AMBLER, Pa. (March 12, 2013) – Wolters Kluwer Health, a leading global provider of information and point-of-care solutions for the healthcare industry, today announced a collaboration between Lippincott’s Nursing Solutions and the American Association of Long Term Care Nursing (AALTCN) to develop a new point-of-care support solution for nurses working in nursing homes and other long-term care settings.  The collaboration is creating a new category of the Lippincott’s Nursing Procedures and Skills product designed to meet the needs of long-term care (LTC) nurses.

Charlotte Eliopoulos, Director and Co-Founder of AALTCN, is directing the development project.  Eliopoulos tapped into her organization’s membership to assemble a team of practicing nurses who are currently engaged in LTC settings and were enlisted for their individual expertise and ability to document procedures from a real world perspective. 

“With a growing and clinically complex population coming into long term care and with all of the emphasis on reducing hospital readmissions, there’s a lot of sensitivity about competently caring for this group,” said Eliopoulos.  “To have a cost effective, user-friendly product that can equip us to effectively provide the proper care is essential, and makes this a timely project.” 

“We are really excited to merge the existing strengths and functionality of Lippincott’s Nursing Procedures and Skills together with all of the insight and expertise that AALTCN brings to the profession,” said Carolyn Dalton, Senior Digital Product Manager, Wolters Kluwer Health.  “The end result is LTC focused procedures that will have considerable impact on that space.”

Lippincott’s Nursing Procedures and Skills, part of Lippincott’s Nursing Solutions family of products, gives nurses accurate, step-by-step guidance for over 1,300 evidence-based procedures.  Video clips and/or high-quality visuals that aid in understanding accompany most procedures.  The online resource provides skills checklists and competency tests for each procedure to help facilities verify staff competence.  Each procedure undergoes a thorough annual review process to ensure the most up-to-date clinical information is provided.  Facilities can customize and add procedures to meet their specific needs.

Lippincott’s Nursing Solutions is a comprehensive, integrated application suite of online clinical information technology and professional development products that supports evidence-based practice, standardizes care, enhances productivity, and streamlines workflows for nursing professionals.  Created by nurses for nurses, it is currently helping more than 1,500 healthcare facilities promote clinical excellence by creating a culture of safety and continuous quality improvement.  Key products under its umbrella include Lippincott’s Nursing Advisor; Lippincott’s Professional Development Programs; and Lippincott’s Nursing Procedures and Skills.

The agreement with AALTCN includes the creation of 75 new and/or modified long-term care procedures that are being added to the existing Lippincott’s Nursing Procedures and Skills product.  The additions will start rolling out in April and will be completely populated by the end of the year.  The enhancements are targeted at health systems with LTC departments, nursing homes, assisted living communities, community care programs and other long-term sub-acute care providers.  To learn more, visit its website or call (855) 695-5070.

About American Association for Long Term Care

The American Association for Long Term Care Nursing (AALTCN) unites all levels of nursing staff to advance excellence in the specialty of long-term care nursing. The association encourages respect for long-term care nursing staff by informing colleagues and consumers about the complexities, competencies, and commitment of the special caregivers who commit to this specialty. As the nation’s largest network of caregivers, the mission of the American Association for Long Term Care Nursing is to create community and teamwork, provide educational resources, support and promote excellence in care, and advocate for an improved status and voice for long-term care nursing staff.

About Wolters Kluwer Health

Wolters Kluwer Health (Philadelphia, PA) is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health’s customers include professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands include Lippincott Williams & Wilkins, Ovid^®, Medknow, UpToDate^®, Medi-Span^®, Facts & Comparisons^®, Pharmacy OneSource^®, Lexicomp^® and ProVation^® Medical.Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2012 annual revenues of €3.6 billion ($4.6 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America.

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Tom Kivett
Kivett & Company Communications
212-727-2935
tkivett@kivettandco.com

Philadelphia, Pa. (March 18, 2012) – Nurses are the largest group of health care professionals and have the most interaction with patients.  Yet previously, there has been limited research regarding nursing’s contributions to improving the quality of care.  A special April supplement to Medical Care provides an update from the Interdisciplinary Nursing Quality Research Initiative (INQRI) — an ongoing program, sponsored by the Robert Wood Johnson Foundation (RWJF), to “generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality.”  Medical Care is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The INQRI program was launched in 2005 to help address the lack of evidence linking nursing to the quality of patient care.  The INQRI program is led by Mary D. Naylor, PhD, of the University of Pennsylvania School of Nursing and Mark Pauly, PhD, of the University of Pennsylvania Wharton School, in collaboration with RWJF senior program officer Lori Melichar, PhD.

