['Neurodevelopmental treatment' following stroke: no beneficial effect shown in measurements taken after 1 year; comparative study]. / 'Neurodevelopmental treatment' na een beroerte: geen gunstig effect bij meting na i jaar; vergelijkend onderzoek.

OBJECTIVE: To determine whether neurodevelopmental treatment (NDT) in the care of stroke patients is effective with respect to the functional status and quality of life (QoL) during one year after stroke onset. DESIGN: Prospective, non-randomised, comparative parallel group design. METHODS: 324 consecutive stroke patients from 12 Dutch hospitals were divided into 2 groups: an experimental group (n=223), in which nurses and physiotherapists used the NDT approach, and a control group who received conventional therapy (n=101). Functional status was assessed with the Barthel Index. Primary outcome was considered poor when the Barthel Index <12 after 1 year or when the patient had died. QoL was assessed with the 'Stroke adapted sickness impact profile'-30 and on a visual analogue scale. RESULTS: At 12 months, 59 patients in the NDT group (26%) and 24 patients in the control group (24%) had a poor outcome (corresponding adjusted odds ratio: 1.7; 95% CI: 0.8-3.5). At point of discharge and after 6 months, the adjusted odds ratio was 0.8 (95% CI: 0.4-1-5) and 1.6 (95% CI: 0.8-3.2) respectively. The adjusted mean differences of the QoL measurements did not show statistically significant differences between the 2 study groups at 6 and 12 months after stroke onset. CONCLUSION: The NDT approach was not an effective method in the care of stroke patients. Health care professionals need to reconsider the use of the NDT approach.

Effectiveness of the nursing programme 'Coping with itch': a randomized controlled study in adults with chronic pruritic skin disease.

BACKGROUND: The nursing programme 'Coping with Itch' aims at reducing itch and at helping patients with chronic pruritic skin diseases cope with itch. The programme consists of educational and cognitive behavioural interventions. Dermatology nurses carry out the programme, which supplements standard medical treatment given by a dermatologist, in individual sessions at a nurse clinic organized by the dermatology outpatient department. OBJECTIVES: To evaluate the effectiveness of the nursing programme 'Coping with Itch' in patients with chronic pruritic skin diseases. METHODS: A randomized controlled study was carried out. Patients with chronic pruritic skin diseases were randomly assigned to the intervention group or the control group. The intervention group received standard care from a dermatologist and nursing care according to the programme 'Coping with Itch' for a mean of 2.9 visits. The control group received usual care from a dermatologist. Data collection took place at baseline, at 3 months (t1) and at 9 months (t2) after baseline. Most visits to the nurse clinic took place during the first 3 months of the study. Main outcome measures were the frequency and intensity of itching and scratching, itch-related coping, and skin-related and general psychosocial morbidity. Secondary outcome measures were the number of visits to the dermatologist and the use of medication and ointments. Mann-Whitney tests and analyses of covariance were used to analyse differences between the two groups. RESULTS: Data on 29 patients in the intervention group and 36 patients in the control group were used in the analyses. A trend to significance (P = 0.07) was shown in the difference between the two groups in the frequency of itching and scratching at t1. A significant difference (P = 0.04) was shown between the two groups in catastrophizing and helpless itch-related coping at t1. No significant differences were revealed at t2 between the groups. Patients in the intervention group visited the dermatologist significantly less frequently during the intervention period than did control group patients. CONCLUSIONS: The nursing programme 'Coping with Itch' led to a reduction in the frequency of itching and scratching and to a reduction of catastrophizing and helpless coping in patients with chronic pruritic skin diseases during the period immediately following the intervention. We suggest further follow-up visits to the itch clinic to extend these results over a longer period.

Effectiveness of turning with unequal time intervals on the incidence of pressure ulcer lesions.

AIM: This paper reports a study investigating whether repositioning patients lying on a pressure-reducing mattress alternately for 2 hours in a lateral position and 4 hours in a supine position reduces the incidence of pressure ulcers in comparison with repositioning every 4 hours. BACKGROUND: Repositioning is commonly recognized as an effective preventive measure. Almost no research has been carried out so far on the necessary turning frequencies to prevent pressure ulcer lesions. The pressure is higher in a lateral than in a supine position. METHOD: A two-arm randomized controlled trial was conducted in 16 Belgian elder care nursing homes. Patients with non-blanchable erythema were randomly assigned to either an experimental or a control group. In the experimental group (n = 122), patients were repositioned alternately 2 hours in a lateral position and 4 hours in a supine position. In the control group (n = 113), patients were repositioned every 4 hours. The sitting protocol was identical in both groups. Pressure areas were observed daily and classified according to the four grades of the European Pressure Ulcer Advisory Panel. RESULTS: In the experimental group, 16.4% patients developed a pressure ulcer lesion (grade 2-4), while 21.2% did so in the control group. The incidence was not statistically significantly different between the two groups (P = 0.40). The severity (P = 0.65) and location (P = 0.19) of pressure ulcer lesions, and the time to developing them (P = 0.29) were also similar in both groups. No patient developed a pressure ulcer at the hips. A considerable number of patients changed from a lateral to a supine position between the turning intervals. CONCLUSION: More frequent repositioning on a pressure-reducing mattress does not necessarily lead to fewer pressure ulcer lesions and consequently cannot be considered as a more effective preventive measure.

