The Role of the Clinical Educator in Evaluating Nursing Competency

INTRODUCTION: Evaluation of nursing competency is critical to assuring patient safety and maintaining high professional standards in the practice of nursing. All nurses must graduate from an approved nursing program and successfully pass the national board exam before receiving initial licensure. State boards of nursing fulfill the role of gatekeeper, seeking to assure the public that nurses provide safe, competent care. In turn, high public awareness and patient advocacy initiatives require close monitoring of nursing competency. [See PDF for complete abstract

Telerehabilitation services for stroke

Publisher version made available in accordance with the publisher's policy. This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy. 'This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2013, Issue 12. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.’Background Telerehabilitation is an alternative way of delivering rehabilitation services. Information and communication technologies are used to facilitate communication between the healthcare professional and the patient in a remote location. The use of telerehabilitation is becoming more viable as the speed and sophistication of communication technologies improve. However, it is currently unclear how effective this model of delivery is relative to rehabilitation delivered face-to-face. Objectives To determine whether the use of telerehabilitation leads to improved ability to perform activities of daily living amongst stroke survivors when compared with (1) in-person rehabilitation (when the clinician and the patient are at the same physical location and rehabilitation is provided face-to-face); or (2) no rehabilitation. Secondary objectives were to determine whether use of telerehabilitation leads to greater independence in self care and domestic life and improved mobility, health-related quality of life, upper limb function, cognitive function or functional communication when compared with in-person rehabilitation and no rehabilitation. Additionally, we aimed to report on the presence of adverse events, cost-effectiveness, feasibility and levels of user satisfaction associated with telerehabilitation interventions. Search methods We searched the Cochrane Stroke Group Trials Register (November 2012), the Cochrane Effective Practice and Organization of Care Group Trials Register (November 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 11, 2012), MEDLINE (1950 to November 2012), EMBASE (1980 to November 2012) and eight additional databases. We searched trial registries, conference proceedings and reference lists. Selection criteria Randomised controlled trials (RCTs) of telerehabilitation in stroke. We included studies that compared telerehabilitation with in-person rehabilitation or no rehabilitation. In addition, we synthesised and described the results of RCTs that compared two different methods of delivering telerehabilitation services without an alternative group. We included rehabilitation programmes that used a combination of telerehabilitation and in-person rehabilitation provided that the greater proportion of intervention was provided via telerehabilitation. Data collection and analysis Two review authors independently identified trials on the basis of prespecified inclusion criteria, extracted data and assessed risk of bias. A third review author moderated any disagreements. The review authors contacted investigators to ask for missing information. Main results We included in the review 10 trials involving a total of 933 participants. The studies were generally small, and reporting quality was often inadequate, particularly in relation to blinding of outcome assessors and concealment of allocation. Selective outcome reporting was apparent in several studies. Study interventions and comparisons varied, meaning that in most cases, it was inappropriate to pool studies. Intervention approaches included upper limb training, lower limb and mobility retraining, case management and caregiver support. Most studies were conducted with people in the chronic phase following stroke. Primary outcome: no statistically significant results for independence in activities of daily living (based on two studies with 661 participants) were noted when a case management intervention was evaluated. Secondary outcomes: no statistically significant results for upper limb function (based on two studies with 46 participants) were observed when a computer programme was used to remotely retrain upper limb function. Evidence was insufficient to draw conclusions on the effects of the intervention on mobility, health-related quality of life or participant satisfaction with the intervention. No studies evaluated the cost-effectiveness of telerehabilitation. No studies reported on the occurrence of adverse events within the studies. Authors' conclusions We found insufficient evidence to reach conclusions about the effectiveness of telerehabilitation after stroke. Moreover, we were unable to find any randomised trials that included an evaluation of cost-effectiveness. Which intervention approaches are most appropriately adapted to a telerehabilitation approach remain unclear, as does the best way to utilise this approach

A Bespoke Kinect Stepping Exergame for Improving Physical and Cognitive Function in Older People: A Pilot Study

Background: Systematic review evidence has shown that step training reduces the number of falls in older people by half. This study investigated the feasibility and effectiveness of a bespoke Kinect stepping exergame in an unsupervised home-based setting. Materials and methods: An uncontrolled pilot trial was conducted in 12 community-dwelling older adults (mean age 79.3 ± 8.7 years, 10 females). The stepping game comprised rapid stepping, attention, and response inhibition. Participants were recommended to exercise unsupervised at home for a minimum of three 20-minute sessions per week over the 12-week study period. The outcome measures were choice stepping reaction time (CSRT) (main outcome measure), standing balance, gait speed, five-time sit-to-stand (STS), timed up and go (TUG) performance, and neuropsychological function (attention: letter-digit and executive function:Stroop tests) assessed at baseline, 4 weeks, 8 weeks, and trial end (12 weeks). Results: Ten participants (83%) completed the trial and reassessments. A median 8.2 20-minute sessions were completed and no adverse events were reported. Across the trial period, participants showed significant improvements in CSRT (11%), TUG (13%), gait speed (29%), standing balance (7%), and STS (24%) performance (all P < 0.05). There were also nonsignificant, but meaningful, improvements for the letter-digit (13%) and Stroop tests (15%). Conclusions: This study found that a bespoke Kinect step training program was safe and feasible for older people to undertake unsupervised at home and led to improvements in stepping, standing balance, gait speed, and mobility. The home-based step training program could therefore be included in exercise programs designed to prevent falls

