The Development of the Canadian Physiotherapy Assessment of Clinical Performance (ACP) 2.0 - Alignment with the 2017 Competency Profile

Purpose

Clinical education and assessment of students' performance during clinical placements are key components of Canadian entry-to-practice physiotherapy curriculum and important in developing entry-level physiotherapy practitioners. The Canadian Physiotherapy Assessment of Clinical Performance (ACP) is the measure currently used to assess physiotherapy student performance on clinical placements in most of the entry-to-practice physiotherapy programmes across Canada. The release of the 2017 Competency Profile by the National Physiotherapy Advisory Group resulted in a revision of the existing ACP. The purpose of this study is to report the process used to develop a revised version of the ACP based on the 2017 Competency Profile, henceforth called the ACP 2.0.

Method

Using a multistage process, we sought input from Canadian clinical education academics, an expert consultant panel, as well as physiotherapists across Canada using a questionnaire, meetings, and an online survey, respectively.

Results

Twelve of 15 clinical education academics responded to a questionnaire. The expert consultant panel (n = 12) met three times. There were 144 physiotherapists who initiated the national, online, survey and met the inclusion criteria; 84 completed the survey. In the ACP 2.0, rating scales and comments boxes were grouped, and additional text was added to 12 items for further clarification. The ACP 2.0 came to have 18 items and 9 comment boxes in addition to summative comments, in contrast to the original ACP's 21 items and 9 comment boxes.

Conclusions

In November 2020, Canadian clinical education academics reviewed the proposed draft ACP 2.0 and unanimously accepted it for implementation in Canadian physiotherapy university programmes.

Exploring the Experiences and Impacts of Research Role-Emerging Placements in Physiotherapy

Purpose

Research role-emerging placements (RREPs) have been integrated into placement offerings in Canadian physiotherapy programmes. The purpose of the present study is to describe the experiences and impacts of RREPs completed by graduates of Canadian physiotherapy programmes.

Methods

Participants were recruited by purposive sampling and completed semi-structured interviews to explore their RREP experiences. Themes were identified using thematic analysis and collaboratively analyzed using the DEPICT model.

Results

Eleven participants who completed RREPs during their Canadian physiotherapy programmes (three men, eight women; aged 26.9 [SD 2.7] years) took part in this study. The participants expressed the RREP was a valuable experience. Four themes emerged from the data: (1) Motivators for selecting an RREP included interest in research or a medical injury, (2) The RREP experience involved benefits and challenges, (3) Impacts of completing an RREP, and (4) RREP participant suggestions.

Conclusions

RREPs are valuable placement opportunities for learners in Canadian physiotherapy programmes facilitating the development of essential competencies in a non-traditional setting. RREPs could be considered as a placement opportunity for other allied health programmes, as the skills gained are beneficial for all health care professionals.

Physiotherapists' Perspectives on Professional Practice Leadership Models: Key Features to Enhance Physiotherapy Practice

Purpose: The purpose of this study was to explore professional practice leadership models (PPLMs) within the Toronto Academic Health Science Network (TAHSN) by outlining the PPLMs currently in use, identifying elements of the PPLMs from physiotherapists' perspectives, and determining key features of PPLMs that enhance physiotherapy (PT) practice. Methods: In this qualitative, cross-sectional study, we used focus groups to explore physiotherapists' knowledge about their facility's PPLM, physiotherapists' role within the PPLM, the impact of professional practice leaders on PT practice, the impact of the PPLM on physiotherapists' job satisfaction, and the elements of an ideal PPLM. We coded transcripts using qualitative software and followed an inductive data analysis approach to develop themes. Results:We conducted eight focus groups with physiotherapists from six TAHSN facilities (four organizations). Five key features of PPLMs emerged from participants' perspectives: support network, organizational structure, professional development opportunities, influence of the leader in professional practice, and balance of workloads and accountabilities. Each key feature encompassed a group of interrelated elements - that is, components of the PPLMs that influenced PT practice. Conclusions: Our study is the first to explore elements and key features of the PPLMs used in TAHSN facilities as they relate to PT. We provide five recommendations to enhance PPLMs with respect to the PT profession.

Assessing the inter-rater and intra-rater reliability of the Physical Therapy Competence Assessment for Airway Suctioning (PT-CAAS)

BACKGROUND AND PURPOSE

The Physical Therapy Competence Assessment for Airway Suctioning (PT-CAAS) is a recently developed measure to assess the clinical competence of physiotherapists who perform airway suctioning with adults. The purpose of this study was to assess the inter-rater and intra-rater reliability of the PT-CAAS.

METHODS

Scoring rules were developed through expert consultation. Reliability was then assessed using nine videos of suctioning performed in a simulated learning environment. A repeated measures design was used, with two replicate sets of measurements made by each participant for all videos. Data were analyzed using a repeated measures model for the concurrent assessment of inter-rater and intra-rater reliability. Participants were physiotherapists with suctioning experience.

RESULTS

Twenty physiotherapists completed initial scoring and re-scoring for all nine videos; their data were included in the analysis. Intraclass correlation coefficients (ICCs) for inter-rater reliability ranged from 0.569 [lower one-sided 95% confidence interval (CI): 0.395; standard error of measurement (SEM): 0.963] for infection control to 0.759 (lower one-sided 95% CI: 0.612; SEM: 0.722) for post-suctioning assessment and care. The inter-rater ICC for overall performance was 0.752 (lower one-sided 95% CI: 0.602; SEM: 0.660). ICCs for intra-rater reliability ranged from 0.759 (lower one-sided 95% CI: 0.197; SEM 0.721) for infection control to 0.860 (lower one-sided 95% CI: 0.544; SEM: 0.550) for post-suctioning assessment and care. The intra-rater ICC for overall performance was 0.867 (lower one-sided 95% CI: 0.559; SEM: 0.483).

DISCUSSION

Evidence of moderate to good inter-rater and good intra-rater reliability was found; however, the results should be interpreted with caution given the wide CIs and relatively large SEMs. Improved assessor training and assessments of reliability using a larger sample size are recommended.

