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This study examined US prelicensure nursing program use of clinical judgment models and teaching strategies to promote students' clinical judgment.Growing interest in teaching clinical judgment associated with upcoming changes in NCLEX-RN testing warrants exploration of how models and teaching strategies are currently used.A cross-sectional survey with multiple-choice and open-ended response items was used to examine programs' use of clinical judgment educational models.Of 234 participants (9 percent response rate), 27 percent reported using a model; 51 percent intended and 20 percent did not intend to start using a model. Tanner's clinical judgment model was the most used, followed by the clinical reasoning cycle. Models were used to inform design of teaching/learning strategies and facilitate clinical teaching and evaluation.Clinical judgment model use may increase as programs prepare for changes in NCLEX-RN. Research is needed to understand how model use contributes to measurable differences in clinical judgment skill.

This article combines collective biography, diffractive analysis, and speculative fabulation to weave together the authors’ childhood memories of “common worlding.” Our collective biography brings into focus how we engaged in common worlding in our childhoods through dreaming, metamorphosis, and play by tactfully moving across different worlds and learning with the human and more-than-human others we encountered. As we foreground childhood memory and its potential to reimagine pasts, presents, and futures, we explore what kind of conditions are necessary to (re)attune ourselves to the multiple worlds around us in order to maintain and nurture children’s—and our own—other-worldly connections.

The aims of this study were to examine the psychometric properties of the Brief Assessment of Impaired Cognition (BASIC) case-finding instrument in clinical settings focusing on (i) test–retest reliability, (ii) the discriminative validity of BASIC and its components for identification of Alzheimer disease (AD) dementia and non-AD dementia, and (iii) the association of expert clinical rating of cognitive status with BASIC performance Background and purpose: The aims of this study were to examine the psychometric properties of the Brief Assessment of Impaired Cognition (BASIC) case-finding instrument in clinical settings focusing on (i) test–retest reliability, (ii) the discriminative validity of BASIC and its components for identification of Alzheimer disease (AD) dementia and non-AD dementia, and (iii) the association of expert clinical rating of cognitive status with BASIC performance. Methods: The test–retest reliability analysis was based on a sample of general practice patients (n = 59) retested with a mean interval of 19 days. Discriminative validity analyses and analysis of the association of cognitive status with BASIC performance were based on data from the primary validation study of BASIC in memory clinics. Results: The test–retest reliability of BASIC was high (r = 0.861). No significant difference in discriminative validity was found for identification of AD dementia (sensitivity = 0.99, specificity = 0.98) and non-AD dementia (sensitivity = 0.90, specificity = 0.98). All components of BASIC contributed to the high discriminative validity of both AD and non-AD dementia. BASIC performance was significantly correlated with expert clinical rating of the cognitive status of patients. A crude staging model for cognitive status using BASIC score intervals had superior classification accuracy (70%) compared to a Mini-Mental State Examination (MMSE) score range-based model (58% accuracy). Conclusions: BASIC is a reliable and valid case-finding instrument for AD dementia and non-AD dementia in clinical settings. BASIC performance is significantly associated with the degree of cognitive impairment, and BASIC seems to be superior to MMSE for staging of impairment.

Safe patient care is closely linked to clinical judgment. Concerns about inadequate practice readiness and the impending inclusion of clinical judgment items on the NextGen NCLEX have resulted in increasing interest and publications about teaching clinical judgment. However, little is known about actual current practices for teaching this skill.This research describes findings about current strategies to teach clinical judgment used in US prelicensure nursing programs.Cross-sectional methodology was used to survey program deans and directors across the United States.Programs are using multiple strategies to teach clinical judgment. The most common strategies used include case studies and simulation. Participants believed strategies have a positive impact on student thinking, practice readiness, and program outcomes. They described insights into implementation of teaching for clinical judgment.The results of this research provide foundational data to inform current teaching practices and further research for this essential skill.

