bluuebunny/crossref_metadata_2025 huggingface dataset:
Underacting Inferior Oblique Muscle Following Myectomy or Recession for Unilateral Inferior Oblique Overaction
Authors: Bhatta Sudipto , Auger Graham , Ung Tsiang , Burke John
Published: April 2011

Purpose:

To assess the incidence and investigate the functional impact of postoperative overcorrection following primary unilateral inferior oblique muscle recession and myectomy for inferior oblique overaction.

Methods:

A retrospective study of 79 consecutive patients undergoing inferior oblique myectomy (43) or recession (36) with a minimum 6 months of postoperative follow-up. All underwent ocular motility examinations preoperatively and postoperatively at approximately 2 weeks and 6 months. The vertical deviation in primary position and on contralateral gaze and inferior oblique versions and ductions on contralateral elevation were analyzed.

Results:

At 6 months, 51 patients had no inferior oblique underaction (group 1), 23 of 28 who had developed inferior oblique underaction were asymptomatic (group 2), and the remaining 5 were symptomatic (group 3). The mean preoperative hyperdeviation was 12.9 (group 1), 13.1 (group 2), and 15 (group 3) prism diopters (PD) in primary position. Postoperatively, these measured 3.8 (group 1), 3.8 (group 2), and −7.8 (group 3) PD (- indicates deviation reversal). The mean preoperative and postoperative inferior oblique versions for these three groups were +2.7, +2.2, +2.2 units and +0.9, −1.0, −1.4 units, respectively.

Conclusion:

Inferior oblique underaction was common (28 patients, 35.4%), generally mild, persistent, and usually asymptomatic 6 months following surgery. Although uncommon (5 patients, 6.3%), symptomatic inferior oblique underaction required further surgery with a successful outcome. They included 2 patients with a history of head or orbital trauma and one with masked and one with highly asymmetric bilateral inferior oblique overaction.
Initial Visual Field as a Predictor of Recurrence and Postoperative Visual Outcome in Children With Craniopharyngioma
Authors: Lee Min Joung , Hwang Jeong-Min
Published: April 2011

Purpose:

The aim of this study was to investigate the significance of the initial visual field as a predictor of recurrence of craniopharyngioma and postoperative visual outcome in children with craniopharyngioma.

Methods:

A retrospective analysis was performed on 27 children 15 years of age or younger with craniopharyngioma. Records of clinical features including ocular and systemic symptoms, optic disc findings, and size of the tumor were analyzed according to preoperative visual field. Postoperative visual acuities, visual fields, and recurrence rates were also evaluated.

Results:

Preoperatively, 13 patients had a normal visual field and 14 patients had various visual field defects. The size of the tumor was not correlated with the preoperative visual field defects (
P
= .15). Preoperative visual field defects were associated with polyuria and polydipsia (
P
= .01), higher recurrence (
P
< .001), and poorer postoperative visual acuities (
P
< .001).

Conclusion:

Preoperative visual field can be a reliable clinical indicator of systemic manifestations, recurrence, and postoperative visual outcome in children with craniopharyngioma.
Management of Retinal Vasoproliferative Tumor Associated with ROP by Plaque Brachytherapy
Authors: Kitei Paul M. , Say Emil Anthony T. , Shields Carol L. , Regillo Carl D. , Shields Jerry A.
Published: April 2011

The authors report a secondary exudative vasoproliferative tumor of the retina associated with retinopathy of prematurity, managed by plaque radiotherapy. A 15-year-old girl with a history of mild, stable retinopathy of prematurity in both eyes noted progressively reduced visual acuity to hand motions in the left eye. Examination disclosed a vasoproliferative tumor of 10-mm base and 3.5-mm thickness with near total (macula-off) exudative retinal detachment. She was treated with iodine-125 plaque radiotherapy, giving apex dose of 40 Gy over 4 days. The tumor regressed to 1.9 mm and retinal detachment resolved 8 months following therapy. Epiretinal membrane with significant macular pucker and edema later developed and was managed with pars plana vitrectomy and membrane peeling. Visual acuity was counting fingers due to photoreceptor loss. Retinopathy of prematurity is a rare cause of vasoproliferative tumor. Iodine-125 plaque radiotherapy can lead to tumor regression and reattachment of the retina in such cases.
Bell’s Palsy in a 3-Month-Old Infant: Recommendations for Management of Pediatric Cases
Authors: Manzouri Bita , Shankar Vikas , Sawczenko Andrew , Ali Nadeem
Published: April 2011

Bell’s palsy is an idiopathic unilateral paresis or paralysis of the facial nerve. The authors describe a 3-month-old infant with Bell’s palsy and detail the investigation and management appropriate for the pediatric age group.
Congenital Upper Eyelid Ectopic Cilia
Authors: Nakra Tanuj , Blaydon Sean M. , Durairaj Vikram D. , Shinder Roman
Published: April 2011

Ectopic eyelid cilia is an uncommon congenital anomaly typically occuring in otherwise healthy children. It is asymptomatic, but parents may wish surgical excision for cosmetic benefits. The authors describe three cases of ectopic upper eyelid cilia, surgical intervention, and follow-up results.
Implementation of Comfort Rooms
to Reduce Seclusion, Restraint Use, and Acting-Out Behaviors
Authors: Sivak Kim
Published: April 2011

