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Background: Misconceptions about men in nursing may influence recruitment and retention, further perpetuating the gender diversity imbalance in the nursing workforce. Identifying misconceptions and implementing early intervention strategies to address these deep-rooted stereotypes remain challenging but is considered critical to support students who are commencing a nursing career. Objective: To develop and evaluate the psychometric properties of the ‘Gender Misconceptions of meN in nursIng (GEMINI) Scale. Design: Cross-sectional survey. Methods: Pre-registration nursing students enrolled in undergraduate nursing programmes across 16 nursing institutions in Australia were surveyed from July to September 2021. The17-item self-report GEMINI Scale measured the gender misconceptions of men in nursing. Results: Of the 1410 completed surveys, data from 683 (45%) women were used for exploratory factor analysis showing a one factor structure, while data from 727 men (47%)were used for confirmatory factor analysis of the 17-item GEMINI Scale, which showed a good model fit. The scale demonstrated high internal consistency (Cronbach’s alpha of0.892). Men were found to have higher gender misconceptions (p < 0.001) while respondents who: (a) identified nursing as their first career choice (p = 0.002); (b) were in their final year of programme enrolment (p = 0.016); and (c) engaged in health-related paid work (p = 0.002) had lower gender misconceptions. Conclusion: The GEMINI Scale is a robust, valid, reliable, and easy to administer tool to assess misconceptions about men in nursing, which may potentially influence academic performance and retention. Identifying and addressing specific elements of misconceptions could inform targeted strategies to support retention and decrease attrition among these students. Impact statement: Genderism harms nursing, as well as the men and women working in the profession. Recruitment and retention of men into nursing is needed to cultivate male role models and diversify the workforce, however this is impeded by negative portrayals in popular culture and misconceptions entrenched in society Refereed/Peer-reviewed

To evaluate acceptability, efficiency, and quality of a new digital care management system in a residential aged care home (RACH).Improving care quality and efficiency in RACH, while simultaneously upgrading data management, is a priority for communities and governments.Participatory action research with mixed methods data collection was employed to evaluate a digital care management system implemented at a 169-bed RACH. This paper reports qualitative findings of the 2-year evaluation.Qualitative data were collected using focus groups with residents, visitors, nurses, managers, care workers, and consultants; resident/visitor and staff hallway interviews and responses to open-ended questions in online staff surveys. Data were analysed thematically under the four predetermined study objectives. Reporting adhered to COREQ guidelines.325 data captures from 88 participants, over seven data sources were coded. Findings indicate that the system was acceptable to both residents and staff due to perceptions of time-saving and improved quality of care. Increased efficiency was perceived through timeliness as well as reduced time spent retrieving and documenting information. Quality of care was improved through care scheduling individualised to resident needs, with reminders to avoid missed care. Relatives were reassured and activities were scheduled to loved one's preferences. The co-design implementation process was successful through commitment to quality from leadership teams and prioritising the focus on the holistic needs of the residents.A strong emphasis on co-design with care staff in developing and implementing the digital care system contributed to a system that supported nursing and care work, facilitated reporting and documentation, and improved resident care and well-being including identification of missed care.Nurses, carers, administrators, and advocates can support the co-design creation of information systems that suit the workflow of an organisation and keep the focus on individualised models of care provision.

Objectives The SPeEDy study (Surgery vs. physiotherapist-led exercise for traumatic tears of the rotator cuff) is a two-arm, parallel group, pilot and feasibility randomised controlled trial aiming to evaluate the feasibility of a future main trial. In this paper, the development process and the resultant physiotherapist-led exercise programme used in the SPeEDy study is described. Methods Thirteen physiotherapists and three patients met to discuss and develop the key principles that should underpin the exercise programme. Results Taking in to account the current research evidence and incorporating expert clinical and patient opinion, the group developed an individualised, structured and progressive physiotherapist-led exercise programme based on the principle of self dosing. Exercise prescription within the programme is based on establishing the current functional capacity of the patient in relation to the most challenging shoulder movements and is supported over approximately six contact sessions across a 12-week period. Conclusion The SPeEDy study aims to recruit 76 participants across eight hospitals and will provide high quality evidence about the feasibility of a future main randomised controlled trial in a clinical area where there is a lack of evidence from randomised controlled trials to support clinical decision-making. ClinicalTrials.gov (NCT04027205) – Registered on 19 July 2019. Available via https://clinicaltrials.gov/ct2/show/NCT04027205

