Does a short intervention with vibration foam roller recover lifeguards better after a water rescue? A pilot study

PurposeThe aim of this study was to analyze the effects of a recovery program based on foam roller with and without vibration on blood lactate clearance and perceived fatigue after a water rescue.MethodsA quasi-experimental crossover design was carried out to compare passive (PR) recovery and a short protocol of foam roller (FR) and vibration foam roller (VFR) recovery after a 100 m water rescue in 7 volunteer lifeguards. Blood lactate and perceived exertion were measured before and after the rescue, and also after the 5-min recovery intervention.ResultsBlood lactate levels decrease significantly with foam roller (p = 0.013; effect size = 0.97) and vibration foam roller recovery (p < 0.001; effect size = 1.62). Passive recovery did not show significant differences clearing out blood lactate. Fatigue perceived decrease significantly with all the recovery methods, but foam roller has higher effects on the global fatigue and VFR on the legs.ConclusionFR and VFR clear out more blood lactate and decrease fatigue more than PR, with the subsequently increase of the physical conditioning to perform another effort.     

Coping with rheumatoid arthritis. How can specialist nurses influence it and promote better outcomes?

• ? Psychological stressors are said to be an important influence on the outcome of chronic illnesses such as rheumatoid arthritis (Engel, 1977).
• ? Helping patients to cope with stressors is identified as a central concept in the delivery of nursing care (Khan et al., 1994). It is thus reasonable to suggest that rheumatology nurses may be key players in the process of coping with rheumatoid arthritis.
• ? But in order for rheumatology nurses to be effective players in this process, they need to discourage coping behaviour(s) linked to poor outcomes, and/or promote an overall behaviour pattern linked to a better outcome. Literature showing the link between different coping behaviours and outcome is examined, and cognitive restructuring is emphasized as one method nurses could use.
• ? Having identified coping behaviour which is optimal in terms of future outcome, further study of different forms of coping-based educational intervention is suggested, to reveal how such patterns of behaviour can be taught by nurses in the most effective way

     

How much can carpus rotate axially? An in vivo study

BACKGROUND: Supination and pronation movements occur primarily at the forearm though are possible at the wrist joint too. The axial rotation of the wrist also called the radiometacarpal rotation has been quantified but for its passive range which may never occur during the day-to-day routine activities. It is normally not possible for the wrist joint to rotate axially in an active manner. However, voluntary effort to rotate the forearm while keeping the hand fixed on a custom designed device is able to provide active rotation of the wrist which occurs in a manner similar to that occurring during the daily routine activities. METHODS: The present study measured axial rotation of the wrist in 20 asymptomatic volunteers who had axial CT done of their wrist with elbow in 10-30 degrees flexion and forearm positioned parallel to the long axis of the table with thumb pointing up towards the roof. The examination was repeated twice while the subject actively tried to supinate and pronate the forearm against the fixed hand and the metacarpals using maximum voluntary effort on a custom designed positioning device. FINDINGS: The mean radiometacarpal supination and pronation were 17.15 degrees (SD 7.9) and 17.0 degrees (SD 10) respectively. The movement was found to occur predominantly at midcarpal joint with radiocarpal joint contributing only 18% to supination and 31% to pronation. INTERPRETATION: The radiometacarpal rotation has a crucial bearing in the development of the wrist prostheses. The design of the prostheses should consider accommodating axial movements that occur in the carpus during the activities of daily living.     

How can we improve platelet preparation and storage?

The use of platelet additive solutions to replace the major part of plasma as storage medium can improve storage through supply of fuel in platelet metabolism. It is important to avoid platelet activation, e.g. through optimal anticoagulation and gentle procedures at preparation. Leucodepletion of platelet concentrates (PCs) reduces HLA immunization and therapeutic refractoriness. Leucofiltration has become common to obtain leucocyte-depleted PCs, but frequently results in considerable platelet loss. Attempts at improvements must be validated, e.g. by testing post-transfusion increments and function in vivo. The in vitro bleeding-time test seems to be a valuable tool for the latter purpose. Bacterial contamination of PCs occur more commonly than so far believed, however, severe clinical complications seem to be relatively rare. Newly available methods for bacterial culture are sufficiently rapid and sensitive to be useful in PC testing. Bacterial decontamination, e.g. using psoralen-UVA, may be a future possibility for obtaining safer PCs.     

