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Objectives: The aim of this study was to assess the measurement equivalence of individual response scale types by using a patient reported outcome measure (PROM) collected on paper and migrated into electronic format for use on the subject's own mobile device (BYOD) and on a provisioned device (site device).Methods: Subjects suffering from chronic health conditions causing daily pain or discomfort were invited to participate in this single-site, single visit, three-way crossover study. Association between individual item and instrument subscale scores was assessed by using the intraclass correlation coefficient (ICC) and its CI. Participant attitudes toward the use of BYOD in a clinical trial were assessed through use of a questionnaire.Results: In this study, 155 subjects (females 83 [54%]; males 72 [46%]) ages 19 to 69 years (mean ± SD: 48.6 ± 13.1) were recruited. High association between the modes of administration (paper, BYOD, site device) was shown with analysis of ICCs (0.79-0.98) for each response scale type, including visual analogue scale, numeric rating scale, verbal response scale, and Likert scale. Of the subjects, 94% (146 of 155) stated that they would definitely or probably be willing to download an app onto their own mobile device for a forthcoming clinical trial. Forty-five percent of subjects felt BYOD would be more convenient compared with 15% preferring a provisioned device (40% had no preference).Conclusions: This study provides strong evidence supporting the use of BYOD for PROM collection in terms of the conservation of instrument measurement equivalence across the most widely used response scale types, and high patient acceptance of the approach. [ABSTRACT FROM AUTHOR]

This paper examines the impact of residence-based ethnic networks on mental health; such networks are defined as the concentration of residents from the same country of origin in a neighborhood. To estimate the effect, we utilize administrative registry data, together with data on quasi-random assignment of apartments to non-Western households with housing needs to various neighborhoods. After controlling for individual characteristics, time-invariant neighborhood characteristics, and general practitioners (GP) fixed effects, we find that a 1–percentage-point increase in the concentration of residence-based co-ethnics (RBCEs) increases the probability of being treated with psychiatric medications by 0.7-percentage point over a 5-year period after the assignment. With 19% of the population being treated with psychiatric medications the year before assignment, the result translates into an effect size of 3.7%. The results indicate that relatively high concentrations of co-ethnics treated with psychiatric medications increase the probability of being treated with psychiatric medications. The positive impact on treatment with psychiatric medication reflects an increase in the demand for these drugs when moving into a neighborhood with neighbors of the same ethnicity. If new residents are in good mental health condition when moving, these results suggest that moving into a neighborhood with a high co-ethic concentration worsens mental health status. However, as the population in this study is a vulnerable group an increase in treatment with psychiatric medications likely reflects that untreated mental health problems are treated, and the mental health status improved. The group of non-Western immigrants in this study differs significantly from the population in general, thus, results may not be generalized to all non-Western immigrants. • We study the impact of residence-based ethnic networks on mental health. • We utilize quasi-random assignment of immigrants in urgent housing needs. • Residence-based ethnic networks increase the use of psychiatric medication. • The characteristics of co-ethnic neighbors impact significantly mental health. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to determine the effect of motivational interviewing on the change of breast cancer screening behaviors among rural Iranian women.Methods: This Randomized controlled trial (RCT) was performed on 120 Iranian rural women selected through cluster random sampling method. Out of all 20 rural health centers of Abish Ahmad District, in the northwest of Iran, about one third (six clusters) were randomly selected; out of which three were randomly assigned to the control group and three to the intervention group. A list of women aged 40-69 years in the selective health centers was prepared and 60 participants were selected for each group through the convenience sampling method based on the inclusion and exclusion criteria. Then, six group sessions (two educational and four motivational interviewing sessions) were held for the intervention group. The data were collected using demographic and obstetric questionnaire, paper-based health records, and the stages of change checklist and analyzed in SPSS 24. The groups were compared through the chi square test, homogeneity test, and the sequential logistic regression with generalized estimating equations.Results: Two months after the intervention, a significant difference was found between the two groups in terms of the stages of change for clinical breast examination and mammography by taking into account the pre-intervention stages (p = 0.001).Conclusion: MI-based counseling increased the Iranian rural women's motivation for displaying breast cancer screening behaviors.Practice Implications: The application of MI for enhancing cancer screening programs among Iranian women is suggested. [ABSTRACT FROM AUTHOR]

This study was to examine the relationship between health literacy (HL) and health behaviors in the South Bohemia Region in the Czech Republic (CR) and compare them to HL and health behaviors in the Visegrád group countries (Czech Republic, Hungary, Poland, and Slovakia). The paper reports the results from the research in the CR. A quantitative descriptive study. The sample was stratified by sex and age and included a representative sample of 303 adults. The data were collected using the combination of a country-specific questionnaire with the HLS-EU-16 standardized questionnaire. Exercise was significantly associated with perceived health and HL; those with a lower level of HL did not exercise during the previous month. Based only on full answers (N = 251), inadequate HL was identified in 17.5% of the respondents (44), marginal HL in 31.5% (77), and adequate HL in 51% (128) of the respondents. Nearly 49% of the participants evaluated their health as 'good', 25.7% rated their health as 'very good' and 'satisfactory' by 25.7%. But 41.6% experienced one or more chronic diseases, 37.6% had some limitations to their health, and 20.5% smoked. For alcohol consumption, 26% drank weekly and 23% drank two to three times a month. Exercise varied from never (29.7%) to daily (7.9%). Based on our results, we conclude that health behavior risk factors are still present in the South Bohemia region of the CR regardless of levels of HL reported on the HLS-EU-16. • Inadequate health literacy (HL) was identified in 17.5% of the respondents, marginal HL in 31.5%. • Exercise was significantly associated with perceived health and HL. • For alcohol consumption, 26% drank weekly and 23% drank two to three times a month. • Health behavior risk factors are still present in South Bohemia region of the CR. • We still have not accomplished universal levels of adequate health literacy. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the feasibility and effectiveness of an intensive lifestyle intervention adapted for people with impaired mobility.Study Design: This was a randomized, wait-list controlled trial. The experimental group immediately received the 12-month weight loss program; the wait-list control group received it after a 6-month delay. Between-group comparisons were conducted for the 6-month RCT study design. Repeated measures were conducted for both groups combined after receiving the 12-month intervention. Data were collected August 2015-February 2017 and analyzed in 2017.Setting/participants: A community-based sample received 23, group-based sessions via a mix of telephone and in-person sessions in a hospital-based setting. Participants with impaired mobility (n=66) were middle-aged (49.80 [SD=11.37] years), mostly White (66.7%), female (66.7%), and most commonly had spinal cord injury (47.0%).Intervention: The 12-month intervention delivered 23 group-based sessions that promoted weight loss through reducing caloric intake and increasing physical activity.Main Outcome Measures: Primary outcomes were effectiveness measured as change in weight and time spent in moderate physical activity. Feasibility was assessed in 12-month combined group analyses, measured as retention, attendance, and dietary self-monitoring.Results: The 6-month RCT results showed that the immediate and delayed groups differed significantly (p<0.05) in weight (-1.66 [SD=4.42] kg loss vs 0.05 [SD=4.15] kg gain) and moderate physical activity (52.93 [SD=90.74] minutes/week increase vs -14.22 [SD=96.02] minutes/week decrease), accounting for baseline weight, time with disability, and age of onset. The 12-month results with groups combined demonstrated 74.2% retention and 77.7% core session attendance. Self-monitoring was higher in the delayed group (77.3%), who used a smartphone app, than the immediate group (47.3%), who mostly used paper trackers. Participants achieved significant 12-month weight loss of 3.31 (SD=10.13) kg (d=0.33) in mixed modeling analyses with groups combined yet did not significantly increase moderate physical activity.Conclusions: Group Lifestyle Balance Adapted for Individuals with Impaired Mobility is a feasible, effective approach to teach healthy lifestyle skills to individuals with mobility impairment, yielding modest weight loss and enhanced self-efficacy.Trial Registration: This study is registered at www.clinicaltrials.gov NCT03307187. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of nutrition education program on hemodialysis patients' quality of life (QoL) and serum electrolytes levels.Methods: This study was a randomized controlled trial in which 94 eligible hemodialysis patients were randomly assigned to intervention (n = 48) and control (n = 46) groups. In the intervention group, the patients were trained in healthy nutrition for four weeks. After two months, samples of both groups completed the Kidney Disease Quality of Life Instrument (KDQOL) and Na, K, P, Ca and Mg levels were also measured and compared.Results: There were no significant differences in QoL scores and electrolytes between the two groups before intervention (p > 0.05). After intervention the QoL scores in the intervention group were significantly higher than in the control group (p < 0.05). However, after intervention the levels of Na, K, P and Mg in the intervention group were significantly lower than in the control group (p < 0.05). Calcium level was not significantly different between the two groups after intervention (p = 0.16).Conclusion: The results showed that e-learning is effective in improving the QoL and serum electrolytes of hemodialysis patients.Practice Implications: This paper could serve as support for clinical healthcare professionals to improve patient knowledge and QoL through virtual education methods. [ABSTRACT FROM AUTHOR]