Aim To use expert consensus to develop guidance for nurse leaders implementing e-health tools to support nursing work in hospitals. Background Nurse leaders are increasingly required to make decisions about the selection, development, implementation and optimisation of e-health tools for nursing work in hospitals. Guidance in this rapidly evolving and complex space is limited. Design A two-phase modified Delphi study. Methods Phase one involved in-depth interviews with five nursing informatics experts. Analysis used the qualitative framework method, informed by the Theoretical Domains Framework (TDF), to develop statements for an anonymous online Delphi scoring survey. This was distributed using snowball sampling methods to Australian nurse informatics leaders and experts. Final analysis involved synthesis of qualitative and quantitative data. The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist. Results Ten guidance statements to support nurse leaders to implement e-health tools in hospitals were developed from the synthesis of qualitative interview data and 29 experts' responses to the 55-item Delphi response survey. Conclusion Implementation of e-health tools for nursing work is complex in health settings and requires careful examination of multiple factors and interactions between clinicians, tools, service users and the health organisation. This research proposes ten statements to support nurse leaders with decisions about implementing e-health tools to support nursing work in hospitals. Relevance to clinical practice The ten statements developed by this research provide a resource to assist policy and practice decisions about e-tools to ensure they are suited to supporting nursing work. Nurse leaders can use the ten statements for guidance in the selection, development, implementation and optimisation of e-health tools to ensure suitability and adaptation for nursing work in hospitals.

Clinicians delivering palliative care require the specific knowledge, skill and understanding to meet the needs of the dying. Research shows that undergraduate nursing students report feeling inadequately prepared to provide safe and effective palliative care.To identify existing empirical evidence on generalist palliative care content within international undergraduate nursing curricula and to synthesize existing generalist palliative care topics.An integrative systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO).Keywords were searched in six electronic databases CINAHL, Medline, APA PsycINFO, SCOPUS, Cochran Library and ProQuest NursingAllied Health Database, between January 2000 and February 2022.Studies were selected as per a pre-determined inclusion and exclusion criteria. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Tabulation of the author, year, country, aim, participants and setting, method, generalist palliative care content topics, additional findings and limitations were compiled. A thematic analysis of the data was conducted to organise and categorise generalist palliative care topics into an additional table followed by a narrative synthesis.Of the n = 1014 papers retrieved, n = 13 studies of varying methodological quality were included in the analysis (n = 8 quantitative descriptive, n = 5 mixed method). Most studies were published in high income countries with developed economies. Methods used to obtain data include survey, extraction of secondary data and expert consensus. Generalist palliative care topics were presented as a list reporting frequency taught/discussed/cited (n = 10), recommended competencies (n = 2), and teaching modules (n = 1). A large variety of topics were identified with differing levels of detail and clear differences in topics identified globally. Overall, the most frequently mentioned generalist palliative care topics were pain and symptom management (n = 12), grief lossbereavement (n = 12) and communication (n = 11).This review demonstrates for the first time that international primary research evidence on generalist palliative care content in undergraduate nursing curriculum is minimal, of varying methodological quality, with visible inconsistencies among studies designed to inform curriculum verses studies reporting what is taught to students. More research is required to create evidence informed generalist palliative care content for undergraduate nursing curriculum.It is recommended for future research to use international consensus-based methods to inform and develop internationally agreed educational topics to optimise patient care at the point of nurse registration.