'Stories' or 'snapshots'? A study directed at comparing qualitative and quantitative approaches to curriculum evaluation

The focus of this paper is a study designed to explore the validity of quantitative approaches of student evaluation in a pre-registration degree programme. As managers of the students' education we were concerned that the quantitative method, which used lecturer criteria, may not fully represent students' views. The approach taken is that of a process-type strategy for curriculum evaluation as described by Parlett and Hamilton (1972). The aim of the study is to produce illuminative data, or students' 'stories' of their educational experiences through use of semi-structured interviews. The results are then compared to the current quantitative measurement tools designed to obtain 'snapshots' of the educational effectiveness of the curriculum. The quantitative measurement tools use Likert scale measurements of teacher-devised criterion statements. The results of the study give a rich source of qualitative data which can be used to inform future curriculum development. However, complete validation of the current quantitative instruments used was not achieved in this study. Student and teacher agendas in respect of important issues pertaining to the course programme were found to differ. Limitations of the study are given. There is discussion of the options open to the management team with regard to future development of curriculum evaluation systems.     

What is the foot strike pattern distribution in children and adolescents during running? A cross-sectional study

BackgroundThere is a lack of studies describing foot strike patterns in children and adolescents. This raises the question on what the natural foot strike pattern with less extrinsic influence should be and whether or not it is valid to make assumptions on adults based on the knowledge from children.ObjectivesTo investigate the distribution of foot strike patterns in children and adolescents during running, and the association of participants’ characteristics with the foot strike patterns.MethodsThis is a cross-sectional study. Videos were acquired with a high-speed camera and running speed was measured with a stopwatch. Bayesian analyses were performed to allow foot strike pattern inferences from the sample to the population distribution and a supervised machine learning procedure was implemented to develop an algorithm based on logistic mixed models aimed at classifying the participants in rearfoot, midfoot, or forefoot strike patterns.ResultsWe have included 415 children and adolescents. The distribution of foot strike patterns was predominantly rearfoot for shod and barefoot assessments. Running condition (barefoot versus shod), speed, and footwear (with versus without heel elevation) seemed to influence the foot strike pattern. Those running shod were more likely to present rearfoot pattern compared to barefoot. The classification accuracy of the final algorithm ranged from 80% to 88%.ConclusionsThe rearfoot pattern was predominant in our sample. Future well-designed prospective studies are needed to understand the influence of foot strike patterns on the incidence and prevalence of running-related injuries in children and adolescents during running, and in adult runners.     

How can care managers strengthen health literacy among patients with common mental disorders? A qualitative study

Background

In order for persons with mental illness to be able to promote and preserve their health, sufficient knowledge about health is required. An effective means to improve the health of the patients is to strengthen their health literacy. The aim of this study was to explore how care managers work with health literacy in patients with common mental disorders to help them to better understand and manage their illness.

Method

A qualitative study was conducted, using written reports from 25 care managers regarding meetings with patients with common mental disorders in the primary care in a Swedish region. The care managers' reports were coded based on Sörensen's four dimensions for the domain “health care” and analysed deductively through systematic text condensation according to Malterud.

Results

The care managers described how they worked strategically and continuously with follow-up and wanted to be responsive to the patients' stories. They confirmed the patients' feelings with the goal of creating increased interaction, thereby involving the patients in their own care. The care managers also worked actively to provide well-balanced care at an early stage. Using various tools such as self-assessment instruments, the care manager started from the patient's basic problem, gave support and discussed strategies based on the patient's condition and situation.

Conclusions

The care managers used multifaceted health literacy interventions. They worked in a person-centred, strategic and encouraging manner based on the patient's unique conditions, where sensitivity and adapted information were important aspects. The aim of the interventions was for the patients to become knowledgeable, gain new insights and work independently with their own health.     

How can brain activity and hypnosis inform each other?

Applying P. Teitelbaum's conception of the method of physiological psychology as interlocking stages of analysis and synthesis, the authors examine how studies of brain function can advance the understanding of hypnosis as a psychological process. They consider the exploration of animal analogues of human hypnosis, the study of brain injury in humans as a window on mechanisms underlying hypnosis, the distinct questions that brain-imaging studies of hypnosis can address, and the potential for comparative and developmental approaches to hypnosis as close allies to psychophysiological approaches. They conclude both that hypnosis is a powerful technique for studying the brain mechanisms of conscious experience and that underlying brain mechanisms may shed new light on longstanding theoretical debates about hypnosis.     

