Student nurses’ de-escalation of patient aggression: A pretest-posttest intervention study

Background

Experts recommend staff training to prevent and manage aggressive situations involving patients or their relatives. However, in many countries this subject is not covered in pre-registration nursing education. In addition, the evidence regarding its impact on practical placements remains weak.

Objective

This study examines the influence of an aggression management training programme for nursing students on their performance in de-escalating aggressive patients.

Design

Pretest-posttest within-and-between-groups design.

Setting

A School of Nursing in Germany.

Participants

Convenience sample out of six classes of nursing students at differing educational levels (10th to 28th month of nursing education, n = 78, mean age = 22).

Methods

In a cross-sectional and longitudinal two groups before and after design nursing students encountered two scenarios (A or B) with simulation patients. After completing the training, each student was confronted with the unknown other scenario. De-escalation experts from three German-speaking countries evaluated 156 video scenes using the De-escalating Aggressive Behaviour Scale (DABS), not knowing whether the videos had been recorded before or after the training. Mean values and statistical significance tests were computed to compare the results.

Results

The performance levels of students who had been trained rose significantly from 2.74 to 3.65 as measured by the DABS on a 5-point Likert scale (Wilcoxon test p < .001). The trained students managed scenario A significantly better than the untrained students (untrained 2.50, trained 3.70; Mann-Whitney-U-test p < .001,). Similar results were found for scenario B (untrained 3.01, trained 3.61; Mann-Whitney-U-test p < .001). No significant differences were found in the pretest results irrespective the students’ age or duration of previous nursing education.

Conclusions

Aggression management training is able to improve nursing students’ performance in de-escalating aggressive behaviour. A maturation-effect on the de-escalating performance due to general nursing education or age is unlikely.     

Association between PON1 5′-regulatory region polymorphisms, PON1 activity and ischemic stroke

Objectives

Paraoxonase I (PON1) was known as a risk factor for cerebrovascular diseases. This study assessed the association of single nucleotide polymorphisms (SNPs) in the PON1 5′-regulatory region with ischemic stroke and serum PON1 activity.

Design and methods

Study subjects consisted of 418 healthy controls and 86 ischemic stroke patients with small vessel occlusion. SNPs were identified by DNA sequencing and a primer extension-based method.

Results

Among 10 identified SNPs, only −1434GG genotype was observed with a lower frequency in patients on borderline statistical significance (OR(95% CI), 0.297(0.083-1.060), p = 0.0615). However, haplotype analysis in a dominant model revealed that ht2 was observed with a significantly lower frequency in patients (OR(95% CI), 0.390(0.153-0.991), p = 0.0477). Both C(−1434)G mutation and ht2 distribution were associated with serum PON1 activity.

Conclusion

Our results suggest that haplotypes observed in the PON1 5′-regulatory region should be considered as risk factors for ischemic stroke.     

5-Repetition Sit-to-Stand Test in Subjects With Chronic Stroke: Reliability and Validity

Mong Y, Teo TW, Ng SS. 5-repetition sit-to-stand test in subjects with chronic stroke: reliability and validity.

Objectives

To examine the (1) intrarater, interrater, and test-retest reliability of the 5-repetition sit-to-stand test (5-repetition STS test) scores, (2) correlation of 5-repetition STS test scores with lower-limb muscle strength and balance performance, and (3) cut-off scores among the 3 groups of subjects: the young, the healthy elderly, and subjects with stroke.

Design

Cross-sectional study.

Setting

University-based rehabilitation center.

Participants

A convenience sample of 36 subjects: 12 subjects with chronic stroke, 12 healthy elderly subjects, and 12 young subjects.

Interventions

Not applicable.

Main Outcome Measures

5-Repetition STS test time scores; hand-held dynamometer measurements of hip flexors, and knee flexors and extensors; ankle dorsiflexors and plantarflexors muscle strength; Berg Balance Scale (BBS); and limits of stability (LOS) test using dynamic posturography.

Results

Excellent intrarater reliability of intraclass correlation coefficient (ICC) (range, .970-.976), interrater reliability (ICC=.999), and test-retest reliability (ICC range, .989-.999) were found. Five-repetition STS test scores were also found to be significantly associated with the muscle strength of affected and unaffected knee flexors (ρ=-.753 to -.830; P<.00556) of the subjects with stroke. No significant associations were found between 5-repetition STS test and BBS and LOS tests in subjects with stroke. Cut-off scores of 12 seconds were found to be discriminatory between healthy elderly and subjects with stroke at a sensitivity of 83% and specificity of 75%.

