Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study

BackgroundThe Western Pacific region constitutes one-quarter of the world's population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses' professional development within the Western Pacific region.MethodsThis study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 - December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare.ResultsThirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research.ConclusionsDemand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments

Surgical treatment of confirmed intratendinous rotator cuff tears: retrospective analysis after an average of eight years of follow-up.

HYPOTHESIS: This study evaluated clinical features, diagnostic techniques, and summarized the results of open repair in a series of surgically confirmed cases of intratendinous rotator cuff tears. MATERIALS AND METHODS: Between 1986 and 1999, 19 patients (17 men and 2 women) with intratendinous rotator cuff tears underwent surgery. Clinical findings, diagnostic results, and surgical findings were evaluated. The shoulder scores of the Japanese Orthopaedic Association (JOA) and the American Shoulder and Elbow Surgeons (ASES) were used to assess recovery at an average of 92 months (range, 31-231 months). RESULTS: All patients had symptoms consistent with rotator cuff tendonitis. History of overt trauma was noted in 16 (84.2%). Neither ultrasound nor magnetic resonance imaging proved reliable for preoperative diagnosis. Surgery was performed if at least 6 months of conservative treatment, such as rest, heat, and physical therapies, failed. The definitive diagnosis was established intraoperatively with a longitudinal split along the fibers of the supraspinatus tendon. None of the intratendinous lesions had communication to the subacromial bursa or the glenohumeral joint. Excision of the intratendinous tear and repair resulted in improvement in pain and total scores of both JOA (66.8 vs 94.1) and ASES (37.1 vs 91.0). CONCLUSIONS: Intratendinous rotator cuff tears were difficult to diagnose preoperatively. Our data suggest that conservative treatment failed, anterior acromioplasty and excision of the diseased portion of the tendon, followed by tenorrhaphy, proved effective. Satisfactory outcomes were achieved in 18 patients (94.7%) in this series

Surgical treatment of confirmed intratendinous rotator cuff tears: retrospective analysis after an average of eight years of follow-up.

HYPOTHESIS: This study evaluated clinical features, diagnostic techniques, and summarized the results of open repair in a series of surgically confirmed cases of intratendinous rotator cuff tears. MATERIALS AND METHODS: Between 1986 and 1999, 19 patients (17 men and 2 women) with intratendinous rotator cuff tears underwent surgery. Clinical findings, diagnostic results, and surgical findings were evaluated. The shoulder scores of the Japanese Orthopaedic Association (JOA) and the American Shoulder and Elbow Surgeons (ASES) were used to assess recovery at an average of 92 months (range, 31-231 months). RESULTS: All patients had symptoms consistent with rotator cuff tendonitis. History of overt trauma was noted in 16 (84.2%). Neither ultrasound nor magnetic resonance imaging proved reliable for preoperative diagnosis. Surgery was performed if at least 6 months of conservative treatment, such as rest, heat, and physical therapies, failed. The definitive diagnosis was established intraoperatively with a longitudinal split along the fibers of the supraspinatus tendon. None of the intratendinous lesions had communication to the subacromial bursa or the glenohumeral joint. Excision of the intratendinous tear and repair resulted in improvement in pain and total scores of both JOA (66.8 vs 94.1) and ASES (37.1 vs 91.0). CONCLUSIONS: Intratendinous rotator cuff tears were difficult to diagnose preoperatively. Our data suggest that conservative treatment failed, anterior acromioplasty and excision of the diseased portion of the tendon, followed by tenorrhaphy, proved effective. Satisfactory outcomes were achieved in 18 patients (94.7%) in this series

Clinical results of a surgical technique using endobuttons for complete tendon tear of pectoralis major muscle: report of five cases.