An intervention study to prevent relapse in patients with schizophrenia.

PURPOSE: To determine whether the use of relapse prevention plans (RPPs) in nursing practice is an effective intervention in reducing relapse rates among patients with schizophrenia. DESIGN AND METHODS: Experimental design. Patients with schizophrenia (or a related psychotic disorder) and nurses from three mental health organizations were randomly assigned to either an experimental (RPP) or control condition (care as usual). The primary outcome measure was the psychotic relapses in the research groups. RESULTS: The relapse rates in the experimental and control groups after 1-year follow-up were 12.5% and 26.2%, respectively (p=. 12, ns). The relative risk of a relapse in the experimental versus the control group was 0.48 (ns). CONCLUSIONS: In this study no statistically significant effects of the intervention were found. Effectiveness research in this area should be continued with larger sample sizes and longer follow-up periods.

Prediction of pressure ulcer development in hospitalized patients: a tool for risk assessment.

OBJECTIVES: To identify independent predictors for development of pressure ulcers in hospitalized patients and to develop a simple prediction rule for pressure ulcer development. DESIGN: The Prevention and Pressure Ulcer Risk Score Evaluation (prePURSE) study is a prospective cohort study in which patients are followed up once a week until pressure ulcer occurrence, discharge from hospital, or length of stay over 12 weeks. Data were collected between January 1999 and June 2000. SETTING: Two large hospitals in the Netherlands. PARTICIPANTS: Adult patients admitted to the surgical, internal, neurological and geriatric wards for more than 5 days were eligible. A consecutive sample of 1536 patients was visited, 1431 (93%) of whom agreed to participate. Complete follow up data were available for 1229 (80%) patients. MAIN OUTCOME MEASURES: Occurrence of a pressure ulcer grade 2 or worse during admission to hospital. RESULTS: Independent predictors of pressure ulcers were age, weight at admission, abnormal appearance of the skin, friction and shear, and planned surgery in coming week. The area under the curve of the final prediction rule was 0.70 after bootstrapping. At a cut off score of 20, 42% of the patient weeks were identified as at risk for pressure ulcer development, thus correctly identifying 70% of the patient weeks in which a pressure ulcer occurred. CONCLUSION: A simple clinical prediction rule based on five patient characteristics may help to identify patients at increased risk for pressure ulcer development and in need of preventive measures.

Neurodevelopmental treatment after stroke: a comparative study.

BACKGROUND: Neurodevelopmental treatment (NDT) is a rehabilitation approach increasingly used in the care of stroke patients, although no evidence has been provided for its efficacy. OBJECTIVE: To investigate the effects of NDT on the functional status and quality of life (QoL) of patients with stroke during one year after stroke onset. METHODS: 324 consecutive patients with stroke from 12 Dutch hospitals were included in a prospective, non-randomised, parallel group study. In the experimental group (n = 223), nurses and physiotherapists from six neurological wards used the NDT approach, while conventional treatment was used in six control wards (n = 101). Functional status was assessed by the Barthel index. Primary outcome was "poor outcome", defined as Barthel index <12 or death after one year. QoL was assessed with the 30 item version of the sickness impact profile (SA-SIP30) and the visual analogue scale. RESULTS: At 12 months, 59 patients (27%) in the NDT group and 24 (24%) in the non-NDT group had poor outcome (corresponding adjusted odds ratio = 1.7 (95% confidence interval, 0.8 to 3.5)). At discharge the adjusted odds ratio was 0.8 (0.4 to 1.5) and after six months it was 1.6 (0.8 to 3.2). Adjusted mean differences in the two QoL measures showed no significant differences between the study groups at six or 12 months after stroke onset. CONCLUSIONS: The NDT approach was not found effective in the care of stroke patients in the hospital setting. Health care professionals need to reconsider the use of this approach.

The development of evidence-based nursing interventions: methodological considerations.

