A study into the effectiveness of a postural care training programme aimed at improving knowledge, understanding and confidence in parents and school staff.

BACKGROUND: Parents and school staff lack knowledge and confidence when providing postural care to physically disabled children. This can act as a barrier to the successful implementation of therapy. To address this problem, we developed a novel training programme to improve knowledge and confidence in providing postural care and evaluate the impact of the training programme in parents and school staff. METHODS: The postural care training programme included three elements: a 2-h interactive workshop facilitated by physiotherapists and occupational therapists, a follow-up home/school visit and a follow-up telephone call. The Understanding, Knowledge and Confidence in Providing Postural Care for Children with Disabilities questionnaire was utilized to evaluate the impact and includes subscales assessing knowledge and understanding, concerns and confidence in providing postural care. The Understanding, Knowledge and Confidence in Providing Postural Care for Children with Disabilities questionnaire was completed at baseline and 6 weeks later. The training programme was delivered to N = 75 parents and school staff. Of these, N = 65 completed both baseline and follow-up measures and were used in the data analysis. Participants and therapists were also invited to provide further feedback on the overall training programme via interviews and focus groups. RESULTS: Paired samples t-tests were used to determine statistically significant differences between baseline and follow-up scores for each of the three subscales. Mean levels of understanding and knowledge and confidence improved (P < 0.001), while concerns decreased (P < 0.001). Qualitative data were collected via interviews and group discussions providing an in-depth perspective on how participants experienced change. DISCUSSION: Results suggest improvement in knowledge, understanding and confidence in parents and school staff that care for children with significant physical postural care impairments.

Development of a reliable, valid measure to assess parents' and teachers' understanding of postural care for children with physical disabilities: the (UKC PostCarD) questionnaire.

BACKGROUND: Previous research has highlighted lack of knowledge, understanding and confidence among parents and teachers responsible for the postural care of children with physical disability. Interventions designed to improve these qualities require a reliable and validated tool to assess pre- and post-intervention levels. Currently, however, no validated measure of postural care confidence (i.e. self-efficacy) exists. Hence, the aim of this research was to develop a reliable and valid questionnaire to assess parents' and teachers' confidence, alongside knowledge and understanding of postural care - the Understanding Knowledge and Confidence in providing POSTural CARe for children with Disabilities (UKC PostCarD) questionnaire. METHODS: Items were developed by a multidisciplinary team and designed to map onto the content of 'An A-to-Z of Postural Care'. Parents, teachers and therapists assessed items for face validity. Scale reliability was then assessed using Cronbach's alpha and known-group validity was assessed by comparing scores of an 'expert' group (physiotherapists and occupational therapists) with those of a 'non-expert' group (with no formal training in postural care). RESULTS: The total scale and all three subscales (understanding and knowledge, confidence and concerns) demonstrated adequate reliability (α > 0.83) and subscale correlations formed a logical pattern (understanding and knowledge correlated positively with confidence and negatively with concerns). Experts' (n = 111) scores were higher than non-experts' (n = 79) for the total scale and all subscales (P < 0.001). CONCLUSION: Findings support the reliability and validity of the UKC PostCarD questionnaire as a measure of understanding, knowledge and confidence in providing postural care for children with disabilities.

Neutrophil apoptosis is delayed by trauma patients' plasma via a mechanism involving proinflammatory phospholipids and protein kinase C.

BACKGROUND: Delayed apoptosis of primed neutrophils (PMNs) may facilitate PMN-mediated tissue injury leading to multiple organ failure (MOF). We previously reported delayed apoptosis and priming of PMNs in severely injured patients at risk for MOF. Our in vitro and in vivo data have implicated phospholipids in PMN cytotoxicity following trauma and shock. The phospholipid signaling pathway remains to be elucidated, but may involve protein kinase C (PKC). We hypothesized that circulating platelet-activating factor (PAF) and PAF-like proinflammatory phospholipids mediate delayed postinjury PMN apoptosis and that PKC is integral to the signaling pathway. METHODS: Blood was drawn from severely injured patients (n = 6; mean injury severity score = 21 and transfusion = 10 units) at 6 h postinjury. The plasma fraction was isolated and incubated (5% CO(2), 37 degrees C, 24 h) with PMNs harvested from healthy volunteers. Some PMNs were preincubated with a PAF receptor antagonist (WEB 2170, 400 microM) or a PKC inhibitor (Bis I, 1 microM). Apoptotic index (% PMNs undergoing apoptosis) was assessed morphologically. RESULTS: Trauma patients' plasma delayed PMN apoptosis compared with plasma from controls. The PMN apoptotic index was not altered by WEB 2170 or Bis I alone; however, WEB 2170 or Bis I pretreatment abrogated delayed PMN apoptosis in response to trauma patients' plasma. CONCLUSION: Trauma patients' plasma delays apoptosis of PMNs. Our data implicate PAF-like phospholipids in this effect, and PKC appears to be integral in the signaling process. Further elucidation of specific lipids and signaling pathways may reveal clinically accessible therapeutic targets to prevent PMN-mediated hyperinflammation.

