Telerehabilitation position paper.

Though the use of telerehabilitation technologies is expanding quickly as a viable method of service delivery for many practitioners within the field of health care, there remain issues of efficacy, cost, reimbursement, legal and ethical ramifications, and practitioner competence. There is a significant need for occupational therapy practitioners to document, research, and publish on the efficacy of consultation, intervention, and follow-up services provided using telerehabilitation technologies. Further investigation of the use of telehealth technologies in professional development and supervision is needed to clarify effectiveness and efficiency, as demand for services, particularly in rural areas, threatens to exceed services available. Occupational therapy practitioners using telerehabilitation methods must adhere to the AOTA Occupational Therapy Code of Ethics (AOTA, 2000), maintain the AOTA Standards of Practice (AOTA, 2005), and comply with state regulations, ensuring both their proficiencies as practitioners and the well being of their clients.     

Artificial ventilation in the prone position.

Turning a ventilated patient into the prone position can greatly enhance arterial blood oxygenation independent of ventilator parameters. This article explores the physiology relating to pulmonary ventilation, highlighting an overall improvement in ventilation/perfusion matching as a result of the prone position. A series of small studies seems to suggest that prone positioning can have a dramatic effect on life-threatening hypoxia, including adult respiratory distress syndrome (ARDS) but as yet there have been no large, randomised, multi-centre trials to put beyond doubt the benefits of prone ventilation. Turning the patient prone precipitates many issues in caring for him/her in this position. Many are practical problems and the article goes on to explore a variety of these, including turning and positioning the patient, emergencies and access and the psychological effects of being in the prone position. It is important that nurses understand the physiological basis for any actions, including turning the patient prone, but it is also important that nurses doctors and other professionals appreciate the practical difficulties that this form of management can produce. All team members must work together to ensure a safe, cohesive approach to turning and caring for the ventilated patient in the prone position.     

Intrathoracic cardiac position in the fetus.

In a 4-year period, 83 fetuses have been noted to have an abnormal fetal heart position within the thorax on fetal echocardiography. In 55 cases where the heart lay in the right chest, this was due to the presence of a left-sided diaphragmatic hernia; in one case, the heart was abnormally far into the left chest because of a left-sided diaphragmatic hernia. Of the remaining 27 cases, the heart lay in the right chest in 16 cases. In seven of those 16, there was a congenital heart malformation; in six, there were lung anomalies; a hiatus hernia was present in one; both congenital heart disease and lung abnormality were present in one and one fetus had isolated dextrocardia. In nine cases, the heart lay in the center of the chest and in three, the heart lay further to the left than normal. Congenital heart disease was found in nine of these 12. Chromosomal anomalies were found in four of the 27 cases with an abnormal heart position but an intact diaphragm. In summary, it is important to be familiar with the normal cardiac orientation within the thorax and to investigate abnormalities of position. A diaphragmatic hernia will be the most common underlying cause but, where the diaphragm is intact, other explanations must be sought in order to counsel correctly or plan appropriate perinatal management. Lung disorders, congenital heart disease and chromosomal anomalies will be the principal differential diagnoses.     

Treatment with a position feedback-controlled head stabilizer.

A position feedback-controlled head stabilizer has been developed to provide cerebral palsied individuals with resistive exercise to strengthen the neck musculature. This apparatus detects "involuntary" head motion and stabilizes the head by applying opposing forces; it also can be used to facilitate muscular contraction by resisting the subject's voluntary movements. The purpose of the present study was to determine whether voluntary head control in cerebral palsied individuals can be improved through systematic exercise using the stabilizer to strengthen the muscles of the neck and improve their balance of action. The findings support the author's contention that this is possible. The apparatus consists of a helmet and shoulder pads, interconnected so that the head is supported in the helmet by a manipulator arm. At its lower end, the manipulator arm is attached to the shoulder pad mounting frame via a gimbal assembly which allows head movement in two planes of tilt (pitch, or forward-and back, and roll, or side-to-side). Feedback control circuitry is so arranged that any deviation of the head from the desired position leads to actuation of pneumatic cylinders, which apply torques to the manipulator gimbal axes so as to oppose or conteract the incipient head movement. It is particularly significant that none of these patients participating in these experiments were at all apprehensive about or resisted being placed in the apparatus. (Even the youngest subject to use the apparatus--five year old-- did not mind being restrained by the shoulder pads or having his head gripped by helment.) While JG utilized the safety release valve quite often during the first few head control training sessions, he soon became confident enough in the action of the stabilizer that he did not even bother to grip the handle of the release valve. While DA had the action of safety valve explained and demonstrated for her, she never bothered to use it even from the outset of her experience with the stabilizer. Thus, it seems that the football shoulder pads use to stabilize the shoulders and the hockey helmet used to grip and manipulate the head actually make the apparatus attractive to younger patients, while the padding thereby provided makes it comfortable enough to be tolerated well by older individuals. And, the subject's knowing that he has an override control by means of which he can assert command over the entire system appears to be of psychological benefit in establishing confidence in both the apparatus and the investigator.     

Transcultural Nursing Society position statement on human rights.

In 2006, the Transcultural Nursing Society created a business plan with a firm commitment to social change and the support of human rights. One of the primary goals of the plan was to seek recognition from the United Nations as a Human Rights Organization. As a first step in articulating this goal, the board of trustees of TCNS tasked a small group of Transcultural Nursing Scholars to develop a position statement. This article is the culmination of the collaborative task force's efforts to define how TCNS seeks the fulfillment of human rights for people of all cultures worldwide.     

护理学在灾难医学中的地位和作用

近年来,灾难逐渐呈现大规模、长期化的趋势,完善灾难医疗系统是当务之急,而卫生救援工作离不开护理学的相关知识,任何院内外的卫生救援都伴随着护理活动的进行,护理学的理论和实践是灾难医学理论、实践的重要组成部分。所以,我们应该认识到护理学在灾难医学中的地位和作用,以完善和发展灾难护理学为己任。