Pronociceptive pain modulation in patients with painful chemotherapy-induced polyneuropathy

Context

Several chemotherapy agents induce polyneuropathy that is painful for some patients, but not for others. We assumed that these differences might be attributable to varying patterns of pain modulation.

Objectives

The aim of the present study was to evaluate pain modulation in such patients.

Methods

Twenty-seven patients with chemotherapy-induced polyneuropathy were tested for detection thresholds (cold, warm, and mechanical) in both the forearm and foot, as well as for heat pain threshold, mechanical temporal summation (TS), and conditioned pain modulation (CPM; also known as the diffuse noxious inhibitory control-like effect), which were tested in the upper limbs.

Results

Positive correlations were found between clinical pain levels and both TS (r = 0.52, P = 0.005) and CPM (r = 0.40, P = 0.050) for all patients. In addition, higher TS was associated with less efficient CPM (r = 0.56, P = 0.004). The group of patients with painful polyneuropathy (n = 12) showed a significantly higher warm detection threshold in the foot (P = 0.03), higher TS (P < 0.01), and less efficient CPM (P = 0.03) in comparison to the group with nonpainful polyneuropathy.

Conclusion

The painfulness of polyneuropathy is associated with a “pronociceptive” modulation pattern, which may be primary to the development of pain. The higher warm sensory thresholds in the painful polyneuropathy group suggest that the severity of polyneuropathy may be another factor in determining its painfulness.     

An external focus of attention attenuates balance impairment in patients with Parkinson's disease who have a fall history

Objectives

Studies using young, non-impaired adults have shown that by directing attention to the outcome of movements (external focus) rather than directing attention to the movements involved in a specific skill (internal focus), motor skill acquisition is enhanced. The purpose of this study was to investigate the generalisability of these attentional focus findings to balance in subjects with Parkinson's disease.

Design

Experimental, repeated measures design.

Setting

Physiotherapy research facility.

Participants

Twenty-two subjects diagnosed with idiopathic Parkinson's disease.

Interventions

Subjects were tested under three attentional focus conditions; no instruction, internal focus and external focus.

Main outcome measure

Balance equilibrium scores from three computerised dynamic posturography conditions.

Results

A significant condition x attentional focus interaction was found (F [4, 84] = 2.86, P < 0.05), indicating increased sway with internal focus relative to no focus instructions (control) under the eyes-open condition. More importantly, when only subjects with a history of falls were considered, there was a significant interaction between condition and attentional focus (F [4, 36] = 4.40, P < 0.01). Post hoc tests revealed that the external focus instructions resulted in less sway than both internal focus and no attentional focus instructions under sway-referenced conditions.

Conclusion

These findings support previous research studies on attentional focus. In particular, it was demonstrated that the balance of subjects with Parkinson's disease and a fall history can be enhanced by instructing subjects to adopt an external focus.     

Pilot study of an exercise intervention suitable for older heart failure patients with left ventricular systolic dysfunction

Background

Most studies of exercise training for heart failure have been conducted on relatively young patients with little comorbidity. Such programmes are unsuitable for the majority of older frail heart failure patients.

Aims

To test the acceptability and tolerability of an outpatient exercise programme in older heart failure patients with comorbid disease.

Methods

17 patients aged 70 years and over with left ventricular systolic dysfunction attended twice weekly group exercise classes for 12 weeks, focussing on endurance exercise and everyday functional tasks. Outcome measures were proportion of sessions attended; adverse events and reasons for non-attendance; six-minute walk, accelerometry, hospital depression and anxiety score, Guyatt quality of life scale, carer strain and satisfaction scores.

Results

83% of sessions were attended; 80% of subjects attended at least 80% of allocated sessions. One adverse incident occurred in 324 person-sessions. Encouraging improvements were seen in six minute walk test (+ 19 m, p = 0.14) and in Functional Limitation Profile score (− 82 points, p = 0.02). 50% of informal carers attended at least one session. No increase in carer strain was noted.

Conclusions

Twice-weekly group exercise focussing on aerobic endurance and everyday functional tasks was acceptable and well-tolerated in this patient group.     

Haplotype-based case-control study between human apurinic/apyrimidinic endonuclease 1/redox effector factor-1 gene and cerebral infarction

Objectives

The aim of this study was to investigate the relationship between cerebral infarction (CI) and the human apurinic/apyrimidinic endonuclease 1/redox effector factor-1 (APE1/REF-1) gene using single-nucleotide polymorphisms (SNPs) and a haplotype-based case-control study.

