scholarly journals The Art of Electrosurgery: Trainees and Experts

2017 ◽  
Vol 24 (4) ◽  
pp. 373-378 ◽  
Author(s):  
Frédérique C. Meeuwsen ◽  
Annetje C. P. Guédon ◽  
Ewout A. Arkenbout ◽  
Maarten van der Elst ◽  
Jenny Dankelman ◽  
...  
Keyword(s):  
Best Practice ◽  
Power Level ◽  
Measurement Data ◽  
Well Being ◽  
Reliable Estimate ◽  
Activation Time ◽  
Practice Model ◽  
Instrument Selection ◽  
Application Techniques ◽  
Activation Times

The benefits of electrosurgery have been acknowledged since the early 1920s, and nowadays more than 80% of surgical procedures involve devices that apply energy to tissues. Despite its widespread use, it is currently unknown how the operator’s choices with regard to instrument selection and application technique are related to complications. As such, the manner in which electrosurgery is applied can have a serious influence on the outcome of the procedure and the well-being of patients. The aim of this study is to investigate the variety of differences in usage of electrosurgical devices. Our approach is to measure these parameters to provide insight into application techniques. A sensor was developed that records the magnitude of electric current delivered to an electrosurgical device at a frequency of 10 Hz. The sensor is able to detect device activation times and a reliable estimate of the power-level settings. Data were recorded for 91 laparoscopic cholecystectomies performed by different surgeons and residents. Results of the current measurement data show differences in the way electrosurgery is applied by surgeons and residents during a laparoscopic cholecystectomy. Variations are seen in the number of activations, the activation time, and the approach for removal of the gallbladder. Analysis showed that experienced surgeons have a longer activation time than residents (3.01 vs 1.41 seconds, P < .001) and a lower number of activations (102 vs 123). This method offers the opportunity to relate application techniques to clinical outcome and to provide input for the development of a best practice model.

scholarly journals How COVID-19 will boost remote exercise-based treatment in Parkinson’s disease: a narrative review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Agnes Langer ◽  
Lucia Gassner ◽  
Anna Flotz ◽  
Sebastian Hasenauer ◽  
Jakob Gruber ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Best Practice ◽  
Well Being ◽  
Functional Mobility ◽  
Physical Mobility ◽  
Conventional Physiotherapy ◽  
Difficult Times ◽  
Non Motor Symptoms

AbstractThe lack of physical exercise during the COVID-19 pandemic-related quarantine measures is challenging, especially for patients with Parkinson’s disease (PD). Without regular exercise not only patients, but also nursing staff and physicians soon noticed a deterioration of motor and non-motor symptoms. Reduced functional mobility, increased falls, increased frailty, and decreased quality of life were identified as consequences of increased sedentary behavior. This work overviews the current literature on problems of supplying conventional physiotherapy and the potential of telerehabilitation, allied health services, and patient-initiated exercise for PD patients during the COVID-19 period. We discuss recent studies on approaches that can improve remote provision of exercise to patients, including telerehabilitation, motivational tools, apps, exergaming, and virtual reality (VR) exercise. Additionally, we provide a case report about a 69-year-old PD patient who took part in a 12-week guided climbing course for PD patients prior to the pandemic and found a solution to continue her climbing training independently with an outdoor rope ladder. This case can serve as a best practice example for non-instructed, creative, and patient-initiated exercise in the domestic environment in difficult times, as are the current. Overall, many recent studies on telemedicine, telerehabilitation, and patient-initiated exercises have been published, giving rise to optimism that facilitating remote exercise can help PD patients maintain physical mobility and emotional well-being, even in phases such as the COVID-19 pandemic. The pandemic itself may even boost the need to establish comprehensive and easy-to-do telerehabilitation programs.

scholarly journals Developing a best practice pathway to support improvements in Indigenous Australians’ mental health and well-being: a qualitative study: Figure 1