Relationship between vitamin D and physical activity: systematic review and meta-analysis

Abstract Vitamin D plays an important role in immune function and inflammation and the physical activity demonstrate relationship near to syntheses of vitamin D, considering to necessary to factors immunologics, environmental and physical. We searched five databases through February 20, 2021. Two reviewers screened the studies, collected data, assessed the risk of bias, and ranked the evidence for each outcome across the studies, independently and in duplicate. The prespecified endpoints of interest were Cardiorespiratory Fitness; Sunlight Exposure; Body Mass Index (BMI). We only included data from peer-reviewed articles in our primary analyses. In our primary analysis, there was a positive trend between serum 25(OH)D <20 ng/ml and body mass index, this result should be interpreted with caution, considering confidence intervals (RR 1.10 95% CI 0.37 to 1.83. We identified 4 high quality evidence that vitamin D levels and high physical activity required a direct relationship considering (four trials with 2,253) ; RR 0. (RR 0.0; 95% CI -0.15 to 0.15) (RR 0.59; 95% CI 0.43 to 0.75. Although the evidence available so far, from observational studies of medium quality, can be seen as showing a trend towards an association between sufficient serum levels of 25(OH)D and physical activity, this relationship has been shown. have a stimulating effect on vitamin D synthesis, the relationship of low body mass index with sufficient vitamin D levels is not based on solid evidence. We await results from ongoing studies to determine this effectiveness.

Physiotherapy Students' Performance in Clinical Education: An Analysis of 1 Year of Canadian Cross-Sectional Data

Purpose: This research examines 1 year of cross-sectional, Canada-wide ratings from clinical instructors using the Canadian Physiotherapy Assessment of Clinical Performance (ACP) and analyzes the performance profiles of physiotherapy students' performance ratings over the course of their entry-to-practice clinical placements. Method: Canadian physiotherapy programmes that use the ACP were invited to submit anonymized, cross-sectional data for placements completed during 2018. Descriptive analyses and summary statistics were completed. Mixed-effects modelling was used to create typical performance profiles for each evaluation criterion in the ACP. Stepwise ordered logistic regression was also completed. Results: Ten programmes contributed data on 3,290 placements. Profiles were generated for each ACP evaluative item by means of mixed-effects modelling; three profiles are presented. In all cases, the predicted typical performance by the end of 24 months of study was approximately the rating corresponding to entry level. Subtle differences among profiles were identified, including the rate at which a student may be predicted to receive a rating of "entry level." Conclusions: This analysis identified that, in 2018, the majority of Canadian physiotherapy students were successful on clinical placements and typically achieved a rating of "entry level" on ACP items at the end of 24 months.

How Do I Choose a Job? Factors Influencing the Career and Employment Decisions of Physiotherapy Graduates in Canada

Purpose: Physiotherapy is a diverse profession: there are many areas in which physiotherapists can practise. New graduates must decide in which area of physiotherapy they would like to work and with which organizations to seek employment. The purpose of this study was to describe the factors that influenced the career (area of practice, practice setting) and employment (organization) decisions of recent physiotherapy graduates. Method: Given Canada's vast expanse, we used survey methodology. We invited English-speaking physiotherapists who had completed their physiotherapy education between October 2015 and December 2017 to participate in this study. The survey was emailed to 1,442 physiotherapists in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Nova Scotia. Results: We collected 351 responses (24%). Almost all respondents reported currently working as a physiotherapist, and the majority worked with patients with musculoskeletal conditions. Clinical education experiences were most influential in determining career decisions. Area of practice, practice setting, and mentorship were the most influential factors contributing to employment decisions. Conclusions: Clinical education experiences are influential in shaping physiotherapy students' career and employment decisions. Employers who want to recruit physiotherapy graduates may consider partnering with physiotherapy programmes to offer clinical placement experiences and develop mentorship programmes that help build novice physiotherapists' competence and confidence.

Using Expert Consensus to Develop a Tool to Assess Physical Therapists' Knowledge, Skills, and Judgement in Performing Airway Suctioning

Purpose: The aim of this study was to develop a tool to assess physical therapists' knowledge, skills, and judgement in performing airway suctioning with intubated and non-intubated adults. Method: A modified Delphi methodology was used to develop the tool and to evaluate its sensibility (i.e., common-sense nature). Participants were experienced cardiorespiratory physical therapists who perform airway suctioning and physical therapists employed in academic positions related to cardiorespiratory physical therapy at Canadian universities. Round 1 focused on refining which items to include in the tool, Round 2 focused on finalizing the items, and Round 3 focused on evaluating a preliminary version of the tool. Results: A total of 34 individuals participated in Round 1, 30 participated in Round 2, and 25 participated in Round 3. A literature review identified 11 relevant domains and 69 supporting competencies. In Round 1, consensus was achieved for all domains; however, it was borderline for the professionalism domain. Multiple participants suggested that it was redundant because it is a global requirement for all physical therapists. Consensus was also achieved for 64 of the 69 supporting competencies; however, it was borderline for 5 of these items, and 5 achieved no consensus. In Round 2, participants rated a series of recommendations related to items requiring further consideration, as well as 9 new items suggested by the participants in Round 1. In Round 3, the preliminary tool was found to be globally sensible, but concerns were expressed about the inclusion of redundant factors and the tool's length. The tool was revised, resulting in a tool with 4 domains, 6 sub-domains and 43 supporting competencies, as well as an item rating the individual's overall performance. Conclusions: The final-round sensibility questionnaire provided preliminary evidence of the tool's face and content validity. We will investigate the tool's measurement properties in a future study.

Designing, Implementing, and Evaluating a Practice Tutor Internship Model during an Acute Care Clinical Internship

Purpose: The purpose of this study was to implement and evaluate a novel internship model that incorporates a practice tutor in physiotherapy clinical education during an acute care cardiorespiratory internship at a large acute tertiary care teaching hospital in Canada. Method: A prospective evaluation of this model was conducted by means of a mixed-methods approach using surveys and focus groups. The participants were students and clinical instructors (CIs) who were taking part in the internship. Results: Half of the CIs agreed that the practice tutor model gave them more time to manage their caseload and work with the student than did the traditional model, and 63% would recommend the model for future internships. In reviewing the focus group and open-ended data, we identified four themes: benefits, tensions, critical logistics, and unforeseen blind spots. There was a trend for patient attendance to increase with the practice tutor model compared with the previous year's internship session and with the 5 weeks immediately preceding the internship. Conclusions: On the basis of CIs' and students' self-reports, the piloted practice tutor model was perceived to facilitate students' clinical reasoning and collaborative learning skills. In addition, during the 5-week internship, the number of patients seen each day by the individual CIs and their students was not reduced, with a trend toward increased patient attendance. There was also a trend toward CIs having the same or more time to manage their caseload and work with the students compared with a non-practice tutor internship model. Recommendations to improve this model in future implementations are made.

