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Coded data are the basis of information systems in all countries that rely on Diagnosis Related Groups in order to reimburse/finance hospitals, including both administrative and clinical data. To identify the problems and barriers that affect the quality of the coded data is paramount to improve data quality as well as to enhance its usability and outcomes. This study aims to explore problems and possible solutions associated with the clinical coding process. Problems were identified according to the perspective of ten medical coders, as the result of four focus groups sessions. This convenience sample was sourced from four public hospitals in Portugal. Questions relating to problems with the coding process were developed from the literature and authors' expertise. Focus groups sessions were taped, transcribed and analyzed to elicit themes. Variability in the documents used for coding, illegibility of hand writing when coding on paper, increase of errors due to an extra actor in the coding process when transcribed from paper, difficulties in the diagnoses' coding, coding delay and unavailability of resources and tools designed to help coders, were some of the problems identified. Some problems were identified and solutions such as the standardization of the documents used for coding an episode, the adoption of the electronic coding, the development of tools to help coding and audits, and the recognition of the importance of coding by the management were described as relevant factors for the improvement of the quality of data. [ABSTRACT FROM AUTHOR]

Malnutrition is a disease that imposes a significant healthcare cost burden in the United States, especially when left undiagnosed and untreated for an extended period of time. This article discusses traditional malnutrition diagnostic criteria for adults and why registered dietitian nutritionists and physicians should no longer use these criteria to determine nutrition status. It concludes with the malnutrition clinical characteristics currently accepted in the United States and globally, with implications for practice. Clinical documentation specialists and medical coders can use this information to better interpret medical record documentation and assign the correct International Classification of Diseases, 10th Revision, Clinical Modification codes to the coding abstract. [ABSTRACT FROM AUTHOR]

Background: Health records are the basis of clinical coding. In Portugal, relevant diagnoses and procedures are abstracted and categorised using an internationally accepted classification system and the resulting codes, together with the administrative data, are then grouped into diagnosis-related groups (DRGs). Hospital reimbursement is partially calculated from the DRGs. Moreover, the administrative database generated with these data is widely used in research and epidemiology, among other purposes. Objective: To explore the perceptions of medical coders (medical doctors) regarding possible problems with health records that may affect the quality of coded data. Method: A qualitative design using four focus groups sessions with 10 medical coders was undertaken between October and November 2017. The convenience sample was obtained from four public hospitals in Portugal. Questions related to problems with the coding process were developed from the literature and authors' expertise. The focus groups sessions were taped, transcribed and analysed to elicit themes. Results: There are several problems, identified by the focus groups, in health records that influence the coded data: the lack of or unclear documented information; the variability in diagnosis description; "copy & paste"; and the lack of solutions to solve these problems. Conclusion and implications: The use of standards in health records, audits and physician awareness could increase the quality of health records, contributing to improvements in the quality of coded data, and in the fulfilment of its purposes (e.g. more accurate payments and more reliable research). [ABSTRACT FROM AUTHOR]

Socialization has crucial outcomes for both the employee and the employer. Through an exploratory qualitative study conducted in India, we examined how people with disabilities (PWD) viewed various aspects of their socialization process. Specifically, we looked at the role of coworkers, supervisors, organizational practices, and employee proactive behaviors in influencing organizational integration. We found that integration was most influenced by coworkers and supervisors. Organizational practices and employee proactive behaviors were less important. Respondent gender and tenure also influenced certain findings. Specifically, PWD with less tenure sought and accepted more help from coworkers and supervisors. Further, more men with disabilities than women with disabilities indicated that they were proactive in terms of obtaining training to make themselves employable, and more men with disabilities indicated that having coworkers with a disability helped them during socialization. We discuss both theoretical and practical implications as well as future research directions based on our findings. © 2011 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

This study explored the perspectives of children with disabilities regarding the concept of inclusion in physical activity. Participants were children (two girls, nine boys, Mage = 10 years, five months, age range: 8-12 years) with disabilities, including cerebral palsy, fine and gross motor delays, developmental coordination disorder, muscular dystrophy, nemaline myopathy, brachial plexus injury, and severe asthma. Children's perspectives on inclusion in physical activity (e.g., sports, games, and play) were explored through semistructured interviews. Interviews were digitally audio taped and transcribed verbatim. Data were analyzed through content analysis. Three themes emerged from the data: gaining entry to play, feeling like a legitimate participant, and having friends. These themes were associated with feeling included to varying degrees in sports, games, and play. In essence, it was the actions of others that were the prominent features identified by children that contributed to feeling more or less included in physical activity contexts. These results are discussed in relation to inclusion in physical education, recreation, and unstructured free play. [ABSTRACT FROM AUTHOR]

This article focuses on the production side of clinical data work, or data recording work, and in particular, on its multiplicity in terms of data variability. We report the findings from two case studies aimed at assessing the multiplicity that can be observed when the same medical phenomenon is recorded by multiple competent experts, yet the recorded data enable the knowledgeable management of illness trajectories. Often framed in terms of the latent unreliability of medical data, and then treated as a problem to solve, we argue that practitioners in the health informatics field must gain a greater awareness of the natural variability of data inscribing work, assess it, and design solutions that allow actors on both sides of clinical data work, that is, the production and care, as well as the primary and secondary uses of data to aptly inform each other's practices. [ABSTRACT FROM AUTHOR]

