Competency frameworks, nursing perspectives, and interdisciplinary collaborations for good patient care: Delineating boundaries

Abstract: To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. These are some of the reasons behind current movements to develop competency frameworks that can enhance cross‐disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care

How to treat stiffness after proximal humeral fractures?

Shoulder stiffness is a frequent complication after proximal humeral fractures treated with or without surgery. Shoulder stiffness is associated with high rates of absence from work and a significant financial burden for the healthcare system. Secondary stiffness is characterized by additional extracapsular adhesions, including subacromial, subcoracoid, and subdeltoid spaces, usually derived from post-fracture or post-surgical extraarticular hematomas. Several secondary causes may coexist with capsular and extracapsular adhesions decreasing the shoulder motion, such as malunion, nonunion, metalwork failure, infection, and osteoarthritis, among others. Conservative treatment, usually prescribed for primary shoulder stiffness, has shown unfavorable results in secondary stiffness, and surgical intervention may be required. Surgical interventions need to be patient-specific. Usually, open or arthroscopic fibro-arthrolysis and subacromial release are performed, together with plate removal and biceps tenotomy/tenodesis. In severe osteoarthritis, shoulder replacement may be indicated. Ruling out infection is recommended in every case

Multiplexed gas spectroscopy using tunable VCSELs

Detection and identification of gas species using tunable laser diode laser absorption spectroscopy has been performed using vertical cavity surface emitting lasers (VCSEL). Two detection methods are compared: direct absorbance and wavelength modulation spectroscopy (WMS). In the first, the output of a DC-based laser is directly monitored to detect for any quench at the targeted specie wavelength. In the latter, the emission wavelength of the laser is modulated by applying a sinusoidal component on the drive current of frequency {omega}, and measuring the harmonics component (2{omega}) of the photo-detected current. This method shows a better sensitivity measured as signal to noise ratio, and is less susceptible to interference effects such as scattering or fouling. Gas detection was initially performed at room temperature and atmospheric conditions using VCSELs of emission wavelength 763 nm for oxygen and 1392 nm for water, scanning over a range of approximately 10 nm, sufficient to cover 5-10 gas specific absorption lines that enable identification and quantization of gas composition. The amplitude and frequency modulation parameters were optimized for each detected gas species, by performing two dimensional sweeps for both tuning current and either amplitude or frequency, respectively. We found that the highest detected signal is observed for a wavelength modulation amplitude equal to the width of the gas absorbance lines, in good agreement with theoretical calculations, and for modulation frequencies below the time response of the lasers (<50KHz). In conclusion, we will discuss limit of detection studies and further implementation and packaging of VCSELs in diode arrays for continuous and simultaneous monitoring of multiple species in gaseous mixtures

Application of layered poly (L-lactic acid) cell free scaffold in a rabbit rotator cuff defect model

<p>Abstract</p> <p>Background</p> <p>This study evaluated the application of a layered cell free poly (L-lactic acid) (PLLA) scaffold to regenerate an infraspinatus tendon defect in a rabbit model. We hypothesized that PLLA scaffold without cultivated cells would lead to regeneration of tissue with mechanical properties similar to reattached infraspinatus without tendon defects.</p> <p>Methods</p> <p>Layered PLLA fabric with a smooth surface on one side and a pile-finished surface on the other side was used. Novel form of layered PLLA scaffold was created by superimposing 2 PLLA fabrics. Defects of the infraspinatus tendon were created in 32 rabbits and the PLLA scaffolds were transplanted, four rabbits were used as normal control. Contralateral infraspinatus tendons were reattached to humeral head without scaffold implantation. Histological and mechanical evaluations were performed at 4, 8, and 16 weeks after operation.</p> <p>Results</p> <p>At 4 weeks postoperatively, cell migration was observed in the interstice of the PLLA fibers. Regenerated tissue was directly connected to the bone composed mainly of type III collagen, at 16 weeks postoperatively. The ultimate failure load increased in a time-dependent manner and no statistical difference was seen between normal infraspinatus tendon and scaffold group at 8 and 16 weeks postoperatively. There were no differences between scaffold group and reattach group at each time of point. The stiffness did not improve significantly in both groups.</p> <p>Conclusions</p> <p>A novel form of layered PLLA scaffold has the potential to induce cell migration into the scaffold and to bridge the tendon defect with mechanical properties similar to reattached infraspinatus tendon model.</p