Diabetic lower extremity ischemia (DLEI) causes approximately 90,000 leg amputations each year in the United States. A review of the literature revealed that sufficient evidence exists to consider using pulsed electromagnetic field (PEMF) therapy as a non-invasive curative modality that could prevent many of these amputations. However, the staggering number of leg amputations following lengthy episodes of ischemic deterioration suggests a lack of consensus as to the efficacy of PEMF. Therefore, the purpose of this study is to provide an evidentiary basis for using PEMF therapy in a primary care setting to promote microvascular angiogenesis and thereby prevent skin ulceration. In this study, 7 people between the ages 54 and 65 who have diabetes mellitus type 2 and some level DLEI underwent 10 to 22 treatments with a Diapulse® PEMF device. Each participant was tested for microvascular red blood cell (RBC) perfusion (Q), volume concentration of moving RBCs (V), RBC speed (U) and temperature (T) in the plantar skin. These parameters were measured using a laser Doppler flowmeter before and after the course of treatment. The Wilcoxon Signed Rank Test showed significant increases in V and decreases in U (p = 0.018 for both) with Q being slightly above the significance level at p = 0.063. These findings are consistent with those found in the literature. Therefore, the use of PEMF for treating chronic wounds should be considered for inclusion in standard Advanced Practice Registered Nursing (APRN) guidelines for evidenced-based practice. However, the results of the pilot study do need to be confirmed by repeating the experiment with a larger sample size. This paper also provides a review of the evidence in the medical literature that demonstrates the development of angiogenesis in heart muscle as a means of reversing congestive heart failure following myocardial ischemia resulting from atherosclerosis in the minute coronary circulation. The available evidence suggests that achieving new collateral circulation in ischemic heart muscle is highly achievable.

The implementation of the integrated approach to mental health care at primary health care (PHC) clinics could pose a challenge to PHC nurses. The study explored the perceptions of the professional nurses on the challenges affecting the implementation of the integrated approach to mental health care.  A qualitative, descriptive and exploratory design was used. The population comprised of PHC nurses working in the Mutale sub-district PHC facilities in Limpopo Province, South Africa. Probability systematic random sampling and purposive sampling were used to obtain a sample of six PHC clinics and 45 PHC nurses respectively. Ethical principles were taken into account. Focus groups and individual interviews were used to collect data. Data analysis was done using Tesch’s open coding method.  Poor management of PHC resources and difficulties in managing psychotic patients were found to affect the implementation of the integrated approach to mental health care at PHC clinics. The study suggests that staff development programs be instituted and staff trained to acquire skills to handle aggressive mentally ill patients.

This participatory action research conceptualized from problems of subacute stage in stroke patients admitted at Luangporpern hospital for intensive rehabilitation program and found that ADL decreased after discharged. Objective was to develop health care practice guideline for treatment of subacute stroke patients using care map applied from 12 steps conceptual framework of the NHMRC, Australia1. The health care practice guidelines developed by researcher included SOP, stroke clinical care manuals and care map, contents validated by 3 experts (CVR=1). Two sample groups included 10 patients and 12 multidisciplinary personnel, data collection using questionnaires; 1) effectiveness assessment of SOP and care map; 2) satisfaction assessment form by 12 multidisciplinary personnel and 10 patients / relatives; 3) ADL and personal care skills assessment by 10 patients / relatives. Data analysis using frequency distribution: The results showed that: 1. SOP consists of 6 elements2: 1) Protection of patients' rights and ethics. 2) Patient condition assessment. 3) Patients management for receiving rehabilitation and discharge planning. 4) Health care knowledge provided. 5) Home visits and continuous care. 6) Development of health service quality. 2. Care map and SOP were transparency, convenient and easy to follow. The satisfaction assessment of both sample groups was high (80%). Patients and relatives had well health care skills, knowledge and ability to follow care manuals correctly (80%). ADL score of patients after discharged increased upon the follow up at 1 month (100%) as well as no diseases complications. The extension of care map using in other diseases at sub-acute stage suggested.

With the increase in the use of simulation as a viable training technology there is considerable need to provide areas where simulation can be effectively and efficiently deployed. The level of complexity required for those spaces for the utilization of various simulators varies greatly from a total immersive environment to just a desk. A considerable effort is required in the planning of simulator based training areas to maximize the benefits of the technology. Flexibility is one of the key criteria as well as a high degree of future proofing. In many cases simulation equipment and associated systems are shoehorned into existing areas therefore the need for creative design and a detailed understanding of simulation based training is more critical. More challenges exist with low budgets, non recurring funding. There are some basic design rules which are very applicable in meeting the challenges as well as technological solutions. The process of identifying what technology and design s works and what wont is based on a needs analysis with the outcomes weighted against financial, technological and educational criteria. The process is not just area design but a multifaceted approach.

The aim of the study was to examine the impact of a six- week exercise, education and self-management intervention on pain and physical function in women with OA at a local primary health care clinic in Cape Town. A randomized control trial, single blinded, pre-test-post-test design was used. Women (N=63) with osteoarthritis (OA) were recruited (EXP=31, CON=32) and completed a six-week intervention and the 12 week follow-up testing. Furthermore, the groups were similar in age, personal and socio-economic characteristics at baseline testing.There was a significant difference between the groups over the 12 week study. For the primary outcome measure, function and disability according to WHODAS, a significant reduction in scores were evident at week 12 (p<0.01) between groups. For the lower limb functional tests according to Aggregated locomotor function tests (ALF), a significant improvement in scores were noticed at week 6 (p<0.01) between groups. In addition, there was a significant effect over the 12 weeks with improvements in scores for pain severity (p=0.02) and pain interference (p<0.01) of the BPI at weeks 6 and 12. This study found that the six-week intervention had significantly reduced the functional disability scores, reduced the overall time to complete the functional tests (walking, climbing stairs, sit-to-stand) and reduced the pain severity and interference scores, thereby improving pain and physical function in women with OA in the EXP group. This intervention could be appropriate to implement at PHC clinics to help reduce pain and improve physical function in women suffering from osteoarthritis.

The team in family practice often meets life-risk patients. Simulation is an excellent way for health care workers to train their skills in a safe environment. It is an effective, ethical and safe way to practice theoretical knowledge. Trainees acquire experience in simulation in life threatening situation, how to approach acute situation and situations where decisions have consequences. This way we approach the clinical environment as close as we can. But sadly, learning with simulations in healthcare is usually not available to professionals. Contributing factors to this problem are the lack of knowledge and poor equipment combined with high education costs and time shortage in medical teams. We have developed a mobile simulation unit (SIM mobile) that will enable all medical teams in primary healthcare access to modern simulation equipment. We have used SIM mobile to conduct simulations in over 20 diferent locations in Slovenia (Comunity health centres, prehospital units). Participants were doctors of family medicine, nurses and EMT workers. The study was caried out from june 2018 to august 2018. SIM mobile was avaliable for 120 hours in 10 days. Total training time was 120 hours and was used 100% of the time by the participants of the study. SIM mobile provides opportunities for outstanding educational experiences that translate into better patient care and improved provider safety. A mobile simulation experience that can be brought to healthcare professionals in rural and frontier communities, thus reducing the need for providers to travel for training.