Introduction: There are increasing recommendations to use the biopsychosocial model (BPSM) as a guide for musculoskeletal research and practice. However, there is a wide range of interpretations and applications of the model, many of which deviate from George Engel’s original BPSM. These deviations have led to confusion and suboptimal patient care.Objectives: 1) To review Engel’s original work; 2) outline prominent BPSM interpretations and misapplications in research and practice; and 3) present an “enactive” modernization of the BPSM.Methods: Critical narrative review in the context of musculoskeletal pain.Results: The BPSM has been biomedicalized, fragmented, and used in reductionist ways. Two useful versions of the BPSM have been running mostly in parallel, rarely converging. The first version is a “humanistic” interpretation based on person- and relationship-centredness. The second version is a “causation” interpretation focused on multifactorial contributors to illness and health. Recently, authors have argued that a modern enactive approach to the BPSM can accommodate both interpretations.Conclusion: The BPSM is often conceptualized in narrow ways and only partially implemented in clinical care. We outline how an “enactive-BPS approach” to musculoskeletal care aligns with Engel’s vision yet addresses theoretical limitations and may mitigate misapplications.

There is a rising critique of the process and position of decision-making across music interventions, which has been evidenced through the MUSOC research network debates that we, as doctoral students, have participated in. In this article, we specifically discuss ‘intervention’ as ‘deliberate strategies that seek to enable people to find self-expression through musical means’ (Bartleet and Higgins 2018: 3). We offer three perspectives from three different intervention contexts: community music in schools, organizational settings and music-making workshops. Through this article, we share and reflect on our experience with intervention and decision making within our practice. We give specific focus to: how intentions and motivations underpinning interventionist practice manifest in different contexts; how this is currently informed by the decision-making structures through which community music is practised in each context; and, the extent to which dominant modes of practice have potential to disempower participants, including how they are reinforced and re-enacted through this process. Finally, we suggest that how we talk about intervention across peers, and how we enact it through our practice as practitioners and researchers is possibly misaligned. This warrants further consideration if explorations of the term ‘intervention’ are to feed into discussion and action for responsible practice.

Aim To describe the self-reported experiences of clinicians evaluating a novel Health Information System in an acute care environment. Design The Health Information System was implemented over a one-month period in 2017 into a 26-bed acute medical ward within a 760-bed tertiary teaching hospital in Australia. Methods Data were collected using interviews with 48 multidisciplinary clinicians and 20 patients, and 2 focus groups with 13 nurses, and analysed with a ‘content, context, and process’ evaluation framework. Results Three themes reflecting unanticipated difficulties emerged from the qualitative data: (1) inconsistent expectations; (2) decisional conflict between managers and end-user nurses; and (3) workflow impacts. Conclusions Designers and evaluators of information systems must listen to, prioritise and respond to the needs of the clinicians who provide care.

Background Optimal rehabilitation following arthroscopic shoulder stabilisation for traumatic anterior instability is unknown. The purpose of this study was to establish current UK practice for this patient group. Methods A self-administered online questionnaire was developed and distributed to UK surgeons and physiotherapists. Results 138 responses were received. Routine immobilisation was reported in 79.7% of responses with a cross-body sling being the preferred position (63.4%). Duration of immobilisation and timescales to initiate movement were highly variable. Return to light work was advised when patients felt able (25.4%) or after 6 weeks (26.1%). 58.7% recommended waiting for 12 weeks to return to manual work. 56% recommended non-contact sport could be resumed after 12 weeks. For contact sport, recommendations varied from 6 weeks (3.8%) to 6 months (5.8%). Psychological readiness was the most frequently cited criteria for return to play (58.6%). Factors such as hyperlaxity (40.6%), age (32.6%) and kinesiophobia (28.3%) were not considered as relevant as reported quality of surgical fixation (50%). Conclusion There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation. Further work is required to establish high value, personalised pathways for this patient group.