Design and methods

We selected 5 SNPs in the human APE1/REF1 gene (rs1760944, rs3136814, rs17111967, rs3136817 and rs1130409), and performed case-control studies in 177 CI patients and 309 control subjects.

Results

rs17111967 was found to have no heterogeneity in Japanese. The overall distribution of the haplotype-based case-control study constructed by rs1760944, rs3136814 and rs1130409 showed a significant difference. The frequency of the G-C-T haplotype was significantly higher in the CI group than in the control group (2.5% vs. 0.0%, p > 0.001).

Conclusions

Based on the results of the haplotype-based case-control-study, the G-C-T haplotype may be a genetic marker of CI, and the APE1/REF-1 gene may be a CI susceptibility gene.     

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.     

The effect of quantity of ice and size of contact area on ice pack/skin interface temperature

Objective

To determine the effect of quantity of ice and contact area on ice pack/skin interface temperature during a 20-minute cooling period.

Design

Repeated measures.

Setting

Laboratory setting in an educational institution.

Participants

Twenty healthy males aged between 18 and 22 years.

Interventions

An ice pack was applied to the right thigh with compression using an elastic bandage. The effects of three packs measuring 18 cm × 23 cm containing 0.3, 0.6 and 0.8 kg of ice, and one pack measuring 20 cm × 25 cm containing 0.6 kg of ice were compared.

Main outcome measure

The reduction in temperature at the ice pack/skin interface during 20-minute ice applications was monitored at 1-minute intervals.

Results

The application of 0.8-kg and 0.6-kg ice packs led to a significantly greater decrease in the interface temperature compared with the 0.3-kg ice pack [0.8 kg vs. 0.3 kg: −2.35 °C, 95% confidence interval (CI) of the difference −3.36 to −1.34 °C; 0.6 kg vs. 0.3 kg: −2.95 °C, 95% CI −4.07 to −1.83 °C]. No significant difference in temperature was found between the 0.6-kg and 0.8-kg ice packs (0.8 kg vs. 0.6 kg: 0.6 °C, 95% CI −0.12 to 1.32 °C, P > 0.05). The size of the contact area did not alter the degree of cooling significantly (difference between smaller and larger pack: 0.05 °C, 95% CI −0.93 to 1.03 °C, P > 0.05). The lowest temperature during ice application was reached after 8-9 minutes of cooling.

Conclusion

Application of an ice pack containing at least 0.6 kg of ice leads to a greater magnitude of cooling compared with application of a 0.3-kg ice pack, regardless of the size of the contact area. Thus, clinicians should consider using ice packs weighing at least 0.6 kg for cold treatment.     

A prospective comparative study of the relationship between different types of ring and microbial hand colonization among pediatric intensive care unit nurses

Objectives

The aim of the study is to assess the effect of ring wearing and ring types on hand contamination and efficacy of alcohol-based hand disinfection among nurses working in intensive care settings.

Methods

Hand cultures were obtained from 84 nurses providing direct patient care in intensive care units of a pediatric hospital. Colony counts were compared depending on ring wearing and the type of ring worn. Twenty-eight nurses were asked to a wear plain wedding ring, 28 to wear rings with stones and 28 not to wear any rings, starting 15 days before and continuing throughout the study. Cultures were obtained by using sterile gloves containing phosphate-buffered-saline solution (PBS) after an alcohol-based hand disinfectant was used and bacteria were identified with standard laboratory tests.

Results

The nurses wearing rings had more Gram-positive, Gram-negative and total bacterial colonization on their hands than the nurses without rings despite using an alcohol-based rub (p = 0.001). When comparing the two groups with rings (plain wedding rings and rings with stones), colony counts of Gram-positive, Gram-negative and total bacteria did not differ (p > 0.05).

Conclusions

Ring wearing increases the bacterial colonization of hands and alcohol-based hand disinfection might not significantly reduce contamination of the ring-wearing hands. The type of ring did not cause any significant difference on the bacterial load. Wearing rings could increase the frequency of transmission of potential nosocomial pathogens.     

Bandura's exercise self-efficacy scale: Validation in an Australian cardiac rehabilitation setting

Background

Despite the established benefits of cardiac rehabilitation (CR) in improving health outcomes for people with cardiovascular disease, adherence to regular physical activity at recommended levels remains suboptimal. Self-efficacy has been shown to be an important mediator of health behaviour, including exercise.

Objectives

To assess the psychometric properties of Bandura's exercise self-efficacy (ESE) scale in an Australian CR setting.

Design

Validation study.

Setting

Cardiac rehabilitation.

