Mobility deficit – Rehabilitate, an opportunity for functionality

There are many pathological conditions that cause mobility deficits and that ultimately influence someone’s autonomy.Aims: to evaluate patients with mobility deficits functional status; to implement a Rehabilitation Nursing intervention plan; to monitor health gains through mobility deficits rehabilitation.Conclusion: Early intervention and the implementation of a nursing rehabilitation intervention plan results in health gains (direct or indirect), decreases the risk of developing Pressure Ulcers (PU) and the risk of developing a situation of immobility that affects patients’ autonomy and quality of life

An Overview of Antithrombotics in Ischemic Stroke

The use of antithrombotic medications is an important component of ischemic stroke treatment and prevention. This article reviews the evidence for best practices for antithrombotic use in stroke with focused discussion on the specific agents used to treat and prevent stroke

Telehealth Stroke Education For Rural Elderly Virginians

Objective: Stroke is a prevalent condition found in elderly, rural populations. However, stroke education, which can be effective in addressing the risks, is often difficult to provide in these remote regions. The objective of this study is to evaluate the effectiveness of delivering stroke education to elderly individuals through telehealth versus in-person stroke prevention education methods. Materials and Methods: A quasi-experimental nonequivalent control group design was used in this study. A convenience sample of 11 elderly adults (36% men, 64% women) with a mean age of 70 was selected from an Appalachian Program for All Inclusive Care for the Elderly (day care) facility. Subjects completed preintervention surveys, received a 20-min group in-person or telehealth delivered education session, and then completed the postintervention surveys. Results: Satisfaction with delivery method and post-education knowledge was equivalent between the two groups. Knowledge increased in both groups after the educational programs. Likelihood of reducing risk factors showed no differences pre-posttest. However, there were significant improvements in the pre-post likelihood scores of the telehealth group in contrast to the in-person group. Conclusions: This project provided a rural, high-risk population access to telehealth stroke education, thus enabling these individuals to receive education at a distance from experts in the field. The telehealth program was found to be equivalent to in-person stroke education in regards to satisfaction, knowledge, and likelihood of making changes to decrease vascular risk factors. The study demonstrated feasibility in providing effective stroke education through telehealth, thus suggesting an often overlooked route for providing patient education at a distance

Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries

Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones – antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed

Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness

BACKGROUND: There are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU). METHODS: In a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention. The primary end point was the number of days alive without delirium or coma during the 14-day intervention period. Secondary end points included 30-day and 90-day survival, time to freedom from mechanical ventilation, and time to ICU and hospital discharge. Safety end points included extrapyramidal symptoms and excessive sedation. RESULTS: Written informed consent was obtained from 1183 patients or their authorized representatives. Delirium developed in 566 patients (48%), of whom 89% had hypoactive delirium and 11% had hyperactive delirium. Of the 566 patients, 184 were randomly assigned to receive placebo, 192 to receive haloperidol, and 190 to receive ziprasidone. The median duration of exposure to a trial drug or placebo was 4 days (interquartile range, 3 to 7). The median number of days alive without delirium or coma was 8.5 (95% confidence interval [CI], 5.6 to 9.9) in the placebo group, 7.9 (95% CI, 4.4 to 9.6) in the haloperidol group, and 8.7 (95% CI, 5.9 to 10.0) in the ziprasidone group (P=0.26 for overall effect across trial groups). The use of haloperidol or ziprasidone, as compared with placebo, had no significant effect on the primary end point (odds ratios, 0.88 [95% CI, 0.64 to 1.21] and 1.04 [95% CI, 0.73 to 1.48], respectively). There were no significant between-group differences with respect to the secondary end points or the frequency of extrapyramidal symptoms. CONCLUSIONS: The use of haloperidol or ziprasidone, as compared with placebo, in patients with acute respiratory failure or shock and hypoactive or hyperactive delirium in the ICU did not significantly alter the duration of delirium. (Funded by the National Institutes of Health and the VA Geriatric Research Education and Clinical Center; MIND-USA ClinicalTrials.gov number, NCT01211522 .)

Marine Volcaniclastic Record of Early Arc Evolution in the Eastern Ritter Range Pendant, Central Sierra Nevada, California

Marine volcaniclastic rocks in the Sierra Nevada preserve a critical record of silicic magmatism in the early Sierra Nevada volcanic arc, and this magmatic record provides precise minimum age constraints on subduction inception and tectonic evolution of the early Mesozoic Cordilleran convergent margin at this latitude. New zircon Pb/U ages from the Ritter Range pendant and regional correlations indicate arc inception no later than mid‐Triassic time between 37 and 38°N. The regional first‐order felsic magma eruption rate as recorded by marine volcanic arc rocks was episodic, with distinct pulses of ignimbrite emplacement at ca. 221 to 216 Ma and 174 to 167 Ma. Ignimbrites range from dacite to rhyolite in bulk composition, and are petrographically similar to modern arc‐type, monotonous intermediate dacite or phenocryst‐poor, low‐silica rhyolite. Zircon trace element geochemistry indicates that Jurassic silicic melts were consistently Ti‐ and light rare earth‐enriched and U‐depleted in comparison to Triassic melts of the juvenile arc, suggesting Jurassic silicic melts were hotter, drier, and derived from distinct lithospheric sources not tapped in the juvenile stage of arc construction. Pulses of ignimbrite deposition were coeval with granodioritic to granitic components of the underlying early Mesozoic Sierra Nevada batholith, suggesting explosive silicic volcanism and batholith construction were closely coupled at one‐ to two‐million‐year time scales

The EU’s stability-democracy dilemma in the context of the problematic accession of the Western Balkan states

The accession of the remaining six Western Balkan states into the EU is shrouded in much uncertainty. Despite Croatia finally traversing the difficult path to eventual membership in 2013, not one of the remaining Western Balkan countries can claim to be on a definite pathway to membership today. An increasingly prevalent argument is that the EU’s engagement with its neighbourhoods has faltered because its strategies have been undermined by an inherent stability-democracy dilemma. This article examines the EU’s engagement with the Western Balkans and finds that although the EU tried to transcend this dilemma, in reality, a tension between stability and democracy was present with the former generally receiving more attention in policymaking. This led to not only a lack of tangible democratization amongst the Western Balkan states, but further uncertainty about their accession prospects. By 2018, it was clear that the EU’s engagement with the Western Balkans needed a rethink, resulting in a new approach: the ‘Six Flagship Initiatives’. However, given the apprehensiveness of some member states (especially France) coupled with the presence of outsiders such as Russia and China in the area, the accession prospects of the six non-EU Western Balkan states remains blurred