Wellness Following Wins and Losses Based on Psychological Hardiness in Division I Women's Lacrosse.

Psychological hardiness encompasses three components: commitment, control, and challenge, and illustrates how individuals respond to stressors. Analyzing athletes' responses to wins and losses, depending on their psychological hardiness level, may provide insight of the impact of game outcome on student-athlete wellness. The purpose of this study was to examine postgame subjective wellness scores based on level of psychological hardiness following wins and losses in collegiate female lacrosse athletes. Players (n = 17) took the Dispositional Resilience Scale Scale-15 (DRS-15) at the start of the academic year and were grouped based on hardiness level: above average (AH) and below average (BA). Participants took a daily wellness survey rating their overall wellness, energy level, muscle soreness, stress level, and sleep quality. RM-ANOVA indicated no difference in post-game wellness scores between hardiness groups (Lambda(5,11) = 1.073, p = .426, ES = .328), by game outcome (Lambda(5,11) = 2.361, p = .109, ES = .518), or an interaction between hardiness and outcome of game (Lambda(5,11) = 1.421, p = .291, ES = .392). No hardiness group differences were found for overall wellness or sub-scores. These results show subjective wellness scores decrease collectively after a loss versus a win but refute prior studies as hardy players did not experience significantly less stress than their less hardy counterparts. Future studies should be conducted to assess wellness after differing game outcomes over many seasons to assist coaching staff on the subjective, psychological impacts of game.

Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion.

OBJECTIVE: To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain. DESIGN: Single-blind case series. SETTING: Three outpatient physical therapy clinics. PARTICIPANTS: Patients with shoulder pain and limited AROM (N=69). INTERVENTION: Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder. MAIN OUTCOME MEASURES: We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy. RESULTS: There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°. CONCLUSIONS: A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects.

Safe chemotherapy in the home environment.

The Oncology Nursing Society and the American Society of Clinical Oncology have established guidelines for the safe and effective use of chemotherapeutic medications in the acute and outpatient care settings. A review of literature was performed to determine the safe and effective administration of chemotherapy in the home environment. The administration of oral and intravenous chemotherapy in the home has become a common intervention for patients being treated for cancer based on patient preference, cost-effectiveness of healthcare delivery, and increasing demand for oncology services. Home healthcare nurses can greatly impact the management of adverse effects of chemotherapy in the home, increasing the quality of life and improving patient outcomes.

Evaluation of a high-risk case management pilot program for Medicare beneficiaries with Medigap coverage.

The objective was to evaluate the 3-year experience of a high-risk case management (HRCM) pilot program for adults with an AARP Medicare Supplement (Medigap) Insurance Plan. Participants were provided in-person visits as well as telephonic and mailed services to improve care coordination from December 1, 2008, to December 31, 2011. Included were adults who had an AARP Medigap Insurance Plan, resided in 1 of 5 pilot states, and had a Hierarchical Condition Category score>3.74, or were referred into the program. Propensity score weighting was used to adjust for case-mix differences among 2015 participants and 7626 qualified but nonparticipating individuals. Participants were in the program an average of 15.4 months. After weighting, multiple regression analyses were used to estimate differences in quality of care and health care expenditures between participants and nonparticipants. Increased duration in the program was associated with fewer hospital readmissions. Additionally, participants were significantly more likely to have recurring office visits and recommended laboratory tests. The program demonstrated $7.7 million in savings over the 3 years, resulting in a return on investment of $1.40 saved for every dollar spent on the program. Savings increased each year from 2009 to 2011 and with longer length of engagement. The majority of savings were realized by the federal Medicare program. This study focused on quality of care and savings for an HRCM program designed solely for Medicare members with Medicare Supplement coverage. This program had a favorable impact on quality of care and demonstrated savings over a 3-year period.