Use of the Houghton Scale to Classify Community and Household Walking Ability in People With Lower-Limb Amputation: Criterion-Related Validity.

OBJECTIVE: To examine the criterion-related validity of using the self-reported Houghton Scale to classify community-dwelling people with lower-limb amputation according to the suggested score ranges for independent community (Houghton Scale score ≥9), household and limited community (Houghton Scale scores 6-8), and limited household (Houghton Scale score ≤5) walking ability categories as referenced to performance-based balance ability and walking speed criteria. DESIGN: Cross-sectional cohort study. SETTING: Community-based wellness walking programs in 8 states in the Mid-Atlantic, Midwest, and Southeast regions of the U.S. PARTICIPANTS: Volunteers (N=180; 66.5% men, n=118; mean age, 55.5±16y) 7.1±13.1 years since amputation, with transtibial-level amputation in 47% (n=79) and amputation caused by vascular disease in 49.4% (n=89). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Self-reported data: Houghton Scale, Prosthetic Evaluation Questionnaire mobility subscale, and Activities-specific Balance Confidence (ABC) Scale. Clinical performance-based measures: balance ability assessed with 3 Berg Balance Scale (BBS) items and walking ability assessed with the timed Up and Go (TUG) test and 2-minute walk test (2MWT). The primary reference criteria were performance-based balance ability measured with the 3 BBS items and gait speed calculated from the 2MWT. RESULTS: On the Houghton Scale, 45.9% (78/170) of the participants scored ≥9, 30.6% (52/170) of the participants scored between 6 and 8, and 23.5% (40/170) of the participants scored ≤5. The Houghton Scale correlated with the Prosthetic Evaluation Questionnaire mobility subscale (r=.73), ABC Scale (r=.76), balance ability (r=.67), TUG test (r=-.67), and 2MWT (r=.73). The 3 Houghton Scale ability categories differed significantly from each other (P<.05) for all outcome measures: Prosthetic Evaluation Questionnaire mobility subscale, ABC Scale, balance ability, TUG test, and 2MWT. CONCLUSIONS: The Houghton Scale demonstrated criterion-related validity by differentiating community-dwelling people with lower-limb amputation into community, limited community/household, and household ability categories that corresponded to performance-based balance and walking criteria. Average prosthetic walking speeds for each category compared with similar walking ability categories defined in other patient populations.

Identification of 16p11.2 deletion syndrome on a child inpatient psychiatric unit: A case report and call for inpatient genetic testing.

PURPOSE: This case highlights the importance of nursing-directed interprofessional treatment and inpatient unit genetic testing to identify genetic syndromes that may potentiate psychiatric conditions. SOURCES USED: A case study of a 10-year-old Caucasian male with a history of a congenital heart defect, hand malformation, and low academic functioning who was admitted to the child inpatient psychiatric unit for eloping from school, aggression, and possible psychotic symptoms. Data were collected using patient medical records and interprofessional evaluation from nursing, psychiatry, and occupational therapy. RESULTS: The patient was treated with risperidone to manage psychotic symptoms. Dietary, occupational therapy, and scholastic plans were also implemented. After discharge, results of genetic microarray analysis revealed a Type 1 16p11.2 deletion. CONCLUSION: The role of nursing, interprofessional collaboration, and access to consultation teams play a crucial role in patient care for early diagnosis and treatment. Inpatient genetic testing has the potential to quickly identify and diagnose previously unidentified symptom clusters, leading to early intervention, closer monitoring, and improved patient outcomes.

Factors associated with committed participation in a wellness-walking program for people with lower limb loss: A prospective cohort study.

BACKGROUND:: Wellness activities can benefit health, yet committed adherence is challenging. OBJECTIVES:: Identify factors associated with committed participation in an amputee wellness-walking program and determine benefits of committed participation. STUDY DESIGN:: Prospective longitudinal cohort. METHODS:: Two former Paralympians led the wellness-walking sessions. Participants provided medical history and self-reported balance confidence and prosthetic functional measures. Physiotherapy professionals/paraprofessionals assessed balance and gait. Committed participants-those attending three sessions within 3 years-were compared to one-time-only participants using Fisher's exact and independent t-tests. First and third sessions for committed participants were compared with t-tests. A bootstrapped multivariable logistic regression model was developed using significant univariate predictors. RESULTS:: A total of 305 volunteers averaged 55.7 ± 15.2 years, including 68.4% men, 78.4% White race; 51.8% with dysvascular amputations, 40.5% with ⩾1 prosthetic knee; and 49.1% independent community walkers. Committed participants were initially similar to one-time-only participants ( p > 0.05) except for fewer years since amputation ( p = 0.007), better balance ability ( p = 0.001), and greater likelihood of dieting ( p = 0.030). The final model-balance ability (odds ratio = 2.4), dieting (odds ratio = 3.3), and years since amputation (odds ratio = 0.94)-identified 88.0% of committed participants ( p = 0.007). Balance confidence and functional improvements after three sessions were not significant ( p > 0.07). CONCLUSION:: Committed participants were more likely to diet, have better balance ability, and have more recent amputations than one-time-only participants. CLINICAL RELEVANCE: Knowing which characteristics identify people most likely to become committed participants-such as people with recent amputations, an interest in dieting, and better balance ability-may help health practitioners from different professions promote consistent participation in wellness activities that may benefit self-reported function.

Guidelines for the organization of a blood transfusion service / edited by W. N. Gibbs, A. F. H. Britten / Pautas para la organización de un servicio de transfusión de sangre / L' Organisation d' un service de transfusion sanguine : principes directeurs

A comprehensive guide to the principles and procedures involved in establishing or reorganizing a national blood transfusion service in developing countries. Focusedon organizational principles rather than technical details, the book responds to both the growing clinical need for safe and effective blood products and the many problems inherent in the organization of a transfusion service. Guidelines and advice draw upon several clear examples of successes and failures taken from international experiences in the difficult process of establishing a new transfusion service. The objective is to provide information to decision-makers and planners on how to develop a correctly organized scheme of management, select equipment, establish standard procedures, and train staff so as to provide an adequate supply of blood and blood products which are as safe as possible and accessible at reasonable cost. To this end, cost-saving options are presented together with clear indications of areas where expense is inevitable and no short-cuts are possible. The book has nine chapters. The first introduces the main functions, responsibilities, and organizational options of a national transfusion service. Information includes a discussion of the importance of following a policy of voluntary blood donation, an outline of the strengths and weaknesses of different systems for organizing a transfusion service, and advice on how to calculate the staff needs and operating costs of a service. Readers are reminded that a blood transfusion service is an expensive and complex organization, that careful design and management are essential, and that a scheme for meeting recurrent costs needs to be in place. Subsequent chapters outline the guiding principles for planning a donor recruitment programme and discuss the procedures to be followed during blood collection. Details range from the simple observation that a U-shaped arrangement of donation beds increases staff efficiency to a series of 15 questions that can help ensure the safety of both donors and recipients. Of particular value is a chapter devoted to the screening of blood for hepatitis, AIDS, syphilis and yaws, malaria, Chagas disease, cytomegalovirus, and other transmissible diseases. Other chapters outline the organizational procedures that should guide the production of laboratory reagents at the national or regional level, the selection of methods for blood-grouping and compatibility testing, and the acquisition of basic equipment and consumables, moving from refrigerators and centrifuges to pipettes and marking pens. The book concludes with guidelines for quality assurance and biosafety, followed by an outline of clinical indications for the use of whole blood, red cells, plasma, platelets, cryoprecipitate, factor VIII concentrate, factor IX complex, albumin, and immunoglobulins