Students' Perspectives on Their Experience in Clinical Placements: Using a Modified Delphi Methodology to Engage Physiotherapy Stakeholders in Revising the National Form

Purpose: We developed an evidence-informed Student Evaluation of the Clinical Placement form. This form gives students the opportunity to share their feedback and perceptions of their clinical placement experiences and provides meaningful data to all stakeholders. Method: We used a modified Delphi process to engage a sample of national stakeholders: physiotherapy clinical education leads of academic departments, centre coordinators of clinical education, clinical instructors, and students. An expert consultant panel, in addition to the investigators, reviewed the responses from each round and helped develop the questionnaire for the subsequent round and finalize the evaluation form. Results: The response rate was 65.3% (47 of 72) for Round 1, 76.6% (36 of 47) for Round 2, and 100% (36 of 36) for Round 3. After three rounds of questionnaires, 89% of participants thought that the evaluation form met their needs. Conclusions: We developed a revised Student Evaluation of the Clinical Placement form that is informed by the literature and meaningful to all stakeholders. This form is being implemented in physiotherapy university programmes across Canada to enable students to share their experiences at clinical sites.

Assessing the Clinical Competence of Health Care Professionals Who Perform Airway Suctioning in Adults

Airway suctioning is an important health care intervention that can be associated with serious adverse effects. Given the risks involved with suctioning, it is important to ensure the clinical competence of health care professionals who perform it. A scoping review was conducted to identify the nature and extent of research related to the assessment of airway-suctioning competence for health care professionals working with adults. This included an examination of the assessment context, the type of suctioning and health care professionals being assessed, and the methods used to assess competence. Four scientific electronic databases (MEDLINE, EMBASE, CINAHL, and the Cochrane Library) were searched from inception to March 9, 2018. A gray literature search was also performed. Two reviewers independently screened articles and resources for inclusion, and data were extracted using a form created by the authors. Seventy full text articles and resources were screened for eligibility, with 36 included in the review. Endotracheal suctioning was the most common type, and intensive or critical care units were the primary setting of interest (28 of 36, 78%). Competence or a component of competence for nurses, nursing students, nursing assistants, or nurse technicians was specifically addressed in 97% (35 of 36) of the included articles and resources; 4 of 36 (11%) also included physical therapists, 1 of 36 (3%) included respiratory therapists, and 1 of 36 (3%) was aimed toward all clinicians who perform suctioning. Nine (25%) used questionnaire-based assessments, 11 (31%) used checklists, audit forms, or other observational tools, and 16 (44%) used both. Directed content analysis revealed 3 major themes: consistency across overarching evaluation frameworks, inconsistency across detailed components, and inconsistency in the evaluation or reporting of assessment tool measurement properties. Additional gaps in the literature included limited consideration of health care professionals beyond nursing, limited consideration of settings beyond intensive and critical care, a lack of tools to assess nasotracheal and orotracheal suctioning, and limited detail regarding assessment tool development.

Building successful and sustainable academic health science partnerships: exploring perspectives of hospital leaders

BACKGROUND

Clinical work-based internships form a key component of health professions education. Integral to these internships, academic health science partnerships (AHSPs) exist between universities and teaching hospitals. Our qualitative descriptive study explored the perspectives of hospital leadership on AHSPs: what they are composed of, and the facilitators and barriers to establishing and sustaining these partnerships.

METHODS

Fifteen individuals in a variety of hospital leadership positions were purposively sampled to participate in face-to-face interviews, after which a thematic analysis was conducted.

RESULTS

Participants reported that healthcare and hospital infrastructure shapes and constrains the implementation of clinical education. The strength of the hospitals' relationship with the medical profession facilitated the partnership, however other health professions' partnerships were viewed less favourably. Participants emphasized the value of hospital leaders prioritizing education. Further, our findings highlighted that communication, collaboration, and involvement are considered as both facilitators and barriers to active engagement. Lastly, opportunities stemming from the partnership were identified as research, current best practice, improved patient care, and career development.

CONCLUSION

Our study found that AHSPs involve the drive of the university and hospitals to gain valued capital, or opportunities. Reciprocal communication, collaboration, and involvement are modifiable components that are integral to optimizing AHSPs.

Clinical Instructors' Experiences Working with and Assessing Students Who Perform below Expectations in Physical Therapy Clinical Internships

Purpose: Clinical education is an integral component of the curriculum of all physical therapy (PT) entry-to-practice programmes in Canada. The literature indicates that working with and assessing students performing below expectations (SPBE) can be procedurally and emotionally difficult. Our study aimed to explore the experiences of clinical instructors (CIs) and the decision-making process involved when supervising SPBE in PT. Method: A total of 19 in-depth, semi-structured interviews were conducted with CIs, transcribed, and coded using qualitative thematic analysis. Results: Four factors appeared to be important for CIs when they were deciding how to assess SPBE: (1) features of student performance, (2) factors related to the CIs, (3) academic and clinical facility influencers, and (4) strategies and available resources. Concerns about safety and professional behaviour, a student's clinical reasoning skills, and a lack of progression were key factors that CIs considered in recommending a final grade. CIs were more likely to recommend a failing grade if there was a series of repeated incidents rather than an isolated incident. Conclusions: We make several recommendations for the student, CI, and facilities to consider to better support and facilitate the process of working with SPBE in PT clinical education.