Aims: The TTM2-trial is a multi-centre randomised clinical trial where targeted temperature management (TTM) at 33 °C will be compared with normothermia and early treatment of fever (≥37.8 °C) after Out-of-Hospital Cardiac Arrest (OHCA). This paper presents the design and rationale of the TTM2-trial follow-up, where information on secondary and exploratory outcomes will be collected. We also present the explorative outcome analyses which will focus on neurocognitive function and societal participation in OHCA-survivors.Methods: Blinded outcome-assessors will perform follow-up at 30-days after the OHCA with a telephone interview, including the modified Rankin Scale (mRS) and the Glasgow Outcome Scale Extended (GOSE). Face-to-face meetings will be performed at 6 and 24-months, and include reports on outcome from several sources of information: clinician-reported: mRS, GOSE; patient-reported: EuroQol-5 Dimensions-5 Level responses version (EQ-5D-5L), Life satisfaction, Two Simple Questions; observer-reported: Informant Questionnaire on Cognitive Decline in the Elderly-Cardiac Arrest version (IQCODE-CA) and neurocognitive performance measures: Montreal Cognitive Assessment, (MoCA), Symbol Digit Modalities Test (SDMT). Exploratory analyses will be performed with an emphasis on brain injury in the survivors, where the two intervention groups will be compared for potential differences in neuro-cognitive function (MoCA, SDMT) and societal participation (GOSE). Strategies to increase inter-rater reliability and decrease missing data are described.Discussion: The TTM2-trial follow-up is a pragmatic yet detailed pre-planned and standardised assessment of patient's outcome designed to ensure data-quality, decrease missing data and provide optimal conditions to investigate clinically relevant effects of TTM, including OHCA-survivors' neurocognitive function and societal participation. [ABSTRACT FROM AUTHOR]

Introduction: Church-based interventions have been shown to improve the dietary health of underserved populations, yet few studies have examined sustainability of health behavior change over time. This paper examines dietary outcomes over a 24-month period (baseline and 6, 18, and 24 months) for fruit and vegetable and fat consumption behaviors of African-American participants in the Health for Hearts United church-based intervention in North Florida.Study Design: This quasi-experimental, longitudinal trial was conducted from 2009 to 2012. Data were analyzed in 2018.Setting/participants: Six churches in a 2-county area (3 treatment, 3 comparison) were selected for the study using community-based participatory research approaches. Participants were African-American adults (aged ≥45 years; n=211 at baseline) randomly selected from the churches, stratified by age and sex.Intervention: Health for Hearts United intervention was developed by the 3 treatment churches. The 18-month intervention was implemented in 3 6-month phases, framed around 3 conceptual components, which included 4 types of programs and 4 key messages.Main Outcome Measures: Fruit and vegetable consumption was assessed using a single item (fruit and vegetable intake) and the National Cancer Institute Fruit and Vegetable Screener. Fat consumption was determined using a single item (fat intake) and the National Cancer Institute Fat Screener. Background characteristics included age, sex, educational level, and marital status.Results: Significant time effects only were found for daily fruit and vegetable intake (p<0.001), fat intake (p<0.001), and the Fat Screener (p<0.001) with dietary improvements in both treatment and comparison groups across the intervention phases. Fruit and Vegetable Screener results showed that time (p<0.001) and the interaction between time and treatment (p<0.01) were significant, with increases in fruit and vegetable consumption over time for both the treatment and comparison groups and with the increase differing between groups. Post hoc analysis revealed that the treatment group had greater increases in fruit and vegetable consumption than the comparison group between Phases 1 and 3 (p=0.03).Conclusions: Dietary behaviors of mid-life and older African Americans can be improved and sustained over 24 months using a church-based heart health intervention, with similar improvements noted for both comparison and treatment participants.Trial Registration: This study is registered at www.clinicaltrials.govNCT03339050. [ABSTRACT FROM AUTHOR]

• We provide new evidence for the benefits and challenges of accessing SMART Recovery mutual-help groups virtually via videoconference. • Identified benefits include availability, ease of access and the zoom chat feature. • Potential challenges included in-group engagement, group size, non-verbal cues, social interaction and technology problems. • Virtual SMART Recovery mutual-help groups appealed to different people under different circumstances. • Our findings have implications for research, training and practice. COVID-19 prompted widespread transition of face-to-face mutual-help groups to virtual delivery. Current understanding of the experience of virtual mutual-help groups is limited to 12-step approaches or asynchronous groups (e.g., forums). This paper explores participant and facilitator perspectives regarding the benefits and challenges of accessing SMART Recovery mutual-help groups virtually via videoconference. A self-selected convenience sample of participants (n = 29) and facilitators (n = 15) from SMART Recovery mutual-help groups in Australia were enrolled. Participants and facilitators were sampled to reflect experience of virtual groups delivered via videoconference ('online'), face-to-face groups ('face-to-face') or both types of groups ('both'). Telephone qualitative interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed, and analysed using iterative categorisation. Participant and facilitators discussed their experience across eight interconnected themes benefits were typically discussed with regard to the (1) availability, (2) ease of access and (3) value add of the chat feature in online groups. Challenges largely pertained to (1) in-group engagement, (2) group size, (3) non-verbal cues, (4) social interaction and (5) technology problems. The impact of these challenges on participant and facilitator experience varied, and neither modality was consistently identified as superior. SMART Recovery mutual-help groups provided participants with another option for accessing mutual-help and appealed to different people under different circumstances. Depending on the needs and preferences of the individual, online SMART Recovery mutual-help groups may help to mitigate a range of barriers to help seeking and may also engage people otherwise unable or reluctant to engage in treatment. To inform training, practice and policy, improved understanding of the individual and contextual factors that enhance participant engagement, experience and outcomes is needed. [ABSTRACT FROM AUTHOR]

Background: Little is known about the influence of practice schedules on motor learning and skills transfer in children with and without developmental coordination disorder (DCD). Understanding how practice schedules affect motor learning is necessary for motor skills development and rehabilitation.Aims: The study investigated whether active video games (exergames) training delivered under variable practice led to better learning and transfer than repetitive practice.Methods and Procedures: 111 children aged 6-10 years (M=8.0, SD=1.0) with no active exergaming experience were randomized to receive exergames training delivered under variable (Variable Game Group (VGG), n=56) or repetitive practice schedule (Repetitive Game Group (RGG), n=55). Half the participants were identified as DCD using the DSM-5 criteria, while the rest were typically developing (TD), age-matched children. Both groups participated in two 20min sessions per week for 5 weeks.Outcomes and Results: Both participant groups (TD and DCD) improved equally well on game performance. There was no significant difference in positive transfer to balance tasks between practice schedules (Repetitive and Variable) and participant groups (TD and DCD).Conclusions and Implications: Children with and without DCD learn balance skills quite well when exposed to exergames. Gains in learning and transfer are similar regardless of the form of practice schedule employed.What This Paper Adds: This is the first paper to compare the effect of practice schedules on learning in children with DCD and those with typical development. No differences in motor learning were found between repetitive and variable practice schedules. When children with and without DCD spend the same amount of time on exergames, they do not show any differences in acquisition of motor skills. Transfer of motor skills is similar in children with and without DCD regardless of differences in practice schedules. [ABSTRACT FROM AUTHOR]

