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Purpose: To determine whether a 1-month physical therapy (PT) program that includes a balance component improves balance impairments and fear of falling in individuals with chronic obstructive pulmonary disease (COPD), and to evaluate the utility of the Four Square Step Test (FSST) and Functional Reach Test (FRT) in this population. Methods: A retrospective analysis of participants with COPD in a PT program between May 2015 and December 2015. Assessments performed before and after therapywere the Berg Balance Scale (BBS), FRT, FSST, and Activities Balance Confidence Scale (ABC) questionnaire. Statistical analysis used Pearson product-moment coefficient of correlation, 1-tailed T test, and Independent T test. Results: Twenty-five individuals with COPD completed the PT program. Individuals at high risk of falls experienced significant improvements on the BBS (6.6 points, P 5 .0097), FSST (6.75 seconds, P5.001), and FRT (5.63 cm, P5.01333). The BBS and FSSTwere correlatedwith each other (r5 0.70) at baseline. Improvements in the ABC were not statistically significant (P5.071). Use of supplemental oxygen was not correlated with any assessment tool. Conclusions: People with greater balance deficits had significant improvements in balance after a 1-month PT program. The FSST should be investigated further in patients with COPD. [ABSTRACT FROM AUTHOR]

Aim: To explore the relationship between ethical climate (EC) and nurses' service behaviours (SB) and examine the moderating effect of nurses' employment type. Background: As most public hospitals in China implement the "dual‐track system" of nurses' employment, the two different types of nurses, contract‐employed nurses and state‐employed nurses, receive the different pay for the same work, which results in they providing different SB. It has become critical for hospital administrators and nursing managers to understand better the state of two groups of nurses and to find an effective method to improve the service level of the nursing workforce. Design: Stepwise multiple regression analyses of survey data collected in June and July 2017 from Chinese nurses employed in three tertiary hospitals. Methods: Chinese nurses (298 of 350 [85.1%]) were interviewed using the Ethical Climate Scale and Nurses' Service Behaviour Scale. Data were analysed statistically using descriptive statistics, confirmatory factor analysis, correlation coefficients (Pearson), two‐tailed t‐test and stepwise multiple regression analyses were conducted to test the proposed hypotheses. Data were analysed using SPSS and AMOS. Results: There were statistically significant correlations between EC and nurses' extra‐role service behaviour (ERSB) and overall service behaviour and nurses' employment type moderated the proposed relationships. Conclusion: Healthcare institutions should pay more attention to cultivate EC and implement new incentive mechanism to better stimulate nurses to provide ERSB. [ABSTRACT FROM AUTHOR]

The article discusses a mobility program that could be hardwired on the medical-surgical unit to improve patient quality of care and shorten hospital length of stay. Topics mentioned include complications occurring during hospitalizations at the project site due to immobility and deconditioning, the effects of mobilization on hospital-acquired conditions, and the comparison of implementing set ambulation protocols using a mobility plan versus standard care.

Purpose: When a behavioral treatment is generally efficacious, the central research questions shift to optimized dose delivery. In this study, we determine whether a validated treatment method can be made more effective or efficient by increasing the dose density employed. Method: Twenty children were treated with Enhanced Conversational Recast methods to treat morphological errors. Half received 24 doses per session within a half hour (approximately 1 dose/1.25 min), and the other received the same number of doses within 15 min (approximately 1 dose/38 s). Generalization of morpheme use was probed throughout treatment and at a 6-week follow-up. Spontaneous use of treated morphemes was also tracked. Results: Although the treatment was effective overall, there were no significant differences between treatment conditions on any of the outcome measures. Follow-up performance correlated significantly with performance at the end of the treatment period. Conclusion: Minimal between-groups differences suggest that performance does not suffer when dose rates are compressed into half the time during treatment, making the high-density dose delivery method a more efficient delivery method. This could make time available within a treatment session to address other goals or allow for more classroom instructional time for the child. [ABSTRACT FROM AUTHOR]

Adolescent mothers have been shown to have lower self-esteem than nonparenting adolescents. The purpose of the current clinical project was to explore the feasibility of adopting a school-based support group model to provide education and skills for increasing self-esteem and self-confidence among adolescent mothers using self-efficacy–focused activity sessions. This project took place at an alternative public school for pregnant and/or parenting female adolescents. Participants attended self-efficacy–focused activity sessions, and completed the General Self-Efficacy Scale. Increased confidence in finding solutions demonstrated statistical correlation with the number of sessions attended. Development of positive self-esteem and self-confidence remain important concerns during the adolescent period. Implementing self-efficacy activities in a school-based setting is one potential approach to improving self-esteem. Further exploration into ways to foster positive mental health and build confidence in adolescents is recommended. [Adolescent mothers have been shown to have lower self-esteem than nonparenting adolescents. The purpose of the current clinical project was to explore the feasibility of adopting a school-based support group model to provide education and skills for increasing self-esteem and self-confidence among adolescent mothers using self-efficacy–focused activity sessions. This project took place at an alternative public school for pregnant and/or parenting female adolescents. Participants attended self-efficacy–focused activity sessions, and completed the General Self-Efficacy Scale. Increased confidence in finding solutions demonstrated statistical correlation with the number of sessions attended. Development of positive self-esteem and self-confidence remain important concerns during the adolescent period. Implementing self-efficacy activities in a school-based setting is one potential approach to improving self-esteem. Further exploration into ways to foster positive mental health and build confidence in adolescents is recommended. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 11–15.] [ABSTRACT FROM AUTHOR]

A cross-sectional descriptive correlation study was performed to investigate the risk of posttraumatic stress disorder (PTSD) among 300 family caregivers of individuals with schizophrenia or bipolar disorder and examine the relationship between perceived social support and risk of PTSD. The Arabic version of the PTSD Checklist for A cross-sectional descriptive correlation study was performed to investigate the risk of posttraumatic stress disorder (PTSD) among 300 family caregivers of individuals with schizophrenia or bipolar disorder and examine the relationship between perceived social support and risk of PTSD. The Arabic version of the PTSD Checklist for DSM-5 (APCL-5) was used to investigate risk of PTSD; the Arabic version of the Multidimensional Scale of Perceived Social Support was used to measure perceived social support. Mean score of the APCL-5 was 46.1, indicating risk of PTSD among family caregivers. A negative moderate correlation was found between risk of PTSD and perceived social support. The caring process is demanding and highly stressful, putting family caregivers at risk for PTSD. Social support is crucial in decreasing this risk. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 37–43.] [ABSTRACT FROM AUTHOR]