Let's Talk about the Talk: Exploring the Experience of Discussing Student Performance at the Mid- and Final Points of the Clinical Internship

Purpose: The purpose of this study was to explore the experiences of physiotherapy students and clinical instructors (CIs) when discussing student clinical performance at the mid- and final points of clinical internships. The objectives were to identify why performance assessment discussions are valuable, explore the role of each participant throughout the discussion, identify the challenges associated with these discussions, and explore the effect of the standardized assessment tool on the discussion. Methods: This study used a qualitative descriptive design, consisting of student and CI focus groups in the Greater Toronto Area from January to June 2016. Results: All participants (N=29) recognized the importance of having face-to-face performance assessment discussions in a quiet and private space. Students and CIs agreed that the Canadian Physiotherapy Assessment of Clinical Performance helped to structure and focus the discussions. Valuable discussions occurred when students were open minded and self-reflected on their performance and when CIs were honest and used their expertise to guide learning. Other key features included mutual preparedness, two-way feedback that was constructive and tangible, and a goal-setting process. Students described the emotional component of these discussions as being challenging, and CIs found it difficult when a student took a more passive role in the discussion. Conclusions: Our findings indicate that valuable discussions can provide meaningful feedback, strengthen the student-CI relationship, and engage the learner in an ongoing and cumulative learning process that contributes to professional development.

A mandala of faculty development: using theory-based evaluation to explore contexts, mechanisms and outcomes

Demonstrating the impact of faculty development, is an increasingly mandated and ever elusive goal. Questions have been raised about the adequacy of current approaches. Here, we integrate realist and theory-driven evaluation approaches, to evaluate an intensive longitudinal program. Our aim is to elucidate how faculty development can work to support a range of outcomes among individuals and sub-systems in the academic health sciences. We conducted retrospective framework analysis of qualitative focus group data gathered from 79 program participants (5 cohorts) over a 10-year period. Additionally, we conducted follow-up interviews with 15 alumni. We represent the interactive relationships among contexts, mechanisms, and outcomes as a "mandala" of faculty development. The mandala illustrates the relationship between the immediate program context, and the broader institutional context of academic health sciences, and identifies relevant change mechanisms. Four primary mechanisms were collaborative-reflection, self-reflection and self-regulation, relationship building, and pedagogical knowledge acquisition. Individual outcomes, including changed teaching practices, are described. Perhaps most interestingly, secondary mechanisms-psychological and structural empowerment-contributed to institutional outcomes through participants' engagement in change leadership in their local contexts. Our theoretically informed evaluation approach models how faculty development, situated in appropriate institutional contexts, can trigger mechanisms that yield a range of benefits for faculty and their institutions. The adopted methods hold potential as a way to demonstrate the often difficult-to-measure outcomes of educational programs, and allow for critical examination as to how and whether faculty development programs can accomplish their espoused goals.

Canadian Physiotherapy Assessment of Clinical Performance: Face and Content Validity

PURPOSE

To investigate face and content validity of a draft measure to be used across Canada to assess physiotherapy students' performance in clinical education, through broad consultation with physiotherapy clinical instructors (CIs) across Canada.

METHODS

An online survey was used to collect input on the draft measure. In addition to demographics, the questionnaire included questions on the preferred rating scale, the items within the measure that should have their own rating scale, and general impressions.

RESULTS

Among the 259 CIs who completed the survey, a discrete rating scale with six anchors and 10 boxes or a continuous-line rating scale with six anchors was preferred. Respondents favoured using one rating scale for each key competency in the Expert role but considered a single rating scale sufficient for assessing the Scholarly Practitioner role. CIs agreed that the proposed measure would allow them to assess a student who was performing poorly or very well. The name Canadian Physiotherapy Assessment of Clinical Performance (ACP) received the most votes in the questionnaire.

CONCLUSIONS

CIs' collective preferences on the design, organization, and naming of the measure they will use in evaluating students are reflected in the second draft of the ACP.

Evidence of Reliability, Validity, and Practicality for the Canadian Physiotherapy Assessment of Clinical Performance

Purpose: To investigate the internal consistency, construct validity, and practicality of the Canadian Physiotherapy Assessment of Clinical Performance (ACP), a descriptive measure used by physiotherapy students and their clinical instructors (CIs) at the mid- and endpoints of an internship to describe the students' behaviours as observed in the clinical education setting relative to what might be expected of an entry-level physiotherapist. Methods: This multi-centre study piloted the ACP in 10 university physiotherapy (PT) programmes. Both CIs and students undertaking clinical internships completed the ACP and the current tool, the Physical Therapist Clinical Performance Instrument (PT-CPI; Version 1997). Results: CIs assessing PT students' performance during internships representing a variety of areas of practice completed the ACP at the midpoint (n=132) and the endpoint (n=126) of the internship. The end-of-internship sample consisted of 55 junior, 30 intermediate, and 41 senior students. The ACP demonstrated strong internal consistency: Alpha coefficients for each role ranged from 0.94 to 0.99. Aligned items on the ACP and PT-CPI were significantly correlated (r=0.51-0.84). Senior PT students performed significantly better than intermediate students, who, in turn, performed better than junior students (p<0.0001). Effect sizes for midpoint to final scores on the ACP ranged from medium to large (0.40-0.74). Participants were satisfied with the online education module that provided instruction on how to use and interpret the ACP, as indicated by satisfaction scores and qualitative comments. Conclusions: The ACP is a reliable, valid, and practical measure to assess and describe the PT students' behaviours as observed during clinical education relative to what is expected of an entry-level physiotherapist.

Development of the Canadian Physiotherapy Assessment of Clinical Performance: A New Tool to Assess Physiotherapy Students' Performance in Clinical Education

PURPOSE

To develop the first draft of a Canadian tool to assess physiotherapy (PT) students' performance in clinical education (CE). Phase 1: to gain consensus on the items within the new tool, the number and placement of the comment boxes, and the rating scale; Phase 2: to explore the face and content validity of the draft tool.

METHODS

Phase 1 used the Delphi method; Phase 2 used cognitive interviewing methods with recent graduates and clinical instructors (CIs) and detailed interviews with clinical education and measurement experts.

RESULTS

Consensus was reached on the first draft of the new tool by round 3 of the Delphi process, which was completed by 21 participants. Interviews were completed with 13 CIs, 6 recent graduates, and 7 experts. Recent graduates and CIs were able to interpret the tool accurately, felt they could apply it to a recent CE experience, and provided suggestions to improve the draft. Experts provided salient advice.

CONCLUSIONS

The first draft of a new tool to assess PT students in CE, the Canadian Physiotherapy Assessment of Clinical Performance (ACP), was developed and will undergo further development and testing, including national consultation with stakeholders. Data from Phase 2 will contribute to developing an online education module for CIs and students.