Conclusions

The 5-repetition STS test is a reliable measurement tool that correlates with knee flexors muscle strength but not balance ability in subjects with stroke.     

Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer's disease: An exploratory comparative design

Background

Research into burden among spouse and adult-child caregivers of patients with Alzheimer's disease has generated contradictory results as regards the group which suffers the greatest burden and the factors underlying any differences.

Objectives

The aim of the present study was to identify and compare the factors associated with caregiver burden among spouse and adult-child caregivers.

Design

Cross-sectional analytic study.

Settings

All clinical subjects had been referred on an out-patient basis to the Memory and Dementia Assessment Unit of the Santa Caterina Hospital in Girona (Spain).

Participants

Data were collected from 251 patients and their caregivers, 112 with spouse and 139 with adult-child caregivers.

Methods

The association between caregiver burden and the socio-demographic and clinical variables of both patients and caregivers was analysed, the results being compared for spouse vs. adult-child caregivers. Burden was analysed using a multivariate linear regression including all the variables for the two groups of caregivers.

Results

The results show greater burden among adult-child caregivers (p < .05), who experience more feelings of guilt (p < .001). In both groups the behavioural and psychological symptoms of patients were correlated with burden (p < .001). Living with the patient has a notable influence on burden among adult children (p < .001). Husbands, wives, daughters and sons, in this order, showed increasing levels of burden (p < .05) and progressively worse mental health (p < .01). However, the correlations between burden and mental health were strongest in daughters (p < .001).

Conclusion

The differences in burden between spouse and adult-child caregivers were not associated with age, physical health or clinical factors of the patients. Overall burden was greater among adult-child caregivers, especially those who lived with the patient and who had other family duties. Feelings of guilt were associated with not living with the patient, and there was a strong correlation between burden and mental health. These results support the hypothesis that spouses regard caregiving as part of their marital duties, whereas for adult children such tasks imply an important change in their lifestyle.     

Do smokers with chronic obstructive pulmonary disease report their smoking status reliably? A comparison of self-report and bio-chemical validation

Background

Chronic obstructive pulmonary disease (COPD) is predominantly caused by cigarette smoking and is considered a worldwide preventable chronic illness. Smoking cessation is considered the primary intervention for disease management and nurses should play a major role in assisting patients to stop smoking. Currently there is a lack of professional consensus on how cessation interventions should be evaluated. The vast array of biochemical markers reported in the literature can be confusing and can make the comparisons of results difficult.

Objective

To validate self-report data on smoking with exhaled carbon monoxide in patients with chronic obstructive pulmonary disease over twelve months.

Design

We performed a secondary analysis of a previously published randomized controlled trial evaluating nursing interventions to assist respiratory patients to stop smoking.

Setting

Northern Ireland's Regional Respiratory Centre.

Participants

A total of 91 cigarette smokers attending secondary care for the treatment for COPD participated in the study.

Method

Self-reported smoking status and cigarettes smoked per day were compared to exhaled carbon monoxide readings at baseline, 2, 3, 6, 9 and 12 months. The cut-off value of ≤10 ppm was used to identify non-smokers. The p-values are based on Pearson's correlation coefficient and Kappa Coefficient as appropriate.

Results

Findings suggest self-reported smoking status and cigarette consumption amongst patients with chronic obstructive pulmonary disease was highly consistent with exhaled carbon monoxide results (p = 0.001-0.003).

Conclusion

The majority of patients with chronic obstructive pulmonary disease reliably report their cigarette consumption.     

Homocysteine level and metabolism in ischemic stroke in the population of Northern Poland

Objectives:

In this study we analyzed the occurrence of ischemic brain stroke in Northern Poland in regard to risk factors.

Design and methods:

131 ischemic stroke patients and 64 controls were studied. Analyzed risk factors included conventional risk factors, total plasma homocysteine level and polymorphisms of the main enzymes of homocysteine metabolism—methylenetetrahydrofolate reductase (polymorphisms C677T and A1298C) and cystathionine β synthase (polymorphism T833C).

Results:

We confirmed the occurrence of a number of conventional risk factors in ischemic stroke. We found that hyperhomocysteinemia is an independent risk factor (p = 0.0001). Plasma homocysteine correlated inversely with plasma vitamin B₆. We also found a relationship between C677T polymorphism type and hyperhomocysteinemia (p = 0.0266).

