What about the fundamentals of nursing-its interventions and its continuity among older people in need of home- or facility-based care: a scoping review

AIM

This scoping review investigated and descriptively summarised previous research about fundamental nursing, its focus (what care needs are described, how is it described and by whom is it described), continuity of care (is it described in relation to fundamental nursing) and possible nursing interventions or activities targeting older people's fundamentals of care needs in home- or facility-based care.

METHODS

This scoping review was carried out following the steps of Arksey and O'Malley's methodology and PRISMA-ScR reporting guidelines. Searches were conducted in PubMed via NIH, CINAHL via EBSCO and PsycInfo via ProQuest for the time period between January 2002 and May 2023.

RESULTS

Forty-two studies were included where the majority had been conducted in a facility-based care context. Nutrition-or rather nutritional care activities targeting eating and drinking-was the most frequently described fundamental care needs addressed. After this came personal care such as cleansing, dressing, oral care, skin, and foot care. Few studies addressed more than one fundamental care need at the time. The nursing staff described fundamental nursing as complex, comprehensive, and demanding. Older people and relatives described a gap between the fundamental nursing provided and their perceived need for support. Less attention was given to older peoples relational and psychosocial needs. Identified nursing interventions mainly targeted physical care needs. Our findings also implied that interventions focusing on fundamental nursing were described as feasible in practice with favourable or moderate results, while long-term effects were difficult to detect. No studies were identified focusing on fundamental nursing in relation to outcomes such as continuity of care.

CONCLUSION

Fundamental nursing was mainly described in relation to physical care needs, which were essentially conducted within facility-based care contexts. Interventions and activities primarily focused on one fundamental need at the time, mainly within the physical domain. No nursing interventions were identified focusing on relational and psychosocial needs where continuity of care can be viewed as a relevant outcome. Such limited focus are especially concerning as research has highlighted the importance of that older people with complex care needs can benefit from a holistic and person-centred approach i.e. fundamental nursing.

TRIAL REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/XJ39E Protocol: http://dx.doi.org/10.1136/bmjopen-2022-069798.

Six weeks of intensive rehearsals for the Swan Lake ballet shows ultrasound tissue characterization changes of the Achilles tendons in dancers

The objective was to investigate, first, whether six weeks of intensive ballet dance exposure is associated with structural and clinical changes in the Achilles tendon; second, the importance of demographics, self-reported Achilles pain, and generalized joint hypermobility (GJH). Data were collected at baseline and at six weeks' follow-up, using Achilles tendon ultrasound tissue characteristics (UTC) as primary outcome (percentage distribution of echo-type I-IV: type I = intact and aligned bundles, type II = discontinuous/wavy bundles, type III = fibrillar, and type IV = amorphous cells/fluid). Secondary outcomes included clinical signs of Achilles tendinopathy, Achilles tendon pain during single-leg heel raise, self-reported symptoms (VISA-A questionnaire), and GJH. Sixty-three ballet dancers (aged 18-41) participated. From baseline to follow-up, UTC echo-type I decreased significantly (β = -3.6, p = 0.001; 95% CI: -5.8;-1.4), whereas echo-type II increased significantly (β = 3.2, p < 0.0001, 95% CI: 1.6;4.8). Furthermore, a significant effect of limb (left limb showed decreased echo-type I and increased echo-type III + IV) and sex (women showed decreased echo-type I and increased in type II) was found. No significant changes in the remaining secondary outcomes were found. Ballet dancers showed structural changes in UTC, corresponding to a decreased echo-type I distribution after six weeks of rehearsing for Swan Lake ballet. No changes in self-reported symptoms, clinical signs of Achilles tendinopathy, and single-leg heel raise test were seen from pre- to post-rehearsal. Thus, UTC changes in the Achilles tendon seem to appear earlier than clinical signs of tendinopathy.

Shoulder Rotational Strength Profiles of Danish National Level Badminton Players

BACKGROUND

Increased age has been shown to be associated with weaker external rotators and stronger internal rotators of the shoulder in pitchers and tennis players. Whether this age-associated change is present in elite badminton players is unknown.

