Effect of Yakson and Gentle Human Touch versus usual care on urine stress hormones and behaviors in preterm infants: a quasi-experimental study

Background

Touching, one of the most developed senses, is proven to relax preterm infants. Yakson is a Korean touching method for healing and relaxation similar to Gentle Human Touch (GHT), which is used in the United States.

Objective

The goal of this study was to test the effect of Yakson and GHT on preterm infants’ stress and behaviors compared to usual nursing care.

Design

A quasi-experimental study design was used.

Participants

Fifty-nine preterm infants (26-34 weeks gestational age) in the neonatal intensive care unit were chronologically assigned into three groups; Yakson (n = 20), GHT (n = 20), and control group (n = 19).

Methods

The Yakson and GHT groups each received an intervention for 15 min twice a day for 15 days while the control group received usual nursing care. Yakson consists of three five-minute phases: resting the hand on the infant, gentle caressing, and resting the hand again. GHT consists of hand resting for 15 min. Twenty-four-hour urine cortisol and norepinephrine samples were collected both before and after the 15-day intervention period. The infants’ sleep and awake states were observed before, during, and after each intervention.

Results

Following the intervention period, preterm infants in the Yakson and GHT groups had significantly lower stress hormone levels compared to the control group preterm infants. No significant difference was found in stress hormone levels between Yakson and GHT group preterm infants. After Yakson or GHT, the infants exhibited an increased percentage of sleep states and a decreased percentage of awake and fussy states.

Conclusions

The findings suggest that Yakson is another touching method that is not aversive or stressful to preterm infants, and which may provide several positive effects on preterm infants.     

The relationship between nurse staffing and quality of care in nursing homes: a systematic review

Background

Nursing homes have an important role in the provision of care for dependent older people. Ensuring quality of care for residents in these settings is the subject of ongoing international debates. Poor quality care has been associated with inadequate nurse staffing and poor skills mix.

Objectives

To review the evidence-base for the relationship between nursing home nurse staffing (proportion of RNs and support workers) and how this affects quality of care for nursing home residents and to explore methodological lessons for future international studies.

Design

A systematic mapping review of the literature.

Data sources

Published reports of studies of nurse staffing and quality in care homes.

Review methods

Systematic search of OVID databases. A total of 13,411 references were identified. References were screened to meet inclusion criteria. 80 papers were subjected to full scrutiny and checked for additional references (n = 3). Of the 83 papers, 50 were included. Paper selection and data extraction completed by one reviewer and checked by another. Content analysis was used to synthesise the findings to provide a systematic technique for categorising data and summarising findings.

Results

A growing body of literature is examining the relationships between nurse staffing levels in nursing homes and quality of care provided to residents, but predominantly focuses on US nursing facilities. The studies present a wide range and varied mass of findings that use disparate methods for defining and measuring quality (42 measures of quality identified) and nurse staffing (52 ways of measuring staffing identified).

Conclusions

A focus on numbers of nurses fails to address the influence of other staffing factors (e.g. turnover, agency staff use), training and experience of staff, and care organisation and management. ‘Quality’ is a difficult concept to capture directly and the measures used focus mainly on ‘clinical’ outcomes for residents. This systematic mapping review highlights important methodological lessons for future international studies and makes an important contribution to the evidence-base of a relationship between the nursing workforce and quality of care and resident outcomes in nursing home settings.     

Utilization of analgesics, sedatives, and pain scores in infants with a prolonged hospitalization: A prospective descriptive cohort study

Aim

Describe the utilization of analgesic and sedative medications and documentation of pain scores in a cohort of critically ill infants in a neonatal intensive care unit.

Method

A prospective, longitudinal, cohort study of infants with a predicted length of stay ≥28 days. Dosages and routes of administration of analgesic and sedative medications and documentation of pain scores were collected on a daily basis.

Results

55 infants were enrolled into the study. Oral sucrose was administered to all 55 infants, 51 infants (93%) were administered enteral acetaminophen and 50 (91%) infants were administered morphine during their hospitalization. Sedatives were administered to 42 infants (76%); 36 (65%) were administered chloral hydrate and 32 (58%) were administered intravenous midazolam. With the exception of the first week of admission, when there was highest utilization of opioids and lower use of sucrose, acetaminophen and sedatives, the pattern of administration of analgesic and sedative agents remained relatively constant throughout the hospitalization. Pain scores were documented for 36 (65%) infants during their hospitalisation, however for these 36 infants, pain scores were infrequently recorded.

