The Interaction of Compliance and Activation on the Force-Length Operating Range and Force Generating Capacity of Skeletal Muscle: A Computational Study using a Guinea Fowl Musculoskeletal Model.

A muscle's performance is influenced by where it operates on its force-length (F-L) curve. Here we explore how activation and tendon compliance interact to influence muscle operating lengths and force-generating capacity. To study this, we built a musculoskeletal model of the lower limb of the guinea fowl and simulated the F-L operating range during fixed-end fixed-posture contractions for 39 actuators under thousands of combinations of activation and posture using three different muscle models: Muscles with non-compliant tendons, muscles with compliant tendons but no activation-dependent shift in optimal fiber length (L0), and muscles with both compliant tendons and activation-dependent shifts in L0. We found that activation-dependent effects altered muscle fiber lengths up to 40% and increased or decreased force capacity by up to 50% during fixed-end contractions. Typically, activation-compliance effects reduce muscle force and are dominated by the effects of tendon compliance at high activations. At low activation, however, activation-dependent shifts in L0 are equally important and can result in relative force changes for low compliance muscles of up to 60%. There are regions of the F-L curve in which muscles are most sensitive to compliance and there are troughs of influence where these factors have little effect. These regions are hard to predict, though, because the magnitude and location of these areas of high and low sensitivity shift with compliance level. In this study we provide a map for when these effects will meaningfully influence force capacity and an example of their contributions to force production during a static task, namely standing.

A Interação de Conformidade e Ativação na Faixa de Operação Força-Comprimento e Capacidade de Geração de Força do Músculo Esquelético: Um Estudo Computacional Usando um Modelo Musculoesquelético de Galinhas-D'angola O desempenho muscular é influenciado por onde ele opera na sua curva de força-comprimento. Aqui, exploramos como a ativação e a conformidade do tendão interagem para influenciar os comprimentos musculares e a capacidade de geração de força. Para estudar isso, construímos um modelo musculoesquelético do membro inferior da galinha-d'angola e simulamos a faixa de operação força-comprimento durante contrações fixas de postura e extremidade para 39 atuadores sob milhares de combinações de ativação e postura usando três modelos musculares diferentes: músculos com tendões não-complacentes, músculos com tendões complacentes, mas sem desvio dependente de ativação no comprimento ideal de fibra (L0), e músculos com tendões complacentes e desvios dependentes de ativação em L0. Descobrimos que os efeitos dependentes da ativação alteraram os comprimentos da fibra muscular em até 40% e aumentaram ou diminuíram a capacidade de força em até 50% durante as contrações de extremidade fixas. Normalmente, os efeitos de ativação e conformidade reduzem a força muscular e são dominados pelos efeitos de complacência do tendão em altas ativações. Em baixa ativação, no entanto, desvios dependentes de ativação em L0 são igualmente importantes e podem resultar em mudanças de força relativas de até 60% para músculos de baixa complacência. Existem regiões da curva de força-comprimento em que os músculos são mais sensíveis à complacência e há baixas de influência onde esses fatores têm pouco efeito. Essas regiões são difíceis de prever porque a magnitude e a localização dessas áreas de alta e baixa sensibilidade mudam com o nível de conformidade. Neste estudo, fornecemos um mapa para quando esses efeitos influenciarão significativamente a capacidade de força e um exemplo de suas contribuições para a produção de forças durante uma tarefa estática, ou seja, em pé. Translated to Portuguese by G. Sobral (gabisobral@gmail.com).

Service users' experiences of 'as needed' psychotropic medications in acute mental healthcare settings.

AIMS: This paper reports a study which aimed to explore service users' views and experiences of the processes associated with the prescription and administration of 'as needed' (p.r.n.) psychotropic medications in acute mental health settings. BACKGROUND: Few studies have explored the use of 'as needed' medication in acute mental healthcare settings. Such medication is frequently requested by service users, but the literature is unclear about the reasons for these requests or service users' experiences of this treatment. METHOD: A convenience sample of 22 inpatients participated in face-to-face semi-structured interviews exploring their treatment experiences of 'as needed' psychotropic medication in acute mental health settings in a large city in the United Kingdom in 2005. Thematic content analysis was carried out. RESULTS: Interviewees highlighted the value of 'as needed' medications. However, the process associated with their use was perceived as confusing and stigmatizing. Service users had limited understanding of and felt unsupported in attempts to use alternatives approaches. Additionally, the decision-making and information-giving processes were unclear to them, which raises issues of power and control in acute mental health settings. CONCLUSIONS: Nurses should take account of the issues of power and control when administering 'as needed' medication. The provision of adequate treatment information should be a priority to enable informed choices to be made about this form of medication.