Philip Hoyle presents a compelling argument for the significant and highly valued role that the management of health information plays in the Australian healthcare system and the delivery of health services in this country. However, he also brings to our attention the ill-defined nature of the ethical oversight of this very information. Hoyle uses words such as "honesty," "commitment to beneficence," "commitment to equity" and "respect for variation" when describing the characteristics of ethical leadership. He singles out health information management professionals – Health Information Managers (HIMs) and Clinical Coders (CCs) – as the key professional group who need to step up and seize the initiative, get conversations going, form partnerships, do research and publish findings, so the knowledge and insights that the health information management profession has the potential to offer are not only more widely known and understood but also more useful to others working in the healthcare arena. Hoyle calls on health information management professionals to step out from behind the scenes and take responsibility for the ethical use of the information they help produce. Hoyle's words resonated powerfully with me, particularly with respect to the clinical coding workforce in Australia, which is made up of trained CCs and qualified HIMs. In a truly ethical environment, HIMs and CCs would not be asked to meet performance indicators for increased funding metrics or to change codes to avoid triggering certain indicators; they would simply be asked to ensure complete, accurate coding for every episode of care. This is what ethical leadership would look like. I am concerned about our clinical coding workforce. I am now asking, are our CCs and HIMs up to the task of taking back absolute and unchallenged ownership of their particular skill set, which makes them the keepers of the clinical coding standards and the experts in accurate and complete code assignment? [ABSTRACT FROM AUTHOR]

Objective As part of the Title V Maternal and Child Health (MCH) Services Block Grant, administered by the Health Resources and Services Administration’s (HRSA’s) Maternal and Child Health Bureau (MCHB), states are required to conduct a comprehensive needs assessment identifying MCH priorities every 5 years. The most current needs assessment (2015) occurred after a transformation of the program, in which a new performance measurement framework was created. This analysis examined current patterns and trends in state MCH priorities and selected performance measures to identify changing needs and inform technical support. Methods Multiple coders categorized: (1) state priority needs from 2000 to 2015 into focus areas and subcategories for examination of current, diminishing, and emerging needs; and (2) the selection of linked national and state performance measures in 2015 for all 59 states and jurisdictions. Results Between 2000 and 2015, the proportion of states with a need around pre- and inter-conception care increased from 19% to 66%. More states had needs in the breastfeeding subcategory (42%) compared with 20% of states or less in previous years. Fewer states had needs around data capacity than in past years. Emerging needs included supporting families/relationships. The most commonly selected national performance measures (NPMs) were around breastfeeding and well-woman visits. The state performance measures (SPMs) analysis also emphasized assets, with measures around community/context and positive development. Teen births and postpartum depression were areas where multiple states had SPMs. Conclusions for practice Increasing and emerging needs may help to inform technical assistance and future national measures for the Title V program. [ABSTRACT FROM AUTHOR]

Inpatient psychiatric facilities in the United States lack systematic regulation and monitoring of a variety of patient safety concerns. We conducted a qualitative analysis of 61 news articles to identify common causes and types of harms within inpatient psychiatric facilities, with a focus on physical harm. The news articles reported on patient self-harm, patient-patient violence, and violence between patients and staff, noting that youth, older adults, and veterans were especially vulnerable. Harms occurred throughout the care continuum — at admission, during the inpatient stay, and at discharge — and retaliation towards whistleblowers deterred facility accountability. We recommend 1) addressing staffing shortages, 2) instituting systematic monitoring of critical incidents and the experiences of consumers and staff, 3) improving both inpatient safety and post-discharge community supports, and 4) continued journalistic coverage of harms within inpatient psychiatric facilities. [ABSTRACT FROM AUTHOR]

Scientific publications are meant to keep professionals up to date with the latest research and information in their field. The most renowned scientific publications are written in English, which has become the language of communication in sciences. All papers submitted for publication in a scientific journal need to be accompanied by an abstract written according to the guidelines for authors, which are specific to each journal. Moreover, submission of abstracts is a requirement and a means of selecting the most interesting pieces of research to be presented at conferences and congresses. That is why, we believe that abstract writing in English needs to be part of the training of all undergraduate students in various fields of science. The aim of our study was to observe how the theory of abstract writing is put into practice in genuine research papers, in order to identify the best way of teaching students how to write abstracts of scientific articles. Also, we aimed to find out whether there are differences between abstract writing in economics and in medical journals, or whether there is a common way of writing abstracts of scientific articles which could be taught in ESP classes. For this purpose, we analysed a total of 40 recent abstracts from widely read journals with an impact factor of above 2, as follows: 20 abstracts from medical journals included in PubMed, and 20 abstracts from economics journals included in the Philadelphia List. We formulated ten research questions concerning the macrostructure of the abstracts, which referred to their structure, headings, length, keywords, references and related information. We also studied the guidelines for authors in each of the chosen journals, in order to have a clearer view of the requirements for writing abstracts in these publications, and to compare the analysed abstracts with the instructions for authors. We compared the results of our analyses and found significant differences between abstracts in medical and in economics journals. Some of these differences are in line with the literature and others come to complete the information available on abstracts in scientific journals. For example, we found that while most abstracts in medical journals were structured (75%), the majority of abstracts in economics journals were unstructured (95%). Also, abstracts of medical articles were significantly longer (270-530 words) than abstracts of articles in economics (65-178 words). A surprising finding was that most abstracts of medical articles were not accompanied by keywords (75%), whereas in the case of economics journals, key words were provided in all the analysed publications. Our conclusion was that while abstracts in economics and medicine differ significantly in terms of macrostructure, there are certain common elements which support the idea that abstracts of scientific articles have a common ground, based on a shared general structure: introduction (background/objectives), methods, results and conclusions. Finally, based on the results of our research, we designed several activities to be used in the LSP class, which would enable students to learn about writing abstracts of scientific articles and about the particularities of such abstracts in the field of their study -- medicine and economics respectively. [ABSTRACT FROM AUTHOR]