BMJ Open ◽  
2015 ◽  
Vol 5 (8) ◽  
pp. e007938 ◽  
Author(s):  
Rachael Hinton ◽  
David J Kavanagh ◽  
Lesley Barclay ◽  
Richard Chenhall ◽  
Tricia Nagel
Keyword(s):  
Mental Health ◽  
Qualitative Study ◽  
Best Practice ◽  
Well Being ◽  
Indigenous Australians ◽  
Health And Well Being

Abstract T P259: What Should Really be Happening to Our Stroke Patients Post-Acute Care?: A System Best Practice Model for Inpatient Rehab

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Shelley Sharp ◽  
Elizabeth Linkewich ◽  
Jacqueline Willems ◽  
Nicola Tahair ◽  
Charissa Levy ◽  
...  
Keyword(s):  
Acute Care ◽  
Stroke Unit ◽  
Best Practice ◽  
Patient Flow ◽  
System Capacity ◽  
Stroke Patients ◽  
Practice Model ◽  
Term Care ◽  
Stroke Unit Care ◽  
The Right

Background: A regional Stroke Report Card identified poor performance on system efficiency, effectiveness, and integration of stroke best practice. This engaged regional funders and 17 organizations (11 acute, 6 rehab) to collaborate in stroke system planning. The focus included stroke unit care and access to timely and appropriate rehabilitation, including increased access for severe stroke. Changes in acute care, including pre-hospital, have facilitated access to stroke unit care in the city. A model of patient flow from acute care was needed to understand other system capacity needs. Purpose: To use best practice and benchmarks to delineate post-acute patient flow and facilitate alignment of resources for inpatient rehabilitation. Methods: Administrative data from national reporting and local rehab referral system databases were used to review current system usage from acute care. A model of proportional distribution of cases from acute, specifically to inpatient rehab, was established using provincial benchmarks, evidence informed targets, and organization market share of total inpatient rehab system capacity. Iterative discussions were required to confirm the organizations’ commitment to stroke best practice. New volume and case mix changes were applied to determine capacity and resource planning needs across organizations. Results: The best practice model, approved by all stakeholders, proposes 40% of stroke patients discharged alive from acute care should access inpatient, 13% outpatient rehabilitation and 6% to Complex Continuing Care and Long Term Care. Current practice is 26%, <5% and 13% respectively. A projected volume increase of 278 patients is distributed across 5/6 rehab providers. This results in a total proportional system shift from 20% (n=160) to 41.5% (n =446) of severe patients receiving access to high intensity rehab. A reduction in the overall proportion of moderate and mild stroke patients from 65% (519) to 49.5% (n=534) and 15% (n=119) to 9% (n=96) respectively. Conclusion: Significant investment/redistribution of resources within the system is required to support patient flow and provide care in the right place at the right time. System funder support is critical to create a quality of care (best practice) system.

Music Therapy Pre-internship Education and Training: Support for a Methods-Based Approach

2021 ◽  
Author(s):  
Susan C Gardstrom ◽  
James Hiller ◽  
Annie Heiderscheit ◽  
Nancy L Jackson
Keyword(s):  
Music Therapy ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Education And Training ◽  
Population Based ◽  
Music Therapists ◽  
Training Support ◽  
And Training

Abstract As music therapists, music is our primary realm of understanding and action and our distinctive way of joining with a client to help them attain optimal health and well-being. As such, we have adopted and advocate for a music-focused, methods-based (M-B) approach to music therapy pre-internship education and training. In an M-B approach, students’ learning is centered on the 4 music therapy methods of composing, improvising, re-creating, and listening to music and how these music experiences can be designed and implemented to address the health needs of the diverse clientele whom they will eventually encounter as practicing clinicians. Learning is highly experiential, with students authentically participating in each of the methods and reflecting on these self-experiences as a basis for their own clinical decision-making. This is differentiated from a population based (P-B) approach, wherein students’ attention is directed at acquiring knowledge about the non-musical problems of specific “clinical populations” and the “best practice” music interventions that are presumed to address these problems. Herein, we discuss both approaches, identifying the limitations of a P-B perspective and outlining the benefits of an M-B curriculum and its relevance to 21st-century music therapy practice.