Background: Observing how experienced nurses assess and manage complex situations may assist students in developing clinical judgment. Method: Evaluation of a combined learning activity including an audiovisual simulation demonstrating expert nurse care of a patient with delirium delivered across three international programs. Participants responded to five survey questions; two open-ended questions; and provided information about previous experiences with delirium. Results: Highest rated benefits: watching an expert nurse; and how assessment and care were provided. Qualitative themes: global perspectives; questions that challenged; level of realism; the expert nurse; technical issues; and contribution to learning and practice. Conclusion: Irrespective of country/program, participants rated the learning activity as beneficial in developing skills for clinical judgment. Refereed/Peer-reviewed

Although care management departments have been able to hire more case managers, there is still a shortage of experienced case managers. An academic medical center and school of nursing began with an academic practice partnership that focused on expanded education and practicums on care coordination and transitions management. This partnership has led to successful hiring of new traditional BSN graduates directly into inpatient case management positions.

Objectives: Brief Assessment of Impaired Cognition (BASIC), which combines self- and informant report with cognitive testing, was previously found to be highly accurate in identification of dementia and cognitive impairment. The aim of the present study was to develop and validate a questionnaire version of BASIC, the BASIC-Q, for use in community settings. Methods: In order to construct a questionnaire version of BASIC, we substituted cognitive testing with questions regarding orientation. BASIC-Q was validated based on further analysis of data from the primary BASIC validation study, where patients consecutively referred from general practice were tested at their first memory clinic admission prior to diagnosis. Control participants were primarily recruited among participating patients' relatives. Expert clinical diagnosis was subsequently used as reference standard for estimation of classification accuracy. Results: A high discriminative validity (sensitivity 0.92, specificity 0.97) for cognitive impairment (n = 159) vs socio-demographically matched control participants (n = 109) was found. In comparison, the MMSE had 0.76 sensitivity and 0.81 specificity. Administration time for BASIC-Q was less than 5 minutes compared to approximately 10 minutes for the MMSE. Conclusions: BASIC-Q is a brief, efficient and valid tool for identification of cognitive impairment in a clinical setting. Further validation in a community setting is needed.

This chapter examines how a team of university experts within the field of education adjusted the focus of a professional development (PD) model to teach action research to 60 international educators. Three key educational elements were used to create the PD model: 1) transformational learning theory, 2) language acquisition and learning methodologies, and 3) a personalized system of instruction (PSI). When the unexpected worldwide pandemic caused a shift to remote learning, the team was tasked with adjusting the original face-to-face model. Evidence from meeting agendas, action plan tracking spreadsheets, and personal communication were analyzed as the program moved to an online learning environment. Based on this data, the team recognized that the theoretical principles and conceptual framework did not change but were refocused and emphasized a more human-centered approach. Future research should explore continued long-term professional development after action research has been implemented to support reflective practice and inquiry.

OBJECTIVES: The aim of this study was to develop and validate a new brief and accurate case-finding instrument for dementia and cognitive impairment. Previous research indicates that combining cognitive tests with informant and/or patient report may improve accuracy in dementia case-finding. The Brief Assessment of Impaired Cognition (BASIC) integrates these three sources of information.METHODS: BASIC was prospectively validated in five memory clinics. Patients consecutively referred from general practice were tested at their initial visit prior to diagnosis. Control participants were primarily recruited among participating patients' relatives. Expert clinical diagnosis was subsequently used as gold standard for estimation of the classification accuracy of BASIC.RESULTS: A very high discriminative validity (specificity 0.98, sensitivity 0.95) for dementia (n = 122) versus socio-demographically matched control participants (n = 109) was found. In comparison, the MMSE had 0.90 specificity and 0.82 sensitivity. Extending the discriminative validity analysis to cognitive impairment (both dementia and MCI, n = 162) only slightly reduced the discriminative validity of BASIC whereas the discriminative validity of the MMSE was substantially attenuated. Administration time for BASIC was approximately 5 minutes compared with 10 to 15 minutes for the MMSE.CONCLUSIONS: BASIC was found to be an efficient and valid case-finding instrument for dementia and cognitive impairment in a memory clinic setting.