PURPOSE

To compare the internal and external rotation strength of the shoulder in adolescent and adult elite badminton players.

STUDY DESIGN

Cross-sectional.

METHODS

Thirty-one adolescent (12 females aged 16.8 ± 1.6 years and 19 males aged 17.1 ± 1.6 years) and 29 adult (10 females aged 25 ± 2.9 years and 19 males aged 26.2 ± 4.6 years) national level badminton players were tested pre-seasonally for external rotation (ER) and internal rotation (IR) isometric muscle strength bilaterally, using a hand-held dynamometer. Within-group ER to IR strength ratios were calculated (ER/IR×100%).

RESULTS

The adolescents had stronger shoulder ER than the adults on both sides (p < 0.05). The adult males tended to have stronger IR of the dominant shoulder than the adolescent males (p = 0.071). In the dominant shoulders, the strength ratios for adult females and males were 77% and 78%, respectively, while the same ratio for adolescent females and males were 85% and 99%, respectively. In the non-dominant shoulders, the ER/IR strength ratios for adult females and males were 90% and 87%, respectively, while the ratios for adolescent females and males were 116% and 102%, respectively.

CONCLUSION

This study is the first to demonstrate that in shoulder injury-free national team badminton players, adolescents have stronger shoulder ER than adults on both sides. Therefore, increased age appears to be associated with weaker shoulder ER muscles in elite badminton players.

LEVEL OF EVIDENCE

3b.

Immediate versus delayed meniscal allograft transplantation in sheep

The aim of the current study was to assess the effect of immediate and delayed transplantation on articular cartilage. Icelandic sheep had surgery on the medial menisci in both knees. The knees were divided into four groups; 16 control knees had sham surgery, 15 knees had meniscectomy, 14 knees had immediate allograft transplantation, and 14 knees had delayed transplantation 3 months after meniscectomy. The two horns of the fresh allograft were fixed with suture anchors through bone tunnels. The sheep had autopsies 6 months after surgery. An additional six knees were examined 3 months after meniscectomy to examine the cartilage before the delayed implantation. Four standardized samples were taken from the medial compartment of the knee for histologic evaluation according to a modification of Mankin's system, where degenerative changes to the articular cartilage were scored semiquantitatively for structure, proteoglycan content, cellularity, and cell cloning. Knees that had meniscectomy and delayed transplantation showed equally high scores in articular cartilage degeneration, and both scored higher than knees that had immediate transplantation, which again scored higher than the control knees. In short-term observations, immediate medial meniscal allograft transplantation reduced but did not prevent degeneration of the articular cartilage. Immediate transplantation was superior to delayed transplantation in preventing cartilage degeneration.

Differences in the movement pattern of a forward lunge in two types of anterior cruciate ligament deficient patients: copers and non-copers

OBJECTIVE

To determine whether differences in the knee joint movement pattern of a forward lunge could be quantified in healthy subjects and in anterior cruciate ligament deficient subjects who were able to return to the same activity level as before their injury (copers) and in those who were not (non-copers).

DESIGN

The movement patterns of the injured leg of the coper and non-coper anterior cruciate ligament deficient subjects and the right leg of the control subjects were compared statistically.

BACKGROUND

The forward lunge seems to be a less stressful test than the commonly used one-legged hop test, which makes it a possible tool for evaluating and comparing the functional performance of non-copers and copers.

METHODS

The movement pattern of a forward lunge was analysed by using a two-dimensional inverse dynamics method. The electromyographic activity of the quadriceps and hamstring muscles were recorded.

RESULTS

The non-copers moved more slowly and loaded the knee joint less than the copers and controls. The copers moved more slowly during the knee flexion phase but as fast as the controls during the knee extension. The EMG results suggest that the copers stabilized their knee joint by increasing the co-contraction of the hamstrings during the extension phase.

CONCLUSIONS

Differences between the three groups' movement patterns could be quantified. The forward lunge test seems appropriate to discriminate between the knee function in coper and non-coper anterior cruciate ligament deficient subjects.