Conclusion

There was substantial and varied analgesic and sedative use in this cohort of infants, yet infrequent documentation of pain assessment scores. These practices highlight important clinical implications for sick infants requiring careful consideration of pain and distress management.     

The effect of health visitors' postpartum home visit frequency on first-time mothers: cluster randomised trial

Background

Postpartum home visiting by nurses can benefit higher-risk families. Yet, little is known about the effects of universal services which provide care for all families including those at lowest risk (e.g. provision by health visitors-United Kingdom specialist community public health nurses).

Objective

It was to determine the effect of frequency of health visitors’ home visits on ‘low-risk’ first-time families’ outcomes to 8 weeks postpartum and 7 months follow-up.

Design

A cluster randomised controlled trial.

Setting

Within one health and social care managerial area in Northern Ireland.

Participants

First-time ‘low risk’ mothers who had given birth during 2002-2004 and were visited by a health visitor who had agreed to take part in the study, were invited to participate. In total, n = 39 health visitors were allocated to ‘intervention’ and n = 41 to ‘control’. Of n = 295 ‘low-risk’ first-time mothers who agreed to take part, n = 136 with intervention health visitors were offered six home visits 2-8 weeks postpartum and n = 159 within the control group were offered one planned visit.

Methods

Self-completed measures of parenting, maternal wellbeing and service use were gathered pre-intervention, 8 weeks and 7 months postpartum. The main outcome was the Edinburgh Postnatal Depression Scale (EPDS). At 8 weeks and 7 months postpartum, n = 129 and n = 115 intervention mothers, also n = 151 and n = 141 control mothers completed outcome measures.

Results

An intention to treat analysis was performed using multilevel modelling analysis which statistically controlled for pre-home visit outcomes, clinic attendance and antenatal contact. The intervention had no impact on most outcomes, however, it was associated with an increased EPDS score (after adjustment: 0.16, 2.36 95%CI) at 8 weeks (before accounting for outliers) but not at 7 months (−0.62,1.65 95%CI). Intervention mothers had higher service satisfaction (7.7, 21.28, 95%CI 8 weeks; 4.69, 22.71, 7 months) and were less likely to have used emergency medical services for their infants to 8 weeks (OR: 0.15, 0.85, 95%CI).

Conclusion

Weekly postpartum visits to ‘low-risk’ mothers had variable effects, therefore, practitioners and researchers should consider further development and application of effective, evidence based home visiting content.     

The impact of social support on mental health service users’ sense of coherence: A longitudinal panel survey

Background

Social support is a crucial coping resource in the development of a strong sense of coherence. However, little is known about which components of social support are most important for the positive development of sense of coherence.

Objectives

The aim of this study is to investigate the ability of the six social provisions in Weiss's theory of social support to predict the positive development of sense of coherence among people with mental health problems.

Design

The study has a prospective design including a baseline assessment and one-year follow-up.

Settings

The community mental health care system in a large city in Norway.

Participants

The sample comprised 107 people with mental health problems. The inclusion criteria were: 18-80 years of age, living at home, mental health problems considered relatively stable, able to engage in dialogue, reliant on the mental health services and/or an activity centre, good orientation, mastery of the Norwegian language and no alcohol and/or drug problems. A total of 92 completed both measures.

Methods

Sense of coherence was measured by the Sense of Coherence questionnaire, mental symptoms by the revised Symptom Checklist-90-R and social support by The Social Provision Scale (all Norwegian versions).

Results

The results show that while social support predicted change in sense of coherence (standardized beta coefficient for social support was 0.32, P = 0.016), mental symptoms did not (standardized beta coefficient −0.07, P = 0.621). The social provision of opportunity for nurturance contributed most to the prediction (standardized beta coefficient 0.24, P = 0.019).

Conclusions

The results indicate that improving social support with special emphasis on opportunity for nurturance might provide important opportunities for increasing sense of coherence among people with mental health problems.     

HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in adolescents: A cross-sectional questionnaire survey

Background

High incidence rates of HIV/AIDS infections among youth draw attention to the need for emphasizing the reduction of risky sexual behavior, a major contributor to the spread of HIV/AIDS. Few researchers have examined the relationship between self-efficacy for HIV/AIDS preventions, depressive symptoms, and adolescent risky sexual behavior. This insufficient understanding limits nurses’ ability to provide effective programs for reducing adolescents’ risky sexual behaviors.

Objectives

This study was conducted to investigate the relationships among HIV/AIDS preventive self-efficacy, depressive symptoms, and risky sexual behavior in Taiwanese adolescents.

Design

A cross-sectional, correlational study.

Settings

Seven vocational high schools located in a metropolitan area in southern Taiwan.

Participants

A convenience sample of 16-18-year-old vocational high school Taiwanese adolescents (n = 734) participated in this study.

Methods

Several self-administrated questionnaires, including HIV/AIDS Preventive Self-efficacy scale, the Center for Epidemiological Studies-Depression scale, Safe Sex Behavior Questionnaire, and a form for demographic data, were used to collect data.

Results

Taiwanese adolescents who had higher HIV/AIDS preventive self-efficacy scores had less overall risky sexual behavior. Adolescents who had less depressive symptoms had higher HIV/AIDS preventive self-efficacy. More depressive symptoms were correlated to more risky sexual behavior.

Conclusion

Improving Taiwanese adolescents’ HIV/AIDS preventive self-efficacy could be useful to reduce risky sexual behaviors in this population. Results of this study may assist nurses in understanding factors related to adolescents HIV/AIDS related risky sexual behavior and its’ preventions. However, future longitudinal studies are needed to clarify whether depressive symptoms is a major influential factor that might interfere with the effectiveness of HIV/AIDS prevention programs.     

Measuring Mobility Limitations in Children With Cerebral Palsy: Development, Scalability, Unidimensionality, and Internal Consistency of the Mobility Questionnaire, MobQues47

Roorda LD, Scholtes VA, van der Lee JH, Becher J, Dallmeijer AJ. Measuring mobility limitations in children with cerebral palsy: development, scalability, unidimensionality, and internal consistency of the Mobility Questionnaire, MobQues47.

Objectives

To develop a questionnaire that specifically and comprehensively measures mobility limitations in children with cerebral palsy (CP) and to investigate certain psychometric properties (scalability, unidimensionality, internal consistency) of this questionnaire.

Design

Cross-sectional study.

Setting

Private physical therapy practices and outpatient departments of hospitals and rehabilitation centers.

Participants

Children with CP undergoing physical therapy or rehabilitation. The Mobility Questionnaire, 47-item (MobQues47), was completed by the mothers of these children (N=323; mean age ± SD, 7.1±2.9y; 57% boys; Gross Motor Function Classification levels: I [48%], II [26%], III [19%], IV [7%]).

Interventions

Not applicable.

Main Outcome Measures

Mokken scale analysis was used to investigate (1) scalability, indicating that the items form a scale; (2) unidimensionality, indicating that the items measure only 1 concept; and (3) internal consistency, indicating the degree of interrelatedness of the items.

Results

The MobQues47, made up of 47 items, was developed on the basis of 3 pilot studies and careful operationalization of the concept (or construct) of mobility limitations. The scalability (coefficient H=.70), unidimensionality, and internal consistency (coefficient ρ=.99) of the MobQues47 were found to be very good.

Conclusions

The MobQues47 is a unidimensional scale with excellent internal consistency that can be used to measure caregiver-reported mobility limitations in children with CP.     

Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial

Shields N, Taylor NF, Dodd KY. Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial.

Objective

To determine whether progressive resistance training improves muscle strength, muscle endurance, and physical function in adults with Down syndrome.

Design

Single-blind randomized controlled trial.

Setting

General community.

Participants

Adults (N=20) with Down syndrome (13 men, 7 women; mean age, 26.8±7.8y) were randomly assigned through a concealed allocation block randomized method to either an intervention group (n=9) or a control group (n=11).