Background The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. We aimed to validate the PACIC questionnaire by (1) assess patients’ perception of the quality of care for Danish patients with type 2 diabetes, (2) identify which factors are most important to the quality of care designated by the five subscales in PACIC, and (3) the validity of the questionnaire. Methods A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results In total, 2,696 individuals with type 2 diabetes completed ≥ 50 % of items. The floor effect for individual items was 8.5–74.5 %; the ceiling effect was 4.1–47.8 %. Cronbach’s alpha was 0.73–0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents, who receive diabetes care primarily at general practice and outpatient clinics had higher scores compared to those receiving care at a private specialist. Receiving rehabilitation was followed by higher scores in all subscales. Those 70 years or older had lower mean total and subscale scores compared to younger patient groups. A higher number of diabetes visits were associated with higher total scores; a higher number of emergency department visits were associated with lower total scores. The effects of healthcare utilisation on subscale scores varied. Conclusions These results provide insight into variations in the quality of provided care and can be used for targeting initiatives towards improving diabetes care. Factors important to the quality of perceived care are having a GP or hospital outpatient clinic as the primary organization. Also having a higher number of visits to the two organizations are perceived as higher quality of care as well as participating in a rehabilitation program. Floor and ceiling effects were comparable to an evaluation of the PACIC questionnaire in a Danish population. Yet, floor effects suggest a need for further evaluation and possible improvement of the PACIC questionnaire in a Danish setting. Total PACIC scores were lower than in other healthcare systems, possible being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark.

BACKGROUND Capstone clinical experiences provide opportunities for students to develop increasing competence and independence in nursing practice, as well as to focus on care that is fundamental to contemporary nursing practice. PROBLEM Increasingly in the United States, nursing practice is expanding to community settings, with enhanced focus on population health, whereas promoting safe practice within acute care settings remains an imperative. Student learning needs vary by the clinical setting as does delivery of clinical experiences and associated programmatic challenges. Yet, safe and effective practice is required in all environments. APPROACH This article describes 2 concept-based approaches to promote deep understanding of key aspects of nursing care developed to manage specific challenges in hospital and community settings. Outcomes/Conclusions: Concept-based learning activities, used to promote deeper clinical thinking and integration of theory with practice, support students to develop increased competence in care of specific patient populations in both environments.

Background: The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. However, it has yet to be validated in a Danish diabetes population. We aimed to validate the PACIC, assess the quality of care for Danish patients with type 2 diabetes, and identify factors associated with quality of care. Methods: A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results: In total, 2,696 individuals with type 2 diabetes completed ≥ 50% of items. The floor effect for individual items was 8.5-74.5%; the ceiling effect was 4.1- 47.8 %. Cronbach’s alpha was 0.73-0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents receiving rehabilitation and reporting primary of diabetes care had higher total mean scores; those 70 years or older had lower mean total and subscale scores. A higher number of diabetes visits were associated with higher total scores; higher number of emergency department visits were associated with lower total scores. The effect of healthcare utilisation on subscale scores varied. Conclusions: Floor effects suggest a need for further evaluation of the PACIC questionnaire in Danish settings. Total PACIC scores were lower than in other healthcare systems, possibly being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark.

Objectives: The aim of this study was to validate the Brief Assessment of Impaired Cognition (BASIC) and the Brief Assessment of Impaired Cognition Questionnaire (BASIC-Q) for identification of mild cognitive impairment (MCI) in a memory clinic setting. Methods: A total of 163 sociodemographically matched patients (MCI, n = 42, and dementia, n = 121) and 83 control participants were included in the study. Two instruments were validated: (a) BASIC, including the components self-report, informant report, and two brief cognitive tests, and (b) BASIC-Q, including the components self-report, informant report, and orientation. BASIC can be administered in 5 minutes and BASIC-Q in less than 5 minutes. Results: A high discriminative validity for MCI vs control participants was found for both BASIC (sensitivity 0.86, specificity 0.89) and BASIC-Q (sensitivity 0.88, specificity 0.88). In comparison, the MMSE had low sensitivity (0.61) and moderate specificity (0.72). All components of BASIC and BASIC-Q contributed significantly to differentiate MCI from control participants. The components of BASIC and BASIC-Q also contributed significantly to differentiate MCI from dementia, except for self-report, which was identical in the two groups. Conclusions: Both BASIC and BASIC-Q are brief, valid, and effective instruments for identification of patients with possible MCI in a memory clinic setting. Further cross-validation of the instruments in a general practice or primary care setting is needed.