How Do Nurses Contribute to Health Care Quality Improvement?

“Over two and a half million registered nurses provide care in a diverse range of settings across the United States,” according to an introductory article by Drs Naylor, Pauly, Melichar and coauthors.  “Yet there is limited understanding about nurses’ specific and distinct contribution to the quality of care provided to patients, families, and communities.” 

The special issue assembles invited contributions from experts working on various INQRI-funded initiatives, providing an update on the accomplishments of the INQRI program.  The supplement papers discuss timely issues in research design and implementation, placing INQRI research in the context of advances in quality improvement, health policy and health services research.  Naylor and colleagues write, “This edition of Medical Care provides an overview of some of the key discoveries made by INQRI grantees, examines cross-cutting issues experienced by research teams, and describes recommended approaches to advance this line of inquiry and its impact.”

Dr Naylor is also lead author of a comprehensive review of research through the first five years of INQRI.  The review shows significant advances in research supporting nursing’s impact on the quality of care, “reflected in higher rates and quality of publications, enhanced methodologic rigor, and evidence of stronger interdisciplinary collaboration.”   While this progress can’t be wholly ascribed to the INQRI project, “[T]he evidence supports the increased importance of changes consistent with INQRI’s goal of measuring and enhancing nursing’s contributions to the quality of patient care.”

The supplement also presents reviews and updates from INQRI experts in five key areas:

• New tools for quality measurement—A report on four INQRI projects designed to develop “simple, feasible, affordable” tools for measuring health care quality.  INQRI teams are focusing on measures that can be integrated into the health care delivery system and the growing use of electronic health records.
• Challenges to conducting interdisciplinary research—Collaborative efforts across nursing, medicine, economics, engineering, statistics, and other disciplines are viewed as essential, using “the entire continuum of care to provide value-added and cost effective care.”
• Challenges in implementation science—New research methods from the emerging field of implementation science can provide the critical link between effective interventions, clinical practice, and patient outcomes.
• Dissemination and implementation—The experience of INQRI-funded projects to implement new quality improvement initiatives is presented, illustrating the key issues in achieving widespread adoption of effective innovations in care delivery.
• Building the “business case” for nursing.—Experience from INQRI studies highlights the challenges of demonstrating the value of investing in nursing, with the ultimate goal of achieving better patient outcomes in a financially sustainable manner.

“To achieve better care and outcomes while ensuring the efficient use of finite resources, it is essential to advance our understanding of the causal linkages between nurses and the care they deliver,” Dr Naylor and coauthors conclude.  Together with the editors of Medical Care, they hope the special issue will draw attention to INQRI’s role in building the evidence base for nurses’ contributions to “the quality of health delivery and the improvement of that care.”

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care.  This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care.  Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.  In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume.  Medical Care is the official journal of the Medical Care Section of the American Public Health Association

 About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (March 12, 2013) – For patients with “drug-resistant” epilepsy requiring surgery, an updated stereoelectroencephalography (SEEG) technique provides a more efficient process for obtaining critical data for surgical planning, according to a study in the March issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

“SEEG is a safe and accurate procedure for invasive assessment of the epileptogenic zone,” according to the new report by Dr. Francesco Cardinale of Niguarda Ca’ Granda Hospital, Milan, and colleagues. Their “updated workflow” combines sophisticated imaging data reconstructions and robot-assisted surgery, “providing essential information in the most complex cases of drug-resistant epilepsy.”

Stereo EEG Technique Updated and Simplified

The researchers describe the development of and initial experience with an updated SEEG technique for planning epilepsy surgery. The concept of SEEG is not new. Originally developed by French researchers named Talairach and Bancaud, SEEG uses electrodes implanted in the brain to localize the epileptogenic zone—the area in which seizures originate. The traditional SEEG technique includes two surgical steps: 3-D imaging of the brain blood vessels (stereotactic angiography) followed by electrode implantation.

