Devastating Transboundary Impacts of Sea Star Wasting Disease on Subtidal Asteroids.

Sea star wasting disease devastated intertidal sea star populations from Mexico to Alaska between 2013-15, but little detail is known about its impacts to subtidal species. We assessed the impacts of sea star wasting disease in the Salish Sea, a Canadian / United States transboundary marine ecosystem, and world-wide hotspot for temperate asteroid species diversity with a high degree of endemism. We analyzed roving diver survey data for the three most common subtidal sea star species collected by trained volunteer scuba divers between 2006-15 in 5 basins and on the outer coast of Washington, as well as scientific strip transect data for 11 common subtidal asteroid taxa collected by scientific divers in the San Juan Islands during the spring/summer of 2014 and 2015. Our findings highlight differential susceptibility and impact of sea star wasting disease among asteroid species populations and lack of differences between basins or on Washington's outer coast. Specifically, severe depletion of sunflower sea stars (Pycnopodia helianthoides) in the Salish Sea support reports of major declines in this species from California to Alaska, raising concern for the conservation of this ecologically important subtidal predator.

Ochre star mortality during the 2014 wasting disease epizootic: role of population size structure and temperature.

Over 20 species of asteroids were devastated by a sea star wasting disease (SSWD) epizootic, linked to a densovirus, from Mexico to Alaska in 2013 and 2014. For Pisaster ochraceus from the San Juan Islands, South Puget Sound and Washington outer coast, time-series monitoring showed rapid disease spread, high mortality rates in 2014, and continuing levels of wasting in the survivors in 2015. Peak prevalence of disease at 16 sites ranged to 100%, with an overall mean of 61%. Analysis of longitudinal data showed disease risk was correlated with both size and temperature and resulted in shifts in population size structure; adult populations fell to one quarter of pre-outbreak abundances. In laboratory experiments, time between development of disease signs and death was influenced by temperature in adults but not juveniles and adult mortality was 18% higher in the 19 °C treatment compared to the lower temperature treatments. While larger ochre stars developed disease signs sooner than juveniles, diseased juveniles died more quickly than diseased adults. Unusual 2-3 °C warm temperature anomalies were coincident with the summer 2014 mortalities. We suggest these warm waters could have increased the disease progression and mortality rates of SSWD in Washington State.

Evaluation of a hospital-based tobacco treatment service: outcomes and lessons learned.

BACKGROUND: The efficacy of smoking cessation interventions for hospital patients has been well described, but we know little regarding implementation and outcomes of real-world programs. OBJECTIVE: To describe the services provided and outcomes of an academic medical center-based tobacco treatment service (UKanQuit) located in the Midwestern United States. METHOD: This is a descriptive observational study. Both quantitative and qualitative data of all patients treated by UKanQuit over a 1-year period were analyzed. RESULTS: Among 513 patients served, average interest in quitting was 7.9, standard deviation (SD) 2.9 on a scale of 0 to 10. More than 1 in 4 had been given an in-hospital medication to ameliorate withdrawal prior to seeing a counselor. Counselors recommended medication changes for 1 in 3 patients, helped 73% set a goal for quitting or reducing tobacco use, and fax referred 56% to quitlines. Six-month follow-up (response rate, 46%) found a 7-day abstinence rate of 32% among respondents for an intent-to-treat abstinence rate of 15%. Post-discharge, 74% made at least one serious quit attempt, 34% had used a quit smoking medication, but only 5% of those referred to the quitline reported using it. CONCLUSIONS: In a hospital setting, interest in quitting is high among smokers who requested to see a tobacco counselor but administration of inpatient medications remains low. Many smokers are making unassisted quit attempts post-discharge because utilization of cessation medications and quitline counseling were low. Fax-referral to quitline may not, on its own, fulfill guideline recommendations for post-discharge follow-up.

The relationship between mood state, interpersonal attitudes and psychological distress in stroke patients.