Purpose: To investigate psychological distress among parents of children with autism spectrum disorder and the associated sociodemographic factors influencing parents' distress. Design and Methods: A cross‐sectional design with a sample of 123 Jordanian parents providing care to children with autism spectrum disorder was used. A sociodemographic questionnaire, the Oberst Caregiving Burden Scale, the Bakas Caregiving Outcomes Scale, and the Hospital Anxiety and Depression Scale were utilized for data collection. Findings: Parents reported moderate levels of burden, negative life changes, and borderline depression and anxiety. The perceived burden related to caregiving task difficulty positively correlated with that related to time spent on tasks and negatively correlated with caregivers' caregiving‐related outcomes. The perceived burden of caregiving tasks was negatively correlated with depression and anxiety and anxiety levels were positively correlated with depression (P < 0.001). Practice Implication: Healthcare providers, advanced practice nurses, and policy makers should be aware of the burden, anxiety, and depression experienced by caregivers of children with autism spectrum disorder. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the current state of face‐to‐face bullying and cyberbullying among nurses in the workplace and to identify the effects of nursing organisational culture on face‐to‐face bullying and cyberbullying. Background: It is important to accurately examine the current state of workplace bullying to acknowledge the gravity of the situation faced by nurses and devise prevention strategies. Electronic communication by computer or smartphone is widely used as a prompt and efficient means of facilitating nursing work; however, this leads to the possibility of cyberbullying as well as face‐to‐face bullying among nurses. Design: Descriptive cross‐sectional study. Methods: A total of 226 staff nurses working in one of five upper tertiary hospitals in Korea with a career of 10 years or shorter were surveyed using a self‐reported questionnaire. The collected data were evaluated using various statistical analyses, including hierarchical regression. Our study was applied to the STROBE checklist of items. Results: The mean face‐to‐face bullying score was 1.32 ± 0.53 and the cyberbullying score was 1.14 ± 0.37 (possible range: 1–5); most were work‐related negative experiences. The explanatory power of nursing organisational culture for face‐to‐face bullying was 6.3%, and relation‐oriented culture and hierarchy‐oriented culture were major factors affecting face‐to‐face bullying. The explanatory power of nursing organisational culture for cyberbullying was 4.3%, and relation‐oriented culture was a major factor affecting cyberbullying. Conclusions: Relation‐oriented culture had a significant effect on both face‐to‐face bullying and cyberbullying. Therefore, organisations should strive to foster a relation‐oriented nursing organisational culture in order to prevent and resolve workplace bullying among nurses. Relevance to clinical practice: Cyberbullying should be addressed as an important type of workplace bullying in nursing, which occurs via various information and communication devices. To prevent workplace bullying among nurses, various strategies that promote relation‐oriented nursing organisational cultures should be considered. [ABSTRACT FROM AUTHOR]

This study examines variables associated with behavior for obtaining prescription medications with or without doctors' prescriptions following direct-to-consumer prescription medication advertisement (DTCA) exposure. Data were analyzed from 631 college students. We found that viewing traditional or cable television DTCA was associated with lower agreement for obtaining prescription medications from a doctor. Reading social media DTCA print content on Twitter was associated with higher agreement for obtaining a prescription medication without a doctor's prescription. In conclusion, college students go for digital social media DTCA and not digital Internet DTCA or traditional DTCA. [ABSTRACT FROM AUTHOR]

Background and Purpose: We sought to evaluate the Balance Outcome Measure for Elder Rehabilitation (BOOMER) in community-dwelling women 65 years and older with vertebral fracture and to describe score distributions and potential ceiling and floor effects. Methods: This was a secondary data analysis of baseline data from the Build Better Bones with Exercise randomized controlled trial using the BOOMER. A total of 141 women with osteoporosis and radiographically confirmed vertebral fracture were included. Concurrent validity and internal consistency were assessed in comparison to the Short Physical Performance Battery (SPPB). Normality and ceiling/floor effects of total BOOMER scores and component test items were also assessed. Exploratory analyses of assistive aid use and falls history were performed. Results and Discussion: Tests for concurrent validity demonstrated moderate correlation between total BOOMER and SPPB scores. The BOOMER component tests showed modest internal consistency. Substantial ceiling effect and nonnormal score distributions were present among overall sample and those not using assistive aids for total BOOMER scores, although scores were normally distributed for those using assistive aids. The static standing with eyes closed test demonstrated the greatest ceiling effects of the component tests, with 92% of participants achieving a maximal score. Conclusions: While the BOOMER compares well with the SPPB in community-dwelling women with vertebral fractures, researchers or clinicians considering using the BOOMER in similar or higher-functioning populations should be aware of the potential for ceiling effects. [ABSTRACT FROM AUTHOR]

Purpose To explore the perceptions of interprofessional socialization in nursing, medical imaging, and physical therapy students using an interprofessional education acute-care simulation. Methods A mixed-methods design was used to evaluate the effect of a single simulation-based experience on interprofessional collaborative practice using the Interprofessional Socialization and Valuing Scale (ISVS-21) and 3 postactivity open-ended descriptive questions. Students participated in a patient care simulation with an elderly patient after total hip replacement surgery in an acute-care inpatient setting. Descriptive and exploratory statistics examined pre- and post-ISVS-21 survey responses, and phenomenological inquiry was used to explore the students' experiences and knowledge gained from participating in the simulation. Results One-hundred-nine students participated in the acute-care patient simulation, including 42 from nursing, 47 from physical therapy, and 20 from radiography. ISVS-21 survey results indicated improved scores because of the simulation activity, including significant improvements in each of the survey items. Qualitative themes emerged related to creating a culture of communication and teamwork and professional role discernment. Discussion Implementation of this acute-care simulation successfully exposed many students to interprofessional collaborative practice. Mixed-method analysis demonstrated significant improvement in attitudes related to socialization and interprofessional collaborative practice in students of each discipline. Conclusion This study adds a unique perspective on interprofessional simulation because it included nursing, physical therapy, and radiography students. Students' perceptions of interprofessional patient care, interdisciplinary communication, teamwork, and appreciation for professional role discernment can be enhanced after a single interprofessional simulation-based experience. Although each health care profession has a specific culture, it is possible to improve student beliefs, behaviors, and attitudes about teamwork and collaborative practice, which can carry over into professional practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Age- and lifestyle-related changes in respiratory and physical function affect cough strength. However, in older adults, the main factors that relate to cough strength remain unclear. This study was a preliminary investigation of factors that contribute to cough strength and the relationships between cough strength and respiratory function, physical performance, physical activity, and sedentary behavior in community-dwelling older adults. METHODS: By using accelerometers and other tools, we assessed cough peak flow (CPF), FVC, maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax), chest and abdominal wall mobility (breathing movement scale), physical performance (Timed Up and Go test and 30-s chair stand test), physical activity (steps, and locomotive and non-locomotive moderate-to-vigorous physical activity), and sedentary behavior (sedentary time) in 65 community-dwelling older adults (25 males and 40 females) without air-flow limitation. RESULTS: Twenty-six percent of the subjects (17/65) had reduced CPF (<240 L/min). The subjects with reduced CPF had significantly lower FVC, PImax, PEmax, chest and abdominal wall mobility, physical performance, and locomotive moderate-to-vigorous physical activity compared with those with non-reduced CPF. Significant correlations between CPF and variables of respiratory function (FVC, PImax, PEmax, and breathing movement scale) and physical performance were weak to moderate. FVC and PImax were independently associated with CPF during the multiple regression analysis adjusted for sex, age, and height. The receiver operating characteristic analysis showed that FVC and PImax had fair-to-good sensitivity for detecting reduced CPF. CONCLUSIONS: Analysis of our results indicated that FVC and PImax were related to CPF and provided preliminary evidence that supported strategies for preserving and improving cough strength in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Purpose: Many young adults with a mild hearing loss can appear unaware or unconcerned about their loss or its potential effects. A question that has not been raised in prior research is whether slight variability, even within the range of clinically normal hearing, may have a detrimental effect on comprehension of spoken sentences, especially when attempting to understand the meaning of sentences that offer an additional cognitive challenge. The purpose of this study was to address this question. Method: An exploratory analysis was conducted on data from 3 published studies that included young adults, ages 18 to 29 years, with audiometrically normal hearing acuity (pure-tone average < 15 dB HL) tested for comprehension of sentences that conveyed the sentence meaning with simpler or more complex linguistic structures. A product--moment correlation was conducted between individuals' hearing acuity and their comprehension accuracy. Results: A significant correlation appeared between hearing acuity and comprehension accuracy for syntactically complex sentences, but not for sentences with a simpler syntactic structure. Partial correlations confirmed this relationship to hold independent of participant age within this relatively narrow age range. Conclusion: These findings suggest that slight elevations in hearing thresholds, even among young adults who pass a screen for normal hearing, can affect comprehension accuracy for spoken sentences when combined with cognitive demands imposed by sentences that convey their meaning with a complex linguistic structure. These findings support limited resource models of attentional allocation and argue for routine baseline hearing evaluations of young adults with current age-normal hearing acuity. [ABSTRACT FROM AUTHOR]