Background Academic educators are challenged to foster the development of clinical judgment in diverse learners. The impact of nursing students' backgrounds on clinical judgment has not previously been studied. Aims 1. Determine what identifiable background variables influence what students notice and how they interpret what is noticed; 2. Identify some implications for pedagogical approaches that may foster clinical judgment development among diverse learners. Sample Prelicensure/preregistration students, representing three international English-speaking programs in 3 countries, comprised the sample (N = 532). All were enrolled in the first course in which perioperative content was taught. Data collection An online learning activity was designed to elicit responses to a simulated case study of an expert nurse role model caring for an older adult patient experiencing delirium several days post-operatively. Data analysis Dyads of coders did three rounds of coding. Logistic and multinomial logistic regression models used background variables to look for patterns in student responses. Findings The data strongly suggest that background variables impact clinical judgment, however, not in interpretable patterns. Conclusion Nurse educators must acknowledge that prelicensure students' backgrounds impact their clinical judgment and assist them to learn to think like nurses.

Since the late 1980s there has been an increase of ‘second career teachers’ (SCTs), professionals that switch careers to become teachers. Little is known about SCTs and their sense of professional identity. Building from Pierre Bourdieu’s concepts of power and cultural capital, the professional identities of teachers were examined through the following questions: What are the professional identities of SCTs? How can SCTs inform the field of teaching about professional identities? This mixed methods study gathered perspectives on professional identities through an online survey of 236 educators within 1 school district which were analysed and compared to interviews of 16 SCTs and their supervisors from the same district. The study findings invite us to consider alternative definitions of professionalism in teaching, especially for teacher leadership.

Assessing newly hired nurses' readiness for practice is critical for safe practice and the quality care of patients; therefore, hospitals need effective assessment strategies to promote clinical judgment development. One large medical center hospital developed a process to assess new hires' clinical judgment, using case studies. This article describes the assessment process and reports findings from a retrospective analysis of the clinical judgment competency of the participants. The findings suggest that more orientation time and experience are needed for less-experienced nurses ( J Contin Educ Nurs . 2015;46(12):563–571.

BACKGROUND: A small proportion of patients account for the majority of health care costs. This group is often referred to as high-cost users (HCU). A frequently described characteristic of HCU is chronic disease. Yet, there is a gap in understanding the economic burden of chronic diseases associated with HCU to different types of health care services. OBJECTIVE: To analyze which frequent chronic diseases have the strongest association with HCU overall, and HCU in hospital, primary care, and prescription medication. DESIGN: This is a register-based observational study on Danish health service costs for various diseases in different medical settings. PARTICIPANTS: A total of 1,350,677 individuals aged ≥ 18 years living in the Capital Region of Denmark by 1 January 2012 were included. MAIN MEASURES: Chronic diseases, costs, and sociodemographic data were extracted from the nationwide registers, including data from hospitals, primary care, and medicine consumption. These information were merged on an individual level. KEY RESULTS: Cancer, mental disorders except depression, and heart diseases have the strongest association with HCU overall. Mental disorders except depression were in the three diseases most prevalent in HCU in all the three health care services. CONCLUSIONS: Our results show that the chronic diseases that have the strongest association with HCU differ between different types of health care services. Our findings may be helpful in informing future policies about health care organization and may guide to different prevention, treatment, and rehabilitation strategies that could lessen the burden in the hospital. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-019-05315-w) contains supplementary material, which is available to authorized users.