Over the last few years, Dr. Cardinale and colleagues have been working to develop an updated SEEG workflow allowing a one-step surgical technique. Before surgery, the patient undergoes 3-D magnetic resonance imaging and 3-D digital subtraction angiography. The digital imaging data then undergo processing for reconstruction, resulting in the creation of a detailed computerized model of the brain and of the vascular tree. A key part of the development process was creating a “homemade” computer script to automate the necessary series of data processing steps.

Using the software program from an image-guided neurosurgical robot, the reconstructed data are used to plan the surgical approach, or “trajectory.” Robot-assisted surgery was then performed to implant the electrodes. Whether performed by the traditional or updated workflow, the goal of SEEG is to provide the surgeon with highly precise information on the location of the epileptogenic zone, used for planning epilepsy surgery. (In a brief online video, Dr. Cardinale outlines the steps involved in the updated workflow: http://links.lww.com/NEU/A513)

The researchers report on the outcomes of 500 SEEG procedures performed between 1996 and 2011 in patients with drug-resistant epilepsy. Both techniques were highly successful in guiding electrode placement to localize the epileptogenic zone. Complications occurred in 12 cases, for a rate of 2.4 percent.

The first 419 procedures were done with the traditional two-step process; the next 81 procedures were done using the new workflow. The updated technique provided good data reconstructions with no loss of information and a “dramatic reduction in procedural error risks.” Use of the 3-D data with the neurosurgical robot allowed neurosurgeons to target any area of the brain, from a wide range of angles. They were also able to create 3-D representations of the brain anatomy and electrode placement, which facilitated communication among the surgical team members and patients.

Detailed analysis in a subset of cases found improved accuracy with the new technique. Median error in localizing the implanted electrodes decreased by about 1 millimeter both at the entry point (the most risky zone) and at the deepest point. The authors believe their technique allows them to estimate a “safe entry region” for electrode placement with 99 percent accuracy.

The new experience adds to the evidence that SEEG is a safe and effective procedure for electrode placement and surgical planning in patients with drug-resistant epilepsy.  Dr. Cardinale and colleagues conclude, “The traditional Talairach methodology, recently updated by the use of the most advanced multimodal planning tools and robot-assisted surgery, allows one to directly record electric activity from every brain structure, providing valuable information in the most complex cases of refractory epilepsy.” They are currently working on developing a “SEEG automatic planner.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Wolters Kluwer Health

Wolters Kluwer Health (Philadelphia, PA) is a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Serving more than 150 countries and territories worldwide, Wolters Kluwer Health’s customers include professionals, institutions and students in medicine, nursing, allied health and pharmacy. Major brands include Lippincott Williams & Wilkins, Ovid^®, Medknow, UpToDate^®, Medi-Span^®, Facts & Comparisons^®, Pharmacy OneSource^®, Lexicomp^® and ProVation^® Medical.

Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company. Wolters Kluwer had 2012 annual revenues of €3.6 billion ($4.6 billion), employs approximately 19,000 people worldwide, and maintains operations in over 40 countries across Europe, North America, Asia Pacific, and Latin America.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (February  19, 2013) – For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomes—whether or not the patient later undergoes surgery, according to a study in the February 15 issue of Spine.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study raises questions about the benefits of steroid injection—a widely used treatment for the common problem of spinal stenosis in the lower (lumbar) spine.  “There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically,” according to the study by Dr Kris E. Radcliff of Thomas Jefferson University, Philadelphia, and colleagues.

Do Steroid Injections Help in Spinal Stenosis?

The researchers analyzed data from the Spine Outcomes Research Trial (SPORT)—one of the largest clinical trials of surgery for spinal disorders.  In SPORT, patients meeting strict criteria for spinal stenosis (or other common spinal problems) were randomly assigned to surgery or nonsurgical treatment (such as physical therapy and medications).  Patients with spinal stenosis have narrowing of the spinal canal, causing back pain, leg pain, and other symptoms.

The current analysis focused on the effects of ESI as part of treatment for spinal stenosis.  Steroid injection is commonly recommended for patients whose symptoms don’t improve with initial treatment.