scholarly journals Emotional Well-Being and the Importance for Women with Fear of Birth to have a Known Midwife at Birth

2018 ◽  
Vol 2 (1) ◽  
pp. 01-07
Author(s):  
Ingegerd Hildingsson
Keyword(s):  
Emotional Distress ◽  
Best Practice ◽  
Well Being ◽  
Cross Sectional Study ◽  
Health Issues ◽  
Fear Of Childbirth ◽  
Cross Sectional ◽  
Additional Support ◽  
Study Setting ◽  
Fragmentation Of Care

Background: Previous research has shown that women with fear of childbirth often suffer from other mental health issues. Continuity of caregiver through a known midwife is best practice for pregnant women, and women with childbirth related fear value continuity of care. In Sweden the maternity care is fragmented and women’s opinion remains under-investigated. Objective: The aim of this study was to investigate emotional well-being and the importance of having a known midwife during birth in women referred to counselling for childbirth related fear. Design: Cross sectional study Setting: 3 Swedish hospitals providing counseling for childbirth related fear. Participants: Women who were referred for counseling due to fear of childbirth. Measures: The importance of having a known midwife at birth, background factors, emotional well-being and attitudes. Results: 77 women referred to counseling consented to participate. The majority of women were likely to present with previous or ongoing emotional distress, high levels of anxiety or depressive symptoms, low Sense of Coherence and Major worries. For the majority of women (71%) it was important to have a known midwife at birth and most important for women with high levels of childbirth fear. Conclusion: This study highlights that women referred to counseling due to fear of childbirth might need additional support to cope with their emotional distress. The results also indicated that having a known midwife at birth was important to these women, especially for women with higher fear. The option of having a known midwife during birth is rarely accomplished in Sweden due to the fragmentation of care.

scholarly journals Bachmann bundle impairment following linear ablation of left anterior wall: impact on left atrial function

2020 ◽  
Author(s):  
Yanjuan Zhang ◽  
Fengming Wu ◽  
Yu Gao ◽  
Nan Wu ◽  
Gang Yang ◽  
...  
Keyword(s):  
Contractile Function ◽  
Anterior Wall ◽  
Activation Time ◽  
Linear Ablation ◽  
Measured Activation ◽  
Mechanical Remodeling ◽  
Activation Times ◽  
And Function ◽  
Bachmann Bundle

Background: We aimed to evaluate the effect of Bachmann bundle (BB) impairment on electrical and mechanical function of the left atrium (LA), as well as the long-term clinical impact of such impairment. Design: We measured activation time in the five LA walls in 56 patients with atrial fibrillation. LA reservoir, conduit, and contractile function were also evaluated. Patients were divided into two groups based on ablation strategy: the circumferential pulmonary vein isolation (CPVI) group and CPVI with anterior wall linear ablation (LAWA) group. Patients in the CPVI+LAWA group were divided into two sub-groups based on ECG differences following ablation: the BB impairment group and intact BB group. LA activation time and function were then compared between the ablation strategy groups and the CPVI+LAWA subgroups. Results: Patients in the CPVI+LAWA group exhibited longer activation times in the anterior and lateral walls of the LA, poorer LA synchrony, and reduced LA contractile and reservoir function when compared with those in the CPVI group. In the BB impairment subgroup, we observed a discrepancy between electrical/mechanical remodeling. Among five walls, activation time was longest in this region. BB impairment was also associated with reduced LA function. Conclusion: Significant changes in LA function and conductibility were observed in patients with anterior wall ablation, especially those with iatrogenic BB impairment.

scholarly journals A Conceptual Paper on The Best Financial Management Model That Has Become The Practice of the Malay in Klang Valley

2019 ◽  
Vol 5 (2) ◽  
pp. 15
Author(s):  
Leylawati Joremi
Keyword(s):  
Financial Management ◽  
Best Practice ◽  
Practice Model ◽  
The Public ◽  
Body Of Knowledge ◽  
Quantitative Studies ◽  
Family Finances ◽  
Klang Valley ◽  
Conceptual Paper ◽  
The Government