Participants

One hundred and ten patients (Mean: 60.11, S.D.: 10.57 years).

Methods

Participants completed a six-minute walk test (6MWT) and Bandura's exercise self-efficacy scale at enrolment and on completion of a 6-week CR program.

Results

Bandura's ESE scale had a single factor structure with high internal consistency (0.95), and demonstrated no floor or ceiling effects. A comparison of ESE scores by distance walked on 6MWT indicated those who recorded more than 500 m at baseline had significantly higher ESE scores (Mean: 116.26, S.D.: 32.02 m) than those patients who only achieved up to 400 m on the 6MWT at baseline (Mean: 89.94, S.D.: 29.47 m) (p = 0.044). A positive and significant correlation between the change in scores on the ESE scale and the change in the 6MWT distance (r = 0.28, p = 0.035) was seen.

Conclusions

The ESE scale was a robust measure of exercise self-efficacy over the range of patients attending this outpatient cardiac rehabilitation program. Interventions to improve self-efficacy may increase CR patient's efficacy for regular physical activity.     

Physiotherapy and Guillain-Barré syndrome: results of a national survey

Objective

To discover the extent to which persons with Guillain-Barré syndrome receive treatment by a physiotherapist (as inpatients and outpatients), and to assess whether the amount of treatment received is related to outcome.

Design

Survey method using self-administered questionnaires distributed through a national database.

Participants

Members of the Guillain-Barré Syndrome Support Group (n = 1535).

Main outcome measures

General patient data, general mobility, F-score, Hospital Anxiety and Depression Scale, Short Form-36 and Fatigue Severity Scale.

Results

In total, 884/1535 (58%) complete responses were received. Nearly 10% of respondents had not received treatment by a physiotherapist in hospital despite their average functional level being the same as respondents who had received treatment in hospital. One-quarter of respondents said that they had not received treatment following hospital discharge despite the identification of relatively high levels of disability. Those who did not receive treatment by a physiotherapist following discharge were less severely disabled. This may indicate that physiotherapists tend to offer treatment to more severely disabled patients. The majority of patients reported disabling fatigue; whilst not statistically related to receipt of treatment by a physiotherapist, this highlights the importance of assessing fatigue in treatment plans to improve physical functioning.

Conclusion

Improvements to policy and practice can be made by widening inpatient accessibility to treatment by a physiotherapist and increasing outpatient provision of treatment for patients with Guillain-Barré syndrome of all degrees of severity.     

Effects of floor coverings on measurement of gait and plantar pressure

Objectives

To assess different flooring surfaces currently used in sheltered housing, and to record differences in foot pressures using the Musgrave Medical Underplantar Pressure Technology System.

Design

Experimental repeated measures design.

Participants

Ten female volunteer subjects (mean age 78.3 years).

Interventions

A total of 12 different flooring surfaces were tested and pressure recordings obtained in standardised footwear.

Main outcome measures

Heel strike, toe off, time between heel strike and toe off, contact area and maximum load were recorded.

Results

Important differences in the outcome variables were noted between the surfaces with the most favourable pattern occurring with heavy duty carpet without underlay, with a mean heel strike of 2.1 scans [95% confidence interval (CI) 1.6 to 2.6], a mean toe off of 1.5 scans (95% CI 1.0 to 1.9) and a short mean interval from heel strike to toe off of 1004 milliseconds (95% CI 871 to 1137). This can be compared with a less favourable surface, a bedroom pile with underlay for example, which recorded a mean heel strike of 6.0 scans (95% CI 5.0 to 7.0) with a mean toe off of 7.5 scans (95% CI 5.6 to 9.3) and a mean interval from heel strike to toe off of 1034 milliseconds (95% CI 924 to 1143).

Conclusion

Floor surfaces have an important influence on gait and are likely to affect walking stability.     

Influence of reduction in the elution times on HPLC glycohaemoglobin results

Objectives

To compare HPLC methods with short and long elution times for HbA1c measurement in blood.

Methods

Comparison between G7-Tosoh (1.2 min); Bio-Rad-Variant-II-Turbo (1.3 min) and Arkray-HA-8160 (2.9 min).

Results

Passing-Bablok regression equations were: Y = 0.17 + 0.96X; Y = − 0.39 + 1.01X; Y = − 0.40 + 1.0X and the means of the differences using Bland-Altman Plot were 0.02; − 0.34; 0.32 for HA-8160/G7-Tosoh, HA-8160/Variant-II-Turbo and G7-Tosoh/Variant-II-Turbo, respectively.