MINI: The publication rate of conference abstract presentations as full-length manuscripts is a potential measure of meeting quality. 43.8% of abstracts presented at the 2010-2012 North American Spine Society annual meetings were published as full-length manuscripts within 3 years. Podium presentations and "Best" or "Outstanding" paper presentations were more likely to be published.Study Design: Retrospective review of conference abstracts.Objective: The aim of this study was to determine the publication rate of podium and poster presentations at the 2010-2012 North American Spine Society (NASS) annual meetings.Summary Of Background Data: Presentations at medical conferences are utilized to disseminate new clinical information. The orthopedic literature estimates the rate of publication for abstracts presented at major meetings to be between 34.0% and 67.1%. However, few studies have analyzed the publication rate of accepted abstracts to the NASS annual meetings.Methods: All abstracts presented at the 2010-2012 NASS annual meetings were reviewed. PubMed and Google Scholar databases were searched to determine whether each abstract was published as a full-length manuscript before or up to 3 years after its NASS meeting presentation. Statistical analyses included descriptive statistics, Poisson regression with robust error variance, and linear regression.Results: A total of 1045 abstracts were accepted to the 2010-2012 NASS annual meetings. 43.8% were published before or up to 3 years after their NASS presentation. Podium presentations were more likely to be published than poster presentations (47.1% vs. 37.7%, P = 0.005). Abstracts with "Best" or "Outstanding" designations were also more likely to be published than abstracts without those designations (54.4% vs. 45.0%, P = 0.034). Presentations designated as "Best" or "Outstanding" articles had shorter time to publication than presentations without those designations (369 vs. 486 days, P = 0.002).Conclusion: This study suggests that only 43.8% of abstracts accepted to NASS are published as full-length manuscripts. As such, practitioners should use caution when altering clinical practice based solely on conference presentations. Additionally, podium presentations are more likely to be published than poster presentations. This trend may be reflective of the higher quality of abstracts accepted as podiums, or may be associated with a larger number of lower-quality abstracts being accepted because of the use of the e-poster format.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

The Injury Severity Score (ISS) is a measure of injury severity widely used for research and quality assurance in trauma. Calculation of ISS requires chart abstraction, so it is often unavailable for patients cared for in nontrauma centers. Whether ISS can be accurately calculated from International Classification of Diseases, Ninth Revision (ICD-9) codes remains unclear. Our objective was to compare ISS derived from ICD-9 codes with those coded by trauma registrars. This was a retrospective study of patients entered into 9 U.S. trauma registries from January 2006 through December 2008. Two computer programs, ICDPIC and ICDMAP, were used to derive ISS from the ICD-9 codes in the registries. We compared derived ISS with ISS hand-coded by trained coders. There were 24,804 cases with a mortality rate of 3.9%. The median ISS derived by both ICDPIC (ISS-ICDPIC) and ICDMAP (ISS-ICDMAP) was 8 (interquartile range [IQR] = 4–13). The median ISS in the registry (ISS-registry) was 9 (IQR = 4–14). The median difference between either of the derived scores and ISS-registry was zero. However, the mean ISS derived by ICD-9 code mapping was lower than the hand-coded ISS in the registries (1.7 lower for ICDPIC, 95% CI [1.7, 1.8], Bland–Altman limits of agreement = −10.5 to 13.9; 1.8 lower for ICDMAP, 95% CI [1.7, 1.9], limits of agreement = −9.6 to 13.3). ICD-9-derived ISS slightly underestimated ISS compared with hand-coded scores. The 2 methods showed moderate to substantial agreement. Although hand-coded scores should be used when possible, ICD-9-derived scores may be useful in quality assurance and research when hand-coded scores are unavailable. [ABSTRACT FROM AUTHOR]

