Search for tag: "practices"

Interviewer: If you break bone, do you still get a plaster of Paris cast that your friends can sign? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. "The Specialists" with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi. I'm Dr. Tom Miller and I'm here with Dr. Bruce Thomas. He's an orthopedic surgeon here at the Department of Orthopedics at the University of Utah and also practices at our Farmington facility in Farmington, Utah.

Bruce, do we still use plaster of Paris? I mean, when I was training, we'd go into the cast room and they had this big, goopy bin full of plaster of Paris. And they wrapped you up and put all the plaster of Paris on there. It dried and then your friends wrote all over the cast. Times change a little bit or not?

Dr. Thomas: For most things, times have changed.

Dr. Miller: I would suspect.

Dr. Thomas: Plaster is . . . It's been good. It's traditional. It's heavy. It's dirty. And for a long time, orthopedic surgeons felt like it held the molds better. There are studies that show that fiberglass will hold the mold that we put on the cast as well as fiberglass. And when we mold the cast, we put pressure on the bones in the right place to hold the fracture in place. The orthopedic axiom is crooked cast, straight bone.

Dr. Miller: So you can mold the fiberglass right around the arm or leg in the same way that you did with the plaster of Paris?

Dr. Thomas: You can. And when they've looked at it scientifically, the results were very similar.

Dr. Miller: So I suspect it's a lot lighter than that big, clubby plaster of Paris cast that people wore around for eight weeks.

Dr. Thomas: Significantly lighter, much cleaner, and your friends can still write on it.

Dr. Miller: That's great. How about the cast itself? These fiberglass casts, can it be removed so that you can shower or put back on? Does that just depend on the type of fracture?

Dr. Thomas: It does. It depends on the fracture and how stable it is. Once the fiberglass is on, it's not easy for the patient to take it off, but we can cut the cast and make it removable, if there is a fracture that is stable and we're not worried about a lot of displacement.

Dr. Miller: So casts are lighter. You can still write on them. And sometimes you can even take them off to take a shower.

Dr. Thomas: True.

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Dr. Jones: Old Chinese foot binding practices to make women hobble on little five-inch, deformed feet. You, five inch high heels for your pretty Christmas dress, awesome. This is Dr. Kirtly Jones from Obstetrics and Gynecology at The University of Utah Health Care and this is, "Women's Feet" on The Scope.

Announcer: Covering all aspects of woman's health this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Some years ago, I had the opportunity to visit a museum in Kuala Lumpur entitled, "Enduring Beauty." Wandering through the exhibit, I saw what I thought were tortuous practices of neck elongation, plates put in the lips and ears, Chinese foot binding, and others. The last room in the exhibit was enlightening, 19th-century corsets and contemporary girdles and high heels.

It's a good thing that most millennials have never worn a girdle if you don't count Spanx, but high heels? Over many years of my career as a gynecologist, I have been in a unique position to observe the damage that a life in high heels can do women's feet. Ladies, you know what I mean. Men and woman have been wearing elevated shoes for thousands of years. In ancient Egypt, they might have been a sign of class.

Shoes are made of tougher stuff and are more likely to survive for historical studies so we know about this. Those early elevated shoes were more platforms than heels, though. Men and women wore heels as part of fashion going back to the 1500s when shoes were made of two parts and heels were added. This was popularized by several royal women who weren't very tall who wanted to feel taller than their husband's mistresses.

So a person of social standing and wealth could be called well-heeled. And men may have worn heels as a practical matter to keep their boots in stirrups. Okay. Ao heels have been around for a long time and fashion comes and goes. But very high heels have been back since the late 1980s and '90s and there are consequences.

Recently, a study from the University of Alabama published in the "Journal of Foot and Ankle Injuries" stated, "In the US, emergency rooms treated 123,355 high heel-related injuries between 2002 and 2012." And it had doubled in the past 10 years. More than 19,000 of those injuries occurred in 2011 alone. Sprains and strains to the foot and ankle were the most common and most patients were in their 20s and 30s.

One in five of those accidents resulted in broken bones. And those are just the injuries that took women to the emergency room. Not the ones that hurt but women stayed home. So let's talk about an interesting study of South Korean flight attendants looking at ankle stability in a career spent in high heels. Students at a school for flight attendants, who have to wear heels all day long at school, had their balance tested.

In the first year, their balance was poor. Probably like mine in heels. The second year, the woman had developed significant strength in muscles and tendons that support the ankle side to side, less wobble and had better balance. But by the fourth year, women had worse balance because they lost strength support front to back. Wearing high heels all the time limits the flexion of the foot and ankle.

