Using the Literature to Design a Study in the Rehabilitation Setting: An Example with Stroke Patients

A literature review can provide direction for decisions that are made at each step of the research process. Rehabilitation nurses can use a review of the research literature to provide the foundation for designing a clinical study. The purpose of this article is to describe how a literature review can contribute to designing nursing studies in rehabilitation care settings. Examples of the literature on discharge planning for stroke patients are used to illustrate this process.     

Using a Video Feedback Intervention Package to Improve Affective Empathy Skills for Adolescents with Autism Spectrum Disorder

Journal of Developmental and Physical Disabilities - Impairments in empathic responding are related to decreased social interactions and fewer friendships for adolescents with autism spectrum...     

Feasibility of a Smartphone-Based Exercise Program for Office Workers With Neck Pain: An Individualized Approach Using a Self-Classification Algorithm

Objective

To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM).

Simplified Equations Using Two Concentrations To Calculate Area under the Curve for Antimicrobials with Concentration-Dependent Pharmacodynamics: Daptomycin as a Motivating Example

The effects of several antimicrobial agents are predicted by the ratio of the area under the concentration-time curve (AUC) to the MIC (AUC/MIC). Peak (C_p) and trough (C_t) concentrations are often measured clinically as surrogates of AUC because actual computation of AUC from 1 or 2 samples requires sophisticated mathematical methods. Given that the effects of daptomycin are predicted by AUC/MIC, our objective was to compare simple equation calculated AUC based on C_p and C_t to model integrated AUC. A standard population pharmacokinetic model was used to simulate 5,000 daptomycin concentration-time profiles after 5 doses of 6 mg/kg of body weight/day (0.5-h infusions). The AUC for the 24-h period was computed by integration and by equations with 110 C_p-C_t combination pairs. The C_p time points were in 15-min increments between 0.5 h and 3 h and C_t in 15-min increments within an hour of the end of the dosing interval for each dose. The precision and bias of the calculated AUC relative to the integrated AUC were determined to identify C_p-C_t pairs associated with the lowest bias and highest precision. The equations were further validated using two daptomycin concentration-time data sets from healthy volunteers and critically ill patients. The precision and bias of calculated AUC were based primarily on C_p, and use of a daptomycin C_p 1.5 h to 3 h from the start of infusion was associated with a bias of <10% and an R² of >0.95. Data from the healthy volunteers and critically ill patients also demonstrated declining bias with use of C_p ≥1.5 h from the start of infusion with relatively good precision. Simplified equations using a daptomycin C_p approximately 2 h from the start of infusion and a C_t within an hour of the end of the dosing interval should yield precise and unbiased estimates of daptomycin AUC.     

部分脱乙酰甲壳质生物套管小间隙桥接修复周围神经损伤:免疫组织化学观察

目的:神经断端保留小间隙的静脉桥接模拟神经外膜形成神经再生室,为周围神经再生创造了良好的生理环境,从而保证神经束的良好对合。实验采用部分脱乙酰甲壳质作为套管材料,用小间隙桥接方法修复坐骨神经损伤,观察套管内的神经再生情况,并与传统外膜缝合法进行比较。方法:实验于2001-01/2002-10在北京大学人民医院创伤骨科实验室完成。①主要材料:实验所用中空圆柱形套管为北京大学人民医院与中国纺织科学院共同发明的一种部分脱乙酰甲壳质生物套管(专利号:01136314.2)。实验中所用套管尺寸为:管长4 mm,壁厚0.1 mm,内径1.5 mm。②实验动物:健康成年雄性SD大鼠20只,随机分成2大组,每组10只,每一大组全部10只动物的左腿坐骨神经为一组,右腿坐骨神经为另一组,每组10根坐骨神经。另取5只同样大鼠双侧坐骨神经未做处理作为正常对照组。③实验方法:外膜原位缝合组:切断坐骨神经,显微镜下神经外膜原位缝合;生物套管小间隙原位桥接组:切断坐骨神经,显微镜下小间隙套管桥接;断端旋转180°外膜缝合组:切断坐骨神经,显微镜下远端旋转180°后,神经外膜缝合;断端旋转180°生物套管小间隙桥接组:切断坐骨神经,显微镜下远端旋转180°后,小间隙套管桥接。④实验评估:术后第7,14,21,28,42天取坐骨神经,进行免疫组织化学染色及观察。结果:再生神经延套管中央走行,7 d时已有部分纤维通过2 mm间隙,14 d时有髓纤维数量明显多于近端。21 d后,套管组与原位外膜组新生有髓神经纤维数相近。再生纤维胞核数量较多,髓鞘纤细。套管结构完整。结论:此种部分脱乙酰甲壳质生物套管内的再生神经连续、整齐,髓鞘完整,其神经再生情况好于传统外膜缝合法。     

