Designing an intervention: therapeutic showering in labor

Therapeutic showering is a nonpharmacologic comfort measure used during labor but is not tested empirically. The purpose of this article was to report the systematic development of therapeutic showering during labor using best available evidence so that nurses in practice and research can further test and refine this nursing intervention.     

Corticosteroid and Anesthetic Injections for Muscle Strains and Ligament Sprains in the NFL

Background

Administering local anesthetic or corticosteroid injections in professional athletes to allow return to play is common but has traditionally been viewed as suspect and taboo. The skepticism surrounding therapeutic injections stems predominantly from anecdotal experience as opposed to scientific data.

Questions/Purposes

The purpose of this paper is to evaluate the current use of corticosteroid injections for muscle strains and ligaments sprains in the National Football League to document player’s ability to return to play and possible adverse effects.

Patients and Methods

Athletes from a single National Football League team who received at least one corticosteroid or anesthetic injection for either a muscle strain or ligament sprain during three consecutive seasons were retrospectively reviewed. Thirty-seven injections were given over the three seasons. Injections were either performed blindly or by using ultrasound guidance.

Results

Twice as many defensive players were injected than offensive players. The average number of days of conservative treatment before injection was 6.5 days. All players returned to play after injection. There were no complications from any of the injections. Seventeen (55%) players did not miss a single game, and nine (30%) did not miss a single day. Quadriceps strains were associated with the most missed games (four) and the most missed days (36.5). Proximal hamstring strains were second with an average of three missed games and 28 missed days.

Conclusion

Corticosteroid injections are a safe and effective therapeutic intervention for treating muscle strains and ligament sprains in order to enable athletes to return to competition earlier.     

Review of Current Surgical Treatments for Lymphedema

Background

The current mainstay of lymphedema therapy has been conservative nonsurgical treatment. However, surgical options for lymphedema have been reported for over a century. Early surgical procedures were often invasive and disfiguring, and they often had only limited long-term success. In contrast, contemporary surgical techniques are much less invasive and have been shown to be effective in reducing excess limb volume, the risk of cellulitis, and the need for compression garment use and lymphedema therapy. Microsurgical procedures such as lymphaticovenous anastomosis and vascularized lymph node transfer lymphaticolymphatic bypass can treat the excess fluid component of lymphedema swelling that presents as pitting edema. Suction-assisted protein lipectomy is a minimally invasive procedure that addresses the solid component of lymphedema swelling that typically occurs later in the disease process and presents as chronic nonpitting lymphedema. These surgical techniques are becoming increasingly popular and their success continues to be documented in the medical literature. We review the efficacy and limitations of these contemporary surgical procedures for lymphedema.

Methods

A Medline literature review was performed of lymphedema surgery, vascularized lymph node transfer, lymphaticovenous anastomosis, lymphatic liposuction, and lymphaticolymphatic bypass with particular emphasis on developments within the past 10 years. A literature review of technique, indications, and outcomes of the surgical treatments for lymphedema was undertaken.

Results

Surgical treatments have evolved to become less invasive and more effective.

Conclusions

With proper diagnosis and the appropriate selection of procedure, surgical techniques can be used to treat lymphedema safely and effectively in many patients when combined with integrated lymphedema therapy.     

Prophylactic Bracing Versus Taping for the Prevention of Ankle Sprains in High School Athletes: A Prospective, Randomized Trial

Prophylactic ankle taping has been considered the mainstay of ankle injury prevention and has been used at all levels of competitive football. An alternative to taping is a semirigid ankle orthosis. This study prospectively compared the incidence of ankle sprains in high school football players during a single season, after randomization to either prophylactic bracing or taping of both ankles. Of 83 athletes followed up for an entire season, 6 ankle sprains occurred, 3 in each treatment group; and there was no statistically significant difference in the incidence of ankle sprains between the 2 groups. The time required to tape an athlete averaged 67 seconds per ankle, resulting in a total of 97 minutes per ankle during an entire season, and the average cost to tape each ankle during an entire season was greater than the cost of the commercially available brace. The projected cost savings for an athletic program using prophylactic bracing could be substantial when compared with the use of prophylactic taping of the ankle.     

The art therapy large group as a teaching method for the institutional and political aspects of professional training

This paper discusses a unique experiential teaching method in the context of training for art psychotherapists and raises issues relevant to teaching for all workers in health and social care. The art therapy large experiential group of all the students and all the staff (80+), which is held six times a year on the 2-year full-time/3-year part-time programme, is identified with three educational components: learning about art therapy processes, learning about the educational process of becoming a professional, and learning about institutional and political issues relevant for the work-place. This educational method engages the unconscious dynamics of both students and staff and brings this together, through creative activity, with a critical engagement in social and political issues. The group has implications for all health workers in its attention to non-verbal communication, activity as a means to learning and agency in institutional issues in the work-place. The paper brings together a case example in which students were able to process the impact of a nationwide, union strike in the university, with relevant literature from large group theory, small art therapy group theory and performance art. Discussion is given to the process by which the art therapy large group meets its learning objectives.