Purpose: This article investigates the possible connections between the level of chronic stress and success of steroid therapy in patients with sudden sensorineural hearing loss (SSNHL). Method: A single-center, retrospective, longitudinal cohort studyon55patientsinatertiary referral otology center was examined. Patients diagnosed with SSNHL between 2014 and 2017 were asked to complete a Measure of Perceived Stress (Brajac, Tkalcic, Dragojević,&Gruber, 2003) questionnaire. Inclusion criteria were patients > 18 years of age, SSNHL diagnosed within 4 previous weeks, completed steroid treatment, and complete documentation. Results: There were 30 patients (55%) that showed significant improvement in their pure-tone audiogram (PTA) hearing threshold average (≥ 15 dB) after steroid treatment. Two- step cluster analysis identified 3 clusters based on average PTA hearing threshold recovery and average Measure of Perceived Stress scores. The difference between pretreatment and posttreatment hearing levels was significantly higher in the cluster with moderate stress compared to clusters with mild and high stress levels (Kruskal--Wallis test, Friedman test, p < .001). There were no significant differences in average PTA hearing threshold recovery after steroid therapy between groups of patients with mild and severe stress. Conclusion: Patients with moderate stress levels show significantly better results after steroid treatment for SSNHL than patients with low or high stress levels. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study determined whether 1 health system's frontline nursing model redesign to integrate clinical nurse leaders (CNLs) improved care quality and outcome score consistency. METHODS: Interrupted time-series design was used to measure patient satisfaction with 7 metrics before and after formally integrating CNLs into a Michigan healthcare system. Analysis generated estimates of quality outcome: a) change point; b) level change; and c) variance, pre-post implementation. RESULTS: The lowest-performing unit showed significant increases in quality scores, but there were no significant increases at the hospital level. Quality metric consistency increased significantly for every indicator at the hospital and unit level. CONCLUSIONS: To our knowledge, this is the 1st study quantifying quality outcome consistency before and after nursing care delivery redesign with CNLs. The significant improvement suggests the CNL care model is associated with production of stable clinical microsystem practices that help to reduce clinical variability, thus improving care quality. [ABSTRACT FROM AUTHOR]

Background: Osteochondral allograft transplantation (OCA) is a successful knee joint preservation technique; however, the effects of defect size and defect size:condyle ratio (DSCR) are poorly understood. Purpose: To quantify clinical outcomes of isolated OCA of the knee based on defect size and DSCR. Study Design: Cohort study; Level of evidence, 3. Methods: Data from patients who underwent OCA of the knee without major concomitant procedures by a single surgeon were analyzed at a minimum follow-up of 2 years. Osteochondral defect size was measured intraoperatively, and femoral condyle size was measured with preoperative imaging. Patient-reported outcomes, reoperations, and survival rates were analyzed per defect size and DSCR, comparing males and females and patients <40 and ≥40 years old. Results: Sixty-eight patients were included, of whom 57% were male (mean ± SD: age, 34.5 ± 10.3 years; follow-up, 5.2 ± 2.6 years). Mean osteochondral defect size and DSCR were 3.48 ± 1.72 cm2 and 0.2 ± 0.1, respectively. Defect size was larger among males as compared with females (3.97 ± 1.71 cm2 vs 2.81 ± 1.16 cm2, P =.005), while DSCRs were not significantly different between sexes (P =.609). The cohort as a whole demonstrated improvements in the following scores: Lysholm, International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and 12-Item Short Form Health Survey Physical (P <.05). There were 27 reoperations (39.7%) at a mean of 2.5 ± 1.92 years and 8 failures (11.8%) at a mean of 2.62 ± 1.3 years. Mean DCSR was higher among patients with graft failure (0.26 ± 0.20 vs 0.19 ± 0.07, P =.049). After stratification by age, failures among patients ≥40 years old were associated with a larger defect size (mean 5.37 ± 3.50 cm2 vs 3.22 ± 1.32 cm2, P =.03) and higher DSCR (mean 0.30 ± 0.25 vs 0.19 ± 0.06, P =.05) when compared with nonfailures. Failures among patients <40 years old were not significantly associated with defect size or DSCR (P >.05) as compared with nonfailures. Conclusion: Patients undergoing isolated OCA transplantation demonstrated significant clinical improvements and a graft survival of 88.2% at 5.2 years. Failures overall were associated with a larger DSCR, and failures among patients ≥40 years old with a larger DSCR and larger defect size. Increasing defect size among males was positively correlated with some improved outcomes, although this was not maintained in analysis of the DSCR, suggesting similar prognosis after OCA regardless of sex. Clinical Relevance: Failed osteochondral allografts are associated with larger defect sizes and defect:condyle ratios in this study, providing additional information to surgeons for appropriate patient consultation. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine the views of nurses and physicians working in intensive care units (ICU) about the aims of glycaemic control and use of their protocols. Background: Evidence about the optimal aims and methods for glycaemic control in ICU is controversial, and current local protocols guiding practice differ between ICUs, both nationally and internationally. The views of professionals on glycaemic control can influence their practice. Design: Cross‐sectional, multicentre, survey‐based study. Methods: An online short survey was sent to all physicians and nurses of seven ICUs, including questions on effective glycaemic control, treatment of hypoglycaemia and deviations from protocols' instructions. STROBE reporting guidelines were followed. Results: Over half of the 40 respondents opined that a patient spending <75% admission time within the target glycaemic levels constituted poor glycaemic control. Professionals with more than 5 years of experience were more likely to rate a patient spending 50%–74% admission time within target glycaemic levels as poor than less experienced colleagues. Physicians were more likely to rate a patient spending <50% admission time within target as poor than nurses. There was general agreement on how professionals would rate most deviations from their protocols. Nurses were more likely to rate insulin infusions restarted late and incorrect dosage of rescue glucose as major deviations than physicians. Most professionals agreed on when they would treat hypoglycaemia. Conclusions: When surveyed on various aspects of glycaemic control, ICU nurses and physicians often agreed, although there were certain areas of disagreement, in which their profession and level of experience seemed to play a role. Relevance to clinical practice: Differing views on glycaemic control amongst professionals may affect their practice and, thus, could lead to health inequalities. Clinical leads and the multidisciplinary ICU team should assess and, if necessary, address these differing opinions. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of augmented reality (AR) activities on students' academic achievement and motivation in a biology course. For this purpose, a mixed study was conducted, and a pretest and posttest control group model was used. In addition, the opinions of the experimental group students and the teacher about the AR activities were taken, and classroom observations were made during the study. The study group consisted of 40 (22 female and 18 male) ninth‐grade biology course students. The control group followed the biology course programme, whereas the experimental group students conducted AR activities in addition to the course programme using tablets. Consequently, it was found that the motivation of the students in the experimental group increased more than that of the students in the control group. However, no significant difference was found between the academic achievement scores of the groups. The teacher and the students stated that AR activities might be effective in increasing course success and motivation. Lay Description: What is already known about this topic: Biology is one of the fields that cover too many abstract and invisible contents.Abstract and invisible course contents cause misunderstandings and low academic achievement.Augmented reality (AR) technology stands out with its visualization feature.AR appears to be an effective technology for making invisible subjects visible and giving concrete examples for abstract content in biology education.What this paper adds: AR activities could positively affect students' motivation in biology courses.Students' perceptions of the augmented reality into classroom are highly positive.AR activities raise students' participation to the course.However, AR does not significantly affect students' academic achievement.Implications for practice and/or policy: More long‐term and interaction‐based AR activities in a school with proper infrastructure might influence students' academic achievement positively.AR materials that have better image quality, more interesting design for students, and more interactivity will increase the effectiveness of instruction.It could be beneficial to use more AR technology when preparing curricula and textbooks. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper was to determine the attachment strategies of prospective adoptive parents and any correlation between attachment and the defensive strategies they used when talking about loss of fertility. The study also examined whether attachment strategy of the applicants had a bearing on the decision by the local authority to place a child. Design/methodology/approach: The sample was comprised of 48 respondents (21 couples) representing 84 per cent of all people who applied to one UK Social Services Department in a 12-month period. Placement of a child was reviewed two years following the assessment. The study used the dynamic maturational model version of the adult attachment interview (DMM-AAI), together with added questions on loss of fertility to assess the applicants' attachment strategies together with unresolved loss and trauma and the DMM modifiers. Findings: Unlike adoption studies using the Main and Goldwyn system, this study rated very few of the applicants' AAIs as secure (13 per cent), 48 per cent were in the normative low-risk range and 52 per cent of the AAIs were coded in the more complex DMM insecure strategies. There was a significant bias towards marriages where the partners deployed opposite low-risk/DMM strategies (13 (62 per cent) of couples). Compared with data on non-clinical populations the AAIs showed a high level of unresolved loss or trauma (58 per cent). Using a six-way distribution (A1-2, C1-2, B, A3-4, C3-6 and A/C) there was an 87 per cent correspondence between discourse about loss of fertility and that about attachment, thereby supporting the established proposition that reproduction is part of the attachment system. Twenty one per cent of the AAIs were coded as "disorientated" and this is discussed in terms of conflict for adoptive of parents concerning the raising of a child who carries their own genes or those of strangers. A case is made to conceptualise negative impact of infertility in terms of unresolved trauma rather than loss. Research - limitations/implications: This study adds to research showing that the DMM approach is more finely calibrated than the ABC+disorganised model with the latter likely over coding for security. The results emphasise that fertility and reproduction are legitimate subjects for attachment studies and that AAI discourse analysis is a valid methodology for future research. However coder agreement as to whether or not loss of fertility was resolved was only fair (64 per cent) κ. 0.25 (po0.33). More work is required in order to determine what constitutes unresolved loss of fertility and what impact, if any, this has on parenting an adopted child. Practical implications: The practice implications are considered in a separate paper. Social implications: The findings are contentious in that they suggest a significant number (48 per cent) of adoptive parents have needs not dissimilar to other clients of psychological services. Originality/value: This is the first DMM-AAI study with prospective adoptive parents and the findings show significant differences when compared with previous studies using the Main and Goldwyn AAI. It is also the first study to establish fertility as a legitimate area for attachment studies by using AAI discourse analysis. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to evaluate Turkish nurses' attitudes, awareness and practices regarding reproductive health needs of individuals with schizophrenia. Method: The sample of this descriptive study consisted of 96 psychiatric nurses and 90 nurses and midwives working in family health centers who agreed to participate. The data were presented as numbers and percentages, and chi-square analyses were used to compare the groups. Findings: Although the majority of nurses stated that family planning education should be given to individuals with schizophrenia, to both genders and to both single and married patients, the proportion of those who give family planning education is only 23.5%. Of the nurses, 58.8% recommend tubal ligation as a method of family planning for individuals with schizophrenia, 39.6% of nurses think that involuntary abortion or sterilization for individuals with schizophrenia is necessary even if they do not support it culturally, and 20.3% of nurses provide sexual health counseling to individuals with schizophrenia. It appears that nurses, as members of society, do not approve of marriage or parenting by individuals with schizophrenia. Result: This study found that both nurses working in primary care and psychiatric clinics had negative attitudes towards the reproductive health of individuals with schizophrenia. [ABSTRACT FROM AUTHOR]