Aims: The RECORD study evaluated the effects of rosiglitazone on cardiovascular outcomes. A 4-year observational follow-up was added to the study to monitor the occurrence of cancer and bone fractures. We present the cancer and bone fracture data aggregated across the main study and its observational follow-up. Methods: RECORD was a multicentre, open-label trial in people with type 2 diabetes on metformin or sulfonylurea monotherapy randomly assigned to addition of rosiglitazone ( n = 2,220) or to a combination of metformin and sulfonylurea ( n = 2,227). At the end of the main study, patients stopped study drug and were invited to enter the observational follow-up during which glucose-lowering treatment was selected by the patient's physician. Serious adverse events of cancer and serious and non-serious events of bone fracture were recorded. The study is registered with ClinicalTrials.gov, number NCT00379769. Results: Of the 4,447 patients comprising the intent-to-treat population, 2,546 entered the observational follow-up (1,288 rosiglitazone, 1,258 metformin/sulfonylurea) and added 9,336 patient-years experience to the main RECORD study, making an aggregate of 33,744 patient-years. Based on the totality of follow-up, malignancies were reported in 179 of 2,220 patients (8.1 %) in the group originally randomised to rosiglitazone and in 195 of 2,227 patients (8.8 %) in the group allocated metformin/sulfonylurea [relative risk, RR, 0.92 (95 % CI 0.76-1.12)]. More patients reported bone fractures in the rosiglitazone group (238, 10.7 %) than in the metformin/sulfonylurea control [151, 6.8 %; RR 1.58 (1.30-1.92)]. For women, the corresponding figures were rosiglitazone 156 (14.5 %), metformin/sulfonylurea 91 (8.5 %), RR 1.71 (1.34-2.18), and for men, the corresponding figures were rosiglitazone 82 (7.2 %), metformin/sulfonylurea 60 (5.2 %), RR 1.37 (0.99-1.90). Potentially high-morbidity fractures (hip, pelvis, femur, and spine) occurred in the same number of patients (31, 1.4 %) in the two treatment groups. Conclusions: We conclude that data from a 4-year observational follow-up, combined with the main RECORD study data, do not suggest an increased risk of cancer in patients randomised to rosiglitazone combination use compared with those randomised to metformin/sulfonylurea. Consistent with the main study, rosiglitazone is associated with an increased risk of peripheral bone fracture in women, and probably in men, but the combined data do not suggest an increase in potentially high-morbidity (hip, pelvis, femur, and spine) fractures. [ABSTRACT FROM AUTHOR]

Purpose The development and successful implementation of a comprehensive medication prior-authorization service are described. Summary At our 550-bed academic medical center, we found an increasing number of Medicare write-offs as a result of the off-label use of specialty medications. Furthermore, more insurers were requiring that prior authorization be attained before patients began treatment with a high-cost specialty medication. After investigating who was pursuing these prior authorizations and where they were documented, it became clear that no department within the hospital owned this responsibility. Our pharmacy department initiated a specialty medication prior-authorization and medication assistance program to review all medication orders written for high-cost specialty medications administered or infused in any of the health system’s outpatient clinics, including chemotherapy infusions. A full-time specialty pharmacy coordinator was hired in fall 2010. This pharmacist was responsible for spearheading the overall specialty medication strategy for the health system. Our prior-authorization work across our health system has not only helped to reduce Medicare write-offs and commercial insurance denials but also has resulted in closer working relationships with individuals in other departments of the hospital. Several million dollars in additional write-offs were avoided because our prior-authorization staff identified prescribed therapies that would not be covered by Medicare or commercial insurers before they were started. In total, we decreased write-offs or increased revenues by over $6.2 million during this time frame, a return on investment exceeding 20:1. Conclusion A comprehensive medication prior-authorization service generated additional revenue due to a decrease in lost charges and an increase in net reimbursement. [ABSTRACT FROM AUTHOR]

This paper investigates the coding of dementia in the episode of care in a pilot study group (N=48) post hospital discharge and the possible implications of under-coding. The assigned ICD-10-AM codes and Diagnosis Related Groups were reviewed. Results demonstrate under-coding of dementia and of cognitive deficits; poor correlation between admission diagnoses and dementia codes on separation; and changes in individual patients' cognitive status across forms and assessments in the same admission. The complexities of accurately coding dementias will impact upon planning for future treatments and service provision and will have a flow-on effect for patients, hospitals, and patient care in Australia. [ABSTRACT FROM AUTHOR]

Background: Children in northern Uganda have undergone significant psychosocial stress during the region's lengthy conflict. A Psychosocial Structured Activities (PSSA) program was implemented in 21 schools identified as amongst those most severely affected by conflict-induced displacement across Gulu and Amuru Districts. The PSSA intervention comprised a series of 15 class sessions designed to progressively increase children's resilience through structured activities involving drama, movement, music and art (with additional components addressing parental support and community involvement). Method: Eight schools were selected by random quota sampling from those schools receiving the PSSA intervention. Two hundred and three children were identified in these schools as being scheduled to receive intervention, and were followed up 12 months later following engagement with PSSA activities. A comparison group comprised 200 children selected from schools that had met inclusion criteria for receipt of intervention, but were not scheduled for intervention coverage until later. Preliminary research used participatory focus group methodology to determine local indicators of child well-being as viewed by parents, teachers, and children respectively. Pre- and post- assessments focused on ratings for each child - by parents, teachers and children - with respect to these indicators. Results: Significant increases in ratings of child well-being were observed in both intervention and comparison groups over a 12-month period. However, the well-being of children who had received the PSSA intervention increased significantly more than for children in the comparison group, as judged by child and parent (but not teacher) report. This effect was evident despite considerable loss-to-follow-up at post-testing as a result of return of many households to communities of origin. Conclusion: General improvement in child well-being over a 12-month period suggests that recovery and reconstruction efforts in Northern Uganda following the onset of peace had a substantive impact on the lives of children. However, exposure to the PSSA program had an additional positive impact on child well-being, suggesting its value in post-conflict recovery contexts. [ABSTRACT FROM AUTHOR]

