Health-Related Quality of Life Following Concussion in Collegiate Student-Athletes With and Without Concussion History.

The purpose of this study was to compare global and specific health-related quality of life (HRQOL) throughout concussion recovery between those with and without concussion history. Student-athletes diagnosed with concussion completed global (Short Form-12v2; SF-12) and specific (Hospital Anxiety and Depression Scale: HADS) HRQOL assessments at baseline, 24-48 h, asymptomatic, return-to-play, and 6-months post-injury. Baseline scores were compared to post-injury time points for SF-12 subscores (physical and mental; PCS-12, MCS-12) and HADS subscores (depression and anxiety; HADS-D, HADS-A). We conducted a 2 × 5 mixed model ANOVA for group (with and without concussion history) and time (four post-injury assessments compared to baseline). We did not observe interaction or main effects for group, except those with concussion history had worse HADS-D subscores than those without concussion history. PCS-12 subscores were worse at 24-48 h, asymptomatic, and return-to-play compared to baseline, but returned to baseline 6-months post-injury. MCS-12 subscores did not differ at any time points. HADS-D subscores worsened 24-48 h post-injury, but improved for additional assessments compared to baseline. HADS-A improved post-injury compared to baseline at asymptomatic, return-to-play, and 6-month assessments, but was similar to baseline 24-48 h post-injury. HRQOL physical aspects slightly worsened post-injury and restored to baseline after returning to play.

Evidence-based practice for enteral feedings: aspiration prevention strategies, bedside detection, and practice change.

Nurses questioned the hospital policy of using blue dye in all enteral feedings. A project team gathered and disseminated information from the literature and national practice benchmarks. Hospital policy and nursing practice were revised according to the evidence-based information.

Functional outcome in knee osteoarthritis after treatment with hylan G-F 20: a prospective study.

OBJECTIVE: To assess functional change in patients with knee osteoarthritis (OA) after treatment with intra-articular hyaluronic acid (Hylan G-F 20; Synvisc). DESIGN: Prospective case series with 6-month follow-up. SETTING: Outpatient community orthopedic practice. PARTICIPANTS: Eighty-four consecutive patients referred to private orthopedic group with symptoms and radiographic evidence of unilateral or bilateral knee OA who had either failed or could not tolerate the side effects of conservative treatment. Sixty-one patients completed the study. Nineteen patients were lost to follow-up. Four patients withdrew from study due to subsequent knee arthroplasty. INTERVENTION: Three weekly injections of Hylan G-F 20 into one or both (if bilaterally symptomatic) knees (110 knees total). OUTCOME MEASURE: SF-36 Health Survey was completed before treatment and 6 months after treatment. RESULTS: Statistically significant improvement (p < .001) in Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, and Role-Emotional categories on 6-month follow-up survey. Age and percent above ideal body weight were not significant predictors of functional change. CONCLUSION: Efficacy of intra-articular injection of Hylan G-F 20 for knee OA 6 months after injection is demonstrated in several categories of the SF-36, indicating a measurable improvement in overall functioning in these patients.

The implementation of bedside bladder ultrasound technology: effects on patient and cost postoperative outcomes in tertiary care.

RESEARCH PROBLEM: The purpose of this study was to determine the effect of ultrasound assessment of bladder volume on patient and cost outcomes for patients needing postoperative catheterization. RESEARCH METHODS: Prospective descriptive and quasi-experimental designs were used with patients having general surgery (N = 50) and patients having orthopaedic surgery (N = 103), respectively. Four outcomes were measured: number of catheterizations over the hospitalization period, infection rates, cost, and patient and provider satisfaction. RESULTS: Accuracy of the technology ranged from .76 to .97 (p = .01). Catheterizations were avoided in 38% (in the "Due to Void" category) and in 81% (in the "Void with Residual" category) of patients in the general surgery group. Patients in the orthopaedic surgery group having ultrasound experienced 1.68 and the standard catheterization group, 1.96 catheterizations, throughout hospitalization. This difference was not statistically significant. UTI rates from admission to 30 days after discharge were 4% and 13% of patients in the ultrasound and standard orthopaedic groups, respectively, and 17% of patients in the general surgical population. Based on acquisition catheter cost, approximately 3 years of ultrasound machine use would be needed to recover the acquisition cost for each machine. The satisfaction rate with the technology was 93% of patients and 97% of nurses. In postoperative patients, bedside bladder ultrasound is accurate, is effective in decreasing numbers of catheterizations, reduces cost over time, and provides high patient and provider satisfaction.

