The value of the whole picture: rehabilitation outcome measurement using patient self-report and clinician-based assessments after spinal cord injury.

STUDY DESIGN: This is a retrospective longitudinal study. OBJECTIVES: To explore the relative impact and contribution of using both the Spinal Cord Independence Measure III (SCIM) and Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) to assess rehabilitation outcome following an acute spinal cord injury (SCI). SETTING: The study was performed at National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK. METHODS: A patient self-report SMS-NAC and clinician-rated SCIM were administered on admission and discharge from the NSIC as part of standardised care. This paper presents a retrospective analysis of the rehabilitation outcomes of 195 people with spinal cord injury (PwSCI) following their first admission. RESULTS: In both measures, PwSCI improved from admission to discharge. Individuals with higher SCI obtained lower scores in both measures, at both admission and discharge. The SMS-NAC demonstrated the greatest increase in knowledge and skill for PwSCI who had higher and more complete injuries. On the SCIM, PwSCI who had lower and less complete injuries demonstrated the greatest increase in outcome. CONCLUSIONS: Overall, both measures demonstrated responsiveness to change during SCI rehabilitation and enable clinicians to systematically determine areas to focus rehabilitation effort. The relative strengths and contribution to delivering person-centred care for each are identified. The SMS-NAC enables clinicians to record, for people with higher injuries, their subjective self-report of skill and knowledge gains from rehabilitation that may be missed with other measures. Consequently, using both is encouraged in appreciation of the value of recording verbal (instructional) independence as well as functional (physical) independence.

Psychological outcomes of MRSA isolation in spinal cord injury rehabilitation.

STUDY DESIGN: Retrospective secondary analysis with a quantitative, matched-pairs design. Patients isolated due to methicillin-Resistant Staphylococcus aureus (MRSA) were matched with controls without MRSA infection admitted to a multi-bedded ward, based on: gender, injury level, injury severity (AIS grade), age at the time of injury and year of admission. OBJECTIVES: Determine the implications of MRSA-related infection isolation on spinal cord injury patients' anxiety, depression, appraisals of disability, perceived manageability and pain intensity. Hypotheses predicted patients who were isolated due to MRSA during inpatient stay would demonstrate poorer psychological health outcomes at discharge in comparison with non-isolated matched controls. SETTING: National Spinal Injuries Centre, England, UK. METHODS: Secondary analyses were conducted on pre-existing data based on patients' first admission for primary rehabilitation. Psychometric scales were used to measure outcome variables. Assessments were repeated at the time of admission and discharge. RESULTS: Nonparametric longitudinal analyses using the nparLD package in R were conducted. Relative treatment effects demonstrated that there were no significant differences between groups across all outcome measures. There was a significant effect of time (admission vs discharge) on perceived manageability and pain intensity, indicating improved outcomes at discharge. There was no difference in the overall length of stay between the isolated and non-isolated groups. CONCLUSIONS: Isolation experienced by rehabilitation inpatients with spinal cord injury with MRSA had no effect on a series of psychological outcomes. Engaging with rehabilitation had a positive impact in reducing pain unpleasantness and increasing perceived manageability of spinal cord injury, irrespective of infection isolation.

The "five senses of success" in nursing students: Assessing first-year support engagement.

OBJECTIVES: This study aimed to identify School and University support services available and accessed by nursing students transitioning into a university environment as many struggle to adjust to competing demands of personal commitments and expectations at university. METHODS: A mixed methods design was used, based on activity theory and Lizzio's Five Senses of Success frameworks as exploratory guides. This study was conducted amongst the first year cohort at one campus of the Bachelor of Nursing (BN) program in Queensland, Australia. An initial baseline assessment of what University and School-based support services were on offer for students, and how the students interacted with the support services was conducted. This was followed by a survey to identify awareness and access to support services. Focus groups were then conducted to clarify the previous results and to determine engagement with these support services. RESULTS: A randomly selected number of students (n = 150) in the first-year 2014 cohort of the BN program (n = 300) were included in this study. The survey was completed by 54 students and three semi-structured focus groups were conducted. The analysis indicated that the support services in place were successful in reaching the majority of students and contributed to their sense of success at university. Specifically students identified that a whole cohort approach to support enhanced their transition to university. CONCLUSION: Identifying lesser known services early in the first year will ensure that students are supported and encouraged to use all services, contributing to their sense of success at university.

Cognitive appraisals and emotional status following a spinal cord injury in post-acute rehabilitation.

STUDY DESIGN: Retrospective, cross-sectional study. OBJECTIVES: To investigate the factor structure of the ADAPSS-short form (ADAPSS-SF) in an acutely injured SCI population and to assess the relationship between cognitive appraisals made in the initial phase of rehabilitation and the experience of anxiety and depression. SETTING: National Spinal Injuries Centre, UK. METHOD: Participants were acutely injured patients admitted to the NSIC over 35 months. Cognitive appraisals were measured using the ADAPSS-SF; psychological distress was measured using the HADS. Individual profiles, including demographics and injury characteristics, were collected. RESULTS: Principle Component Analysis with oblique rotation demonstrated a coherent two-factor structure of the ADAPSS-SF: resilience and loss. Correlational analysis found that individuals who negatively appraised their injury were more likely to report lower mood. Findings identified four vulnerable subgroups that were more likely to negatively appraise their injury: females, individuals older at the time of SCI, individuals with AIS-A injuries and individuals whose SCI was acquired through assault. Hierarchical regression analysis reported that resilience and loss factors were significant predictors of depression. Gender, resilience and loss factors were significant predictors of anxiety. Cognitive appraisals accounted for more variance in mood above biological markers. CONCLUSIONS: Findings support a two-factor structure and validity of ADAPSS-SF in acute SCI rehabilitation. The study provides support for the role of cognitive appraisals in psychological adjustment in the early phases of rehabilitation, above injury characteristics. Findings highlighted the vulnerable subgroups that are more likely to initially endorse negative appraisals, which may influence clinical practice and provides an avenue for further research.

CO(2) acts as a signalling molecule in populations of the fungal pathogen Candida albicans.

When colonising host-niches or non-animated medical devices, individual cells of the fungal pathogen Candida albicans expand into significant biomasses. Here we show that within such biomasses, fungal metabolically generated CO(2) acts as a communication molecule promoting the switch from yeast to filamentous growth essential for C. albicans pathology. We find that CO(2)-mediated intra-colony signalling involves the adenylyl cyclase protein (Cyr1p), a multi-sensor recently found to coordinate fungal responses to serum and bacterial peptidoglycan. We further identify Lys 1373 as essential for CO(2)/bicarbonate regulation of Cyr1p. Disruption of the CO(2)/bicarbonate receptor-site interferes selectively with C. albicans filamentation within fungal biomasses. Comparisons between the Drosophila melanogaster infection model and the mouse model of disseminated candidiasis, suggest that metabolic CO(2) sensing may be important for initial colonisation and epithelial invasion. Our results reveal the existence of a gaseous Candida signalling pathway and its molecular mechanism and provide insights into an evolutionary conserved CO(2)-signalling system.