Holistic review in admissions considers an applicant's background and experience in combination with academic achievement. In order to evaluate baccalaureate nursing school applicants more holistically, a school of nursing added group interviews as part of the admissions process. The school's Admission and Progression Committee consulted with other schools, developed interview questions, and implemented a strategy to interview applicants. Results of this process were high levels of candidate and faculty satisfaction and enrollment of a diverse cohort of students with a high preadmission grade point average. Areas for improvement and further research are discussed.

It is crucial to understand the epidemiology and natural history of human papillomavirus (HPV) infection in both men and women, to prevent the increasing HPV-related disease burden in men. Data on HPV prevalence among men in the general population are limited. In this cross-sectional population-based study, we aimed to estimate genital HPV infection prevalence in Danish men using 2 different test methods.Penile swab samples from 2460 male employees and conscripts at military barracks in Denmark were tested for HPV DNA with the hybrid capture 2 (HC2) method, and a polymerase chain reaction (PCR) assay, Inno-LiPA. The overall and age- and type-specific prevalence of HPV infection with 95% confidence intervals (CIs) were estimated, and the correlation between the 2 assays was assessed.The overall HPV prevalence was 22.2% (95% CI, 20.6-23.9) in the HC2 test and 41.8% (95% CI, 39.9-43.8) with PCR. Of the PCR-positive samples, 50.9% were negative in the HC2 test. Of 183 PCR-positive samples that could not be genotyped (HPVX), 88.0% (95% CI, 83.2-92.7) were HC2 negative. The most prevalent types were HPV-51, HPV-16, HPV-66, HPV-53, and HPV-6. The prevalence of high-risk and low-risk HPV peaked among men aged 20 to 29 years, whereas the HPVX prevalence increased with age.Human papillomavirus is highly prevalent in the general male population of Denmark, with HPV-16 and HPV-51 being the most prevalent. Polymerase chain reaction detects twice as many positive samples as HC2 but includes HPVX, possibly representing cutaneous HPV types found on normal genital skin.

Aim: First intercourse at the age of 14 years or younger is usually considered high-risk behaviour for sexually transmitted infections (STIs). It has been linked to other types of risky behaviour in women, while conflicting results have been obtained for men. The aim of the study was to estimate the prevalence of first intercourse at a young age in various birth cohorts of men and to determine any association with later risky behaviour. Methods: We studied 22,979 randomly selected men aged 18–45 years from the Danish general male population who responded to a self-administered questionnaire. Multiple sexual partners over a lifetime, multiple new sexual partners within the past 6 months, intercourse with a commercial sex worker, having an STI, binge drinking and current smoking were considered risky behaviour. Results: First intercourse at the age of 14 years or younger was more prevalent in younger (14%) than in older (10%) birth cohorts and among men with shorter schooling. Young age at sexual debut was associated with a more than twofold increase in the risks for subsequent risky behaviour. Conclusions: More than 10% of Danish men first had sex at an early age, and this was closely related to subsequent risk-taking behaviour.

A clinical education model was developed and implemented by nursing faculty in the Oregon Consortium for Nursing Education undergraduate curriculum to improve clinical learning for preparation of nurses to practice in the 21st century. This clinical education model, developed though collaborative work by nursing practice and education representatives throughout the state, moves away from a "random access opportunity" model of clinical education reliant on "total patient care" experiences to an intentional design of clinical learning activities based on course competencies appropriate to student level. Five elements of the model were proposed: case-based, concept-based, intervention skill-based, focused direct client care and integrative experiences. Different elements are dominant in early, middle and late clinical experiences to best support the developmental level of the student. Expectations for faculty, students and clinical staff were also developed to enhance best practices in clinical learning. Preparation of clinical partners for a change in clinical learning and student accountability are essential for optimal learning. This paper provides an overview of the model with clinical application examples for each element with a particular emphasis on case-based, concept-based and integrative clinical experiences.