Background: Medication dispensing errors are common in clinical trials, and have a significant impact on the quality and validity of a trial. Therefore, the definition, calculation and evaluation of such errors are important for supporting a trial's conclusions. A variety of medication dispensing errors can occur. In this paper, we focus on errors in trials where the intervention includes multiple therapies that must be given in a pre-specified order that varies across treatment arms and varies in duration.Methods: The Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial was a Phase III multi-site, randomized trial to compare the effectiveness and safety of 1:1:1 transfusion ratios of plasma and platelets to red blood cells with a 1:1:2 ratio. In this trial, these three types of blood products were to be transfused in a pre-defined order that differed by treatment arm. In this paper, we present approaches from the PROPPR trial that we used to define and calculate the occurrence of out of order blood transfusion errors. We applied the proposed method to calculate protocol adherence to the specified order of transfusion in each treatment arm.Results: Using our proposed method, protocol adherence was greater in the 1:1:1 group than in the 1:1:2 group (96% vs 93%) (p<0.0001), although out of order transfusion errors in both groups were low. Final transfusion ratios of plasma to platelets to red blood cells for the 1:1:1 ratio group was 0.93:1.32:1, while the transfusion ratio for the 1:1:2 ratio group was 0.48:0.48:1.Conclusions: Overall, PROPPR adherence to blood transfusion order pre-specified in the protocol was high, and the required order of transfusions for the 1:1:2 group was more difficult to achieve. The approaches proposed in this manuscript were useful in evaluating the PROPPR adherence and are potentially useful for other trials where a specific treatment orders with varying durations must be maintained. [ABSTRACT FROM AUTHOR]

Background: Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores.Methods: The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14.Results: On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound.Conclusions: Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care.Clinical Trial Registration: NCT02492191. [ABSTRACT FROM AUTHOR]

Determining volitional activation (VA) can provide insights on the cause of muscle weakness in orthopedic and neurological populations. Two electrical stimulation techniques are traditionally used to quantify VA: interpolation (IT) and superimposition (CAR). IT allows for a more accurate VA estimation, however it requires individuals to be stimulated twice, compared to once for CAR, and thus increases stimulation associated discomfort. To date, there is no agreement on what is the best practical technique for calculating quadriceps VA. This paper aims to address this problem by determining what reference force (i.e., using either peak force or force at the time of stimulation) and type of stimulation (train of pulses (burst), doublet, and twitch) is the best technique to use. Our findings showed that the IT with the force at the time of stimulation as a reference should be used to determine VA and that when a burst was used, the VA ratio computations were more accurate. Additionally, using a twitch with a 2ms pulse duration produced reliable VA calculations and may be an acceptable alternative for pain-sensitive subjects. Accurate assessment of VA deficits can help clinicians design rehabilitation programs that are based on subject-specific strength impairments and are more effective. [ABSTRACT FROM AUTHOR]

Background: The PARAMEDIC cluster randomised trial evaluated the LUCAS mechanical chest compression device, and did not find evidence that use of mechanical chest compression led to an improvement in survival at 30 days. This paper reports patient outcomes from admission to hospital to 12 months after randomisation.Methods: Information about hospital length of stay and intensive care management was obtained through linkage with Hospital Episode Statistics and the Intensive Care National Audit and Research Centre. Patients surviving to hospital discharge were approached to complete questionnaires (SF-12v2, EQ-5D, MMSE, HADS and PTSD-CL) at 90days and 12 months. The study is registered with Current Controlled Trials, number ISRCTN08233942.Results: 377 patients in the LUCAS arm and 658 patients in the manual chest compression were admitted to hospital. Hospital and intensive care length of stay were similar. Long term follow-up assessments were limited by poor response rates (53.7% at 3 months and 55.6% at 12 months). Follow-up rates were lower in those with worse neurological function. Among respondents, long term health related quality of life outcomes and emotional well-being was similar between groups. Cognitive function, measured by MMSE, was marginally lower in the LUCAS arm mean 26.9 (SD 3.7) compared to control mean 28.0 (SD 2.3), adjusted mean difference -1.5 (95% CI -2.6 to -0.4).Conclusion: There were no clinically important differences identified in outcomes at long term follow-up between those allocated to the mechanical chest compression compared to those receiving manual chest compression. [ABSTRACT FROM AUTHOR]

For Americans experiencing illnesses and disabilities, crowdfunding has become a popular strategy for addressing the extraordinary costs of health care. The political, social, and health consequences of austerity--along with fallout from the 2008 financial collapse and the shortcomings of the Affordable Care Act (ACA)--are made evident in websites like GoFundMe. Here, patients and caregivers create campaigns to solicit donations for medical care, hoping that they will spread widely through social networks. As competition increases among campaigns, patients and their loved ones are obliged to produce compelling and sophisticated appeals. Despite the growing popularity of crowdfunding, little research has explored the usage, impacts, or consequences of the increasing reliance on it for health in the U.S. or abroad. This paper analyzes data from a mixed-methods study conducted from March–September 2016 of 200 GoFundMe campaigns, identified through randomized selection. In addition to presenting exploratory quantitative data on the characteristics and relative success of these campaigns, a more in-depth textual analysis examines how crowdfunders construct narratives about illness and financial need, and attempt to demonstrate their own deservingness. Concerns with the financial burdens of illness, combined with a high proportion of campaigns in states without ACA Medicaid expansion, underscored the importance of crowdfunding as a response to contexts of austerity. Successful crowdfunding requires that campaigners master medical and media literacies; as such, we argue that crowdfunding has the potential to deepen social and health inequities in the U.S. by promoting forms of individualized charity that rely on unequally-distributed literacies to demonstrate deservingness and worth. Crowdfunding narratives also distract from crises of healthcare funding and gaping holes in the social safety net by encouraging hyper-individualized accounts of suffering on media platforms where precarity is portrayed as the result of inadequate self-marketing, rather than the inevitable consequences of structural conditions of austerity. [ABSTRACT FROM AUTHOR]

For decades various pressure ulcer risk assessment scales (PURAS) have been developed and implemented into nursing practice despite uncertainty whether use of these tools helps to prevent pressure ulcers. According to current methodological standards, randomised controlled trials (RCTs) are required to conclusively determine the clinical efficacy and safety of this risk assessment strategy. In these trials, PURAS-aided risk assessment has to be compared to nurses' clinical judgment alone in terms of its impact on pressure ulcer incidence and adverse outcomes. However, RCTs evaluating diagnostic procedures are prone to specific risks of bias and threats to the statistical power which may challenge their validity and feasibility. This discussion paper critically reflects on the rigour and feasibility of experimental research needed to substantiate the clinical efficacy of PURAS-aided risk assessment. Based on reflections of the methodological literature, a critical appraisal of available trials on this subject and an analysis of a protocol developed for a methodologically robust cluster-RCT, this paper arrives at the following conclusions: First, available trials do not provide reliable estimates of the impact of PURAS-aided risk assessment on pressure ulcer incidence compared to nurses' clinical judgement alone due to serious risks of bias and insufficient sample size. Second, it seems infeasible to assess this impact by means of rigorous experimental studies since sample size would become extremely high if likely threats to validity and power are properly taken into account. Third, means of evidence linkages seem to currently be the most promising approaches for evaluating the clinical efficacy and safety of PURAS-aided risk assessment. With this kind of secondary research, the downstream effect of use of PURAS on pressure ulcer incidence could be modelled by combining best available evidence for single parts of this pathway. However, to yield reliable modelling results, more robust experimental research evaluating specific parts of the pressure ulcer risk assessment-prevention pathway is needed. [ABSTRACT FROM AUTHOR]

Background: As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems. Objectives: To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey. Design and settings: We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe. Participants: Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field. Methods: The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context. Results: The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation. Conclusions: The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation. [ABSTRACT FROM AUTHOR]