Intervention

The intervention was a supervised, group progressive resistance training program, consisting of 6 exercises using weight machines performed twice a week for 10 weeks. Participants completed 2 to 3 sets of between 10 to 12 repetitions of each exercise until they reached fatigue. The control group continued with their usual activities.

Main Outcome Measures

The outcomes measured by blinded assessors were muscle strength (1-repetition maximum [1-RM]), muscle endurance (number of repetitions at 50% of 1-RM) for chest press and leg press, timed stairs test, and the grocery shelving task.

Results

The intervention group showed significant improvement in upper-limb muscle endurance compared with the control group (mean difference in the number of repetitions of the chest press at 50% of 1-RM was 16.7, 95% confidence interval, [CI] 7.1-26.2); and a trend toward an improvement in upper-limb muscle strength (mean difference in chest press 1-RM, 8.6kg; 95% CI, −1.3 to 18.5kg) and in upper-limb function (mean difference in grocery shelving task, −20.3s; 95% CI, −45.7 to 5.2s). There were no significant differences between the groups for lower-limb muscle performance or physical function measures. No major adverse events for the intervention were noted.

Conclusions

Progressive resistance training is a safe and feasible fitness option that can improve upper-limb muscle endurance in adults with Down syndrome (ACTR identifier ACTRN 012606000515594.)     

Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: A questionnaire survey

Background

Previous studies about the prevalence and impact of lower urinary tract symptoms (LUTS) were focused on urinary incontinence or overactive bladder in the general population. Little research has been focused on the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL).

Objectives

To estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS.

Design

This study was a cross-sectional, questionnaire survey.

Settings

Three medical centers and five regional hospitals in Taipei were selected randomly.

Participants

In the selected hospitals, 1065 female nurses were selected randomly. Data analyses were based on 907 usable surveys. All participants were native Taiwanese; most of the female nurses were 26-35 years of age (mean = 31.02, SD = 6.32), had normal body mass index, and had never given birth. Most nurses’ bladder habits were poor or very poor and their personal habits of fluid consumption at work were inadequate.

Methods

Data were collected using the Taiwan Nurse Bladder Survey and the Short Form 36 Taiwan version. Chi-square tests were used to compare the prevalence rates of different LUTS for nurses in different age groups. Student's t-tests were conducted to compare the mean scores of HRQL for nurses with and without LUTS.

Results

Based on 907 usable surveys, 590 (65.0%) experienced at least one type of LUTS. The prevalence for different LUTS ranged from 8.0% to 46.5%. Nurses who reported LUTS also reported lower HRQL, more so on physical health than mental health, than nurses who did not report LUTS.

Conclusions

Although most of the nurses in this study were young (≦35 years) and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to concerns about nurses’ possible dysfunctional voiding patterns and possible effects of working environment and poor bladder and personal habits on LUTS. Study results showed a possible negative impact of LUTS on nurses’ physical health. Designing a continence-related education program for this group is essential for delivering information about LUTS prevention and management.     

The "Superhero Cape Burrito": a simple and comfortable method of short-term procedural restraint

Background

Restraint is sometimes necessary to successfully perform procedures on pediatric patients in the emergency department. A papoose may be intimidating and uncomfortable, and a wrapped sheet may not keep the child’s arms from wiggling free.

Discussion

We present an adaptation of the wrapped sheet (burrito) technique, using a pillowcase to better immobilize the child’s arms. The arms are inserted in the pillowcase behind the child’s back, and then the child is placed supine over a horizontally placed sheet and turned to each side so the sheet is tucked behind the back. The child is thereby easily and comfortably restrained.

Conclusions

We believe this technique more successfully restrains the child than the wrapped sheet alone, and is easier to execute than other wrapped sheet techniques aimed at improving arm immobilization.     

Twenty-four hours light exposure experiences in postpartum women and their 2-10-week-old infants: an intensive within-subject design pilot study

Background

Adequate light exposure is critical for entraining circadian rhythms, regulating sleep-wake cycles, and maintaining optimal mood. Yet, few studies have reported normative data on light exposure experiences in postpartum women and young infants; none has examined the two simultaneously.