Conclusions:

The occurrence of studied polymorphisms in the population of northern Poland was higher than reported previously for similar populations. However, none of the studied genetic factors were found to be significant risk factors in ischemic brain stroke.     

Health behaviour beliefs and physical health risk factors for cardiovascular disease in an outpatient sample of consumers with a severe mental illness: A cross-sectional survey

Background

Consumers with a mental illness have a significantly higher risk of physical health problems than the general population. The role of health behaviour beliefs and their part in the health of consumers with a mental illness has been poorly explored in the literature.

Objectives

To understand the relationship between physical health risk factors and health behaviour beliefs in consumers with schizophrenia.

Design

A cross-sectional survey study design using the European Health and Behaviour Survey and assessing (n = 99) consumer's blood pressure, waist circumference, body mass index, smoking history, exercise levels, demographics, family history of diabetes and cardiovascular disease was used.

Settings

The study was conducted in a 76-bed psychiatric facility located within a 550-bed metropolitan generalist hospital in Sydney, Australia.

Participants

Patients attending an outpatient clozapine clinic at the mental health service were asked to participate in the survey by a nurse working in the clinic during the study period.

Results

Of the 163 consumers asked to be involved in the study, n = 99 agreed to participate. Mean waist circumference and body mass index for both males and females were significantly above normal population limits. Overall, consumer's beliefs toward their health on the European Health and Behaviour Survey were positive, having statistically significantly more positive attitudes to the statements ‘avoiding too much sugar’, ‘drinking no alcohol’ and ‘yearly blood pressure checks’ than a previously published non-mental health consumer sample. Whilst having positive attitude toward their healthcare, consumers’ physical health risk parameters were higher than general population norms.

Conclusions

Consumers with a mental illness have a significantly higher risk for serious physical health problems, yet possess high positive attitudes toward their physical health care. Models of care need to explore this contradiction within mental health services to improve patient outcomes.     

Patterns of cognitive change in elderly patients during and 6 months after hospitalisation: A prospective cohort study

Background

The extent and patterns of cognitive change regularly occurring in elderly patients who experience prolonged hospitalisation have not been well examined.

Objective

To describe patterns of cognitive change during and 6 months after hospitalisation and to identify prognostic factors associated with different patterns of changes.

Design

A prospective cohort study.

Setting

Five med-surgical units at a tertiary hospital in Taipei, Taiwan.

Participants

Patients ≥65 years old without preexisting profound cognitive impairment (Mini-Mental State Examination score ≥20) and with an expected hospital length of stay >5 days were drawn from consecutive admissions. Of 351 patients, 82.9% (138 women, 153 men, mean age = 71.6 years) completed all four scheduled assessments.

Methods

Cognition was measured by the Mini-Mental State Examination at 4 times: admission, discharge, and 3 and 6 months post-discharge. Possible prognostic factors at admission included demographics, comorbidities, number of medications, serum haemoglobin, length of hospital stay, and surgery.

Results

Four cognitive-change patterns with a high prevalence of decline were identified by cluster analysis. The worsening then improve group (n = 47) had a deep V-shape with a mean fluctuation of 3.9 points on the Mini-Mental State Examination, and the low continuous group (n = 83) had little change. Both the start high and decline (n = 66) and start low and decline (n = 95) groups showed persistent and accelerated declines, with baseline cognitive scores of 29.1 and 25.5 points, respectively. Predictor variables at admission for different patterns of cognitive change were age, total education (years), cardiovascular comorbidities, number of medications, functional and nutritional status, depressive symptoms, surgical treatment, and haemoglobin level <12 g/dL.

Conclusions

Cognitive decline during and after hospitalisation shows four heterogeneous patterns of change. Different patterns of change were predicted by age, education, cardiovascular comorbidities, number of medications, functional and nutritional status, depressive symptoms, surgical treatment, and haemoglobin level <12 g/dL, most of which are potentially modifiable factors.     

Serum butyrylcholinesterase activity and phenotype associations with lipid profile in stroke patients

Background

Butyrylcholinesterase (BuChE) catalyzes the hydrolysis of acetylcholine and other choline esters and is also involved in lipid metabolism. The purpose of this study was to investigate any association between BuChE serum phenotype and activity and lipid profile of ischemic stroke patients.

Methods

We determined serum BuChE activities and phenotypes, and levels of total cholesterol (TC), LDL-C, HDL-C and triacylglyerol (TG) in 33 patients with acute ischemic stroke within 12 h of the onset of the attack and 29 controls.