Institutionwide pain management improvement through the use of evidence-based content, strategies, resources, and outcomes.

The Agency for Health Care Policy and Research pain guidelines and implementation theories were used in this improvement initiative to ensure that evidence-based pain management reached every provider and patient in a large tertiary care hospital. Implementation strategies, products, and outcome measures are described for use in the clinical setting. Critical success factors and implementation barriers are also addressed.

Improving pain management after total joint replacement surgery.

PURPOSE: To test the effects of implementing evidence-based postoperative pain management content and strategies on patient, provider (nurse and physician), and fiscal outcomes. SAMPLE: 118 patients, 57 before and 61 after implementation, having total knee replacement (TKR) (54%) and total hip replacement (THR) (45%), and 28 orthopaedic nurses. METHODS: A research utilization approach with a pretest/posttest design was used. Independent variables (interventions) included evidence-based pain management content, education of care providers and patients, and system changes at the point of care. Dependent variables (outcomes) were patient perception of the postoperative pain experience, provider practice patterns, and length of stay (LOS). FINDINGS: The hypotheses of decreased provider use of meperidine and increased use of hydromorphone, i.v. route, pain plans of care, and nurse knowledge were supported. LOS was significantly reduced. The patient hypotheses decreased pain intensity and side effects and increased satisfaction and function were not supported. CONCLUSION: Methodical implementation of evidence-based pain management information changed practice and fiscal outcomes. Improvement in the patient perception of pain management was more difficult to achieve.

Interregional healthcare: patient stories and chart reviews.

The literature and healthcare provider experiences leave questions about which interventions might best assist patients during interregional healthcare. The research was conducted to gain information on the current reality of interregional healthcare for patients needing tertiary cardiovascular care distant from their home. A purposive sample of patients having a cardiovascular diagnosis who were transferred for procedures or surveillance to a tertiary site were interviewed (n = 17), and their charts were reviewed (n = 27). Six broad themes were extracted from the interviews and chart reviews: healthcare provider behaviors, healthcare system issues, patient education or information, discharge from the hospital, overall reflections on the healthcare experience, and healthcare communication issues. A redesign of interregional healthcare is needed to address the areas of care and expert behaviors by providers, documentation, continuity, communication, education, and rehabilitation/adaption. The advanced practice nurse is well suited to lead these practice changes.

Effects of consecutive thiouracil exposures in the juvenile and adult single comb White Leghorn chicken on body weight and reproductive performance.

The effects of consecutive exposures to dietary thiouracil (TU) in juvenile and adult Single Comb White Leghorn chickens on plasma thyroxine (T4) concentrations, egg production (EP), egg weight (EW), concentrations eggshell quality were determined. Thiouracil was provided in the feed at levels of 0, 0.1, or 0.2% (PTRT) from 0 to 6 wk of age and at levels of 0 or 0.1% (TRT) from 32 to 38 wk of age. Body weight gain was simulated but T4, EW, EP, and eggshell quality were generally reduced by 0.1% TU TRT. However, TU PTRT alleviated a latent depressing effect of TU TRT on BW after 38 wk of age. Thiouracil PTRT, particularly at the 0.2% level, induced significant decreases in EW but increased EP between 32 and 50 wk. The effects of early thyroid suppression in juveniles with TU PTRT on the subsequent reproduction of adults were primarily in response to a delay in the onset of sexual maturity, and not directly to prolonged responses in T4 or BW that extended into lay.

Lowering the threshold for the diagnosis of gestational diabetes.

OBJECTIVE: Our purpose was to determine whether lowering the diagnostic threshold for gestational diabetes mellitus on 3-hour 100 gm oral glucose tolerance testing will select a population at risk for adverse perinatal outcome. STUDY DESIGN: In this retrospective study 434 patients with an abnormal 50 gm glucose screen result (> or = 140 mg/dl) underwent a standardized 3-hour oral glucose tolerance test. The results were stratified according to maternal weight and the criteria recommended by Sacks or Carpenter. Birth weight and rate of macrosomia were the primary perinatal outcome variables analyzed. RESULTS: Analysis of the data set stratified according to the Sacks criteria revealed results very similar to the Carpenter criteria data set. Patients who would have been newly diagnosed with gestational diabetes mellitus only if the lowered criteria were used (group 2) were older and heavier. No other variable comparisons achieved statistical significance. When the same patients were stratified according to prepregnancy weight, overweight patients were older, gained less weight during the third trimester, underwent cesarean section more often, and had higher cumulative maternal morbidity. Regression analysis showed that the degree of hyperglycemia did not predict macrosomia or influence birth weight, but prepregnant maternal body mass index was associated with macrosomia. CONCLUSIONS: Fetal macrosomia is influenced by maternal prepregnant body mass index. Lowering the glucose tolerance test threshold would result in overdiagnosis of gestational diabetes mellitus without improving perinatal outcome.