A meta-analysis of k = 53 studies containing 60 non-overlapping samples and 10,073 participants was conducted to investigate whether psychopathy was associated with delinquency and (violent) recidivism in juveniles. The results showed that psychopathy was moderately associated with delinquency, general recidivism, and violent recidivism. Moderator effects revealed that various study and participant characteristics influenced the strength of the association between psychopathy, delinquency, and (violent) recidivism. It was concluded that screening for the (early) detection of psychopathy is important, as delinquent behavior and recidivism can be predicted from psychopathy as early as the transition from middle childhood to adolescence. [ABSTRACT FROM AUTHOR]

Background: To investigate links between inhibitory control (IC) and behavior problems in early childhood, as well as genetic and environmental covariances between these two constructs. Methods: Parent and laboratory ratings of IC and parent ratings of externalizing and attention deficit hyperactivity disorder behaviors were administered at 24 months of age on a sample of 291 same-sex twin pairs (131 monozygotic, 160 dizygotic). Results: There were significant phenotypic associations between both IC assessments and the two areas of behavioral maladjustment (correlations ranged from −.13 to −.57). Multivariate analyses revealed that phenotypic covariance between IC and behavior problems could be substantially explained by common genetic influences (genetic correlations ranged from −.30 to −.74). Parent ratings of IC showed higher phenotypic and genetic correlations with behavior problems than lab ratings of IC. Conclusions: This study is the first to examine the etiology of the covariance between IC and related behavioral difficulties in toddlerhood. Findings suggest that low levels of IC can be considered a genetic risk factor for the development of early emerging behavior problems. [ABSTRACT FROM AUTHOR]

Aim. To explore patients' experiences of the symptoms of suspected wound infection in external fixator pin sites. Background. Pin site infection is painful and distressing and can threaten the success of treatment. It is difficult for patients and clinicians to differentiate between pin site infection and irritation or foreign body reaction to the pin. There is no validated outcome measure for infection that enables the success of interventions for prevention and management to be evaluated. There is a need to develop accurate patient-orientated assessment criteria. Design. Qualitative design, using grounded theory. Method. Following written informed consent, a theoretical sample of 16 adults with an external fixation device that had been in situ for at least 12 weeks was recruited. They had experienced a pin site infection in the previous four weeks. Data were collected using semistructured interviews, and data collection was stopped when saturation was achieved. Analysis took place using constant comparative analysis. Results. Participants described three 'clinical states' of pin site wounds: calm, irritated and infected. They described the differences in each state in relation to pain, redness, swelling, discharge and general symptoms. Symptoms were absent or varied in intensity depending on whether the pin sites were calm, irritated or infected. Conclusion. This study provides insight into patients' experiences of the symptoms of pin site infection resulting in an emerging theory based on conceptualisation of this experience, which is that of dimensions of inflammatory pin site states. The detail given will enable clinicians and researchers to be more accurate in recognising infection and begins to clarify the difference between a wound that is irritated and a wound that is infected. The findings will enable the development of a patient-orientated outcome questionnaire for pin site infection. Relevance to clinical practice. There is a need for patients and clinicians to be able to differentiate between infected, not infected and irritated pin sites. [ABSTRACT FROM AUTHOR]

Research addressing the delivery of early intervention programmes offers guidelines that, when followed, presumably maximize the programmes’ intended benefits. In this study, the authors used a quasi-mixed, monostrand method to investigate how families of children with disabilities in south-east Turkey perceived the service delivery they were receiving. Organizing their perceptions under a framework related to the Turkish-law-mandated guidelines, the authors found that the provision of services in the region varied greatly from one professional team task to the next. Implications for the improvement of service delivery are discussed. [ABSTRACT FROM PUBLISHER]

This article examines the effect of democratic attitudes on social capital in four Latin American countries. It relies on a secondary analysis of data from a multi-national study conducted in 2005—2006. Findings indicate that democratic attitudes had a significant positive effect on social capital even in rural settings, and that social capital increased as democratic attitudes improved. [ABSTRACT FROM PUBLISHER]