The use of seclusion and restraint as methods to control acting-out behaviors by individuals with mental illness continues, despite deaths and other negative outcomes to both the clients themselves and the staff members applying these techniques. Additionally, client-to-client and client-to-staff assaults and self-injurious behaviors can lead to injury or possible fatalities to both parties. Thus, there is a need to find alternative approaches to mitigate or even eliminate some of these behaviors. The use of comfort rooms is one such approach. With the institution of comfort rooms, one small, rural, tertiary mental health hospital demonstrated a reduction in seclusion and restraint use and assaultive behaviors of clients. In addition, 92.9% of the clients who used these rooms found them to be helpful when they experienced increasing levels of distress. With the provision of an area for clients to go voluntarily to self-manage their distress, nurses play a role in promoting autonomy and person-centered care, while reducing environmental stress and potential negative outcomes.
Gender Differences in the Roles and Functions of Inpatient Psychiatric Nurses
Authors: Torkelson Diane J. , Seed Mary S.
Published: April 2011

This study explored the difference between male and female psychiatric nurses’ job performance and job satisfaction levels on an acute care inpatient unit. The amount of time male (
n
= 28) and female (
n
= 45) nurses spent on 10 specific functions and roles during a shift were observed and recorded. The nurses also self-rated the amount of time they spent on these specific functions and roles. The observed and self-rated functions were then correlated with job satisfaction. Female nurses were observed and self-rated as spending significantly more time on patient care activities, and these activities were significantly correlated with higher job satisfaction levels. Male nurses who self-rated spending more time on patient care activities had significantly lower job satisfaction scores. Findings confirm the concepts from social role theory that gender identity and expectations influence job performance in psychiatric nursing. The results offer insight for increasing job satisfaction and recruitment/retention efforts.
Successful Aging
Authors: Giblin Joanne C.
Published: April 2011

This article defines wisdom and despair as choices for cognitively intact older adults. Some individuals are able to integrate the conditions of old age while others respond in ways that inhibit effective integration. The conscious aging theory, as well as Erikson’s developmental theory regarding achievement of integrity/wisdom, provides a theoretical basis for exploration of this topic. Constructs of personality, including self-concept, self-acceptance, destiny control, interiority, rigidity, and flexibility, are described. Finally, guidelines for nurses working with older adults who are facing this developmental stage of life are provided.
Phakic Intraocular Lens Implantation for Treatment of Anisometropia and Amblyopia in Children: 5-year Follow-up
Authors: Alió Jorge L. , Toffaha Bader T. , Laria Carlos , Piñero David P.
Published: April 2011

PURPOSE:

To evaluate the safety and efficacy during 5-year follow-up of phakic intraocular lens (PIOL) implantation to correct high anisometropia in amblyopic children who were non-compliant with traditional medical treatment including spectacles or contact lenses.

METHODS:

Retrospective study of 10 eyes of 10 children with high anisometropia who underwent PIOL implantation (9 with an iris-supported IOL and 1 with a posterior chamber IOL). Patient age at the time of implantation ranged from 2 to 15 years. Mean preoperative spherical equivalent refraction was −10.14±6.96 diopters (D) (range: +8.00 to −18.00 D). Mean logMAR corrected distance visual acuity (CDVA) was 0.84±0.52. Postoperative data at 6, 24, and 60 months were evaluated.

RESULTS:

Corrected distance visual acuity improved in all children. At 24 months, logMAR CDVA was 0.39±0.35 and at 5 years was 0.36±0.38 (range for both: 0.1 to 1.0) (
P
=.01). Improvement of more than three logMAR lines of CDVA was achieved in all children except for one (one line improvement) who was implanted with a posterior chamber PIOL. No loss of CDVA was detected in any patient. Five years after surgery, endothelial cell count was >2000 cells/mm
2
in eight (80%) patients; for the remaining two patients, one reported frequent eye rubbing and the other suffered ocular trauma.

CONCLUSIONS:

Phakic IOL implantation in children with anisometropic amblyopia showed a positive long-term impact on visual acuity.
Epithelial Thickness Up to 26 Years After Radial Keratotomy: Three-dimensional Display With Artemis Very High-frequency Digital Ultrasound
Authors: Reinstein Dan Z. , Archer Timothy J. , Gobbe Marine
Published: April 2011

PURPOSE:

To characterize the epithelial thickness profile in a population of eyes after radial keratotomy for myopia.

METHODS:

The epithelial thickness profile was measured in vivo by Artemis very high-frequency digital ultrasound arc-scanning (ArcScan Inc) across the central 10-mm diameter of the cornea on 14 eyes after radial keratotomy for myopia. Maps of the mean and standard deviation of epithelial thickness were plotted and compared to the epithelial thickness of a previously published population of normal untreated eyes.