Different allergenicity of pollen extracts of three Mediterranean cypress species accounted for cytological observations

BACKGROUND

Cypresses play an important role in the urban landscape of the Mediterranean region, releasing a huge amount of allergenic airborne pollen which causes a specific pollinosis in exposed people.

OBJECTIVE

The aim of this work is to evaluate, in vivo and in vitro, the potential allergenicity of Cupressus macrocarpa pollen, and to compare it with the allergenicity observed for C. arizonica and C. sempervirens.

METHODS

Pollen extracts of the three species were prepared, to determine their protein profile through SDS PAGE analysis and to evaluate their allergenic potential through EAST inhibition assays and SPT. Pollen grain composition was evaluated using a cytochemical approach with optical microscopy.

RESULTS

SDS PAGE, EAST inhibition and SPT indicated the higher allergenic potential of C. arizonica compared to C. sempervirens and C. macrocarpa. No significant differences in allergenic potential were found between the latter two species. Cytochemical observations reveal higher β-glucans and protein content in the intine of C. arizonica during hydration.

CONCLUSION

The higher protein content found in C. arizonica pollen grains extract may be due to higher enzyme activity leading to the movement of β-glucans and pectins from the intine to the partially developed pollen cell wall during hydration. This could explain the higher potential allergenicity of C.arizonica in respect to C. macrocarpa and C. sempervirens.

Use of Simulation Learning Experiences in Physical Therapy Entry-to-Practice Curricula: A Systematic Review

PURPOSE

To review the literature on simulation-based learning experiences and to examine their potential to have a positive impact on physiotherapy (PT) learners' knowledge, skills, and attitudes in entry-to-practice curricula.

METHOD

A systematic literature search was conducted in the MEDLINE, CINAHL, Embase Classic+Embase, Scopus, and Web of Science databases, using keywords such as physical therapy, simulation, education, and students.

RESULTS

A total of 820 abstracts were screened, and 23 articles were included in the systematic review. While there were few randomized controlled trials with validated outcome measures, some discoveries about simulation can positively affect the design of the PT entry-to-practice curricula. Using simulators to provide specific output feedback can help students learn specific skills. Computer simulations can also augment students' learning experience. Human simulation experiences in managing the acute patient in the ICU are well received by students, positively influence their confidence, and decrease their anxiety. There is evidence that simulated learning environments can replace a portion of a full-time 4-week clinical rotation without impairing learning.

CONCLUSIONS

Simulation-based learning activities are being effectively incorporated into PT curricula. More rigorously designed experimental studies that include a cost-benefit analysis are necessary to help curriculum developers make informed choices in curriculum design.

Analyzing international clinical education practices for Canadian rehabilitation students

BACKGROUND

Clinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training ("WEIGHT Guidelines") were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master's-level rehabilitation students at a Canadian university.

METHODS

In-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research.

RESULTS

Five themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about "costs", (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing.

CONCLUSIONS

International clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian "sending institution", including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the "receiving organizations" based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.

What clinical instructors want: perspectives on a new assessment tool for students in the clinical environment

PURPOSE

Many Canadian physical therapy education programs use the 1997 version of the Physical Therapist Clinical Performance Instrument (PT-CPI) to evaluate students in their clinical placements. Recent evidence that clinical instructors (CIs) are unsatisfied with the PT-CPI, however, suggests a need to develop a new assessment tool. The purpose of this study was to gather Canadian CIs' perspectives on rating scales, preferred training methods, and format for future tool development.

METHODS

This qualitative descriptive study involved five focus groups from across Canada. English-speaking CIs who had supervised at least one Canadian student in clinical practice were eligible for the study.

RESULTS

Participants identified concerns with the PT-CPI and indicated a preference for (1) more objective rating scales with clearly defined anchors, (2) both in-person and online training methods for CIs, and (3) a tool that could be completed and reviewed on paper or online.

CONCLUSIONS

CIs affirmed the need to develop a new assessment tool. RESULTS of the study will be used to inform the development of a new assessment tool to better evaluate Canadian physical therapy students' performance in the clinical setting.

Physiotherapists and Physiotherapy Student Placements across Regions in Ontario: A Descriptive Comparison

PURPOSE

To describe the distribution and type of physiotherapy student placements in one year relative to the number of practising physiotherapists of Ontario.

METHODS

Site information about physiotherapy students' clinical placements in Ontario in 2010 was obtained from Academic Coordinators of Clinical Education. Worksite information about physiotherapists who reported providing direct patient care at a primary employment site in Ontario and at least 600 practice hours in their annual renewal was obtained from the College of Physiotherapists of Ontario. Each placement and each physiotherapist was attributed to one of Ontario's 14 local health integration networks (LHINs). For each LHIN, a ratio of student placements to practising physiotherapists was calculated, using summed counts. Counts of placement types by setting, patient mix, and practice area were also calculated for each LHIN.

RESULTS

The 5 LHINs in which the university programmes are located had high placement:physiotherapist ratios, from 0.92 to 0.38. The other 9 LHINs had lower ratios, the 3 lowest at approximately 0.15. There was a wide mix of clinical placement types across LHINs.

CONCLUSION

Physiotherapists' participation in physiotherapy students' clinical education varied widely among Ontario regions. Future research could explore whether regional differences are persistent, why they occur, and whether they should be reduced.

Academic Dishonesty among Physical Therapy Students: A Descriptive Study

PURPOSE

To examine academically dishonest behaviours based on physical therapy (PT) students' current practices and educators' prior behaviours as PT students.

METHOD

A Web-based questionnaire was sent to 174 students and 250 educators from the PT programme at the University of Toronto. The questionnaire gathered data on demographics as well as on the prevalence of, seriousness of, and contributing factors to academic dishonesty (AD).

RESULTS

In all, 52.4% of educators and 44.3% of students responded to the questionnaire over a 6-week data-collection period. Scenarios rated the most serious were the least frequently performed by educators and students. The impact of generation on attitudes and prevalence of AD was not significant. The factors most commonly reported as contributing to AD were school-related pressure, disagreement with evaluation methods, and the perception that "everyone else does it."