Analyzing Health-Related Quality of Life Data to Estimate Parameters for Cost-Effectiveness Models: An Example Using Longitudinal EQ-5D Data from the SHIFT Randomized Controlled Trial

Introduction

The aim of this article is to discuss methods used to analyze health-related quality of life (HRQoL) data from randomized controlled trials (RCTs) for decision analytic models. The analysis presented in this paper was used to provide HRQoL data for the ivabradine health technology assessment (HTA) submission in chronic heart failure.

Methods

We have used a large, longitudinal EuroQol five-dimension questionnaire (EQ-5D) dataset from the Systolic Heart Failure Treatment with the I _f Inhibitor Ivabradine Trial (SHIFT) (clinicaltrials.gov: NCT02441218) to illustrate issues and methods. HRQoL weights (utility values) were estimated from a mixed regression model developed using SHIFT EQ-5D data (n = 5313 patients). The regression model was used to predict HRQoL outcomes according to treatment, patient characteristics, and key clinical outcomes for patients with a heart rate ≥75 bpm.

Results

Ivabradine was associated with an HRQoL weight gain of 0.01. HRQoL weights differed according to New York Heart Association (NYHA) class (NYHA I–IV, no hospitalization: standard care 0.82–0.46; ivabradine 0.84–0.47). A reduction in HRQoL weight was associated with hospitalizations within 30 days of an HRQoL assessment visit, with this reduction varying by NYHA class [?0.07 (NYHA I) to ?0.21 (NYHA IV)].

Conclusion

The mixed model explained variation in EQ-5D data according to key clinical outcomes and patient characteristics, providing essential information for long-term predictions of patient HRQoL in the cost-effectiveness model. This model was also used to estimate the loss in HRQoL associated with hospitalizations. In SHIFT many hospitalizations did not occur close to EQ-5D visits; hence, any temporary changes in HRQoL associated with such events would not be captured fully in observed RCT evidence, but could be predicted in our cost-effectiveness analysis using the mixed model. Given the large reduction in hospitalizations associated with ivabradine this was an important feature of the analysis. Funding: The Servier Research Group.

     

Using the prone position for ventilated patients with respiratory failure: a review

Aims: This review explored the evidence relating to prone positioning in ventilated patients diagnosed with respiratory failure, including acute lung injury (ALI) or adult respiratory distress syndrome (ARDS). Background: Mortality rates for ventilated patients with ALI or ARDS are high, and there is a growing body of evidence suggesting that the position these patients are nursed in may influence clinical outcomes. However, there are no guidelines to inform nursing practice in positioning these patients. Method: Medline, Scopus, Cinahl and the Cochrane Library databases were searched for original research reports or systematic reviews of evidence between 2000 and 2009. Reference lists of retrieved papers were hand searched and included studies were analysed using the Critical Appraisal and Skills Programme framework. A narrative data synthesis considered the strengths and limitations of studies, and findings were collated and interpreted. Results: Application of the search strategy identified a systematic review, currently underway, which has not yet reported and 14 relevant studies eligible for inclusion in this review. Analysis showed considerable variation in study design, but suggests that PaO₂/FiO₂ ratio, incidence of VAP and mortality may be positively affected by prone positioning. Conclusions: Evidence of the clinical benefits associated with prone positioning is inconclusive and provides little guidance for nursing practice. There is a need for further research into the clinical outcomes of prone positioning, and greater understanding of the practicalities of prone positioning critically ill patients is required. Relevance to clinical practice: Nurses have a central role to play in the continual assessment and management of this patient group, including the position they are nursed in, not only to ensure the best clinical outcomes but also to provide care and comfort to the patient and their family. It is therefore important that their nursing practice and interventions are informed by the best available evidence.     