RESULTS:

Ultrasound scanning using the Artemis was performed a mean 16.7±5.8 years (range: 1.6 to 26.3 years) after radial keratotomy. The mean epithelial thickness profile showed the epithelium to be thicker centrally and thinner paracentrally, which was different from the population of normal eyes. The mean thickest epithelial thickness was 78.8±6.0 μm (range: 64.8 to 89.6 μm) and the mean thinnest epithelial thickness was 43.7±4.3 μm (range: 36.1 to 49.3 μm), which were statistically significantly different from the epithelial thickness at these locations in the population of normal eyes.

CONCLUSIONS:

Three-dimensional thickness mapping of the epithelial thickness profile demonstrated epithelial changes that compensated in part for the central corneal flattening induced by the radial keratotomy incisions. The fact that epithelial changes were consistent across eyes from approximately 2 to 26 years after radial keratotomy suggests that epithelial changes are a permanent response to corneal curvature changes.
Artisan Iris-supported Phakic IOL Implantation in Patients With Keratoconus: A Review of 16 Eyes
Authors: Sedaghat Mohamadreza , Ansari-Astaneh Mohammad-Reza , Zarei-Ghanavati Mehran , Davis Scott W. , Sikder Shameema
Published: April 2011

PURPOSE:

To evaluate the clinical outcomes of Artisan phakic intraocular lens (PIOL; Ophtec BV) implantation in patients with stable keratoconus.

METHODS:

In a prospective, nonrandomized case series, 14 Artisan PIOLs and 2 toric Artisan PIOLs were implanted in 13 patients (16 eyes) with stable keratoconus who had contact lens intolerance. Pre- and postoperative data were collected.

RESULTS:

Mean follow-up was 14.2±7.8 months. Preoperative uncorrected distance visual acuity (UDVA) was counting fingers in all patients. Mean final logMAR (Snellen equivalent) UDVA and corrected distance visual acuity (CDVA) were 0.15(20/28)±0.13 and 0.11(20/26)±0.10, respectively. The improvements in UDVA and CDVA were statistically significant (
P
<.0001 and
P
<.002, respectively). All patients achieved a final UDVA of 20/40 or better, and 84.6% had a final CDVA of 20/32 or better. No postoperative complications occurred except for two cases of sterile uveitis.

CONCLUSIONS:

Implantation of the Artisan PIOL is effective in improving visual acuity in patients with stable keratoconus. Long-term safety remains to be established as no postoperative endothelial cell counts were performed.
Toric Intraocular Lens Misalignment Inducing Astigmatism After Refractive Surgery
Authors: Forseto Adriana S. , Nosé Ricardo M. , Nosé Walton
Published: April 2011

PURPOSE:

To report the unexpected induction of astigmatism after phacoemulsification and toric intraocular lens (IOL) implantation in an eye with previous corneal refractive surgery.

METHODS:

Case report of a 46-year-old man with bilateral nuclear cataract and previous photorefractive keratectomy. Because corneal topography identified regular corneal astigmatism at the central optical zone, phacoemulsification and implantation of a one-piece hydrophobic acrylic toric IOL were performed.

RESULTS:

Unexpected induction of astigmatism occurred in the first operated eye despite proper alignment of the IOL according to the preoperative calculations using simulated K values to determine toric IOL power and alignment. A retrospective qualitative analysis of corneal topography showed mismatching of the steepest meridian, leading to an off-axis IOL. Secondary IOL rotation improved both uncorrected and corrected distance visual acuity.

CONCLUSIONS:

Qualitative analysis of the corneal topography is mandatory during the assessment of toric IOL alignment in eyes with previous corneal refractive surgery to identify the actual location of the steepest meridian.
Macular Hole Secondary to X-Linked Juvenile Retinoschisis
Authors: Brasil Oswaldo Ferreira Moura , da Cunha Anibal Luis Gomes , de Castro Márcia Brazuna , Japiassú Ricardo Miguel
Published: April 2011

The authors describe a rare case of full-thickness macular hole formation in a 10-year-old boy with X-linked juvenile retinoschisis.
Cine, literatura y mito: Don Quijote en el cine, más allá de la adaptación
Authors: Pardo García Pedro Javier
Published: April 2011

Este trabajo se ocupa de la presencia en el cine de Don Quijote, pero no del libro sino del mito, una perspectiva que va mucho más allá de la adaptación y abre considerablemente el campo de estudio. Para ello, se propone una descripción que se sabe provisional pero intenta ser rigurosa del mito o el patrón narrativo quijotesco como el del lector/imitador romántico e inadecuado de ficción, a partir de la cual se puede elaborar un primer corpus de películas quijotescas. En él se incluyen las protagonizadas por imitadores fallidos de modelos cinematográficos, por Quijotes femeninos que romantizan la realidad y por diversos tipos de héroes que son quijotescos por su inadecuación a su tarea o misión heroica. Para ilustrar esta profunda penetración del mito en el medio cinematográfico se examina un ejemplo reciente en el cine español, la película El corazón del guerrero (2000), del realizador Daniel Monzón, en la que estas diferentes variantes del mito pueden observarse de forma integrada y con claridad meridiana. A lo largo de este recorrido se realizan una serie de distinciones con las que pueden ordenarse y categorizarse los diferentes tipos de relación entre Don Quijote y el cine (cine cervantino, quijotesco y quijotizante) y, finalmente, se extraen una serie de conclusiones teóricas de aplicación general al estudio comparado de cine y literatura.
Una carta de Jardiel Poncela a propósito de la versión cinematográfica de "Las inquietudes de Shanti Andía", por Arturo Ruiz Castillo
Authors: Herrera Javier
Published: April 2011

