Building multidisciplinary health workforce capacity to support the implementation of integrated, people-centred Models of Care for musculoskeletal health.

To address the burden of musculoskeletal (MSK) conditions, a competent health workforce is required to support the implementation of MSK models of care. Funding is required to create employment positions with resources for service delivery and training a fit-for-purpose workforce. Training should be aligned to define "entrustable professional activities", and include collaborative skills appropriate to integrated and people-centred care and supported by shared education resources. Greater emphasis on educating MSK healthcare workers as effective trainers of peers, students and patients is required. For quality, efficiency and sustainability of service delivery, education and research capabilities must be integrated across disciplines and within the workforce, with funding models developed based on measured performance indicators from all three domains. Greater awareness of the societal and economic burden of MSK conditions is required to ensure that solutions are prioritised and integrated within healthcare policies from local to regional to international levels. These healthcare policies require consumer engagement and alignment to social, economic, educational and infrastructure policies to optimise effectiveness and efficiency of implementation.

Safe exercise prescription for children and adolescents.

This article provides practical advice on healthy exercise prescription for children. There is growing scientific evidence about the abilities and limits of child athletes in both recreational and competitive environments. As exercise becomes essential for the prevention of illness and maintenance of health, the counselling for an exercise prescription requires enhanced knowledge. The latest recommendations on safe strength, resistance and weight training are presented in a concise format for office use.

The need for nursing and midwifery programmes of education to address the health care needs of minority ethnic groups.

The article reviews some of the more influential literature of the past decade on the health needs of ethnic groups, in an effort to identify what is being done by nursing and midwifery education to address the health care needs of these groups and to prepare practitioners who are able to respond to these needs. The article suggests that despite the relative lack of progress in this field of health care and education, there still exists much confusion, disagreement and lack of clarity around many issues, such as the identification of relevant content, the integration of this content into the curriculum and more importantly the delivery of this content. The literature seems to point to a lack of cultural knowledge, particularly for certain ethnic groups, which needs to be rectified. But even when knowledge is available, the evidence clearly indicates that both educators and practitioners are failing to translate this into effective and culturally sensitive care. The article suggests that nursing and midwifery education could and should play an important role in the development and dissemination of culturally sensitive care.

Promoting transcultural care in a college of health care studies.

This article describes the steps taken by the North London College of Health Studies to facilitate the development and delivery of culturally sensitive courses. It suggests that transcultural education for transcultural care can only truly be achieved if the organisational ethos, the epistemology which underpins the curriculum and the way that this is structured and taught, articulate together into a cohesive framework to enable the rhetoric to become reality.

Learning from colleagues of different cultures.

Much can be learned about transcultural care from nursing colleagues who belong to minority ethnic groups. If they are willing and adequately empowered these nurses can become effective role models for their colleagues.

Transcultural nursing and nurse education.

This is the first of a series of articles that will discuss some of the concepts associated with transcultural nursing. It suggests that nurse education fails in any significant way to deliver culturally sensitive care.

Antiracism within transcultural nurse education.

This article examines the problems of the multicultural approach in our multiracial society. It describes a need for nurses to be aware of the contribution of racism to inequalities in health care and to have insight into cultural and ethnic issues.

The management of sickle cell crisis pain as experienced by patients and their carers.

This study sought to provide insights into the personal experiences of individuals with sickle cell disorder and nurses involved in the management of painful sickle cell crisis. The sample consisted of 10 patients who experienced hospitalization for the management of pain during sickle cell crisis and 10 nurses who have cared for patients during such crises. The method of data collection used a combination of group and individual interviews, utilizing a 'guided conversation approach'. Data analysis consisted of content analysis of transcribed interviews which resulted in the identification of the following categories of problems: poor pain management, anxieties about pethidine, loss of control, lack of individuality and playing up. The results revealed that pain control during sickle cell crisis is often inadequate, with nurses admitting that they often have to resort to 'trial and error' strategy to manage pain. The findings are discussed in terms of attitudinal and knowledge factors and an individualized approach to pain management.

