scholarly journals Training and certification of doctors of chiropractic in delivering manual cervical traction forces: Results of a longitudinal observational study

2014 ◽  
Vol 28 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Maruti Ram Gudavalli ◽  
Robert D. Vining ◽  
Stacie A. Salsbury ◽  
Christine M. Goertz
Keyword(s):  
Observational Study ◽  
Computer Software ◽  
Traction Force ◽  
Simulated Patients ◽  
Traction Forces ◽  
Certification Process ◽  
Longitudinal Observational Study ◽  
Asymptomatic Volunteers ◽  
Cervical Traction ◽  
Training Protocol

Objective Doctors of chiropractic (DCs) use manual cervical distraction to treat patients with neck pain. Previous research demonstrates variability in traction forces generated by different DCs. This article reports on a training protocol and monthly certification process using bioengineering technology to standardize cervical traction force delivery among clinicians. Methods This longitudinal observational study evaluated a training and certification process for DCs who provided force-based manual cervical distraction during a randomized clinical trial. The DCs completed a 7-week initial training that included instructional lectures, observation, and guided practice by a clinical expert, followed by 3 hours of weekly practice sessions delivering the technique to asymptomatic volunteers who served as simulated patients. An instrument-modified table and computer software provided the DCs with real-time audible and visual feedback on the traction forces they generated and graphical displays of the magnitude of traction forces as a function of time immediately after the delivery of the treatment. The DCs completed monthly certifications on traction force delivery throughout the trial. Descriptive accounts of certification attempts are provided. Results Two DCs achieved certification in traction force delivery over 10 consecutive months. No certification required more than 3 attempts at C5 and occiput contacts for 3 force ranges (0–20 N, 21–50 N, and 51–100 N). Conclusions This study demonstrates the feasibility of a training protocol and certification process using bioengineering technology for training DCs to deliver manual cervical distraction within specified traction force ranges over a 10-month period.

Development of Force-Feedback Technology for Training Clinicians to Deliver Manual Cervical Distraction

2013 ◽  
Author(s):  
Maruti Ram Gudavalli ◽  
Vikas Yadav ◽  
Robert Vining ◽  
Michael Seidman ◽  
Stacie Salsbury ◽  
...  
Keyword(s):  
Neck Pain ◽  
Head And Neck ◽  
Force Feedback ◽  
Controlled Trial ◽  
Three Dimensional ◽  
Traction Force ◽  
Simulated Patients ◽  
Traction Forces ◽  
Force Transducers ◽  
Graphical Feedback

Objective: Neck pain is a prevalent musculoskeletal (MSK) complaint and costly societal burden. Doctors of chiropractic (DCs) provide manual therapies for neck pain patients to relieve discomfort and improve physical function. Manual cervical distraction (MCD) is a chiropractic procedure for neck pain. During MCD, the patient lies face down on a specially designed chiropractic table. The DC gently moves the head and neck in a cephalic direction while holding a gentle broad manual contact over the posterior neck, to create traction effects. MCD traction force profiles vary between clinicians making standardization of treatment delivery challenging. This paper reports on a bioengineering technology developed to provide clinicians with auditory and graphical feedback on the magnitude of cervical traction forces applied during MCD to simulated patients during training for a randomized controlled trial (RCT). Methods: The Cox flexion-distraction chiropractic table is designed with a moveable headpiece. The table allows for long axis horizontal movement of the head and neck, while the patient’s trunk and legs rest on fixed table sections. We instrument-modified this table with three-dimensional force transducers to measure the traction forces applied by the doctor. Motion Monitor software collects data from force transducers. The software displays the magnitude of traction forces graphically as a function of time. Real-time audible feedback produces a steady tone when measured traction forces are <20N, no tone when forces range between 20–50N, and an audible tone when forces exceed 50N. Peer debriefing from simulated patients reinforces traction force data from the bioengineering technology. Results: We used audible and graphical feedback to train and certify DCs to apply traction forces to the cervical spine of simulated patients within three specific ranges. This technology supports a RCT designed to assess the ability of clinicians to deliver MCD within specified force ranges to patients randomized to different force dosages as an intervention. Future applications may include training chiropractic students and clinicians to deliver the MCD treatment.