Con motivo del estreno de Las inquietudes de Shanti Andía realizada por Arturo Ruiz Castillo a partir de la obra de Baroja, Jardiel Poncela le escribe una extensa carta, totalmente inédita, en la que, entre otras consideraciones de gran interés para conocer su pensamiento estético y sus ideas acerca del público y el papel de la mujer, le elogia la adaptación realizada de la obra barojiana al tiempo que le hace una serie de consideraciones teóricas muy interesantes sobre las relaciones entre la literatura y el cine.
La Bella y la Bestia en el cine laberíntico de Guillermo del Toro: El espinazo del diablo (2001) y El Laberinto del Fauno (2006)
Authors: Pastor Brígida M.
Published: April 2011

El espinazo del diablo (2001) y El laberinto del fauno (2006) son dos películas dirigidas por el mexicano Guillermo del Toro, y pueden considerarse sus dos obras de esencia española. Ambas tienen como telón de fondo la Guerra Civil Española, pero ninguna llega a constituir un relato sobre el luctuoso episodio histórico. Este tenso y opresor contexto ofrece a Del Toro la oportunidad de explorar un tema de mayor complejidad: La “monstruosidad” y su relación con la noción cultural de género. Aunque los monstruos son habitualmente el epítome del miedo y los protagonistas de los géneros fantásticos, este estudio demostrará, desde el marco teórico del psicoanálisis, que el cineasta mexicano recurre a la yuxtaposición del mundo real y fantástico para construir un elocuente paralelismo entre la representación de la monstruosidad y el género. El objetivo principal de Guillermo del Toro es cuestionar y reevaluar la establecida y respetada hegemonía patriarcal y sus consecuencias perversas sobre el individuo.
La maldad genera cuentos de hadas: Análisis de la película de Guillermo del Toro El Laberinto del Fauno
Authors: Labrador Ben Julia María
Published: April 2011

El laberinto del fauno (2006) de Guillermo del Toro es una película con dos planos que se entrecruzan constantemente: el real, que se corresponde con la España de posguerra de 1944, en el que unos militares capitaneados por Vidal persiguen sin piedad a los maquis de la zona, y el imaginario, ideado por Ofelia en paralelo como evasión ante los acontecimientos negativos que vive o que la rodean. Cuando la maldad circundante es extrema, huir a un mundo de fantasía se convierte en una salida para sobrevivir, pero sólo es una solución parcial, porque la realidad negativa irrumpirá con mayor o menor medida en ese mundo imaginario y no siempre se podrá evitar. Guillermo del Toro plantea una ficción que tiene su origen en la maldad, pero adquiere una forma mucho más cercana a lo contrario, un cuento de hadas, sin embargo, no todo va a ser bondad en ese mundo inicialmente idílico.
Tema y narración en Eyes Wide Shut
Authors: Cánovas Méndez Marcos
Published: April 2011

A partir de la complejidad argumental y temática de la película Eyes Wide Shut, dirigida por Stanley Kubrick, se presenta una propuesta interpretativa que analiza la relación entre el tema de la película, la trama narrativa y la novela en que se basa, Traumnovelle (Relato soñado), de Arthur Schnitzler. La estructura argumental se sostiene en un elemento temático específico, los impulsos sexuales de una pareja –y los sueños y las fantasías vinculados–, en una trama en la que se suceden episodios que representan estos impulsos. Las escenas proyectan las tendencias del inconsciente de los personajes (en sueños, en fantasías y también en situaciones dudosamente reales) de forma cada vez más intensa, hasta llegar al anticlímax de cotidianidad con que concluye la película.
Nevus Lipomatosus Superficialis with a Folliculosebaceous Component: Report of 2 Cases
Authors: Bancalari Eugenia , Martínez-Sánchez Diego , Tardío Juan C.
Published: April 2011

Nevus lipomatosus superficialis (NLS) is an uncommon hamartomatous lesion of the skin characterized by the presence of clusters of mature fat cells among the collagen bundles of the dermis. Usually, the number of adnexal structures is reduced in NLS as compared to the normal adjacent skin, but their morphology is not altered. Nevertheless, in some instances, associated pilar abnormalities have been reported. We here report 2 cases of NLS with disorganized pilosebaceous units. The follicular structures were dilated and showed infundibular type keratinization and there were numerous mature sebaceous lobules radiating from them resembling the histology of a folliculosebaceous cystic hamartoma (FSCH) or a sebaceous trichofolliculoma. Only 2 cases of NLS with FSCH have been previously reported. Our cases represent examples of a very rare hamartomatous cutaneous lesion composed of mesenchymal and epithelial components.
Hyponatremia and Congestive Heart Failure: A Marker of Increased Mortality and a Target for Therapy
Authors: Romanovsky Adam , Bagshaw Sean , Rosner Mitchell H.
Published: April 2011