Introduction: The understanding of the temporal pattern of individuals can add a wider perspective to interventions. Therefore, the present study is aimed toward analysis of the temporal activity pattern of individuals with stroke compared to healthy adults. Method: This study is a prospective, case–control, analytic research study. The study sample comprised 50 individuals with stroke and 50 individuals without disease, for 80% power with a 5% type 1 error. The Modified Occupational Questionnaire was administered to assess the temporal activity pattern. Individuals identified the activities performed at each hour of the day and data was analyzed. Results: The temporal activity pattern of individuals with stroke differed from healthy controls; education and play activities were not part of stroke participants' daily routines. Also, participation in work, leisure and social participation activities was significantly different for people with stroke compared to healthy controls (p < 0.01). The study group assigned very low values to the activities; the value perceived by individuals differed significantly between groups (p < 0.01). Conclusion: Clinicians are in a position to enable individuals' time use and help to engage them in meaningful activity. Individuals with stroke may benefit from a program focusing on the temporal aspect of activities. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the relationship between maximal placental thickness during routine anatomy scan and birthweight at delivery. Methods: This retrospective descriptive study analyzed 200 term, singleton deliveries in 2016 at Penn State Hershey Medical Center. We measured maximal placental thickness in the sagittal plane from the ultrasound images of the placenta obtained at the 18–21-week fetal anatomy screen. The relationship between placental thickness and neonatal birthweight was assessed using Pearson's correlation coefficient (r) with 95% confidence interval (CI). Logistic regression was used to assess the association between placental thickness and secondary binary outcomes of neonatal intensive care unit (NICU) admission and poor Apgar scores. Two-sample t-tests, or exact Wilcoxon rank-sum test for non-normally distributed data, were used to assess for differences attributable to medical comorbidities (pre-gestational diabetes, gestational diabetes, chronic hypertension, gestational hypertension, preeclampsia and eclampsia). Results: Placental thickness had a positive correlation with neonatal birthweight [r=0.18, 95% CI=(0.05, 0.32)]. The mean placental thickness measured 34.2±9.7 mm. The strength of the correlation remained similar when adjusting for gestational age (r=0.20) or excluding medical comorbidities (r=0.19). There was no association between placental thickness and NICU admission, Apgar scores <7 or medical comorbidities. Conclusion: Our study demonstrated a positive correlation between sonographic placental thickness and birthweight. Future prospective studies are warranted in order to further investigate whether a clinically significant correlation exists while adjusting for more covariates. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to examine alcohol use behaviors among a national sample of occupational therapy students. Survey instruments, including the AUDIT and a checklist of risky and unprofessional behaviors related to alcohol abuse, were mailed to 1,000 occupational therapy students randomly selected from membership in the American Occupational Therapy Association. Surveys were returned by 309 student members; however, 24 indicated they were not currently occupational therapy students. Of the 285 participants, 97% reported drinking alcohol at some point over the previous year, with 1 in 5 drinking two or more times a week, often consuming four or more drinks per occasion. Predominant risky and unprofessional behaviors included binge drinking, saying something very inappropriate, combining alcohol and energy drinks, and attending class with a hangover. In general, these students tended to drink alcohol in a socially responsible and acceptable manner. Nevertheless, based on AUDIT guidelines, almost two-thirds of the students did consume alcohol on some singular or more frequent occurrence in the previous year at harmful or hazardous levels. As a consequence, the need to address the topic of alcohol abuse at both the university and the professional levels is warranted, along with the provision of counseling and occupationbased treatment services for those experiencing physiological and psychological problems stemming from alcohol abuse and/or addiction. [ABSTRACT FROM AUTHOR]

