Potential value of home square-stepping exercises for inactive older adults: an exploratory case study

Background Most older adults do not engage in regular physical activity. However, more research on options to partake in regular exercise in this population by reducing barriers and enhancing enablers while still reaching benefits is needed. Methods Using embedded mixed methods, 10 inactive older adults over the age of 65 completed a 3-week square-stepping exercise intervention to help overcome the initial barriers and activate initial enablers to perform regular exercise. Physical activity level was tracked at home with a pedometer using median steps/day over seven days for pre-post measure. Aerobic intensity while doing square-stepping exercises was quantified via a heart rate monitor in a supervised session. Each participant had an interview asking about barriers and enablers to regular exercise and if the intervention could modify any. Based on initial physical activity a framework matrix was used to pull potential barriers to compare, contrast, and search for patterns between participants with lower and higher initial physical activity levels. Results The 3-week square-stepping exercise intervention helped participants overcome barriers such as being uncomfortable in a fitness facility and body image and activate enablers such as the use of home equipment and convenience. The median total steps/day increased by 12% (p = 0.02), and a moderate-intensity level was reached by 80% of the sample participants when performing the square stepping exercise during a supervised session. Common barriers such as having a suitable program, hard to keep the intensity were reported by participants regardless of the initial physical activity level. Conclusion Regardless of initial physical activity level, inactive older adults can increase physical activity level at the recommended intensity and overcome common barriers to exercise when performing square-stepping exercises, especially for those intimidated by a fitness facility setting and those concerned with their body image. A longer intervention including more participants using the square-stepping exercises is required to understand if square-stepping exercises can increase the proportion of older adults exercising regularly.

Collaboration Beyond the School

The authors of this chapter posit that collaboration with related and instructional personnel, as well as regional and state education agencies, can serve to combat teacher retention issues while improving student services. Acknowledging common barriers to effective collaboration, practical tools for overcoming these challenges are suggested. Further, key stakeholders in the collaborative process and their roles are identified. The chapter concludes by organizing collaborative efforts to engage in throughout a student's educational career.

Physician Experiences and Perceived Barriers to Providing Quality Infertility Care in the Greater Accra Region of Ghana

High-quality, patient-centered care is essential to achieving equity and dignity for individuals with infertility, yet few studies have explored quality of infertility care in sub-Saharan Africa. We interviewed 13 non-specialist physicians and 2 medical school faculty to explore experiences in and perceptions of providing infertility care in Greater Accra, Ghana. We used a patient-centered infertility care model to inform our analysis and results. Individualized care and taking time to counsel and emotionally support patients were perceived as the most important things a physician can do to provide quality infertility care. Financial costs and lack of infertility services within a single facility were the most common barriers reported to providing quality infertility care. To the best of our knowledge, our study is the first to explore quality of infertility care provided by physicians in public sector facilities in Ghana, shedding light on existing barriers and identifying strategies for improvement.

SIGNIFICANCE OF SPORT ACTIVITIES FOR PERSONS WITH DISABILITIES

Although there are numerous categorizations and large differences in the specific characteristics between individual categories of disabilities, they all have something in common - barriers that people with disabilities deal with. Social, physical and mental limitations can be reduced or removed through sport, which can significantly improve the quality of life of people with disabilities, as we will try to document in this paper by research findings. Unfortunately, even today, the usual societal attitude about the quality of life of people with disabilities is not focusing on specific social and cultural context affecting disability. Instead, we are still focusing on individual coping strategies and behaviors in response to difficulties arising from biological limitations. Psychology is one of the sciences whose contribution to this topic can be important, especially in providing a framework for evidence-based practice. Simultaneously, promoting this topic can, hopefully, contribute to improving relevant policy.

A Scoping Review of Perinatal Palliative Care: Allowing Parents to Be Parents

Objective–Perinatal palliative care (PPC) is an option for patients who discover that their infant has a life-limiting fetal condition, which decreases the burden of the condition using a multidisciplinary approach. Study Design–This review discusses the landmark literature in the past two decades, which have seen significant growth and development in the concept of PPC. Results–The literature describes the background, quality, and benefits of offering PPC, as well as the ethical principles that support its being offered in every discussion of fetal life-limiting diagnoses. Conclusions–PPC shares a similar risk profile to other options after life-limiting diagnosis, including satisfaction with choice of continuation of pregnancy. The present clinical opinion closes by noting common barriers to establishing PPC programs and offers a response to overcome each one. Key Points

Critical care ultrasound training: a survey exploring the “education gap” between potential and reality in Canada

Background Critical care ultrasound (CCUS) is now a core competency for Canadian critical care medicine (CCM) physicians, but little is known about what education is delivered, how competence is assessed, and what challenges exist. We evaluated the Canadian CCUS education landscape and compared it against published recommendations. Methods A 23-item survey was developed and incorporated a literature review, national recommendations, and expert input. It was sent in the spring of 2019 to all 13 Canadian Adult CCM training programs via their respective program directors. Three months were allowed for data collection and descriptive statistics were compiled. Results Eleven of 13 (85%) programs responded, of which only 7/11 (64%) followed national recommendations. Curricula differed, as did how education was delivered: 8/11 (72%) used hands-on training; 7/11 (64%) used educational rounds; 5/11 (45%) used image interpretation sessions, and 5/11 (45%) used scan-based feedback. All 11 employed academic half-days, but only 7/11 (64%) used experience gained during clinical service. Only 2/11 (18%) delivered multiday courses, and 2/11 (18%) had mandatory ultrasound rotations. Most programs had only 1 or 2 local CCUS expert-champions, and only 4/11 (36%) assessed learner competency. Common barriers included educators receiving insufficient time and/or support. Conclusions Our national survey is the first in Canada to explore CCUS education in critical care. It suggests that while CCUS education is rapidly developing, gaps persist. These include variation in curriculum and delivery, insufficient access to experts, and support for educators.