Managing periorbital space abscess. Secondary to dentoalveolar abscess.

Although orbital space infections are a relatively rare sequela of dentoalveolar infections, such cases have been reported. This case report describes the management of an abscess involving the left eye that originated as a dental abscess.

Effects of dietary thiouracil on thyroid activity, egg production, and eggshell quality in commercial layers.

The effects of thyroid suppression induced during the rearing period by providing various dietary thiouracil (TU) regimens on plasma thyroxine (T4) concentrations, growth, and subsequent egg production (EP) and eggshell quality were determined in Single Comb White Leghorn chickens. Thiouracil was provided in the feed at levels of 0, .1, and .2% from 0 to 6 wk of age in Experiment 1, and at levels of 0, .05, and .1% from 6 to 16 wk of age in Experiment 2. In both experiments, T4 concentrations were reduced during TU treatment. However, T4 later became elevated at 12 and 20 wk in both dosage level groups in Experiment 1. Additionally, BW and egg weights were suppressed by both TU treatments, and EP was reduced up to Week 23 in the .1% TU-treated birds and through Week 25 in the .2% TU-treated birds. No effects on EP were noted in Experiment 2, but feed consumption (FC) was reduced during Week 6 in birds fed .05% TU and during Weeks 6, 10, and 19 in birds fed .1% TU. Both liver and thyroid weights were increased in .1% TU-treated birds relative to controls at Week 16. Eggshell quality was affected only in Experiment 2, in which birds given .05% TU had a higher relative conductance, or maximum rate of water loss, at Week 38 than 0 and .1% TU dosage levels, and .1% TU-treated birds had a higher breaking strength than 0 and .05% TU-treated birds at Week 22.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of ascorbic acid on plasma thyroxine concentrations and eggshell quality of Leghorn chickens treated with dietary thiouracil.

Because ascorbic acid (AA) and the thyroid hormones are known to influence eggshell formation, the effects of AA on body weight, total plasma thyroxine (T4), egg production, and eggshell quality of Single Comb White Leghorn (SCWL) hens concurrently and previously treated with thiouracil (TU) were determined. Hens were provided feed containing either 0 or 100 ppm AA from 47 to 67 wk of age and either 0 or .1% TU from 47 to 57 wk of age. A three-way split-plot analysis was employed to test for the effects of AA, TU, and time, and their interactions. Dietary TU increased body weight between 53 and 59 wk, and increased thyroid weight at 67 wk; however, TU only depressed plasma T4 level at 51 wk. Dietary TU depressed egg production from 50 to 56 wk and egg weight at 49, 51, and 57 wk. Dietary TU depressed eggshell weight per unit surface area at 49 wk. There was no significant effect due to AA and no AA by TU interaction for any of the parameters examined. It was concluded that .1% dietary TU from 47 to 57 wk of age did not alter eggshell quality and that dietary AA at the 100 ppm level did not influence the effects of .1% TU on body weight, egg production, or egg weight of SCWL hens.

Arthroscopic-assisted arthrodesis of the knee.

Arthrodesis of the knee is an accepted procedure to alleviate pain and deformity in posttraumatic degenerative arthritis, in patients who are not candidates for total joint arthroplasty. Most all of the accepted surgical methods involve an arthrotomy to remove bone and prepare the surfaces for fusion. We present an unusual case of posttraumatic arthritis of the knee in a young woman with a history of osteomyelitis. An arthrodesis was planned, but an arthrotomy was precluded. Arthroscopically assisted preparation of the fusion bed was performed for compression arthrodesis of the knee with an external fixator. A successful arthrodesis was obtained in 14 weeks.

Follicular-phase serum progesterone levels of nonsmoking women do not differ from the levels of nonsmoking men.