Using a novel exercise programme for patients with muscular dystrophy. Part I: a qualitative study

Muscular dystrophy patients have often experimented with different alternative or complementary methods since there is at present no curative medical treatment.

Purpose: To evaluate, through qualitative analysis of interview data, the subjective experiences of twenty-eight patients with muscular dystrophy practising a complementary method, qigong.

Methods: Semi-structured qualitative interviews were performed and data were analysed by a method inspired by Grounded Theory. The material was first coded into 119 categories, thereafter condensed to 59 categories through a constant comparison analysis. In the final analysis, six broad categories were formed out of these 59 categories.

Results: These broad categories were: (1) experience of health care and alternative methods; (2) expectations, acceptance and compliance; (3) qigong as an adaptable form of exercise; (4) stress reduction and mental effects; (5) increased body awareness and physical effects; (6) psychosocial effects of group training.

Conclusion: Qigong was accepted as a novel exercise regimen and there was a wide variation of experience regarding it among the participants. Depending upon factors such as expectation of benefits, time available to do qigong and perceived effects doing it, compliance varied. One major advantage of qigong is the ability to adapt the different exercises to the physical capability of the person practising qigong. There were reports of mental, physical and psychosocial effects of the qigong, which reduced the feeling of stress and improved well-being.     

Using a novel exercise programme for patients with muscular dystrophy. Part I: a qualitative study

Muscular dystrophy patients have often experimented with different alternative or complementary methods since there is at present no curative medical treatment.

Purpose:?To evaluate, through qualitative analysis of interview data, the subjective experiences of twenty-eight patients with muscular dystrophy practising a complementary method, qigong.

Methods:?Semi-structured qualitative interviews were performed and data were analysed by a method inspired by Grounded Theory. The material was first coded into 119 categories, thereafter condensed to 59 categories through a constant comparison analysis. In the final analysis, six broad categories were formed out of these 59 categories.

Results:?These broad categories were: (1) experience of health care and alternative methods; (2) expectations, acceptance and compliance; (3) qigong as an adaptable form of exercise; (4) stress reduction and mental effects; (5) increased body awareness and physical effects; (6) psychosocial effects of group training.

Conclusion:?Qigong was accepted as a novel exercise regimen and there was a wide variation of experience regarding it among the participants. Depending upon factors such as expectation of benefits, time available to do qigong and perceived effects doing it, compliance varied. One major advantage of qigong is the ability to adapt the different exercises to the physical capability of the person practising qigong. There were reports of mental, physical and psychosocial effects of the qigong, which reduced the feeling of stress and improved well-being.     

Using a novel exercise programme for patients with muscular dystrophy. Part II: a quantitative study

PURPOSE: To quantitatively evaluate the effects of qigong in patients with muscular dystrophy. METHODS: Thirty-six patients with muscular dystrophy were assigned to either a treatment or comparison group, by means of a stratified randomization procedure. The intervention period lasted for 3 months. Balance and respiratory function were assessed by means of Berg's Balance Scale and an electronic spirometer, respectively. Health-related quality of life was tested by means of a Swedish version of the Medical Outcome Study Short Form Health Survey (SF-36), coping levels by means of a Swedish version of the Ways of Coping Questionnaire and depression levels by means of a modified version of the Montgomery ?sberg Depression Rating Scale. RESULTS: Perceived general health was maintained in the treatment group whereas this was not the case in the comparison group (p=0.05). Positive reappraisal coping decreased in the treatment group but not in the comparison group (p=0.05). There was a tendency to maintain balance function during training and performance of qigong whilst there was a decline when not training. CONCLUSION: Qigong may be useful as an adjunct therapy regimen in patients with muscular dystrophy in that it can bring about a decreased rate of decline in general health. The change in coping pattern in this study needs more investigation. More research is also needed in order to more fully investigate the effects of qigong on such physical variables as balance function.     

Using a novel exercise programme for patients with muscular dystrophy. Part II: a quantitative study

Purpose:?To quantitatively evaluate the effects of qigong in patients with muscular dystrophy.

