The physiological and perceptual responses of stand-up paddle board exercise in a laboratory- and field-setting

This study quantified the physiological and perceptual responses of stand-up paddle boarding (SUP) during a range of stroke rates in a laboratory- and field-setting. Ten participants (eight male, two female; mean ± standard deviation [SD] age: 23 ± 3 years; body mass: 70.5 ± 9.1 kg; height: 170 ± 9 cm; body mass index [BMI]: 24.3 ± 1.5 kg m²) completed a SUP ⩒O_2peak trial, and two SUP trials in both a laboratory- and field-setting (5-min at 10, 20 and 30 strokes min^-1 per stage). Energy expenditure (EE), metabolic equivalents (METs), heart rate (HR) and rating of perceived exertion (RPE) were recorded throughout. In the laboratory-setting, mean ± SD EE and METs increased (P < .001) linearly when SUP at 10 (3.3 ± 1.0 kcal min^-1, 2.7 ± 0.5), 20 (5.5 ± 0.9 kcal min^-1, 4.4 ± 0.7) and 30 strokes min^-1 (7.6 ± 1.6 kcal min^-1, 6.1 ± 1.2), respectively. During these efforts, mean ± SD percentage of maximal HR were 56 ± 5%, 69 ± 6% and 84 ± 8%, respectively. In the field-setting, mean ± SD EE and METs also increased (P < .001) linearly when SUP at 10 (3.6 ± 0.9 kcal min^-1, 2.7 ± 0.9), 20 (4.3 ± 1.8 kcal min^-1, 3.5 ± 1.0) and 30 strokes min^-1 (6.3 ± 2.1 kcal min^-1, 4.6 ± 1.4). During the three conditions, mean ± SD percentage of maximal HR were 58 ± 8%, 65 ± 7% and 73 ± 9%. SUP at ≥20 strokes min^-1 in the laboratory- and field-setting meet the criteria for moderate-intensity exercise (3.0-5.9 METs). These findings may now be included in the latest Compendium of Physical Activities guidelines and offer the potential to improve cardiorespiratory fitness if SUP is undertaken regularly by young, healthy adults.

Curriculum design of a case-based knowledge translation shift for emergency medicine residents

BACKGROUND

Principles of evidence-based medicine (EBM) may be inconsistently applied to clinical decision-making due to lack of practice-based training, experience, and time.

OBJECTIVES

The authors sought to design, implement, and test the feasibility of an experiential learning model for senior emergency medicine (EM) residents to apply EBM principles during real-time clinical practice.

METHODS

Targeted program evaluation of this learning model was conducted through a prospective observational cohort study involving EM residents at a large, urban, 4-year EM residency program. The curriculum development of a case-based knowledge translation shift followed Kern's six-step design process. Subjects asynchronously completed a 1-hour EBM tutorial and were then assigned to clinical shifts in which they contributed to the care of emergency department (ED) patients by completing formal literature searches related to active management questions. Pre- and post-intervention self-assessments of practice norms and attitudes were used to evaluate the effect of this experiential learning model for individual residents. Self-assessments of the likelihood that the experience would result in future practice change were reported on a five-point Likert scale (1 = greatly impeded, 2 = somewhat impeded, 3 = no change, 4 = somewhat improved, 5 = greatly improved). Subjects presented available evidence to the primary ED team, formally disseminated their findings as a brief "EBM rounds" at sign-out and completed an "EBM consult note" and case log to document shift performance. Changes in patient management and/or disposition were recorded. EBM search questions and resultant findings were entered in a local database.

RESULTS

Of the 45 eligible senior EM resident shifts, 91% resulted in complete sets of performance data and self-assessments. A total of 80 patient encounters were documented during 45 scheduled shifts over a 3-month study period. Literature review took a mean (±SD) of 36.2 (±26.4) minutes per case. During the 3-hour interval before or after shift sign-out, residents completed a mean (±SD) of 2.11 (±1.4) literature searches and recorded a mean (±SD) of 3.0 (±1.5) articles for each case. Alterations in ED management for 13 of 80 patient encounters (16.3%) were documented to be the direct result of on-shift literature searches.

CONCLUSIONS

Case-based knowledge translation shifts for senior EM residents can provide opportunities to practice EBM skills in the ED. This experiential learning model may result in future practice change by resident learners, as well as affect the management of active patients in the ED.

The freelance nurse writer role

Freelance nurse writers are skilled in facilitating a dialogue and writing from the perspective of the group. This article, written by an experienced freelance author, describes efficient methods to incorporate information gleaned from group interviews. The author provides tips on what type of projects to look for, how to develop the role, and even how to charge.

Knowledge-based technology in the service of health

The significance of numerical information for decision-making usually has to be assessed on the basis of knowledge that does not readily lend itself to quantification. Computational logic can help to handle the complexity of this process of interpretation without sacrificing the necessary rigour. When this approach is used, health indicators are expressed in the form of a "knowledge map".

Systems approach to resolving conduct issues among staff members

This article describes the outcomes of a foundation grant directed toward strengthening hospital nursing groups to improve patient care. The OR director and the grant-sponsored group facilitator at MeritCare Hospital, Fargo, ND, describe a systems approach to resolving pervasive conduct issues (eg, verbal abuse) in the surgical suite, thereby cultivating a positive work environment for perioperative staff members.