Objectives

The objective of this pilot study was to document the 24-h light exposure experiences in postpartum women and their infants.

Design

An intensive within-subject design was employed.

Settings

The participant’s natural home environment.

Participants

Twenty-four healthy mother-infant pairs were recruited from the general community in Seattle, USA. Two mother-infant pairs did not have complete data, resulting in a final sample size of 22 (12 female infants).

Methods

Mothers and infants wore a monitor to continuously record illumination levels for 7 days. Data were aggregated within subject to calculate summary measures of illumination exposure. Circadian patterns of light were examined using cosinor analysis. Pearson correlation was used to examine the relation between maternal and infant light exposure.

Results

Mothers spent 71.13 ± 11.58% and infants spent 80.07 ± 8.27% of their daytime hours (defined as 06:00-21:59) in an illumination level <50 lux. Mean minutes >1000 lux per day was 54 ± 39 for mothers and 23 ± 18 for infants. Maternal and infant light exposure exhibited a modest circadian pattern and a strong correlation, both in the timing of peak illumination exposure (r = 0.93, p < 0.01) and in the level of light exposure (r = 0.70 ± 0.07).

Conclusions

Postpartum women and infants experience low ambient light levels with short periods of bright light during the day. Whether this level of light is sufficient for optimal postpartum mood and infant circadian entrainment warrants further investigation. If higher levels of light were indeed necessary for postpartum women and young infants, increasing ambient light levels through the use of natural sunlight (i.e., walking outdoors) could be a simple and economic nursing intervention. The strong pattern synchrony between maternal and infant light exposure suggests that mothers play the primary role in providing a lighting environment suitable for infants to synchronize their circadian rhythms to a 24-h day.     

Accuracy of stroke diagnosis by registered nurses using the ROSIER tool compared to doctors using neurological assessment on a stroke unit: a prospective audit

Background

Recombinant tissue plasminogen activator (rT-PA) is an effective treatment for acute ischaemic stroke when given within 3 h of symptom onset but can be delayed as patients wait for a diagnosis. The ROSIER assessment tool (Fig. 1) has been found to be effective in diagnosing stroke but to date has only been tested when used by doctors.

Objective

To compare registered nurses’ ability to diagnose stroke using the ROSIER assessment tool with doctors’ ability to diagnose stroke using traditional neurological assessment.

Design, setting, and participants

A prospective audit of all suspected stroke patients (n = 106) admitted to the stroke unit of a district general hospital over an eight month period, assessed by registered nurses trained to use the ROSIER assessment tool to identify stroke.

Main outcome measures

Time from admission to the stroke unit until initial assessment by doctors and registered nurses. Comparison of initial diagnosis by doctors and registered nurses with final diagnosis by a consultant for stroke.

Results

Of 106 suspected stroke patients, 78 (73.5%) had a final diagnosis of stroke or transient ischaemic attack (TIA) and 28 (26.4%) had an alternative diagnosis. Six patients with TIA were subsequently excluded as they were asymptomatic at the time of assessment, leaving 100 participants in the validation phase of the study. Using the ROSIER tool registered nurses achieved a diagnostic sensitivity for stroke of 98% (95% confidence interval 88-99), positive predictive value (PPV) 83% (95% confidence interval 73-90). Doctors using standard neurological assessment had a similar diagnostic sensitivity of 94% (95% confidence interval 86-98), PPV 80% (95% confidence interval 70-88). The mean time from initial assessment by registered nurses using the ROSIER tool, until assessment by doctor on the stroke unit was 75 min (SD = 65.8 min).

Conclusions

Registered nurses working on a stroke unit using the ROSIER assessment tool are able to diagnose stroke with a degree of accuracy comparable to doctors using clinical neurological assessment. Prompt assessment of suspected stroke patients by registered nurses using the ROSIER tool could reduce delays in eligible stroke patients being assessed for rT-PA treatment.     

Validation of the APLS age-based vital signs reference ranges in a Chinese population

Reference ranges for vital signs may differ significantly among children of different ethnic origins.

Aim

(1) To validate the Advanced Paediatric Life Support (APLS) age-based vital signs reference ranges in Chinese children in Hong Kong. (2) To derive age-based centile curves for systolic blood pressure, heart rate and respiratory rate for Chinese children. (3) To summarize the reference ranges in a table format appropriate for applying APLS to ethnic Chinese patients.