The objective of this formative research was to assess the acceptability of a micronutrient powder (Sprinkles®) and a lipid-based nutrient supplement (Nutributter®), and to explore people's willingness to pay for these products in a resource-poor context like Niger. In four sites, 84 focus group discussions among mothers, fathers and grandmothers of children 6-23 months were conducted, as well as 80 key informant interviews of mothers who participated in a home study where their children 6-23 months were given either Sprinkles® or Nutributter® to use either for a period of 4 weeks, or they were given both products over the 4-week period, i.e. Sprinkles® for 2 weeks and Nutributter® for an additional 2 weeks. The mothers understood how to use the products and generally used the products correctly. Both products were highly acceptable to adults and most children. In Niamey, where the 4-week home study used both products for 2 weeks each, the mothers tended to prefer Nutributter®. The mothers who used either product were pleased with the improvements they saw in their children's health, including increased appetite, weight gain and increased energy and activity. A few mothers were concerned with how they would be able to provide for their child's increased appetite. Most participants across all four sites reported that they would be willing and able to afford to buy a single sachet of either Sprinkles® at a cost of US$0.03 or Nutributter® at a cost of US$0.08 several times a week. This study provides evidence that both of these products were are highly acceptable in different settings in Niger and suggests that delivery of Nutributter® or Sprinkles® at a low or subsidized cost through a market-based system may be possible in Niger, if an appropriate distribution system can be identified. [ABSTRACT FROM AUTHOR]

Little is understood about parents’ experiences following children’s moderate to severe traumatic brain injury (TBI). Using descriptive phenomenology, we explored common experiences of parents whose children were diagnosed with moderate to severe TBI. Parents from across the United States (N = 42, from 37 families) participated in two semistructured interviews (~ 90 minutes in length and 12 to 15 months apart) in the first 5 years following children’s TBI. First interviews were in person. Second interviews, done in person or by phone, facilitated updating parents’ experiences and garnering their critique of the descriptive model. Parent themes were (a) grateful to still have my child, (b) grieving for the child I knew, (c) running on nerves, and (d) grappling to get what my child and family need. Parents reported cultural barriers because of others’ misunderstandings. More qualitative inquiry is needed to understand how the knowledge, attitudes, beliefs, and culture-based expectations of others influence parents’ interactions and the family’s adjustment and well-being. [ABSTRACT FROM PUBLISHER]

Purpose: We aimed to demonstrate the suitability of the Anatomical Therapeutic Chemical Classification (ATC) to describe duplicate drugs and duplicate drug classes in prescription data and describe the pattern of duplicates from public and private primary care clinics of Kuala Lumpur, Malaysia. Methods: We analyzed prescription data year 2005 from all 14 public clinics in Kuala Lumpur with 12,157 prescriptions, and a sample of 188 private clinics with 25,612 prescriptions. As ATC Level 5 code represents the molecule and Level 4 represents the pharmacological subgroup, we used repetitions of codes in the same prescription to describe duplicate drugs or duplicate drug classes and compared them between the public and private clinics. Results: At Level 4 ATC, prescriptions with duplicates drug classes were 1.46% of all prescriptions in private and 0.04% in public clinics. At Level 5 ATC, prescriptions with duplicate drugs were 1.81% for private and 0.95% for public clinics. In private clinics at Level 5, 73.3% of prescriptions with duplicates involved systemic combination drugs; at Level 4, 40.3% involved systemic combination drugs. In the public sector at Level 5, 95.7% of prescriptions with duplicates involved topical products. Conclusions: Repetitions of the same ATC codes were mostly useful to describe duplicate medications; however, we recommend avoid using ATC codes for tropical products for this purpose due to ambiguity. Combination products were often involved in duplicate prescribing; redesign of these products might improve prescribing quality. Duplicates occurred more often in private clinics than public clinics in Malaysia [ABSTRACT FROM AUTHOR]

Background: Attachment theory was conceptualized by Bowlby as relevant across the life span, from 'cradle to grave'. The research literature on attachment in infants and preschool-aged children is extensive, but it is limited in adolescence. In particular, it is unclear whether or not attachment security is distinguishable from other qualities of the parent-adolescent relationship and predicts adjustment independently of alternate measures of it. Methods: Data from three parallel studies of adolescents, representing normal- to high-risk status, were combined, n = 248. Attachment was assessed using the Child Attachment Interview, a recently constructed measure designed for older children and adolescents. Parent-adolescent relationship quality was assessed in detail through questionnaires, interviews and observation of a standard problem-solving interaction. Adolescent adjustment was assessed through parental psychiatric interview, teacher questionnaire and adolescent self-report. Results: Bivariate analyses showed that secure attachment representations were modestly associated with diverse measures of the current parent-adolescent relationship such as monitoring, negative expressed emotion, and directly observed parental warmth and anger. In addition, attachment representations were reliably associated with key indicators of psychological adjustment in adolescence, including parent-rated oppositional-defiant disorder symptoms and teacher-reported emotional and behavioural difficulties. Regression analyses revealed that secure attachment representations explained unique variance in these indicators of adjustment, independent of alternative measures of the parent-adolescent relationship. Conclusion: Adolescents' representational models of attachment are related to but distinct from current parenting quality and provide unique insight into the understanding of behavioural adjustment. The findings support a distinct conceptual role of attachment representations in adolescence. Clinical assessment and treatment models should include attachment patterns in this age group. [ABSTRACT FROM AUTHOR]