Because we had observed that smoking has a pronounced effect on serum progesterone levels, we reinvestigated in healthy nonsmokers the relative progesterone levels of men and follicular-phase women. Each of eight women had multiple measurements of serum progesterone during the follicular phase of a menstrual cycle (10 days through 3 days prior to the luteinizing hormone peak of that cycle), and the average of those values was taken to represent the basal progesterone level for that woman. Seven men had blood samples drawn at 20-minute intervals between 6:00 and 9:00 AM, through an indwelling venous catheter, and the average of those values was taken. The mean follicular-phase serum progesterone level in the women was 21.4 +/- 5.4 ng/dl and the mean level in the men was 18.1 +/- 3.1 ng/dl. The difference was not statistically significant. In view of this finding, we conclude that there is essentially no ovarian secretion of progesterone during the follicular phase of the menstrual cycle.

Subnormal follicular-phase serum progesterone levels and elevated follicular-phase serum estradiol levels in young women with insulin-dependent diabetes.

In a search for possible hormonal reasons for the loss of protection from myocardial infarction seen in diabetic women, serum levels of estradiol, progesterone, and luteinizing hormone were compared throughout a menstrual cycle (17 points) in eight healthy nonsmoking women and five otherwise healthy nonsmoking insulin-dependent diabetic women. The total length of the menstrual cycle and the lengths of the follicular and luteal phases did not differ between the groups. During the periovulatory and luteal phases, there was no significant intergroup difference with respect to any of the three hormones. During the follicular phase, in both groups, there was a plateau in serum progesterone concentration, with the level approximately 42% lower in the diabetic group (12.0 +/- 6.6 ng/dl versus 20.7 +/- 5.7; P less than 0.0001). Follicular-phase serum estradiol showed a rising curve in both groups; day-by-day comparison (days -10 to -3 before the luteinizing hormone peak) showed consistently higher levels in the diabetic group (mean, 108 pg/ml versus 95 pg/ml; P less than 0.001). The follicular-phase serum estradiol to progesterone ratio was nearly twice as high in the diabetic group as in the normal group (8.9 versus 4.6), a difference that was highly significant. The finding of elevated serum estradiol and subnormal serum progesterone concentrations during the follicular phase is so far unique to women with insulin-dependent diabetes mellitus. The possibility that this pronounced abnormality in diabetic women may be related to coronary disease merits testing in suitable in vivo and in vitro models of atherogenesis.

The effect of smoking on serum progesterone, estradiol, and luteinizing hormone levels over a menstrual cycle in normal women.

Since smoking has been shown to affect serum progesterone and estradiol levels in postmenopausal women, we evaluated the levels of these hormones and luteinizing hormone (LH) over an entire menstrual cycle (17 points) in eight healthy nonsmokers and eight healthy smokers. The total length of the cycle and the lengths of the follicular and luteal phases did not differ between the groups. There was no difference in estradiol, progesterone, or LH levels during the periovulatory and luteal phases. Follicular-phase serum progesterone, which had a level 37% higher in smokers, showed a plateau in both groups (28.3 +/- 5.7 ng/dl versus 20.7 +/- 5.7; P less than 0.0001). Follicular-phase serum estradiol showed a rising curve in both groups. The mean value in smokers was slightly higher than that in nonsmokers (107 pg/ml versus 95; P approximately 0.05); during the early part of the follicular phase, prior to the rapid preovulatory increase, the difference was greater (23%) and of higher statistical significance (80 pg/ml versus 65; P less than 0.001). The follicular-phase LH levels of smokers were skewed downward from the levels in nonsmokers, presumably by negative feedback from the elevated estradiol and progesterone levels; the difference was significant (P less than 0.001). The elevations of serum progesterone and estradiol in smokers probably represent activation of adrenocortical secretion by smoking. The greater and more clear-cut rise of progesterone than of estradiol is probably due to the fact that essentially all of the follicular-phase serum progesterone is secreted by the adrenal, while only part of the follicular-phase serum estradiol comes from the adrenal (via androstenedione and estrone).

The Health Self-Determinism Index for Children.

A convenience sample of 501 children 7 to 13 years old completed the newly developed Health Self-Determinism Index for Children (HSDI-C), a measure of intrinsic motivation in health behavior. Construct validity was supported through the factorial isolation of four theory-consistent subscales, and the correlation of the total HSDI-C (r = .36, p less than or equal to .009) with a general measure of intrinsic motivation. Alpha coefficients in three separate trials ranged between .79 and .88 for the total scale, and .78 to .88, .87 to .92, .78 to .86, and .63 to .77 on the respective subscales. Test-retest reliability for the total scale was .83 at 2 weeks and .48 at 1 year. A nominated population of 21 third- through seventh-grade children known to practice positive health promotion behaviors had an HSDI-C mean score of 106.5 versus 76.5 in the general sample of children.