Can an advanced nurse practitioner take on the role of senior house officer within a specialised area of practice: an evaluation.

This study looked at the impact of advanced nurse practitioners (ANPs) taking on the role of senior house officer (SHO) within obstetrics and gynaecology. It was anticipated that such a change would have benefits for patients and for service delivery. The project took place in the gynaecology department of a district general hospital. All patients who would normally be under the care of the SHOs with one medical team received this care from one or other of two ANPs. Focus groups were used to look at the impact of the changes on other staff within the unit. Patient questionnaires were used to assess the opinions of patients about the care they received. Length of stay, readmissions and cancellations were used to assess the impact on patient care. The change in role of the ANPs has had lasting benefits in terms of better communication and multidisciplinary working and the development of an informal referral system that allowed patients to be seen more quickly and appropriately. There were no ill effects on patient care.

Influence of early discharge after hysterectomy on patient outcome and GP workloads.

This paper examines the impact of early discharge following hysterectomy on patient outcome and GP workload. Results are presented from a survey of patient attitudes on care and recovery, pain relief and contacts overall with their general practitioner (GP) surgery. The findings are compared with those of a previous study where a policy of early discharge had been shown to increase GP workloads. The paper discusses the importance of preparing patients adequately for their surgery and postoperative recovery, and highlights the beneficial effects on patient attitudes of the introduction of patient information leaflets, a preadmission clinic and a telephone advice service following discharge.

Avoiding common pitfalls in qualitative data collection and transcription.

The subjective nature of qualitative research necessitates scrupulous scientific methods to ensure valid results. Although qualitative methods such as grounded theory, phenomenology, and ethnography yield rich data, consumers of research need to be able to trust the findings reported in such studies. Researchers are responsible for establishing the trustworthiness of qualitative research through a variety of ways. Specific challenges faced in the field can seriously threaten the dependability of the data. However, by minimizing potential errors that can occur when doing fieldwork, researchers can increase the trustworthiness of the study. The purpose of this article is to present three of the pitfalls that can occur in qualitative research during data collection and transcription: equipment failure, environmental hazards, and transcription errors. Specific strategies to minimize the risk for avoidable errors will be discussed.

The roles of the pastor in the interdisciplinary rehabilitation team.

People with chronic illnesses and functional limitations may face a lifetime of changes and adjustments. Often, the onset of a long-term illness or disease requires a person to rethink values and develop new coping strategies in order to adapt to a life-changing event. At such times, people may draw on sources of spiritual support, finding comfort from a pastor or other clergy. This article describes key roles taken by the clergy who provide these services. Patients discharged from inpatient rehabilitation units have reported using faith and prayer as effective coping strategies. Religious faith can have a positive influence on emotions and may be directly related to improved functional ability. Disciplines of faith, such as solitude, silence, and meditation, may promote mental health. Although this article presents information from a Christian church perspective, readers should note that services should be considered from a wide range of spiritual representatives.

The poststroke journey: from agonizing to owning.

Stroke is a leading cause of death among older adults. Despite the high incidence of stroke, little research has been done on the poststroke recovery process. The purpose of this article is to present a descriptive or explanatory model for poststroke rehabilitation and recovery that includes six stages.

Using focus groups in rehabilitation nursing.

The purpose of this paper is to describe the research method of focus groups and give an example of how it could be used to advance rehabilitation nursing in the area of poststroke adaptation or recovery. Stroke is a leading cause of death and disability in elderly Americans. Although much is known about the physical effects and treatments of stroke, little has been published on the adaptive behaviors or recovery process of stroke survivors. The focus-group technique can provide an "insider's" view of the adaptive behaviors of stroke survivors and is a cost-effective way to generate rich qualitative data to guide nursing practice.

Effectiveness of a nurse-managed follow-up program for rehabilitation patients after discharge.

Former patients in a rehabilitation unit at a large Midwestern hospital continued to actively seek services provided by the inpatient nursing staff, primarily through telephone contact, long after their discharge. A proactive formal follow-up program managed by an advanced practice nurse in rehabilitation was proposed as a better means of providing continuing care for rehabilitation patients after discharge. To examine the efficacy of the nurse-managed follow-up program, a randomized clinical trial was conducted. One hundred patients were randomly assigned to either the intervention group or the control group. Comparisons were made between the two groups on several outcome measures at 4 months after discharge. Outcomes included Functional Independence Measure (FIM) instrument scores, complication rates, rehospitalizations, and anxiety levels. The organizational outcomes included number and types of calls to staff, as well as time spent by staff nurses and social workers. The results indicated significant differences between the intervention and control groups in terms of anxiety levels, the number of calls made to the unit, and the amount of time spent by staff nurses and social workers.