Objectives The cognitive state of the dying in the last days of life may deteriorate, resulting in a reduced ability to communicate their care needs. Distressing symptoms, physical and existential, may go unrecognized and untreated. The objectives of this integrative review were to systematically interrogate the literature to determine the changing conscious state of dying adults and to identify changes in their care needs. Methods An integrative review protocol was registered with PROSPERO (CRD42020160475). The World Health Organization definition of palliative care informed the review. CINAHL, MEDLINE (OVID), Scopus, PsycINFO, Cochrane Library, and PubMed were searched from inception to October 2019 using search strategies for each database. Inclusion and exclusion criteria were applied. Methodological quality was appraised using the Joanna Briggs Institute Checklist for the Case Series appraisal tool. Extracted data were synthesized using a narrative approach. Results Of 5,136 papers identified, 11 quantitative case series studies were included. Six themes were identified: conscious state and change over time, awareness, pain, absence of holistic care, the voiceless patient, and signs and symptoms of dying. Significance of results In the last days of life, the physical and conscious state of the dying patient declines, resulting in an inability to express their care needs. Dignity in dying and freedom from pain and suffering are both an imperative and a human right; and unvoiced care needs can result in unnecessary suffering and distress. This review revealed that little is known about how healthcare professionals assess holistic care needs at this vulnerable time. Although much has been written about palliative and end-of-life care, the assessment of care needs when patients are no longer able to voice their own needs has largely been ignored, with little attention from clinical, educational, or research perspectives. This gap in evidence has important implications for the dying and their families.

Resume Objectif Le but de cet article etait de synthetiser les resultats de recherche qui explorent les options de traitement pour les personnes souffrant d’une douleur d’epaule associee a une dechirure non traumatique de la coiffe des rotateurs, puis d’utiliser ces informations pour developper un outil d’aide aux patients pour la prise de decision therapeutique. Methodes Une revue de litterature a ete entreprise pour identifier les facteurs susceptibles d’influencer les choix de traitement qui s’offrent aux patients souffrant d’une douleur d’epaule associee a une dechirure non traumatique de la coiffe des rotateurs. Les donnees ont ete rassemblees dans un format adapte a la checklist pour les utilisateurs d’outils d’aide aux patients pour la prise de decision therapeutique de l’International Patient Decision Aid Standards Collaboration. Une deuxieme revue de litterature a ete realisee a propos des preoccupations specifiques des patients, pour leur proposer une reponse robuste, basee sur des preuves, et faciliter leur prise de decision. Resultats L’outil d’aide aux patients pour la prise de decision therapeutique qui resulte de ce travail offre un resume de la litterature actuelle. Il reflete les preoccupations courantes des patients souffrant d’une douleur d’epaule associee a une dechirure non traumatique de la coiffe des rotateurs, qui doivent choisir entre une prise en charge chirurgicale ou non chirurgicale. L’outil propose les labels simplifies « Vrai », « Faux » ou « Inconnu » representatifs du niveau de preuves actuel pour qualifier les raisons identifiees qui influencent les patients dans leur choix de traitement. Conclusion Un fort niveau de preuve suggere que les outils d’aide aux patients pour la prise de decision therapeutique ameliorent la comprehension des options de traitement par les patients, les aident a se sentir mieux informes et plus en capacite d’identifier ce qui est important pour eux. Il s’agit du premier outil d’aide a la prise de decision therapeutique qui explore les options de traitement chirurgical et non chirurgical pour les patients souffrant de douleurs d’epaule associees a une dechirure non traumatique de la coiffe des rotateurs. Niveau de preuve 5.

Rehabilitation after primary reverse total shoulder arthroplasty (RTSA) is accepted to be an essential component to successful outcome achievement, but successful rehabilitation approaches have yet to be well described in the literature. This retrospective review documents the outcomes of a cohort of 29 patients undergoing RTSA surgery with rehabilitation following the Upper Limb Treatment and Rehabilitation Advice (ULTRA) guideline (Appendix 1). The Oxford Shoulder Score, Quick Disabilities of the Arm, Shoulder and Hand score, range of movement (degrees of flexion, abduction and external rotation) and numerical rating score for pain were prospectively collected pre-operatively and at one- and two-years post-operatively. Scores were then evaluated to establish whether or not there were any significant changes over time. Statistically significant improvements were seen in all outcome domains from pre-operative to one-year post-operative. All improvements met the threshold for achieving substantial clinical benefit as well as exceeding the minimum clinically important difference, and all improvements were maintained at the two-year post-operative time point. The present study showed that following the ULTRA guideline after elective RTSA can give statistically significant improvements in range of movement, pain score and patient-reported outcome at one-year post-operatively, which can be maintained up to two-years post-operatively.