Conclusions

Faster elution methods had no problems on reproducibility of results obtained by slower elution methods.     

A randomised control trial comparing two techniques for locating chest compression hand position in adult Basic Life Support

Introduction

Chest compressions performed correctly have the potential to increase survival post cardiac arrest. The 2005 European Resuscitation Council (ERC) guidelines altered and simplified instructions for hand position placement to increase the number of chest compressions performed. This randomised controlled trial compares chest compression efficacy (hand position and number of effective chest compressions) after training using the 2005 guidelines or the 2005 guidelines with a hand position modification based on 2000 ERC guidelines.

Methods

First year healthcare students at the University of Birmingham, United Kingdom, were randomly allocated to either ‘2005’ or ‘intervention’ group immediately after passing a Basic Life Support (BLS) assessment to ERC standards. The 2005 group performed 2 min of BLS on a SkillReporter™ manikin (Laerdal Medical, Stavanger, Norway). The intervention group received training on hand placement using landmark techniques from the 2000 ERC guidelines; emphasising rapid hand positioning. This group also performed 2 min of BLS on a SkillReporter™ manikin.

Results

82 students were assessed; 41 in the 2005 group and 41 in the intervention group. Average compression rate was 102 in the 2005 group and 104 in the intervention group (p = 0.29). Average number of incorrect hand placements was 24 in the 2005 group and 9 in the intervention group (p = 0.03).

Conclusions

The use of landmark measurement techniques in hand placement for external chest compressions does not have a detrimental effect on the number of chest compressions performed during BLS and increases correct hand positioning.     

Choline for diagnosis and prognostication of acute coronary syndromes in the Emergency Department

Objectives

Choline has been identified as a promising marker of coronary inflammation, plaque destabilisation and ischaemia. We sought to evaluate plasma choline levels for rapid confirmation or exclusion of acute myocardial infarction (AMI) in the Emergency Department (ED) and for predicting major adverse cardiac events (MACE).

Methods

We prospectively recruited 361 patients who presented to the ED with suspected cardiac chest pain within the previous 24 h. Blood was drawn at the time of presentation for plasma choline levels. All patients underwent troponin T testing ≥ 12 h after symptom onset and were followed up for the occurrence of MACE within 6 months. Whole blood choline (WBCho) levels were also measured in a convenience sample of 39 patients.

Results

Plasma choline levels did not help to predict a diagnosis of AMI (odds ratio (OR) 1.00 (95% confidence intervals (CI) 0.91-1.10, p = 0.98). For a diagnosis of AMI the area under the receiver operating characteristic (ROC) curve was 0.48. Plasma choline was not predictive of the combined endpoint of MACE (OR 1.03, 95% CI 0.95-1.12, p = 0.45) but predicted AMI within 6 months (OR 1.31, 95% CI 1.09-1.56, p = 0.003). WBCho levels were significantly different to plasma levels and were predictive of MACE.

Conclusions

Plasma choline, measured at the time of ED presentation, is not a diagnostic marker of AMI but predicts AMI within 6 months. While plasma choline failed to predict MACE, WBCho was predictive and warrants further evaluation.     

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.     

Evaluation of telephone-cardiopulmonary resuscitation advice for paediatric cardiac arrest

Introduction

Telephone-cardiopulmonary resuscitation (CPR) advice aims to increase the quality and quantity of bystander CPR, one of the few interventions shown to improve outcome in cardiac arrest. We evaluated a current paediatric telephone protocol (AMPDS v11.1) to assess the effectiveness of verbal CPR instructions in paediatric cardiac arrest.

Methods

Consecutive emergency calls classified by the AMPDS as cardiac arrests in children <8 years old, over an 11 month period, were compared with their corresponding patient report forms (PRFs) to confirm the diagnosis. Audio recordings and PRFs were then evaluated to assess whether bystander CPR was given, and when it was, the time taken to perform CPR interventions, before paramedic arrival.

Results

Of the 42 calls reviewed, 19 (45.2%) were confirmed as cardiac arrest. CPR was already underway in two cases (10.5%). Of the remaining callers, 11 (64.7%) agreed to attempt T-CPR, resulting in an overall bystander-CPR rate of 68.4%. The median time to open the airway was 126 s (62-236 s, n = 11), deliver the first ventilation was 180 s (135-360 s, n  = 11), and perform the first chest compression was 280 s (164-420 s, n  = 9).

Conclusion

Although current telephone-CPR instructions improve the numbers of children in whom bystander CPR is attempted, effectiveness is likely to be limited by the significant delays in actually delivering basic life support.