Results

The mean (± SD) serum BuChE activity and the BuChE of U/A phenotype in the stroke individuals were significantly lower and higher than that of the control (315 (± 124) IU/L. vs. 384 (± 99) IU/L, p = 0.02, t = − 2.4 and 21.2% vs.3.4%, p = 0.026 respectively).

Conclusions

Our results showed that a negative correlation between BuChE activity with TC level, in addition the frequency of BuChE phenotypes with low activity is high in stroke patients, who have high levels of cholesterol, may have increased susceptibility to stroke.     

Cervical erector spinae and upper trapezius muscle activity in children using different information technologies

Objectives

Researchers investigating the effects of computer use and the development of musculoskeletal disorders have mainly focused on the effects of prolonged muscle loading associated with postures assumed during computer use in the adult population. The objective of this study was to investigate the effects of different forms of old and new information technology (IT) on muscle activity levels in a paediatric population.

Design

A 3 × 3 × 2 mixed model design was used for this study.

Participants

Thirty-two schoolchildren aged 4-17 years participated in this study.

Outcome measures

Surface electromyography (EMG) data were collected from the left and right cervical erector spinae and upper trapezius muscles. Participants performed a 5-minutes reading task using the three IT types (book, laptop and desktop computer).

Results

Cervical erector spinae and upper trapezius muscle activity levels were significantly higher when children used the laptop set-up (P < 0.001). The lowest muscle activity levels were found when children used the desktop set-up. Cervical erector spinae and upper trapezius muscle activities were found to be higher on the left side in the book set-up compared with higher right muscle activity levels in the computer set-ups (P = 0.047 and <0.001, respectively).

Conclusions

The three IT types had different effects on cervical erector spinae and upper trapezius muscle activity, suggesting varying risks associated with different IT types. Activity levels were often above 5% maximum EMG (MEMG). As adult studies have linked activity levels greater than 5%MEMG with the development of musculoskeletal disorders, it seems that children are potentially at risk of replicating these adverse health reactions associated with adult IT use.     

Assistive Walking Devices in Nonambulant Patients Undergoing Rehabilitation After Stroke: The Effects on Functional Mobility, Walking Impairments, and Patients' Opinion

Tyson SF, Rogerson L. Assistive walking devices in nonambulant patients undergoing rehabilitation after stroke: the effects on functional mobility, walking impairments, and patients' opinion.

Objective

To assess the immediate effects of assistive walking devices on functional mobility, walking impairments, and patients' opinions in nonambulant patients after stroke.

Design

Randomized crossover trial.

Setting

Inpatient rehabilitation units of 3 United Kingdom hospitals.

Participants

Twenty nonambulant patients with stroke undergoing rehabilitation to restore walking.

Interventions

Five walking conditions: (1) Walking with no device (the control condition), (2) walking with a walking cane, (3) ankle foot orthosis, (4) slider shoe, and (5) a combination of all 3 devices.

Main Outcome Measures

Functional mobility (functional ambulation categories), walking impairments (speed, step length of the weak leg), and patients' opinions.

Results

Functional mobility improved with all assistive devices (P<.0001-.005; effect sizes 1.68-0.52; number needed to treat=2-5). Walking impairments were unchanged (P<.800-.988). Participants were generally positive about the devices. They felt their walking, confidence, and safety improved and found the appearance and comfort of the devices acceptable. They would rather walk with the devices than delay walking until a normative gait pattern was achieved without them.

Conclusions

Assistive walking devices improved functional mobility in nonambulant rehabilitation patients with stroke. No changes in walking impairments were found. Participants were generally positive about using the devices. The results support the use of assistive walking devices to enable early mobilization after stroke; 2 patients would need to be treated with a cane or combined devices for 1 to improve functional mobility.     

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.     

Relationship between blood, nasopharyngeal and urinary bladder temperature during intravascular cooling for therapeutic hypothermia after cardiac arrest

Objectives

Therapeutic hypothermia improves survival and neurological outcome in patients successfully resuscitated after cardiac arrest. Accurate temperature control during cooling is essential to prevent cooling-related side effects.

Methods

Prospective observational study of 12 patients assessed during therapeutic hypothermia (32-34 °C) achieved by intravascular cooling following cardiac arrest. Simultaneous temperature measurements were taken using a Swan-Ganz catheter (blood temperature BLT), nasopharyngeal probe (nasopharyngeal temperature NPT) and the urinary bladder catheter (urinary bladder temperature UBT). A total of 1728 measurements (144 measurements per patient) were recorded over a 48-h period and analyzed. Blood temperature was considered as the reference measurement.