Disasters such as a major hurricane are likely to disrupt individuals' habits, routines, and roles. The purpose of this qualitative collective case study was to explore the extent to which master's students' habits, routines, and role participation were affected by Hurricane Ike during the transition from academic work to Level II Fieldwork placement. Three master's level occupational therapy students who experienced the hurricane while attending school were recruited for the study and were administered a qualitative interview and the Role Checklist. On the basis of the interview, emerging themes with subthemes were Temporal Aspects-preparation, storm, immediate poststorm, and recovery/rebuilding; Effects of Storm on Occupational Performance-loss of personal space, lack of leisure participation, changes in habits, and loss of routines; and Personal Outcomes-areas of transformation and changes in roles. As noted by the Role Checklist, some new roles were assumed by the participants following the storm, while some prehurricane roles were not resumed posthurricane. Implications for occupational therapy for individuals affected by disasters are highlighted including the importance of role participation and impact upon occupational performance. [ABSTRACT FROM AUTHOR]

Wikipedia advocates a strict 'neutral point of view' (NPOV) policy. However, although originally a U.S-based, English-language phenomenon, the online, user-created encyclopedia now has versions in many languages. This study examines the extent to which content and perspectives vary across cultures by comparing articles about famous persons in the Polish and English editions of Wikipedia. The results of quantitative and qualitative content analyses reveal systematic differences related to the different cultures, histories, and values of Poland and the United States; at the same time, a U.S./English-language advantage is evident throughout. In conclusion, the implications of these findings for the quality and objectivity of Wikipedia as a global repository of knowledge are discussed, and recommendations are advanced for Wikipedia end users and content developers. [ABSTRACT FROM AUTHOR]

This article describes the outcomes of research that examined the practice of web information architecture (IA) in large organizations. Using a grounded theory approach, seven large organizations were investigated and the data were analyzed for emerging themes and concepts. The research finds that the practice of web IA is characterized by unpredictability, multiple perspectives, and a need for responsiveness, agility, and negotiation. This article claims that web IA occurs in a complex environment and has emergent, self-organizing properties. There is value in examining the practice as a complex adaptive system. Using this metaphor, a pre-determined, structured methodology that delivers a documented, enduring, information design for the web is found inadequate - dominant and traditional thinking and practice in the organization of information are challenged. [ABSTRACT FROM AUTHOR]

This study investigated the use of cognitive state verbs (CSVs) and complement clauses in children with specific language impairment (SLI) and their typically developing (TD) peers. In Study 1, conversational samples from 23 children with SLI ( M == 6;2), 24 age-matched TD children ( M == 6;2) and 21 vocabulary-matched TD children ( M == 4;9) were analysed for the proportional use of CSVs, verb types, co-occurrence with complement clauses and syntactic frame types. Children in all three groups had similar performance in all measures. Study 2 compared a subset of children on CSV use in conversational and narrative//expository samples. Conversation elicited more high-frequency verbs, whereas narrative//expository samples elicited more low-frequency verbs. Children with SLI used fewer different verbs and were less likely to combine low-frequency verbs with a complement clause than their TD peers. We conclude that these observed deficits can be attributed to limitations in lexical knowledge rather than a syntactic deficit. [ABSTRACT FROM AUTHOR]

Aims. To explore and describe the distinctive role of nurses in delivering school health services for primary and secondary school students in Hong Kong. Background. The practical responsibility of nurses in delivering school health services has not been established. There is no literature on this topic and, in particular, nothing has been written from the perspective of the practitioner in communities in Hong Kong. Design. A qualitative design using semi-structured interviews was employed. Methods. Thirteen school nurses were recruited and interviewed in 2006. The narratives were analysed using content analysis steps to identify categories. Results. Seven categories were formulated. School nurses described their roles as providers, counsellors, leaders, promoters, collaborators, referrers and administrators and housekeepers. The school nurses also reported that they needed to maintain a diverse range of skills and knowledge, such as effective communication skills and clinical updated knowledge, to cope with the demands and the diversity of their roles and to support the health and educational needs of the students and their local communities. Conclusion. The future development of the 'one school, one nurse' policy envisaged by the current government for ordinary schools in Hong Kong will not occur unless the role of school nurses is clearly delineated and valued by society as reducing school children's and adolescents' risk-taking behaviours and promoting the health and well-being of school children and adolescents. Relevance to clinical practice. The findings provide relevant information for school nurse leaders and school nurse policy makers to understand how school nurses are practicing and promoting child and adolescent health services, which can inform regional and national policy and practice. [ABSTRACT FROM AUTHOR]

