Denis Visentin

The effect of yoga on women with secondary arm lymphoedema from breast cancer treatment

BackgroundWomen who develop secondary arm lymphoedema subsequent to treatment associated with breast cancer require life-long management for a range of symptoms including arm swelling, heaviness, tightness in the arm and sometimes the chest, upper body impairment and changes to a range of parameters relating to quality of life. While exercise under controlled conditions has had positive outcomes, the impact of yoga has not been investigated. The aim of this study is to determine the effectiveness of yoga in the physical and psycho-social domains, in the hope that women can be offered another safe, holistic modality to help control many, if not all, of the effects of secondary arm lymphoedema.Methods and designA randomised controlled pilot trial will be conducted in Hobart and Launceston with a total of 40 women receiving either yoga intervention or current best practice care. Intervention will consist of eight weeks of a weekly teacher-led yoga class with a home-based daily yoga practice delivered by DVD. Primary outcome measures will be the effects of yoga on lymphoedema and its associated symptoms and quality of life. Secondary outcome measures will be range of motion of the arm and thoracic spine, shoulder strength, and weekly and daily physical activity. Primary and secondary outcomes will be measured at baseline, weeks four, eight and a four week follow up at week twelve. Range of motion of the spine, in a self-nominated group, will be measured at baseline, weeks eight and twelve. A further outcome will be the women’s perceptions of the yoga collected by interview at week eight.DiscussionThe results of this trial will provide information on the safety and effectiveness of yoga for women with secondary arm lymphoedema from breast cancer treatment. It will also inform methodology for future, larger trials.Trial registrationACTRN12611000202965

Ghostman: Augmented Reality Application for Telerehabilitation and Remote Instruction of a Novel Motor Skill

This paper describes a pilot study using a prototype telerehabilitation system (Ghostman). Ghostman is a visual augmentation system designed to allow a physical therapist and patient to inhabit each others viewpoint in an augmented real-world environment. This allows the therapist to deliver instruction remotely and observe performance of a motor skill through the patients point of view. In a pilot study, we investigated the efficacy of Ghostman by using it to teach participants to use chopsticks. Participants were randomized to a single training session, receiving either Ghostman or face-to-face instructions by the same skilled instructor. Learning was assessed by measuring retention of skills at 24-hour and 7-day post instruction. As hypothesised, there were no differences in reduction of error or time to completion between participants using Ghostman compared to those receiving face-to-face instruction. These initial results in a healthy population are promising and demonstrate the potential application of this technology to patients requiring learning or relearning of motor skills as may be required following a stroke or brain injury.

Control of the motion of the ions in rotating magnetic field current drive: 2. Transient analysis

The time-dependent equations describing current drive in an infinitely long plasma cylinder by means of two counter-rotating magnetic fields are solved numerically neglecting the second and higher harmonics. The accessibility of steady state solutions where both rotating magnetic fields (RMFs) penetrate into the plasma much farther than the classical skin depth, the electrons being entrained by the (−) RMF and the ions by the (+) RMF, is demonstrated. The slip of the ions with respect to the (+) RMF is required to be initially negative, with a suitable radial profile. It is also shown that the use of two counter-rotating RMFs is possible only when the frequency of the (+) RMF is larger than the electron–ion momentum-transfer collision frequency (ω+>νei).

Ion motion control in RMF current drive by means of a frequency modulated counter-RMF

A numerical model of current drive is developed in an infinitely long plasma cylinder, by means of two counter-rotating magnetic fields (RMFs) where the frequency of the (+) RMF is allowed to vary. The accessibility of steady state solutions where both RMFs penetrate into the plasma much farther than the classical skin depth, the electron fluid rotating synchronously with the (-) RMF and the ion fluid rotating synchronously with the (+) RMF, is examined. It is demonstrated that the steady state solutions are accessible from a broader class of initial conditions by allowing the frequency of the (+) RMF to decrease linearly. The rate of change in the frequency of the (+) RMF is required to be greater than the ion relaxation rate due to collisions with the electron fluid.

