A brief fall prevention intervention for manual wheelchair users with spinal cord injuries: A pilot study.

Objective: To conduct a pilot study of an intervention to decrease fall incidence and concerns about falling among individuals living with Spinal Cord Injury who use manual wheelchairs full-time. Design: Pre/post. After a baseline assessment, a structured intervention was implemented. The assessment protocol was repeated 12 weeks after the baseline assessment. Setting: Research laboratory and community. Participants: 18 individuals living with SCI who use a manual wheelchair full-time with an average age of 35.78 ± 13.89 years, lived with SCI for 17.06 ± 14.6 years; 61.1% were female. Intervention: A 1:1, 45 minute, in-person intervention focused on factors associated with falls and concerns about falling: transfers skills and seated postural control. Outcome measures: Participants reported fall incidence and completed the Spinal Cord Injury Fall Concerns Scale, Community Participation Indicators and the World Health Organization Quality of Life - short version (WHOQOL-BREF). Transfer quality was assessed with the Transfer Assessment Instrument (TAI) and seated postural control with the Function In Seating Test (FIST). Results: Recruitment, assessment and delivery of the intervention were successfully completed. After exposure to the intervention, fall incidence significantly decreased, (P = 0.047, dz = 0.507) and FIST scores improved (P = 0.035, dz = 0.54). Significant improvements were also found in the WHOQOL-BREF Physical (P = 0.05, dz = 1.566) and Psychological (P = 0.040, dz = 0.760) domains. Conclusion: The feasibility of the structured intervention was established and the intervention has the potential to reduce fall incidence and improve quality of life among individuals living with SCI who use a wheelchair. Appropriately powered randomized controlled trials of the program are warranted.

Napping in college students and its relationship with nighttime sleep.

UNLABELLED: Abstract. OBJECTIVE: To examine the habit of napping and its relationship with nighttime sleep in college students. PARTICIPANTS: Four hundred and forty undergraduate students who responded to an anonymous online survey in April 2010. METHODS: Three questions were asked to determine the frequency, length, and timing of napping during the past month. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The PSQI score significantly differed among self-reported nap-frequency (p=.047) and nap-length (p=.017) groups, with those who napped more than 3 times per week and those who napped more than 2 hours having the poorest sleep quality. Students who napped between 6 and 9 pm had shorter sleep on school nights compared with students in other nap-timing groups (p=.002). CONCLUSIONS: College students who are self-reported frequent, long, and late nappers may have a higher risk of poor nighttime sleep quality and more severe sleep deprivation.

Peripheral brain derived neurotrophic factor (BDNF) in bulimia nervosa: a systematic review.

INTRODUCTION: Currently, there is limited understanding of the etiology of BN. While multifaceted etiology is likely, several neurobiological factors may play a role. Brain derived neurotrophic factor (BDNF), a potential biomarker linked to eating and weight disorders, is one factor of recent investigation. This paper examined studies comparing BDNF blood levels in BN to healthy control (HC) subjects. METHODS: A systematic review of the literature was conducted utilizing five databases (PubMed, CINAHL, EMBASE, PsycINFO, and Medline). Key terms included eating disorders, BDNF, and bulimia nervosa. CONCLUSIONS: BDNF blood levels appear lower in BN than in HC subjects; however, studies are needed to examine the influence of possible correlates including symptom severity, mood, medications, exercise, and substance use.

Validity and reliability of the critical care pain observation tool: a replication study.

Critically ill patients are often not able to self-report the presence of pain. Currently there is no generally accepted assessment tool for this population. The Critical-Care Pain Observation Tool (CPOT) was developed for pain assessment of critically ill patients. The purpose of this study was to replicate the findings of the Gelinas et al. (2006) CPOT reference study and examine the interrater reliability (IRR), discriminant validity (DV), and criterion validity (CV) of the CPOT. This quantitative study used a repeated measures design with a convenience sample of 21 postoperative open heart surgery patients cared for in a tertiary-care teaching hospital. Testing for IRR in this sample showed a range of results resulting in fair to almost perfect IRR; the findings of this study suggest that the instrument's IRR is acceptable but variable. Testing for DV demonstrated a significant difference in mean scores between noxious (painful) and nonnoxious (nonpainful) procedures. Testing for CV showed a weak nonsignificant Spearman correlation of 0.26 (P < .312) between CPOT scores and patient self-report during repositioning after extubation. This replication study adds to four studies that have examined psychometric attributes of the instrument and contributes to the process of translating the use of this instrument to the clinical setting.

How do clinicians assess, communicate about, and manage patient sleep in the hospital?

OBJECTIVE: The objective of this study was to characterize how clinicians assess, communicate about, and manage patient sleep, with the focus on identifying existing barriers and facilitators to sleep promotion in clinical practice. BACKGROUND: Sleep is a critical need for improving for hospitalized patients. METHODS: Content analysis was used to interpret descriptive data from 4 group interviews with a total of 62 clinicians. RESULTS: Clinicians reported they did not formally assess for patient sleep, which led to largely unmanaged sleep disruption during hospitalization. Major barriers to effective sleep management were limited understanding of the importance of sleep, lack of a standardized tool for assessment, and inadequate communication. Facilitators included collaborative communication with patients and the healthcare team and customized patient-centered interventions. CONCLUSIONS: It is critical to inform clinicians on the importance of sleep, to standardize sleep assessment, and to facilitate collaboration among caregivers to promote sleep for hospitalized patients.

The Clinical Scholar Model: Evidence-based practice at the bedside.

The Clinical Scholar Model serves as an effective framework for investigating and implementing evidence-based practice (EBP) changes by direct care providers. The model guides one in identifying problems and issues, key stakeholders, and the need for practice changes. It provides a framework to critique and synthesize the external and internal evidence. Three EBP projects conducted at a large tertiary care facility in northern New England illustrate the process of using the Clinical Scholar Model.