Learning problems (LP) can have wider implications than the academic deficits per se. The goal of the present series of studies was to develop a reliable and valid quality-of-life measure targeted to children and adolescents with LP. In Study 1, using a 35-item questionnaire, we surveyed 151 parents/guardians of children referred for assessment of learning disorders. Exploratory factor analysis identified a three-factor model: Academic Performance, School Understanding, and Child/Family Psychological. These factors were validated against standardized measures of academic achievement and psychosocial functioning. The questionnaire was then reduced to 15 items—the LD/QOL15 —and administered to a community sample of 325 parents/guardians of children in Grades 1 to 8 (Study 2). The three-factor model was verified with confirmatory factor analysis. Comparison of general education (n = 232) and LP (n = 93) groups within the community sample documented substantial group differences (p < .0001), with the LP group having higher mean scores. These differences were larger for older students (Grades 5–8) than younger students (Grades 1–4; p < .01). The LD/QOL15 is a brief and reliable measure that is valid to assess quality of life and, potentially, outcomes in children and adolescents with LP. [ABSTRACT FROM AUTHOR]

Aims: This study examines how career barriers and supports (i.e., perceived discrimination, lack of advancement, human capital, and social capital) impact affective, normative, and continuance aspects of professional commitment and thus nurses' professional turnover intention. Background: Professional commitment is known to influence professional turnover intention. However, little is known about how career barriers and supports contribute to professional commitment and reduce professional turnover intention. Methods: This study adopted a cross‐sectional design and a survey to collect representative data in a major hospital in northern Taiwan. We used proportionate random sampling to ensure sample representativeness and obtained 524 responses. Results: Perceived discrimination and lack of advancement were negatively related to affective professional commitment. Human capital was positively related to affective, normative, and continuance professional commitment. Social capital was positively related to normative professional commitment. All aspects of professional commitment were negatively related to professional turnover intention. Conclusion: Career barriers and supports have an important influence on professional commitment. Reduced barriers and enhanced support may therefore help reduce nurses' professional turnover intentions. Implications for Nursing Management.: Nursing managers could aim to lessen career barriers while increasing career support for nurses, helping strengthen nurses' professional commitment and retention. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyse the association between social determinants and the presence of essential hypertension in type 2 diabetes mellitus patients in one rural county (Jintan) of China. A health survey of Jintan residents was conducted in 2013, applying a cluster sampling method. Three hundred and fifty-seven type 2 diabetes mellitus patients were selected as research subjects. Among the patients selected, essential hypertension prevalence was 45.4% (n = 162). After univariate analyses and logistic regression analyses, an association was observed between the presence of essential hypertension in type 2 diabetes mellitus patients and marital status, described as 'others (unmarried, divorce, widower, etc.)', and participating in active physical activity. Both of these two significant variables were positively associated with the higher prevalence of essential hypertension in type 2 diabetes mellitus patients. In conclusion, the patients suffering from type 2 diabetes mellitus combined with essential hypertension often reported an association with more negative social determinants (with the exception of participation in physical activity). Further strengthening the comprehensive multi-disease management to control and reduce the prevalence of essential hypertension in type 2 diabetes mellitus patients is required. [ABSTRACT FROM AUTHOR]

Background: Anterior shoulder instability is a debilitating condition that can require stabilization via a Latarjet procedure. Purpose: The aim of this study was to characterize the histological composition of the articular-sided surface of the coracoid bone graft after Latarjet procedure. Specific features of cells isolated from the coracoid and graft tissues were assessed. Study Design: Case series; Level of evidence, 4. Methods: Tissue samples were harvested from 9 consecutive patients undergoing arthroscopic debridement and screw removal after arthroscopic or open Latarjet procedure. Tissues were processed histologically. In 2 patients, the samples were analyzed to assess specific cellular properties. Results: Safranin O staining indicated that glenoid tissues contained variable amounts of glycosaminoglycan (GAG) and round chondrocytic cells mainly organized in clusters. Graft tissues contained less GAG and were more cellular but were not organized in clusters and had variable morphological features. An association appeared to exist between the cartilage quality of glenoid tissues and that of the graft tissues. Cells isolated from glenoid and graft tissues exhibited similar proliferation capacity. Conclusion: The results of our analysis show that cells located at the articular-sided surface of transferred coracoid grafts demonstrate fibrocartilaginous properties and may have the capacity for chondral proliferation. Further studies are needed to confirm this observation and future application. [ABSTRACT FROM AUTHOR]

This study examined the high incidence and high mortality rates of prostate cancer in Haiti by exploring the constructs of the Health Belief Model as a predictor to Haitian men's intention to screen for prostate cancer. Perceived benefits emerged as a predictor. [ABSTRACT FROM AUTHOR]

Burnout in nursing staff is a major cause for turnover and absenteeism. Identifying risk and protective factors may be helpful in decreasing burnout symptoms. Moreover, research indicates that ambulatory assessments of the autonomic nervous system might be helpful in detecting long‐term stress and burnout symptoms. One hundred and ten forensic nursing staff members completed questionnaires measuring experiences with aggressive behaviour, emotional intelligence, personality, and job stress during four waves of data collection across a 2‐year period. Multilevel analyses were used to test the predicted associations and moderation effects with (the development of) burnout symptoms. Burnout was predicted by a combination of emotional intelligence, job stress, aggression, personality factors, and skin conductance, but no moderation effects over time were found. Over a period of 2 years, the model approximately predicts a change in one burnout category on the Maslach Burnout Inventory. The amount of burnout symptoms in nurses might be used as an indicator to predict turnover and absenteeism considering the increase in symptoms over time. Nursing staff who experience severe aggression and who have relatively low levels of emotional intelligence and altruism and high levels of neuroticism and job stress should be monitored and supported to decrease the risk of burnout. Staff members can be trained to increase their emotional intelligence and relieve stress to decrease their burnout symptoms and turnover and absenteeism on the long term. Ambulatory assessment might be helpful as a nonintrusive way to detect increasing levels of burnout. [ABSTRACT FROM AUTHOR]

Previous work showing that revised parallel analysis can be effective with dichotomous items has used a two-parameter model and normally distributed abilities. In this study, both two- and three-parameter models were used with normally distributed and skewed ability distributions. Relatively minor skew and kurtosis in the underlying ability distribution had almost no effect on Type I error for unidimensional data and reduced power for two-dimensional data slightly with smaller sample sizes of 400. Using a two-parameter model on three-parameter data produced dramatically increased rejection rates for the unidimensional data. Using the correct three-parameter model reduced the unidimensional rejection rates but yielded lower power than the two-parameter data in some conditions. [ABSTRACT FROM AUTHOR]

