The influence of bed height as a percentage of participant height on low back forces when boosting a patient up in bed.

BACKGROUND: Repositioning patients is a frequent task for healthcare workers causing substantial stress to the low back. Patient handling methodologies that reduce low back load should be used. Some studies have observed the effect of bed height on back forces using a limited range of heights. This study details a wider range. OBJECTIVE: The aim of this study was to discover an optimal bed height for reducing low back force when boosting a patient. METHODS: 11 university students and local residents participated by completing a series of boosts with a 91.6 kg research assistant acting as dependent. The bed was adjusted 3% of participant height and 3 boosts were completed at each height which resulted in 8-10 different bed heights depending on the height of the participant. Motion and force data were collected to estimate low back forces via 3DSSPP. Pearson's R was performed to observe the correlation between caregiver height and low back forces. RESULTS: There were significant negative correlations between bed height and low back compression force at L4-L5 (r = -0.676, p = <0.001) and L5-S1 (r = -0.704, p = <0.001). There were no significant correlations with any shear forces. CONCLUSION: The highest bed height led to decreased low back compression forces regardless of participant height, but there was not a significant difference in shear forces. Thus, healthcare workers may experience less low back stress with the bed at a higher height. There may be a force tradeoff between the low back and other parts of the body that needs further exploration. Healthcare workers need to be made aware of the implications of adjusting the environment when performing patient handling tasks.

Healthcare worker choice and low back force between self-chosen and highest bed height when boosting a patient up in bed.

Healthcare workers have a high rate of low back injury due to patient handling tasks. These workers receive training in patient handling methods such as adjusting bed height, but often ignore them. In this study, 35 healthcare workers completed patient boosts at a self-chosen bed height and again with the bed in a higher standardised position. Motion capture and force data were collected for analysis. Given the choice, less than half of participants adjusted the bed at all and none of them moved the bed to the highest position (99.1 cm). The self-chosen bed position yielded significantly higher low back force than the higher position at L4-L5 and L5-S1 (p = 0.02, p = 0.01 respectively). Low back forces can be reduced by raising the bed prior to engaging in patient handling tasks, which is a simple step that can reduce forces placed on healthcare workers' low backs. Practitioner summary: Healthcare workers experience high rates of low back pain secondary to patient handling tasks. In this cross-sectional crossover study, healthcare workers consistently chose a low bed height when boosting a patient, which resulted in higher low back loads compared to the highest bed height.

Long-term running in middle-aged men and intervertebral disc health, a cross-sectional pilot study.

PURPOSE: To measure intervertebral disc (IVD) health parameters in middle-aged long-term runners compared to matched non-physically active controls. METHODS: Seventeen males aged 44-62yr were included in the study: 9 runners with a running history of >10yr, averaging >50km/week, and eight matched non-physically active controls, the data from one participant had to be excluded. T2-relaxometry, diffusion weighted imaging, T1- and T2-weighted MR scanning, as well as T2 time mapping were performed. Morphological data relating to IVD were extrapolated. RESULTS: Compared to controls on average, runners had 20% greater IVD height (p = 0.002) and seven percentage points greater IVD-vertebral body height ratio (p = 0.001). No significant differences were observed between groups for mean(SD) IVD hydration status, as indicated by similar T2-times (runners: 94.4(11.1)ms, controls: 88.6(23.6)ms), or apparent diffusion coefficients (runners: 249.0(175.2)mm2/s, controls: 202.3(149.5)mm2/s). Average Pfirrmann score for the L5-S1 IVD was 2.2(0.7) for runners and 3.3(1.0) for controls (p = 0.026), average scores for all lumbar levels (L2-S1) were 1.9(0.2) and 2.5(0.7), respectively (p = 0.036). Anterior annulus T2-time and overall average lumbar level Pfirrmann grades were strongly correlated (r = 0.787, p = 0.021 and r = -0.704, p = 0.034, respectively) with greater distances run per week. Average lumbar level Pfirrmann grades were also strongly correlated (r = -0.823, p = 0.006) to total years of running. CONCLUSION: Middle-aged long-term endurance runners exhibit less age-related decline in their lumbar IVDs. In addition, the measures of IVD morphology appeared to be better in those who had been running for a greater number of years, as well as in those who ran a greater distance per week.

Positional changes in distance to the pleura and in muscle thickness for dry needling.

OBJECTIVE: This study was conducted to measure and to determine differences in tissue depth in the upper back for two prone positions and to stratify the results by body composition and sex of the patient. In addition, muscle thickness changes with positioning were assessed. This information is important for clinicians who dry needle in the thorax area, cognizant of the dangers of inadvertently piercing the pleura or lung tissue. DESIGN: Descriptive cross-sectional. SETTING: Health and Human Performance laboratory at a university campus. PARTICIPANTS: Sample of convenience of 60 college-aged subjects, 20 subjects in three body composition groups. MAIN OUTCOME MEASURES: Distances from skin to lung tissue, skin to ribs and muscle thickness were measured and compared between two prone positions. RESULTS: There was a significant increase in depth to the lung tissue (0.7cm, 95% confidence interval 0.4-1.0cm) when using a bolster under the shoulder. There were also differences in depths between body composition classifications and between sexes, but not between sides. The average thickness of all muscles increased significantly by up to 0.4cm (95% confidence interval 0.3-0.5) when the shoulder was positioned in retraction. CONCLUSIONS: Positioning, body constitution and sex of the patient change tissue depth significantly and should be considered when dry needling. This change is largely attributed to a modification in muscle thickness.

