Efficacy of baby-CIMT: study protocol for a randomised controlled trial on infants below age 12 months, with clinical signs of unilateral CP

BACKGROUND: Infants with unilateral brain lesions are at high risk of developing unilateral cerebral palsy (CP). Given the great plasticity of the young brain, possible interventions for infants at risk of unilateral CP deserve exploration. Constraint-induced movement therapy (CIMT) is known to be effective for older children with unilateral CP but is not systematically used for infants. The development of CIMT for infants (baby-CIMT) is described here, as is the methodology of an RCT comparing the effects on manual ability development of baby-CIMT versus baby-massage. The main hypothesis is that infants receiving baby-CIMT will develop manual ability in the involved hand faster than will infants receiving baby-massage in the first year of life. METHOD AND DESIGN: The study will be a randomised, controlled, prospective parallel-group trial. Invited infants will be to be randomised to either the baby-CIMT or the baby-massage group if they: 1) are at risk of developing unilateral CP due to a known neonatal event affecting the brain or 2) have been referred to Astrid Lindgren Children’s Hospital due to asymmetric hand function. The inclusion criteria are age 3–8 months and established asymmetric hand use. Infants in both groups will receive two 6-weeks training periods separated by a 6-week pause, for 12 weeks in total of treatment. The primary outcome measure will be the new Hand Assessment for Infants (HAI) for evaluating manual ability. In addition, the Parenting Sense of Competence scale and Alberta Infant Motor Scale will be used. Clinical neuroimaging will be utilized to characterise the brain lesion type. To compare outcomes between treatment groups generalised linear models will be used. DISCUSSION: The model of early intensive intervention for hand function, baby-CIMT evaluated by the Hand Assessment for Infants (HAI) will have the potential to significantly increase our understanding of how early intervention of upper limb function in infants at risk of developing unilateral CP can be performed and measured. TRIAL REGISTRATION: SFO-V4072/2012, 05/22/201

Acción : diario de Teruel y su provincia: Año II Número 80 - (23/02/33)

Aim: To explore and compare the impact of the physical environment on patients’ activities and care at three newly built stroke units. Background: Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients’ activities in relation to the design of the physical environment of stroke units are scarce. Design: This work is a comparative descriptive case study. Method: Patients (n=55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioral mapping analyzed with descriptive statistics and field note taking analyzed with deductive content analysis. Data were collected from April 2013 to December 2015. Results: The units differed in the patients’ levels of physical activity, the proportion of the day that patients spent with health professionals, and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single room design. Stroke units that were easy to navigate and offered variations in the physical environment impacted patients’ activities and care. Conclusions: Patients’ activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment.status: accepte

Нравственное воспитание будущих врачей при обучении их русскому языку как иностранному

НРАВСТВЕННОЕ ВОСПИТАНИЕРУССКИЙ ЯЗЫК КАК ИНОСТРАННЫЙВОСПИТАНИЕ СТУДЕНТОВОБУЧЕНИЕИНОЯЗЫЧНОЕ ОБРАЗОВАНИЕИНОСТРАННЫЕ СТУДЕНТ

Area of ischemia assessed by physicians and software packages from myocardial perfusion scintigrams.

The European Society of Cardiology recommends that patients with >10% area of ischemia should receive revascularization. We investigated inter-observer variability for the extent of ischemic defects reported by different physicians and by different software tools, and if inter-observer variability was reduced when the physicians were provided with a computerized suggestion of the defects

A trial to evaluate the effect of the sodium–glucose co‐transporter 2 inhibitor dapagliflozin on morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction (DAPA‐HF)

Background: Sodium–glucose co‐transporter 2 (SGLT2) inhibitors have been shown to reduce the risk of incident heart failure hospitalization in individuals with type 2 diabetes who have, or are at high risk of, cardiovascular disease. Most patients in these trials did not have heart failure at baseline and the effect of SGLT2 inhibitors on outcomes in individuals with established heart failure (with or without diabetes) is unknown. Design and methods: The Dapagliflozin And Prevention of Adverse‐outcomes in Heart Failure trial (DAPA‐HF) is an international, multicentre, parallel group, randomized, double‐blind, study in patients with chronic heart failure, evaluating the effect of dapagliflozin 10 mg, compared with placebo, given once daily, in addition to standard care, on the primary composite outcome of a worsening heart failure event (hospitalization or equivalent event, i.e. an urgent heart failure visit) or cardiovascular death. Patients with and without diabetes are eligible and must have a left ventricular ejection fraction ≤ 40%, a moderately elevated N‐terminal pro B‐type natriuretic peptide level, and an estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2. The trial is event‐driven, with a target of 844 primary outcomes. Secondary outcomes include the composite of total heart failure hospitalizations (including repeat episodes), and cardiovascular death and patient‐reported outcomes. A total of 4744 patients have been randomized. Conclusions: DAPA‐HF will determine the efficacy and safety of the SGLT2 inhibitor dapagliflozin, added to conventional therapy, in a broad spectrum of patients with heart failure and reduced ejection fraction

