Work simplification. Does it work simply?
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Fatigue was studied in 12 subjects with post-polio sequelae (PPS). Results of the Fatigue Severity Scale (FSS) demonstrated a mean score of 4.8 +/- 1.6 (non-disabled scores = 2.3 +/- 0.7). The Human Activity Profile (HAP) was not sensitive enough to measure fatigue. Fifty percent of subjects scored below the first percentile based on age and sex matched norms. The Activity Record (ACTRE) results revealed that subjects spent 5% of their time resting and 1% in planning or preparation activities. Fatigue peaked in the late morning or early afternoon and was relieved by rest periods. Use of energy conservation and work simplification skills along with frequent rest periods was suggested as a possible method for managing PPS fatigue.
Individuals experiencing post-polio sequelae (PPS) are usually advised to make significant lifestyle changes to lessen symptoms and prevent further decline in function. These individuals have spent most of their lives equating success with over-achievement and find it difficult to implement such recommendations. As specialists in energy conservation and work simplification, occupational therapyists increasingly are being called on to evaluate and treat these patients. Over the past 2 years, an occupational therapy educational program has been developed to educate patients about their condition and about ways to implement lifestyle changes while preserving the ability to do valued activities. This article describes the components of a thorough occupational therapy evaluation and the design and functional outcomes of a successful occupational therapy educational program to treat PPS.
Rehabilitation and nursing care of patients with postmenopausal osteoporosis require a comprehensive team effort. The primary purpose of rehabilitation is to restore these elderly women to an optimal level of well-being and activity and return them to home and community life as soon as possible. Medical management, rehabilitative nursing and physical therapy are interdependent. Emphasis is placed on estrogen replacement to prevent further fractures and height loss, individualization of care, early ambulation, improving patient confidence, physiotherapy procedures, orthopedic supports, optimal nutrition, safety precautions, work simplification, occupational therapy and the need for appropriate social contacts. The economic, physical and emotional consequences of deforming postmenopausal osteoporosis are enormous. Current research indicates that this disease is preventible. An effective program of prophylaxis is needed now; otherwise many more women will need increasing amounts of costly rehabilitation.
A data collection system on microcomputer connected with an automatic medical report system for operations, was developed to facilitate both medical report as well as documentation. Linking different commercial software products by use of a Pascal programme, we were able to speed up daily routine work as well as establish efficient graphical statistics of patient data.
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Endodontic treatment is an important part in operative dentistry. While quantity of treatment increases, the quality should not be neglected. Means to improve the individual success rate are shown in the article. The simplification of the armamentarium and systematics of procedures are of utmost importance. As the basic technique the hand instrumentation is described.
A method to expedite processing of electrocardiograms (ECGs) is described. The hardware configuration utilizes conventional equipment, and the ECG data is stored in magnetic data cards. The electrocardiographer's interpretation is made using a specially developed code of 253 diagnostic statements of 2 to 9 words each. A minicomputer converts the code into full alpha-numeric description and 2 characters into English statements. The diagnostic print-out appears in the same page as the reproduction of the original ECG data. This system has significantly reduced the ECG processing time, freed manpower to increase availability of technicians and decreased the size of permanent files.
An electrocardiometer (ECM) which computes the T/R ratio of Lead I and simultaneously prints out Lead I was used to screen 1,004 consecutive hospitalized patients for EKG abnormalities. When the combined meter and Lead I print out analyses were used, 77.9% of abnormal EKG's were identified with a false-positive rate of less than 4%. The method is highly specific for detecting EKG abnormalities associated with anterior and lateral left ventricular disease. It could be used as an inexpensive mass screening device for electrocardiographic risk factors associated with coronary disease.
This study used psychophysical methods to determine the acceptable mean maximum lifting workload for eight Chinese young male subjects, and examined the effects of lifting technique (including freestyle, stoop and squat), lifting frequency (including 2, 3, 4, 5 and 6 lifts/min) and physical characteristics on the maximum acceptable workload. The results are described as follows: (1) The maximum acceptable weights selected by subjects varied from 11.34 to 18.33 kg with changes in lifting technique and frequency. These data were lower than those previously obtained; (2) The upper limit of physiological tolerance over an 8 h workday was also generally lower than previously suggested. However, this upper limit varied with changes in lifting technique and frequency, and in some circumstances it was the same as or even higher than previous limit; (3) Lifting efficiency was affected significantly by technique and frequency. The rank order of efficiency for three lifting techniques were freestyle, stoop and squat. Efficiency was greatest when lifting frequency was between 5 and 6 lifts/min; and (4) The correlations between the maximum acceptable workloads selected by subjects and anthropometric sizes were significant, but those between maximum acceptable workload and isometric strength were not.
A laboratory study was conducted in an effort to reduce back stress for nursing personnel while performing the patient handling tasks of transferring the patient from bed to wheelchair and wheelchair to bed. These patient handling tasks were studied using five manual techniques and three hoist-assisted techniques. The manual techniques involved one-person and two-person transfers. One manual technique involved a two-person lift of the patient under the arms; the others used a rocking and pulling action and included the use of assistive devices (a gait belt using a two-person transfer, a walking belt with handles using a one-person and a two-person transfer, and a patient handling sling with cutout areas to allow for a hand grip (Medesign) for a one-person transfer). The three mechanical hoists were Hoyer, Trans-Aid and Ambulift. Six female nursing students with prior patient transfer experience served both as nurses and as passive patients. Static biomechanical evaluation showed that pulling techniques, as compared to lifting the patient, required significantly lower hand forces and produced significantly lower erector spinae and compressive forces at the L5/S1 disc (P greater than or equal to 0.01). Shear force, trunk moments and the percentage of females who were capable of performing the transfers (based on static strength simulation) also favoured pulling methods. Perceived stress ratings for the shoulder, upper back, lower back and whole body were lower for pulling methods than those for lifting the patient (P less than or equal to 0.01). Patients found the pulling techniques, with the exception of when using the gait belt, felt more comfortable and more secure than the lifting method (P less than or equal to 0.01). However, a number of subjects believed that the patient handling sling (Medesign) and the walking belt with one person making the transfer would not work for those patients who could not bear weight and those who were heavy, contracted or combative. A walking belt with two persons was the preferred manual method. Two out of three hoists (Hoyer lift and Trans-Aid) were perceived by the nurses to be as physically stressful as manual methods. Patients found these two hoists to be more uncomfortable and felt less secure than with three of the five manual methods (one- and two-person walking belts and Medesign). Ambulift was found to be the least stressful, the most comfortable, and the most secure among all eight methods. Pulling techniques and hoists took significantly longer amounts of time to make the transfer than manually lifting the patient (P less than or equal to 0.01). The two-person walking belt using a pulling technique and Ambulift are recommended for transferring patients from bed to wheelchair and wheelchair to bed. A large-scale field study is needed to verify these recommendations.
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