Search results for: patient safety in home hemodialysis

Authors: S. M. A. Ismail, M. I. Ibrahim, H. Masdar, F. M. Effendi, M. F. Suhaimi, A. Suun

Abstract:

Introduction: It is generally known that the rehabilitation process is as important as the reconstruction surgery. Several literature has focused on how early the rehabilitation modalities can be initiated after the surgery to ensure a safe return of patients to sports or at least regaining the pre-injury level of function following an ACL reconstruction. Objectives: The main objective is to study and evaluate the outcome of early balance exercises and agility training in sports rehabilitation for patients post ACL reconstruction. To compare between early balance exercises and agility training as intervention and control. (material or non-material). All of them were recruited for material exercise (balance exercises and agility training with strengthening) and strengthening only rehabilitation protocol (non-material). Followed the prospective intervention trial. Materials and Methods: Post-operative ACL reconstruction patients performed in Selayang and Sg Buloh Hospitals from 2012 to 2014 were selected for this study. They were taken from Malaysian Knee Ligament Registry (MKLR) and all patients had single bundle reconstruction with autograft hamstring tendon (semitendinosus and gracilis). ACL injury from any type of sports were included. Subjects performed various type of physical activity for rehabilitation in every 18 week for a different type of rehab activity. All subject attended all 18 sessions of rehabilitation exercises and evaluation was done during the first, 9th and 18th session. Evaluation format were based on clinical assessment (anterior drawer, Lachmann, pivot shift, laxity with rolimeter, the end point and thigh circumference) and scoring (Lysholm Knee scoring and Tegner Activity Level scale). Rehabilitation protocol initiated from 24 week after the surgery. Evaluation format were based on clinical assessment (anterior drawer, Lachmann, pivot shift, laxity with rolimeter, the end point and thigh circumference) and scoring (Lysholm Knee scoring and Tegner Activity Level scale). Results and Discussion: 100 patients were selected of which 94 patients are male and 6 female. Age range is 18 to 54 year with the average of 28 years old for included 100 patients. All patients are evaluated after 24 week after the surgery. 50 of them were recruited for material exercise (balance exercises and agility training with strengthening) and 50 for strengthening only rehabilitation protocol (non-material). Demographically showed 85% suffering sports injury mainly from futsal and football. 39 % of them have abnormal BMI (26 – 38) and involving of the left knee. 100% of patient had the basic radiographic x-ray of knee and 98% had MRI. All patients had negative anterior drawer’s, Lachman test and Pivot shift test during the post ACL reconstruction after the complete rehabilitation. There was 95 subject sustained grade I injury, 5 of grade II and 0 of grade III with 90% of them had soft end-point. Overall they scored badly on presentation with 53% of Lysholm score (poor) and Tegner activity score level 3/10. After completing 9 weeks of exercises, of material group 90% had grade I laxity, 75% with firm end-point, Lysholm score 71% (fair) and Tegner activity level 5/10 comparing non-material group who had 62% of grade I laxity , 54% of firm end-point, Lyhslom score 62 % (poor) and Tegner activity level 4/10. After completed 18 weeks of exercises, of material group maintained 90% grade I laxity with 100 % with firm end-point, Lysholm score increase 91% (excellent) and Tegner activity level 7/10 comparing non-material group who had 69% of grade I laxity but maintained 54% of firm end-point, Lysholm score 76% (fair) and Tegner activity level 5/10. These showed the improvement were achieved fast on material group who have achieved satisfactory level after 9th cycle of exercises 75% (15/20) comparing non-material group who only achieved 54% (7/13) after completed 18th session. Most of them were grade I. These concepts are consolidated into our approach to prepare patients for return to play including field testing and maintenance training. Conclusions: The basic approach in ACL rehabilitation is to ensure return to sports at post-operative 6 month. Grade I and II laxity has favourable and early satisfactory outcome base on clinical assessment and Lysholm and Tegner scoring point. Reduction of laxity grading indicates satisfactory outcome. Firm end-point showed the adequacy of rehabilitation before starting previous sports game. Material exercise (balance exercises and agility training with strengthening) were beneficial and reliable in order to achieve favourable and early satisfactory outcome comparing strengthening only (non-material).We have identified that rehabilitation protocol varies between different patients. Therefore future post ACL reconstruction rehabilitation guidelines should look into focusing on rehabilitation techniques instead of time.

Keywords: post anterior cruciate ligament (ACL) reconstruction, single bundle, hamstring tendon, sports rehabilitation, balance exercises, agility balance

Procedia PDF Downloads 255

Authors: Ran Yue, Zhejing Li

Abstract:

Context: The context of this study is the field of Digital Basketball Sports Games (DBSG). The existing DBSGs often prioritize competitiveness and confrontation, neglecting the narrative and progressive expression, especially from a female standpoint. This study aims to address this gap by analyzing existing DBSGs and proposing a comprehensive framework tailored to meet the needs and desires of women in basketball. Research Aim: The aim of this research is to examine the narrative perspectives of women in basketball and understand their desires and expectations within the sport. It also seeks to investigate methods to seamlessly integrate women's basketball stories into gameplay, addressing their specific needs and expectations. Additionally, the study aims to develop a digital basketball sports game framework that combines narrative richness and entertainment, with a focus on the female audience. Methodology: The study utilizes affective-arousal theories as a psychological framework to explore how emotional arousal influences player engagement and responses in the digital basketball sports game. It employs in-depth case studies to examine specific instances and gain insights into the implementation and impact of narrative elements and educational features in existing DBSGs. Comparative studies are conducted to analyze different DBSGs, identifying effective strategies and shortcomings. Findings: The research findings contribute to the development of a digital basketball game framework from a female perspective. This framework enhances the completeness, diversity, and inclusivity of digital basketball sports games. By addressing the specific needs of women in basketball, including fundamental knowledge, sports skills, safety awareness, and rehabilitation training methods, the framework provides a foundational reservoir for a broader range of basketball participation. It enriches the gaming experience by enhancing enjoyment, narrative, and diversity. It also acts as a catalyst to encourage more women to engage with basketball stories, participate in the sport, persevere, and derive greater enjoyment while benefiting their physical fitness and health. Theoretical Importance: The study contributes to the existing literature by incorporating game motivation psychology theories and proposing a comprehensive framework that caters to the specific needs of women in basketball. It emphasizes the importance of considering the narrative and progressive expression in DBSGs, especially from a female perspective. The research explores affective-arousal theories and provides insights into how emotional arousal can influence player engagement and responses in digital basketball sports games. Data Collection and Analysis Procedures: The study collects data through in-depth case studies of existing DBSGs, examining specific instances to uncover insights into the implementation and impact of narrative elements and educational features. Comparative studies are conducted to contrast and analyze various DBSGs, identifying effective strategies and shortcomings. The analysis procedures involve identifying commonalities, differences, strengths, and weaknesses among the DBSGs, guiding the development of a female-centric perspective in the proposed framework. Questions Addressed: The study addresses the following questions: What are the narrative perspectives of women in basketball? How can women's basketball stories be seamlessly integrated into gameplay? What are the specific needs and expectations of women in basketball? What effective strategies and shortcomings exist in current DBSGs? How can a digital basketball game framework be developed to cater to the female audience? Conclusion: In conclusion, this study contributes to the field of DBSGs by proposing a comprehensive digital basketball game framework from a female perspective. The framework enhances the inclusivity, diversity, and enjoyment of DBSGs by addressing the specific needs and desires of women in basketball. It provides a foundation for a broader range of basketball participation, enriching the gaming experience and benefiting women's physical fitness and health. The research, using affective-arousal theories and in-depth case studies, provides valuable insights into the implementation and impact of narrative elements and educational features in existing DBSGs, guiding the development of the proposed female-centric framework.

Keywords: digital basketball game, game framework, female perspective, game narratives

Procedia PDF Downloads 65

Authors: Julie M. Novak, Simone K. Brennan, Lacey Brim

Abstract:

Undergraduate medical education (UME) curriculum notably addresses micro-level communications (e.g., patient-provider, intercultural, inter-professional), yet frequently under-examines the role and impact of organizational communication, a more macro-level. Organizational communication, however, functions as foundation and through systemic structures of an organization and thereby serves as hidden curriculum and influences learning experiences and outcomes. Yet, little available research exists fully examining how students experience organizational communication while in medical school. Extant literature and best practices provide insufficient guidance for UME programs, in particular. The purpose of this study was to map and examine current organizational communication systems and processes in a UME program. Employing a phenomenology-grounded and participatory approach, this study sought to understand the organizational communication system from medical students' perspective. The research team consisted of a core team and 13 medical student co-investigators. This research employed multiple methods, including focus groups, individual interviews, and two surveys (one reflective of focus group questions, the other requesting students to submit ‘examples’ of communications). To provide context for student responses, nonstudent participants (faculty, administrators, and staff) were sampled, as they too express concerns about communication. Over 400 students across all cohorts and 17 nonstudents participated. Data were iteratively analyzed and checked for triangulation. Findings reveal the complex nature of organizational communication and student-oriented communications. They reveal program-impactful strengths, weaknesses, gaps, and tensions and speak to the role of organizational communication practices influencing both climate and culture. With regard to communications, students receive multiple, simultaneous communications from multiple sources/channels, both formal (e.g., official email) and informal (e.g., social media). Students identified organizational strengths including the desire to improve student voice, and message frequency. They also identified weaknesses related to over-reliance on emails, numerous platforms with inconsistent utilization, incorrect information, insufficient transparency, assessment/input fatigue, tacit expectations, scheduling/deadlines, responsiveness, and mental health confidentiality concerns. Moreover, they noted gaps related to lack of coordination/organization, ambiguous point-persons, student ‘voice-only’, open communication loops, lack of core centralization and consistency, and mental health bridges. Findings also revealed organizational identity and cultural characteristics as impactful on the medical school experience. Cultural characteristics included program size, diversity, urban setting, student organizations, community-engagement, crisis framing, learning for exams, inefficient bureaucracy, and professionalism. Moreover, they identified system structures that do not always leverage cultural strengths or reduce cultural problematics. Based on the results, opportunities for productive change are identified. These include leadership visibly supporting and enacting overall organizational narratives, making greater efforts in consistently ‘closing the loop’, regularly sharing how student input effects change, employing strategies of crisis communication more often, strengthening communication infrastructure, ensuring structures facilitate effective operations and change efforts, and highlighting change efforts in informational communication. Organizational communication and communications are not soft-skills, or of secondary concern within organizations, rather they are foundational in nature and serve to educate/inform all stakeholders. As primary stakeholders, students and their success directly affect the accomplishment of organizational goals. This study demonstrates how inquiries about how students navigate their educational experience extends research-based knowledge and provides actionable knowledge for the improvement of organizational operations in UME.

Keywords: medical education programs, organizational communication, participatory research, qualitative mixed methods

Procedia PDF Downloads 115