Burnout and compassion fatigue: prevalence and associations among Israeli burn clinicians

Acute health care environments can be stressful settings with clinicians experiencing deleterious effects of burnout and compassion fatigue affecting their mental health. Subsequently, the quality of patient care and outcomes may be threatened if clinicians experience burnout or compassion fatigue. Therefore, the aim of this descriptive, cross-sectional study was to evaluate the prevalence of burnout and compassion fatigue among burn clinicians in Israel. Fifty-five clinicians from Burns, Plastics and Reconstruction Surgery and Intensive Care completed four validated surveys to assess burnout (Maslach Burnout Inventory), depression (PRIME-MD), health-related quality of life (SF-8), and compassion fatigue (Professional Quality of Life version 5). Burn clinicians were compared with Plastics and Reconstruction Surgery and Intensive Care clinicians. This study identified a high prevalence of burnout (38.2%) among Intensive Care, Plastics and Reconstruction and Burns clinicians, with Burns clinicians having a greatly increased prevalence of burnout compared to Intensive Care clinicians (OR =24.3, P=0.017). Additional factors contributing to compassion fatigue were those without children (P=0.016), divorced (P=0.035), of a younger age (P=0.019), and a registered nurse (P=0.05). Burnout increased clinicians’ risk of adverse professional and personal outcomes and correlated with less free time (P<0.001), increased risk of experiencing work-home disputes (P=0.05), increased depression (P=0.001) and decreased career satisfaction (P=0.01). Burnout was also associated with higher physical (mean difference =3.8, P<0.001) and lower mental (mean difference =−3.5, P<0.001) Quality of Life scores. Caring for burn survivors can lead to burnout, compassion fatigue, and vicarious trauma. Identifying strategies to abate these issues is essential to ensure improved clinicial environments and patient outcomes.

Acid burn attacks: Looking beneath the surface

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/jan.13532 This article is protected by copyright. All rights reserved. PROFESSOR MICHELLE CLEARY (Orcid ID : 0000-0002-1453-4850)

The development and impact of heterotopic ossification in burns: A review of four decades of research

Introduction: Heterotopic ossification (HO) is the formation of lamellar bone within connective and other tissue where bone should not form and is a rare complication after burn injury. However, it leads to severe pain and distress, marked reduction in joint range of motion (ROM), impaired function and increased hospital length of stay. The pathophysiology, incidence and risk factors of HO remain poorly understood in burns and other traumas and the management, controversial. The aim of this comprehensive review, therefore, was to synthesise the available evidence on the development and treatment of HO after acute burn injury. Methods: The review was based on a systematic search of five electronic databases PubMed, EMBASE, CINAHL, LILACS and Scopus. Results: Synthesis and analysis of the data highlighted that, despite the passage of time, little translatable evidence is available to guide any prevention, screening, diagnostic or pharmacological or physical management protocols. Discussion: Causes of HO remain confounded, therefore prevention is difficult. Although spontaneous resolution is possible, surgical resection remains the recommended treatment when ROM and activities of daily living are severely affected. Conclusion: The findings from this review indicate that multicentre data pooling is needed to understand the optimum pathway to prevention, identification and treatment of HO in acute burn patients. Lay Summary Background to this subject: Heterotopic ossification (HO) is the formation of bone within the tissue where bone should not form and is a rare complication after burn injury. However, it leads to severe pain and distress, marked reduction in joint range of motion (ROM), impaired function and increased hospital length of stay. The pathophysiology, incidence and risk factors of HO remain poorly understood in burns and other traumas and the management, controversial. Question being asked or issue explored: The aim of this comprehensive review was to synthesise the available evidence on the development and treatment of HO after acute burn injury. Details of how the work was conducted: The review was based on a systematic search of medical electronic databases to identify relevant published literature. What we did and did not learn from this study: Synthesis and analysis of the data highlighted that, despite the passage of time, little translatable evidence is available to guide any prevention, screening, diagnostic or pharmacological or physical management protocols. Causes of HO remain confounded, therefore prevention is difficult. Although spontaneous resolution is possible, surgical resection remains the recommended treatment when ROM and activities of daily living are severely affected. The findings from this review indicate that multicentre data pooling is needed to understand the optimum pathway to prevention, identification and treatment of HO in acute burn patients.