Heart failure is one of the most common chronic medical conditions in the developed world. It is characterized by neurohormonal activation of multiple systems that can lead to clinical deterioration and significant morbidity and mortality. In this regard, hyponatremia is due to inappropriate and continued vasopressin activity despite hypoosmolality and volume overload. Hyponatremia is also due to diuretic use in an attempt to manage volume overload. When hyponatremia occurs, it is a marker of heart failure severity and identifies patients with increased mortality. The recent introduction of specific vasopressin-receptor antagonists offers a targeted pharmacological approach to these pathophysiological derangements. Thus far, clinical trials with vasopressin-receptor antagonists have demonstrated an increase in free-water excretion, improvement in serum sodium, modest improvements in dyspnea but no improvement in mortality. Continued clinical trials with these agents are needed to determine their specific role in the treatment of both chronic and decompensated heart failure.
Bioinformatic Prediction of Ultraviolet Light Mutagenesis Sensitivity of Human Genes and a Method for Genetically Engineering UVB Resistance
Authors: Lease Kevin A. , Papageorgio Chris
Published: April 2011

Living on earth, we are exposed to ultraviolet (UV) light as part of the solar radiation. UVB spectrum light exposure contributes to the development of skin cancer by interacting with pyrimidine pairs to create lesions called cyclobutane pyrimidine dimers. If these lesions are not removed by nucleotide excision repair, they often give rise to C to T transition mutations. Based on these observations, a bioinformatics approach was used to predict the vulnerability of human protein coding genes to UVB induced loss of function mutations. This data was used to evaluate in depth those genes associated with malignant melanoma. In addition, we demonstrate a method of genetically engineering genes that significantly improves resistance to UVB loss of function mutations.
A comparison of Methods for Data-Driven Cancer Outlier Discovery, and An Application Scheme to Semisupervised Predictive Biomarker Discovery
Authors: Karrila Seppo , Lee Julian Hock Ean , Tucker-Kellogg Greg
Published: April 2011

A core component in translational cancer research is biomarker discovery using gene expression profiling for clinical tumors. This is often based on cell line experiments; one population is sampled for inference in another. We disclose a semisupervised workflow focusing on binary (switch-like, bimodal) informative genes that are likely cancer relevant, to mitigate this non-statistical problem. Outlier detection is a key enabling technology of the workflow, and aids in identifying the focus genes.

We compare outlier detection techniques MOST, LSOSS, COPA, ORT, OS, and t-test, using a publicly available NSCLC dataset. Removing genes with Gaussian distribution is computationally efficient and matches MOST particularly well, while also COPA and OS pick prognostically relevant genes in their top ranks. Also our stability assessment is in favour of both MOST and COPA; the latter does not pair well with prefiltering for non-Gaussianity, but can handle data sets lacking non-cancer cases. We provide R code for replicating our approach or extending it.
Illicit Opioid Intoxication: Diagnosis and Treatment
Authors: Fareed A. , Stout S. , Casarella J. , Vayalapalli S. , Cox J. , Drexler K.
Published: April 2011

Opioid intoxications and overdose are associated with high rates of morbidity and mortality. Opioid overdose may occur in the setting of intravenous or intranasal heroin use, illicit use of diverted opioid medications, intentional or accidental misuse of prescription pain medications, or iatrogenic overdose. In this review, we focused on the epidemiology of illict opioid use in the United States and on the mechanism of action of opioid drugs. We also described the signs and symptoms, and diagnoses of intoxication and overdose. Lastly, we updated the reader about the most recent recommendations for treatment and prevention of opioid intoxications and overdose.
The Impact of Intersection Design on the Driving Performance of Adults in the Recovery Phase of a Turn
Authors: Classen Sherrilene , Shechtman Orit , Stephens Burton , Davis Ethan , Lanford Desiree , Mann William
Published: April 2011

Driving, an instrumental activity of daily living, requires safe person-environment interactions. The effectiveness (safety) of four United States Federal Highway Administration intersection design guidelines in the recovery phase of a turn was tested on older and younger adults. Using kinematics measures from an instrumented vehicle, drivers negotiating improved and unimproved intersections were examined in Gainesville, Florida.

The findings from a 2 × 2 repeated measures ANOVA (within-subject variable = intersection condition: improved versus unimproved; between-subject variable = age: young versus old) yield support for three manoeuvres: extended receiving lane, right-turn channelisation with acceleration lane and left-turn offset, but not for no acute turn angle. One interaction effect (age x intersection) existed and age effects (favouring older drivers) appeared for three manoeuvres, yet showed little practical significance, suggesting that these design guidelines benefit older and younger drivers alike.

This study informs occupational therapists that enhancements in the environment have an impact on safer driving, particularly at urban intersections. A replication of the concept of this study, that is, testing intersection design guidelines in the United Kingdom, may generate valuable information on the plausibility of environmental design guidelines and their effects on the driving performance of older and younger adults.
‘I Feel So Much Safer’: Unravelling Community Equipment Outcomes
Authors: Sainty Mandy , Lambkin Christopher , Maile Louise
Published: April 2011

Health and wellbeing outcomes are the new currency of health and social care commissioning. To explore the extent to which community equipment had an impact on the health and wellbeing outcomes of choice and control, quality of life and personal dignity, a postal survey was carried out among a sample of adults who had been prescribed community equipment by social or primary care services to meet mobility, domestic, personal care or sensory needs. A response rate of 52% (251) was achieved.

