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In this pilot study, the NOC instruments Knowledge of Medication, Caregiver Home Care Readiness, and Health Promoting Behavior were evaluated for use in measuring outcomes of a nurse care manager program with chronically ill veterans. The convenience sample included 10 chronically ill veterans who were diagnosed with at least three of the high priority diagnoses targeted for care management: congestive heart failure, ischemic heart disease, chronic obstructive pulmonary disease hypertension, and diabetes. The typical patient was a 68-year-old married Caucasian male. The Caregiver Home Care Readiness and Health Promotion Behavior instruments demonstrated strong correlations for inter-rater reliability and overall reliability using Cronbach's alpha. The correlation coefficient for inter-rater reliability was below the acceptable .80 for Knowledge of Medications. This instrument had been modified considerably from the original NOC instrument because many of the indicators were in the scope of responsibility of pharmacists rather than nurse care managers in the Veterans Administration Medical Center (VAMC). All of the instruments showed acceptable inter-item reliability of .71 to .87. Use of chart audits to collect data regarding health promotion behavior and knowledge of medications was compared to the procedures of data collection with modified NOC instruments. The results from this pilot study demonstrated that NOC instruments provided more reliable data than the chart audits. [ABSTRACT FROM AUTHOR]

Two cases are presented of closed rapture of the extensor pollicis longus due to rotational trauma to the forearm. Case 1 was successfully managed by indicis proprius transfer and the operative findings are described. The rarity of this injury is stressed by a review of the sparse relevant literature. [ABSTRACT FROM PUBLISHER]

Seating arrangements for cerebral palsy children with total body involvement are often unsatisfactory and can pose considerable problems for the multi-disciplinary team. Hip joints at risk of dislocation must be kept in an abducted position in order to minimize pain. A new wheelchair with a barrel-shaped cylindrical seat has been developed which improves the femoral head location and alleviates pain. [ABSTRACT FROM AUTHOR]

Metabolic bone is highly innervated by both sensory and sympathetic nerves. In addition to skeletal development, neural regulation participates in local bone remodeling, which is important for successful osseointegration of titanium implants. Neurectomy is a model used to investigate the lack of neural function on bone homeostasis, but the relative impacts of direct denervation to bone or denervation-induced muscle paralysis are less well defined. To investigate this difference, we used two nerve intervention models, sciatic and femoral neurectomy (SFN) v. botox-induced muscle paralysis (BTX) and assessed the resulting femoral bone phenotype and Ti implant osseointegration. Male Sprague Dawley rats (19) were randomly divided into three groups: implant control (n = 5), SFN (n = 7), and BTX (n = 7). Ti implants (microrough/hydrophilic [modSLA], Institut Straumann AG) were placed in the distal metaphysis of each femur on day 24 post-SFN or BTX. Bone and muscle were examined on day 28 after implant insertion. Both nerve intervention models impaired osseointegration. MicroCT and histology indicated that both models had reduced trabecular bone formation. Only BTX reduced cortical bone formation and increased cortical bone porosity. BTX resulted in more bone loss characterized by the least trabecular and cortical bone, as well as osseointegration. Osteoblasts isolated from the tibia exhibited a model-specific phenotype when they were grown on Ti substrates in vitro. Neurectomy caused more severe muscle atrophy than botox injection. These results indicate that neural regulation directly modulates bone formation and osseointegration. Muscle paralysis modulated the effects of loss of neural inputs into bone, supporting the hypothesis that mechanical loading of bone is a factor in achieving successful osseointegration. The different effects of botox and neurectomy on bone phenotype indicated that the sensory and sympathetic nerves had a role in the osseointegration process., (Copyright © 2021 Elsevier Inc. All rights reserved.)