This study investigated whether increasing positive mood improved interpersonal attitudes and relieved depression in depressed stroke patients despite levels of cognitive and emotional dysfunction. Depressed stroke (n = 30) and rheumatic/orthopaedic controls (n = 30) were compared on the effect of verbal and nonverbal positive and neutral mood induction on mood state, interpersonal attitudes, psychological distress and related cognitive and emotional processing deficits. Compared with the neutral mood induction condition, the positive mood induction significantly improved mood state, interpersonal attitudes and psychological distress, irrespective of cognitive and emotional processing deficits. The nonverbal material was effective for all patients but was more marked for the left hemisphere stroke group. There was no obvious influence of humour appreciation despite reduced understanding in the right hemisphere stroke group. Although the effect is likely to be short-lived, these results support the trial of positive mood induction within therapy programmes to relieve depression.

Assessing the cognitive regulation of emotion in depressed stroke patients.

This study evaluated the psychometric properties of a simple scale for measuring positive interpersonal attitudes of depressed stroke patients, with regard to their cognitive limitations. Two versions of the Attitudes Towards Relationships Scale were developed and administered to depressed stroke (n = 48) and control rheumatic/orthopaedic (n = 45) patients during a study that investigated the relationship between mood state, interpersonal attitudes and psychological distress. Both versions produced homogeneous results and showed acceptable concurrent validity, test-retest reliability, internal consistency and measurement specificity. A principal component analysis produced a three-factor structure highlighting the importance of attitudes towards future interpersonal relationships. These results suggest that the Attitude Towards Relationships Scale may be a psychometrically sound measure that shows some potential as a therapeutic measure of progress in stroke and other comparable samples.

A study analysing inconsistent responses from people with multiple sclerosis in a recent national audit.

PURPOSE: An audit of NHS services for people with multiple sclerosis (PwMS) revealed inconsistency in individuals' responses to different types of questions. The main aim of this subsequent study was to analyse systematically the qualitative data gathered as part of the audit and use the findings to investigate the disparity between the global expressions of satisfaction and the negative, and at times heart wrenching, free text comments made. METHOD: This study analysed questionnaires completed by 557 PwMS, 336 of which had made free text comments. This qualitative data was analysed using content analysis by grouping content into positive and negative comments and then into more detailed categories and sub-categories. Inter-coder and intra-coder reliabilities were confirmed and the data manipulated to address the aim of the study. RESULTS: The study found that PwMS who gave conflicting reports of satisfaction with services were more likely to give negative comments regarding the provision of service rather than the quality of service. CONCLUSION: This study has revealed that simple, single questions on satisfaction with services do not offer a valid measure of patient experience. It has shown that there is a place for qualitative research in the area of patient satisfaction.

Pain assessment and cognitive impairment: part 2.

AIM: To evaluate the use of a tool for pain assessment in cognitively impaired adults. METHOD: A multi-dimensional tool was implemented and evaluated in relation to use rate; frequency of specific pain indicators; staff perceptions of advantages and disadvantages of pain assessment in this patient group; and factors that aid or impede this assessment. RESULTS: Some indicators are more likely to be observed and documented. There was a lack of compliance by nurses in making and recording pain observations on every shift. Observations that were recorded occurred most frequently on the morning shift. Factors that were identified as assisting in the assessment of pain related to nursing staff having the appropriate knowledge and skills gained through experience of caring for cognitively impaired adults. CONCLUSION: Pain assessment for cognitively impaired adults should continue to be based on a combination of physiological and behavioural indicators. Assessment should be conducted as indicated by the nurse's clinical judgement and follow-up pain assessment should be undertaken after implementation of appropriate comfort measures.

Pain assessment and cognitive impairment: part 1.

People with cognitive impairment are often unable to inform others of their pain. Nurses need to be able to assess pain in cognitively impaired adults so that appropriate pain management strategies can be implemented. Evidence suggests that certain verbal, facial and behavioural signs may be indicative of pain. This article describes the process undertaken in developing a specific tool to facilitate pain assessment. The tool was developed after extensive analysis of pain research literature, input from experienced nurses and critical review by a panel of experts in dementia care. The research study will be published in next week's Nursing Standard.