Method

A cross-sectional study was performed on a population of healthy Chinese children recruited from 8 kindergartens and 6 primary schools in Hong Kong. Trained operators visit the sites to obtain measurements. Age-groups: small toddlers (12-23 months); pre-school (24-59 months); and school (60-143 months). Z-test was used to assess statistical significance for proportions of each parameter falling outside the APLS reference range. One-sample t-test was used for comparison with APLS means according to age-groups. LMS Chartmaker Pro v2.3 software was used to describe the data in centile curves.

Results

A total of 1353 patients (55.1% boys) were included. For heart rate, systolic blood pressure and respiratory rate respectively, 34.1%, 55.9% and 55.7% of corresponding measurements were outside the APLS age-based reference ranges. In the ‘pre-school’ and ‘school’ age-groups, the mean value for blood pressure is significantly higher, and the mean values for heart rate and respiratory rate significantly lower, in comparison to APLS mean values.

Conclusion

Independently derived vital signs reference ranges are more appropriate for use when applying APLS to Chinese patients in Hong Kong.     

Effect of Taping on Actual and Perceived Dynamic Postural Stability in Persons With Chronic Ankle Instability

Delahunt E, McGrath A, Doran N, Coughlan GF. Effect of taping on actual and perceived dynamic postural stability in persons with chronic ankle instability.

Objective

To investigate whether 2 different mechanisms of ankle joint taping ([1] lateral subtalar sling or [2] fibular repositioning) can enhance actual and perceived dynamic postural stability in participants with chronic ankle instability (CAI).

Design

Laboratory-based repeated-measures study.

Setting

University biomechanics laboratory.

Participants

Participants (n=16) with CAI.

Interventions

Participants performed the Star Excursion Balance Test (SEBT) under 3 different conditions: (1) no tape, (2) lateral subtalar sling taping and (3) fibular repositioning taping.

Main Outcome Measures

Reach distances in the anterior, posteromedial, and posterolateral directions on the SEBT. Participants' perceptions of stability, confidence, and reassurance when performing the SEBT under 2 different taping conditions.

Results

Taping did not improve reach distance on the SEBT (P>.05). Feelings of confidence increased for 56% of participants (P=.002) under both tape conditions. Feelings of stability increased for 87.5% of participants (P<.001) using condition 2 (lateral subtalar sling taping) and 75% of participants (P=.001) using condition 3 (fibular repositioning taping). Feelings of reassurance increased for 68.75% of participants (P=.001) using condition 2 (lateral subtalar sling taping) and 50% of participants (P=.005) using condition 3 (fibular repositioning taping).

Conclusions

No significant change in dynamic postural stability was observed after application of either taping mechanism; however, participants' perceptions of confidence, stability, and reassurance were significantly improved. Further research is necessary to fully elucidate the exact mechanisms by which taping may help reduce the incidence of repeated injury in subjects with CAI.     

Comparison between a tilt-in-space wheelchair and a manual wheelchair equipped with a new rear anti-tip device from the perspective of the caregiver

Kirby RL, MacDonald B, Smith C, MacLeod DA, Webber A. Comparison between a tilt-in-space wheelchair and a manual wheelchair equipped with a new rear anti-tip device from the perspective of the caregiver.

Objective

To test the hypothesis that, in comparison with a commercially available tilt-in-space wheelchair, a lightweight manual wheelchair equipped with a new, rear anti-tip device (Arc-RAD) provides caregivers with improved wheelchair-handling performance, less exertion, and greater satisfaction.

Design

Within-participant comparisons.

Setting

Rehabilitation center.

Participants

Able-bodied participants (n=19) simulating caregivers and simulating wheelchair users (n=7).

Intervention

Caregiver participants were trained (50-75min) in wheelchair-handling skills.

Main Outcome Measures

Each participant was tested in both wheelchairs, in random order. To evaluate wheelchair-handling skills, we used the total percentage score on the Wheelchair Skills Test (WST), version 3.2. For exertion, we used a visual analog scale (in percent). For satisfaction, we used the Quebec Users' Evaluation of Satisfaction with assistive Technology (QUEST; range of values, 8-40), version 2.