CONCLUSION

This study parallels the findings of similar research conducted in other health care programmes: AD does occur within the PT curriculum. AD was more prevalent in situations associated with helping peers than in those associated with personal gain. The consistency in behaviours reported across generations suggests that some forms of cheating are accepted as the social norm and may be a function of the environment.

Who am I? Key influences on the formation of academic identity within a faculty development program

INTRODUCTION

Professional identity encompasses how individuals understand themselves, interpret experiences, present themselves, wish to be perceived, and are recognized by the broader professional community. For health professional and health science educators, their 'academic' professional identity is situated within their academic community and plays an integral role in their well being and productivity. This study aims to explore factors that contribute to the formation and growth of academic identity (AI) within the context of a longitudinal faculty development program.

METHODS

Using a qualitative case study approach, data from three cohorts of a 2-year faculty development program were explored and analyzed for emerging issues and themes related to AI.

RESULTS

Factors salient to the formation of AI were grouped into three major domains: personal (cognitive and emotional factors unique to each individual); relational (connections and interactions with others); and contextual (the program itself and external work environments).

DISCUSSION

Faculty development initiatives not only aim to develop knowledge, skills, and attitudes, but also contribute to the formation of academic identities in a number of different ways. Facilitating the growth of AI has the potential to increase faculty motivation, satisfaction, and productivity. Faculty developers need to be mindful of factors within the personal, relational, and contextual domains when considering issues of program design and implementation.

Virtually present: the perceived impact of remote facilitation on small group learning

BACKGROUND

The engagement of facilitators located remotely for small group learning has received little research attention. However, this approach could increase the pool of experts for small group learning, thus addressing challenges to sustainability faced by in-person models of small group facilitation.

AIM

The objective of this study was to describe the experiences and perceptions of students regarding the use of remote facilitation for small group learning in a health education setting.

METHODS

This qualitative study involved three focus groups (n = 16) composed of students in the advanced neuromusculoskeletal teaching unit in the University of Toronto, Department of Physical Therapy. Focus groups were audio-taped and transcribed verbatim, and data were analyzed thematically.

RESULTS

Three main influences emerged related to the experiences of students regarding the use of remote facilitation for small group learning in a health education setting: technology (including audio and visual), facilitator (including quality of facilitation and facilitator expertise), and group dynamics (including ground rules, roles and responsibilities, and learning style). Each of these influences acted independently and interdependently to shape participants' perceptions.

CONCLUSION

This study prompts a widening of the concept of distance learning to also include distance teaching, which may have wide applicability to health profession programs.

Insights into a hydration regulating system in Cupressus pollen grains

BACKGROUND AND AIMS

Hydration, rupture and exine opening due to the sudden and large expansion of intine are typical of taxoid-type pollen grains. A hemispheric outgrowth external to the exine was observed on Cupressus and Juniperus pollen grains before the intine swelling and exine release. However, the actual existence of this permanent or temporary structure and its precise role in pollen hydration is still being debated. The aim of this paper is to collect information on the actual presence of this peculiar outgrowth on the surface of the Cupressus pollen grain, its structure, composition and function.

METHODS

Pollen grains of several Cupressus species were observed using various techniques and methodologies, under light and fluorescence microscopy, phase-contrast microscopy, confocal microscopy, scanning electron microscopy, and an environmental scanning electron microscope. Observations were also performed on other species with taxoid-type pollen grains.

KEY RESULTS

A temporary structure located just above the pore was observed on Cupressus pollen grains, as well as on other taxoid-type pollens. It is hemispheric, layered, and consists of polysaccharides and proteins. The latter are confined to its inner part. Its presence seems to regulate the entrance of water into the grains at the beginning of pollen hydration.

CONCLUSIONS

The presence of a temporary structure over the pore of taxoid-type pollen grains was confirmed and its structure was resolved using several stains and observation techniques. This structure plays a role in the first phases of pollen hydration.

Examining international clinical internships for canadian physical therapy students from 1997 to 2007

PURPOSE

To describe international clinical internships (ICIs) for Canadian physical therapy (PT) students, explore the experiences of individuals involved in ICIs, and develop recommendations for future ICIs based on these findings.

METHODS

This study employed a mixed-methods approach. An online questionnaire surveyed academic coordinators of clinical education (ACCEs, n=14) on the availability, destinations, and number of ICIs from 1997 to 2007. Semi-structured telephone interviews were then conducted with eight PT students, seven ACCEs, and three supervising clinicians to investigate their ICI experiences. Interview transcripts were coded descriptively and thematically using NVivo.

RESULTS

ICIs are currently available at 12 of 14 Canadian PT schools. A total of 313 students participated in ICIs in 51 different destination countries from 1997 to 2007. Over this period, increasing numbers of students participated in ICIs and developing countries represented an increasing proportion of ICI destinations. Key themes identified in the interviews were opportunities, challenges, and facilitating factors.

CONCLUSIONS

ICIs present unique opportunities for Canadian PT students. Recommendations to enhance the quality of future ICIs are (1) clearly defined objectives for ICIs, (2) additional follow-up post-ICI, and (3) improved record keeping and sharing of information on ICI destination countries and host sites.

The feasibility of an electronic reflective practice exercise among physiotherapy students

BACKGROUND

Reflective practice is a skill that serves as a model for continuous learning. Like any skill, reflective practice can be improved and health professional curricula should include opportunities to develop these skills. The clinical component of health professional curriculum is a natural component where reflective practice skills can be developed. Electronic means will help students and faculty stay in contact during clinical internships.

AIMS

The purpose of this study was to evaluate the feasibility of an electronic reflective practice exercise during a clinical internship and explore the potential trends on students' reflective practice skills and self-directed learning readiness.

METHODS

We used a prospective pre-post intervention design in a cohort of physiotherapy students to examine feasibility and explore trends. Faculty also rated the depth of reflection papers. In addition, students completed a reflective practice exercise questionnaire and the self-directed learning readiness scale (SDLRS) was completed pre- and post-internship.

RESULTS

All 84 students completed the reflective practice questionnaire. Sixty-six students consented to complete the questionnaire and 17 consented to complete the SDLRS pre- and post-internship. It took an average of 7 min for faculty to review each student's reflection and there were no significant electronic difficulties encountered. Initial reflection papers were rated at a descriptive (23%), descriptive-analytical (28%) or analytical level (33%). Eighty-six percent of students rated faculty feedback as helpful and 92% rated peer feedback as helpful. Almost all students (97%) students reported that they followed through on some or all of the items on their reflective practice learning plans. The SDLRS significantly improved with the exercise (mean difference 6.8 +/- 9.9; p < 0.05).