Where Do Guidance Counsellors’ Work? : Only Your Imagination Sets the LimitsA qualitative study of career opportunities for guidance counsellors outside the education system

Även om studie- och yrkesvägledarutbildningen oftast förknippas med skolväsendet visar undersökningar att nästan varannan examinerad studie- och yrkesvägledare arbetar utanför skolväsendet. Syftet med detta arbete är att utforska utbildade studie- och yrkesvägledares karriärmöjligheter utanför skolväsendet. Syftet är även att undersöka orsakerna till dessa karriärval och dess inverkan på studie- och yrkesvägledares upplevda yrkesidentitet. Studiens frågeställningar är: (1) Hur resonerar våra informanter kring studie- och yrkesvägledares karriärmöjligheter utanför skolväsendet? (2) Vilka faktorer har påverkat deras karriärval utanför skolväsendet efter avslutad studie- och yrkesvägledarutbildning? (3) Hur ser våra informanter på sin yrkesidentitet som utbildade studie- och yrkesvägledare?. En kvalitativ metod användes och sju intervjuer genomfördes. Det empiriska materialet analyseras med hjälp av begrepp som motivationsfaktorer, hygienfaktorer, karriär/yrkesidentitet och kompetens. Studiens resultat visade på olika syn på studie- och yrkesvägledares karriärmöjligheter utanför skolväsendet. Majoriteten ansåg att studie- och yrkesvägledare har goda karriärmöjligheter; andra upplevde arbetsmarknaden utanför skolväsendet vara begränsad. Studien visade också att de viktigaste faktorerna som påverkat informanterna för att arbeta utanför skolväsendet har varit utveckling, meningsfulla arbetsuppgifter, samt ansvar, ledarskap och lön. Studien kom fram till att det fanns stora skillnader i huruvida informanterna identifierade sig som studie- och yrkesvägledare, vilket påverkades av informanternas arbetslivserfarenhet som studie- och yrkesvägledare.

Kvinnliga avdelningschefers erfrenheter av sitt ledarskap inom vården

Literature describes what it is like to be a leader in the healthcare and what is looked upon as the most characteristic quality for female leadership. Women often use a leadership technique that motivates the employee and they allow themselves to develop a humanitarian leadership. The aim of this study was to describe female head nurses’ experience of their leadership in healthcare. The collection of data has been carried out from interviews. The material was treated and analysed from a qualitative analysis of contents. The results were presented from the following areas: The significance of the central leadership, the gender perspective, the relations and the endorsement for the own leadership, and the personal leadership role. The work as a head nurse was known as an interesting and stimulating task that however often was disturbed by routine work. The most important part of the commission, that is to say to develop the work and the process had to step back. They experienced a solitude that they tried to take care of by networks within and outside the enterprise. Most of them had not been prepared for the task when they took up office and a plan for winding up after the commission is over was neither elucidated. Continued research in these areas would be a way to give the head nurses a better working environment and it would be of advantage both to co-workers and patient

Where Do Guidance Counsellors’ Work? : Only Your Imagination Sets the LimitsA qualitative study of career opportunities for guidance counsellors outside the education system

Även om studie- och yrkesvägledarutbildningen oftast förknippas med skolväsendet visar undersökningar att nästan varannan examinerad studie- och yrkesvägledare arbetar utanför skolväsendet. Syftet med detta arbete är att utforska utbildade studie- och yrkesvägledares karriärmöjligheter utanför skolväsendet. Syftet är även att undersöka orsakerna till dessa karriärval och dess inverkan på studie- och yrkesvägledares upplevda yrkesidentitet. Studiens frågeställningar är: (1) Hur resonerar våra informanter kring studie- och yrkesvägledares karriärmöjligheter utanför skolväsendet? (2) Vilka faktorer har påverkat deras karriärval utanför skolväsendet efter avslutad studie- och yrkesvägledarutbildning? (3) Hur ser våra informanter på sin yrkesidentitet som utbildade studie- och yrkesvägledare?. En kvalitativ metod användes och sju intervjuer genomfördes. Det empiriska materialet analyseras med hjälp av begrepp som motivationsfaktorer, hygienfaktorer, karriär/yrkesidentitet och kompetens. Studiens resultat visade på olika syn på studie- och yrkesvägledares karriärmöjligheter utanför skolväsendet. Majoriteten ansåg att studie- och yrkesvägledare har goda karriärmöjligheter; andra upplevde arbetsmarknaden utanför skolväsendet vara begränsad. Studien visade också att de viktigaste faktorerna som påverkat informanterna för att arbeta utanför skolväsendet har varit utveckling, meningsfulla arbetsuppgifter, samt ansvar, ledarskap och lön. Studien kom fram till att det fanns stora skillnader i huruvida informanterna identifierade sig som studie- och yrkesvägledare, vilket påverkades av informanternas arbetslivserfarenhet som studie- och yrkesvägledare.