RELEVANCE

Information about the performance of movements, which significantly load the knee joint in coper and non-coper anterior cruciate ligament deficient patients may contribute to a better understanding of dynamic knee joint stabilization, which is relevant in relation to the development of rehabilitation strategies.

EMG activity of the iliopsoas muscle and leg kinetics during the soccer place kick

The purpose of the study was to develop a method to record intramuscular electromyogram (EMG) from the iliopsoas muscle and to relate this activity to the kinetics during the soccer place kick. Seven skilled soccer players performed 3 maximal velocity place kicks. The kicks were filmed with a high-speed camera (400 Hz) and EMG recordings were obtained from 5 muscles of the kicking leg, including wire electrodes inserted into the m. iliopsoas. The EMG signals were compared to the kinetics of the kicking leg, which were calculated from the digitised film. The results showed hardly any torque reversal about the hip joint before impact. Angular deceleration of the thigh segment did not increase the angular velocity of the shank (work -3.57 to 0.0%). M. iliopsoas was active during the entire kicking motion (average EMG 65.1-100.9%), even in the period when the thigh was decelerating. Wire electrodes can successfully be applied to EMG recordings of fast unloaded movements.

Reduced degenerative articular cartilage changes after meniscal allograft transplantation in sheep

The objective of this study was to examine the gross changes after meniscal allograft transplantation with reference to the development of degenerative articular cartilage changes (DACC) and to examine the transplant behavior. The medial menisci of both knees in 32 Iceland sheep were operated on with either sham operation (C6), medial meniscectomy (M6), primary transplantation (P6), or secondary transplantation 3 months after meniscectomy (S6). These sheep were observed for 6 months. Another six sheep were observed for 3 months after meniscectomy (M3) and contralateral sham operation (C3). The DACC of the knee were visualized with an intra-articular toluidine blue injection. The dissemination area of DACC on the medial tibial plateau (MTP), the meniscal area, and the meniscus-free, exposed central area on the MTP were measured by computer image analysis based on digitized photos of the tibial plateau. These area measurements were calculated relative to the area of the MTP. The DACC in P6 knees had a mean of 4.3%, which was less than the 12.6% in M6 (P < 0.001) and the 16.1% in S6 (P < 0.001), but more pronounced than the 0.5% in C6 (P < 0.005). There were no detectable differences in DACC between M6, S6 and M3 (16.9%). The measurements of DACC were reproducible with correlation coefficient r = 0.97 on intra-tester test-retest measurements. The area of the free exposed MTP was larger in P6 and in S6 than in C6 (P < 0.001), demonstrating a displacement of the graft. S6 transplants showed shrinkage and were smaller than C6 menisci (P < 0.01). In conclusion, primary meniscal allograft transplantation reduced DACC within 6 months in sheep knees, but DACC were still present in transplanted knees. The meniscal transplants demonstrated peripheral displacement.

Meniscal substitutes--animal experience

Animal studies have shown that meniscus allografts and tendon autografts generally heal to the capsule, are revascularized and repopulated with host cells. In animals, neither meniscal allografts nor tendon or fat autografts gain the properties of a normal meniscus. Meniscus allografts and tendon autografts are promising as both seem to offer some protection to the cartilage of the tibial plateau. There is no evidence that meniscal transplantation can prevent cartilage degenerative changes, and the long-term effect of meniscal transplantation on articular cartilage remains unknown. Whether cellular repopulation of the meniscal allograft is sufficient to restore its biomechanical properties is unknown. Collagen scaffolds and tissue engineered grafts are still under investigation, showing promising results especially for the former. Viable meniscal allografts should be implanted within 1 to 2 weeks after harvesting, as the production of proteoglycans decreases after 2 weeks.

Function of the normal meniscus and consequences of meniscal resection

The principal functions of the meniscus are load transmission and shock absorption, based on the meniscal collagen architecture, the biochemical fluid composition, and the proteoglucan-collagen meshwork. The mobile menisci transmit 50-90% of load over the knee joint, depending on knee flexion angle, femoral translation and rotation. The meniscus contributes to knee joint proprioception and probably also to joint stability. Late consequences of total and partial meniscectomy are radiographic osteoarthritis, with a varying percentage of these patients having symptoms. Malalignment, concomitant articular cartilage lesions, and ligament instability are absolute risk factors, while age, lateral compartment, and continued sport activity are relative risk factors. Acute reinsertion of meniscal tears in the red-red or red-white zones can be performed successfully by arthroscopic technique. Also in chronic tears stable healing can be expected in most cases, if the scar tissue is resected.