Results

Mean percentage WST scores ± SD for the Arc-RAD and tilt-in-space wheelchairs were 95.9%±4.2%, and 91.9%±4.8%, respectively (P=.008). The mean perceived exertions during Arc-RAD and tilt-in-space wheelchair use were 26.1%±20.4% and 46.6%±23.2% (P=.003). The mean total QUEST satisfaction scores for the Arc-RAD and tilt-in-space wheelchairs were 35.1±3.8 and 28.4±4.7 (P=.002).

Conclusions

In comparison with the larger and heavier tilt-in-space wheelchair, a lightweight manual wheelchair equipped with a new rear anti-tip design allows 4.4% better wheelchair-handling performance, 44% less exertion, and 23.6% greater wheelchair satisfaction.     

Examining the Relationship Between Cognition and Driving Performance in Multiple Sclerosis

Schultheis MT, Weisser V, Ang J, Elovic E, Nead R, Sestito N, Fleksher C, Millis SR. Examining the relationship between cognition and driving performance in multiple sclerosis.

Objective

To identify cognitive predictors of driving performance after multiple sclerosis (MS).

Design

Prospective design examining predictive value of cognitive measures on driving performance.

Setting

All data were collected in an outpatient research setting and an outpatient driver rehabilitation program.

Participants

Participants were community-dwelling persons (N=66) with clinically defined MS (86% relapsing-remitting, 14% progressive) with a mean age of 43.47 years. All were active drivers who met vision requirements established by their respective states, and none required adaptive driving equipment.

Intervention

Not applicable.

Main Outcome Measures

Participants were administered a comprehensive neuropsychologic assessment and a clinical behind-the-wheel (BTW) driving evaluation. Additional measures of driving performance included history of traffic violations and collisions (since MS onset).

Results

Logistic regression indicated that information processing speed (Symbol Digit Modality Test [SDMT]) was the strongest predictor of BTW performance. A logistic regression revealed that the strongest predictors of collision and violation frequency were visuospatial learning and recall (7/24 Spatial Recall Test [SPART 7/24]).

Conclusions

These findings indicate that information processing and visuospatial skills are predictive of driving performance among persons with MS. These measures (SDMT and SPART 7/24) may serve as screening methods for identifying the potential impact of cognitive impairment on driving. Furthermore, the findings raise questions regarding the appropriateness of the BTW evaluation to evaluate driving difficulties accurately among individuals with MS.     

Early miscarriage as ‘matter out of place’: An ethnographic study of nursing practice in a hospital gynaecological unit

Background

Early miscarriage has been conceptualised as loss and bereavement where nurses are urged to provide sympathetic, psychological care for women. However, the reality of women's experience is also about blood, ‘dirt’ and failure which are under explored in the literature.

Objective

To explore the management and care of women having an early miscarriage within a hospital setting.

Design

A qualitative, ethnographic study.

Setting

A gynaecological unit consisting of an early pregnancy clinic and two gynaecological wards in a general hospital in an urban area of Wales, United Kingdom.

Participants

The first group was a purposive, volunteer sample of eight women who had experienced an early miscarriage and were admitted to hospital for active management of their miscarriage. The second was a purposive, volunteer sample of 16 hospital health professionals actively involved in the care of women having an early miscarriage. This included 10 nurses, three doctors and three ultrasonographers.

Methods

Three main methods were employed. Firstly, 20 months participant observation working alongside gynaecological nurses in a gynaecological unit. Secondly, documentary analysis of key documents such as nursing care plans. Finally, in-depth interviews with women who had experienced early miscarriage and hospital health professionals involved in their care.

Results

Three key categories emerged; ‘first signs and confirmation’, ‘losing the baby’ and ‘the aftermath’. ‘First signs’ relates to the women's experiences when first realising that their pregnancy is under threat. ‘Losing the baby’ further explores women's accounts of their experience and the ‘aftermath’ relates to the long term impact of miscarriage on them and their lives. This paper focuses on the women's experiences of the physical manifestations of miscarriage in ‘losing the baby’. Drawing on anthropological literature and the concepts of dirt and pollution, it is argued that miscarriage for both women and health professionals can be considered as ambiguous and that miscarriage and the early passage of the foetus can be seen as ‘matter out of place’.