Results

Temperature profiles obtained from BLT, NPT and UBT compared with the use of analysis of variance did not differ significantly. Pearson correlation revealed that the correlation between BLT and NPT as well as BLT and UBT was statistically significant (r = 0.96, p < 0.001 and r = 0.95, p < 0.001, respectively). Bland-Altman analysis proved that the agreement between all measurements was satisfactory and the differences were not clinically important.

Conclusions

In 12 post-cardiac arrest patients undergoing intravascular cooling, both nasopharyngeal and urinary bladder temperature measurements were similar to blood temperatures measured using a pulmonary artery catheter.     

Validation of the Charlson Comorbidity Index for predicting functional outcome of stroke

Tessier A, Finch L, Daskalopoulou SS, Mayo NE. Validation of the Charlson Comorbidity Index for predicting functional outcome of stroke.

Objective

To determine whether a separate comorbidity index is needed to predict functional outcome after stroke, we compared the predictability of the Charlson Comorbidity Index (CMI) and the Functional Comorbidity Index (FCI) to that of a stroke-specific comorbidity index with function quantified with a measure developed with a Rasch model as outcome.

Design

Two prospective inception cohort studies, in 1996 through 1998 and in 2002 through 2005, with up to 9 months of follow-up.

Setting

Participants enrolled in 2 studies were recruited from acute care hospitals in the Montreal area.

Participants

For study one, 1027 persons with a first stroke discharged into the community were eligible; the 437 who were interviewed a second time at 6 months were included in the analysis. In study two, 235 of 262 patients with stroke were enrolled.

Interventions

Not applicable.

Main Outcome Measures

To predict recovery, we developed 3 stroke-specific comorbidity algorithms based on the estimated strength of association between comorbidities and stroke function. The various indices were compared on the basis of their predictive ability with a c statistic.

Results

In study 1, the c statistics were .758, .763, .766, and .763 for the stroke-specific algorithms 1, 2, and 3 and the CMI, respectively. In study 2, the c statistics were .680, .700, .704, .714, and .714 for the algorithms 1, 2, and 3, the CMI, and the FCI, respectively.

Conclusions

For purposes of case-mix adjustment, the CMI seems to be more than adequate.     

Three different LDL apheresis columns efficiently and equally reduce lipoprotein(a) concentrations in patients with familial hypercholesterolemia and small apolipoprotein(a) particles

Introduction

High levels of lipoprotein(a) [Lp(a)] and apolipoprotein(a) [apo(a)] are associated with cardiovascular disease. In this study we determined apo(a) particle size and compared the Lp(a) reducing efficacy of three different LDL apheresis columns; DL-75, LA-15 and EC-50W in patients with familial hypercholesterolemia (FH).

Results

Average Lp(a) concentration was reduced by 70%, 74% and 75% (all p < 0.0001) for DL-75, LA-15 and EC-50W, respectively. No significant changes in the relative proportion of the isoforms of 14 and 32 K 4 domains were observed after apheresis.

Conclusion

Three different LDL apheresis columns reduced Lp(a) efficiently with preserved ratio between apo(a) isoforms.     

Quality of closed chest compression on a manikin in ambulance vehicles and flying helicopters with a real time automated feedback

Context

Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation.

Objective

To assess the effect of real time automated feedback on the quality of resuscitation in an emergency transportation setting.

Design

Randomised cross-over trial.

Setting

Medical University of Vienna, Vienna Municipal Ambulance Service and Helicopter Emergency Medical Service Unit (Christophorus Flugrettungsverein) in September 2007.

Participants

European Resuscitation Council (ERC) certified health care professionals performing CPR in a flying helicopter and in a moving ambulance vehicle on a manikin with human-like chest properties.

Interventions

CPR sessions, with real time automated feedback as the intervention and standard CPR without feedback as control.

Main outcome measures

Quality of chest compression during resuscitation.

Results

Feedback resulted in less deviation from ideal compression rate 100 min⁻¹ (9 ± 9 min⁻¹, p < 0.0001) with this effect becoming steadily larger over time. Applied work was less in the feedback group compared to controls (373 ± 448 cm × compression; p < 0.001). Feedback did not influence ideal compression depth significantly. There was some indication of a learning effect of the feedback device.