Fit for the Next Fifty Exercise Program: 25 Years of Reflections, Results, and Partnerships

Consistent exercise provides a multitude of physical, social, and emotional benefits. Common barriers to regular exercise for older adults include time, transportation, risk of injury, existing limitations, and negative experiences or attitudes about exercise. Fit for the Next Fifty is a comprehensive exercise and wellness program designed to address barriers and excuses. The program , based in CNY, has an impressive 25 year history of providing a unique mix of aerobic, strength training, yoga, and balance-based ballet. Participants (100-120) attend up to 5 classes per week at no charge during summer months and continue through winter months for a small fee. Developing and sustaining funding partnerships has been critical to the long-term success of Fit for the Next Fifty. Participants, ages 60-96, are active providers of feedback and suggestions, a key component to keeping the music, movements, and fellowship enjoyable and meaningful for over two decades. Program details, participant pictures and testimonials, research results, surveys across the years, and partnering/funding strategies provided. Of special interest is the social support dimension of the program. Participants have developed a sophisticated network to support each other outside of the exercise and wellness programs provided by Fit for the Next Fifty.

Corporate Social Responsibility of Organizations as Part of a Quality Management System

The paper deals with the topic of social responsibility in selected organizations in the Czech Republic. This topic is mainly associated with the requirements for economical and ecological production. In reality, however, this area has a much broader meaning. In the introduction, the paper deals with the definition of corporate social responsibility, the importance of this industry, the description of stake-holders and the basic principles of the whole concept. Furthermore, the paper deals with the benefits of implementing corporate social responsibility in the overall concept of the organization and describes the most common barriers to the adoption of the concept of CSR in organizations. The next part analyses the current attitude of organizations to CSR in the form of a questionnaire survey. Organizations from various areas of the private as well as the public sector were involved in the survey. The questionnaire is divided into three groups within the questions asked to the respondents. The first part of the questions is focused on the identification of organizations, focus size and other information. The second part focuses on awareness of corporate social responsibility and the last part deals with issues related to strengthening awareness of CSR.

Abstract 14218: Post-Cardiac Arrest Care Delivery Varies Widely Across Institutions Belonging to the PediRES-Q Collaborative

Introduction: Despite national pediatric post-cardiac arrest care (PCAC) guidelines to improve survival and neurological outcomes, there are limited studies describing PCAC delivery in pediatric institutions. The objective of this study was to describe reported PCAC delivery in pediatric institutions. We hypothesized that there would be variability in PCAC processes across institutions. Methods: An IRB-approved REDCap survey was distributed electronically to the lead resuscitation investigator at each institution belonging to the international Pediatric Resuscitation Quality Improvement collaborative (PediRES-Q). Data were summarized using descriptive statistics. A chi-square test was used to compare categorical data. Results: Twenty-four of 47 centers completed the survey (51%). Most respondents (58%) belonged to large centers (≥1000 annual PICU admissions). Two-third (67%) of centers reported using no specific selection criteria to initiate PCAC with the other third employing order sets, paper forms, or institutional guidelines. Smaller centers (<1000 annual PICU admissions) more frequently reported the use of attending-directed care for PCAC initiation/delivery (80%) versus larger centers (57%), p = 0.04. Common PCAC targets included temperature (96%), glucose (75%), and age-based blood pressure (88%). Most PCAC included EEG (75%) but neuroimaging was only included at 46% of centers. Duration of PCAC was either tailored to clinical improvement and neurological exam (54%) or time-based (45%). Only 25% of centers reported having a mechanism for evaluating PCAC adherence. Common barriers to effective PCAC implementation included lack of time and limited training opportunities (Figure 1). Conclusions: There is wide variation in PCAC delivery among surveyed pediatric institutions. Targeting common themes such as standardization of PCAC initiation and bundle components and implementing adherence evaluation could improve PCAC.

The movement-to-music (M2M) study: study protocol for a randomized controlled efficacy trial examining a rhythmic teleexercise intervention for people with physical disabilities

Background People with physical disabilities need exercise routines that are enjoyable, readily available in the home, adapted to their functional level, and eliminate common barriers to exercise participation related to transportation and time commitment. The purpose of the movement-to-music (M2M) study is to address these issues by establishing a remotely delivered, rhythmic exercise program for people with physical disabilities. Methods The study is a two-arm randomized controlled efficacy trial examining a 12-week remotely delivered M2M intervention (eM2M) in 108 people with physical disabilities. The primary outcomes are changes in cardiorespiratory fitness and muscle strength at post 12-week intervention. Discussion The eM2M study will enhance our understanding of an alternative intervention design and delivery mode that removes common barriers to exercise participation experienced by people with physical disabilities. The eM2M intervention may be an alternative option for people with physical disabilities to obtain regular exercise, especially during a pandemic when exercising in indoor facilities may be problematic. Trial registration ClinicalTrials.gov NCT03797378. Registered on January 9, 2019, with the trial name “Movement-to-Music: Lakeshore Examination of Activity, Disability, and Exercise Response Study (M2M LEADERS)”.