Background: Recent clinical studies identified sagittal plane posterior tibial slope as a risk factor for increased postoperative laxity after single-bundle posterior cruciate ligament reconstruction (PCLR). Purpose/Hypothesis: To retrospectively compare the degree of posterior tibial slope and its effect on posterior tibial translation (PTT) after double-bundle (DB) PCLR. Our null hypothesis was that preoperative tibial slope would not be associated with graft laxity. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent DB PCLR between 2010 and 2017 by a single surgeon were retrospectively analyzed. Measurements of posterior tibial slope were performed on lateral radiographs, and PTT was measured with pre- and postoperative kneeling stress radiographs. Simple and multiple linear regression was performed to estimate the unadjusted and adjusted effect of tibial slope on postoperative graft laxity, respectively. Results: A total of 103 patients with posterior cruciate ligament tears and subsequent reconstructions were included. There was a significant reduction of the mean ± SD side-to-side difference in PTT between stress radiographs (preoperative, 10.6 ± 2.7 mm; postoperative, 1.5 ± 2.6 mm; mean difference, 9.1 mm; 95% CI, 8.4-9.8; P < .001). Linear regression analysis revealed no significant correlation between preoperative posterior tibial slope and the amount of side-to-side difference in PTT on postoperative stress radiographs obtained at a mean 18.5 months (R = −0.115, P = .249). Combined ligament injury (beta = −1.01; 95% CI, −2.00 to −0.01; P = .047) was a significant independent predictor of decreased postoperative side-to-side difference in PTT. Conclusion: Graft laxity, determined by PTT in posterior kneeling stress radiographs, was not influenced by decreased posterior tibial slope after DB PCLRs. The observed results in the current study support the use of DB PCLR. Future studies should be conducted to compare the effect of tibial slope after SB PCLR and DB PCLR at long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Recent efforts have focused on eliminating dangerous hits in ice hockey. Fair play rule changes have successfully reduced injury risk but have not been widely implemented. Purpose: To determine the effect of a penalty infraction minutes (PIM) rule change in high school boys' ice hockey on injuries and game disqualification penalties. Study Design: Cohort study; Level of evidence, 3. Methods: Injury data were collected from 2 Rhode Island hospital systems and game/penalty data through the Rhode Island Hockey Coaches Association website. Participants included high school boys' hockey varsity players aged 13 to 19 years presenting to 5 emergency departments for hockey injuries during 6 seasons (December 2012–April 2018). Rule change for the 2015-2016 season implemented varying suspensions for players accumulating ≥50 PIM and ≥70 PIM during regular season and playoffs. Injuries were classified as body checking or non–body checking related, and injury rates pre– versus post–rule change were compared via the Cochran-Mantel-Haenszel chi-square test with the odds ratio (OR) to measure risk reduction. Results: During the study period, 1762 boys' high school varsity hockey games were played. Of 134 game-related injuries, 82 (61.2%) were attributable to body checking. The PIM rule change was associated with a significant reduction in all injuries (OR, 0.55; 95% CI, 0.35-0.86; P = .008), concussion/closed head injury (OR, 0.44; 95% CI, 0.23-0.85; P = .012), and combined subgroups of concussion/closed head injury and upper body injury (OR, 0.50; 95% CI, 0.31-0.80; P = .003). Game disqualification penalties per season were not significantly reduced following the rule change, occurring in 5.2% of games before the rule change and 4.4% of games after (OR, 0.84; 95% CI, 0.54-1.31; P = .440). Conclusion: Implementation of a statewide PIM restriction rule change effectively reduced the mean number of game-related injuries per season among high school boys' hockey varsity players. [ABSTRACT FROM AUTHOR]

Background: Femoral nerve block (FNB) is a commonly performed technique that has been proven to provide effective regional analgesia after anterior cruciate ligament (ACL) reconstruction. The adductor canal block (ACB) uses a similar sensory block around the knee while avoiding motor blockade of the quadriceps muscles. Purpose/Hypothesis: The purpose of our study was to compare the efficacy of FNB versus ACB for pain control after ACL reconstruction. It was hypothesized that there would be no difference in pain levels or opioid requirements between the 2 groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: We performed a prospective, double-blinded, randomized controlled trial. Sixty patients undergoing primary ACL reconstruction with bone-patellar tendon-bone autograft were randomized to receive either an ACB or an FNB preoperatively. The primary outcomes assessed were pain levels (visual analog scale) and narcotic requirements for 4 days after surgery. Secondary outcomes included ability to perform a straight leg raise in the recovery room and difference in thigh circumference between the operative and nonoperative leg measured at 7 days postoperatively. Results: Morphine requirements were less in the ACB group in the first 4 hours postoperatively (P = .02). Aside from this time interval, no differences were found between the 2 groups with regard to opioid requirements and pain scores at any other time. Similarly, no differences were noted in patients' ability to perform a straight leg raise in the recovery room (P = .13) or in thigh circumference at the first postoperative visit (P = .09). Conclusion: The results of our study suggest similar efficacy in perioperative pain control with the use of an ACB for ACL reconstruction when compared with FNB. The potential long-term benefit of quadriceps preservation with the ACB is worthy of future study. Registration: NCT03033589 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Substance abuse has long been identified as a risk factor for elder mistreatment, yet research on the topic remains sparse. This study tested hypotheses whether perpetrator and victim substance use problems were associated with financial exploitation, physical abuse, emotional abuse, and neglect versus no abuse. Cross-sectional data were collected on 948 cases with yes/no substantiation decisions where 357 cases had no abuse in elder mistreatment investigations. Hypotheses were tested using odds ratios, bivariate, and multiple linear regression analyses including a control for victim vulnerability. Of 948 alleged victims, 42 (4.4%) exhibited signs of substance use problems. Among the 323 alleged perpetrators, 87 (26.9%) were reported to have substance use problems. Substance use problems by alleged perpetrators were associated (p < .01) with financial exploitation, physical abuse, and emotional abuse but not neglect. Substance use problems by alleged victims were associated with neglect, but not the other types. Alleged perpetrators with substance use problems tended to commit multiple forms of abuse, were male and not caregivers. Except for the findings on neglect, the associations with elder mistreatment were stronger for alleged perpetrators with substance use problems, than for alleged victims. Clarification of the role of perpetrator risk factors such as substance abuse should improve risk identification and subsequent intervention. [ABSTRACT FROM AUTHOR]

Pain control is an important concern in limb trauma. The most ideal agent for this purpose varies among different hospitals. The objective of this study was to compare the analgesic effect of oral diclofenac potassium versus intravenous acetaminophen in patients with limb trauma. This was a double-blind randomized clinical trial conducted on 60 adult patients. Oral diclofenac potassium (50 mg) was given in Group D, and intravenous acetaminophen (1 g in 500 ml normal saline over 20 min) was administered in Group A. Patients' pain scores (visual analogue scale) were recorded and compared at baseline, 5, 15, 30, 60 min, and 4 hr after drug administration. The mean age was 42.62 ± 15.42 and 38.04 ± 17.48 years in Group A and Group D, respectively. No significant change was observed between the 2 groups ( p= 0.11). In this study, both drugs could decrease the pain score effectively and safely in isolated limb trauma. [ABSTRACT FROM AUTHOR]

Background: developing coping strategies to use in stressful situations is an essential nursing skill. Prolonged and constant stress is harmful to nurses' health and leads to organisational inefficiency, high staff turnover and decreased job satisfaction. Aim: to identify nurses' stress coping strategies and determine the relationship between coping strategies and sociodemographic factors. Method: a descriptive cross-sectional study using a self-administered questionnaire was undertaken at an emergency department and critical care units at the largest referral hospital in Brunei. Results: problem-solving and positive reappraisal were the predominant positive coping strategies identified. Those working in medical intensive care employed escape-avoidance behaviours more frequently. Married participants exhibited higher levels of confrontative coping behaviours. Conclusion: to the authors' knowledge, this is the first study to examine job-stress coping strategies among nurses in Brunei. The authors examined the different strategies and the poor health outcomes associated with using negative coping styles. Future stress management interventions should target staff who employ negative coping strategies to promote positive strategies, enabling them to provide better quality care. [ABSTRACT FROM AUTHOR]