BACKGROUND: The call for evidence-based practice presents numerous challenges to nurses who are responsible for developing interventions and expanding the associated knowledge base. The challenge is compounded because there is limited literature concerning development of interventions and their evidence base. AIM: The purpose of this article is to present a model that has been successfully used to guide the process of developing and testing complex nursing interventions, especially those in which the experience of the client plays an important role. DISCUSSION: The model consists of four stages: problem definition, accumulation of building blocks for intervention design, intervention design and intervention validation. Each stage is described and examples from research studies are presented. Specific attention is given to the manner in which the model allows for the accumulation of empirical evidence and theory development during the development process. CONCLUSIONS: Use of the model could facilitate effective communication among nurses, researchers and educators when discussing the development and testing of nursing interventions.

Relapse prevention in patients with schizophrenia.

This article describes the development and content of a nursing intervention protocol for the recognition of the early signs of psychosis. Applying this protocol, nurses can contribute to the prevention of psychotic relapse in patients with schizophrenia or a related disorder. The background and construction of the intervention protocol are described. The judgment of experts in the care of patients with schizophrenia on the content and applicability of the protocol is presented. Finally, the experience is summarized that has been acquired during the conduct of a number of case studies of the application of the intervention protocol.

The development and psychometric testing of an instrument to measure diabetes management self-efficacy in adolescents with type 1 diabetes.

Adherence to treatment is a major issue for people with diabetes mellitus, and attention has been given to improving self-management in persons with this chronic disease. Most studies show that knowledge alone will not improve self-management behavior. Self-efficacy, a concept introduced by Bandura, has been shown to be an important variable in improving health behaviors. In order to determine whether self-efficacy can influence self-management of diabetes, however, instruments to measure self-efficacy are needed in native languages at an appropriate developmental level, and with good psychometric properties. The study reported here was part of a larger project in the Netherlands, Belgium and the United States in which several instruments, measuring diabetes management self-efficacy, have been developed, both in English and Dutch, for different types of diabetes and different age groups. This article reports on the development and psychometric testing of an instrument measuring self-efficacy in adolescents with type 1 diabetes mellitus. Initially 30 items for the instrument were generated through focus group interviews and their relevance was judged by a team of 10 experts on self-management behavior in adolescents. The final instrument contained 26 items. The sample for psychometric testing consisted of 90 patients with type 1 diabetes who were between 12 and 18 years old. Cronbach's alpha of the instrument was 0.86. An exploratory factor analysis produced two factors which reflect general and more difficult diabetes self-management situations.

Effects of video interaction analysis training on nurse-patient communication in the care of the elderly.

This paper describes an empirical evaluation of communication skills training for nurses in elderly care. The training programme was based on Video Interaction Analysis and aimed to improve nurses' communication skills such that they pay attention to patients' physical, social and emotional needs and support self care in elderly people. The effects of the training course were measured in an experimental and control group. They were rated by independent observers, by comparing videotapes of nursing encounters before and after training. Forty nurses participated in 316 videotaped nursing encounters. Multi-level analysis was used to take into account similarity among same nurse encounters. It was found that nurses who followed the training programme, provided the patients with more information about nursing and health topics. They also used more open-ended questions. In addition, they were rated as more involved, warmer and less patronizing. Due to limitations in the study design, it could not be demonstrated that these findings can entirely be ascribed to the training course. Further research, incorporating a randomized controlled design and larger sample sizes, is recommended to determine whether the results can be attributed to this specific type of training.

Do pressure relief cushions really relieve pressure?

In a laboratory setting, interface pressures of 29 cushions and a sheepskin were measured on 20 healthy volunteers. Each participant was seated in an upright posture with their back against the back of the chair, hands resting on the lap, knees bent at an angle of 90 degrees, and feet resting on the floor. Only 13 cushions had any pressure-reducing effect. Gel cushions and sheepskins appear to have no pressure-reducing effect. The category of foam includes both cushions that reduce interface pressure very well and cushions that increase interface pressure. The lowest interface pressures were measured on air cushions and on some foam cushions.

Sitting posture and prevention of pressure ulcers.

The aim of this study was to gain insight about the influence of body posture on the pressure at the seat surface and to establish to what extent different seat cushions designed for incontinent patients reduce maximum pressures. Pressures were measured for 56 healthy volunteers in eight postures using four cushions. The posture in which the lowest maximum pressure was measured was the sitting-back posture with the lower legs on a rest. If the seat could not be tilted back, the maximum pressure in the upright sitting posture with the feet on the ground was significantly lower than sitting upright with the legs supported on a rest. Sliding down and slouching caused the highest maximum pressure. Regular checking of the posture and using positioning cushions should form part of any pressure-ulcer prevention protocol. The four selected cushions each have different pressure-reducing effects. A thick air cushion (Repose) has the lowest maximum pressure and is significantly better than the other cushions at reducing the high pressure when slouching or sliding down.