Mealtime assistance may be necessary to prevent declines in hospitalized older adults' nutritional well-being. This paper reports on the implementation of the Support for and Promotion Of Optimal Nutritional Status (SPOONS) Volunteer Assistance Program. Patients were aged 65+, admitted to the Acute Care for Elders Unit at the University of Alabama at Birmingham Hospital, and in need of mealtime assistance. There were 236 documented patient-volunteer encounters at which social interaction (n=217; 91.9%), assistance with tray set-up (n=162; 68.8%), and prompting to eat (n=161; 68.2%) among other activities were performed. Mean time of interaction was 47.8 minutes, with an average estimated cost savings of $11.94 per encounter had the service been provided by a Patient Care Technician and $26.00 per encounter had it been provided by a Registered Nurse. This demonstration of the SPOONS program should be followed up with an evaluation of its effectiveness. .
There remains a paucity of literature comparing tendon transfers with alternatives. However, when considering a tendon transfer, certain principles are critical in order to achieve an optimal outcome:The recipient and transferred tendons must have similar musculotendinous excursion.The recipient and transferred tendons should have similar lines of pull.One tendon (the transferred) should be designed to replace 1 function (of the recipient).The function of the transferred tendon and muscle should be expendable without substantial donor site morbidity.The strength of the transferred muscle must be at least grade 4.When deciding between the LT and LD transfer, certain considerations should be taken into account. The LD transfer has a proven history of successfully treating massive irreparable posterosuperior rotator cuff tears in studies with long-term follow-up. Alternatively, although the LT transfer has only recently gained popularity, it has the advantage of "in-phase" muscle function, since the trapezius naturally contracts during shoulder external rotation. Furthermore, its line of pull almost completely mimics the infraspinatus.
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