The incidence of drug-related problems as a cause of hospital admissions in children.

OBJECTIVES: To determine the incidence of hospital admissions for drug-related problems (DRPs) among children, and to examine cases for causality, preventability and clinical severity. DESIGN: Prospective assessment involving review of case notes and parent interview to determine if an admission was associated with a DRP. PATIENTS AND SETTING: All patients admitted to a large university-affiliated paediatric hospital in Melbourne, Victoria, for medical reasons (i.e., not surgical, trauma or oncology patients) during 56 consecutive days from 24 June to 19 August 1996 for which a DRP could be identified. Patients whose parents or guardians could not communicate adequately in English were excluded. MAIN OUTCOME MEASURES: The incidence, type, causality, preventability and clinical severity of DRPs associated with admission. RESULTS: Of 1682 eligible patients admitted to the Royal Children's Hospital during the study period, 58 admissions (3.4%) were associated with DRPs. Non-compliance was implicated in 50%. Causality was ranked as "definite" (34.5%), "possible" (56.9%) and "doubtful" (8.6). Two-thirds of admissions associated with DRPs were deemed preventable. Although no patients died from DRPs, four were admitted to the intensive care unit. CONCLUSIONS: The incidence of DRPs as a cause of hospital admission in this study falls within the range of incidences published for the Australian adult population (range, 2.4%-22%). In contrast to findings among Australian adults, a high proportion of admissions for DRPs in this study were associated with non-compliance. The high percentage of preventable admissions indicates that further study is necessary to characterise risk factors within this population and to test prevention strategies.

The factor V Leiden mutation may predispose women to severe preeclampsia.

OBJECTIVE: A recent study showed that resistance to activated protein C may underlie some cases of severe preeclampsia. A common missense mutation in the factor V gene, the Leiden mutation, is the most frequent genetic cause of resistance to activated protein C. Our objective was to determine whether this mutation is more prevalent in patients with severe preeclampsia than in normotensive controls. STUDY DESIGN: Deoxyribonucleic acid was extracted from whole blood of 158 gravid women meeting criteria of The American College of Obstetricians and Gynecologists for severe preeclampsia and 403 normotensive gravid women. The polymerase chain reaction was used to amplify exon 10 of the factor V gene, followed by allele-specific restriction with Mnl 1 for mutation detection. Results were analyzed with a chi(2) contingency table. RESULTS: No patients were homozygous for the Leiden mutation. Fourteen of 158 women with severe preeclampsia (8.9%) were heterozygous for the Leiden mutation compared with 17 of 403 normotensive gravid controls (4.2%). The difference in frequency between women with severe preeclampsia and normotensive controls was statistically significant, chi(2) 4.686, p = 0.03. CONCLUSIONS: Our data suggest that carriers of the factor V Leiden mutation are at increased risk for severe preeclampsia. Deoxyribonucleic acid analysis for the factor V Leiden mutation could serve as one component of a genetic screening profile for preeclampsia and other adverse pregnancy outcomes. Women who carry this mutation are at increased risk for deep venous thrombosis. Carriers of this common thrombophilic mutation may be identified so that adequate counseling regarding future contraceptive usage and effective thromboembolic prophylaxis during pregnancy and surgical procedures may be offered.

Developing and implementing a stroke education series for patients and families.

Stroke is the third leading cause of death and the major reason for disability in American adults (Sullivan, 1992). Stroke can be a recurrent disease, but most strokes are preventable. Patient and family education about stroke is a vital link in eliminating the knowledge deficit that can help lead to stroke. This article describes the process of developing and implementing a stroke education program that involves both patients and their significant others. In 1990, rehabilitation nurses at St. Margaret Mercy Healthcare Centers in Hammond, IN, identified 11 essential areas for education and grouped them into six 1-hour teaching sessions. A program was developed and held weekly for a trial period of 3 months. It was so well received that it continues to be a permanent part of the rehabilitation program. Such structured teaching in a relaxed atmosphere better prepares patients for discharge and eases the transition to the home environment.

Defining the concept of self-care.

Self-care is a concept frequently referred to in both the theory and the clinical practice of nursing. This article presents an overview of self-care theory as described by Henderson, Hall, and Orem. Self-care theory operates on the assumption that all individuals have a need to care for themselves. While this premise may be true, it poses difficult questions for the nurse who must intervene with patients who refuse to achieve their maximum level of independence. When a disease process occurs that alters self-image, some patients (particularly elderly females who have cared for others most of their adult lives) may consciously opt to become the ones cared for. This choice gives them a temporary sense of control over a situation in which they feel helpless. When nursing care is directed toward returning control of the situation to the patient, the process of self-care and healing can begin.