Impact of aerobic exercise on haemostatic indices in paediatric patients with haemophilia.

UNLABELLED: This study investigated the impact of aerobic exercise on laboratory assessments of haemostatic activity in boys (5-18 years of age) with haemophilia A (HA) or B (HB), examining the hypothesis that laboratory coagulation parameters temporarily improve with exercise. Thirty subjects meeting eligibility criteria (19 HA; 11 HB; mean age: 12.8 years) were invited to participate. They underwent a replacement factor washout period and were advised against strenuous activity for three days prior to the planned intervention. At study visit, baseline blood samples were drawn prior to exercise on a stationary cycle ergometer, aiming to attain 3 minutes (min) of cycling at 85 % of predicted maximum heart rate. Blood work was repeated 5 min (t5) and 60 min (t60) post exercise completion. Samples were assessed for platelet count (PC), factor VIII activity ( FVIII: C), von Willebrand antigen (VWF:Ag), ristocetin cofactor activity (VWF:RCo) and platelet function analysis (PFA-100); maximum rate of thrombus generation (MRTG) in blood was measured via thromboelastography and plasma peak thrombin generation (PTG) via calibrated automated thrombography. Mean duration of exercise was 13.9 (± 2.6) min. On average, t5 samples showed significant elevation, relative to baseline in PC, FVIII:C, VWF:Ag, VWF:RCo and PTG, while FVIII: C, VWF:Ag, VWF:RCo and MRTG were significantly elevated in t60 samples. Within the cohort, participants with severe HA showed no change in FVIII: C levels with exercise. The greatest improvement in haemostatic indices was observed in post-adolescent males with mild-moderate HA, who thus represent the group most likely to benefit from a reduction of bleeding risk in the setting of exercise.

Grade disputes: considerations for nursing faculty.

Nursing faculty take grading of assignments seriously. Faculty realize students are sensitive about their grade point averages and that students must maintain certain grades for progression and the retention of scholarships. Faculty further recognize that the grading of clinical performance is complex and subjective by nature. Some faculty are reluctant to assign a failing grade for poor clinical performance for fear of litigation. In this article, the authors discuss several landmark cases that have come before the courts, which have set precedence for grade disputes. The courts overwhelmingly have supported faculty decisions regarding grade assignment, as long as the grades were not arbitrary or capricious. Nursing instructors should not be fearful of failing a student solely on the basis of poor clinical performance. However, faculty must be prepared to explain how grades are assessed related to the program and course objectives.