scholarly journals The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ingmar Schäfer ◽  
Heike Hansen ◽  
Agata Menzel ◽  
Marion Eisele ◽  
Daniel Tajdar ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Rural Areas ◽  
Longitudinal Observational Study ◽  
Multivariable Analyses ◽  
Gastrointestinal Complaints ◽  
Urban And Rural Areas ◽  
Quota Sampling ◽  
Primary Care Practices

Abstract Objectives The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP. Methods We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices. Results One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001). Conclusions We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.

Energy Intakes of Ultraendurance Cyclists During Competition, an Observational Study

2012 ◽  
Vol 22 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Katherine E. Black ◽  
Paula M.L. Skidmore ◽  
Rachel C. Brown
Keyword(s):  
Observational Study ◽  
Energy Intake ◽  
Energy Requirement ◽  
Negative Relationship ◽  
Computer Software ◽  
High Energy ◽  
Energy Deficit ◽  
Food Diary ◽  
Food And Drink ◽  
And Performance

Endurance events >10 hr are becoming increasingly popular but provide numerous physiological challenges, several of which can be attenuated with optimal nutritional intakes. Previous studies in ultraendurance races have reported large energy deficits during events. The authors therefore aimed to assess nutritional intakes in relation to performance among ultraendurance cyclists. This observational study included 18 cyclists in a 384-km cycle race. At race registration each cyclist’s support crew was provided with a food diary for their cyclist. On completion of the race, cyclists were asked to recall their race food and drink intakes. All food and fluids were analyzed using a computer software package. Mean (SD) time to complete the race was 16 hr 21 min (2 hr 2 min). Mean (SD) energy intake was 18.7 (8.6) MJ, compared with an estimated energy requirement for the race of 25.5 (7.4) MJ. There was a significant negative relationship between energy intake and time taken to complete the race (p = .023, r2 = −.283). Mean (SD) carbohydrate, fat, and protein intakes were 52 (27), 15.84 (56.43), and 2.94 (7.25) g/hr, respectively. Only carbohydrate (p = .015, r2 = −.563) and fat intake (p = .037, r2 = −.494) were associated with time taken to complete the race. This study demonstrates the difficulties in meeting the high energy demands of ultraendurance cycling. The relationship between energy intake and performance suggests that reducing the energy deficit may be advantageous. Given the high carbohydrate intakes of these athletes, increasing energy intake from fat should be investigated as a means of decreasing energy deficits.

Enhancing the Social Interaction Skills of Preschoolers with Visual Impairments

2002 ◽  
Vol 96 (8) ◽  
pp. 576-584 ◽  
Author(s):  
Tana D'Allura
Keyword(s):  
Social Interaction ◽  
Observational Study ◽  
Learning Strategies ◽  
Learning Strategy ◽  
Visual Impairments ◽  
Interaction Patterns ◽  
Longitudinal Observational Study ◽  
The Social ◽  
Social Interaction Skills ◽  
Children With Visual Impairments

This longitudinal, observational study of 13 children in a preschool for children with visual impairments examined the effects of reverse mainstreaming, in combination with the cooperative learning strategy, on the social interaction patterns of preschoolers with and without visual impairments. It found that the type of environment provided and the learning strategies used affect both whether and how children relate to their environment.

scholarly journals Impact of tobacco outlet density and proximity on smoking cessation: A longitudinal observational study in two English cities

2014 ◽  
Vol 27 ◽  
pp. 45-50 ◽  
Author(s):  
Tha Han ◽  
Myriam Alexander ◽  
Aphrodite Niggebrugge ◽  
Gareth J. Hollands ◽  
Theresa M. Marteau
Keyword(s):  
Smoking Cessation ◽  
Observational Study ◽  
Longitudinal Observational Study ◽  
Outlet Density
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