So what to do? If you wear heels just for special occasions, you aren't likely to do permanent structural damage of your feet and ankles, unless you fall over, which you are more likely to do. So take care. Walk arm-in-arm with your honey. Can you wear those foldable little flats until you get to the occasion while you're walking on the street? Don't catch your stilettos in ventilation grates and put your heels on when you get there.

If you need to wear heels for work, although I cannot see US companies requiring heels as part of business casual, but you want to and you wear them all the time. Take them off when they're under your desk. Flex your feet up and down and stretch your calves gently on the edge of stair steps. This is an exercise called heel lifts and heel drops. Give your feet and ankles a chance to normalize with exercise at night and weekends in bare feet or running shoes that are flat, well-fit, and supportive.

For those of you who can wear high heels gracefully, they do look lovely. So I've been conditioned, like every other American woman, to see beauty in style and high heels. I'm envious of ladies who can carry it off, but be practical even if your shoes aren't. Don't' run, watch for treacherous terrain that can grab your stilettos, and be careful what you drink at a party that might further affect your balance. Stay smart and stay safe.

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Interviewer: You know what? We're getting better and better and better at helping identify children with autism early on and a lot of that is because of some of the great and exciting research that's going on right now. Actually, taking that research and then putting it out in the real world so it does good, that can be a bit of a challenge. That's what Dr. Aubyn Stahmer specializes in, or that's what she's interested in right now, I should say. She's an autism researcher and currently is examining how you take evidence-based practices for autism and then put them into the clinical and the school settings. So we're excited to find out about some of the latest findings from the research and how these best practices are actually being implemented, and what we can learn and what we can do to maybe help with that.

Dr. Stahmer: thanks for taking time. First of all, tell me about some of the new evidence-based practices you're currently trying to bring to community settings that have you most excited.

Dr. Stahmer: Well, we're really excited about the early interventions program that we are bringing into communities in San Diego and Sacramento. It's an evidence-based program that was developed for preschoolers that we've moved down to toddler age and developed some parent-friendly materials and manuals with the project developer and then a training program too. We have this great team of psychologists and speech pathologists and funding agencies and psychiatrists and all people from the community who have helped shape the intervention itself and the training program. So we're really excited about that one.

Interviewer: Is this kind of a cutting edge way of looking at it? Is what you're doing there, will it hopefully then go to the United States? Give me some context.

Dr. Stahmer: I think the challenge is that a lot of kids who are seen in early intervention aren't seen very intensively. We know for autism we want the service to be intensive as possible as soon as possible. We know that training parents is one way to get intensity up. Now it shouldn't be the only intervention. I'm not saying parents should do the intervention, but it's one way to get things started. As early interventionists, we don't go into this business thinking we're going to work with adults. We think we're going to work with kids.

Interviewer: Sure. Okay.

Dr. Stahmer: One of the things we think that's really exciting about our program is that we're training people to coach parents and how to do that in a way that's successful and that is meaningful both to them and to the parents, which I think will be really wonderful for a lot of different kids with different disabilities where parents need to learn strategies.

And then also teaching them these engagement strategies that are specific to kids with autism, really getting their attention, getting right in their area of focus and helping them to engage with people rather than objects. In the context of that really engaged moment, teaching new skills that they need to learn because the usual kind of child development strategies that most early intervention providers are used to learning aren't quite structured enough to use with kids with autism. But the alternative that we have in our community is really, really, really structured. It's probably too structured for families to use so we're trying to find that balance.

Interviewer: Yeah, it's a challenging thing. It's also interesting that you mention that you're helping parents. Just briefly, is that a new thought?

Dr. Stahmer: Yeah. It's not particularly new that we're training parents. It's something that has been around . . . I've been working with projects that train parents for 20 years. But I think it's becoming more common, especially in very early intervention where now we have legislation that says we need to do parent coaching and lots of data showing that it really is an important adjunct to education. So now we have the challenge of being careful not to have too much pressure on parents to be the interventionists because, really, they're the parent, and finding strategies they can use within their regular daily activities that don't again add stress and pressure to them, but that they can integrate into things they're already doing.

There are lots of researchers across the country using these naturalistic developmental behavioral interventions that are working on . . . which is good, I think. Lots of reliability in different labs of the kinds of strategies we need to be using. Now, really working on how to help families use them in a way that fits with their family.

Interviewer: What is one obstacle or problem that you keep trying to overcome in your work and if you could just overcome it, things would be so much better?