Mentor programs have been recognized as an integral tool in the child welfare services array. However, there are few conceptual frameworks for planning and developing mentor programs for a key constituency group: foster parents . This study employed Concept Mapping (CM) with a convenience sample of 59 foster parents in one southeastern state. CM is a participatory, mixed-method research approach that utilizes non-metric multidimensional scaling and hierarchical cluster analyses to analyze qualitative data. As a result, pictorial representations of the data are generated. Results yielded seven (7) distinct clusters: Ongoing Supports, Matching Practices , and Program Evaluation , among others. Participants viewed the Recruitment cluster as most pertinent and most important for mentor programs. Contrariwise, Program Evaluation and Matching clusters were viewed as least feasible and least important, respectively. After a review of pertinent literature, this paper explicates CM methodology as applied to the current study, reports results, and discusses lessons learned as they apply to child welfare research and practice. [ABSTRACT FROM AUTHOR]

Abstract: Background: Many critical appraisal tools (CATs) exist for which there is little or no information on development of the CAT, evaluation of validity, or testing reliability. The proposed CAT was developed based on a number of other CATs, general research methods theory, and reporting guidelines but requires further study to determine its effectiveness. Objectives: To establish a scoring system and to evaluate the construct validity of the proposed critical appraisal tool before undertaking reliability testing. Methods: Data obtained from this exploratory study along with information on the design of the proposed CAT were combined to evaluate construct validity using the Standards for educational and psychological testing which consist of five types of evidence: test content, response process, internal structure, relations to other variables, and consequences of testing. To obtain data for internal structure and relations to other variables, the proposed CAT was analysed against five alternative CATs. A random sample of 10 papers from six different research designs across the range of health related research were selected, giving a total sample size of 60 papers. Results: In all research designs, the proposed CAT had significant (p <0.05, two-tailed) weak to moderate positive correlations (Kendall''s τ 0.33–0.55) with the alternative CATs, except in the Preamble category. There were significant moderate to strong positive correlations in the quasi-experimental (τ 0.70–1.00), descriptive/exploratory/observational (τ 0.72–1.00), qualitative (τ 0.74–0.81), and systematic review (τ 0.62–0.82) designs and to a lesser extent in the true experimental (τ 0.68–0.70) design. There were no significant correlations in the single system research designs. Conclusions: Based on the results obtained, the theory on which the proposed CAT was designed, and the objective of the proposed CAT there was enough evidence to show that inferences made from scores obtained from the proposed CAT should be sound. [Copyright &y& Elsevier]

This paper calls for improved survey research methods both in formal research projects and in everyday use of survey questionnaires in libraries. The author proposes that probability sampling be recognized as the best practice in library and information science. The problem of selection bias arising from the use of nonprobability sampling, and convenience sampling in particular, is explored. The paper presents examples of unfounded research conclusions appearing in studies using this sampling approach. It also espouses library research and assessment practices that aspire to higher standards of soundness, accuracy, validity, and impartiality. [Copyright &y& Elsevier]

More than a decade of research has found strong evidence for P(if A, then C)=P(C|A) ("the Equation"). We argue, however, that this hypothesis provides an overly simplified picture due to its inability to account for relevance. We manipulated relevance in the evaluation of the probability and acceptability of indicative conditionals and found that relevance moderates the effect of P(C|A). This corroborates the Default and Penalty Hypothesis put forward in this paper. Finally, the probability and acceptability of concessive conditionals ("Even if A, then still C") were investigated and it was found that the Equation provides a better account of concessive conditionals than of indicatives across relevance manipulations. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effects of surface preparation and the application time of adhesives on the resin-dentine bond strengths with universal adhesives.Methods: Sixty molars were cut to exposed mid-coronal dentine and divided into 12 groups (n=5) based on three factors; (1) adhesive: G-Premio Bond (GP, GC Corp., Tokyo, Japan), Clearfil Universal Bond (CU, Kuraray Noritake Dental Inc., Okayama, Japan) and Scotchbond Universal Adhesive (SB, 3M ESPE, St. Paul, MN, USA); (2) smear layer preparation: SiC paper ground dentine or bur-cut dentine; (3) application time: shortened time or as manufacturer's instruction. Fifteen resin-dentine sticks per group were processed for microtensile bond strength test (μTBS) according to non-trimming technique (1mm(2)) after storage in distilled water (37 °C) for 24h. Data were analyzed by three-way ANOVA and Dunnett T3 tests (α=0.05). Fractured surfaces were observed under scanning electron microscope (SEM). Another 12 teeth were prepared and cut into slices for SEM examination of bonded interfaces.Results: μTBS were higher when bonded to SiC-ground dentine according to manufacturer's instruction. Bonding to bur-cut dentine resulted in significantly lower μTBS (p<0.000). Shortening the application time resulted in significantly lower bond strength for CU on SiC and GP on bur-cut dentine. SEM of fractured surfaces revealed areas with a large amount of porosities at the adhesive resin interface. This was more pronounced when adhesives were bonded with a reduced application time and on bur cut dentine.Clinical Significance: The performance of universal adhesives can be compromised on bur cut dentine and when applied with a reduced application time. [ABSTRACT FROM AUTHOR]

Background: Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study.Methods: This study protocol is a multi-site, cluster randomized trial (N=7) guided by Proctor's conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability.Discussion: The study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care. [ABSTRACT FROM AUTHOR]

Treatment preferences reflect individuals' choice of therapy and influence their adherence to treatment and achievement of outcomes. The two-stage partially randomized clinical or preference trial (two-stage PRCT) is an appropriate design for examining the contribution of treatment preferences. It involves a two-stage process for assigning participants to treatments, which is useful to dismantle the effects of the treatments from those of treatment preferences. In this paper, we explain the role of treatment preferences in intervention evaluation research, describe the protocol for implementing the two-stage PRCT, and discuss issues in its application. The issues are encountered in the selection of treatments, assignment of participants and assessment of treatment preferences. Lastly, we propose ways to address the issues. [ABSTRACT FROM AUTHOR]

Background: Death and dying are inevitable life encounters, but a nurse’s first experience with patient death may pose considerable cognitive, emotional and clinical challenges. This paper reports the findings of the second phase of a study; the first has been reported elsewhere. This phase explored the earliest memorable patient death experiences of New Zealand registered nurses. Method: A purposeful, self-selected sub-sample of a larger study of New Zealand registered nurses, took part in individual face-to-face semi-structured interviews. Interpretative phenomenological analysis was utilised to seek to understand participants’ experiences. Thematic analysis was undertaken to identify emerging themes, with participants’ own words used as theme headings, where their phrases provided succinct or powerful descriptors. Results: A diverse participant group of twenty, currently practising, New Zealand registered nurses provided rich and detailed descriptions of their earliest memorable experience with patient death. Participants from a variety of training backgrounds described patient deaths, which occurred in a range of settings – some only a few months prior, others – more than thirty years ago. Seven emergent themes, and features of more positive, or negative experiences were identified: Event Significance; Emotional Challenges; Sharing the Experience; Learning; Feeling Unprepared, Responses to Death and Finding Benefits. Conclusion: For participants in this study, there was considerable evidence that their earliest memorable patient death was a significant event. Furthermore, although most participants’ experiences were characterised by emphatic or poignant description, there was most often a balance of challenges and rewards. [ABSTRACT FROM AUTHOR]

This paper explores social scientists' and humanities (SSH) scholars' integration within the academic medical research environment. Three questions guided our investigation: Do SSH scholars adapt to the medical research environment? How do they navigate their career within a culture that may be inconsistent with their own? What strategies do they use to gain legitimacy? The study builds on three concepts: decoupling, doxa, and epistemic habitus. Twenty-nine semi-structured interviews were conducted with SSH scholars working in 11 faculties of medicine across Canada. Participants were selected through purposeful and snowball sampling. The data were analyzed by thematic content analysis. For most of our participants, moving into medicine has been a challenging experience, as their research practices and views of academic excellence collided with those of medicine. In order to achieve some level of legitimacy more than half of our participants altered their research practices. This resulted in a dissonance between their internalized appreciation of academic excellence and their new, altered, research practices. Only six participants experienced no form of challenge or dissonance after moving into medicine, while three decided to break with their social science and humanities past and make the medical research community their new home. We conclude that the work environment for SSH scholars in faculties of medicine does not deliver on the promise of inclusiveness made by calls for interdisciplinarity in Canadian health research. [ABSTRACT FROM AUTHOR]