Postoperative follow-up and rehabilitation after meniscus replacement

Even though basic scientific knowledge about the meniscal loading pattern may advocate restrictive rehabilitation after meniscus repair, experience and one controlled study favour accelerated rehabilitation. The current protocols for rehabilitation after meniscal substitution follow personal experience with parameters such as pain, effusion, locking, and gait pattern used as clinical guidance. Controlled clinical studies on rehabilitation should be encouraged. An example of a rehabilitation protocol is given. As meniscus replacement is a new treatment option, it is essential to document details about the graft, the knee status at operation and the surgical procedure. The goal of a postoperative follow-up is to control quality, to measure patient satisfaction and to show whether meniscus replacement is beneficial in relation to the natural history of meniscectomy cases. There is a need for a standard follow-up evaluation of patients after meniscus replacement, and the development of a meniscus transplantation score including subjective and objective data is suggested.

An epidemiological analysis of the injury pattern in indoor and in beach volleyball

This study was designed to evaluate the injuries in indoor and in beach volleyball, and to compare the injury pattern in the two different types of volleyball. Injuries in 295 volleyball players were recorded during the beach volleyball season 1993 and during the following indoor volleyball season 1993 to 1994. The method of enquiry was two identical questionnaires. Equal numbers of men and women, elite and recreational players were represented. In beach volleyball 24 injuries were reported and 286 in indoor volleyball, representing an incidence of 4.9 injuries per 1000 volleyball hours in beach volleyball and 4.2 in indoor volleyball. The most frequent injuries were acute injuries located in the ankle and finger and overuse injuries in the knee and shoulder. The injury pattern was different in indoor and in beach volleyball. In beach volleyball most injuries occurred in field defence and in spiking, with overuse injuries in the shoulder as the major site. In indoor volleyball most injuries occurred during blocking and spiking, resulting most frequently in acute finger and ankle injuries, respectively.

Injuries in elite volleyball

During the 1993-1994 volleyball season, injuries to players in the two Danish elite divisions were registered by means of a questionnaire survey. Eighty per cent of the players returned the questionnaire. A total of 70 female players reported 79 injuries and 67 male players reported 98 injuries, representing an overall incidence of 3.8 injuries per player per 1000 volleyball hours played. The injury incidence was the same for female and male players. Most injuries occurred in spiking (32%) and in blocking (28%). The injuries were predominantly either acute injuries to fingers (21%) and ankles (18%) or overuse injuries to shoulders (15%) and knees (16%). Shoulder injuries seemed to be a more serious problem in females. During the past 10 years the rate of overuse injuries has increased from 16% to 47% in male elite volleyball, corresponding to a significant increase in the incidence of these injuries from 0.5 to 1.8 injuries per player per 1000 played hours (P < 0.001). A possible explanation for this could be a 50% increase in training activity during this period.

Platinum-based cytotoxic therapy in basal cell carcinoma--a review of the literature

Systemic cytotoxic therapy with platinum containing regimens has been reviewed in 53 patients with progressive disease of basal cell carcinoma. The overall response rate in 46 evaluable patients was 83% with complete remission obtained in 17 patients (37%), and partial remission in 21 patients (46%). Eight patients (17%) did not respond to platinum containing therapy. The median observation time was 26 months and the median time to progression 24 months. The median number of courses was 3 (range 2 to 12), and objective response was seen after median 2 courses (range 1 to 6). Platinum-based systemic chemotherapy, either alone or in combination with other therapeutic modalities, may be indicated as treatment of basal cell carcinoma when local therapy is inadequate, or in the rare cases with advanced lesions or metastatic disease.