Dr Radcliff and colleagues compared outcomes for 69 patients who underwent steroid injection during their first three months of enrollment in SPORT versus 207 patients who did not receive ESI.  The two groups were similar in terms of most initial characteristics, although patients receiving steroid injections were more likely to prefer nonsurgical treatment:  62 versus 33 percent.

‘Significantly Less Improvement’ in Patients with ESI

“Despite equivalent baseline status, ESI were associated with significantly less improvement at four years among all patients with spinal stenosis in SPORT,” the researchers write.  Among patients who eventually had surgery, those who had ESI showed less improvement in physical functioning through four years’ follow-up.  For those treated nonsurgically, steroid injections were associated with less improvement in pain as well as functioning.

There was also evidence that surgery was more complicated in patients who had previously been treated with epidural steroids.  On average, surgery took about one-half hour longer in patients who had received ESI, who also spent about one day longer in the hospital.  Patients who received ESI were also more likely to “crossover” from their initially assigned treatment to the other treatment group.  There was no evidence that receiving steroid injections helped patients to avoid surgery.

Lumbar spinal stenosis is a common problem in older adults.  Epidural steroid injection is a common treatment for spinal stenosis, despite a lack of evidence showing its long-term benefits.  The SPORT data provides an opportunity to examine how steroid injections affect long-term outcomes of spinal stenosis.

The new study has some important limitations, especially in that patients weren’t randomly assigned to epidural steroid treatment.  However, the results suggest that patients with spinal stenosis who receive ESI have less improvement at four years’ follow-up, whether or not they subsequently undergo surgery.

Dr Radcliff and colleagues conclude, “Despite the common treatment practice of incorporating one or more ESI in the initial nonoperative management of patients with spinal stenosis, these results suggest that ESI is associated with worse outcome in the treatment of spinal stenosis,” write.  They believe the “most likely” reason for the worse outcomes after ESI is that the injection causes worsening of the spinal narrowing or result spinal nerve impingement, although other explanations are possible.  The authors call for further research to clarify the “indications and results of this common procedure.”

About Spine

Recognized internationally as the leading journal in its field, Spine (www.spinejournal.com) is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine.  According to the latest ISI Science Citation Impact Factor, Spine is the most frequently cited spinal deformity journal among general orthopaedic journals and subspecialty titles.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (February  19, 2013) – Follow-up data on patients with degenerative disease of the upper (cervical) spinal vertebrae show little or no evidence of worsening degeneration over time, according to a study in the February 15 issue of Spine.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

For many patients with “unstable” cervical degenerative spondylolisthesis, observation may be a better choice than surgery, according to the new research by Dr Moon Soo Park and colleagues of Medical College of Hallym University, Republic of Korea.  They write, “Our results suggest that the majority of these patients may be stable and do not develop progression of disease or catastrophic neurologic deficits.”

Is Unstable Spondylolisthesis Really Unstable?

The researchers analyzed the “natural history” of cervical degenerative spondylolisthesis in 27 patients.  Degenerative spondylolisthesis refers to “slipped” vertebrae caused by bone degeneration.  Because spondylolisthesis is commonly thought to result in instability of the cervical spine, spinal fusion surgery (arthrodesis) is sometimes considered the appropriate treatment.

The 16 men and 11 women in the study underwent cervical spine radiographs (x-rays) on two occasions at least two years apart.  The patients’ average age at the time of the initial radiograph was 59 years; average time to the follow-up radiographs was 39 months.  Measurements on the paired radiographs were carefully compared to determine whether and how much the cervical slippage increased over time.

Initial x-rays showed “instability”—at least two millimeters of displacement between vertebrae—in several patients.  However, during follow-up, none of the patients had further progression, defined as additional displacement of two millimeters or more.  The average progression was only about one-half millimeter.

Twenty-one patients had backward displacement (“retrolisthesis”) of the cervical vertebrae, while six had forward displacement (“anterolisthesis”).  The patients with retrolisthesis had somewhat greater slippage during follow-up; however, none had a dislocation or suffered neurological damage.

No Progression of ‘Slippage’ or Symptoms

Of 16 patients who had symptoms such as neck pain or sensory abnormalities at the initial visit, most were successfully managed without surgery.  Of the 11 patients who were initially symptom-free, none developed symptoms during follow-up.

