Teaching Your First Continuing Education Seminar~September 29th, 8:30-5:30 Christiansburg VA Inquire for Registration Info

How to Teach Your First Continuing Education Course Introduction to some theories of adult learning ·       Teaching Modalities of Interest ·       Adult Learning ·       Maslow’s Hierarchy of Needs ·       What it means to be an Adult Learner ·       What is learning? ·       The experiential learning cycle ·       Types of Learners ·       Qualities teachers should possess as suggested by Paulo Freirè ·       Institutional Agenda (IA) and Learner’s Agenda (LA) ·       Constructivism ·       What we understand about constructivism ·       Situated Learning ·       Group Dynamics ·       Barriers to Reflections Teaching design and presentation §  Learning Outcomes §  Preparation §  Preparation and Initiation o   Environment o   Set §  Timekeeping o   Dialogue §  Explaining §  Exploring §  Critiquing §  Questioning §  Summarizing §  Responding The Lecture                           §  Advantages §  Limitations §  Structure o   Set (including environment) o   Dialogue o   Interactive Lectures §  Buzz Groups §  Brainstorming §  Interactive Handouts o   Closure §  Questions §  Summary o   Verbal Style §  Voice §  Rate §  Modulation §  Emphasis §  Redundancy §  Enthusiasm o   Non-verbal Style §  Body language §  Proximity §  Eye Contact Workshops and Discussion Groups ·       Learning Outcomes o   Small groups o   Group size o   Interpersonal Issues o   Space ·       Closed Discussion Groups ·       Workshops o   Directed cases o   Role play ·       Open Discussions Teaching Skills ·       Perception ·       Guided Response ·       Mastery ·       Autonomy ·       Relationship of skills teaching to learning styles o   Stage 1- Real time demonstration o   Stage 2- Instructor demonstration with instructor Commentary o   Stage 3- Instructor Demonstration and Learner Commentary- Three possibilities §  Instructor takes the lead and learner describes what is happening §  Instructor follows the learner’s instructions §  A mixture of both of these o   Stage 4- Learner Demonstration with Learner Commentary ·       Four stage teaching approach over time ·       Other Approaches Role Play and Simulated Scenarios ·       Definition ·       Five types of Role Play ·       Running a role play ·       Running a Simulation ·       Non-technical skills Clinical Teaching ·       Challenges ·       Characteristics of a good clinical teacher ·        Opportunistic teaching ·        Knowing the Learners E-learning  ·       Benefits vs. Challenges ·       Communities of Practice ·       E-moderating ·        How to design an E-learning Module

Lymphatic Reconstructive Surgery for Lymphedema: No Cure Yet

Chronic lymphedema is a type of swelling that typically manifests in an arm or leg, due to the accumulation of lymph fluid.  This accumulation is a result of damage to a patient’s lymphatic system, typically through lymph node removal or irradiation during cancer therapy, or as a congenital dysfunction.

Chronic lymphedema is routinely managed with manual lymphatic drainage as part of a treatment approach known as combined decongestive therapy (CDT).  While CDT is effective in reducing swelling, it does not represent a cure, and so patient commitment to life-long management is required.

Reconstructive surgery offers an exciting possibility to cure this condition. Unfortunately, since its debut in the 60’s, surgical efforts have met with mixed reviews.  Best results have been observed for surgeries performed in the early stage post cancer treatment.

A variety of direct and indirect surgical approaches are currently in use in a handful of specialized centers worldwide.  Indirect surgical reconstruction typically involves lymph-node transplantation.  Direct surgical reconstruction approaches include a variety of methods to bypass the afflicted area.  This includes tying still-functional portions of lymph vessels together, or avoiding the damaged lymphatic area entirely by tying lymph vessels into the venous system.  This latter approach known as “lymphatic-venous anastomotic” surgery is one of the most popular methods of direct reconstruction.

One interesting recent article reviews the experiences of the George Washington University School of Medicine with lymphatic reconstructive surgery (Int J Angiol. 2011 June; 20(2): 73–80.).  In this article they describe why they believe lymphatic surgery has failed to gain popularity:

“Because of the complexity of reconstructive lymphatic surgery, it has never been fully understood by most surgeons. These procedures subsequently gained a bad reputation with poorly reproducible outcomes in the majority of cases.”

Worse still, the odds of surgical success are further reduced by typical health policy surrounding surgical procedures.  Since manual lymphatic drainage-based CDT can provide adequate management of lymphedema in most cases, reconstructive surgery is NOT recommended for patients until a failure of CDT is clearly documented. As the authors point out, this policy reduces the likelihood of subsequent surgical success since the majority of patients offered surgery would, as a result, have considerable additional damage to their remaining lymphatic vasculature from long-term lymphatic hypertension during this waiting period.

The authors conclude that:

“Reconstructive lymphatic surgery at best remains an adjunctive treatment that is effective in some patients”, but that “improved long-term results is dependent on patient compliance with maintenance CDT and the prevention and treatment of infection”.

While still holding promise as a potential future cure, additional research is needed.

Written by Ryan

Ryan Davey earned a PhD in Biomaterials and Biomedical Engineering from the University of Toronto, where he specialized in stem cells and regenerative medicine. While not writing and working with Toronto Physiotherapy, Ryan consults in the field of biotechnology.

3rd Annual Walk for Lymphedema and Lymphatic Diseases

03-Jul-2012

3rd Annual Walk for Lymphedema and Lymphatic Diseases Eisenhower Park

East Meadow, New York

For more information email lfr@lymphaticresearch.org or go to the Lymphatic Research Foundation's website. 

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Dr. Sharma's Obesity Notes

Thursday, July 5, 2012

Obesity and Lymphedema

One of the most common clinical findings in patients with obesity is swelling of the lower extremities due to accumulation of fluid.
This is not only cosmetically bothersome to patients but also carries the risk of infection and skin changes.
In the vast majority of cases, this accumulation is benign and can be dealt with by simple physical measures - however, in rare cases it may be the expression of true lymphedema - a more persistent and far more difficult to treat condition.
True lymphedema can be diagnosed by lymphoscinitgraphy, which must show imparied lymphatic function.
In a letter published in the New England Journal of Medicine, Arin Greene and colleagues from Children’s Boston Hospital, describe a series of 15 obese patients presenting with bilateral lower-extremity enlargement (12 women).
All underwent lymphoscintigraphy, which revealed pathological findings consistent with lymphedema in 5 patients - the other 10 had normal results.
Interestingly, the average BMI of those with true lymphedema was around 70 compared to the average BMI of those with normal findings. All patients with lymphedema had a BMI greater than 59 whereas all patients with a BMI less than 54 had normal findings.
This strongly suggests that severe obesity is likely to be an important risk factor for lymphedema and that, as the authors discuss, there may be a threshold of BMI above which lymphatic flow becomes impaired. This could be either due to a change in lymph production (load) or lymphatic function (clearance) - the latter may result from dysfunctional lymphatics due to either local compression through fat mass or inflammation. On the other hand, increased lymph production from an expanding limb may overwhelm lymphatic capacity.
Whatever the cause, the question is whether or not this process can be reversed by weight loss - surprisingly enough the medical literature appears to be rather sparse on this issue.
I wonder if any of my readers have noted reversal of true lymphedema following significant weight loss - surgically or otherwise.
AMS
Edmonton, Alberta
Greene AK, Grant FD, & Slavin SA (2012). Lower-extremity lymphedema and elevated body-mass index. The New England journal of medicine, 366(22), 2136-7 PMID: 22646649