Background: The Clinical Learning Environment, Supervision and Nurse Teacher scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts. Objectives: This paper reports the development and psychometric testing of the Spanish version of the Clinical Learning Environment, Supervision and Nurse Teacher scale. Design: Cross-sectional validation study of the scale. Setting: 10 public and private hospitals in the Alicante area, and the Faculty of Health Sciences (University of Alicante, Spain). Participants: 370 student nurses on clinical placement (January 2011--March 2012). Methods: The Clinical Learning Environment, Supervision and Nurse Teacher scale was translated using the modified direct translation method. Statistical analyses were performed using PASW Statistics 18 and AMOS 18.0.0 software. A multivariate analysis was conducted in order to assess construct validity. Cronbach's alpha coefficient was used to evaluate instrument reliability. Results: An exploratory factorial analysis identified the five dimensions from the original version, and explained 66.4% of the variance. Confirmatory factor analysis supported the factor structure of the Spanish version of the instrument. Cronbach's alpha coefficient for the scale was .95, ranging from .80 to .97 for the subscales. Conclusion: This version of the Clinical Learning Environment, Supervision and Nurse Teacher scale instrument showed acceptable psychometric properties for use as an assessment scale in Spanish-speaking countries. [ABSTRACT FROM AUTHOR]

Background: In recent history, the Internet has emerged as a wealth of archived, ongoing, interactive, and socially mediated data. Conducting Internet ethnography is a fairly new methodological approach, however, it has been previously described as a valid form of inquiry. Illness blogs, in particular, have great implications for nurse researchers, as they are able to study the experience of illness in a naturalistic and longitudinal manner, often with greater detail than data relying solely on participant recall. Participants are able to produce online illness blogs as a way to share their own illness narratives and connect with others going through similar processes. Objectives: The purpose of this paper is to discuss methodological considerations in studying online illness blogs through Internet ethnography. Methods: This article provides an overview of Internet ethnography as an emerging qualitative method and an introduction to research using illness blogs. Through use of this method in an exemplar study of young women with cancer, key decision points are highlighted along with the study team's field experiences. Conclusion: Issues pertaining to method applicability, active vs. passive involvement as a researcher, ethical considerations, what constitutes data, sampling approach, procedural and analytic decisions, and thoughts regarding reflexivity and voice of the research participants' are addressed. Strengths and limitations of the study of online illness blogs through Internet ethnography in nursing science are also discussed. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: International organizations recognize the importance of sacred groves and place them into the context of sustainable development and also emphasize to conserve biodiversity through protection of sacred groves and sties. The significance of medicinal plants from Himalayan region is well known to the world. Therefore, present study was conducted in identified sacred groves of Kumaon Himalaya to investigate and document the utilization of medicinal plants by various local communities and tribal people. Materials and methods: The study was conducted during 2008–2011 in four seasons of the year. Information was collected from 70 locals from different sacred groves by using free listing interviews with randomly selected informants and semi-structured questionnaires; plant specimens were collected, identified and deposited at the CSIR-NBRI herbarium (LWG), Lucknow, India. Results: Seven sacred groves viz., Dhwaj, Haat Kali, Hokra, Malay Nath, Nakuleshwar, Narayan Swami Ashram and Patal Bhuvneshwar were identified from the Pithoragarh district of Kumaon Himalaya. 89 medicinal plants belonging to 52 families and 77 genera of which, 2 are lichens, 4 are pteridophytes, 3 are gymnosperms and remaining 80 plant species are angiosperms. 6 plant species are reported with new therapeutic uses for the first time in this paper. Highest informant׳s consensus factor value was found in liver disorder (0.55) and least by body pains (0.23). 55 ethnomedicinal plants are showing 100% fidelity level against various diseases. Conclusion: Sacred groves in Kumaon region of Indian Himalaya are rich sources and best repository of ethno-medicinally important plants with many rare, endangered and threatened species. It is an excellent example of unique traditional way of in situ conservation of different plant species. [Copyright &y& Elsevier]

Background: International studies have generally defined nursing as a female-dominated occupation. The almost absence of male nurses seems universal, except as a privileged minority occupying positions within nursing specialties ('islands of masculinity'). Nursing is associated with relatively low status owing to gender and income, and is also influenced by cultural perceptions of social status, the nature of the work and sexuality. Objective: This study aims to describe and analyse how gender and cultural perceptions influenced the development of nursing in Mauritius. This paper examines why nursing in Mauritius became gendered in different ways due to the impact of gender equivalence in the work force, the gendered segregation in clinical practice and the absence of caring feminisation in nursing. Design and setting: This qualitative study is based on in-depth, semi-structured interviews and convenience sampling. The sample includes nurses working at five hospitals. They all come from the central and southern part of Mauritius. The data were collected over a fivemonth period during 2006. Participants: Individual qualitative interviews were conducted with 47 nurses, both men (27) and women (20), of different grades, ages, religions and ethnic backgrounds. Results: Nursing practice is gender segregated, influenced and supported by cultural traditions and perceptions of gender relations, sexuality and touch in nursing. However, the professional identity and role is considered non-gendered, implied by the title of 'nursing officer' and the presence of male nurses who constitute almost 50 percent of the work force. Male nurses do not face similar barriers deterring them from entering nursing profession. Nursing did not develop the image of women's work and a low status job in Mauritius. Conclusions: The nursing profession in Mauritius has been shaped by a different 'history of origin', social, cultural and societal conditions on the basis of the absence of gender imbalance in the work force and caring feminisation in nursing. Moreover, the increase of men's presence in nursing influenced its name, status and perception, shifting nursing into a masculine sphere with advantageous impacts on nursing. [ABSTRACT FROM AUTHOR]

Background: Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers' practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned ''How can nurses' infection prevention behaviour be explained?'' This paper presents one of three identified themes 'Rationalising dirt-related behaviour'. Design: This interpretative qualitative study uses vignettes, developed from nurses' accounts of practice, to explore nurses' reported infection prevention behaviours. Participants: Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University. Methods: Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method. Results: The findings demonstrate that participants were keen to give a good impression and present themselves as knowledgeable practitioners, although it was evident that they did not always follow procedure and policy. They rationalised their own behaviour and logically justified any deviations from policy. Deviations in others were criticised as irrational and explained as superficial and part of a 'show' or display. However, participants also gave a presentation of themselves: a show or display that was influenced by the desire to protect self and satisfy patient scrutiny. Conclusions: This study contributes to the identification and explanation of nurses' infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted and complex, stemming from a response to factors that are outside a purely 'scientific' understanding of infection and not simply understood as a deficit in knowledge. This calls for educational interventions that consider beliefs, values and social understanding of dirt and infection. [ABSTRACT FROM AUTHOR]

Background: The Vestibular Disorders Activities of Daily Living Scale (VADL) is considered an important subjective assessment to evaluate patients suffering from dizziness and imbalance. Although frequently used, its metric characteristics still require further investigation. Objective: This paper aims to analyze the psychometric properties of the Brazilian version of the VADL in an elderly population. Method: The sample comprises patients (≥65 years old) with chronic dizziness resulting from vestibular disorders. For discriminant analysis, patients were compared to healthy subjects. All subjects answered the VADL-Brazil by interview. To examine the VADL validity, patients filled out the Dizziness Handicap Inventory (DHI) and the ABC scale and were tested on the Dynamic Gait Index (DGI). To evaluate the VADL responsiveness, 20 patients were submitted to rehabilitation. Results: Patients (n=140) had a VADL total score of 4.1±1.6 points. Healthy subjects scored significantly less than patients in all the subscales and in the VADL total score. The VADL-Brazil was weakly correlated with the DHI and moderately to the ABC scale and the DGI. Instead of the original 3 subscales, factor analysis resulted in 6 factors. The VADL was capable of detecting changes after rehabilitation, which means that the instrument has responsiveness. Conclusions: This study provided more data about the psychometric properties and usefulness of the VADL-Brazil. The use of such a reliable and valid instrument increases the knowledge about disability in patients with vestibular disorders. [ABSTRACT FROM AUTHOR]