Aims: Increasing focus on improvement and optimisation of the treatment in primary care and reduction of healthcare costs emphasize the need to understand which factors determines adherence and non-adherence to clinical guidelines. In the present study, we examined attitudes towards clinical guidelines in Danish general practitioners (GPs). Methods: We conducted a survey among Danish GPs from all five regions of Denmark. In total, 443 GPs answered the web-based questionnaire that contained questions about attitudes and barriers to clinical guidelines. Results: More than 90% of the GPs reported that they have good knowledge of the guidelines and in general follows the guidelines. A majority of the GPs (81%) found it acceptable that economic considerations are part of the guidelines. The most important factors for nonadherence to guidelines were “need of adjustment to clinical practice” and “lack of confidence in guidelines”. The attitudes to clinical guidelines were not significantly associated with practice characteristics such as gender, years of experience, practice organisation and localisation. Conclusions: Our findings show that clinical guidelines are an integrated or internalised part of everyday practice among GPs in Denmark. Furthermore, the findings indicate that Danish GPs are positive towards applying priority setting in their practice. This is decisive in the light of rising healthcare costs due to development of new expensive technologies and ageing populations that puts pressure on the healthcare system in general and primary healthcare in particular.

Background: Concept-based learning is used increasingly in nursing education to support the organization, transfer, and retention of knowledge. Concept-based learning activities (CBLAs) have been used in clinical education to explore key aspects of the patient situation and principles of nursing care, without responsibility for total patient care. The nature of best practices in teaching and the resultant learning are not well understood. Method: The purpose of this multiple-case study research was to explore and describe concept-based learning in the context of clinical education in inpatient settings. Four clinical groups (each a case) were observed while they used CBLAs in the clinical setting. Results: Major findings include that concept-based learning fosters deep learning, connection of theory with practice, and clinical judgment. Strategies used to support learning, major teaching–learning foci, and preconditions for concept-based teaching and learning will be described. Conclusion: Concept-based learning is promising to support integration of theory with practice and clinical judgment through application experiences with patients. [ J Nurs Educ. 2016;55(7):365–371.]

Objectives To estimate the occurrence of and risk factors associated with genital warts in Danish men Methods We conducted a cross-sectional, questionnaire-based study among almost 23 000 men aged 18–45 years, randomly sampled from the general population of Denmark. Data was collected on self-reported clinically diagnosed genital warts, and various lifestyle habits. Results Ever having had clinically diagnosed genital warts was reported by 7.9% of the men. The median age at first occurrence was 22 years. Genital warts within the previous 12 months were reported by 0.92% of the men, with a peak of 1.83% among men aged 21–24 years. The likelihood of reporting genital warts was strongly correlated with the lifetime number of sex partners (OR 8.0; 95% CI 6.0 to 10.8 for ≥15 partners vs 1–2 partners). Other factors associated with an increased risk for genital warts included ever having smoked and having had other sexually transmitted infections. Conclusions Almost 8% of Danish men aged 18–45 years reported having had a diagnosis of genital warts. The results provide baseline information for developing and monitoring prevention strategies against genital warts, such as vaccination against human papillomavirus types 6 and 11.

Objectives To estimate the age and type-specific distribution of low-risk (LR) human papillomavirus (HPV) types in cervical samples from women in the general population and to assess the distribution of LR-HPV without the coexistence of high-risk HPV types in different cytology and histology categories. Methods In a cross-sectional study, liquid-based cytology samples (SurePath) were collected over a 3-year period. The samples were HPV tested by Hybrid Capture II (HC2; Digene) and genotyped using a PCR-based assay (INNO-LiPAv2; Innogenetics Inc.). A total of 40 382 women (14–95 years of age) were included in the study. By linkage with the nationwide Pathology Data Bank, the HPV test results were directly linked to cytological diagnoses made from the same samples and to subsequent histology results. Results Overall, 2790 women (6.9%) tested positive for LR-HPV types, with HPV6 and HPV70 being the most frequent types detected, whereas HPV11 was uncommon. The highest prevalence was observed in the youngest age group (≤19 years). The LR-HPV prevalence was 6.3% in women with normal cytology, 33.1% in atypical squamous cells of undetermined significance (ASCUS), 19.6% in low-grade squamous intraepithelial lesion and 12.7% in those with high-grade squamous intraepithelial lesion. When considering women with LR-HPV alone, the prevalence was 2.0% (normal cytology), 11.3% (ASCUS), 2.6% (low-grade squamous intraepithelial lesion) and 0.7% in women with high-grade squamous intraepithelial lesion, respectively. A similar pattern was observed in relation to the histological diagnoses with the majority of LR-HPV infections detected in CIN1 lesions (24.7%). Conclusions LR-HPV types alone are relatively common in ASCUS, whereas LR-HPV types without coexisting high-risk HPV types are virtually never detected in severe cervical lesions.