The study is one of the few to look at the “natural history” of cervical spondylolisthesis.  The results suggest that, at medium-term follow-up, the conditions appears to be “relatively stable” in most patients.  Dr Park and colleagues write, “This begs the question, if an ‘unstable’ listhesis does fine without treatment, is it really unstable?  Our results suggest that the majority of these patients may be stable and do not develop progression of disease or catastrophic neurologic deficits.”

The researchers acknowledge some important limitations of their study—particularly the small number of patients and relatively short follow-up.  However, the results suggest that, for many patients, cervical spondylolisthesis is a non-progressive condition that does not necessarily require surgical treatment.  Dr Park and coauthors conclude, “In the absence of neurologic symptoms, we recommend observation of patients with degenerative spondylolistheses of the cervical spine.”

About Spine

Recognized internationally as the leading journal in its field, Spine (www.spinejournal.com) is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine.  According to the latest ISI Science Citation Impact Factor, Spine is the most frequently cited spinal deformity journal among general orthopaedic journals and subspecialty titles.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (August 30, 2012) – A “contingency management” approach—offering incentives for negative drug tests—can help promote drug abstinence among pregnant women with heroin or cocaine addiction, reports a study in the September Addictive Disorders & Their Treatment.  The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Contingency management (CM) works just as well whether the incentives are increased (escalating) or fixed over time, the study finds.  Incentives may also be useful in promoting other healthy behaviors during pregnancy, such as quitting smoking.  “These results further the scientific knowledge regarding CM treatment in opioid-dependent pregnant women by supporting the finding that the escalating and fixed CM schedules produce similar amounts of drug negatives urine samples early in treatment,” according to the new research by Hendrée E. Jones, PhD, and colleagues of The Johns Hopkins University School of Medicine, Baltimore.

Whether Fixed or Increasing, Incentives Promote Drug Abstinence

The researchers evaluated two approaches to contingency management in pregnant women being treated for addiction to opioids (heroin and related drugs) or cocaine.  Especially combined with poverty and mental health issues, cocaine and/or heroin abuse during pregnancy can lead to adverse health outcomes for both mother and child.

The study included 90 opioid-addicted women being treated at the Center for Addiction and Pregnancy in Baltimore.  Two-thirds of the women were randomly assigned to contingency management.  In the contingency management approach, patients receive incentives in the form of vouchers as a “reward” for achieving desired outcomes—in this case, negative urine tests showing abstinence from drugs.

One group received escalating incentives, with increasing rewards for each negative urine test.  The other group received fixed incentives—the same reward for each negative test.  Previous research has shown that incentives can quickly increase rates of targeted behavior in patients with substance abuse problems.

The vouchers could be exchanged for merchandise or gift certificates.  In the escalating group, the vouchers had a starting value of $7.50, which increased by $1 per sample day (MWF) as long as the tests remained negative.  In the fixed group, the vouchers were worth $25 for each negative urine test.

Both incentive programs continued for thirteen weeks.  All women received other standard counseling and treatment, including methadone replacement therapy for heroin addiction.

All measures of opioid and heroin dependence were similar in the two contingency management groups.  With 14 opportunities to provide urine samples, the average number of negative test results was 8.1 in the escalating incentive group and 7.4 in the fixed incentive group.

There was a tendency toward higher cocaine abstinence rates among women receiving escalating incentives.  However, after five weeks there was no significant difference between groups.

Added to previous studies, the new results strengthen the evidence that providing incentives for staying drug-free is a useful part of the treatment strategy for pregnant women with opioid dependency.  The researchers believe contingency management may be especially valuable in pregnant women—to quickly reduce drug exposure to the developing fetus, and to help in meeting the goal of having both the mother and baby be drug-free at delivery.

Other reports have suggested promising effects of incentive programs in reducing smoking among pregnant women with substance use disorders.  “One recent study found that voucher reinforcement for smoking reductions  during pregnancy had a significant impact on the  smoking reduction and abstinence rates in this vulnerable population,” comments coauthor Michelle Tuten, LCSW-C.  “These interventions appear to have a clinically meaningful impact on birth outcomes as well, although larger studies are needed to more fully explore birth outcome differences.”  Professor Tuten is conducting further research on contingency management to reduce exposure to maternal smoking.