BACKGROUND: We herein describe a surgical technique for the repair of complete tear of the pectoralis major (PM) tendon using endobuttons to strengthen initial fixation. METHODS: Five male patients (3 judo players, 1 martial arts player, and 1 body builder) were treated within 2 weeks of sustaining complete tear of the PM tendon. Average age at surgery and follow-up period were 28.4 years (range, 23-33) and 28.8 months (range, 24-36). A rectangular bone trough (about 1 × 4 cm) was created on the humerus at the insertion of the distal PM tendon. The tendon stump was introduced into this trough, and fixed to the reverse side of the humeral cortex using endobuttons and non-absorbable suture. Clinical assessment of re-tear was examined by MRI. Shoulder range of motion (ROM), outcome of treatment, and isometric power were measured at final follow-up. RESULTS: There were no clinical re-tears, and MRI findings also showed continuity of the PM tendon in all cases at final follow-up. Average ROM did not differ significantly between the affected and unaffected shoulders. The clinical outcomes at final follow-up were excellent (4/5 cases) or good (1/5). In addition, postoperative isometric power in horizontal flexion of the affected shoulder showed complete recovery when compared with the unaffected side. CONCLUSIONS: Satisfactory outcomes could be obtained when surgery using the endobutton technique was performed within 2 weeks after complete tear of the PM tendon. Therefore, our new technique appears promising as a useful method to treat complete tear of the PM tendon

Control of subjective depth on 3-D displays by a quantified monocular depth cue

Abstract -This paper considers the architecture and the effectiveness of new algorithms that control the subjective depth on 3-D displays by modulating the contrast of stereoscopic pictures on the basis of a quantified monocular depth cue. First, a psychophysical experiment to quantify the relationship between contrast and subjective depth was conducted. This experimental result shows that the higher the contrast, the nearer the object will be perceived, corresponding to the qualitative relationship. Second, this result was applied to image-processing algorithms that expand or contract the subjective depth of stereoscopic pictures. Subjective assessments to verify the effectiveness of the algorithms were also conducted. The results suggest that the algorithms will allow viewers to experience a highly realistic sensation. Keywords -3-D display, subjective depth, monocular-depth cue, contrast, stereoscopic picture. DOI # 10.1889/JSID19.1.1 Introduction Observing the real world, human beings will perceive depth on the basis of various depth cues. The depth cues can be classified into binocular depth cues, such as binocular disparity and convergence, and monocular depth cues, such as aerial perspective and occlusion. Being one of the most effective cues in perceiving depth, binocular disparity can arouse a feeling of highly realistic and dramatic sensation. As a result, some pictures have greater binocular disparity to attract an audience. However, some studies have also revealed that excessive binocular disparity causes visual fatigue or sickness. 1 To avoid these symptoms, the binocular disparity should be reduced so that most viewers feel comfortable while watching stereoscopic pictures, but those with limited binocular disparity sometimes fail to attract observers. We have considered monocular depth cues to be effective means in order to overcome this contradiction. The cues include aerial perspective and occlusion. In particular, aerial perspective has often been used as a pictorial technique in the Mona Lisa and other paintings. This comprises several factors such as contrast, spatial frequency, and saturation. A previous study on the relationship between contrast and subjective depth 2 shows that the higher the contrast between an object and its background in a picture, the nearer the object is perceived to a viewer. This relationship suggests that the technique of aerial perspective can be applied to control of subjective depth. The purpose of this paper is to examine the architecture and the effectiveness of our algorithms which control the subjective depth on 3-D displays by modulating the contrast of stereoscopic pictures on the basis of a quantified monocular depth cue. First, results of psychophysical experiments for the quantification are described. Second, algorithms with the quantified relation are explained. Third, equipment and methods used for a subjective assessment are mentioned. Pictures processed by the proposed algorithms are also presented. Finally, results of the assessment are shown and discussed. Quantification of depth cue To quantify the relationship between the contrast of a picture and the subjective depth, we had conducted some psychophysical experiments. D high = 30.0 * log 10 (C eff ) + 4.2, where D low and D high are the approximate subjective depths in the spatial frequencies equal to or lower than 2 cpd an

A bibliometric analysis of the global research trend in child maltreatment

10.3390/ijerph15071456International Journal of Environmental Research and Public Health157145