Background The aim of this study was to assess the prevalence of women reporting ever having genital chlamydia, genital herpes, Trichomonas vaginalis, and gonorrhea, and to identify factors associated with each of these sexually transmitted infections (STIs). Methods The study was based on a large cross-sectional survey conducted in 2004-2005 among randomly sampled women (18-45 years) from the computerized population registries in Denmark, Iceland, Norway, and Sweden. A total of 69,567 women were included in the study. Results The overall prevalence in Denmark, Iceland, Norway, and Sweden was 1.5% for reporting ever having had Trichomonas vaginalis, 1.9% for gonorrhea, 4.8% for genital herpes, and 17.0% for genital chlamydia. The prevalence of each of these STIs varied with birth cohort and country. In addition, they were strongly associated with lifetime number of partners and having a previous diagnosis of another sexually transmitted infection. Moreover, a diagnosis of genital chlamydia or gonorrhea was associated with early age at first intercourse and smoking initiation. Finally, reporting genital chlamydia was associated with early age at drinking initiation, and ever use of hormonal contraceptives and condoms. Conclusion Genital chlamydia occurs frequently among women in the Nordic countries. Risk-taking behavior, particularly sexual behavior, is strongly associated with STIs, which suggest that further information is needed about STIs and their consequences, targeting high-risk groups. There is also a need for continued monitoring of STIs in order to follow the prevalence and to gain further knowledge about risk factors.

Persisting human papillomavirus (HPV) infection is a critical step in cervical carcinogenesis. This study was conducted to determine the type-specific HPV persistence and risk factors for persistence of high-risk HPV infections in a large cohort of Danish women. The study was based on a population-based prospective cohort study of women aged 20-29 years. Participants were interviewed and underwent two gynecological examinations 2 years apart. Women with Hybrid Capture 2 results at enrolment and a follow-up visit were included in the analysis (n = 7,418). Persistence was defined as positivity for the same high-risk HPV type at both examinations. Overall, 4.2% of the women had persistent HPV infection, accounting for 26.9% of the initially HPV-positive women. HPV 16, HPV 58, and HPV 31, all from species group alpha 9, were the most persistent types; however, other high-risk HPV types that are detected rarely in cancer cases were also likely to persist. The number of high-risk HPV types and detection of HPV 16 infection at baseline and ever use of oral contraceptives increased the risk for persistence. The risk factor analyses also showed that use of an intrauterine device decreased the risk for persistent high-risk HPV infection among women with one high-risk HPV type at baseline. No association was found with viral load or smoking. In conclusion, persistent high-risk HPV infection, especially HPV 16 persistence, was common among women positive for high-risk HPV.

Background Human papillomavirus (HPV) is the cause of cervical cancer. To better understand the natural history of HPV, we assessed the incidence of type-specific HPV infection and examined risk factors for acquisition of high-risk (HR) HPV infection in Danish women. Methods A population-based prospective cohort study of women aged 20 to 29 years was conducted. Participants were interviewed and underwent 2 gynaecological examinations 2 years apart. Women for whom Hybrid Capture 2 results were available at both visits were included in the analysis (n = 7454). Results A HR HPV infection was acquired by 12.8% of the women during follow-up. The incidence decreased with increasing age. The commonest types were HPV16, HPV31, and HPV52. HPV66, HPV58, and HPV53 were mainly acquired with other HR types. Multiple HR types were acquired in 50% of the women who became HPV-positive during follow-up. In initially HPV-negative women age, number of sexual partners, and oral contraceptive use were the main risk factors for acquisition, particularly of multiple HR HPV types. Conclusions HPV infections were commonly acquired. We confirmed the sexually transmitted nature of the infection. Our findings show that both the level of potential exposure and other behavioral factors increase the risk for HR HPV acquisition.