Aims To analyse the clinical practice of Italian physiotherapists within the framework of postoperative rehabilitation of rotator cuff (RC) surgery patients, and to compare it with similar studies carried out in other countries. Methods A web-based, voluntary, cross-sectional survey with 27 closed multiple-choice questions was developed and submitted to Italian-based physiotherapists in order to assess their clinical practice. Results Data from 1160 questionnaires were then analysed. Thirty-five percent of respondents (n = 413/1160) reported that they commence passive range of motion from the first postoperative week, while 49.2% (n = 571/1160) start during the second or third week. The majority of respondents (n = 603/1160, 52.0%) introduce active mobilisation between the fourth and the sixth week after surgery and 41.1% (n = 477/1160) introduce overhead movements between the fourth and the sixth week after surgery. Discussion and conclusions When managing the postoperative rehabilitation of RC surgery patients, Italian physiotherapists' practice is congruent with the guidelines published by American Society of Shoulder and Elbow Therapists (ASSET) and also with other UK surveys. However, while Italian physiotherapists manage immobilisation periods, active and passive mobilisation and the return to sport activities, according to evidence-based best practice guidelines, there is less consistency with respect to physical exercise, patient follow-up and referral.IMPLICATIONS FOR REHABILITATIONItalian physiotherapists' practice with patients following rotator cuff (RC) repair complies with evidence-based practice guidelines regarding immobilisation periods, passive and active mobilisation, and return to sport activities.There is less consistency between reported/declared practice and available evidence concerning physical exercise, patient follow-up, and referral.Physiotherapist with Orthopaedic Manipulative Physical Therapy (OMPT) training is more aligned with the current literature compared to physiotherapists without specific training, in terms of managing rehabilitation programmes, period of immobilisation and therapeutic exercise.More careful adherence to the international guidelines is recommended, in order to manage patients following RC repair in accordance with the evidence and to achieve the best possible outcomes.

Demand is rising for people-centred services in areas such as health, social care and housing. Such services generally seek to manage demand through layers of triage and assessment, reserving their...

ObjectiveTo investigate the influence of trunk and lower limb motion on electromyography (EMG) muscle activity and recruitment patterns around the shoulder.DesignSystematic review.Data sourcesMEDLINE, CINAHL, PEDro, AMED, PubMed, Cochrane Central Register of Controlled trials, Cochrane Database of Systematic reviews, SportsDiscuss and PROSPERO.Eligibility criteriaStudies investigating both multiregional kinetic chain (KC) shoulder exercisesandlocalised non-kinetic chain (nKC) shoulder exercises in healthy subjects under the same experimental conditions were included in this review.ResultsKC exercises produced greater EMG activation levels in 5 of 11 studies for the lower trapezius. Of the remaining studies, five found no difference between the exercise types and one favoured nKC exercises. KC exercises produced greater EMG activation levels in 5 of 11 studies for the serratus anterior. Of the remaining studies, three reported the opposite and three found no significant difference between the exercise types. nKC exercises produced greater EMG activation in infraspinatus in three of four studies. KC exercises produced the lowest trapezius muscle ratios in all studies. Studies investigating the upper trapezius, middle trapezius, supraspinatus, subscapularis, biceps brachii, latifissimus dorsi, pectoralis major, deltoid, and trapezius and serratus anterior ratios showed inconsistency.ConclusionThis review found evidence that integrating the KC during shoulder rehabilitation may increase axioscapular muscle recruitment, produce lower trapezius muscle ratios and reduce the demands on the rotator cuff. Stepping appears preferable to squatting.PROSPERO registration numberCRD42015032557, 2015.

