Physical Therapy Management of a Patient on Portable Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: A Case Report

Introduction

Although the life expectancy for patients with cystic fibrosis (CF) has increased dramatically in the preceding decades, often the final therapeutic option for patients with end-stage CF is lung transplantation. Prior to transplantation, patients with severe disease may require mechanical ventilation. Those refractory to mechanical ventilation may require extracorporeal membrane oxygenation (ECMO). The purpose of this case report is to describe the physical therapy management of a patient who received ECMO as a bridge to lung transplantation.

Case Presentation

A 16-year-old girl with severe acute respiratory failure due to a CF exacerbation eventually required ECMO to maintain adequate gas exchange. While on ECMO, she received physical therapy interventions ranging from therapeutic exercise, manual therapy, and integumentary protection techniques in addition to airway clearance techniques. Prior to her transplant, she was standing multiple times per day with moderate assistance, was sitting on the edge-of-bed, as well as taking steps to transfer to/from a chair. She successfully received a bilateral lung transplant after 8 days on ECMO.

Conclusion

Physical therapy interventions, including out-of-bed mobility, can be safely provided to patients on portable ECMO as a bridge to lung transplantation. These interventions were focused on preventing the negative sequelae of bed rest, increasing her strength and endurance, as well as improving her level of consciousness and psychological well being in preparation for lung transplantation.Key Words: extracorporeal membrane oxygenation, lung transplantation, physical therapy, exercise     

School improvement plans and student learning in Jamaica

A school improvement program that provided support to poor-performing schools on the basis of needs identified in a school improvement plan was implemented in 72 government schools in Jamaica, from 1998 to 2005. In this independent evaluation of the program, we use propensity score matching to create, post hoc, a control group of schools that were similar to program schools in the baseline year. By the final year of the program, we find that program schools had received more inputs to improve literacy and numeracy than control schools, and that some inputs associated with the program were correlated with improvements school average achievement: supplementary reading materials, additional training for reading resource teachers, and functioning computers. At the student level, however, we find no evidence that students enrolled in program schools achieved higher reading or math scores than those in control schools. We suggest three possible reasons for this: (a) the lack of sensitivity of the learning measures to improvements at the lower end of the scales; (b) the availability of program-like inputs in non-program schools, provided by other programs and donors; and (c) the growth in student enrollment in the program schools, which may have diluted the program effect for incoming students in upper grades. Schools with school improvement plans did not outperform comparable schools that did not have these plans.     

Preliminary comparison of the performance of the National Library of Medicine's systematic review publication type and the sensitive clinical queries filter for systematic reviews in PubMed

Objective:The National Library of Medicine (NLM) inaugurated a “publication type” concept to facilitate searches for systematic reviews (SRs). On the other hand, clinical queries (CQs) are validated search strategies designed to retrieve scientifically sound, clinically relevant original and review articles from biomedical literature databases. We compared the retrieval performance of the SR publication type (SR[pt]) against the most sensitive CQ for systematic review articles (CQrs) in PubMed.Methods:We ran date-limited searches of SR[pt] and CQrs to compare the relative yield of articles and SRs, focusing on the differences in retrieval of SRs by SR[pt] but not CQrs (SR[pt] NOT CQrs) and CQrs NOT SR[pt]. Random samples of articles retrieved in each of these comparisons were examined for SRs until a consistent pattern became evident.Results:For SR[pt] NOT CQrs, the yield was relatively low in quantity but rich in quality, with 79% of the articles being SRs. For CQrs NOT SR[pt], the yield was high in quantity but low in quality, with only 8% being SRs. For CQrs AND SR[pt], the quality was highest, with 92% being SRs.Conclusions:We found that SR[pt] had high precision and specificity for SRs but low recall (sensitivity), whereas CQrs had much higher recall. SR[pt] OR CQrs added valid SRs to the CQrs yield at low cost (i.e., added few non-SRs). For searches that are intended to be exhaustive for SRs, SR[pt] can be added to existing sensitive search filters.     