Critical care polyneuropathy in burn injuries: An integrative review

Polyneuropathy is a debilitating condition which may be associated with large burns. The aim of this integrative review is to identify factors that contribute to the development of critical care polyneuropathy in patients admitted to an intensive care unit with a severe burn injury. PubMed, Scopus, CINHAL and EMBASE were searched up until July 2016. Studies/case reports focusing on critical care polyneuropathy for burn injured patients were included. The ten studies, included a total of 2755 burns subjects and identified 128 critical care polyneuropathy patients with an incidence of 4.4%. Three case reports identified prolonged ventilation and development of critical care neuropathy. Overall, factors identified as contributing to the development of critical care polyneuropathy in burn injured patients included prolonged ventilation (>7 days), large and deep total body surface area burns (mean TBSA 40%), and sepsis. Critical care polyneuropathy in burn patients remains challenging to diagnose and treat. To date, there is a lack of long term studies describing the impact of critical care polyneuropathy on functional performance or participation in activities of daily living in the burns population and this is consistent with the general literature addressing the lack of follow up assessments and long term consequences of persistent muscle weakness.

Migration of adult children and mental health of older parents ‘left behind’: An integrative review

Background Although a number of studies have examined the effect of the out-migration of children on the mental health of ‘left behind’ elderly parents, research on the consequences of children’s migration on the mental health and well-being of elderly parents left behind is inconclusive and a systematic review is warranted. Objectives To identify the association between the left behind or empty nest status and the mental health of older parents, and to identify common risk factors for poor mental health among those left behind. Methods Online databases CINAHL, PsycINFO, PubMed, Scopus and ProQuest were searched for research (2000-September 2017) that focused on the relationship between the migration of adult children and the mental health of the older parents (≥50 years) left behind. The JBI Checklist for Analytical Cross Sectional Studies was used to assess the methodological quality of the articles. Results 25 articles met the inclusion criteria. The studies identified that left behind older parents had higher levels of mental health problems compared to non-left behind. Left behind parents had higher depressive symptoms, higher levels of loneliness, lower life satisfaction, lower cognitive ability and poorer psychological health. A number of risk factors were identified for mental health disorders among the left behind parents, which included living arrangements, gender, education, income, physical health status, physical activity, family and social support, age, rural residence and frequency of children’s visit. Conclusions This review synthesised the various studies related to the mental health of left behind parents, advancing the theoretical and empirical understanding of the implications of out-migration of adult children on the psychological health and well-being of older parents. More responsive preventive measures and effective management approaches are required for this vulnerable cohort.

