The Extended ADL scale is a postal measure of Instrumental ADL ability, comprising sub-scales for mobility, household ability and leisure activity. Its validity was examined in 303 stroke patients who had participated in a rehabilitation study. Adequate Guttman scales were found in the mobility scale, an adjusted household scale and, in women, the leisure scale. Extended ADL scores at 6 months after discharge from hospital were independently predicted by the Barthel ADL score at discharge from hospital, the age of the patient, previous mobility, time spent in hospital for the stroke, the abbreviated mental test score at discharge and whether the patient was living alone or not. Extended ADL scores discriminated between patients in institutions and at home. In patients at home, the Extended ADL scores were lower in those who received social and nursing services than in those who did not. Death or institutionalization over the 6 months was uncommon in patients with high Extended ADL scores. These data support the validity of the Extended ADL scale and confirm it to be a useful measure of outcome in stroke research.

INTRODUCTIONThe health sector is facing considerable challenges to meet the health needs of rural communities. Nurse practitioners (NPs) deliver primary health care (PHC) services similar to general practitioner (GP) services, within a health equity and social justice paradigm. Despite GP workforce deficits, New Zealand has been slow to effectively utilise NPs. AIMFrom a larger study exploring the establishment of NP services, this paper reports on the barriers and facilitators to becoming a NP in rural PHC. METHODSOverall, 13 NPs and 4 NP candidates participated in individual or group interviews. Participants were employed in a variety of PHC settings from six district health boards across New Zealand. Using a scaffold map constructed to show the stages of the pathway from nurse to NP, data were analysed to identify experiences and events that facilitated or were barriers to progress. RESULTSExperiences varied considerably between participants. Commitment to the development of the NP role in their local areas, including support, advanced clinical opportunities, supervision, funding and NP job opportunities, were critical to progression and success. Existing GP shortages and the desire to improve health outcomes for communities drove nurses to become NPs. DISCUSSIONImplementation of the NP workforce across New Zealand remains ad hoc and inconsistent. While there are pockets of great progress, overall, the health sector has failed to embrace the contribution that NPs can make to PHC service delivery. A national approach is required to develop the NP workforce as a mainstream PHC provider.

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The COVID-19 Delta August 2021 outbreak in Aotearoa New Zealand initially affected Pacific communities more than any other group, spreading later and rapidly to Māori. From the outset of the global pandemic, historical knowledge of health inequities and the adverse effect of previous epidemics and pandemics, signaled that Pacific peoples, and Māori, would be disproportionately affected by COVID-19. The purpose of this article is to provide an overview of the COVID-19 pandemic in relation to Pacific communities and to begin to capture the learnings for the health system and the Pacific nursing workforce. We use data to show the inequities present before and during the pandemic and highlight the opportunities that were missed early on for prioritising Pacific communities. As nurse leaders, involved with supporting and promoting the Pacific nursing workforce, we reflect on the nursing response to COVID-19 in those Pacific communities, and consider the contribution of Pacific nurses and how we support and strengthen the Pacific nursing workforce in Aotearoa now and in the future.Keywords / Ngā kupu matua: community / hapori; COVID-19; dialogue / whakawhiti kōrero; inequities / ngā korenga e ōrite; nursing / mahi tapuhi; Pacific / Moana-nui-a-Kiwa; primary health care / taurimatanga hauora tuatahi Te Reo Māori translationHe korenga e ōrite me ngā kitenga mai i te horapatanga o te mate urutā o COVID-Delta: Te whakahau kia whakapakaritia te ohu kaimahi tapuhi Moana-nui-a-Kiwa i Aotearoa Ngā ariā matuaI tino pā nui te horapatanga mate urutā COVID-19 i Aotearoa ki ngā hapori Moana-nui-a-Kiwa, he kaha kē atu i te pānga ki ētahi atu momo iwi, ā, nō muri mai ka horapa nui, ka tere horapa hoki ki a ngāi Māori. Mai i te tīmatanga o te mate urutā o te ao, nā te mātauranga mō ngā korenga e ōrite o ngā āhuatanga hauora nui, kua ara ake ngā matapae tērā pea ka kaha ake te mate rawa me te pā nui hoki o ngā raru hauora ki ngā iwi o Te Moana-nui-a-Kiwa me ngā iwi Māori. Ko te whāinga o tēnei tuhinga he whakarāpopoto i te pānga o te urutā o COVID-19 ki ngā hapori o Te Moana-nui-a-Kiwa, kia hopukina hoki ngā akoranga mō te pūnaha hauora me te ohu kaimahi tapuhi Moana-nui-a-Kiwa. Ka whakamahi raraunga mātou kia kitea ngā kōrenga e ōrite o mua, i waenga hoki i te mate urutā, kia whakatairangatia hoki ngā whāinga wāhi kāore i tutuki mō ngā hapori Moana-nui-a-Kiwa He kaihautū tapuhi mātou e tautoko ana, e whakatairanga ana i te ohu kaimahi tapuhi Moana-nui-a-Kiwa, ā, ko mātou tēnei e huritao nei mō te urupare tapuhi ki te COVID-19 i roto i aua hapori Moana-nui-a-Kiwa, me te huritao i te āwhina o ngā tapuhi Moana-nui-a-Kiwa, me pēhea hoki tā tātou tautoko, whakapakari hoki i te ohu tapuhi Moana-nui-a-Kiwa i tēnei rā, ā, haere ake nei.

Sixty-eight patients operated upon for post-infarction VSD from 1980-1987 have been reviewed to identify incremental risk factors which influence survival. Univariate and multivariate analysis was performed on 19 parameters and showed the following in decreasing order of importance to be significantly associated with non-survival: (1) operation within 24 h of occurrence of the VSD; (2) inferior infarct preceding the VSD; (3) requirement for inotropic support preoperatively; (4) preoperative cardiogenic shock; (5) a lower mean pulmonary artery pressure; (6) a lower mean wedge pressure; (7) a lower mean systolic pressure. The presence of a graft to the right coronary artery was associated with a better prognosis. Age, sex, diastolic blood pressure, balloon pumping, mean plasma urea, right atrial pressure, extent of coronary disease, number of coronary grafts, grafts to the left coronary system and method of myocardial preservation had no influence on survival.