface during the freezing process.

Physical therapists' perspectives on practice errors in geriatric, neurologic, or orthopedic clinical settings.

While practice errors have been studied extensively in medicine and pharmacy, little research exists in physical therapy. The purpose of this study was to explore the phenomenon of physical therapy practice errors in geriatric, adult neurologic, and orthopedic clinical settings. Thirty physical therapists with three or more years of practice experience participated in the study, representing four geographically distinct regions of the United States. Four focus groups were conducted via guided discussion questions in four different states. Collected data were transcribed and analyzed by using constant comparative method. Data analysis yielded five major themes including: 1) taxonomy of error, 2) aversive outcomes, 3) individual and systematic causes, 4) post hoc actions, and 5) prevention of future errors. Because human errors are inevitable in physical therapy practice, understanding of causes and prevention strategies is necessary to minimize harm to patients. In addition, physical therapists must recognize their role and responsibility in creating a culture of error analysis and error prevention.

Preventing practice errors and improving patient safety: an examination of case studies reflecting common errors in occupational therapy practice.

Like other health care professionals, occupational therapists make errors in clinical practice. Only recently have we systematically studied errors in occupational therapy practice. In this report, key findings from two grant projects in occupational therapy practice errors are further examined. Specifically, this report includes an in-depth analysis of five examples of occupational therapy practice errors in physical rehabilitation and geriatric settings. These examples from the five most commonly reported causes of errors found in a national survey study on occupational therapy errors are misjudgment, lack of preparation, lack of experience, lack of knowledge, and insufficient communication. For each of the five examples, hypothesized causes of errors and their implications for professional education training and current occupational therapy practice are explored. It is hoped that this report helps to better inform practice and educational approaches to contribute to the prevention and reduction of occupational therapy and other health care practice errors.