For her work in developing behavioral and drug treatments for substance abuse in pregnant and parenting women, Dr Jones has been selected to receive the 2012 Association for Medical Education and Research in Substance Abuse (AMERSA) Betty Ford Award.  The award will be presented during this year’s AMERSA national conference on November 1 in Bethesda, Md., where Dr Jones will discuss new research affecting the clinical management of opioid dependence during pregnancy.

About Addictive Disorders & Their Treatment

Addictive Disorders & Their Treatment is a quarterly international journal devoted to practical clinical research and treatment issues related to the misuses of alcohol and licit and illicit drugs and the study and treatment of addictive disorders and their behaviors. The journal publishes broad-spectrum, patient-oriented coverage of all aspects of addiction, directed toward an audience of psychiatrists, clinical psychologists, psychopharmacologists, and primary care practitioners

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Philadelphia, Pa. (November 23, 2011) – While pedaling power is important in bicycle motocross (BMX) racing—especially at the start of the race—other skills have a greater impact on performance on the difficult tracks encountered in higher-level competitions, according to a study in the November issue of The Journal of Strength and Conditioning Research, official research journal of the National Strength and Conditioning Association (NSCA). The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

On tracks with higher technical difficulty, BMX racers have less opportunity to develop maximum pedaling power, according to the new study, led by Manuel Mateo, of the Spanish Cycling Federation, Madrid.  The researchers believe their study—one of few to examine the mechanical and conditioning requirements of BMX racing—has important implications for training regimens for BMX athletes.

Differing Demands at Different Levels of BMX Tracks

Mateo and colleagues designed a series of experiments to assess pedaling power and speed production in BMX racing.  After an initial test to determine maximum pedaling power, nine members of the Spanish national BMX team were tested with and without pedaling on three different types of BMX tracks:  low, medium, and high difficulty.

There’s no standard track in BMX racing—the different types of tracks were selected to represent the different levels of technical difficulty encountered in BMX competitions.  More difficult tracks had a higher gate start and more difficult and frequent obstacles.

Data from special power meters were analyzed to determine how power and velocity varied during different phases of the race:  the start gate phase, when racers accelerated down the starting ramp; a mixed central phase, with combined periods of pedaling to maintain power and speed with periods of not pedaling when tackling obstacles; and a stamina phase, in which racers tried to maintain maximum speed through power and coordination.

The results showed that peak power was achieved within the first two seconds of the race, reaching about 85 percent of the individual athlete’s maximum pedaling power.  However, average power throughout all phases of the race was much lower:  about 34 percent of the maximum.

Power varied significantly with the difficulty of the track: both peak power and average power were less important on more difficult tracks.  On tracks with lower technical difficulty—a less steep starting ramp and easier and more widely spaced obstacles—the athletes were more likely to pedal at close to maximum power.

On the high-difficulty course, only about three percent of power measurements were between 75 and 85 percent of maximum.  But regardless of track difficulty, the racers were pedaling at less than half of maximum power for nearly 90 percent of the race. The results suggested that up to 83 percent of riding performance may result from impulse actions, without any pedaling.

An increasingly popular sport, BMX was added as an Olympic sport for the 2008 games in Beijing.  Coaches and trainers working with elite BMX racers need scientifically valid information on training regimens to meet the unique power and technical needs of their sport.

The new results show that BMX racers generate maximum pedaling power during the first few seconds of a race.  That’s important, because of the critical competitive advantage of taking the lead position as quickly as possible.  Later in the race, pedaling power plays a less important role, especially on more difficult tracks. “Therefore, as the track difficulty increases, it seems the best athletes should pay special attention to the use of these upper limb and momentum without pedaling techniques,” Mateo and coauthors conclude.

The researchers outline practical guidelines for making “training prescriptions,” based on the individual rider’s maximum power and the competitive level of the track.  Especially when preparing for races at the highest levels of competition, they believe BMX racers should pay special attention to upper body and momentum techniques, without pedaling.

About The Journal of Strength and Conditioning Research

The editorial mission of The Journal of Strength and Conditioning Research (JSCR) is to advance the knowledge about strength and conditioning through research.  A unique aspect of this journal is that it includes recommendations for the practical use of research findings.  While the journal name identifies strength and conditioning as separate entities, strength is considered a part of conditioning.  The journal wishes to promote the publication of peer-reviewed manuscripts which add to our understanding of conditioning and sport through applied exercise science.  The JSCR is the official research journal of the National Strength and Conditioning Association.