Family Physicians and Exercise Counseling: Can they be influenced to provide more?

This trial took 22 volunteer family physicians and randomly exposed some to training intervention and some to no training to study the effect on frequency and quality of exercise prescription to ambulatory adults. During the 6 weeks after training, the trained physicians addressed the issue of exercise with 35.3% of patients. The untrained physicians discussed exercise with only 8.6% of their patients.

Effect of vagal blockade on food- and hormone-stimulated release of pancreatic polypeptide and motilin in dogs.

Vagal control of food- and hormone-stimulated release of pancreatic polypeptide (PP) and motilin was investigated in four conscious dogs by examining the effect of cryogenic vagosympathetic blockade. The postprandial PP response of 189 +/- 7 pM was totally, although reversibly, inhibited to 58 +/- 11 pM with the vagi blocked. Similarly, bombesin-, CCK-OP-, or neurotensin-stimulated PP release was abolished. Although the PP response to intraduodenal perfusion of an elemental diet was also reduced by blockade, the 52 +/- 15% inhibition was less than observed with the meal. In contrast to PP, plasma motilin fell after the meal from a fasting level of 128 +/- 16 pM to a nadir of 52 +/- 7 pM. Vagal blockade reversed this decline as plasma motilin rose to a peak of 121 +/- 18 pM with a pattern resembling the motilin response in the interdigestive state. This motilin increment during blockade was inhibited by atropine and by infusion of porcine PP. Plasma motilin also fell with the elemental diet, but this response was not affected by blockade. During infusion of bombesin, plasma motilin rose by 60 +/- 9 pM; vagal blockade augmented this increment twofold. Thus, the PP response to a meal and to hormonal stimulation is controlled by a vagal cholinergic excitatory pathway. However, intestinal release of PP is mediated in part by the vagus and in part by a vagally independent mechanism which may be neural or hormonal. Alternatively, vagal noncholinergic inhibition is a major mechanism modulating the motilin response after oral food but motilin release exclusively from intestinal nutriments is mediated by nonvagal, noncholinergic mechanisms.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of vagal integrity in gastrin releasing peptide stimulated gastroenteropancreatic hormone release and gastric acid secretion.

The role of the vagus nerve in the control of gastrin releasing peptide (GRP) stimulated gastroenteropancreatic hormone release and gastric acid secretion was investigated in four conscious gastric fistula dogs using a technique of bilateral cryogenic vagal blockade. A 90-min infusion of GRP at a dose of 400 pmol X kg-1. h-1 produced significant elevations in plasma levels of gastrin, motilin, GIP, enteroglucagon, insulin, pancreatic glucagon, pancreatic polypeptide and VIP. Vagal blockade reversibly inhibited the rise of plasma PP and significantly blunted the elevation of plasma VIP. However, the GRP stimulated response of the other hormones investigated was not modified by vagal blockade. Similarly, the substantial secretion of gastric acid observed with GRP was not influenced by vagal blockade. Thus GRP acts predominantly via mechanisms which are independent of vagal integrity, findings that are in support of a major role for the local neuromodulation of hormone release and gastric acid secretion.

A computer primer: systems implementation.

It is important to recognize the process of implementing systems as a process of change. The hospital, through its steering committee, must manage this process, initiating change instead of responding to it. Only then will the implementation of information systems be an orderly process and the impact of these changes on the hospital's organization clearly controlled. The probability of success in implementing new systems would likely be increased if attention centers on gaining commitment to the project, gaining commitment to any changes necessitated by the new system, and assuring that the project is well defined and plans clearly specified. These issues, if monitored throughout the systems implementation, will lead to early identification of potential problems and probable failures. This highly increases the chance of success. A probably failure, once identified, can be given specific attention to assure that associated problems are successfully resolved. The cost of this special attention, monitoring and managing systems implementation, is almost always much less than the cost of the eventual implementation failure.