Methods:?Thirty-six patients with muscular dystrophy were assigned to either a treatment or comparison group, by means of a stratified randomization procedure. The intervention period lasted for 3 months. Balance and respiratory function were assessed by means of Berg's Balance Scale and an electronic spirometer, respectively. Health-related quality of life was tested by means of a Swedish version of the Medical Outcome Study Short Form Health Survey (SF-36), coping levels by means of a Swedish version of the Ways of Coping Questionnaire and depression levels by means of a modified version of the Montgomery Åsberg Depression Rating Scale.

Results:?Perceived general health was maintained in the treatment group whereas this was not the case in the comparison group (p?=?0.05). Positive reappraisal coping decreased in the treatment group but not in the comparison group (p?=?0.05). There was a tendency to maintain balance function during training and performance of qigong whilst there was a decline when not training.

Conclusion:?Qigong may be useful as an adjunct therapy regimen in patients with muscular dystrophy in that it can bring about a decreased rate of decline in general health. The change in coping pattern in this study needs more investigation. More research is also needed in order to more fully investigate the effects of qigong on such physical variables as balance function.     

Review article: Animal bites: An update for management with a focus on infections

Animal bites are a significant public health problem, with an estimated 2% of the population bitten each year. The majority of bites are from dogs and risk factors include young children, men, certain dog breeds and unrestrained dogs. The risk of infection following bites differs among animal species and is dependent on animal dentition and oral flora. Recent studies have demonstrated a broad range of pathogens isolated from infected bite wounds, with Pasteurella species being the predominant isolate from dog and cat bite wounds. Controversy exists about the use of prophylactic antibiotics; however, they are currently only recommended for high‐risk bite wounds. Two fatal cases of Australian bat lyssavirus have been reported and bats are the only identified reservoir in Australia. All bat bites are of high risk and should receive post‐exposure prophylaxis for rabies. Workers handling bats should be offered routine immunization.     

An Algorithm for a Selective use of Throat Swabs in the Diagnosis of Group: A Streptococcal Pharyngo-Tonsillitis in General Practice

A prospective evaluation was made of an algorithm for a selective use of throat swabs in patients with sore throat in general practice. The algorithm states that a throat swab should be obtained (a) in all children younger than 15 years; (b) in patients aged 15 years or more who have pain on swallowing and at least three of four signs (enlarged or hyperaemic tonsils; exudate; enlarged or tender angular lymph nodes; and a temperature ≥ 38°C); and (c) in adults aged 15–44 years with pain on swallowing and one or two of the four signs, but not both cough and coryza. Group A streptococci were found by laboratory culture in 30% of throat swabs from 1783 patients. Using these results as the reference, the algorithm was 95% sensitive and 26% specific, and assigned 80% of the patients to be swabbed. Its positive and negative predictive values in this setting were 36% and 92%, respectively. It is concluded that this algorithm may be useful in general practice.     

Using propensity score matching with doses in observational studies: An example from a child physical abuse and sleep quality study

Both physical abuse and poor sleep quality are public health concerns among adolescents, particularly in mainland China, but examining any causal effect of physical abuse on adolescents’ sleep quality using a randomized controlled trial is not possible for obvious ethical reasons. Researchers have proposed the use of propensity score matching with doses to minimize overt bias and estimate the effect of multidose treatments or varying degrees of risk exposure in observational studies. In this paper, we demonstrate the propensity score methods with a focus on matching with doses in an examination of the relationship between physical abuse levels (frequency and number of perpetrators) and self‐reported sleep quality among adolescents. Secondary analyses were conducted using data from the China Jintan Child Cohort. The sample comprised 707 adolescents (13.16 ± 0.90 years old) who had complete data on physical abuse, sleep, and covariates. Propensity scores were computed from eight covariates and used to carry out pair matching, matching with the frequency of abusive experience, and matching with the number of perpetrators. The standardized differences of covariates suggested an acceptable balance between groups after matching. The results derived from matching sets consistently indicated that adolescents being physically abused by parent(s) have worse sleep quality. Despite its inherent limitations, propensity score matching with doses provides a useful tool for nurse researchers analyzing observational data.     

Using clinical data in program design: a family support program for families with preterm infants

HMOs can use clinical data culled from computerized medical records and provider and patient interviews to examine the impact of premature infant births on the family. The results can help guide health plans in developing a clinical intervention program to address the physical and emotional consequences of low birthweight babies. The Harvard Pilgrim Health Care experience describes the data collection process administrators are taking to design such a clinical intervention.