The Construction of Sham Dry Needles and Their Validity.

Appropriate control interventions are necessary to show the treatment effect of dry needling. Different control procedures, such as dry needling of the contralateral side, and sham treatments, such as random and superficial needle insertion, have been utilized in trials. However, those methods might elicit a physiological response and are subsequently not ideal for use as a control. This descriptive study illustrates the construction of low-cost sham dry needles and evaluates their validity. Forty-two healthy asymptomatic subjects received either sham or real dry needling intervention to their right gluteal muscles and reported if they felt that the needle pierced the skin. They also graded the severity and qualified (sharp or dull) the pain associated with the intervention. The results showed that most of the subjects in both groups believed the needle penetrated the skin. The quantity of pain associated with the treatment was similar in both groups, but the quality assigned was different. The authors conclude that sham dry needling can be accomplished and used as a valid control treatment in dry needling research using these low-cost sham needles.

Forces involved when sliding a patient up in bed.

BACKGROUND: This study investigated the effects of 3 different types of slide sheets upon hand forces while sliding a patient up in bed. METHODS: The sheets used included the reusable Arjo Maxislide, the McAuley disposable sheet, and a standard cotton sheet. Hand forces were measured from 38 male and female participants as they slid a 'patient' up in bed. A repeated measures ANOVA with 5 levels to the repeated factor (number of sheets and sheet type) was used, along with post-hoc repeated measures contrasts to compare differences between each condition. RESULTS: A significant reduction in required force occurred when using the friction reducing sheets as compared to the cotton sheets when used according to manufacturer recommendations, as well as a reduction in one of the single friction reducing sheet categories compared to the cotton. However, it is important to note that there was still substantial force being placed on the participants. CONCLUSIONS: This study illustrates the importance of using friction reducing slide sheets while engaging in manual patient handling. Future research should investigate the forces involved with other friction reducing materials and methods as well as the possibility of combining said materials and methods.

Effect of ambient temperature on viral replication and serum antibody titers following administration of a commercial intranasal modified-live infectious bovine rhinotracheitis-parainfluenza-3 virus vaccine to beef cattle housed in high- and moderate-ambient temperature environments.

OBJECTIVE: To evaluate the effect of ambient temperature on viral replication and serum antibody titers following administration of an intranasal modified-live infectious bovine rhinotracheitis (IBR)-parainfluenza-3 (PI3) virus vaccine to beef calves housed in high- (> 32°C) and moderate- (21°C) ambient temperature environments. ANIMALS: 28 calves (mean weight, 206.8 kg). PROCEDURES: Calves were randomly allocated to 4 treatment groups (housed outdoors during high ambient temperature with [HAT; n = 10] or without [HAC; 4] vaccination or housed indoors in a moderate ambient temperature with [MAT; 10] or without [MAC; 4] vaccination). Rectal and nasal mucosal temperatures were recorded every 2 hours from 8 AM to 8 PM on days 0 (vaccination) and 1. Nasal swab specimens were obtained on days 0 through 7 for virus isolation. Serum samples were collected on days 0, 7, 14, and 28 for determination of antibody titers. RESULTS: Mean rectal temperature did not differ among the treatment groups. Mean nasal temperature for the HAT group was significantly higher than that for the MAT group at 6, 24, 30, 32, and 38 hours after vaccination. Viable IBR virus was isolated from all vaccinated calves on days 1 through 6. Two weeks after vaccination, vaccinated calves had anti-IBR antibody titers that were significantly greater than those for unvaccinated calves. Mean anti-IBR antibody titers did not differ significantly between the HAT and MAT groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that, following vaccination with an intranasal modified-live IBR-PI3 virus vaccine, IBR viral replication and serum antibody titers did not differ significantly between calves housed in high- and moderate-ambient temperature environments.

Management practices associated with the rate of respiratory tract disease among preweaned beef calves in cow-calf operations in the United States.

OBJECTIVE: To assess associations between herd management practices and herd-level rates of bovine respiratory disease complex (BRDC) in preweaned beef calves in US cow-calf operations. DESIGN: Cross-sectional survey. SAMPLE: 443 herds weighted to represent the US cow-calf population. PROCEDURES: Producers from 24 states were selected to participate in a 2-phase survey; 443 producers completed both survey phases and had calves born alive during the study period. Data from those respondents underwent multivariable negative binomial regression analyses. RESULTS: Bred heifer importation was associated with lower BRDC rates (incidence rate ratio [IRR], 0.40; confidence interval [CI], 0.19 to 0.82), whereas weaned steer importation was associated with higher BRDC rates (IRR, 2.62; CI, 1.15 to 5.97). Compared with single-breed herds, operations with calves of 2-breed crosses (IRR, 2.36; CI, 1.30 to 4.29) or 3-breed crosses (IRR, 4.00; CI, 1.93 to 8.31) or composite-herd calves (IRR, 2.27; CI, 1.00 to 5.16) had higher BRDC rates. Operations classified as supplemental sources of income had lower BRDC rates (IRR, 0.48; CI, 0.26 to 0.87) than did operations classified as primary sources of income. Reported feed supplementation with antimicrobials was positively associated with BRDC rates (IRR, 3.46; CI, 1.39 to 8.60). The reported number of visits by outsiders in an average month also was significantly associated with herd-level BRDC rates, but the magnitude and direction of the effects varied. CONCLUSIONS AND CLINICAL RELEVANCE: Management practices associated with preweaning BRDC rates may be potential indicators or predictors of preweaning BRDC rates in cow-calf production systems.