Suicide by charcoal burning: a digital age phenomenon

Charcoal burning is a method of suicide that has only recently been identified, but now attributes to a significant an ever-increasing number of suicides. Before 2000, this method was relatively unknown and the exact mechanism of death unclear. Media coverage has more recently raised awareness of the phenomenon (Chen et al., 2016). The method involves burning of barbecue charcoal in a confined space, leading to carbon monoxide (CO) poisoning (Chen, Yip, Lee, Gunnell, & Wu, 2015). Charcoal is particularly predisposed to smouldering, which results in less effective combustion and more CO emissions than CO2 (Schmitt, Williams, Woodard, & Harruff, 2011). So recent is the uptake of this method that charcoal burning, that it still lacks a specific code under the International Classification of Diseases 10th Edition (Ji, Hong, Stack, & Lee, 2014). Correct categorisation of suicide by charcoal burning is unlikely to persist. A sharp rise was noted in the incidence of charcoal burning in the early 2000s in Japan (Yoshioka, Saijo, & Kawachi, 2016). Following the first reported case of a 38-year old woman in Hong Kong, in 1998 (Liu et al., 2007), it is now one of the most common modes of suicide in Asia, accounting for 20% of all suicides in Hong Kong and Taiwan. In Japan, it accounts for 12.8% of male suicides and 5.9% of females (Kato et al., 2013), with increases also noted in South Korea, Singapore (Cheng, Chang, Guo, & Yip, 2015) and Taiwan, where this method increased 65-fold between 1995 and 2011 (Chang, Kwok, Cheng, Yip, & Chen, 2015). This increase in charcoal suicides in Hong Kong have not been compensated by decreases in other methods, indicating that the availability of this method of suicide may be contributing to increased suicide rates (Liu et al., 2007). Its influence has also been felt in Western nations, with a study in Washington, United States, finding that charcoal burning was increasing with a correlated decrease in suicide by automotive exhaust fume inhalation (Schmitt et al., 2011). Although the study happened to be in a community with the largest Asian population in the USA, the highest incidence was 88% amongst Whites, suggesting no transnational nor cultural boundaries in this area. The concentration of suicides by charcoal burning in Asia and the acceptance of this method by non-Asians in a Western community suggests increased rates of suicide by this method as awareness increases outside of Asia. The emergence and increasing rates of suicide by charcoal requires explanation. Several authors have highlighted the increased accessibility of charcoal for cooking and heating purposes (Cheng et al., 2015), the inexpensiveness of acquiring charcoal (Schmitt et al., 2011), the higher degree of effectiveness (and therefore mortality) than alternatives such as hanging (Ji et al., 2014). The increase in charcoal burning as a mode of suicide has occurred in parallel with the effectiveness of efforts to decrease the toxicity of car exhaust fumes via use of catalytic converters (Schmitt et al., 2011). So convenient and effective is the method of charcoal burning that one Japanese study revealed that increased charcoal burning suicide occurred over a period where the rate of suicide had an overall increase, indicating that acceptance of this method had resulted in more suicides (Yoshioka et al., 2016). The media and Internet have played a significant role in the rising use of charcoal burning as a form of suicide. Over the last two decades there has been a significant rise in the use of the Internet, particularly in Asia, and this has resulted in detailed technical information about methods of suicide becoming readily available to a wide audience (Chang et al., 2015; Cheng et al., 2015). One study found that an increase in Google search volume relating to charcoal burning was related to the incidence of suicide by this method in that same week as suicides increased and in the week following this change (Chang et al., 2015). A further study noted that of the 18 wiki-style pages that detailed suicide methods, none encouraged a person considering suicide to seek help (Cheng et al., 2015). This ready access to information is amplified during periods of media focus on the topic of suicide by charcoal burning. A study in Taiwan found that 87% of survivors of a suicide attempt by charcoal burning had been influenced by media coverage (Chang et al., 2015). The authors observed that the substance of media reporting promoted this method as one that was painless and effective, thereby increasing its appeal to this audience, a finding echoed by Chen et al. (2016). Chen et al. (2016) found that the first news report of a suicide by charcoal burning in Hong Kong described the method in detail and hence it is likely that media influence can increase the cognitive availability of methods in those with suicidal ideation. Media exposure of this particular suicide was then observed to have resulted in a copycat suicide in Taiwan (Ji et al., 2014). Chang et al. (2015) found that in the early stage of the charcoal burning uptake (1998–2000) one media article on the issue was associated with a 16% increase in the use of this method on the following day. The impact of media is amplified by the reporting of “celebrity suicide”. Much research has focused on the impact of a person with a public profile using a particular form of suicide and the resulting trends in choice of method by others in the immediate aftermath. Cheng et al. (2015) identified that after the death by charcoal burning by a notable South Korean actor in 2008 the rate of charcoal burning rose from 0.7% at that time to 7.9% in 2011. DOI: 10.1111/jan.13531