This conceptual paper is presented with the intention to study the best practice model of financial management, which has become the practice of the Malay in Klang Valley.  It begins by reviewing the literature on household financial management and the behavior of households against finances and debt.  The theory of utility and the life-cycle hypothesis were used as the basis of the study.  This study is inspired by the concerns of the government and the public on the growing bankruptcy issue in Malaysia.  Many previous quantitative studies discussed the flaws in money management.  This study, however, slightly different.  Using a qualitative method, it intends to look at the best practices implemented by the household in managing family finances.  The findings can add value to today's body of knowledge.  Identified themes can be used to design financial modules which are more compatible to be used by all levels of society.

The Clinical Practice Model for Persons with Dementia: Application to Music Therapy

2021 ◽  
Author(s):  
Alaine E Reschke-Hernández
Keyword(s):  
Clinical Practice ◽  
Music Therapy ◽  
Behavioral Interventions ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Intervention Development ◽  
Well Being ◽  
Future Research ◽  
Evidence Based ◽  
Practice Model

Abstract Currently, no drug can cure or effectively mitigate symptoms for the growing number of individuals who live with Alzheimer’s disease and related dementias. As they experience declines in memory, communication, and thinking—symptoms that undermine social initiative, autonomy, and well-being—these individuals become increasingly dependent on others. Evidence regarding the benefits of music therapy for persons with dementia is growing. Nonetheless, limitations in existing research have hindered knowledge regarding the use and appropriate application of music as a form of treatment with this population. This article describes the development of The Clinical Practice Model for Persons with Dementia, which provides a theoretical framework to inform evidence-based practice, illustrated here in application to music therapy. Specifically, the model is intended to prompt purposeful application of strategies documented within a broad literature base within 6 thematic areas (Cognition, Attention, Familiarity, Audibility, Structure, and Autonomy); facilitate clinical decision-making and intervention development, including music interventions; and encourage discourse regarding relationships between characteristics of the intervention, the therapist, the person with dementia, and their response to intervention. The model comprises a set of testable assumptions to provide direction for future research and to facilitate the description and investigation of mechanisms underlying behavioral interventions with this population. Although the model is likely to evolve as knowledge is gained, it offers a foundation for holistically considering an individual’s needs and strengths, guidance for applying music and nonmusic strategies in evidence-based practice, and direction for future research.

Self-Care in an Era of Pathos: The Effects of the Trump Presidency on the Well-Being of Social Workers

2021 ◽  
Vol 5 (2) ◽  
pp. 93-107
Author(s):  
Sharon E. Moore ◽  
A. Christson Adedoyin ◽  
Sharon D. Jones-Eversley ◽  
Carla M. Curtis
Keyword(s):  
United States ◽  
Social Workers ◽  
Best Practice ◽  
Self Care ◽  
First Responders ◽  
Well Being ◽  
The United States ◽  
Work Environments ◽  
Review Of The Literature ◽  
Egalitarian Society

ObjectiveThe importance of self-care for social workers as first responders is underscored in light of the sociopolitical, economic, and pandemic challenges that accompanied the presidency of Donald J. Trump, the 45th president of the United States.MethodsWe conducted an extensive review of the literature on the conceptualization, dimensions, benefits, importance, and indispensability of self-care for social workers, especially in stressful socio-political and toxic work environments. Chaos theory served as the theoretical scaffold of our research.ResultsInevitably our research found that the ability of social workers to effectively serve as first responders during chaotic times depends on a proactive and consistent practice of self-care by social workers as an essential best practice.ConclusionsThe consequences of the policies of the 45th president of the United States have taken their toll on the citizenry, with the increase in stress in the nation. Undoubtedly, social workers as first responders, therapists, and educators are at the receiving end of ensuing political and socioeconomic uncertainties. We posit that for social workers to remain steadfast, unshakable, and abiding in the solemn pursuit of social justice and an egalitarian society, this is the era for social workers to embrace and persistently practice self-care.

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