Randomised double blind crossover study comparing ondansetron, granisetron and tropisetron. A cost–benefit analysis

 The goals of this work were to compare the relative efficacy of ondansetron, granisetron and tropisetron in a randomised double blind crossover trial, evaluating objective, subjective and pharmacoeconomic parameters. To this end, 136 patients were enrolled, 120 of whom were eligible and evaluable. Each patient received three identical chemotherapy cycles with an antiemetic protocol which consisted in dexamethasone 20 mg i.v. and a tapering dose schedule for 4 days, and a single i.v. dose of an antiserotoninergic drug in each cycle. Arm A patients received tropisetron 5 mg; arm B patients, granisetron 3 mg; and arm C patients, ondansetron 24 mg. Numbers of patients and days with emetic episodes, grade of nausea, patient preference, headaches, need for metoclopramide, nursing or medical consultation, or admission to emergency room or ward were evaluated. There was no difference in the percentage incidence of acute or delayed nausea and vomiting. Twenty-five per cent of patients preferred tropisetron, 30% preferred granisetron, and 45% preferred ondansetron (P<0.01). Toxicity was mild in less than 10% of patients. Direct and indirect costs of treatment varied from 19.74 to 28.53 euros for tropisetron, 31.07–46.51 euros for granisetron and 22.76–62.61 euros for ondansetron. There was no difference in objective activity. In the schedules studied, patients preferred ondansetron. Indirect costs amount to less than 10% of the total antiemetic cost. Direct costs varied widely and should be considered whenever an antiemetic drug is selected. Published online: 15 March 2000     

How do clinicians and suicide attempters understand suicide attempt impulsivity? A qualitative study

Inconsistencies in the definition of impulsive suicide attempts hamper research integration. To expand the currently limited data on how this construct is used in clinical practice, researchers interviewed eight suicide attempters to create timelines of their suicide process, then had seven experienced clinicians review these timelines. Thematic analysis of the patient and clinician data revealed three themes: “thinking out,” build-up, and unclear intentionality. The results imply that assessing build-up of agitation and exhaustion symptoms can contribute to understanding acuteness of suicide risk. In addition, uncertainty about one’s intentions during the attempt should not be equated to low intent to die.     

How are religion and spirituality related to health? A study of physicians' perspectives

BACKGROUND: Despite expansive medical literature regarding spirituality and medicine, little is known about physician beliefs regarding the influence of religion on health. METHODS: Semistructured interviews with 21 physicians regarding the intersection of religion, spirituality, and medicine. Interviews were transcribed, coded, and analyzed for emergent themes through an iterative process of qualitative textual analysis. RESULTS: All participants believed religion influences health, but they did not emphasize the influence of religion on outcomes. Instead, they focused on ways that religion provides a paradigm for understanding and making decisions related to illness and a community in which illness is experienced. Religion was described as beneficial when it enables patients to cope with illness but harmful when it leads to psychological conflict or conflict with medical recommendations. CONCLUSIONS: Empirical evidence for a "faith-health connection" may have little influence on physicians' conceptions of and approaches to religion in the patient encounter.     

Spinal stenosis, back pain, or no symptoms at all? A masked study comparing radiologic and electrodiagnostic diagnoses to the clinical impression

OBJECTIVE: To assess the relations between clinically recognized lumbar spinal stenosis and the conclusions of masked radiologists and electrodiagnosticians. DESIGN: Prospective, masked, double-controlled trial. SETTING: University spine center. PARTICIPANTS: One hundred fifty persons age 55 to 80 years with or without back pain and with or without magnetic resonance imaging (MRI)-demonstrated stenosis, screened for neuropathy risk, previous surgery, or cancer. INTERVENTIONS: Questionnaires on pain and function; ambulation testing and physical examination; and masked electrodiagnotics and MRI. MAIN OUTCOME MEASURE: Diagnostic impressions of the examining clinician, radiologist, and electrodiagnostician. RESULTS: Following application of post hoc exclusion criteria and elimination of patients due to incomplete or inadequate test data, the clinical diagnosis was lumbar stenosis in 50 subjects, back pain in 44 subjects, and no pain in 32 subjects. Radiologic and clinical impression had no relation (P = .80 vs asymptomatic, P = .99 vs back pain controls). Electrodiagnostic impression trended to relate to clinical impression (P = .14 vs asymptomatic, P = .09 vs back pain). Retrospective application of age-related electrodiagnostic norms for paraspinal electromyographic and limb motor unit changes, established in this study, reclassified 13 of the 17 asymptomatic persons whom the electrodiagnostician thought had stenosis. The clinical impression did correspond to history and physical examination findings typically associated with spinal stenosis and to the independent impression of a neurosurgeon who examined MRI and clinical, but not to the electrodiagnostic data. CONCLUSIONS: The impression obtained from an MRI scan does not determine whether lumbar stenosis is a cause of pain. Electrodiagnostic consultation may be useful, especially if age-related norms obtained in this study are applied.