Aims of the paper: To present a grounded theory of the nursing team involvement in the process of maintaining and promoting the mobility of hospitalised older adults. Background: Being able to mobilise is an important determinant of quality of life in late adulthood. However, advancing age is often accompanied by worsening mobility, which may deteriorate further as a result of illness and particularly hospitalisation. Targeted in-patient rehabilitation interventions may have the capacity to maintain and promote older adults' mobility. Some authors suggest that the nursing team may have a central role in such activities. Objectives: The study set out to describe the involvement of the nursing team in the process of maintaining and promoting the mobility of hospitalised older adults. It also sought to understand how members of the nursing team viewed their work in relation to physiotherapists and in relation to hospital policy on patient handling. Design: Grounded theory provided the philosophical and structural underpinning to the study. Settings: Data collection centred on three clinical settings which included a general rehabilitation ward, a regional spinal injuries unit and stroke rehabilitation ward. Participants: Semi-structured interviews with 39 rehabilitation staff and 61 h of nonparticipant observation comprised the data set. Findings: The nursing team involvement in patients' mobility maintenance and rehabilitation was explained by the core category 'care to keep safe.' This category identified how the nursing team focused primarily on preventing patient problems rather than focusing on rehabilitation goals. A number of contextual factors in the workplace meant that the nursing team found it difficult to engage in activities to support mobility maintenance and rehabilitation. Conclusions: Significant changes in the micro and macro context for rehabilitation practice are needed to enable the nursing team to engage more fully in the processes of mobility rehabilitation. Nurse-led initiatives which allow the nursing team to take an active role in implementing intentional strategies to maintain and promote mobility should be implemented and trialled for effectiveness. [ABSTRACT FROM AUTHOR]

Background: Parents with young children often worry about whether or not to seek medical help for a sick child. Previous research identified parents' anxieties surrounding help seeking from health services but did not explore or explain the underlying psychosocial processes taking place in families at these times. Objectives: This paper presents findings from a British grounded theory study on family management of acute childhood illness at home, which provide an explanation for parent's helping seeking behaviours. Design: Glaserian grounded theory methodology was used for the study. Setting: The sampling sites for the study were in two towns in the East Midlands with population profiles close to the national average for the UK. Participants: Initial purposeful and later theoretical sampling resulted in a sample of fifteen families with children aged between 1 month and 8 years of age. Methods: Four sets of data collection took place between 2001 and 2007. Unstructured family interviews were conducted with adult family members and a draw, write or tell technique was used to interview any children over 4 years of age. Theoretical sensitivity and constant comparative analysis were employed to achieve theoretical saturation around a core category. Findings: Felt or enacted criticism teaches parents informal social rules which direct how they are expected to behave. Their desire to avoid such criticism of their moral status as 'good' parents creates significant hidden anxiety about when to seek medical help. This anxiety sometimes leads to late consultation with potentially serious consequences for their child's health. Conclusion: The grounded theory indicates the need for significant investment in the training of nurses and other health professionals to reduce parents' (and other patients') experiences of felt or enacted criticism and the consequent hidden anxiety. When parents are worried about their child's health, they need to be able to seek help from health professionals without fear of criticism. These conclusions are primarily limited to universal health care environments. [ABSTRACT FROM AUTHOR]

Objectives: This paper provides a theoretical account of nurses' collaboration with patients with chronic obstructive pulmonary disease during non-invasive ventilation treatment in hospital. Background: Despite strong evidence for the effect of non-invasive ventilation treatment, success remains a huge challenge. Nurse-patient collaboration may be vital for treatment tolerance and success. A better understanding of how nurses and patients collaborate during non-invasive ventilation may therefore contribute to improvement in treatment success. Design: A constant comparative classical grounded theory. Method: The data comprised sessions of qualitative participant observation during the treatment of 21 patients with non-invasive ventilation that included informal conversations with the nurses and semi-structured interviews with 11 patients after treatment completion. Data were collected at three intensive care units and one general respiratory ward in Denmark. Results: Succeeding emerged as the nurses' main concern in the nurse-patient collaboration during non-invasive ventilation treatment. Four collaborative typologies emerged as processing their main concern: (1) twofold oriented collaboration; (2) well-being oriented collaboration; (3) outcome oriented collaboration; and (4) absent collaboration. Conclusions: This study offers a theoretical account of nurses' main concern and how they activate different ways of collaboration to achieve successful treatment. We offer a theoretical basis for developing complex interventions. [ABSTRACT FROM AUTHOR]

Abstract: Aims/background: The retention of student nurses continues to concern the education sector internationally. Evidence shows that individual factors are correlated with a high risk of attrition, including age, disability, entry qualifications, financial issues, and placement experience. This paper is a report of a study that aimed to examine factors connected to progression and attrition by mapping student characteristics against Year 1 progression data. Method: The study used a retrospective cohort design. Students within five cohorts in a single University in the north of England were invited to be included (n =807). Quantitative data were collected from the University''s information system (October 2009–January 2010). Of the total potential participants, 695 were included (13.8% excluded). Multinomial logistic regression was used to ascertain factors that predicted progression. Results: As age on entry increased, the likelihood of non-progression from year one became less: i.e. older students appeared to be more likely to progress than their younger counterparts (p <0.001, likelihood ratio chi-square test). Students who lived away from the local area outside term-time were significantly less likely to progress than those whose term-time and holiday domicile were the same (p =0.007, likelihood ratio chi-square test). Students with dependents or previous care experience seemed more likely to progress than those without, although this was not statistically significant in a multivariable regression model. Conclusion: With the changing demographic profile of students, the new ‘all-graduate’ programmes need to consider student characteristics that are correlated with likelihood of progression and not just focus on those that precipitate exit. [Copyright &y& Elsevier]

Abstract: Background: Death has been identified as a known stressor for nurses and has been extensively researched in nursing populations. However, very little is known about the impact of a specific stressful event; that of the novice nurse''s first encounter with patient death. Using a sequential quantitative-qualitative mixed methods design, a study was undertaken to explore the clinical circumstances, impact and challenges and rewards of nurses’ early experiences with patient death. This paper reports the findings of the first phase: an exploratory survey of nurses’ responses to this stressor. Method: A convenience sample of New Zealand Registered Nurses was recruited using email invitations; 174 respondents completed an online questionnaire exploring the clinical circumstances, preparedness, support mechanisms and impact of their earliest memorable patient death. Results: Most nurses reported that their earliest memory of patient death occurred during undergraduate training (61%) or in the first year of qualified practice (23%). Over 80% of these experiences occurred in acute medical, surgical or specialty settings in public hospitals, some involving paediatric or sudden unexpected deaths. Whilst some respondents described a rewarding, ‘learning experience’, others reported acute helplessness, guilt or marked on-going distress. Conclusions: Whilst little can be done to control the clinical circumstances of nurses’ early death encounters, by understanding more about the reactions to death, it may be possible to minimise negative factors such as unexpected elements, feelings of inadequacy, exclusion and role conflicts whilst facilitating coping, sharing of the experience, personal and professional growth, and other positive outcomes. Nurses’ early experiences with patient death appear to have a lasting impact on their professional and personal lives. [Copyright &y& Elsevier]

