Study Design: A direct comparison of synchronous versus asynchronous arm crank ergometry has not been carried out previously. Therefore, a comparative research design was employed. Objective: To assess the physiological responses of arm cranking when performed asynchronously (arms moving opposite to each other) versus synchronously (both arms moving in the same direction simultaneously). Setting: A university hospital setting in Galveston, Texas, USA. Methods: Seventeen individuals between the ages of 19 and 53 years were studied, 11 with paraplegia and six with no apparent disability. Two maximal arm crank graded exercise tests were performed with the subject seated in a wheelchair. Testing consisted of both arms (1) asynchronously (reciprocally) pushing and pulling the crank handles and (2) pushing and pulling the crank handles synchronously. Each test consisted of 2 min stages starting at 20 W and increasing 10 W per stage thereafter until exhaustion. Heart rate, oxygen consumption, and minute ventilation were measured and recorded during each stage. Blood lactate levels were monitored before and after each test. Statistical analysis was performed using the multivariate Hotelling's T 2 followed by post hoc univariate tests. Results: Greater power and longer test times (both groups, P50.05) and higher post test blood lactates (nondisabled P50.01, paraplegic P50.05) were achieved with asynchronous cranking versus synchronous cranking. While submaximal responses were similar between the two modes of cranking, there was a tendency for all variables to be lower with asynchronous. All subjects preferred asynchronous rather than synchronous cranking. Conclusion: Despite few statistically signi®cant dierences, based on the subjective reports from all subjects, we believe there is a clinically signi®cant dierence between the two modes of cranking. The results suggest that the mode of cranking may have implications for arm crank testing, training, and functional locomotion in individuals with lower extremity impairments.

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In introducing a new mattress into practice it is important to evaluate its performance from both the patient's and nurse's perspective. A total of 20 patients admitted to the integrated medical unit were recruited and nursed on a new pressure-relieving mattress offering two modes of pressure relief (Duo). All patients had been recently admitted to hospital and were considered to be 'at very high risk' of developing a pressure ulcer, with an initial Waterlow score > 20. Data were collected on admission, mid-point (three to four days) and study exit (seven days). The primary objective was to investigate the condition of patients' skin and the mode of choice for pressure relief. The secondary objective was to investigate reasons for nurses' and patients' choices. Structured interviews were conducted with the patient, ward nurse and research nurse whenever possible. Nineteen patients maintained or improved their skin condition during the evaluation.

AimsThe NHS Long-Term Plan includes the perinatal mental health objective: by 2023/24 ‘Maternal Mental Health Services’ will be available across the country to provide psychological therapy for those who experience mental health difficulties directly arising from birth trauma and or/perinatal loss. We achieved early implementer status via application to NHS England and, using transformation funding received, ‘Thrive’ was piloted in East Kent. A gap in service provision was identified: some existing primary care services provide intervention for this cohort, however some people remain in psychological distress but do not meet the criteria for specialist perinatal mental health secondary care services; these secondary care services are not commissioned to support those who have experienced perinatal loss. Thrive is co-delivered by a mental health trust and acute healthcare trust; NICE recommended psychological interventions are provided by Psychological Therapists, Specialist Mental Health Midwives and a Peer Support Worker. The aim of this project was to evaluate the effectiveness of the Thrive pilot in reducing PTSD symptomology whilst also collating feedback from patients, their families and healthcare staff across the maternity system, in order to adapt the service offer for full county rollout.Methods40 people who received care from Thrive from 11th January 2021 to 31st December 2021 were included in this evaluation.Data were collected retrospectively at the end of each period of care via:Clinical outcomes measures (quantitative): •PCL-5: a 20-item self-report measure assessing the 20 DSM-5 symptoms of PTSD.•CORE-34: a universal method of establishing well-being and risk.•HoNOS (Health of the Nation Outcomes Scales): a measure of the health and social functioning of people with severe mental illness.Patient Satisfaction Survey (qualitative).Results•100% of patients improved following Thrive intervention: PCL-5 (significant change = a reduction in score by 10–20 points has been met) / CORE-34 (clinically significant change =score above 10 initially and below 10 after intervention).•Clinical improvement: HoNOS = 100% of patients improved following Thrive intervention.ConclusionEvaluation has evidenced the effectiveness of Thrive in successfully treating those with PTSD symptomology arising from their maternity experience. Post-treatment measures indicate that the level of trauma symptomology and the impact of psychological distress on the functioning of patients who have received intervention from Thrive has reduced to a sub-clinical level in all cases.