Evidence for the Validity of a Tool for Improved Pressure Ulcer Staging by the Non-Expert in the Live Patient

Background and Purpose: Pressure ulcers (PrUs) are a costly issue for the health care system. The utilization of a tool that increases the accuracy of PrU identification and staging may allow the health care team to better manage these wounds. The purpose of this study was to determine the validity of the NE1 Wound Assessment Tool (NE1 WAT) for increasing the wound assessment accuracy of novice nurses. Subjects: A convenience sample of 11 novice nurses evaluated 11 wounds on eight patients at a 730 bed, hospital in Las Vegas, Nevada. Methods: Subjects assessed 11 wounds on the patients independently. They then received brief orientation to the NE1 WAT. The subjects then re-assessed the same 11 wounds utilizing the NE1 WAT. Accuracy in wound assessment was then compared when performed with and without the tool. Results: Wilcoxon signed-rank tests were used to compare scores before and after training on how to use the tool. The subjects showed a significant improvement in pressure ulcer staging (p=.005), identification of wounds other than pressure ulcers (p = .024), and overall score across all aspects of wound assessment when using the NE1 WAT (p = .017). Discussion: This study provides evidence for the validity of the NE1 WAT. Improved wound assessment would likely improve care. Due to Medicare billing rules, the NE1 WAT has the potential to impact hospital remuneration. Conclusion: Following brief orientation on tool use, there was increased accuracy of novice nurse wound assessment on live patients

Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study

<p>Abstract</p> <p>Background</p> <p>Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows.</p> <p>Methods</p> <p>Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex.</p> <p>Results</p> <p>Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1^st(7.4 μg/m³) to the 25^th(17.2 μg/m³), 50^th(33.8 μg/m³), 75^th(108.3 μg/m³), and 90^th(180.8 μg/m³) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage.</p> <p>Conclusions</p> <p>The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.</p

Staff walking program : a quasi-experimental trial of maintenance newsletters to maintain walking following a pedometer program

Issue addressed: The Step by Step self-help walking program plus a pedometer previously motivated a community sample of adults to be physically active for up to three months. This study evaluates the effect of enhancement of this program over an additional nine months in a workplace. Methods: A quasi-experimental trial was conducted. Staff defined as inactive received the three month walking program and a pedometer (standard), or the three month program plus four maintenance newsletters over nine months (standard+maintenance). After 12 months a follow-up interview was conducted. Measures included changes in self-reported minutes walking, minutes of moderate-vigorous physical activity (MVPA), total physical activity (PA) in the past week, and the proportion meeting public health recommendations by walking and total PA. Results: Significant increases on all outcome measures were noted for all participants. There were no between group differences in walking minutes. However, the change in MVPA minutes was significantly higher in the standard+maintenance group compared with the standard group (118 min vs 69 min, P=0.029). No significant between group differences were observed for total PA (161 min vs 117 min, P=0.187). Wearing the pedometer at the month of the follow-up interview, and thinking that the pedometer was very useful, increased the likelihood of meeting public health recommendations (AOR=2.7 and 2.5) adjusting for other covariates. Conclusions: Dissemination of the Step by Step guidebook with pedometers in the workplace resulted in a long-term increase in PA of inactive employees with no extra support. Newsletters as a maintenance strategy had no additional benefits. Better outcomes were noted if the pedometer was used and was perceived as being very useful

The implementation of a pilot playground markings project in four Australian primary schools

Issue addressed: Increasing childhood overweight and obesity rates need strategies that promote and engage children in more physical activity and school is one setting for this. This pilot project aimed to determine if coloured playground markings are an effective strategy, in the Australian context, to increase students? physical activity during school break times in primary schools. Methods: Four schools participated, two as intervention schools and two as control schools. A combination of data collection methods were used, including accelerometers on students, playground observations and a teacher survey. Results: The accelerometer and observation data did not show an improvement in the physical activity levels of the intervention students compared to the control students. The teacher survey was positive in all aspects of the project implementation. Observations suggest that most students were active in large grass areas rather than around the playground markings. Conclusion: Based on our data, it is unclear whether playground markings are an effective intervention to increase physical activity in the school setting. The amount of playing space available appears to influence the use of the playground markings