The muscular characteristics of rugby players may make diagnosing the direction of shoulder instability and labral pathology challenging. This study aimed to assess the accuracy of clinical examination and specifically instability tests, in diagnosing the direction of shoulder instability in rugby players. One-hundred-and-forty rugby players, who had undergone a shoulder stabilization procedure, over a 55-month period, were included in this study. The mean age was 21.5 years with 137 males. Data collected included clinical examination and intraoperative findings. The two were compared to calculate the diagnostic accuracy of special tests for instability. The Anterior Apprehension Test had good sensitivity (82.7%), specificity (100%) and PPV (100%) but poor NPV (55.8%). All posterior instability tests demonstrated a sensitivity of over 85%, but all had a specificity of 25% or less. In 83.6% of cases the direction of instability was correctly identified from history and examination. Anterior instability was correctly diagnosed in 78.9% of cases and posterior in 100.0%. The poor NPV of the anterior apprehension test suggests that clinicians should be suspicious of anterior instability in rugby shoulders even in the light of negative examination findings. Positive posterior instability tests are highly suggestive of posterior instability in rugby players.

Evidence on which to base decision-making in the management of atraumatic shoulder instability is limited. This is due to the lack of a universal definition for the condition, small cohort studies and multiple outcome scores being used to evaluate treatment. Despite these limitations it is evident that the vast majority of patients with atraumatic shoulder instability (with or without structural pathology) seem to improve with physiotherapy. Physiotherapy should always be the first line (and second line) of management for such patients. Patients that do not improve should be referred to a specialist orthopaedic shoulder surgeon and shoulder physiotherapist for careful assessment. If necessary, patients with certain indications may be referred directly to tertiary centres early ○ Frequent attendance at A&E for relocation ○ Persistent displacement or shoulder dislocation/subluxation ○ Absence from school (>20%) or work (>3 months) A multidisciplinary team approach is essential in complex cases. Evidence for operative intervention is poor and inconsistently reported in the literature. If surgery is to be undertaken then arthroscopic capsulorrhaphy is not recommended for the treatment of atraumatic shoulder instability. Inappropriate or incorrect surgery is to be avoided as this has been shown to be associated with poor outcomes. We propose a treatment algorithm as shown in Figure 3 to guide the management of patients with atraumatic shoulder instability based on the limited available evidence and expert consensus opinion. Open in a separate window Figure 3. Proposed algorithm for the management of atraumatic shoulder dislocation. EMG: electromyography; MDT: multidisciplinary team.

© 2019 - IOS Press and the authors. All rights reserved. BACKGROUND: Disorders associated with the rotator cuff are regarded as the most common shoulder pain presentation. The range of diagnostic terms used to explain this problem reflect uncertainty in relation to causative mechanisms, diagnosis, prognosis, and the most effective treatments. The aim of this consensus exercise was to facilitate a shared understanding as a means of reducing mixed messages, informing clinical practice and providing a foundation for future research. METHODS: Nine physiotherapists with clinical and academic expertise in shoulder pain participated in an online and face-to-face consensus exercise. RESULTS: This consensus exercise suggests specific factors in the history and physical examination that might raise the index of suspicion of Rotator Cuff Related Shoulder Pain. The suggestions for non-surgical management include a minimal number of exercises prescribed to challenge the functional deficit of the patient over a minimum 12-week period. Apart from aiding exclusion of red flag pathology, imaging is not regarded as useful unless the patient does not respond as expected. Steroid injections wouldn't be considered a first-line intervention unless pain was severe and preventing engagement with exercise. CONCLUSION: This consensus exercise provides a benchmark for clinical reflection while highlighting areas of uncertainty that still exist and require further research.

BackgroundOutcomes of reverse total shoulder arthroplasty (RTSA) have typically been assessed using the same instruments as anatomical shoulder arthroplasties. However, to date, there has been a lack of investigation with respect to the correlation of such scores and patient satisfaction in the RTSA population.MethodsThe Oxford Shoulder Score (OSS) and Quick Disabilities of the Arm, Shoulder and Hand (QD) score were prospectively collected in 38 RTSA patients (41 shoulders) postoperatively. Scores were then evaluated to establish whether or not they correlated with patient satisfaction at a minimum of 1 year postoperatively.ResultsThe correlation coefficient for the OSS and patient satisfaction was found to be 0.313 (p = 0.011) and the correlation coefficient for the QD score and patient satisfaction was -0.292 (p = 0.017), showing a statistically significant but moderately weak relationship between the OSS and QD scores with patient satisfaction (p ConclusionsThe present study showed no strongly significant relationship between patient-reported outcome measure (PROM) scores and patient satisfaction following elective RTSA. These findings emphasise the need to question the appropriateness of standard PROM scores for the assessment of outcome and success following elective RTSA.