About the National Strength and Conditioning Association

The National Strength and Conditioning Association (NSCA) is an international nonprofit educational association founded in 1978. The NSCA develops and presents the most advanced information regarding strength training and conditioning practices and injury prevention. Central to its mission, the NSCA bridges the gap between the scientist in the laboratory and the practitioner in the field. By working to find practical applications for new research findings in the strength and conditioning field, the Association fosters the development of strength training and conditioning as a discipline and as a profession

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.6 billion ($4.7 billion).

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Robert Dekker
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Connie Hughes
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Philadelphia, Pa. (November 8, 2011) – Low oxygen supply (hypoxia) to vulnerable brain tissue is a major contributor to the risk of death or major disability after severe traumatic brain injury (TBI), reports a study in the November issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Led by Dr. Mauro Oddo of University of Pennsylvania Medical Center, Philadelphia, the researchers write, “Brain hypoxia is associated with poor short-term outcome after severe TBI”—independent of other factors like intracranial pressure and cerebral perfusion pressure (i.e. brain blood flow). The results support a recent guideline revision calling for monitoring of brain oxygenation during intensive care for patients with severe head injury.

Brain Hypoxia Linked to Increased Risk of Death or Severe Disability

Dr. Oddo and colleagues looked at how brain hypoxia affected clinical outcomes in 103 patients with TBI. Most of the patients had bleeding within the brain after severe, blunt head trauma. In addition to sensors placed for routine monitoring of intracranial (within the skull) pressure and brain blood flow, all patients underwent monitoring of brain oxygenation.

If the oxygen supply fell below a certain critical level, the patient was considered to have brain hypoxia. The relationship between brain hypoxia and the outcomes of TBI was assessed. Forty-three percent of patients had poor outcomes: death or survival with severe disability or in a vegetative state.

The greater the drop in brain oxygenation, the higher the risk of poor outcomes. The average length of time with brain hypoxia was 8.3 hours for patients with poor outcomes after TBI, compared to 1.7 hours for those with good outcomes—survival with no or moderate disability.

High intracranial pressure is traditionally regarded as a bad prognostic sign for patients with TBI. Among the patients in the study with high intracranial pressure, only 46 percent of those with brain hypoxia had good outcomes, compared to 81 percent of those without brain hypoxia.

Brain oxygenation was also a stronger outcome predictor than cerebral perfusion pressure. Some patients had good brain oxygenation, despite reduced brain blood flow, while maintaining presently recommended levels of cerebral perfusion pressure was sometimes insufficient to avoid low brain oxygenation.

After adjustment for these and other important risk factors, brain oxygenation was a significant and independent predictor of patient outcomes. For each additional hour with brain hypoxia, the risk of poor outcomes increased by 11 percent.

Delayed brain damage occurring in the hours and days after TBI is a major contributor to death and disability. Recently revised guidelines have recommended that patients with severe TBI should undergo monitoring of brain oxygenation—technically called interstitial partial pressure of oxygen in brain tissue. However, it has been unclear whether this provides important additional information, beyond that supplied by monitoring intracranial pressure or brain blood flow—or whether hypoxia is just an indicator of more severe brain injury.

The new study strongly suggests that TBI patients with longer periods of brain hypoxia are more likely to have poor outcomes, independent of intracranial pressure, brain blood flow, and other risk factors. The findings support the recent recommendations adding brain oxygen monitoring after severe TBI, as part of an integrated monitoring strategy. However, more research will be needed to determine whether treatment adjustments in response to brain oxygenation monitoring lead to any improvement in patient outcomes.

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.6 billion ($4.7 billion).

Complications after Breast Surgery Are More Common in Obese Women

Subluxation Theory Quiz
How much do you know about the controversial concept of subluxation and how familiar are you with some key research concepts?

You can now test yourself courtesy of this 10 question quiz by Dr. Robert Leach. Most chiropractors and chiropractic students know Dr. Leach from the editions of his textbook The Chiropractic Theories: A Textbook of Scientific Research. You can see the questions and answers right here or, for a limited time, you can take the interactive quiz here. ]]> http://www.lww.com/wordpress-pe/?feed=rss2&p=573 0