Conclusions

Real time automated feedback improves certain aspects of CPR quality in flying helicopters and moving ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate.     

Therapeutic hypothermia is associated with a decrease in urine output in acute stroke patients

Aims

It is unclear what effect therapeutic hypothermia may have on renal function, because its effect has so far been primarily evaluated in settings in which there may be possible confounding perturbations in cardiovascular and renal physiology, such deep intraoperative hypothermia, general anesthesia, and post-cardiac arrest. We sought to determine if therapeutic hypothermia affects renal function in awake patients with normal renal function who were enrolled into a clinical trial of hypothermia plus intravenous thrombolysis for acute ischemic stroke.

Methods

Eleven patients with normal renal function were cooled to 33 °C for 24 h using an endovascular catheter, and then re-warmed over 12 h to 36.5 °C, while hourly temperature, blood pressure, and fluid status data was recorded. Blood samples for blood urea nitrogen (BUN), creatinine, and hematocrit were drawn prior to treatment (baseline), immediately after hypothermia and re-warming (day 2), and again at day 7 or discharge, and values compared.

Results

On initiation of cooling, temperatures dropped from a median pre-treatment value of 36.1 °C (IQR: 35.8-36.4 °C) to 33.1 °C (IQR: 33.1-33.4 °C). Urine output decreased 5.1 ml/h for every 1 °C decrease in body temperature (p-value = 0.001), with no associated serious adverse events. There were no statistically significant changes in BUN, creatinine, or hematocrit in the hypothermia patients.

Conclusion

Inducing hypothermia in patients with relatively unperturbed renal physiology results in a decrease in urine output that is linearly correlated with the decrease in core temperature. This has important implications for fluid management in patients undergoing therapeutic hypothermia.     

Measurement of soft tissue temperature and impedance following the application of transdermal direct current

Objective

To measure temperature and impedance changes at various depths in human tissue in vivo, after the application of transdermal direct current (TDC).

Design

Prospective experimental single cohort study.

Setting

Genesis Surgery Center.

Participants

Eight patients who underwent a lumbar rhizotomy for chronic low back pain consented to an additional procedure involving TDC with saline solution. Two TDC electrodes (active, 55 mm; dispersive, 62 mm) were placed 51-56 cm apart, and a current amplitude of 4.0 mA was delivered for an average of 18.4 minutes.

Main outcome measures

Temperature and impedance readings recorded by the RFG-3CF Lesion Generator probe, from depths of 5 cm to the skin surface were obtained before TDC, and just before TDC was terminated. Data were analyzed using non-parametric statistics.

Results

A statistically significant decrease in impedance (mean 48 Ω, 95% confidence interval: 26-70) was detected, but there was no interaction of impedance change with tissue depth. Overall, tissue temperature decreased by 2 °C (95% confidence interval: 1.9-2.8) from baseline to the second measurement and the change was greatest within 1 cm of the surface.

Conclusion

The data suggest that transdermal delivery of medications to deep tissues of the lumbar region may not be enhanced by use of direct current as applied clinically.     

Perception of vertical and postural control following stroke: a clinical study

Objectives

To investigate the relationship between subjective visual vertical (SVV) and trunk alignment following stroke.

Setting

Stroke unit of a large general hospital.

Participants

Twelve stroke patients and nine controls were assessed. One patient was assessed at 14, 23, 30, 37 and 58 days post-stroke.

Outcome measures

SVV assessment involved viewing a line, rotating in the frontal plane, through goggles that restricted field of vision. Participants estimated when the line was vertical; the median of 10 estimates was taken to be the SVV. Postural alignment was classified as upright or leaning to the left or right.

Results

The stroke group was less accurate in perception of vertical than the control group (P < 0.001). In the stroke group, nine participants had SVV ≥ 2.5° from true vertical. Two of these participants leaned towards their SVV in sitting. Seven participants could sit upright, but six of these leaned towards their SVV in standing. Two participants had SVV < 2.5°; both maintained upright posture in sitting and standing. The case study demonstrated gradual improvement in SVV and posture; upright posture was regained in sitting whilst SVV was −7°.

Discussion

Postural problems were associated with SVV tilt; however, upright sitting posture was possible despite SVV tilt. We propose that leaning in sitting is due to inaccurate representation of the support surface.

Conclusion

Postural problems following stroke are related to inaccurate spatial representation. Further studies using perceptual assessments to reveal spatial representation are recommended.