Objective: This pre-planned secondary analysis of geriatric interdisciplinary home rehabilitation, which was initially found to shorten the postoperative length of stay in hospital for older individuals following hip fracture, investigated whether such rehabilitation reduced the numbers of complications, readmissions, and total days spent in hospital after discharge during a 12-month follow-up period compared with conventional geriatric care and rehabilitation. Design: Randomized controlled trial. Setting: Geriatric department, participants' residential care facilities, and ordinary housing. Subjects: Individuals aged ⩾70 years with acute hip fracture (n = 205) were included. Intervention: Geriatric interdisciplinary home rehabilitation was individually designed and aimed at early discharge with the intention to prevent, detect, and treat complications after discharge. Main measures: Complications, readmissions, and days spent in hospital were registered from patients' digital records and interviews conducted during hospitalization and at 3- and 12-month follow-up visits. Results: No significant difference in outcomes was observed. Between discharge and the 12-month follow-up, among participants in the geriatric interdisciplinary home rehabilitation group (n = 106) and control group (n = 93), 57 (53.8%) and 44 (47.3%) had complications (P = 0.443), 46 (43.4%) and 38 (40.9%) fell (P = 0.828), and 38 (35.8%) and 27 (29.0%) were readmitted to hospital (P = 0.383); the median total days spent in hospital were 11.5 and 11.0 (P = 0.353), respectively. Conclusion: Geriatric interdisciplinary home rehabilitation for older individuals following hip fracture resulted in similar proportions of complications, readmissions, and total days spent in hospital after discharge compared with conventional geriatric care and rehabilitation. [ABSTRACT FROM AUTHOR]

We assessed overall job satisfaction and factors of job satisfaction among physician assistants (PAs) practicing cardiovascular medicine in the United States. Job satisfaction among health care providers is associated with provider satisfaction and retention, reduced health care costs, increased patient satisfaction, and improved health care. Research regarding job satisfaction among physicians and nurse practitioners has been conducted, but knowledge of job satisfaction among PAs is limited, dated, and inadequate. Job satisfaction among PAs in cardiology, a specialty with a disparity between provider supply and demand, has not been investigated. A quantitative, correlational, descriptive study was conducted using participants from the Association of Physician Assistants in Cardiology database. Overall job satisfaction, 45 factors of job satisfaction, and 6 composite factors were calculated. Correlational analysis was performed for factors most associated with overall job satisfaction. Overall job satisfaction was high. Most PAs (87.3%) were satisfied or very satisfied. Physician assistants were most satisfied with job factors related to challenge and autonomy, and these factors had the greatest correlation to overall job satisfaction. Findings can guide employers, health care administrators, and policy makers to promote job satisfaction among PAs in cardiology and provide insights into job satisfaction among PAs in general. [ABSTRACT FROM AUTHOR]

Background While research has established the negative impact of medical errors or adverse events on healthcare providers, few organizations have evaluated support programs for second victims. Thus, we examined satisfaction with a peer support program to provide lessons learned from early implementation. Methods Participants (N = 466) were recruited from seven neonatal intensive care units affiliated with a large, pediatric hospital. Following implementation of a peer support program, a mixed-method online survey assessed program satisfaction at 12 month follow-up (n = 250, 54%). Results Most participants were female (n = 243, 97%), white (n = 239, 96%), and nurses (n = 180, 72%), with an average age of 40.80 (SD = 11.89) years. Ninety-three (37%) participants observed or were directly involved in an error or adverse event during the preceding six months. Thirty-six (14%) received support from someone within the neonatal intensive care unit, and 16 (16%) had spoken with a peer supporter after the event. All users reported benefit from the interaction. However, most participants were unaware of the program or had not utilized it. Conclusion Findings suggested that peer support programs are likely to be viewed favorably by second victims. Healthcare providers who accessed the program felt it was a valuable resource and helped them return to work effectively after an error or adverse event. Better communication is needed during early implementation of any peer support program to increase awareness and use of this resource among healthcare providers. [ABSTRACT FROM AUTHOR]

Background: Diabetic peripheral neuropathy (DPN) not only produces severe pain, tingling, and numbness sensation in the involved limbs, but also limits physical function due to loss of sensation. There are no recommended methods for clinical situations to measure these signs and symptoms. Studies with high methodological quality use the modified Brief Pain Inventory for Diabetic Peripheral Neuropathic pain (mBPI-DPN) scale and the short form Screening of Activity Limitations and Safety Awareness (sSALSA) scale for measuring these symptoms in DPN population. In order to capture a real change in the variables of interest, the psychometric properties of that measure should be within acceptable limits. As these two measures were not assessed for all of the psychometric properties, there was a need for further evaluation. Methods: Data were collected (n = 38 patients) in a longitudinal cohort study. Test-retest reliability (0-4 weeks) and Responsiveness- Minimal Clinically Important Difference (MCID) (0-12 weeks) were calculated between two sessions. Convergent validity was assessed (between mBPI-DPN pain interference and sSALSA scale). Results: Both measures demonstrated acceptable test-retest reliability (mBPI-DPN scale: ICC = 0.61, SEM = 12.92; the sSALSA scale: ICC = 0.81, SEM = 4.88) and convergent validity (Spearman's correlation coefficient r = 0.62). The computational methods used in different methodologies to calculate MCID for the mBPI-DPN and the sSALSA scale were varied, hence the magnitude of derived MCID scores also varied. Conclusions: Our study have provided evidence to add to the scientific basis surrounding the use of mBPI-DPN and sSALSA scales in DPN population, but standardization of these measures in a larger population is required [ABSTRACT FROM AUTHOR]

Abstract Background Caregivers of breast cancer survivors experience various types of burden, which in turn is linked to patients' physical and psychological status. Family resilience might be able to decrease caregiver burden and facilitate survivors' individual resilience, and individual resilience might be related to caregiver burden. Nevertheless, these relationships have not yet been confirmed. Objective To determine the relationships between family resilience, breast cancer survivors' resilience, and principal caregivers' caregiver burden, as well as determine whether breast cancer survivors' individual resilience plays a mediating role in the relationship between family resilience and caregiver burden. Design Cross-sectional study design. Setting The comprehensive cancer center of a public hospital in Shandong Province, China. Participants The sample comprised 108 dyads of early-stage breast cancer survivors and their principal caregivers. Methods The principal caregivers completed the Shortened Chinese Version of the Family Resilience Assessment Scale and the Chinese Version of the Zarit Caregiver Burden Interview, while the breast cancer survivors completed the 10-item Chinese version of the Connor-Davidson Resilience Scale and provided their sociodemographic information. The mediating effect of individual resilience was estimated using the bootstrap method via IBM SPSS Amos 21.0. Results Caregiver burden was significantly negatively associated with both family resilience and breast cancer survivors' individual resilience (both p <.01). Furthermore, individual resilience mediated the relationship between family resilience and caregiver burden (b = −0.052; 95% confidence interval: −.412, −.036). Conclusions The findings suggest that both family resilience and breast cancer survivors' individual resilience may ease caregiver burden among the principal caregivers of breast cancer survivors, and family resilience tends to promote the survivors' individual resilience. Therefore, family resilience and survivors' individual resilience should be enhanced for breast cancer survivors and their family to ease the principal caregivers' caregiver burden. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to form a better understanding of job satisfaction and retention of clinical teachers in the dedicated education unit (DEU) and in non-DEU clinical education models. Method: This follow-up study uses the tested Nurse Faculty Query survey to investigate job satisfaction and retention of the University of Portland area DEUs and non-DEU clinical teachers. Surveys were administered in person at local clinical sites. Results: Findings indicate overall high job satisfaction among DEU and non-DEU clinical teachers. Conclusion: Although not statistically significant, data trends indicated a need for improved communication between didactic faculty and clinical sites, as well as increased recognition and reward for clinical teachers in the DEU and non-DEU clinical sites. [ABSTRACT FROM AUTHOR]

Background Ongoing development and expansion of trauma centers in the United States necessitates empirical analysis of the effect of investment in such resources on population-level health outcomes. Methods Multiple linear regressions were performed to predict state-level trauma-related mortality among adults and the elderly across 50 US states in 2010. The number of trauma centers per capita in each state and the percentage of each state's population living within 45-min of a trauma center served as the key independent variables and injury-related mortality served as the dependent variable. All analyses were stratified by age (adult versus elderly; elderly ≥ 65 years old) and were performed in SPSS. Results The proportion of a population with geographic proximity to a trauma center demonstrates a consistent inverse linear relationship to injury-related mortality. The relationship reliably retains its significance in models including demographic covariates. Interestingly, access to Levels I and II trauma centers demonstrates a stronger correlation with mortality than was observed with Level III centers. Conclusion Trauma center access is associated with reduced trauma-related mortality among both adults and the elderly as measured by state reported mortality rates. Ongoing efforts to designate and verify new trauma centers, particularly in poorly-served 'trauma deserts', could lead to lower mortality for large populations. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify factors affecting cognitive function in stomach cancer patients. Methods: This was a cross-sectional study designed to obtain data from stomach cancer patients. The Global Assessment of Recent Stress, Hospital Anxiety-Depression Scale, Distress Thermometer, Korean version of the Montreal Cognitive Assessment, and electronic medical records were used to assess stress, anxiety, depression, psychological distress, and cognitive function, respectively. Results: Among 182 total participants, there were statistically significant differences in sex between the group of patients who received chemotherapy and those who did not (χ²=5.32, p=.029). There were statistically significant differences in stress and cognitive function between the two groups. The factors affecting cognitive function in stomach cancer patients included distress, stress, anxiety, and depression. Conclusion: Cognitive function should be examined with consideration of the psychological distress, stress, anxiety, and depression in patients with stomach cancer. Moreover, an improved program to manage cognitive function is needed, which includes mediation between psychological and physiological factors including stress, anxiety, and cognitive level. [ABSTRACT FROM AUTHOR]

Background and Objective: The health behaviors of hypertensive stroke patients in China are not satisfactory. In this study, we tested the effect of a Health Belief Model Comprehensive Reminder System on health behaviors and blood pressure control in hypertensive ischemic stroke patients after occurrence and hospital discharge. Methods: A randomized, parallel-group, assessor-blinded experimental design yielded participation of 174 hospitalized hypertensive ischemic stroke patients. The intervention consisted of face-to-face and telephone health belief education, a patient calendar handbook, and weekly automated short-message services. Data were collected at baseline and 3 months after discharge. Results: Three months after discharge, the intervention group showed statistically, significantly better health behaviors for physical activity, nutrition, low-salt diet, and medication adherence. The intervention group also had statistically, significantly decreased systolic blood pressure and increased blood pressure control rate. Smoking and alcohol use behaviors were not affected. Conclusion: At 3 months, use of the Comprehensive Reminder System based on the Health Belief Model, yielded improvement in most health behaviors and blood pressure control in hypertensive ischemic stroke patients. Continued implementation of this intervention protocol is warranted to determine the long-term effect. Smoking and alcohol use behaviors need to be targeted with a different intervention. [ABSTRACT FROM AUTHOR]

Emotional intelligence (EI) includes skills such as recognizing, understanding, and managing emotions. This pilot study investigated the utility of the Mayer-Salovey-Caruso Emotional Intelligence Test Version 2.0 as a screening instrument in student registered nurse anesthetists by determining if EI predicted clinical performance. Scores from 11 participants enrolled in a single nurse anesthesia program were correlated with formative clinical evaluations. Relationships between EI and clinical performance were examined. Participants consistently met clinical performance objectives but were unable to use emotion to solve problems or to recognize others' emotions, suggesting that EI abilities could impact future student registered nurse anesthetist clinical performance. [ABSTRACT FROM AUTHOR]

Background: Elderly patients are underrepresented in the studies concerning anticoagulation therapy (AT) in atrial fibrillation (AF), while patients’ frailty status is lacking in most of the studies.Objective: Our objective was to evaluate AT in AF elderly patients and study the effect of patients’ frailty status on their long-term AT.Methods: We conducted an observational prospective study that enrolled consecutive AF patients (≥ 75 years) who were hospitalized in the Department of Internal Medicine of the University Hospital of Heraklion, Crete, Greece from 1 June 2015 to 1 June 2016. We recorded the AT on admission and at discharge, all-cause mortality, and hospital readmission in a follow-up period of 1 year after hospital discharge. Frailty status was assessed by pre-established scores.Results: One hundred and four consecutive patients (49% male; median age 87 years) were enrolled, 78 (78.8%) of whom received AT at discharge. Patients who did not receive AT at discharge had a higher HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older age, Reduced platelet count or function, Re-bleeding, Hypertension, Anemia, Genetic factors, Excessive fall risk and Stroke) score (5.5 ± 1.15 vs. 4.79 ± 1.68; p = 0.032), a lower Katz score (2.48 ± 2.23 vs. 4.08 ± 2.25; p = 0.006), and a higher Clinical Frailty Scale score (7 ± 1.95 vs. 5.57 ± 2.05; p = 0.006). Sixty-five patients (62.5%) were readmitted to a hospital during the follow-up period. In-hospital death occurred in five patients (4.8%) and 57 patients (57.6%) died within the follow-up period.Conclusion: A high percentage of the elderly AF patients did not receive AT, even at discharge. Patients who did not receive AT at discharge had higher bleeding and frailty scores. In the 1-year follow-up period after hospital discharge, high all-cause mortality and a high number of hospital readmissions were recorded. [ABSTRACT FROM AUTHOR]

Abstract: Aim: End‐stage renal disease (ESRD) not only threatens a patient's life expectancy but also burdens the family and society with medical expenses. The mortality and prevalence rates are extremely high in Taiwan. Thus, this articleinvestigated the effectiveness of an innovative self‐management program on the physiology, psychology, and management of patients with pre‐ESRD. Methods: This study was designed as a randomized, controlled trial and was set in the department of nephrology in a regional teaching hospital in Taiwan. In total, 112 patients with pre‐ESRD were assigned randomly to either an experimental (n = 67) or a control (n = 45) group. The baseline data collection included physiological indicators, psychological factors (depression, anxiety), and measures of self‐efficacy and self‐management. Routine hospital care was provided for the control group after the pretest and an innovative self‐management intervention was used in the experimental group for 4 weeks after the pretest. The effectiveness of the intervention was evaluated 3 months later. Results: Improvements in the physiological indicators, such as blood urea nitrogen and creatinine, and the psychological indicators, such as depression, self‐efficacy, and self‐management, reached statistical significance. Conclusion: The innovative self‐management program effectively decreased patients' functional indicators (blood urea nitrogen, creatinine) and level of depression and enhanced their self‐efficacy and self‐management. [ABSTRACT FROM AUTHOR]