Does continuous passive motion during keyboarding affect hand blood flow and wrist function? A prospective case report

The purpose of this prospective case report was to evaluate the use of a keyboard platform device that uses continuous passive motion (CPM) on vascular flow to the hand for clerical employees who perform daily keyboarding tasks. Subjects were two female volunteers, one symptomatic of carpal tunnel syndrome (CTS), who were employed in clerical positions and perform daily keyboarding tasks for most of their workday. Data collection consisted of baseline and follow-up measurements at 6 weeks, including: 1) screening for symptoms based on the Carpal Tunnel Function Disability Form, 2) evaluation using standard physical therapy examination and assessment techniques, including modified Semmes- Weinstein monofilament testing, 3) a typing productivity test, and 4) Doppler ultrasound examination to quantify vascular flow at the wrist. Results revealed that both subjects demonstrated an overall increase in both radial and ulnar blood flow velocity with no decrement in typing productivity. The symptomatic subject also demonstrated an overall improvement of 10 wpm in the typing tests, a decrease in her disability score and symptom severity, and improvement in function. Results suggest that use of CPM as a non-intrusive ergonomic intervention may be used to treat, as well as prevent, carpal tunnel-like symptoms in those who keyboard.     

Heading off violence with verbal de-escalation

Respect for the rights and dignity of patients is the underlying principle of therapeutic communication. Its effective practice requires the nurse to identify personal issues, stressors, and one's own anxiety and effectiveness levels. It is important that the caregiver maintain self-control to help others control themselves. By constantly observing patient behavior, the nurse should be able to detect agitation and intervene in a timely fashion, avoiding physical confrontation and the physical restraints that are its usual consequence. To make this outcome possible, the nurse should learn to recognize signs of agitation and escalation; should practice presenting himself or herself as a calm, caring professional; and should maintain poise even when facing a potentially violent patient. The nurse should remain open-minded, knowing that patients frequently react to assumptions made about them, and use the information acquired to find acceptable alternatives to aggression. These alternatives should be presented to the patient, making the choices clear, yet allowing the dignity of choice. Every effort should be made to provide opportunity for patients to be in control of their own behavior. Physical confrontation should always be a last resort, and one used only when there is a clear danger of immediate physical harm to a patient or staff member. Keep in mind that the use of force is an encouragement to aggressive behavior and a hindrance to treatment. Effective use of therapeutic communication encourages patients to express their feelings and become cooperative partners in their treatment.     

GLOBALIZATION, NATIONAL CULTURES AND CULTURAL CITIZENSHIP

The article develops an argument in respect of the media of mass communication, globalization processes and what I call cultural citizenship. In the first instance, I argue that in the British and European contexts that national cultures remain more powerful constructions than many postcolonial and postmodern critics seem aware. Secondly, in respect of cultural citizenship, I argue for a three layered component in respect of: (1) the emergence of cultural cosmopolitanism; (2) the specific application of rights and duties to both the television and film industries and; (3) the importance of the concept of civil society. The aim is to thread together a concern for globalizing processes and an attempt to outline a theory of cultural citizenship in respect of the development of systems of communication.     

Rural and urban women's perceptions of barriers to health, mental health, and criminal justice services: implications for victim services

The purpose of this study was to examine rural and urban women's perceptions of barriers to health and mental health services as well as barriers to criminal justice system services. Eight focus groups were conducted, two in a selected urban county (n = 30 women) and two in each of three selected rural counties (n = 98 women). Results were classified into a barrier framework developed in the health service utilization literature which suggests there are four main dimensions of barriers: affordability, availability, accessibility, and acceptability. Results indicate that: (1) women face many barriers to service use including affordability, availability, accessibility, and acceptability barriers; (2) it takes an inordinate level of effort to obtain all kinds of services; however, women with victimization histories may face additional barriers over and above women without victimization histories; (3) barriers to health and mental health service utilization overlap with barriers to utilizing the criminal justice system; and (4) there are many similarities in barriers to service use among rural and urban women; however, there are some important differences suggesting barriers are contextual. Future research is needed to further clarify barriers to service use for women with victimization histories in general, and specifically for rural and urban women. In addition, future research is needed to better understand how women cope with victimization in the context of the specific barriers they face in their communities.     

Management of premature menopause

There has been some confusion among women and health professionals since the publication of the Women's Health Initiative and Million Women studies about the management of premature ovarian failure (POF). Both studies were undertaken in women aged 50 and over, and cannot be extrapolated to their younger counterparts, who would normally be producing their endogenous estrogen, since they have functioning ovaries. Estrogen-based replacement therapy is the main stay of treatment for women with POF and is recommended at least until the average age of natural menopause (52 years in the UK). This view is endorsed by regulatory bodies such as the Committee on Safety of Medicines (now the Commission on Human Medicines) in the UK. No evidence shows that estrogen replacement increases the risk of breast cancer to a level greater than that found in normally menstruating women, and women with POF do not need to start mammographic screening early unless other risk factors are present, such as family history.     

Reciprocal Associations Among Maternal and Child Characteristics of At‐Risk Families: A Longitudinal Actor–Partner Interdependence Model

Researchers have found linear associations among maternal and child characteristics. However, family systems theorists suggest that relationships are more complex and family members are interdependent. We used actor–partner interdependence modeling to unravel associations among maternal and child characteristics to predict outcomes in adolescence. We used data from 361 mother–child dyads from the Longitudinal Studies of Child Abuse and Neglect and found both actor and partner effects. Maternal depression and history of victimization were associated with children's later reports of lower mother–adolescent relationship quality. Children's perceptions of relationship quality were also associated with mothers' later depressive symptoms and perceptions of relationship quality. Overall, results highlighted interdependence among mothers and their children over time. We discuss implications for marriage and family therapists.     

Supervising Mental Health Clinicians in The Context of Complex Organisational Dynamics

This article discusses the complex dynamics and challenges of providing supervision to mental health clinicians working within an organisational context when the supervisor is not part of the organisation and has no formal managerial or accountability responsibility. It considers two models of supervision and their application to three supervisory relationships in an organisational context. It concludes that for supervision to be effective there needs to be a consideration of the social defences in operation within the organisation and how they are met by the anxieties and defences of the supervisor and supervisee. This requires a mixed approach by the supervisor of the technical with the inter-subjective as a reliance on one model of supervision risks limiting the effectiveness of the intervention. The role of the supervisor can enable the supervisee to establish a clinical framework and the necessary environment essentials for their practice.     

Lean Control for Make‐to‐Order Companies: Integrating Customer Enquiry Management and Order Release

A lead time that is short, predictable, and reliable is an increasingly important criterion in supplier selection. Although many companies may achieve this through lean implementation, high‐variety manufacturers, for example, small and medium‐sized make‐to‐order companies, have found that lean's planning and control techniques do not apply. This article outlines a planning and control concept known as workload control (WLC) that integrates customer enquiry management, including a due‐date setting rule, with order release control. Simulation is then used to assess its impact on shop performance. Results demonstrate that an integrated WLC concept can reduce the percentage of tardy jobs—so short lead times can be realistically quoted—while also reducing and stabilizing workloads. WLC can level demand and production over time when work is not standardized and it is not possible to synchronize flows on the shop floor. Results are shown to be robust to changes in routing characteristics, the mix of orders with due dates specified by the customer and proposed internally, and the strike rate (or order‐winning probability). Hence, an integrated approach to WLC represents an important step toward achieving lean in make‐to‐order companies.