Conclusion

This exploration of how women were managed in a hospital setting reinforced the notion of the ambiguous nature of miscarriage and supports the position that miscarriage may be considered as atypical bereavement. Furthermore, an analysis is offered of the significance of the vaginal blood loss as polluting and gives insights into how nurses manage this ambiguity.     

Safety, Acceptance, and Physiologic Effects of Sauna Bathing in People With Chronic Heart Failure: A Pilot Report

Basford JR, Oh JK, Allison TG, Sheffield CG, Manahan BG, Hodge DO, Tajik AJ, Rodeheffer RJ, Tei C. Safety, acceptance and physiologic effects of sauna bathing in people with chronic heart failure: a pilot report.

Objectives

To perform a pilot study and make a preliminary assessment of the safety and acceptance of supervised sauna bathing at moderate temperatures in people with chronic heart failure (CHF). Secondary measures included its impact on exercise tolerance and neuroendocrine concentrations.

Design

Randomized, controlled, cross-over trial.

Setting

Physical medicine and rehabilitation clinic.

Participants

Six men and 3 women (age, 62-87y) with New York Heart Association Class III and IV CHF.

Interventions

Subjects were randomized into 2 groups and told to maintain their normal medication and activity regimens. One group then began a 3-times-a-week, 4-week sauna bathing program at 60±1°C while the other continued with their usual activities and medications. Assignments were then reversed. Sessions were 15 minutes in length but were prolonged an additional 5 minutes for oral temperature increases less than 1.0°C.

Main Outcome Measures

Patient acceptance, Minnesota Living With Heart Failure Questionnaire (MLWHFQ) scores; treadmill exercise duration and plasma adrenaline, noradrenalin, aldosterone, atrial naturectic factor, adrenomedulin, and endothelin.

Results

Sauna bathing was well tolerated and no adverse effects were reported. Improvements in MLWHFQ scores and treadmill endurance did not achieve statistical significance on a between-group basis but were more marked after the sauna than during the control phase. Neuroendocrine concentrations showed no clear effect of sauna treatment with a between-group statistically significant difference (P=.049) found only in the case of noradrenalin's 24% decrease.

Conclusions

Sauna bathing under the moderate and supervised conditions of this study appears to be well tolerated and may be safe for people with CHF. More research is needed to further evaluate the safety and potential benefits of this approach.     

Cortical Reorganization Induced by Body Weight-Supported Treadmill Training in Patients With Hemiparesis of Different Stroke Durations

Yang Y-R, Chen I-H, Liao K-K, Huang C-C, Wang R-Y. Cortical reorganization induced by body weight-supported treadmill training in patients with hemiparesis of different stroke durations.

Objective

To investigate corticomotor changes induced by body weight-supported treadmill training (BWSTT) in patients with short or long poststroke duration.

Design

Single-blinded and randomized controlled trial.

Setting

Neurologic physical therapy research laboratory.

Participants

Hemiparesis patients (N=18) whose motor-evoked potentials could be induced participated in this study. Subjects in each hemiparesis postonset of short (<6mo) or long (>12mo) duration group were randomly assigned to either the control or experimental group.

Interventions

Subjects in the experimental groups participated in BWSTT for 4 weeks. Those in the control groups received the general exercise program.

Main Outcome Measures

The primary outcomes were motor threshold and map size of the abductor hallucis muscle in the ipsilesional hemisphere. The secondary outcome was Fugl-Meyer Assessment. Outcome measures were blindly assessed before and after completing the 4 weeks of training.

Results

The 4-week BWSTT resulted in a decrease of motor threshold and an increase of map size in subjects with hemiparesis of short duration, whereas only the expansion of the map size was noted in subjects with hemiparesis of long duration. Improvement of motor control occurred in subjects with hemiparesis of both short and long duration after BWSTT.

Conclusions

The BWSTT results in similar improvement in motor control but different patterns of treatment-induced cortical reorganization in subjects with different poststroke durations.