Seventy-eight per cent of respondents reported that they were using all the equipment prescribed. Bathing equipment tended to be either very successful or not used at all. Of those who had used all or some of the equipment prescribed, 91% reported feeling safer and over 80% said that it made a positive difference to their independence, quality of life or ability to do things when they wanted. The provision of equipment had less of an impact on reducing the need for assistance at home, particularly from paid carers.

The practice implications highlighted by the findings focus on the need to review the opportunities available for maximising effective use of bathing equipment.
Measuring Social Inclusion: A Staff Survey of Mental Health Service Users' Participation in Community Occupations
Authors: Dorer Gemma , Harries Priscilla , Marston Louise
Published: April 2011

Mental health service users frequently experience social exclusion and limited occupational engagement. A survey was conducted to gather staff reports of 199 service users' levels of engagement and social inclusion across eight domains of community occupation.

The staff reported that the majority of service users (54%) engaged in two or fewer of the community occupation domains over a 7-day period, the most common being the use of local facilities (92%) and contact with family and friends (61%). The staff reports suggested that far fewer service users were engaged in the other domains: day centres (25%), education (14%), sport (13%), arts (12%), employment (11%) and faith (8%). With regard to social inclusion, activities occurred most frequently in mainstream settings for the domains of faith (100%), use of local facilities (98%), sport (80%), and family and friends (79%). Lower levels of social inclusion were reported for the other domains. Statistical analysis revealed that service users' occupational engagement related to their accommodation type, age and gender, but not to ethnicity.

These findings indicate that further research is needed to explore service users' views on social inclusion and what they feel would support them to engage in community occupations at a level that suits their individual needs.
The Future of Occupational Therapy in Mental Health in Ireland
Authors: Lloyd Chris , Williams Philip Lee
Published: April 2011

The settings and roles of occupational therapists working in Ireland in mental health have changed greatly over the last decade. Occupational therapy's central tenet, however, that of focusing on occupation and the belief that it is vital in maintaining and promoting people's health and wellbeing, has not. If occupational therapists wish to remain a strong presence in mental health, they will have to adopt many generic roles and work activities while developing and maintaining unique discipline-specific roles. It is time for occupational therapists to focus on occupation, government policy and evidence-based practice in order to identify specialist roles for occupational therapy in mental health. Through this process, health promotion, social inclusion and supported employment stand out as three key areas with which occupational therapy has a good fit.
Night-Time Positioning for Children with Postural Needs: What is the Evidence to Inform Best Practice?
Authors: Wynn Nicky , Wickham Jill
Published: April 2011

This paper presents the findings of a review of the literature concerning the assessment and provision of night-time positioning for children with postural needs. The aim of the review was to source and evaluate the evidence available for the efficacy of current treatments and to establish best practice.

There is a small but growing body of evidence demonstrating that night-time positioning is beneficial to children with postural needs when used within a child and family centred 24-hour postural management programme. Children and families need timely assessment and provision of equipment, together with appropriate training and support to learn to use night-time positioning equipment effectively.

Occupational therapists have a distinct role in the assessment and provision of night-time positioning equipment and need to be both skilled in assessment and knowledgeable about postural management and the equipment available. This review of literature suggests that further research is required to strengthen the evidence for the efficacy of night-time positioning equipment and to guide therapists in best practice.
Does the Use of a Sensory Re-Education Programme Improve the Somatosensory and Motor Function of the Upper Limb in Subacute Stroke? A Single Case Experimental Design
Authors: Helliwell Suzanne
Published: April 2011

Purpose:

The purpose was to evaluate the effects of a sensory re-education programme on the somatosensory and motor function of the upper limb in subacute stroke.

Participant:

The participant was a subacute stroke patient with radiological evidence of first unilateral stroke, with motor and sensory impairments.

Procedures:

Following a baseline period to establish a pattern of sensory function, a sensory re-education programme was delivered over 10 sessions. The treatment occurred three times a week on set days and was administered by a trained assistant.

Main outcome measures:

The Rivermead Assessment of Somatosensory Performance (RASP) and the Upper Limb — Motor Assessment Scale (UL-MAS) were completed throughout the baseline phase and then at weekly intervals until the final day of the study. The Functional Independence Measure was completed at the start and end of the intervention phase.

Results:

Surface pressure touch and surface localisation were the most impaired during the baseline phase. Proprioceptive movement and proprioceptive direction showed gradual improvement throughout the intervention phase.

Conclusion:

The results suggest that there may have been an effect on proprioception in the upper limb following intervention. The inconsistency during the baseline phase makes definitive conclusions difficult to draw. The change in proprioception did not have any effect on motor recovery. Further discussion is needed on the implementation of sensory re-education in the subacute stroke population.
Meeting the Challenge: OT and IT
Authors: Morley Mary , Aveling Patricia
Published: April 2011

Government policy requires occupational therapists to provide evidence for the clinical effectiveness of services using information management systems. However, their engagement in the Information Management and Technology programme has been limited.

