Acute Care, Disability and Rehabilitation

A New Approach for Improving Healing Rates of Pressure Ulcers

Project Director/Lead Investigator: Dale S. Feldman, PhD

This project is a preclinical study to determine how to optimally combine current wound-healing treatments with new techniques and then develop an evidence-based implementation strategy to overcome barriers to widespread use of innovative treatments for pressure ulcers in SCI patients. The end result of this study will be an implementation strategy that can be tested to prove that barriers inhibiting widespread adoption can be overcome. In this case, the barrier to widespread use is level of clinical effectiveness as well as patient access to the treatment. Although there are evidenced-based clinically recommended treatments to improve healing, no single non-surgical treatment is widely used due to the need for clinical healing time to approach that of surgical repair, with the added benefits of treatment in a home-health environment. The proposed strategy is to use a synergistic combinatorial therapy approach that is also amenable to the home-health environment to achieve a significant enhancement in wound healing with accessibility by the SCI population in order to overcome the barriers to widespread use. To achieve this goal, a dual mode of stem cell application will be optimized, for healing effectiveness. One mode will apply stem cells locally by placing scaffolds (albumin) infused with stem cells at the wound site, while a second mode will deliver the stem cells systemically resulting in enhanced natural cell homing to the wound site. For ease of use, the implementation strategy is designed to be applied locally and/or systemically using syringes supplied to the home-health nurse. Successful completion of this study will imply that implementation of these treatments in a combinatorial fashion could achieve the effectiveness necessary to reduce treatment costs and merit widespread adoption of these interventions.

Problem-Solving Training Intervention for Caregivers of Veterans with TBI

Project Director/Lead Investigator: Laura E. Dreer, PhD

Traumatic brain injury (TBI) has gained increasing attention in American society as it is now considered the “signature disability” of the Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) campaigns. The widespread use of improvised explosive devices and their resulting blasts during military operations increases the likelihood that service personnel will incur a TBI from combat or as the result of cumulative concussive injuries resulting from multiple exposures to blasts and associated explosive devices. The chronic changes that often occur in the wake of TBI may include a host of problems including memory loss, anxiety, agitation, depression, apathy, impaired social judgment, posttraumatic stress disorder (PTSD), depression, and other cognitive impairments. These disturbances along with possible physical injuries may run a chronic, unremitting course, imposing great strain and distress upon family members or close friends who assume a caregiver role for these wounded veterans as they return to civilian life after military separation. Unfortunately, research has not adequately addressed the unique long-term needs of non-paid, informal caregivers of OIF/OEF veterans with TBI. Thus, the long-term goal of this project is to conduct a randomized clinical trial (RCT) on the effectiveness of a psychoeducational-based intervention for preventing depression and other negative health outcomes for caregivers of OIF/OEF veterans with TBI (i.e., larger RO1 funded project). However, before such an RCT can be reasonably designed, there are several issues that first must be addressed and resolved. This proposal affords us a mechanism by which we can conduct a sequence of essential preliminary activities. The proposed project aims to address this important problem by (1) conducting a needs assessment of the challenges experienced by informal caregivers, (2) examining the impact of problem-solving abilities on aspects of quality of life, (3) using the information to develop a problem-solving therapy (PST) intervention tailored specifically to caregivers of OIF/OEF veterans with TBI, and (4) designing a randomized clinical trial (R01) to evaluate the efficacy of this intervention on the prevention of depression and quality of life for OIF/OEF caregivers. This project will identify the salient needs and challenges confronted by caregivers of veterans with TBI which is critical to developing a meaningful psychoeducational intervention. We anticipate that results from the current proposal will lead to the development of a large-scale, multi-site, randomized clinical trial proposal to evaluate the effectiveness of the PST intervention longitudinally over 2-years.

Assessment of Screening and Brief Intervention (SBI) Training for Trauma Care Providers

Project Director/Lead Investigator: Paul A. MacLennan, PhD

When individuals with alcohol-related injuries arrive at trauma centers, health care providers are well-positioned to screen for alcohol misuse and to provide brief interventions. Although screening and brief intervention (SBI) programs have been reported to reduce trauma recidivism by as much as fifty percent, SBI has not been widely adopted in trauma centers nor are trauma center personnel typically trained to provide SBI.  A number of barriers appear to be impeding the efficient and effective implementation of SBI in trauma centers. Therefore, it is posited that effective SBI training for trauma center personnel may be one way to overcome several of the most challenging barriers.  This seed grant proposal lays the groundwork for a comprehensive process and outcomes evaluation of SBI training and implementation in trauma center settings. This study will result in a proposal for a comprehensive, mixed-methods evaluation to identify effective SBI training content and practices and individual, institutional, training and content factors associated with successful implementation of SBI as a routine practice in trauma centers. This evaluation will also identify barriers to effective SBI training and implementation. Results will be used to improve future SBI training and to facilitate SBI implementation.