The pathophysiology of Stanmore Classification Polar type II/III shoulder instability is not well understood. Functional Magnetic Resonance Imaging was used to measure brain activity in response to forward flexion and abduction in 16 patients with Polar Type II/III shoulder instability and 16 age-matched controls. When a cluster level correction was applied patients showed significantly greater brain activity than controls in primary motor cortex (BA4), supramarginal gyrus (BA40), inferior frontal gyrus (BA44), precentral gyrus (BA6) and middle frontal gyrus (BA6): the latter region is considered premotor cortex. Using voxel level correction within these five regions a unique activation was found in the primary motor cortex (BA4) at MNI coordinates -38 -26 56. Activation was greater in controls compared to patients in the parahippocampal gyrus (BA27) and perirhinal cortex (BA36). These findings show, for the first time, neural differences in patients with complex shoulder instability, and suggest that patients are in some sense working harder or differently to maintain shoulder stability, with brain activity similar to early stage motor sequence learning. It will help to understand the condition, design better therapies and improve treatment of this group; avoiding the common clinical misconception that their recurrent shoulder dislocations are a form of attention-seeking.

Purpose The purpose of this project was to implement clinic system changes that support evidence-based guidelines for childhood obesity prevention. Adherence rates for prevention and screening of children in a rural Midwest primary care setting were used to measure the success of the program. Data sources Retrospective chart reviews reflected gaps in current practice and documentation. An evidence-based toolkit for childhood obesity prevention was used to implement clinic system changes for the identified gaps. Conclusions The quality improvement approach proved to be effective in translating knowledge of obesity prevention guidelines into rural clinic practices with significant improvements in documentation of prevention measures that may positively impact the childhood obesity epidemic. Implications for practice Primary care providers, including nurse practitioners (NPs), are at the forefront of diagnosing, educating, and counseling children and families on obesity prevention and need appropriate resources and tools to deliver premier care. The program successfully demonstrated how barriers to practice, even with the unique challenges in a rural setting, can be overcome. NPs fulfill a pivotal primary care role and can provide leadership that may positively impact obesity prevention in their communities.

The aim of this study was to investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. The case study used multiple data sources captured within a real-life clinical ward context. Quantitative findings included significant reductions in nurse-reported missed care (P

This prospective study evaluates the clinical efficacy of a special implant, PlantTan plate used for fixation of displaced proximal humerus fractures. The PlantTan plate was used for internal fixation of closed displaced proximal humeral fractures in 68 patients from September 1999 to June 2002, in a University Hospital. One of the surgeries was for a non-union, and five patients were lost to follow-up. The patients' ages ranged from 19 to 76 years (mean 61 years and median 66 years). Of the remaining 62 patients, 42 were female and 20 were male. As defined using the Neer classification 19 patients had two part, 37 three part and 6 had four part fractures. Median follow-up was 19 months (11-38). The outcome was assessed using radiographs, American Shoulder and Elbow Surgeons (ASES) score and Hospital for Special Surgery (HSS) scoring system. Fifty-two patients achieved union in a median of 8 weeks. The median cumulative score of activities of daily living of ASES was 20.4/30 (13-27). According to HSS, 11 scored excellent, 26 good, 14 fair and 11 scored poor. Eight patients had fixation failure and two developed avascular necrosis. Eleven patients developed an infection. Six patients developed an infection resulting in implant removal. One had a transient and one permanent axillary nerve palsy. Since the PlantTan plate provides stability, early active rehabilitation can be instituted. The implant is distally placed reducing impingement symptoms. However, the implant requires wide surgical exposure, is bulky and has an unacceptable infection rate. The fixation failure is high in patients with osteoporosis. In view of the above encountered problems, the implant has been discontinued in our hospital.