The benefits of engaging in this agenda are explored and the risks of non-involvement are discussed. Strategies to assist occupational therapists and managers to implement information systems are highlighted. It is concluded that unless occupational therapists engage collectively in the short term, the opportunities to influence information systems will diminish and the unique occupational therapy contribution will be at risk of becoming invisible.
Learning from the Past: Reflections on Two Lives with Polio and Occupational Therapy
Authors: Runge Ulla , Carnduff Ann
Published: April 2011

This paper reflects the personal journeys of two occupational therapists, who have lived with polio and have shared remarkably similar experiences despite living in two different countries. An autoethnographic approach was taken and three phases emerged: appearance, covering the 1940s and 1950s; disappearance, covering the next three decades; and reappearance, covering the 1990s until the present day. These phases encompass the twin tracks of polio and occupational therapy over 60 years of two lives and their joint journey.
Learning in International Practice Placement Education: A Grounded Theory Study
Authors: Barker Alison , Kinsella Elizabeth Anne , Bossers Ann
Published: April 2011

Objective:

There is a growing trend towards international practice placement education in occupational therapy, yet little research documents the learning that individuals who participate in such experiences report. The purpose of this study was to examine the process of learning that arises through engagement with occupational therapy practice placement education in an international context.

Method:

A constructivist grounded theory methodology was employed. In-depth, semi-structured interviews were conducted with eight individuals who had completed an international practice placement during their tenure as an occupational therapy student.

Findings:

The core category of learning identified by participants was personal and professional development. The subcategories included thinking outside the box, adaptability/flexibility, cultural sensitivity, recognition of the value of interpersonal relationships, and gaining confidence through moving beyond one's comfort zone and through increasing autonomy. The comments from participants also invoke critical reflection on the appropriateness of the transfer of North American occupational therapy practice into resource-poor countries.

Conclusion:

This research documents the process of learning described by a group of individuals who participated in international practice placement education as part of their occupational therapy education. The research contributes to knowledge about international practice placement education in occupational therapy.
Feasibility of the Canadian Occupational Performance Measure for Routine Use
Authors: Colquhoun Heather , Letts Lori , Law Mary , MacDermid Joy , Edwards Mary
Published: April 2011

Purpose:

Despite encouragement, routine outcome measurement is not standard practice in occupational therapy. This applies across most practice areas and outcome measures, including occupational therapy measures such as the Canadian Occupational Performance Measure. Barriers to using outcome measures have been proposed, but are gathered from therapists not measuring outcomes routinely. This study gathered therapists' perceptions on outcome measurement following a period of routine outcome measure use. A secondary aim was to propose a therapist-driven template for summarising outcome data routinely.

Procedures:

Using a process evaluation, a short answer survey was used with three occupational therapists following 5 months of Canadian Occupational Performance Measure use in older people's rehabilitation. The data were summarised descriptively, using a proposed template based on therapist feedback.

Findings:

The therapists perceived that the measure facilitated treatment for both therapists and clients but they experienced challenges related to client cognition and sustaining use. Template creation indicated that the therapists placed more importance on individual than group level data.

Conclusion:

The therapists perceived benefit in routine Canadian Occupational Performance Measure use. The instrument appears feasible for meaningful and routine use but not necessarily for sustained use. Increasing outcome measure use is complex, requiring more knowledge on barriers, expectations of value and methods of data utilisation.
Understanding Parenting Occupations in Neonatal Intensive Care: Application of the Person-Environment-Occupation Model
Authors: Gibbs Deanna , Boshoff Kobie , Lane Alison
Published: April 2011

The adoption of family-centred care principles within neonatal intensive care, including support for the development of the parental role, has been increasing in profile over the past decade. During this period, occupational therapy has also had an emerging role in the provision of services within neonatal intensive care. However, there has been limited exploration of the concept of parenting as an occupation as a means of supporting parental role development within the neonatal intensive care unit (NICU). In accordance with the philosophy of family-centred care, opportunities exist to determine how the occupational efforts of parents and preterm infants can best be supported.

This paper provides a review of the current literature and its application to the Person-Environment-Occupation (PEO) Model as a framework for illuminating the acquisition of parenting occupations in the NICU. Illustration is provided of how the application of the PEO Model can be used to direct occupational therapy practice to incorporate a focus on family-centred care and the development of an occupation-based approach through which practice can be enhanced, ensuring that both the infant's and the family's needs are recognised and addressed.
Normal Movement and Functional Approaches to Rehabilitate Lower Limb Dressing following Stroke: A Pilot Randomised Controlled Trial
Authors: Mew Melissa
Published: April 2011

Dressing difficulties are common following stroke. However, specific interventions lack evidence. This pilot single-blind randomised controlled trial investigated normal movement and functional approaches to rehabilitate lower limb dressing, given to four eligible stroke inpatients. The Nottingham Stroke Dressing Assessment, Rivermead Motor Assessment and Canadian Occupational Performance Measure were taken at baseline, discharge and 8 weeks. The small sample lacked power. Preliminary results indicated that while all patients improved with occupational therapy, approaches may differ in rates of motor recovery, independence and treatment duration. A total sample of 30 is required for more conclusive research to inform lower limb dressing interventions.
‘Rip That Book up, I've Changed’: Unveiling the Experiences of Women Living with and Surviving Enduring Mental Illness
Authors: McKay Elizabeth Anne
Published: April 2011

The lives of women with an enduring mental illness have been little researched within occupational therapy. This study explored the experiences of five women living with enduring mental illness in their communities. The women were interviewed over a 2-year period using the life history method. Data were recorded and transcribed verbatim. The data set was analysed in two ways. First, from the narrative analysis, an individual unique narrative of each woman's life was created. Secondly, the data were analysed using the constant comparative method. This paper presents the findings from the constant comparative analysis.