CONCLUSIONS

This electronic reflective practice exercise during the physiotherapy students' clinical internship was feasible and demonstrated trends to positively impact the learners' skills and self-directed learning readiness.

Physiotherapy Internship: An Alternative Collaborative Learning Model

Purpose: The purposes of this article are to (1) present a descriptive qualitative field report of a collaborative learning internship of four students assigned to two clinical instructors (CIs) (4:2 ratio) in the area of cardiorespiratory physiotherapy practice and (2) provide recommendations to CIs and universities based on this field study.

Summary of Key Points: From the perspective of the students, the main advantages of this collaborative internship included increased peer support, knowledge sharing, problem solving, and a comfortable learning environment. The CIs found advantages to include more instructor peer support, increased student collaboration with assessment and treatment planning, and more opportunity for group discussion. The main disadvantages from the perspectives of both the students and the CIs were accommodating various learning styles and personalities and having less 1:1 time with the CIs.

Conclusion: This collaborative learning model did not impede the quality of student education or patient care and was shown to be an educational experience appropriate for implementation in student internships. Given the positive outcomes and the recommendations provided, this 4:2 collaborative learning internship could be implemented to help meet the growing demands of increased enrolment and “hard-to-find” internships and to foster stronger supervisory skills for clinicians.

13-Metre Walk Test Applied to the Elderly with Musculoskeletal Impairment: Validity Study

Purpose: The purpose of this study was to examine concurrent validity and known group validity for the 13-metre walk test.

Methods: Preoperative data were collected from a sample of elderly individuals awaiting total hip replacement. The measures used were the Timed Up & Go Test, 13-metre walk test, 6-minute walk test, Stair Performance Measure, and the three subscales from the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results: Scores on the 13-metre walk test were significantly correlated with each of the other functional outcome measures, although the magnitude of the correlations with the WOMAC subscales was modest. Subjects performed the 13-metre walk test at a greater velocity than the 6-minute walk test (p < .01). Individuals with gait aids performed more poorly than those without (p < .01).

Conclusions: The findings of this study support concurrent validity and known group validity for the 13-metre walk test. Information regarding additional psychometric characteristics, that is, the interrater and intrarater reliability and responsiveness of the 13-metre walk test, would be valuable to further support its use.

Impacts of urban levels of ozone on Pinus halepensis foliage

Between May and September, 1996, seedlings of Pinus halepensis were placed at a site adjacent to an automated air pollution monitoring station within the urban area of Florence. Additional 'control' plants were placed in chambers ventilated with charcoal/Purafil(R)-filtered air. All trees were well watered throughout the whole experimental period. During the exposure period, ambient levels of sulphur dioxide were very low, whilst the accumulated hourly exposure to ozone above 40 ppb (i.e. AOT40) exceeded 20000 ppb h(-1) - peak hourly ozone concentrations rising to levels above 100 ppb. Trees exposed to ambient levels of air pollution exhibited typical symptoms of ozone damage (chlorotic mottle) on previous year needles toward the end of the summer. Similar symptoms were not observed on equivalent trees exposed to filtered-air, nor were visible symptoms accompanied by insect or pest infestation. Anatomical and ultrastructural observations made on symptomatic needles revealed degeneration in mesophyll cells bordering sub-stomatal cavities and alterations in chloroplast ultrastructure (fat accumulation, starch and tannin pattern modifications). These observations are consistent with the known effects of air pollutants (namely ozone) recorded in the literature. Findings are discussed in relation to the impacts of ozone on P. halepensis in the Mediterranean region.

Differential staining for cellulosic and modified plant cell walls

A simple method to enhance the staining of cell wall components for fluorescence microscopy is described. In stems of Nicotiana tabacum and needles of Pinus eldarica lignin, the cuticle and unsaturated lipids are indicated by a purple-red fluorescence while pectocellulosic components fluoresce pale blue.

The West Los Angeles Preterm Birth Prevention Project. I. Program impact on high-risk women

OBJECTIVE

The primary objective of this prospective study was to test whether preterm birth prevention education plus increased clinic visits and selected prophylactic interventions reduce preterm birth.

STUDY DESIGN

Eight West Los Angeles prenatal county clinics, comparable with respect to selected demographics, were randomized to be either experimental or control clinics. High-risk patients in all clinics were identified with a risk scoring system derived from a similar population. High-risk patients (N = 1774) in experimental clinics were offered a program of education and more frequent visits and were randomized to receive various secondary intervention protocols in addition to the basic interventions of education and more frequent visits. Control clinic patients (N = 880) received standard county care.

RESULTS

Preterm birth rates were 19% lower among the experimental high-risk patients (7.4% vs 9.1%), and differences were significant (p < 0.05) when preterm risk was taken into account. There was no evidence to suggest that the secondary interventions provided added benefit over the primary intervention protocol of preterm birth prevention education and increased visits.

CONCLUSION

The 19% reduction in preterm birth rate observed in the experimental clinics suggest an overall program benefit from a protocol that offered education, more frequent visits, and greater attention given to patients while the selected interventions were applied.

[Dietary fiber intake among the general population in 25 prefectures]

The per capita daily intake of dietary fiber in 25 prefectures was calculated from measured values of dietary fiber in each food according to the modified Southgate method and the modified Prosky method. Results obtained were as follows; In the calculated values according to the modified Southgate method, mean per capita daily dietary fiber intake was highest in Gunma 20.5 g and lowest in Okinawa (13.5 g). On the other hand with Prosky method, dietary fiber intake was highest in Gunma (19.3 g) and lowest in Hyogo (12.4 g). Therefore, dietary fiber intake was higher in eastern Japan than in western Japan. In calculated values according to the modified Southgate method, the largest consumption was noted with rice at 30%. On the other hand, in Prosky method, vegetables were noted as the largest and rice ranked second. The mean per capita daily intake of hemicellulose was noted at 50% of the whole, cellulose at 30-35% and lignin at 15-20%.