Experimental Realization of an Optical One-Way Barrier for Neutral Atoms

We demonstrate an asymmetric optical potential barrier for ultracold 87 Rb atoms using laser light tuned near the D_2 optical transition. Such a one-way barrier, where atoms impinging on one side are transmitted but reflected from the other, is a realization of Maxwell's demon and has important implications for cooling atoms and molecules not amenable to standard laser-cooling techniques. In our experiment, atoms are confined to a far-detuned dipole trap consisting of a single focused Gaussian beam, which is divided near the focus by the barrier. The one-way barrier consists of two focused laser beams oriented almost normal to the dipole-trap axis. The first beam is tuned to have a red (blue) detuning from the F=1 -> F' (F=2 -> F') hyperfine transitions, and thus presents a barrier only for atoms in the F=2 ground state, while letting F=1 atoms pass. The second beam pumps the atoms to F=2 on the reflecting side of the barrier, thus producing the asymmetry.Comment: 5 pages, 4 figures; includes changes to address referee comment

Evaluating uncertainties in the calibration of isotopic reference materials and multi-element isotopic tracers (EARTHTIME Tracer Calibration Part II)

A statistical approach to evaluating uncertainties in the calibration of multi-element isotopic tracers has been developed and applied to determining the isotopic composition of mixed U-Pb (202Pb-205Pb-233U-235U) tracers used for accurate isotope dilution U-Pb geochronology. Our experiment, part of the EARTHTIME initiative, directly links the tracer calibration to first-principles measurements of mass and purity that are all traceable to SI units, thereby quantifying the accuracy and precision of U-Pb dates in absolute time. The calibration incorporates new more accurate and precise purity measurements for a number of commonly used Pb and U reference materials, and requires inter-relating their isotopic compositions and uncertainties. Similar methods can be used for other isotope systems that utilize multiple isotopic standards for calibration purposes. We also detail the inter-calibration of three publicly available U-Pb gravimetric solutions, which can be used to bring the same first-principles traceability to in-house U-Pb tracers from other laboratories. Accounting for uncertainty correlations in the tracer isotope ratios yields a tracer calibration contribution to the relative uncertainty of a 206Pb/238U date that is only half of the relative uncertainty in the 235U/205Pb ratio of the tracer, which was historically used to approximate the tracer related uncertainty contribution to 206Pb/238U dates. The tracer uncertainty contribution to 206Pb/238U dates has in this way been reduced to <300 ppm when using the EARTHTIME and similarly calibrated tracers

Isotopic composition (238U/235U) of some commonly used uranium reference materials

We have determined 238U/235U ratios for a suite of commonly used natural (CRM 112a, SRM 950a, and HU-1) and synthetic (IRMM 184 and CRM U500) uranium reference materials by thermal ionisation mass-spectrometry (TIMS) using the IRMM 3636 233U-236U double spike to accurately correct for mass fractionation. Total uncertainty on the 238U/235U determinations is estimated to be < 0.02% (2σ). These natural 238U/235U values are different from the widely used ‘consensus’ value (137.88), with each standard having lower 238U/235U values by up to 0.08%. The 238U/235U ratio determined for CRM U500 and IRMM 184 are within error of their certified values; however, the total uncertainty for CRM U500 is substantially reduced (from 0.1% to 0.02%). These reference materials are commonly used to assess mass spectrometer performance and accuracy, calibrate isotope tracers employed in U, U-Th and U-Pb isotopic studies, and as a reference for terrestrial and meteoritic 238U/235U variations. These new 238U/235U values will thus provide greater accuracy and reduced uncertainty for a wide variety of isotopic determinations

Quantitative ultrasound biomicroscopy for the analysis of healthy and repair cartilage tissue

The increasing spectrum of different cartilage repair strategies requires the introduction of adequate non-destructive methods to analyse their outcome in-vivo, i.e. arthroscopically. The validity of non-destructive quantitative ultrasound biomicroscopy (UBM) was investigated in knee joints of five miniature pigs. After 12 weeks, six 5-mm defects, treated with different cartilage repair approaches, provided tissues with different structural qualities. Healthy articular cartilage from each contralateral unoperated knee joint served as a control. The reflected and backscattered ultrasound signals were processed to estimate the integrated reflection coefficient (IRC) and apparent integrated backscatter (AIB) parameters. The cartilage repair tissues were additionally assessed biomechanically by cyclic indentation, histomorphologically and immunohistochemically. UBM allowed high-resolution visualisation of the structure of the joint surface and subchondral bone plate, as well as determination of the cartilage thickness and demonstrated distinct differences between healthy cartilage and the different repair cartilage tissues with significant higher IRC values and a steeper negative slope of the depth-dependent backscatter amplitude AIBslope for healthy cartilage. Multimodal analyses revealed associations between IRC and the indentation stiffness. Furthermore, AIBslope and AIB at the cartilage-bone boundary (AIBdC) were associated with the quality of the repair matrices and the subchondral bone plate, respectively. This ex-vivo pilot study confirms that UBM can provide detailed imaging of articular cartilage and the subchondral bone interface also in repaired cartilage defects, and furthermore, contributes in certain aspects to a basal functional characterization of various forms of cartilage repair tissues. UBM could be further established to be applied arthroscopically in-vivo

Experimental diagenesis: insights into aragonite to calcite transformation of Arctica islandica shells by hydrothermal treatment

Abstract. Biomineralised hard parts form the most important physical fossil record of past environmental conditions. However, living organisms are not in thermodynamic equilibrium with their environment and create local chemical compartments within their bodies where physiologic processes such as biomineralisation take place. In generating their mineralised hard parts, most marine invertebrates produce metastable aragonite rather than the stable polymorph of CaCO3, calcite. After death of the organism the physiological conditions, which were present during biomineralisation, are not sustained any further and the system moves toward inorganic equilibrium with the surrounding inorganic geological system. Thus, during diagenesis the original biogenic structure of aragonitic tissue disappears and is replaced by inorganic structural features