Six themes were identified, which lifted the veil on the experience of living with and surviving enduring mental illness. Each theme represented a section of the women's lived experiences: a specific frame of the bigger picture of their lives. The themes were present life, life roles, relationships, illness transitions, help and cultural context.

The findings highlighted the complex life roles and needs of the women over time. They unveiled how the women became agents in creating a better life for themselves and others. Practitioners have a role to play in creating meaningful and safe environments that encourage social inclusion and recovery.
Exploring Occupational Adaptation through the Lives of Women with Multiple Sclerosis
Authors: Cahill Mairead , Connolly Deirdre , Stapleton Tadhg
Published: April 2011

Multiple sclerosis (MS) affects people's physical capabilities and the lives of people with MS are constantly changing (Finlayson et al 2005), yet how people adapt to the disease from an occupational perspective has received little attention. This study explored the occupational adaptation of women with MS.

Seven women with MS were recruited from the Multiple Sclerosis Society of Ireland. Each participant completed the Modified Interest Checklist (Kielhofner and Neville 1983), the Role Checklist (Oakley et al 1985) and the Occupational Questionnaire (Smith et al 1986). Qualitative data were also collected, using the Occupational Performance History Interview – II (Kielhofner et al 2004).

The findings from all four tools were amalgamated and analysed. Three main themes emerged: the impact of MS on (i) performance capacity, (ii) roles and (iii) interests. The participants adapted by performing interests and roles differently and developing new meaningful interests and roles that were congruent with their performance capacity.

The findings highlight the importance of having an understanding of the impact of different types of MS on the occupational adaptation process. A greater understanding will facilitate occupational therapists in enabling people with MS to adapt to their condition by engaging in meaningful occupations throughout the lifespan.
Social Inclusion and Mental Health
Authors: Le Boutillier Clair , Croucher Anna
Published: April 2011

Social inclusion is a leading concept in mental health practice. Multiple definitions exist and it is often assumed that full participation is required to achieve full inclusion. Challenging this assumption is the notion of ‘middle-ground’, a personally defined position where an individual feels socially included regardless of his or her physical involvement in the community. Occupational therapists can address this area of inquiry by recognising an alternative to the polar extremes of social inclusion. A practical tool is provided, which views social inclusion as a multidimensional system and promotes reflection on what it really means to be socially included.
Spirituality within Dementia Care: Perceptions of Health Professionals
Authors: Bursell Jennifer , Mayers Christine A
Published: April 2011

There is an increasing awareness that people with dementia should have their spiritual needs addressed. The aim of this study was to investigate health professionals' understanding of spirituality within dementia care and their perceptions of how patients' spiritual needs are met and by whom. A phenomenological approach was used, with semi-structured interviews undertaken with four nurses, two occupational therapists, two physiotherapists, two doctors and one speech and language therapist (n = 11).

All the health professionals found defining ‘spirituality’ difficult, although common terminology was used. They agreed that spirituality was not solely related to religion. Chaplaincy staff were associated with the provision of spiritual care, but 10 of the health professionals identified themselves as staff who should address such spiritual needs. The majority (n = 10), however, reported a lack of confidence with spiritual care and agreed that training would be valuable.

The findings indicate that all health professionals should address the spiritual needs of patients with dementia. A working definition of ‘spirituality’ is needed and further research is also warranted into the type of training needed by health professionals with regard to the spiritual care of patients.
Electronic Tracking for People with Dementia Who Get Lost outside the Home: A Study of the Experience of Familial Carers
Authors: White Eleanor Bantry , Montgomery Paul , McShane Rupert
Published: April 2011

Purpose:

The study aimed to elicit a description of GPS (global positioning system) tracking use in the care of people with dementia in domestic settings and to generate hypotheses about impact.

Procedures:

Users were recruited through a commercial provider. Qualitative interviews with 10 carers were completed to generate an in-depth description of how the devices were used and the perceived impact. A questionnaire was administered to ascertain sample characteristics.

Findings:

Most carers preferred to use tracking as a back-up to other strategies of management, particularly supervision by a carer and locked doors. In cases where the carers perceived the risk of harm from getting lost to be low, tracking was used to preserve the independence of the person with dementia. The carers reported that tracking gave them reassurance and also enhanced the sense of independence both for themselves and for the person with dementia. The poor reliability of the device was identified as a substantial limitation.

Conclusion:

Larger studies are needed to assess the safety and clinical value of GPS tracking. These should explore the views of people with dementia. Assessment tools are needed to assess suitability. Occupational therapy can play a pivotal role in this process of intervention design, assessment and evaluation.