Abstract: Background: As cardiovascular diseases have become the leading cause of death in many countries including China, nurses are increasingly required to be abreast of technological advances and the skills necessary to manage this increasing health care problem. Chinese nurses are under pressure to provide skilled electrocardiography monitoring, and be sufficiently skilled to detect myocardial ischemia and infarction, in this large patient population. This presents a challenge for the nursing profession in China, particularly for nurses working in coronary care in a country where advancement has been so rapid, yet little research has been conducted or reported in the literature. Objectives: The two main objectives were: to explore the demographic and educational factors that affect the use of ST-segment monitoring and correct electrode placement by CCU/ICU nurses in China; and to explore the factors both individual and institutional that affect monitoring and lead placement. Methods: A self-administered questionnaire was distributed to nurses in 126 randomly selected tertiary hospitals, which were stratified into three homogeneous regions across China. The instrument examined demographics, information about hospitals, electrocardiogram devices, current practice patterns and perceptions toward monitoring and lead placement. Data from 734 nurses and 59 nurse managers from 59 hospitals were analyzed using t-tests, ANOVA, Chi-square test and logistic regression. Results: Electrocardiogram monitoring was used to detect myocardial ischemia by 43.7% of respondents, and 35.1% selected leads according to electrocardiogram or angiography findings. Most (70%) agreed that monitoring for acute coronary syndrome was important, while 39.2% did so, and 15.7% were able to identify correct placement. Logistic regression revealed a significant relationship between the uses of ST-segment monitoring and number of hospital beds, continuing education and a belief in its use and ease of use. Correct electrode placement was significantly correlated with respondents from university hospitals, hospitals with more acute coronary syndrome admissions and more independent thinking nurses. Conclusions: Despite best practice evidence, less than half of the sample used electrocardiogram monitoring to detect myocardial ischemia and the majority could not identify correct electrode placement, while ST-segment monitoring was not used routinely. This paper highlights the need for improvements in education both in universities and hospitals and discussion addresses conventions in units, which inhibit development of nurses’ skills. [Copyright &y& Elsevier]

Abstract: Aims: This paper is aimed to develop and validate the hypertension scale of the system of Quality of Life Instruments for Chronic Diseases, QLICD-HY. Methods: The QLICD-HY instrument was developed based on programmed decision procedures with multiple nominal and focus group discussions and pilot testing. A total of 157 inpatients with hypertension were used to provide the data measuring QOL three times before and after treatment. The psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness employing correlation and factor analyses, and t-tests. Results: Correlation and factor analyses confirmed good construct validity and criterion-related validity when using Short Form (36) Health Survey (SF-36) as a criterion. Test–retest reliability coefficients (Pearson r and intra-class correlation (ICC)) for the overall instrument score and all domains except for the hypertension-specific domain (SPD) (0.75) were higher than 0.80 with a range of 0.75–0.91; the internal consistency α for all domains except for the hypertension-specific domain (0.66) was higher than 0.70. The overall score and scores for most facets within each domain except for the social domain (SOD) had statistically significant changes (t-tests) after treatment with moderate effect sizes. Conclusion: QLICD-HY has good validity, reliability, responsiveness and can be used as the quality-of-life instrument for patients with hypertension. [Copyright &y& Elsevier]

Abstract: This paper summarizes research associated with the development of the Public Opinion Survey of Human Attributes–Stuttering (POSHA–S), a survey instrument designed to provide a worldwide standard measure of public attitudes toward stuttering. Pilot studies with early experimental prototypes of the POSHA–S are summarized that relate to questionnaire rating scale prototypes, test–retest reliability, construct validity, item analysis and final item selection, translation to other languages, internal consistency, sampling procedures, manner of administration, and sample size. Future research and public service uses of the POSHA–S are discussed, especially for comparisons using its growing database archive. Learning outcomes: Readers of this article should be able to: (1) describe the purposes of the International Project on Attitudes Toward Human Attributes (IPATHA) initiative, (2) describe procedures to determine reliability and validity of the Public Opinion Survey of Human Attributes–Stuttering (POSHA–S), (3) describe factor analysis and other strategies to select items from the POSHA–E1 and POSHA–E2 pilot studies for the final POSHA–S, and (4) describe uses of the POSHA–S database archive in studies of public attitudes toward stuttering. [Copyright &y& Elsevier]

Abstract: Background: The Perceived Stress Scale has been designed to measure the degree to which situations in a person''s life are perceived as stressful. Objective: The paper describes the development of an Arabic version of the Perceived Stress Scale. Design: A translation process with cross-cultural considerations was employed to produce an Arabic version of the Perceived Stress Scale. Settings: Participants were asked to complete the Arabic version Perceived Stress Scale twice in their homes. Participants: The Jordanian study population for the Arabic version Perceived Stress Scale validation consisted of 126 volunteers (74 male, 52 female). Ninety participants completed the scale twice (55 male, 35 female), of whom 58 were high schools teachers and 32 technical workers. Arabic was the first language of all participants and all gave informed consent. Results: The Arabic version Perceived Stress Scale reliability and validity were evaluated. Prior to an exploratory factor analysis, the suitability of data for factor analysis was assessed with acceptable results. The exploratory factor analysis showed two factors with eigenvalues greater than 1.0 (45.0% of variance). The Cronbach''s alpha coefficients were 0.74 (Factor 1), 0.77 (Factor 2) and 0.80 for the Arabic version Perceived Stress Scale overall. The test–retest reliability had an intra-correlation coefficient of 0.90. Conclusions: The Arabic version Perceived Stress Scale showed an adequate reliability and validity. Therefore, the Arabic Perceived Stress Scale is considered a suitable instrument to assess perceived stress in Arabic people. [Copyright &y& Elsevier]

Abstract: Aim: This paper describes the development and validation of the Revised Perioperative Competence Scale (PPCS-R). Background: There is a lack of a psychometrically tested sound self-assessment tools to measure nurses’ perceived competence in the operating room. Methods: Content validity was established by a panel of international experts and the original 98-item scale was pilot tested with 345 nurses in Queensland, Australia. Following the removal of several items, a national sample that included all 3209 nurses who were members of the Australian College of Operating Room Nurses was surveyed using the 94-item version. Psychometric testing assessed content validity using exploratory factor analysis, internal consistency using Cronbach''s alpha, and construct validity using the “known groups” technique. During item reduction, several preliminary factor analyses were performed on two random halves of the sample (n =550). Results: Usable data for psychometric assessment were obtained from 1122 nurses. The original 94-item scale was reduced to 40 items. The final factor analysis using the entire sample resulted in a 40 item six-factor solution. Cronbach''s alpha for the 40-item scale was .96. Construct validation demonstrated significant differences (p <.0001) in perceived competence scores relative to years of operating room experience and receipt of specialty education. Conclusions: On the basis of these results, the psychometric properties of the PPCS-R were considered encouraging. Further testing of the tool in different samples of operating room nurses is necessary to enable cross-cultural comparisons. [Copyright &y& Elsevier]

Abstract: Background: Nurse–client relationships are valued in descriptions of public health practice and require consideration as work involving knowledge, skill, and personal engagement. Even so, in public health, they are largely taken-for-granted, particularly in the area of tuberculosis (TB). Instead, TB nursing is often structured by a population focus, which at times challenges individually focused relationship ideals. Purpose and design: This paper describes an interpretive phenomenological study which was undertaken to understand the nature of TB nurses’ relational work. Methods: Data were collected over an eight month period through observations of usual nurse–client visits and semi-structured interviews. Setting and participants: The study took place in the TB program of a public health department of a large multicultural Canadian city with nine nurses and 24 clients. Results: The phrase ‘welcome intrusions’ represents the nature of relational work and along with three key themes, ‘getting through the door’, ‘doing TB but more than that’, and ‘beyond a professional’, speaks to the central tension in this relational work: balancing its dual surveillance-care focus. Conclusions: Together these themes emphasize the importance of nurses’ skill of involvement in two key domains of TB nursing practice: providing comfort and being watchful. [Copyright &y& Elsevier]

