An Interdisciplinary Clinical Advancement Program Within a Patient-Centered Care Model

Restructuring in health care does not have to compromise the pursuit of clinical excellence and quality patient care. The clinical advancement program (CAP) at the Hospital for Special Care is a newly developed multidisciplinary reward and recognition program for clinical staff. The program is integrated into the hospital's structure of service line management and, unlike traditional advancement programs, is open to all levels of care providers: professional personnel, technical staff, and aides. This article describes the basic features of the CAP model and how it was developed by a multidisciplinary task force.     

Developing health education materials for inner-city low literacy parents.

The question of identifying and treating childhood illness confronts all new parents. Misconceptions often lead parents to manage illnesses in their young children inappropriately through overly aggressive treatment or insufficient attention. This responsibility is especially challenging for low-income new parents who lack the literacy levels needed to understand and use much of the existing health education literature and who are without access to health facilities and providers. In response to a perceived need for health information directed at low-income, low-literacy parents, students from the University of California at Los Angeles School of Public Health created an easy-to-use reference booklet called "A Parent''s Guide: When Your Child Is Sick." The booklet''s aim is to assist parents in treating common childhood illness and identifying more serious diseases requiring medical attention. A comprehensive and manageable amount of information is provided in the booklet. Behaviors and issues covered include (a) recognition of symptoms, (b) actions that could be taken in the home, (c) medicines that could be administered, and (d) recommendations on how persistent problems might be handled.     

Technical aspects of intraoperative monitoring of lower cranial nerve function

The efficacy of monitoring facial nerve activity in decreasing long-term morbidity has promoted an interest in monitoring other at-risk cranial nerves during procedures that involve manipulation of the basal cranial nerves. This presentation details practical techniques for monitoring the lower cranial nerves, which have been experientially developed over the past 9 years. Emphasis is placed on the selection of electrodes and procedural changes required for reliable and safe stimulation of the basal cranial nerves. Either paired hook-wire or tethered needle electrodes can be used for monitoring glossopharyageal, accessory, and hypoglossal nerve function. Several options for monitoring vagus nerve function are discussed. Of these, the transoral placement of paired hook-wire electrodes remains the most reliable, cost-effective, and least morbid technique. Electrical stimulation of the glossopharyngeal and vagus nerves carries the risk of unanticipated, potentially irreversible disturbances in cardiovascular function. Guidelines for type and optimal placement of stimulating electrodes and recommended intensity levels to prevent unfavorable reactions are presented.     

Motion in the Unstable Cervical Spine When Transferring a Patient Positioned Prone to a Spine Board

Context:

Two methods have been proposed to transfer an individual in the prone position to a spine board. Researchers do not know which method provides the best immobilization.

Objective:

To determine if motion produced in the unstable cervical spine differs between 2 prone logrolling techniques and to evaluate the effect of equipment on the motion produced during prone logrolling.

Design:

Crossover study.

Setting:

Laboratory.

Patients or Other Participants:

Tests were performed on 5 fresh cadavers (3 men, 2 women; age = 83 ± 8 years, mass = 61.2 ± 14.1 kg).

Main Outcome Measure(s):

Three-dimensional motions were recorded during 2 prone logroll protocols (pull, push) in cadavers with an unstable cervical spine. Three equipment conditions were evaluated: football shoulder pads and helmet, rigid cervical collar, and no equipment. The mean range of motion was calculated for each test condition.

Results:

The pull technique produced 16% more motion than the push technique in the lateral-bending angulation direction (F_1,4 = 19.922, P = .01, η² = 0.833). Whereas the collar-only condition and, to a lesser extent, the football-shoulder-pads-and-helmet condition demonstrated trends toward providing more stability than the no-equipment condition, we found no differences among equipment conditions. We noted an interaction between technique and equipment, with the pull maneuver performed without equipment producing more anteroposterior motion than the push maneuver in any of the equipment conditions.

Conclusions:

We saw a slight difference in the motion measured during the 2 prone logrolling techniques tested, with less lateral-bending and anteroposterior motion produced with the logroll push than the pull technique. Therefore, we recommend adopting the push technique as the preferred spine-boarding maneuver when a patient is found in the prone position. Researchers should continue to seek improved methods for performing prone spine-board transfers to further decrease the motion produced in the unstable spine.Key Words: injuries, transfer techniques, logroll

Key Points

• A slight difference in motion was measured between the 2 prone logrolling techniques, with the push technique producing less lateral-bending and anterior-posterior motion than the pull technique.
• The logroll push technique should be adopted as the preferred spine-boarding maneuver when a patient is found in the prone position.
• Individuals who may need to perform this rescue procedure should practice and become proficient in the logroll push technique.
• Researchers should continue to seek improved methods for transferring patients positioned prone to spine boards to further reduce the motion transmitted to the unstable spine.

