ABSTRACT
OBJECTIVE: To investigate the role of participant level of effort (LoE) on outcome in post-acute brain injury rehabilitation with the hypothesis that greater effort is associated with more positive outcomes. DESIGN: Observational cohort study. SETTING: Comprehensive integrated rehabilitation program for brain injury within a skilled nursing facility. PARTICIPANTS: Consecutive admissions with acquired brain injury (N=101). INTERVENTIONS: Individualized interdisciplinary brain injury rehabilitation; therapist rating of participant LoE with Acquired Brain Injury LoE Scale (ABI-LoES) during physical therapy, occupational therapy, and speech and language pathology sessions. MAIN OUTCOME MEASURES: Mayo-Portland Adaptability Inventory, fourth edition (MPAI-4); Supervision Rating Scale (SRS). RESULTS: Linear regression showed that discharge MPAI-4 Total T scores were significantly associated with mean ABI-LoES rating, admission MPAI-4 Total T scores, age at admission, and days from injury but not with standard deviation of ABI-LoES rating, sex, injury type, length of stay, or treatment before or during the COVID-19 pandemic. Discharge SRS scores were significantly associated with mean ABI-LoES rating, admission SRS scores, and age. A 1-unit increase in mean ABI-LoES rating was associated with 5.1-unit lower discharge MPAI-4 Total T scores and 1.5 lower discharge SRS scores, after controlling for other variables. Logistic regression showed that the odds of achieving a minimal clinically important difference on the MPAI-4 were 8.34 times higher with each 1-unit increase in mean ABI-LoES rating after controlling for other variables. Admission MPAI-4 was negatively associated with mean ABI-LoES rating (ß=-0.07, t=-8.85, P<.0001). CONCLUSIONS: After controlling for nonmodifiable variables, average ABI-LoES rating is positively associated with outcome. Initial level of disability is negatively associated with mean ABI-LoES rating.
ABSTRACT
The COVID-19 pandemic has placed nursing at the forefront of public attention across the globe and has highlighted the criti-cal role of nursing in healthcare service provision. Advanced practice nursing has been recognized for more than 50 years, but the rate of its growth and development varies significantly across the world. One of the key aims of the Better Health Programme Mexico, which commenced in 2019, was to develop advanced practice nursing in Mexico. The Programme was based on the United Kingdom model, where advanced practice nursing has been in place-though not subject to statutory regulation-for more than 40 years. The aim of this article is to compare the frameworks that underpin advanced practice nursing in the United Kingdom and in Mexico. In the present article, current practice in both countries was researched, and the structure, systems, and processes relating to nursing regulation and the frameworks to support advanced practice nursing were examined. A gap analysis report undertaken as part of the Better Health Programme identified challenges in developing advanced practice nursing in Mexico and the United Kingdom and highlighted the need for stakeholders to agree on an approach toward a rigorous regulatory framework in both settings. In summary, this article highlights the issues facing nurses and regulators in both countries in terms of advanced practice nursing and identifies strategies that can be used to strengthen the advanced practice nurse role.
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The Covid-19 epidemic has resulted in many workers having prolonged periods away from work, opening an opportunity to clarify the effect of occupational exposures on workers with equivocal diagnoses, and the effectiveness of previous relocation of workers with confirmed occupational asthma. However, investigations have been confounded by many clinics and physiology departments not running during the epidemic. We report a cluster of cases from an office building where previous investigations including two workplace visits with the ventilation engineer and a workplace challenge had been equivocal, but where prolonged periods away from work clarified the occupational cause for the symptoms. The index case was an intelligence officer (forensic computing) who developed cough and recurrent episodes of 'bronchitis' and voice change within weeks of moving into a large air-conditioned office with air supply delivered from the suspended floor and separate cooling delivered through the ceiling. Oasys ABC analysis of serial PEF records showed one positive timepoint (outside the 95% CI for days off work) in the evening after work but a negative ABC score and normal diurnal variation. A second record showed similar results (one late positive timepoint) making it highly likely that the changes were associated with work. Figure 1 shows the mean 2-hourly PEF on workdays (crosses) and days away from work (squares). The lower grey line shows the 95% CI for days away from work from the Oasys plotter. The mean of 11 workdays between 1830-20.30 is significantly lower than the 16 days away from work. At least two others working nearby were affected, a computer programmer had similar work-related symptoms and a data information officer more obviously asthmatic symptoms. The building has been closed during the epidemic and all substantially improved and are currently repeating PEF measurements, which are the only physiological tests readily available at present. The nature of the disease in the index case remains unclear. The PEF changes could be the very earliest indication of occupational asthma, could be due to hypersensitivity pneumonitis, which usually results in bigger PEF changes, or could represent occupational upper airways disease, but the late fall in PEF is unusual.
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S110 Figure 1
ABSTRACT
Despite increasing attention on air travel’s significant and disproportionate contribution to climate change, meaningful reduction in consumer demand is nowhere in sight. Taking a consumer behaviour approach, this study adopts Katz’s attitude functions theory as a framework to better understand factors that shape attitudes towards discretionary air travel amidst growing climate concern. Interviews with Australian travellers indicate that the functions of air travel attitudes are utilitarian, value-expressive, and social-adjustive. These functions serve independent yet interrelated purposes. The ego-defense function was generally dormant until triggered when climate change was discussed directly, but then served as a mechanism for protecting the value-expressive and social adjustive functions. The timeliness and importance of the paper’s insights have been amplified by the need to rebuild post-COVID aviation for a climate safe future. © 2020 Informa UK Limited, trading as Taylor & Francis Group.