Abstract: Background: A comprehensive assessment of patient hesitancy to use analgesics and accurate knowledge related to the promotion of analgesic adherence is necessary for effective pain management. Unfortunately, there has been a lack of a short and concise questionnaire to assess patients’ hesitancy to use analgesics in clinical practice. Objective: This paper is a report of the development and psychometric properties of the short version of the Barriers Questionnaire-Taiwan form (S-BQT). Design: This study employed a descriptive design. Setting: A convenience sample was recruited from oncology clinics at two medical centers in Taiwan. Participants: One hundred and eighty-three (N =183) patients receiving analgesics for cancer pain participated in the study. Methods: Instruments included the Barriers Questionnaire-Taiwan form (BQT), the Taiwanese version of the Morisky Medication Adherence Measure-Taiwan form (MMAM-T). Two self-administered questionnaires were performed at the same time, and the ratio of analgesic usage was computed over a two-week period. Reliability was established by calculating Cronbach''s α and test–retest reliability. The validity was estimated by construct validity, criterion-related validity, and known group validity. Results: To develop the S-BQT, we used reliability analysis to extract nine items from nine subscales. Internal consistency of the S-BQT was indicated by a Cronbach''s alphas score of 0.86. Test–retest reliability was assessed as 0.83 over a two-week interval. Factor analysis revealed two factor structures. Criterion-related validity was examined by correlating the S-BQT score, and MMAM-T score, and the ratio of analgesic use. Known group validity was examined by comparing the S-BQT scores of patients with hesitancy to report pain and take analgesics vs. patients demonstrating no such hesitancy in the previous week. Known group validity was also established by comparing the S-BQT scores among patients with low, moderate, and high adherence to the usage of medication. Conclusions: The S-BQT shows excellent reliability and validity. The use of this instrument can help to improve communication between patients and clinicians regarding the use of analgesics in the management of pain. [Copyright &y& Elsevier]

Abstract: Background: There is a need to develop an evidence base for Chinese herbal medicine (CHM) that is both rigorous and reflective of good practice. This paper proposes a novel methodology to test individualised herbal decoctions using a randomised, double blinded, placebo controlled clinical trial. Method: A feasibility study was conducted to explore the role of CHM in the treatment of endometriosis. Herbal formulae were pre-cooked and dispensed as individual doses in sealed plastic sachets. This permitted the development and testing of a plausible placebo decoction. Participants were randomised at a distant pharmacy to receive either an individualised herbal prescription or a placebo. Results: The trial met the predetermined criteria for good practice. Neither the participants nor the practitioner-researcher could reliably identify group allocation. Of the 28 women who completed the trial, in the placebo group (n =15) 3 women (20%) correctly guessed they were on placebo, 8 (53%) thought they were on herbs and 4 (27%) did not know which group they had been allocated to. In the active group (n =13) 2 (15%) though they were on placebo, 8 (62%) thought they were on herbs and 3 (23%) did not know. Randomisation, double blinding and allocation concealment were successful and the study model appeared to be feasible and effective. Conclusion: It is now possible to subject CHM to rigorous scientific scrutiny without compromising model validity. Improvement in the design of the placebo using food colourings and flavourings instead of dried food will help guarantee the therapeutic inertia of the placebo decoction. [Copyright &y& Elsevier]

Objective: This paper presents the reliability and validity of a "competing food choice" construct designed to assess whether factors related to consumption of less-healthful food were perceived to be barriers to fruit and vegetable consumption in college freshmen. Design: Cross-sectional, self-administered survey. Setting: An urban public college with a large, diverse student population. Participants: A convenience sample of 408 college freshmen. Variables Measured: A "competing food choice" construct and fruit and vegetable intake. Analyses: Factor analysis, Cronbach α, and correlation coefficients were used to determine the reliability and validity of the construct. Results: Three factors were produced from the factor analysis of the 11-item competing food choice construct: "competitive food" barriers (Cronbach α = 0.73), fruit and vegetable-related "time" barriers (Cronbach α = 0.67), and "quality" barriers (Cronbach α = 0.64). Construct validity assessments revealed significant inverse correlations between fruit and vegetable consumption and competitive food barriers (r = -0.15, p < .01 current and r = -0.25, P < .01 prior) and time barriers (r = -0.12, P < .05 current and r -0.10, P < .05 prior). Conclusions and Implications: This "competing food choice" construct demonstrated satisfactory reliability and construct validity among college freshmen. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the influence of Bis-EMA 30 on the resin-to-dentin microtensile bond strength (microTBS) and structural reliability of the experimental three-step etch-and-rinse adhesive systems.Methods: Five experimental primers containing different dimethacrylate monomer concentrations (0, 10, 20, 40, 60 wt% of the Bis-EMA 30, P0.P60) added to acid monomer and solvents (ethanol/water), and a resin bond (Bis-GMA/TEGDMA, 50/50 wt%) were formulated. The adhesive system Scotchbond MultiPurpose (SBMP, 3M ESPE) was tested as commercial reference. Sixty bovine incisors were randomly separated into six groups, and their superficial coronal dentin was exposed. After acid etching and rinsing, the excess water was removed from the surface with absorbent paper. Each experimental primer was actively applied (30 s), followed by a mild air stream (10 s). The experimental adhesive resin was applied and light activated for 20 s. Resin composite restorations were incrementally built up. The restored teeth were stored in distilled water at 37 degrees C for 24 h, and then sectioned to obtain sticks with a cross-sectional area of approximately 0.5 mm(2), after which 24 specimens per group were subjected to the microTBS test. Data (MPa) were analyzed by One-way ANOVA, Tukey test (alpha=0.05) and Weibull analysis.Results: The P40 group showed microTBS means similar to those of the control (SBMP), whereas both had statistically higher values when compared with the other groups (p<0.001). Moreover, P40 showed higher structural reliability, represented by the high Weibull modulus and characteristic strength values. The lowest microTBS was observed in the P0, P10 and P20 groups, which also had low structural reliability.Significance: Bis-EMA 30 is a promising monomer to be considered as a substitute for HEMA in adhesive system compositions. [ABSTRACT FROM AUTHOR]

Abstract: This work describes a novel sampling standardization for improving precision of third-party results in web meta-search. The standardization uses the capture–recapture methodology which is mainly applied for estimating evolution rates in wildlife biological studies, as well as a mechanism that records the users'' browsing behavior during their web search sessions. The paper provides the implementation details and the initial assessment of a third-party results ranking algorithm which employs both mechanisms. It is proved that an important quality factor in providing relevant information is how frequent Internet search services refresh their databases. It is also proved that when users'' browsing behavior is jointly examined with the ability of the Internet search services to offer new and fresh results, a more effective meta-search is provided. Experimental results have shown that the precision levels of third-party results were significantly increased in several recall levels, over a six-month period. For acquiring third-party results we used five known web search services namely, AltaVista, Google, Lycos, MSN, and Yahoo! [Copyright &y& Elsevier]

In the context of coastal management the aim of this paper is to present the development of a fuzzy model through the application of a Genetic algorithm in order to select the most appropriate set of variables and improve our understanding with a set of rules. The case studied is the chlorophyll response as bioindicator of ecological status in the Northeast coastal upwelling system of Rio de Janeiro state, Southeastern of Brazil. The prediction of the fuzzy model has shown an improved performance when compared to the traditional approaches as Multiple Regression modelling. The results show that the set of inferred rules can assess three different water masses. Despite the increased occurrence of upwelling is observed in spring¿summer period and some instability of the model, it is able to forecast some chlorophyll peaks. We conclude that the sampling frequency is crucial to reach a better performance. [Copyright &y& Elsevier]

Vulnerability–stress models suggest that training in specific stress management techniques should yield benefits to those suffering from schizophrenia and related disorders. In this paper, we describe an evaluation of the impact of adding a stress management program to other medical and psychosocial interventions for such patients. Outcomes were compared for 121 patients randomly assigned to receive either a 12-week stress management program with follow-up sessions or participation in a social activities group. The two treatment conditions did not differ in levels of symptoms, perceived stress or life skills immediately after completion of treatment or at 1-year follow-up. Patients who received the stress management program did have fewer hospital admissions in the year following treatment. This effect of stress management was most apparent for those who showed high levels of attendance for treatment sessions. It was concluded that training in stress management may provide patients with skills for coping with acute stressors and reduce the likelihood of subsequent acute exacerbation of symptoms with need for hospitalization. [Copyright &y& Elsevier]