Aims. To describe the nature of being a psychosocial nurse in cancer care. Background. Psychosocial nurses in cancer care are a new profession in cancer nursing in Sweden, with potential to offer unique support to patients regarding somatic and psychological needs. This new profession is hitherto unexplored. Design. A qualitative inductive interview approach was used. Methods. A strategic sample of five nurses working as psychosocial nurses in cancer care in Sweden was interviewed. A thematic stepwise analysis was performed. Results. The analysis revealed the twofold experience of being a psychosocial nurse in cancer care. The nurses felt as if they had two professions: nurse and therapist. They used skills from both professions to help the person, who had cancer and a psychosocial problem. It was stimulating to be able to combine the knowledge and practices of two professions. It was also difficult because they felt an uncertainty about what their roles and responsibilities really were. Conclusions. This new profession seems to need role descriptions and formal education so that psychosocial nurses receive respect and appreciation in their new and relatively unknown work in cancer care. Relevance to clinical practices. The adjustment to the cancer disease and treatment side effects can be difficult for the patients and their families, which has highlighted the need for psychosocial support. To meet this need the health care system has to provide such support. Nurses are available and can be successfully educated to handle psychosocial problems among cancer patients. A new profession among nurses is emerging, which the present study aimed at describing. The present findings have potential to make healthcare professionals grasp what the core of psychosocial cancer nursing is, as well as its potential and pitfalls. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore current practice and opportunities to improve practice in decision-making about transfer of nursing home residents to hospital. Background. Nursing home staff are often faced with the decision of whether to send a resident to hospital for medical treatment. While many residents will benefit from going to hospital, there are also several risks associated with this. This study sought to add to the existing body of research on this issue by seeking the views of nursing home managers, who are the persons most frequently involved in making these decisions. Design. Qualitative design using purposive, quota sampling. Method. Qualitative interviews with 41 nursing home managers from south-western Sydney, Australia. Results. Factors affecting the decision to transfer a resident to hospital include acuteness of their condition; level and style of medical care available; role of family members; numbers, qualifications and skills mix of staff; and concern about criticism for not transferring to hospital. Two factors that have not featured as strongly in previous research are the roles of advance care planning and support from local hospital and community health services. Conclusion. While transferring a nursing home resident to hospital is often necessary, there are many situations where they could be cared for in the nursing home; therefore, avoid complications associated with being in hospital. Apart from a range of factors already identified in the literature, this study has highlighted the important role that advance care planning and support from local health services can play in reducing unnecessary transfers to hospital. Relevance to clinical practice. There are several strategies that nursing homes and local health authorities can adopt to promote advance care planning and build better support systems between the two sectors, thereby reducing the numbers of residents who need to be transferred to hospital for their health care. [ABSTRACT FROM AUTHOR]

The authors conducted a study to determine women's perceived health information needs in various geographic locations to plan health-related outreach in a Midwestern U.S. state. Eighty-seven women representing diverse communities in both urban and rural locations participated. Themes identified from transcripts of focus groups included confusion and information overload, concerns regarding lifestyle and specific health conditions, a lack of time for self care, factors influencing health-related behavior change, navigating the health system, and a need to 'make this system work for me.' The voices of these women contribute to the search for solutions to provide comprehensive, holistic women's health care in the U.S. and internationally. [ABSTRACT FROM AUTHOR]

Background: A/H1N1, more commonly referred to as swine flu, emerged in Mexico in spring 2009. It rapidly spread across the world and was classed as a global pandemic on 11 June 2009. Objective: To analyse UK newsprint coverage of the swine flu pandemic. Methods: Content analysis of 2374 newsprint articles published in eight UK national newspapers between 1 March 2009 and 28 February 2010. Results: Newsprint coverage of the swine flu epidemic was immense. The threat from swine flu was portrayed as greatest in the spring and summer of 2009 when scientific uncertainties about the impact on the UK and global population were at their height and when swine flu cases in the UK first peaked. Thereafter the number of news articles waned, failing to mirror the October peak in flu cases as the virus failed to be as virulent as first feared. Content analysis found little evidence of the media 'over-hyping' the swine flu pandemic. Conclusions: The news media's role as a disseminator of scientific information is particularly important in areas of risk perception. Despite a succession of health scares in recent years in which the media has been accused of exaggerating the risks and contributing to public misunderstandings of the issues, this analysis suggests that the UK newsprint reporting of swine flu in the 2009--10 outbreak was largely measured. The news media's role as disseminators of factual health information on swine flu is to be welcomed, particularly in relation to their handling and responsible reporting on scientific uncertainty. [ABSTRACT FROM AUTHOR]

Aim: This paper examines the behavioural factors that are linked to the gender gap in mortality phenomenon and connects theoretical implications with the findings of a qualitative grounded theory research. Subject and methods: Differences in the life expectancy of men and women are a well-known fact. Though several theories take into account the wide range of factors underlying this phenomenon, they can only partly explain it. To get a deeper understanding of these issues, we use a qualitative approach to study this topic from another point of view. Expert interviews with professionals in the medical field were conducted to gain insights about the health lifestyles of men and women that may reveal hypotheses as to why the gender gap in mortality is narrowing. Results: The results bear in mind that apart from biological factors, behavioural factors are strongly connected to the gender gap in the mortality issue. Men and women tend to behave differently and their behaviour is linked to social norms and expectations. They have a different understanding of illness and also behave in different ways with regard to seeing doctors. However, because of changing gender roles due to changing norms and other influential factors, these health behaviour patterns have started to diminish. Conclusion: A generational change in the health behaviour of men and women is currently taking place. Traditional gender roles are diminishing due to versatile attributes and behavioural patterns of men and women. This development may partly explain the narrowing of the gender gap in life expectancy in Austria. [ABSTRACT FROM AUTHOR]