Dr. Stahmer: I think time to learn the new strategies has been our biggest obstacle for the providers. So this is complicated stuff, treating kids with autism, and it takes a lot of training and expertise to really understand how you need to individualize the particular intervention because all the kids are so different. And then, also on top of that, we're asking them to learn this parent coaching. It takes a lot of time and there isn't a lot of funding for that because agencies, of course, need to get billable hours, as all agencies do. Our partner agency has been great with allowing their therapists time to do this training, but I think more time and practice is our biggest barrier.

Interviewer: And what about for those parents that aren't in your community where this is something that's becoming a reality? Do they just need to be patient?

Dr. Stahmer: Well, we're working on developing some web-based materials. I'm just starting to work with Dr. Sally Rogers to develop some parent coaching materials that we can put online to help families. Laurie Vismara worked on this model as a distance coaching model. Brooke Ingersoll does as well. So people are looking at ways we can provide the training to parents who are in rural areas or low-income areas using technology, I guess, to help them. I think that's one next step.

We're also really working hard to put the training for therapists in a more distance format and figure out ways that we can do it in the most cost-effective ways so we can train therapists in other places to use similar strategies.

Interviewer: So the opposite question now, where does the biggest opportunity lie right now, in your opinion?

Dr. Stahmer: I think in understanding how to use technology to get people trained. Because right now it takes coaching. It really does. The literature is clear. You need practice with feedback, both parents and therapists. If we can figure out some great technology that works all the time where I could be sitting somewhere else giving people feedback while they're working . . . and people are working on this, I know. That, I think, would open a lot of doors for people who aren't living near a research center or a metropolitan area.

Interviewer: Yeah. Why do you do what you do? What gets you up and gets you in and doing this everyday? What's the engine that drives the machine?

Dr. Stahmer: The kids and the families. These are incredible groups of people and no matter . . . we've been to a lot of places where there are very few resources. Recently back from South Africa, did some work in Taiwan and there are families who . . . and in the United States, too. They're really just wanting their kids to do well and I really am motivated to find them ways to do that that are also fun, engaging and not stressful. I think that's our challenge is parents really want their kids to reach their best developmental potential and I want to be able to help them do that in a way that actually makes sense.

Interviewer: If I said, "You have a minute to talk about whatever you want to talk about when it comes to this topic," what would you say? What would you get up on the mountain and talk about?

Dr. Stahmer: Gosh. I think it would be that balance between helping parents help their kids learn and also not charging them with being the therapist for their child. Putting the techniques that we are helping them learn into daily activities that enhance their parenting. Because their kids are learning differently, we want to enhance their parenting and give them some techniques specific to their child needs, but also not give them the entire responsibility of educating their child from the very beginning. And providing the support that they need to keep their family functioning well.

Interviewer: Realizing that there are different roles and helping parents realize what those roles are. Doing what their role says they should do and allowing other people to do what their role says they should do.

Dr. Stahmer: Right. And letting the parents decide what that should be because, of course, it's going to be different for every parent.

Interviewer: Yeah. Sure, sure, sure. If a parent wants to stay on top of some of the latest best practices, do you have any resources where they could learn about this type of stuff? Because I find what you're doing in San Diego just really cool.

Dr. Stahmer: Well, the Autism Speaks website has really nice reviews and updates on research pretty often. It also has a nice section that shows different treatment methods for autism. A lot of these methods you can see examples of them on their website. There's also a new website called the Autism Navigator, I think should be up now, where parents can learn a lot about autism and different resources.

Interviewer: I love bringing this idea of proven, research-tested best practices that show you're going to get the best outcomes into the care of individuals with autism and these strategies. Is there somebody out there that's doing something that excites you? Like kind of give a shout-out to another researcher or a hospital in another community that's doing some exciting things that you've seen.

Dr. Stahmer: I'm going to talk a lot about Dr. Greg Aaron's work at the talk, really looking at leadership in large systems and how that needs to address sustainable practices when we're trying to move evidence-based practices. And so in a lot of our work what we're finding is therapists are really motivated to learn, but they really need some infrastructure. So I'm excited about the work he's doing about how to help leaders provide the infrastructure that is needed to do this.

Interviewer: What will you be talking about at the pre-conference in Salt Lake City? What is your topic?

Dr. Stahmer: My topic is moving evidence-based practices into the community. So I'm going to talk about our research collaborative and how we've done with this early intervention that I've told you about. Then I'm going to try to bring up some other research that people in San Diego have been doing and the types of things organizations need to do to get ready to do evidence-based practice because it takes some preparation. So what kind of leadership does there need to be? What kind of preparation do they need to have? And hopefully have a discussion with the people there in Salt Lake City and around Utah about how some of these strategies might be implemented there.

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