Polio survivors have poorer walking adaptability than healthy individuals

BackgroundFalling is a major health problem in polio survivors, often occurring as a result of tripping, slipping or misplaced steps. Therefore, reduced walking adaptability possibly plays an important role.Research questionDoes walking adaptability, assessed on an interactive treadmill, differ between polio survivors and healthy individuals?MethodsIn this cross-sectional study, 48 polio survivors with at least one reported fall in the past year and/or fear of falling and 25 healthy individuals of similar age walked at self-selected comfortable fixed speed on an instrumented treadmill. Walking adaptability was measured as i) target-stepping accuracy (determined as variable error [VE] in mm independent of speed) in three conditions; 0 %, 20 % and 30 % variation in step length and width, and ii) anticipatory and reactive obstacle avoidance (ObA and ObR, in percentage successfully avoided). All trials were checked for valid step detection.Results46 polio survivors (mean ± SD age: 63.2 ± 8.7 years) and 25 healthy individuals (64.3 ± 6.6 years, p = 0.585) showed valid step detection. Compared to healthy individuals (mean±SE VE: 30.6±1.2 mm), polio survivors stepped less accurately onto targets (36.4±0.9 mm, p = 0.001), especially with their least-affected leg. Polio survivors avoided fewer obstacles successfully (mean±SE ObA: 83±3 %, ObR: 59±4 %) than healthy individuals (100±0.3 %, p < 0.001 and 94±3 %, p < 0.001, respectively), with a stronger decline in success rates from anticipatory to reactive obstacle avoidance for polio survivors (p < 0.001).SignificancePolio survivors reporting falls and/or fear of falling had a demonstrably reduced walking adaptability, especially so for reactive obstacle avoidance, which requires step adjustments under high time-pressure demands. Future research should study the merit of walking-adaptability assessment to currently used clinical methods of fall-risk assessment within this population.     

我国三级医疗机构营养科专业人才队伍情况调查

目的调查分析我国三级医疗机构营养科专业人才队伍情况，提出针对性建议。方法从国家医疗质量管理与控制信息网选取1 283家三级医疗机构调研临床营养专业技术人员数据，应用频数、构成比等进行描述性统计分析。 结果三级医疗机构营养科专业技术人员数量不足且分布不均衡，高层次人才比例偏低。医床比1:556.91，技床比1:841.30，医技比1.51:1，护床比1:1 031.31，均未达到文件标准，营养科医师严重缺编。结论应加强营养科专业人员教育和高层次人才培养，建立规范化培养体系，明确营养科职称评定和岗位技能考核制度，不断扩增专业人才数量，提升临床营养诊疗能力。     

Empowerment of learning and knowledge: Appreciating professional development for registered nurses in aged residential care

Continued education and professional development ensures nursing competence and contributes positively to quality health outcomes, however it must also include a professional pathway that challenges the contextual confrontations faced by registered nurses within the workplace environment. This is especially relevant for the nursing workforce employed in the Aged Residential Care sector. This research was undertaken in New Zealand and uses Appreciative Inquiry to ‘Appreciate the professional development needs of registered nurses working in the sector’.The findings highlighted the uniqueness of the sector, along with the diversity of the nursing workforce which signals the need for ongoing formal and informal professional development methods. Currently, professional development and learning is not assimilated well into the sector and there remains a void in terms of a professional clinical pathway. This has implications for the future development of professional learning for registered nurses in other sectors. Quality is integral to developing any professional learning, accordingly there must be input from both clinical and education providers. This partnership, between the sector and academia, will integrate learning into the practice area and improve outcomes for residents in aged residential care facilities.     

Professional values development during a baccalaureate nursing degree completion program

Faculty recognized a need to further study professional values development in registered nurses during a baccalaureate degree completion program. Study participants were surveyed at the beginning and conclusion of their program using the Nurses Professional Values Scale – Revised (NPVS-R) with several additional open-ended questions. The results supported that associate degree–prepared nurses returning to school possess a level of professional values similar to nurses with a baccalaureate degree.     

Continuing education in the child health handbook: an educational software for primary care1

ObjectiveTo present, the process of development and evaluation of an educational software on the Child Health Handbook proposed for the continuing education of primary care nurses and physicians.MethodsQuantitative study of methodological development. For software development, the following steps were followed: definition of objectives; determination of the target audience; choice of pedagogical and theoretical reference for content; content selection and structuring; software development and evaluation by experts (five nurses and four physicians). All responded to an instrument that included four domains: pedagogical; content; functionality; system presentation and usability. The evaluation criteria were arranged on a Likert-type scale. The percentage of agreement and Content Validity Index were used for the quantitative analysis of the degree of agreement, considering a Content Validity Index cutoff point equal to 0.80.ResultsThe overall agreement index, calculated by the arithmetic mean of the Contents Validity Index of the evaluated domains, was 0.96, with scores ranging from 0.90 to 1.00. The average percentage of agreement of the experts per domain was 92.86%, with lower agreement in the content (80.95%), presentation, and usability (90.48%) domains. 100% of percentage of agreement was observed in the pedagogical and functionality domains among the evaluated specialists.ConclusionThe percentage of agreement, Content Validity Index and overall agreement index of the Child Health Handbook educational software in the context of primary care disclosed the software adequacy as an educational resource for continuing education of primary care nurses and physicians. Considering the assessed dimensions, it can also be used by other health professionals and undergraduate students.     

员工援助计划服务对心内科护士职业认同感、职业价值观、职业压力的影响

目的 探讨员工援助计划服务对心内科护士职业认同感、职业价值观、职业压力的影响。 方法 选择2018年1-3月我院心内科护理人员58名,为其实施员工援助计划服务,评价实施前后心内科护士的职业认同感、职业价值观、职业压力感知、职业压力反应。 结果 实施后,心内科护士工作压力源各维度评分、压力感知与压力反应各维度得分均较实施前下降(P＜0.05);职业价值观各维度及职业认同感各维度评分均较实施前显著提高(P＜0.001)。 结论 员工援助计划可提高心内科护士职业认同感、职业价值观,缓解其职业压力感知以及职业压力反应。     

Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators

Background: While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators.

Objective: To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls.

Methods: Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition).

Results: The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p < .01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p < .05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p < .05).

Conclusions: Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation.