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The article discusses the commentary on Debra Rothschild's paper related to Dissociative Identity Disorder (DID) treatment. The author states the focus of Rothschild's paper on the relation of the concept of integration and the recognition of self-existence. Some elements of treatment used by Rothschild in his therapy to Sarah, a survivor of extreme trauma, are emphasized by the author on his discussion. A detailed discussion of the author's commentary is also presented.

Abstract: This paper explores the nature of the nursing contribution to chronic disease management (CDM) and identifies a number of key nursing activities within CDM both at the individual patient and care system levels. The activities were identified following a detailed review of the literature (160 reports and studies of nursing practice) relating to three tracer disorders: diabetes, chronic obstructive pulmonary disease and multiple sclerosis. The paper examines these activities collectively to generate models expressing some of the core functions of nursing within CDM. The paper illustrates some of the changing characteristics of nursing roles within CDM. More fundamentally, the paper questions the position of nursing in relation to the technologies that define CDM systems and proposes four levels of contribution: the nurse as technology; the nurse as technologist; the nurse as system engineer; and the nurse as architect. These different levels reflect distinctions in the nature of the nursing gaze and power relations within the health care workforce. The paper also highlights how nurses are failing to develop the evidence for their practice in CDM. The paper concludes that there is a need for some clear principles to guide clinical practice and encourage innovation in CDM. It is argued that the principles should not be rule-bound but define a distinctive nursing gaze that will position the nursing profession within the health care system and in relation to other professions. The gaze should incorporate the needs of the individual patient and the care system that they inhabit. [Copyright &y& Elsevier]

Background: Electronic recording of vital sign observations (e-Obs) has become increasingly prevalent in hospital care. The evidence of clinical impact for these systems is mixed. Objective: The objective of our study was to assess the effect of e-Obs versus paper documentation (paper) on length of stay (time between trauma unit admission and "fit to discharge") for trauma patients. Methods: A single-center, randomized stepped-wedge study of e-Obs against paper was conducted in two 26-bed trauma wards at a medium-sized UK teaching hospital. Randomization of the phased intervention order to 12 study areas was computer generated. The primary outcome was length of stay. Results: A total of 1232 patient episodes were randomized (paper: 628, e-Obs: 604). There were 37 deaths in hospital: 21 in the paper arm and 16 in the e-Obs arm. For discharged patients, the median length of stay was 5.4 (range: 0.2-79.0) days on the paper arm and 5.6 (range: 0.1-236.7) days on the e-Obs arm. Competing risks regression analysis for time to discharge showed no difference between the treatment arms (subhazard ratio: 1.05; 95% CI 0.82-1.35; P=.68). A greater proportion of patient episodes contained an Early Warning Score (EWS) ≥3 using the e-Obs system than using paper (subhazard ratio: 1.63; 95% CI 1.28-2.09; P<.001). However, there was no difference in the time to the subsequent observation, "escalation time" (hazard ratio 1.05; 95% CI 0.80-1.38; P=.70). Conclusions: The phased introduction of an e-Obs documentation system was not associated with a change in length of stay. A greater proportion of patient episodes contained an EWS≥3 using the e-Obs system, but this was not associated with a change in "escalation time." Trial Registration: ISRCTN Registry ISRCTN91040762; http://www.isrctn.com/ISRCTN91040762 (Archived by WebCite at http://www.webcitation.org/72prakGTU) [ABSTRACT FROM AUTHOR]

Abstract: This paper is a discussion of the importance of choosing appropriate methodologies to research the breastfeeding experience of women in the United Kingdom. Despite a plethora of research emphasising the benefits of breastfeeding to maternal and infant health, there is a relative dearth of research from the United Kingdom about women''s experiences of breastfeeding. In order to understand the inherent complexities of successfully promoting and supporting breastfeeding, a mothers’ breastfeeding experience must be examined within her specific context. This is increasingly recognised as a vital tool in providing effective support by health care professionals in extending breastfeeding duration. As such, this highlights the importance that appropriate methodologies are chosen through which to explore this phenomenon from the perspective of those experiencing it. This paper debates the importance of philosophical lines of enquiry in relation to breastfeeding research, and argues that engaging with ontological perspectives would offer opportunities for researchers to engage with women''s understanding of breastfeeding in today''s society. A hermeneutic phenomenological approach that is informed from feminist methodologies is deemed the most appropriate in researching mothers’ views of breastfeeding. [Copyright &y& Elsevier]

The purpose of this paper is to describe the Caribbean HIV Evaluation Support demonstration program, a five-site HRSA-funded demonstration project that aimed to implement a peer support intervention to help HIV-positive Caribbeans living in the United States. This paper provides a framework of the demonstration including the rationale for the program, program requirements, and eligibility of participants. In addition, this paper describes each of the five programs including, Brookdale University Hospital and Medical Center, Brooklyn, NY; Lutheran Medical Center, Brooklyn, NY; Community Healthcare Network, New York, NY; University of Miami, Miami, FL; and Montefiore Medical Center, Bronx, NY. The background of each program description includes: setting, theoretical frameworks, peer training, client recruitment & staffing and content of the intervention. Finally, lessons learned including the utility and feasibility of the peer-support intervention program is identified at the closing. [ABSTRACT FROM AUTHOR]

Wilson's disease (WD), an autosomal recessive disorder of copper transport, is one of the most common inherited metabolic disorders in Korea. Despite its frequency, the incidence and carrier frequency of WD has not yet been estimated in the Korean population. We therefore screened for four major missense mutations (p.Arg778Leu, p.Ala874Val, p.Leu1083Phe, and p.Asn1270Ser) of the ATP7Bgene in 476 newborn filter papers by real-time multiplex PCR and melting curve analysis using the SYBR Green intercalator method based on the amplification refractory mutation system test. Newborn filter papers with abnormal melting curves were subjected to subsequent sequence analysis. Three mutated alleles, one p.Arg778Leu and two p.Ala874Val, were detected among the 476 newborn filter papers (952 alleles). The carrier frequency and incidence of WD in the Korean population were determined as 1 in 88.2 and 30,778, respectively, by reversely calculating based on the Hardy–Weinberg law. [ABSTRACT FROM AUTHOR]

This article describes a prototype system for quantifying bioassays and for exchanging the results of the assays digitally with physicians located off-site. The system uses paper-based microfluidic devices for running multiple assays simultaneously, camera phones or portable scanners for digitizing the intensity of color associated with each colorimetric assay, and established communications infrastructure for transferring the digital information from the assay site to an off-site laboratory for analysis by a trained medical professional; the diagnosis then can be returned directly to the healthcare provider in the field. The microfluidic devices were fabricated in paper using photolithography and were functionalized with reagents for colorimetric assays. The results of the assays were quantified by comparing the intensities of the color developed in each assay with those of calibration curves. An example of this system quantified clinically relevant concentrations of glucose and protein in artificial urine. The combination of patterned paper, a portable method for obtaining digital images, and a method for exchanging results of the assays with off-site diagnosticians offers new opportunities for inexpensive monitoring of health, especially in situations that require physicians to travel to patients (e.g., in the developing world, in emergency management, and during field operations by the military) to obtain diagnostic information that might be obtained more effectively by less valuable personnel. [ABSTRACT FROM AUTHOR]

Abstract: The Ugandan Ministry of Health emphasises the pivotal position of women in securing the nation''s health. Drawing on the concept of therapeutic landscapes, this paper explores media constructions of health in Uganda in order to question what role these may play in creating or undermining a ‘therapeutic landscape’ which supports women''s empowerment in a health context. The paper argues for the importance of understanding discursively constructed notions of health in order to ground the promotion of a health care strategy in the everyday lives and discourses of the users implicated. Given the Ugandan government''s current drive to both empower women and push an agenda of formally provided health care, this paper provides an exploratory analysis of how far newspapers facilitate or hinder this vision. [Copyright &y& Elsevier]

Abstract: There is an explosion in the numbers of nurse authors exploring new and exciting opportunities to understand genomic medicine because of international success on The Human Genome Project. Objectives: The primary purpose of this paper is to spotlight and to promote collaborative interdisciplinary and international nursing research within genetics and genomics. Design: Review of the literature. Data sources: Research in nursing pertaining to genetics and genomics, policy statements, and opinion papers. Review methods: Synthesis of the literature in four areas: genetic nursing research, genomic medicine, barriers to international collaboration, and elements that foster international collaboration. Results: Genetics and genomic medicine have implications for virtually all diseases in all health care settings in developed and still developing nations. Research in nursing, genetics and genomics is scarce. There is a gap in nursing literature about how to address barriers to foster international collaboration. Conclusions: The authors who have engaged in international collaboration offer a tentative road map for establishing and assessing the progress of research collaboration. New funding mechanisms to support international nursing research in this area are needed. [Copyright &y& Elsevier]

An introduction is presented in which author discusses articles on topics including focuses on promoting environmental sustainability and an opportunity to share projects related to improve the environmental footprint of critical care.

Abstract: Practice Papers are evaluative summaries of scientific and/or evidence-based topics. They are meant to provide key opportunities for critical reasoning on timely topics and quality improvement in dietetics practice and to include peer-reviewed perspectives from content practitioners and other experts. How does a practice topic become a Practice Paper? Proposals may be generated by any member of the American Dietetic Association via submission of a topic identification proposal, which may be obtained by contacting ADA headquarters at 800/899-4835 or ppapers@eatright.org. The Association Positions Committee oversees the development of Practice Papers and welcomes proposals from members. [Copyright &y& Elsevier]

At the Washington DC Pharmacogenomics in Drug Development and Regulatory Decision-Making: Workshop III – Three Years of Promise, Proposals and Progress on Optimizing the Benefit/Risk of Medicines (11–13 April 2005), one break-out session (Track 2) focused on co-development of therapeutic drug and diagnostic products. The Food and Drug Administration (FDA) released a draft concept paper shortly before the workshop was to convene. Track 2 was a forum for initial discussion of the content of the concept paper, and industry's initial reactions. After the workshop, formal commentaries on the co-development concept paper were submitted by several trade associations (e.g., Pharmaceutical Research and Manufacturers of America (PhRMA), Advanced Medical Technology Association (AdvaMed), American Association for Clinical Chemistry) and individual companies to FDA's Docket No. 2004N-0279. This paper includes a summary of the key features of the draft concept paper, the discussion in Track 2 of the April, 2005 meeting and highlights of the industry comments submitted to the FDA docket following the meeting.The Pharmacogenomics Journal (2006) 6, 375–380. doi:10.1038/sj.tpj.6500392; published online 2 May 2006 [ABSTRACT FROM AUTHOR]

The article presents the summaries of papers on dermatology presented at the main plenary sessions. The National Health Service (NHS) Plan 2000 proposed the development of specialist general practitioners (GPs) to take referrals from other GPs in specialties including dermatology. The NHS Modernization Agency Action on Dermatology program funded pilot site studies of dermatology GPwSI, services and preliminary results were encouraging. By the end of 2005, all referrals from primary care will be performed electronically using a referral template. Currently only a proportion of referrals are electronic, allowing comparison with established paper referrals.

The article presents information on various papers related to women's health that appeared in the 2004 issue of the "Journal of Women's Health." One of such papers is "Caloric Restriction and Incidence of Breast Cancer," by K.B. Michels and A. Ekbom. The context of the study is: Restricting caloric intake is one of the most effective ways to extend lifespan and to reduce spontaneous tumor occurrence in experimental animals, but whether similar associations hold in humans has not been appropriately studied. Another paper is "Induction of Labor After One Prior Cesarean: Predictors of Vaginal Delivery," by J. Grinstead and W.A. Grobman. The objective was to estimate the characteristics most associated with vaginal birth in patients undergoing induction of labor after one prior cesarean delivery. Another paper is "Long-term Effects of Oestrogen Therapy on Bone Loss in Postmenopausal Women: A 23-year Prospective Study," by H.G. Ahlborg, O. Johnell and M.K. Karisson. The aim of the study was to determine the long-term effect of oestrogen therapy on bone loss after menopause. The study findings revealed that the use of oestrogen seems to reduce the rate of bone loss over a period of 23 years, and the longer the duration of the therapy, the less bone loss.

The article presents information about the workshop related to pediatric radiology, which will be held on April 28, 2004. The scientific paper in session I will be related to the 'Neuroimaging,' and scientific paper session II will be related to the gastrointestinal-laboratory. The publications related to the scientific paper 'Neuroimaging,' are--'Comparison of Health Care Providers in System Driven Pediatric Imaging Sedation,' by Marc S. Keller, 'Optimization of MR Evaluation of the Fetal Brain,' by Susan Palasis.

This paper describes intervening conditions that might constrain or facilitate the exercise of Legitimate Influence: The Key to Advanced Nursing in Adult Critical Care, the foundation of which is credibility and advanced clinical nursing practice. Constraining conditions are conflict, resistance, gender bias, political awareness and established values. Credibility, advanced clinical nursing practice and strategic activity are required to enhance patient stay in hospital and improve patient outcome. Intervening conditions that facilitate these are overcoming resistance, political awareness and established values. In a previous paper, it was indicated that enhanced patient stay and improved patient outcome were achieved primarily through strategic activity that emphasized restoring patients to a former, or improved, health status. This paper portrays how intervening conditions can impinge upon this and the exercise of legitimate influence. [ABSTRACT FROM AUTHOR]

The article presents a synopsis on breathing retraining programs that can improve health-related quality of life in people with asthma. Topics discussed include pharmacological treatment is effective in Asthma; produce such substantial improvement in asthma-related quality of life in people; and breathing retraining did not improve pathophysiological outcomes such as clinical control.

Background Following years of sustained pressure on the UK health service, there is recognition amongst health professionals and stakeholders that current models of healthcare are likely to be inadequate going forward. Therefore, a fundamental review of existing social models of healthcare is needed to ascertain current thinking in this area, and whether there is a need to change perspective on current thinking. Method Through a systematic research review, this paper seeks to address how previous literature has conceptualized a social model of healthcare and, how implementation of the models has been evaluated. Analysis and data were extracted from 222 publications and explored the country of origin, methodological approach, and the health and social care contexts which they were set. Results The publications predominantly drawn from the USA, UK, Australia, Canada and Europe identified five themes namely: the lack of a clear and unified definition of a social model of health and wellbeing; the need to understand context; the need for cultural change; improved integration and collaboration towards a holistic and person-centred approach; measuring and evaluating the performance of a social model of health. Conclusion The review identified a need for a clear definition of a social model of health and wellbeing. Furthermore, consideration is needed on how a model integrates with current models and whether it will act as a descriptive framework or, will be developed into an operational model. The review highlights the importance of engagement with users and partner organizations in the co-creation of a model of healthcare. [ABSTRACT FROM AUTHOR]

Gamification is a modern method that seeks to influence wellness and health-related frameworks positively. It is not just because gamified solutions can get individuals more engaged but can make them more responsible for their health-related assessments. This paper qualitatively analyzes the concept of the gamified solution in healthcare through systematic literature review by using PRISMA methodology to figure out the health domains and the impact on solicitation of gamification in the healthcare sector. According to WHO, non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71% of global mortality, which can be controlled through modifiable behavior. Studies proved that intrinsic motivation had got an advantage over extrinsic motivation in the case of health behaviors. Gamification is considered as a solution for motivating people both intrinsically and extrinsically. The need for more research on gamified intervention in health care still remains as a gap. The article attempts to review more about gamification as health solutions, focusing more on research articles reported in Emerald Insight and Science Direct. [ABSTRACT FROM AUTHOR]

Introduction: Measuring patient-perceived outcomes following orthopaedic procedures have become an important component of clinical research and patient care. General and disease-specific outcomes measures have been developed and applied in orthopaedics to assess the patients’ perceived health status. Unfortunately, paper-based, self-administered instruments remain inefficient for collecting data because of: (a) missing data (b) respondent error, and (c) the costs to administer and enter data.Objective: To study the comparability of palm-top computer devices and paper–pencil self-administered questionnaires in the collection of health-related quality of life (HRQL) information from patients.Methods: The comparability of administering HRQL questionnaires using palm-top computer and traditional paper-based forms was tested in a sample of 96 patients with complaints of hip and/or knee pain. Each patient completed mailed versions of the Medical Outcomes Study (MOS), 36-item Health Survey (SF-36), and Western Ontario and McMasters University Arthritis Index (WOMAC) three weeks prior to presenting to clinic. At the clinic they were asked to complete the same outcomes measures using the palm-top computer or a paper-and-pencil version.Analysis: In the analysis, scale distributions, floor and ceiling effects, internal consistency and retest reliability of scales were compared across the two data collection methods. Because the baseline characteristics of the groups were not strictly comparable according to age, the data were analyzed for the entire sample and stratified according to age.Results: Few statistically significant differences were found for the means, variances and intra-class correlation coefficients between the methods of administration. While the scale distribution between the two methods was comparable, the internal consistency of the scales was dissimilar.Conclusions: Administration of HRQL questionnaires using portable palm-top computer devices has the potential advantage of decreased cost and convenience. These data lend some support for the comparability of palm-top computers and paper surveys for outcomes measures widely used in the field of orthopaedic surgery. The present study identified the lack of reliability across modes of administration that requires further study in a randomized comparability trial. These mode effects are important for orthopaedic surgeons to appreciate before implementing innovative data-capture technologies in their practices. [Copyright &y& Elsevier]

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Sleep related breathing disorders (SRBD) impair quality of live, morbidity and mortality of affected patients seriously. Moreover, due to their high prevalence, they have a huge impact on health care systems and national economics. The members of the German Respiratory Society, the German Society of Sleep Research and Sleep Medicine, the Association of Pneumological Clinics and the Association of Pneumologists focus strongly on the diagnosis and treatment of SRBD in their daily work. Prevailing developments in the provision of patients with SRBD, have strong impact on the quality of diagnosis and treatment, on the supply of devices, on the follow-up care and on the role and duties of the physician. Therefore, the societies estimate it essential, to publish this common position paper based on the evaluation and discussion of the scientific literature, the clinical practice and a consensus process of an expert group which is published in more detail (Randerath, Somnologie, DOI 10.1007/s11818-013-0649-2; Pneumologie 2/2014). [ABSTRACT FROM AUTHOR]

Objectives: To develop a paper-and-pencil semi-adaptive test for 5 domains of health-related quality of life (PAT-5D-QOL) based on item response theory (IRT). Methods: The questionnaire uses items from previously developed item banks for 5 domains: (1) walking, (2) handling objects, (3) daily activities, (4) pain or discomfort, and (5) feelings. For each domain, respondents are initially classified into 4 functional levels. Depending on the level, they are instructed to respond to a different set of 5 additional questions. IRT scores for each domain and overall health utility scores are obtained using a simple spreadsheet. The questions were selected using psychometric and conceptual criteria. The format of the questionnaire was developed through focus groups and cognitive interviews. Feasibility was tested in two population surveys. A simulation study was conducted to compare PAT-5D-QOL with a computerized adaptive test (CAT-5D-QOL) and a fixed questionnaire, developed from the same item banks, in terms of accuracy, bias, precision, and ceiling and floor effects. Results: Close to 90 % of the participants in feasibility studies followed the skip instructions properly. In a simulation study, scores on PAT-5D-QOL for all domains tended to be more accurate, more precise, less biased, and less affected by a ceiling effect than scores on a fixed IRT-based questionnaire of the same length. PAT-5D-QOL was slightly inferior to a fully adaptive instrument. Conclusions: PAT-5D-QOL is a novel, semi-adaptive, IRT-based measure of health-related quality of life with a broad range of potential applications. [ABSTRACT FROM AUTHOR]

The U.S. health care system is undergoing a shift from individual clinical practice toward team-based care. This move toward team-based care requires fresh thinking about clinical leadership and responsibilities to ensure that the unique skills of each clinician are used to provide the best care for the patient as the patient's needs dictate, while the team as a whole must work together to ensure that all aspects of a patient's care are coordinated for the benefit of the patient. In this position paper, the American College of Physicians offers principles, definitions, and examples to dissolve barriers that prevent movement toward dynamic clinical care teams. These principles offer a framework for an evolving, updated approach to health care delivery, providing policy guidance that can be useful to clinical teams in organizing the care processes and clinician responsibilities consistent with professionalism. [ABSTRACT FROM AUTHOR]

The progress of information and communication technologies has strongly influenced changes in healthcare and laboratory medicine. E-learning, the learning or teaching through electronic means, contributes to the effective knowledge translation in medicine and healthcare, which is an essential element of a modern healthcare system and for the improvement of patient care. E-learning also represents a great vector for the transfer knowledge into laboratory practice, stimulate multidisciplinary interactions, enhance continuing professional development and promote laboratory medicine. The European Federation of Laboratory Medicine (EFLM) has initiated a distance learning program and the development of a collaborative network for e-learning. The EFLM dedicated working group encourages the organization of distance education programs and e-learning courses as well as critically evaluate information from courses, lectures and documents including electronic learning tools. The objectives of the present paper are to provide some specifications for distance learning and be compatible with laboratory medicine practices. [ABSTRACT FROM AUTHOR]

The emergency room (ER) represents the main system entry for crises-based health care visits. It is estimated that 2% to 10% of children visiting the ER are victims of child abuse and neglect (CAN). Therefore, ER personnel may be the first hospital contact and opportunity for CAN victims to be recognised. Early diagnosis of CAN is important, as without early identification and intervention, about one in three children will suffer subsequent abuse. This educational paper provides the reader with an up-to-date and in-depth overview of the current screening methods for CAN at the ER. Conclusion: We believe that a combined approach, using a checklist with risk factors for CAN, a structured clinical assessment and inspection of the undressed patient (called ‘top–toe’ inspection) and a system of standard referral of all children from parents who attend the ER because of alcohol or drugs intoxication, severe psychiatric disorders or with injuries due to intimate partner violence, is the most promising procedure for the early diagnosis of CAN in the ER setting. [ABSTRACT FROM AUTHOR]

Background: Much implementation research is focused on full-scale trials with little evidence of preceding modelling work. The Medical Research Council Framework for developing and evaluating complex interventions has argued for more and better theoretical and exploratory work prior to a trial as a means of improving intervention development. Intervention modelling experiments (IMEs) are a way of exploring and refining an intervention before moving to a full-scale trial. They do this by delivering key elements of the intervention in a simulation that approximates clinical practice by, for example, presenting general practitioners (GPs) with a clinical scenario about making a treatment decision. Methods: The current proposal will run a full, web-based IME involving 250 GPs that will advance the methodology of IMEs by directly comparing results with an earlier paper-based IME. Moreover, the web-based IME will evaluate an intervention that can be put into a full-scale trial that aims to reduce antibiotic prescribing for upper respiratory tract infections in primary care. The study will also include a trial of email versus postal invitations to participate. Discussion: More effective behaviour change interventions are needed and this study will develop one such intervention and a system to model and test future interventions. This system will be applicable to any situation in the National Health Service where behaviour needs to be modified, including interventions aimed directly at the public. Trial registration: ClinicalTrials (NCT): NCT01206738 [ABSTRACT FROM AUTHOR]

BACKGROUND: Intrathecal administration of vincristine is a rare event but catastrophic for the patient, family and clinical team involved. Analysis of this source of harm shows it to be a classic systems error which has proved intractable for nearly 40 years. Failure to learn from history, communicate safety solutions nationally and internationally, create safety agencies which effectively and reliably prevent adverse events, conduct investigations and enquiries which fully reveals how to mitigate system error, develop robust physical design solutions to prevent harm to patients, make effective solutions universal and preparing for the unexpected are all major challenges. CONCLUSIONS: The elimination of rare yet catastrophic errors like this remains one of the tests of whether we can make healthcare safer. In this paper, we discuss why effective learning has been so slow and illustrate lessons for other fields of patient safety. [ABSTRACT FROM AUTHOR]

As a prologue to the paper titled "Understanding the Personalistic Aspects of Jola Ethnomedicine," the present essay provides a brief anthropologico-philosophical reflection, starting with classic Roman philosopher Seneca and his dictum that "each passing day we die," and continuing on to the profound existential questions pondered by more contemporary thinkers, including Heidegger and Levinas, about life, death, being, time, totality, and infinity. These agonically deep questions are intimately related to the universal human angst about health, illness, and death and the seeking of a restoration to a functional corporal and mental harmony and well-being through various means and methods, whether based on traditional religious or mythical beliefs and practices or on more modern medical practices. This essay also provides a diachronic philological analysis of the evolution of the word "health" in various languages and its age-old semantic connections to the idea of the "holly" and the "sacred." These semantic roots lead the author to define health as a "holistic, cosmic, integral, and sacred state of dynamic harmony." [ABSTRACT FROM AUTHOR]

Traditionally, Scandinavian anaesthesiologists have had a very broad scope of practice, involving intensive care, pain and emergency medicine. European changes in the different medical fields and the constant reorganising of health care may alter this. Therefore, the Board of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) decided to produce a Position Paper on the future of the speciality in Scandinavia. The training in the various Scandinavian countries is very similar and provides a stable foundation for the speciality. The Scandinavian practice in anaesthesia and intensive care is based on a team model where the anaesthesiologists work together with highly educated nurses and should remain like this. However, SSAI thinks that the role of the anaesthesiologists as perioperative physicians is not fully developed. There is an obvious need and desire for further training of specialists. The SSAI advanced educational programmes for specialists should be expanded and include formal assessment leading to a particular medical competency as defined by the European Union of Medical Specialists (UEMS). In this way, Scandinavian anaesthesiologists will remain leaders in perioperative, intensive care, pain and critical emergency medicine. [ABSTRACT FROM AUTHOR]

Kitson A, Conroy T, Wengstrom Y, Profetto-McGrath J, Robertson-Malt S. International Journal of Nursing Practice 2010; 16: 423–434 Defining the fundamentals of care A three-stage process is being undertaken to investigate the fundamentals of care. Stage One (reported here) involves the use of a met a-narrative review methodology to undertake a thematic analysis, categorization and synthesis of selected contents extracted from seminal texts relating to nursing practice. Stage Two will involve a search for evidence to inform the fundamentals of care and a refinement of the review method. Stage Three will extend the reviews of the elements defined as fundamentals of care. This introductory paper covers the following aspects: the conceptual basis upon which nursing care is delivered; how the fundamentals of care have been defined in the literature and in practice; an argument that physiological aspects of care, self-care elements and aspects of the environment of care are central to the conceptual refinement of the term fundamentals of care; and that efforts to systematize such information will enhance overall care delivery through improvements in patient safety and quality initiatives in health systems. [ABSTRACT FROM AUTHOR]

The impact of information and communication technology has been felt globally and the healthcare sector is not immune to the changes brought about by the introduction of new technologies. In contemporary clinical practice environments, information and communication technology skills are advantageous, not only to nurses, but also to the patients for whom they care. There is good evidence that these skills, appropriately utilised, can have a significant impact on patient outcomes. This scholarly paper presents the background to a project that explores graduate nurses' experiences of using information and communication technology in clinical contexts. A broad historical overview of the implementation of information and communication technology in higher education and healthcare in Australia is provided before discussing the extent to which the technology skills learnt at university are relevant or transferable to contemporary practice environments. The current levels and use of information and communication technology among new graduate nurses, the apparent dichotomy between technological versus humanised healthcare, and the need for national information and communication technology competency standards are discussed. [ABSTRACT FROM AUTHOR]

Objective To disentangle the concepts of primary health care and primary care as well as their conceptual and empirical ramifications for progressive transformation. Methods over 400 international and interdisciplinary abstracts and papers with 96 annotated bibliography abstracts of literature across multiple dimensions relating to the knowledge base around mechanisms in PHC development were reviewed. The text is confronted with the reality, as it exists in the field and makes the case for complexity perspectives to assess this phenomenon in its context. Conclusion PHC complexity is an important analytical tool to interrogate the ways in which this phenomenon is socially constructed as well as in the matrices in which it is embedded. It is also a potent analytical tool to assist in the deconstruction of prevalent linear thinking built around PHC as a whole. [ABSTRACT FROM AUTHOR]

The way that the current conception of mutual enactment is understood, any analysis, in order to be ultimately successful must first go badly for some period of time. Any analysis that goes too smoothly is subject to the suspicion that some very difficult interactional material is being mutually unaddressed. In this context I see that Dr. Lauren Levine enacted the role of her abandoned patient (concordant countertransference) and as well, for a time, indeed, figuratively abandoned her patient (complementary countertransference). The author's central contribution in this paper is an illustration of how drawing on difficult and painful dimensions in one's own personal analysis, the analyst has the advantage of being able to withstand highly toxic material in both the transference and the countertransference. Dr. Levine is fortunate in having had a personal analysis that helped her integrate highly shameful aspects of her self, though it must be recognized that this is not always the case in all training analyses. [ABSTRACT FROM AUTHOR]

The present article for improving strategies and interventions for cardiovascular prevention in Italy represents the collaborative work of several scientific societies that recognize their own role and mission in the field of prevention of cardiovascular diseases. It originates from the need, felt in many European and non-European countries, as well as at the level of the EU, to rapidly promote strategies and interventions to better prevent cardiovascular diseases. The main reason for producing this article is represented by the growing clinical and socioeconomic impact that cardiovascular diseases will have in Italy in the next few years. This, in fact, will bring serious problems regarding the ability to sustain the entire national healthcare system in Italy. This article reviews some of the major data available on projections of cardiovascular diseases and their social and economic burden. This article represents a White Paper, and it is conceived as a new starting point, proposing general specific interventions, addressed to decision-makers, stakeholders, institutions, citizens, physicians, healthcare workers, organizations and industries. These proposals are listed, and briefly discussed, leading to the development of a 'call-to-action', aimed at reducing the incidence of cardiovascular diseases and their impact on the healthcare system, even in the short to medium term. [ABSTRACT FROM AUTHOR]

Abstract: Aim: In light of debates arising from recent developments in Irish nursing education, this paper analyses tensions in the positioning of nursing in academia in terms of notions of the sacred and profane, and the symbolic boundaries between them, and discusses the implications of this analysis for nurse academics’ identities. Background: The entry of nursing education to the higher education sector has occurred against a discursive backcloth of opposition which constructs nursing work as either sacred, and under threat from the academy, or profane, and unworthy of a place in it. Method: Conceptual resources derived from the work of Basil Bernstein are deployed to analyse the forces driving the loom weaving this discursive backcloth. These forces are conceptualised as deriving from deep-seated fears and anxieties sparked by changes in the strength of symbolically important boundaries between constructions of the sacred and profane in the fields of nursing and higher education. These constructions are explicated. Findings: Bernstein regards secure academic identities as inhering in strong boundaries between disciplines and between the fields of education and work. The transfer of nursing education from health to the higher education sector and nurse academics’ attempts to articulate a nursing-discipline specific knowledge base can be understood in these terms. This analysis challenges nurse academics who promote disciplinary eclecticism and those who legitimate academic nursing principally in terms of the acquisition of generic and transferable lifelong learning skills. Conclusions: To counter a discourse that constructs them as a profane presence in higher education, some nurse academics have articulated a discourse of legitimation that constructs (academic) nursing as a sacred endeavour. Whether this can provide the grounds of their legitimacy and the basis of their careers as distinctively nursing academics is unclear at this stage of nursing''s development as an academic discipline. [Copyright &y& Elsevier]

Abstract: The current evidence-based practice (EBP) movement in healthcare emphasizes that clinical decision making should be based on the “best evidence” available, preferably the findings of randomized clinical trials. Within this context qualitative research findings are considered to have little value and the old debate in nursing has been re-ignited related to whether qualitative versus quantitative research findings provides the best empirical evidence for nursing practice. In response to this crisis qualitative scholars have been called upon by leaders in the field to clarify for outsiders what qualitative research is and to be more explicit in pointing out the utility of qualitative research findings. In addition, attention to “quality” in qualitative research has been identified as an area worthy of renewed focus. Within this paper two key problems related to addressing these issues are reviewed: disagreement not only among “outsiders” but also some nursing scholars related to the definition of “qualitative research”, and a lack of consensus related how to best address “rigor” in this type of inquiry. Based on this review a set of standard requirements for qualitative research published in nursing journals is proposed that reflects a uniform definition of qualitative research and an enlarged yet clearly articulated conceptualization of quality. The approach suggested provides a framework for developing and evaluating qualitative research that would have both defensible scholarly merit and heuristic value. This will help solidify the argument in favor of incorporating qualitative research findings as part of the empirical “evidence” upon which evidence-based nursing is founded. [Copyright &y& Elsevier]

A correction is presented to the article "Beyond validation: getting wearable activity trackers into cardiovascular care—a discussion paper" published in the previous issue of a periodical.

Evidence indicates that general practice-based multidisciplinary teams can offer a means of addressing some of the key issues currently facing Western health systems, especially workforce and chronic disease management. Elements of team-working have been addressed in research and policy initiatives both overseas and in Australia, yet some important aspects of primary health care multidisciplinary team-working still remain unclear in the Australian context. This discussion paper has been developed by the Australian General Practice Network (AGPN) to raise awareness of and promote thought on four questions relating to multidisciplinary team-working that AGPN considers important but that, as yet, have not been fully addressed. (Except where indicated, it is not a position statement about AGPN's views on this matter.) Questions considered are: Who is in the team? What makes a successful team? How should teams be funded in Australia? Who coordinates the team? Each question broadly considers what is already known about the area through purposeful literature reviews of the published and grey literature, current policy impacting on the area, and suggested areas for policy development in the context of Australian general practice and primary care. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this paper is to provide a comprehensive overview of ethnomethodology and explore its usefulness as a methodology for nursing. Ethnomethodology was conceived through the writings of Harold Garfinkel, an American Sociologist in 1967. The influence of phenomenology, sociology and writings of the linguistic philosopher Wittengenstein is evident in this methodology. In the 1970s, it was both heralded by some as a threat to sociology and by others as a welcome development borne out of the dissatisfaction with positivist paradigm research. It is a methodology that has been utilised not only by sociologists but also by many health care disciplines. However, its utilisation by nurse researchers has not been widespread. [Copyright &y& Elsevier]

Although the public uses the media for sex advice, information and validation, much media coverage of sex contains inconsistent, outdated, or incorrect messages. There is little encouragement for those working in sex therapy, research, education or healthcare to engage with the media. The standard of media training and availability for these professions varies. Not all professionals work from an evidence-based perspective, and not all ‘experts’ in the media are recognised as such by their peers, resulting in inconsistent information being given to journalists by people not always qualified to speak about sex. Furthermore, a lack of training and understanding of sex and relationships results in misunderstanding or misreporting of stories by journalists, and perpetuating poor media coverage of sex. This paper outlines problems in media coverage, and highlights training opportunities and deficits for both sexologists and journalists. It advocates collaborative working, greater training in evidence-based sexology, and challenging problems in media training and sex coverage. [ABSTRACT FROM AUTHOR]

Although the International Committee of Medical Journal Editors has published clear guidance on the authorship of scientific papers, short-term contract research workers, who perform much of the research that is reported in the biomedical literature, are often at a disadvantage in terms of recognition, reward and career progression. This article identifies several professional, ethical and operational issues associated with the assignment of authorship, describes how a university department of primary care set about identifying and responding to the concerns of its contract research staff on authorship and describes a set of guidelines that were produced to deal with the ethical and professional issues raised. These guidelines include directions on how authorship should be negotiated and allocated and how short-term researchers can begin to develop as authors. They also deal with the structures required to support an equitable system, which deals with the needs of short-term researchers in ways that are realistic in the increasingly competitive world of research funding and publication, and may offer a model for more formal guidelines that could form part of institutional research policy. [ABSTRACT FROM AUTHOR]

Abstract: Nurses globally are required and expected to report nursing errors. As is clearly demonstrated in the international literature, fulfilling this requirement is not, however, without risks. In this discussion paper, the notion of ‘nursing error’, the practical and moral importance of defining, distinguishing and disclosing nursing errors and how a distinct definition of ‘nursing error’ fits with the new ‘system approach’ to human-error management in health care are critiqued. Drawing on international literature and two key case exemplars from the USA and Australia, arguments are advanced to support the view that although it is ‘right’ for nurses to report nursing errors, it will be very difficult for them to do so unless a non-punitive approach to nursing-error management is adopted. [Copyright &y& Elsevier]

Interprofessional education (IPE) is being built into the mainstream of professional education for all health and social care professions throughout the United Kingdom (UK) driven by the Labour Government elected in 1997, coincidentally the year that this Journal hosted the first All Together Better Health conference in London. The incoming government prioritized pre-qualifying IPE to be provided in partnership by universities and service agencies supported regionally by workforce development confederations, later absorbed into strategic health authorities (SHAs), and centrally by educational, professional and regulatory bodies. Ambitious agenda for pre-qualifying IPE set by government are being tempered by realistic assessment of current outcomes borne of experience and corroborated by evidence. This paper suggests some ways to ease constraints and improve outcomes, but emphasizes the need to generate continuing interprofessional learning opportunities that build on the basics. It argues that accumulating experience and evidence must be brought to bear in formulating criteria for the approval and review of IPE within regulatory systems for professional education. Can IPE be sustained within mainstream professional education once initial enthusiasm ebbs and earmarked funds run dry? That is the issue. [ABSTRACT FROM AUTHOR]