Queensland Family Cohort: a study protocol

Introduction: The perinatal–postnatal family environment is associated with childhood outcomes including impacts on physical and mental health and educational attainment. Family longitudinal cohort studies collect in-depth data that can capture the influence of an era on family lifestyle, mental health, chronic disease, education and financial stability to enable identification of gaps in society and provide the evidence for changes in government in policy and practice.Methods and analysis: The Queensland Family Cohort (QFC) is a prospective, observational, longitudinal study that will recruit 12 500 pregnant families across the state of Queensland (QLD), Australia and intends to follow-up families and children for three decades. To identify the immediate and future health requirements of the QLD population; pregnant participants and their partners will be enrolled by 24 weeks of gestation and followed up at 24, 28 and 36 weeks of gestation, during delivery, on-ward, 6 weeks postpartum and then every 12 months where questionnaires, biological samples and physical measures will be collected from parents and children. To examine the impact of environmental exposures on families, data related to environmental pollution, household pollution and employment exposures will be linked to pregnancy and health outcomes. Where feasible, data linkage of state and federal government databases will be used to follow the participants long term. Biological samples will be stored long term for future discoveries of biomarkers of health and disease.Ethics and dissemination: Ethical approval has been obtained from the Mater Research Ethics (HREC/16/MHS/113). Findings will be reported to (1) QFC participating families; (2) funding bodies, institutes and hospitals supporting the QFC; (3) federal, state and local governments to inform policy; (4) presented at local, national and international conferences and (5) disseminated by peer-review publications

Feasibility of gaming console exercise and its effect on endurance, gait and balance in people with an acquired brain injury

Objective: To determine feasibility of gaming console exercise and its effect on endurance, gait and balance in people following acquired brain injury (ABI). Method: Twenty-one people following ABI were recruited to an 8-week randomized cross-over trial where 4 weeks of gaming console exercise in addition to usual therapy and 4 weeks of usual therapy alone were received. Feasibility measures included compliance, session duration and adverse events. Measures included endurance measured using a 6-minute walk test, spatiotemporal gait parameters (GAITRite) and balance using Balance Outcome Measure for Elder Rehabilitation (BOOMER). Motivation was measured using the Change Assessment Questionnaire. Results: Compliance with gaming console exercise was high (99%), the majority of sessions reached duration target (82%) and there were no adverse events. There were small, though non-significant increases in 6-minute walk distance (18 metres, 95% CI=-33 to 69), gait speed (0.11ms, 95% CI=-0.18 to 0.29) and balance compared to after usual therapy after gaming console exercise. Conclusions: Gaming console exercise appears feasible in people with ABI. Four weeks of gaming console exercise in addition to usual therapy appears to result in similar improvements in endurance, gait and balance compared to usual therapy alone and may enhance active engagement in therapy

Post-exercise coincidence anticipation in expert and novice Gaelic games players: the effects of exercise intensity

Within the current scientific literature, there is a distinct lack of empirical data examining the effects of exercise intensity on coincidence anticipation and, to date, no study has examined this in Gaelic games. Furthermore, many previous studies failed to consider fully sport specificity. The aims of this study were to examine the effect of moderate- and high-intensity exercise on coincidence anticipation and to determine whether post-exercise changes in coincidence anticipation were the same in novice and expert Gaelic games players (hurlers). Eleven expert and nine novice hurlers participated in this study. After familiarization, coincidence anticipation was measured using the Bassin Anticipation Timer at rest, following moderate- and high-intensity exercise. Exercise intensities were set using an incremental running protocol until the participants reached steady-state 70% and 90% heart rate reserve. To simulate hitting a ball, participants swung or ‘‘pulled’’ using a continuous swing at full speed with a standard hurley through a photoelectric beam as close to the actual arrival time of the stimulus at the target location as possible. Immediately following each exercise condition, participants performed 20 anticipation trials. All testing was randomized and counterbalanced. Raw scores were transformed to three error scores constant error, absolute error, and log variable error. The effect of exercise intensity on constant error, absolute error, and log variable error was analysed using separate 3 (exercise intensities) 20 (trials) 2 (levels of skill) repeated-measures analyses of variance. The results showed no between- or within-group differences for constant error (P 0.05). For both absolute error and log variable error there were highly significant between-group differences (both PB0.01), which indicated that the expert hurlers at all exercise intensities exhibited significantly better coincidence anticipation than novice players probably due to experience among other factors. Further within-group analyses showed no differences in the expert players’ performance across exercise intensities. However, within-group analyses on the novice players’ data showed a significant difference between performance at rest and performance following moderate-intensity exercise. The results suggest that expert players are capable of maintaining coincidence anticipation performance across exercise intensities but the novice players performed optimally following moderate-intensity exercise