Each year, 12 000 incidents of nonfatal spinal cord injury are reported in the United States.¹ Approximately 8.0% of these injuries occur during sport participation.¹ Of all US sports, American football has by far the greatest number of spinal injuries. Between 1982 and 2007, the incidence of direct injuries in males playing American football was 1.89 per 100 000 participants in a college setting and 0.75 per 100 000 participants in a high school setting.²The prehospital management of spinal cord injuries is critical to prevent exacerbation of the injury. In 3% to 25% of patients, neurologic deterioration occurs during the initial management of spinal cord injuries.³ During immobilization and transportation of the patient to the hospital, precautions must be taken to transmit as little motion as possible to the spine. One of the first transfers that rescuers must perform is placing the injured athlete onto a long, rigid spine board. When the injured athlete is supine, lift-and-slide spine-board transfers produce less motion in the spine than logroll spine-board transfers.^4–6 However, when the patient is found in the prone position, a lift-and-slide transfer cannot be performed successfully, and a logroll technique must be used.Swartz et al⁷ recommended how to best manage a catastrophic spine injury in the athlete. They described 2 techniques for logrolling an athlete who is positioned prone: the prone logroll push and the prone logroll pull. Researchers⁸ have shown that the logroll push produces less motion in the unstable thoracolumbar spine. No one knows which of the prone spine-boarding techniques provides the best immobilization in the unstable cervical spine. Therefore, the primary purpose of our study was to determine if motion produced in the unstable cervical spine differs between 2 prone logrolling techniques. Our null hypothesis was that no difference would exist in the amount of motion allowed between the 2 prone logrolling techniques. Our secondary purpose was to evaluate the effect of equipment on the motion produced during the prone logrolling technique. Our null hypothesis was that no difference would exist in the amount of motion allowed among any of the equipment conditions.     

Hydroxyethyl starch. An agent for hypovolaemic schock treatment II. Urinary excretion in normal volunteers following three consecutive daily infusions.

1 Urinary hydroxyethyl starch (HES) concentrations were determined by the anthrone method, in four healthy normal male volunteers following three consecutive daily 500 ml infusions (total 1500 ml), in order to ascertain excretion rates under normal controlled conditions. 2 The HES was excreted at a rate of 2.57, 2.46, and 2.44 g/h during the first hour postinjection, on days 1, 2, and 3, respectively. 3 The rate during the interval 12-24 h postinjection, averaged 0.14, 0.21, and 0.10 g/h, on days 1,2, and 3, respectively. 4 In the intervals 24-72, 72-120, and 120-168 h after the third and final injection, the excretion rate was 0.07, 0.04, and 0.02 g/h, respectively. 5 Renal function, as assessed by serum creatinine and uric acid concentrations and 24 h void volumes, was normal during the entire period of observation. 6 The results indicate that HES is excreted at a similar rate following three consecutive daily infusions without evidence of renal injury.     

An Examination of the Stretch-Shortening Cycle of the Dorsiflexors and Evertors in Uninjured and Functionally Unstable Ankles

OBJECTIVE: To determine if there were differences in concentric peak torque/body-weight (PT/BW) ratios and concentric time to peak torque (TPT) of the dorsiflexors and evertors in uninjured and functionally unstable ankles using a stretch-shortening cycle (SSC) protocol on an isokinetic dynamometer. DESIGN AND SETTING: We employed a case-control study design to examine the test subjects in a climate-controlled athletic training/sports medicine research laboratory. SUBJECTS: Thirty subjects volunteered to participate in this study, 15 with unilateral functional ankle instability and 15 matched controls. MEASUREMENTS: Participants were assessed isokinetically using an SSC protocol for the dorsiflexors and evertors at 120 and 240 degrees.s(-1), bilaterally. Strength was assessed using PT values normalized for body mass. Concentric TPT measurements were also compared between the groups. RESULTS: No differences in concentric PT/BW ratios or concentric TPT were evident between the groups (P >.05). Additionally, there were no differences in these measurements between the ankles for the same motion and speed between the ankles in the subjects with functional instability. CONCLUSIONS: Using the SSC protocol as a measure of ankle function and the stretch-reflex phenomenon, we found no evidence to support the notion that differences in strength and TPT in the active, conscious state exist between those with functional ankle instability and a group of healthy control subjects.     

Assessment of shoulder proprioception in the female softball athlete

BACKGROUND: There have been reports of overhand throwing athletes having decreased joint position sense in their dominant shoulder as compared with the nondominant shoulder. Very little research, however, exists concerning joint position sense in the female athlete. HYPOTHESIS: Female softball athletes have decreased joint position sense in their dominant shoulder as compared with their nondominant shoulder. STUDY DESIGN: Factorial design with investigation of multiple independent variables. METHODS: Joint position sense was assessed in 50 female softball players and 50 nonthrowing female athletes by using an inclinometer during four glenohumeral joint motions. Both the dominant and nondominant shoulders were assessed and error scores were calculated to describe joint position sense. Data were collected during the course of a fall semester and analyzed by using a mixed model analysis of variance with repeated measures on the dependent variable (error scores). RESULTS: A significant group by movement interaction was observed, with the softball athletes demonstrating significantly greater external rotation error scores than the nonthrowing athletes. CONCLUSION: We failed to reject the null hypothesis. Increased error scores (less joint position sense) were observed in both arms of subjects in the softball group. Clinical Relevance: This study suggests that there is decreased shoulder proprioception in asymptomatic female athletes involved in overyhand throwing sports, which may predispose them to injury.     

Patient education needs as reported by congestive heart failure patients and their nurses

Patients with congestive heart failure (CHF) need considerable education to enable them to provide effective self-care for their chronic illness. No information has been published about the learning needs of this population. The purpose of this study was to examine hospitalized CHF patients and their nurses' perceptions regarding the importance and realism of typical patient education content. An instrument to assess learning needs was developed and piloted for use in this study. Thirty hospitalized patients and 26 nurses were surveyed. Both nurses and patients rated all information as important to learn and realistic to learn during the patients' hospitalizations. Patients and nurses agreed that medication information was the most important to learn. Generally, patients rated information as more important than nurses rated the same information areas. Suggested nursing interventions and future research endeavours are addressed.     

National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine–Injured Athlete

Objective:

To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete.

Background:

The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment.

Recommendations:

Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.