Instructional Design and Powerful Learning

Skillfully executed, instructional design can result in effective and efficient means to meet learning goals. However, more powerful learning experiences seem to go beyond effectiveness, efficiency, appeal, and even predetermined goals. This study sought to identify the key features of instructional design, to determine the nature of powerful learning experiences, and to explore how the two might relate. A survey of experts and a series of interviews with adult learners revealed overlap in some areas, for example, in the perceived importance of active engagement in authentic situations, and clear differences in others, most significantly the importance placed by learners on continual face‐to‐face personal interaction with a mentor/expert teacher. Speculations are offered on what similar results from additional studies might imply with regard to design actions and choices, and questions for further research are posed.     

Tertiary Education and Management (TEAM)

Instructions for Authors

Tertiary Education and Management (TEAM)     

JIME: an interactive journal for interactive media

How can new media positively transform scholarly practices? In this article, we describe the Journal of Interactive Media in Education (JIME). JIME's peer-review process is designed to promote multidisciplinary dialogue through the use of a purpose-designed web document–discussion interface. This innovative peer-review model and the resulting enriched digital documents illustrate some of the possibilities for promoting knowledge construction and preserving intellectual products in digital scholarly publications. We present JIME's technical infrastructure, editorial policy, and peer-review process, and discuss how these features are used to support the journal's goals. Finally, we conclude by considering what aspects of our approach might be suitable for e-journals in other disciplines.     

In the eyes of the beholder: How experts and novices interpret dynamic stimuli

Tasks with a complex, dynamic visual component require not only the acquisition of conceptual/procedural but also of perceptual/attentional skills. This study examined expertise differences in perceiving and interpreting complex, dynamic visual stimuli on a performance and on a process level, including perceptual and conceptual strategies. Performance, eye movement, and verbal report data were obtained from seven experts and 14 novices. Results show that experts compared to novices attend more to relevant aspects of the stimulus, use more heterogeneous task approaches, and use knowledge-based shortcuts. Implications for instructional design for the acquisition of perceptual skills are discussed.     

Does (Non‐)Meaningful Sensori‐Motor Engagement Promote Learning With Animated Physical Systems?

Previous research indicates that sensori‐motor experience with physical systems can have a positive effect on learning. However, it is not clear whether this effect is caused by mere bodily engagement or the intrinsically meaningful information that such interaction affords in performing the learning task. We investigated (N = 74), through the use of a Wii Balance Board, whether different forms of physical engagement that was either meaningfully, non‐meaningfully, or minimally related to the learning content would be beneficial (or detrimental) to learning about the workings of seesaws from instructional animations. The results were inconclusive, indicating that motoric competency on lever problem solving did not significantly differ between conditions, nor were response speed and transfer performance affected. These findings suggest that adult's implicit and explicit knowledge about physical systems is stable and not easily affected by (contradictory) sensori‐motor experiences. Implications for embodied learning are discussed.     

Pillow Talk and Cognitive Decision-making Processes: Exploring the Influence of Orgasm and Alcohol on Communication after Sexual Activity

This study explores individuals' postcoital disclosures by investigating the role of orgasm and alcohol on communication after sexual activity over a two-week period. Assessments of the risks and benefits of disclosing were expected to influence the associations among orgasm, alcohol, and postcoital communication. The results revealed that individuals who orgasmed perceived greater benefits to disclosing to their partners after sexual activity. They also disclosed more positively valenced information and information of greater magnitude compared to those who did not orgasm, although risk–benefit assessments did not mediate this relationship. Additionally, the more alcohol individuals consumed, the fewer benefits they assessed to disclosing, the less deep and positively valenced their disclosures were, and the more unintentional they were in their disclosures. Similarly, the relationship between alcohol and the dimensions of disclosure was not mediated by risk–benefit assessments. Finally, individuals who consumed more alcohol and did not orgasm disclosed less positively valenced information than individuals who consumed less alcohol and did not orgasm across occasions. The implications of these findings for couples' communication and future research on the postcoital time interval are discussed.