Nurses working at night have a specific role in supporting sleep and promoting rest and comfort. Sometimes the role of the night duty nurse in promoting sleep and comfort is taken for granted. One author’s experience of working as a night-duty nurse led to reflection on her responsibilities in improving practice and addressing the sleep-related needs of patients in a palliative care setting. Following a literature review, it was clear that there are very few publications on sleep disturbance in palliative care. Using the four principles of palliative care (Aranda, 1998a), the authors construct a series of strategies to prevent and manage sleep issues.

Sports injuries are on the increase, with the increasing interest and involvement in sports around the world. In Europe there is a large diversity of sports, with many sports being more prominent in certain countries. Although injury pathology is similar (e.g. a labral tear), the injury mechanisms are often unique to that sport and the rehabilitation and demands are also unique to the sport. In this Instructional Course chapter, we hope to show you some examples of this and highlight some unique and important current issues in the sports shoulder in 2014.

In acute stroke care, urgent specialist assessment and treatment are essential to reduce the risk of death and disability. However, many patients do not receive them due to a lack of specialist services. One solution is to use telemedicine. This can give all patients with acute stroke symptoms access to immediate expert assessment and advice, regardless of when and where they present to hospital. This article describes a telemedicine system developed and implemented in Lancashire and Cumbria. In its first year of operation, 319 patients received a telestroke video assessment with a consultant stroke physician; 131 of these patients were given thrombolysis. We discuss how the service was designed, staff training and development, and the implications for nursing practice. The development of a standardised telemedicine toolkit that may facilitate future telemedicine projects is also discussed.

This chapter provides an historical analysis of the pedagogical imperatives and priorities for nursing education that triggered interest in the Dedicated Education Unit. The authors discuss how the transition from hospital to university nursing education demanded new partnerships between universities and healthcare organisations, a variety of new student clinical learning models and research into students’ clinical learning. They use a theoretical framework for workplace learning to discuss the Dedicated Education Unit in terms of concepts such as the invitational quality of the learning environment, student agency and identity and the pedagogies of teaching and assessment in clinical education, focusing on curriculum design, feedback and meeting competencies. They also explore the value of community of practice theory to promote knowledge learnt through experience in the Dedicated Education Unit. The chapter ends with identification of four key areas for further research: curriculum design, pedagogies, stakeholder engagement and the Dedicated Education Unit as a learning organisation.

This chapter describes the uptake of the Dedicated Education Unit in Canberra, Australia, based on the Flinders University model. The authors provide brief background information about Canberra and the University of Canberra undergraduate nursing curriculum before describing the curriculum redesign required for uptake of the Dedicated Education Unit, key Dedicated Education Unit roles and responsibilities, key assumptions about students in the Dedicated Education Unit context, supports for student learning, engaging clinicians in the learning culture, activities used to promote learning, assessment strategies and different clinical settings for specific Dedicated Education Units. They then shift the focus to evaluation of current Canberra Dedicated Education Units and reflect on the challenges facing Dedicated Education Units, such as the need for ongoing revision of, and engagement with, this clinical education model, and administration. The chapter ends with considerations about the further development of Dedicated Education Units and research possibilities within them.

Stroke does not only affect physical health; it also has an impact on psychological health and many other aspects of survivors' lives. Nurses have a central role in stroke rehabilitation. This article discusses rehabilitation, the role of the nurse, psychological care, secondary prevention and life after stroke. It focuses on resuming driving and returning to work as these are particularly important for the one-quarter of stroke patients who are aged under 65.

Preserving the integrity of high quality care in a financially restricted environment is the primary challenge facing healthcare providers. The critical question is which delivery system will use limited resources most efficiently without jeopardizing quality of care? Case management has been identified as a solution that offers the most promise. The case management model at Sioux Valley Hospital was developed to deal proactively with resource-intensive patients with chronic illnesses who have frequent admissions and who create financial risk for the hospital. The authors describe the fiscal and clinical outcomes of these select patients.