[Dietary fiber intake and intake patterns among the general population in Aomori, calculated using modified Southgate and Prosky methods]

Based on the result of the Aomori Nutrition Survey, we have calculated daily dietary fiber (DF) intake using modified Southgate and Prosky methods. Result obtained were as follows: DF intake in Aomori was 23.7 +/- 8.4g by the modified Southgate method, and 22.2 +/- 8.5g by the modified Prosky method. As for supply sources of DF, 32.3% was from grains; 22.7%, vegetables; 15.6%, beans; and 7.8%, fruits calculated by the modified Southgate method, and 31.3%, vegetables; 19.0%, grains; 18.0%, beans; and 11.6%, fruits by the modified Prosky method. As to types of DF, intake of hemicellulose was 11.5 +/- 4.2g, cellulose 7.8 +/- 3.0g and lignin 4.4 +/- 2.3g. In the group with DF intake below 10.0g, DF came mainly from grains and fruits, while the group with DF intake above 30.0g took DF from various foods.

[Echo-guided percutaneous alcohol injections of cold non-neoplastic thyroid nodules. Preliminary experience]

Percutaneous ethanol injection (PEI) has been recently used with excellent results to treat toxic and pretoxic thyroid adenomas. We investigated PEI efficacy also in the treatment of "cold" thyroid nodules in 31 patients with nodular goiter. All nodules were proved to be cold on thyroid scintigraphy. There was no clinical or cytologic suspicion of cancer. Informed consent to the experimental study was always obtained. Each patient received 24 +/- 4.1 ml of ethanol, injected once or twice a week. No significant side-effects were observed during treatment. All nodules shrank 66-97.6% (mean: 85.5%, p < 0.001 vs pretreatment volume). US-guided cytologic sampling was repeated at 3 months' follow-up. PEI was precautionally repeated in 4 patients exhibiting sparse follicular cells. Further data about this group are not available yet. These preliminary results prove PEI to be an effective and safe technique to treat thyroid nodules and to make a valuable alternative to surgery and L-thyroxine.

Survey of bottled drinking water sold in Canada. Part 2. Selected volatile organic compounds

Selected volatile organic compound (VOC) contaminants were determined in 182 samples of retail bottled waters purchased in Canada. Samples included spring water (86) packaged in containers of polyethylene or in smaller containers of transparent plastic or glass, mineral water (61) packaged only in transparent plastic or glass, and miscellaneous bottled waters (35). Analyses were performed by 3 laboratories, each using headspace sampling and capillary gas chromatography with either mass spectrometric (1 laboratory) or flame ionization detection with mass spectrometric confirmation, if required (2 laboratories). Benzene, the contaminant of primary interest, was detected in only 1 of the 182 samples at 2 micrograms/kg. Other VOC contaminants detected (number of positive samples, average, and range of positives in micrograms/kg) included toluene (20, 6.92, 0.5-63), cyclohexane (23, 39.2, 3-108), chloroform (12, 25.8, 3.7-70), and dichloromethane (4, 59, 22-97). Cyclohexane was found in the plastic and as a migrant from the plastic in 20 samples of spring water, but it was found in only 1 of 61 mineral water samples analyzed at only 3 micrograms/kg. Chloroform was found almost exclusively in samples that could have been obtained from public water supplies. It was not found in mineral water samples, but it was found in 1 spring water sample at 3.76 micrograms/kg. The source of the toluene contamination was not known. Other VOCs detected include ethanol and limonene, associated with added flavoring; pentane, as a migrant from a foamed polystyrene cap liner; and 1,1,2,2-tetrachloroethylene in a sample of demineralized water.

Capillary column gas chromatographic determination of ethyl carbamate in alcoholic beverages with confirmation by gas chromatography/mass spectrometry

A method is described for determining ethyl carbamate at low microgram/kg levels in several types of alcoholic beverages by capillary column gas chromatography with Hall electrolytic conductivity detection and confirmation by mass spectrometry. Samples are diluted to obtain a uniform concentration of ethanol (ca 10%) then saturated with NaCl and extracted with methylene chloride. Extracts are evaporated to a small volume and injected in ethyl acetate solution for chromatographic analysis. The method was evaluated by 5 laboratories, 4 employing the Hall detector and one using mass spectrometric detection. Overall between-laboratory mean percent recoveries were: wine, 85.3 +/- 21.0% coefficient of variation (CV) (spiking level 20-45 micrograms/kg); sherry, 83.8 +/- 16.1% CV (spiking level, 81-142 micrograms/kg); whiskey, 79.5 +/- 13.9% CV (spiking level 127-190 micrograms/kg); and brandy, 85.0 +/- 12.5% CV (spiking level 297-446 micrograms/kg). Mass spectrometric results agreed well with the Hall results for all commodities. Detection limits were about 5 micrograms/kg for the Hall detector and about 0.5 microgram/kg for mass spectrometric detection.

Changes in dietary fiber intake among Japanese in the 20th century: a relationship to the prevalence of diverticular disease

In view of the fact that Japanese dietary patterns have been undergoing rapid "Westernization," in part characterized by decrease in fiber, we assessed dietary and crude fiber content in the Japanese diet using food consumption tables for the period from 1911 to 1980, and studied the trend in the reported prevalence of diverticular disease of the colon. Fiber content declined in diphasic pattern: the first decline, which probably had started in the late 19th century, progressed until the Second World War. Although records during the war period were unavailable, the high fiber content of the Japanese diet in the period immediately after the war reflects the tendency to supplement rice with more fiber-rich cereals, and to increase the amount of rice through reduced polishing during the war time. The second decline in fiber content in the Japanese diet, which started in the 1950s and progressed throughout the period of "high economic growth," was mainly due to the decrease in cereal consumption. The changes in crude fiber content in the Japanese diet after the Second World War resemble the pattern of rapid decline noted in the United States during the 1930s to the 1950s. The prevalence of diverticular disease in both countries also shows sudden steep upward turns during the period between 1930 and 1950 in the United States and the late 1970s in Japan, suggesting the presence of threshold level(s) of fiber intake for the effective prevention of diverticular disease. The prevalence of diverticular disease is still relatively low in Japan. However, if the current dietary trend continues, it may rise to a level currently found in the "Western" countries in the coming few decades.