Labelling of 5-HT3 receptor recognition sites in the rat brain using the agonist radioligand [3H]meta-chlorophenylbiguanide.

The binding of the tritiated derivative of the 5-HT3 receptor agonist meta-chlorophenylbiguanide ([3H]mCPBG) to rat cortical homogenates and whole rat brain sections was assessed in an attempt to further investigate the binding of agonists to the 5-HT3 receptor. In crude homogenates of rat cortex, no reproducible specific [3H]mCPBG (1.0 nM) binding (defined by either 10 microM granisetron, 100 microM 5-HT or 100 nM 'cold' mCPBG) was detected. Using autoradiographic techniques, in rat hindbrain sections, [3H]mCPBG (1.0 nM) labelled a differential distribution of specific binding sites (defined by the inclusion of granisetron, 1.0 microM). Specific binding was only detected within the dorsal vagal complex (nucleus tractus solitarius, area postrema and dorsal motor nucleus of the vagus nerve). An identical distribution of specific binding was detected in adjacent sections incubated with the selective 5-HT3 receptor radioligand, [3H](S)-zacopride (0.5 nM; non-specific binding defined by the inclusion of granisetron, 1.0 microM). No reproducible specific [3H]mCPBG (1.0 nM) binding (defined by the inclusion of granisetron, 1.0 microM) was detected within the rat forebrain. In contrast, [3H](S)-zacopride (0.5 nM) labelled specific sites (defined by the inclusion of granisetron, 1.0 microM) in some limbic brain structures (e.g. cerebral cortex, hippocampus, amygdala). These studies indicate that [3H]mCPBG labels the 5-HT3 receptor in rat brain tissue. However, the relatively high level of non-specific binding associated with this radioligand appears to mask the specific binding in regions which do not express relatively high densities of the 5-HT3 receptor.

A comparison of rat brain amino acid and monoamine content in diazepam withdrawal and after exposure to a phobic stimulus.

1. The content of amino acids (taurine, glycine, glutamic acid, gamma-aminobutyric acid (GABA) and aspartic acid) and monoamines (5-hydroxytryptamine (5-HT), 5-hydroxyindoleacetic acid (5-HIAA) and noradrenaline) in homogenates of rat cortical and hippocampal tissue were measured by high performance liquid chromatography (h.p.l.c.) with fluorescent and electrochemical detection respectively, after two anxiogenic treatments: exposure to a phobic stimulus (cat odour) and withdrawal from chronic diazepam treatment. 2. In neither of the two anxiogenic situations was there a significant change in any amino acid content, in either brain area. 3. In the group withdrawn from chronic diazepam, cortical 5-HT and 5-HIAA levels and hippocampal 5-HT levels were significantly increased. Noradrenaline content was significantly decreased in the hippocampus. 4. The changes in 5-HT and 5-HIAA levels following cat odour exposure were area-specific in that they decreased in the hippocampus, but increased in the cortex. 5. Following cat odour exposure, noradrenaline levels appeared not to change in either area studied. However during exposure to cat odour, it was found that half the animals avoided the odour source and half were indifferent. The animals showing marked avoidance had significantly higher cortical noradrenaline content and this was significantly different from control, whereas hippocampal noradrenaline levels were not dependent upon the differences in avoidance of the odour source. 6. The results show clearly different neurochemical changes in the rat following exposure to a phobic stimulus and withdrawal from diazepam. It is hoped comparative studies such as this will enable better understanding of anxiety states in the rat which could parallel the different classes of anxiety recognised in the clinic