[Antibiotic prophylaxis in Danish orthopedic alloplastic surgery]

In order to assess the routine use of prophylactic antibiotics (AB) in arthroplastic surgery in Denmark, questionnaires were sent to all Danish orthopaedic departments and all general surgical departments that perform orthopaedic surgery. Fifty-six departments (93%) returned the questionnaires. All departments use prophylactic AB in primary knee and hip arthroplasty and in revision arthroplasty. In addition, all departments but one use prophylactic AB in arthroplasty secondary to osteosynthesis. The largest group of departments uses penicillinase-resistant penicillin (PRP) in their standard prophylaxis regimens. The second largest group uses second generation cephalosporins. With one exception, all use cefuroxime. A small group uses other types of AB. Fifteen percent of the departments combine systemic AB with gentamicin bone cement (GC) in primary hip arthroplasty, whereas 22% use this combination in primary knee arthroplasty. Significantly more departments use GC in revision arthroplasty (89%) and in arthroplasty secondary to osteosynthesis (63%). Prolonged antibiotic prophylaxis (beyond 24 hours) is practised to a significantly higher degree in revision arthroplastic surgery than in the primary arthroplasties. In conclusion, one of two homogeneous groups of prophylactic AB is used in arthroplastic surgery in Denmark as prescribed in the literature.

Computer registration of infections used to measure the effect of prophylactic antibiotics on postoperative infections following osteosynthesis in hip fractures

Continuous registration of operations and wound infections was used to demonstrate the effect of prophylactic antibiotics in hip fracture osteosynthesis. In order to monitor wound infections and other postoperative complications in an orthopaedic department, 2 years' data on 688 patients with hip fractures, were entered into a personal computer program. During 1990, there was no formal policy for antibiotic prophylaxis; during 1991 prophylactic cefuroxime was recommended for osteosynthesis of hip fractures. In 1990 56% of patients were given prophylaxis and in 1991 this rose to 79%. Overall, 68% of patients had prophylaxis. The overall rate of deep wound infections (DWI) was significantly lower in patients treated with prophylactic antibiotics (0.6%), compared with those without prophylaxis (4.6%). Patients with DWI were admitted to the hospital for an average of 43.7 days, compared with 14.6 days for patients without complications. We recommend the use of prophylactic cefuroxime in hip fracture osteosynthesis. Computer registration of complications is a useful method for clinical quality control in an orthopaedic department.

The correlation between work environment and the occurrence of cervicobrachial symptoms

The correlation between symptoms from the neck and upper extremities and some individual and work-related factors was analyzed in 2814 industrial workers. Physical stress by type of job was the factor most strongly correlated with ongoing cervicobrachial symptoms. Symptoms from the neck and upper extremities were twice as common in workers who used vibrating hand tools. Mental stress at the onset of the symptoms was associated with an increased prevalence of trapezius myalgia and with lateral humeral epicondylitis and "radial tunnel syndrome" in the dominant arm. Women had about double the rate of cervicobrachial symptoms as did men. Short stature increased the rate of symptoms from the neck, shoulders, and hands as did overweight. Playing of racquet sports decreased the risk of symptoms from the neck and hands.

Sickness absenteeism in an engineering industry--an analysis with special reference to absence for neck and upper extremity symptoms

Neck and upper extremity symptoms (NES) are reported to increase among industrial workers. In order to quantify sickness absenteeism and relate it to some factors a questionnaire study was performed among 2,814 workers occupied at a Swedish engineering industry. Questions pertaining to age, sex, worker category, work with vibrating handtools, type of job and smoking habits were analyzed and correlated to sickness absenteeism for the previous year (1983). We found that the average days lost for personal illness was 17.2 days; 16.2 for men and 23.5 days for women. Ninety-four persons, 77 men and 17 women comprising 3.0% of all employees were sicklisted for NES corresponding to 3.3% of total sickness time lost. Blue-collar workers were sicklisted for NES five times more often than white collar workers and women in type 3 jobs (high NE stress), twice that of men occupied in the same type of job. Smokers had significantly higher absenteeism than non-smokers for any reason studied including NES. The study indicated a high prevalence of present NES problems (23%) but also that NES as a cause of leave of absence was relatively rare (3%).