The traditional nursing clinical education model of total patient care is becoming inadequate. New models are needed to foster deeper clinical thinking, thereby affecting students' development of clinical judgment. Concept-based learning activities, first introduced in 1990, offer a focus on a specific concept. This study evaluated the effect of concept-based learning activities on the development of clinical judgment in baccalaureate nursing students. The clinical judgment of students who were and were not exposed to concept-based learning activities was compared. Quantitative data were analyzed using a univariate analysis. In addition, a focus group consisting of members of the treatment group provided qualitative data. Results suggest concept-based learning activities are a clinical learning strategy that should be considered by faculty to deepen clinical thinking in preparation for reaching sound clinical judgments.

Several forces are influencing clinical education in the early 21st century. The clinical environment is changing as both patient acuity and patient-to-nurse staffing ratios increase. In many communities, the number of nursing students exceeds the number of clinical placements available. As nursing education moves forward, it is worthwhile to look more closely at how education occurs in the clinical environment regarding student progression from novice to more advanced levels of practice and how best to support development of student clinical judgment. Concept-based learning activities, first described by Heims and Boyd, are used to assist students in examining and addressing fundamental aspects (i.e., concepts) of pediatric patient and family care. The Clinical Judgment Model has been incorporated into concept-based learning activities as a framework to guide student thinking about the concepts.

We investigated the effects of socioeconomic, demographic and health-related indicators on the incidence of and survival from cancers of the cervix, endometrium and ovary diagnosed in 1994-2003 with follow-up through 2006 in Denmark using information from nationwide registers. The analyses were based on the data on 3007 patients with cervical cancer, 3826 with endometrial cancer and 3855 with ovarian cancer in a cohort of 3.22 million persons born between 1925 and 1973 and aged >or=30 years. The incidence of cervical cancer increased with decreasing socioeconomic position; the incidences of endometrial and ovarian cancer were mostly associated with higher disposable income. Relative survival from cervical cancer was the highest among women of high socioeconomic position; increased excess mortality rates from endometrial and ovarian cancer were associated with low educational level, mainly during the first year after diagnosis. Socioeconomic position seemed to affect both the incidence of and the survival from cancers of the female genital organs.

Human papillomavirus (HPV) is considered a necessary cause of cervical cancer. The aim of the current study was to determine the burden of HPV infection among randomly sampled Danish women before the vaccine against HPV is implemented. Further we assessed the risk factor profile for prevalent high risk (HR) HPV infection and infection with multiple HR HPV types.In the present cross-sectional study, we used baseline data from a population-based cohort study where participants were interviewed and had a gynecological examination. Cervical samples were analyzed for HR HPV using Hybrid capture 2 in 10,544 women aged 20-29 years and 1443 women aged 40-50 years. Genotyping was performed using LiPA.The prevalence of HR HPV was 17.9% and 4.4% in women aged 20-29 years and 40-50 years, respectively. HPV16 was the most common HR type overall and among women with abnormal cytology. Multiple HPV types were highly prevalent, notably in the younger cohort. Lifetime number of sexual partners was the main risk factor for HR HPV infection (adj. OR = 2.8 and OR = 3.4 foror =15 partners vs.or =4 in respectively younger and older women), whereas number of recent sexual partners was only associated with risk in younger women. Number of partners, oral contraceptive use and self-reported chlamydia infection increased the risk of having multiple HR HPV types (compared to having a single HR HPV type).HR HPV infection was common among younger women, with HPV16 as the predominant type. We confirmed the importance of sexual activity for the risk of HR HPV infection. In addition, we found that sexual behavior also play an important role for the risk of having multiple HR HPV types.

Reflection is widely used in nursing education to facilitate learning. Student writing and thinking, however, is not always of the quality faculty expect or desire. This project originated from concern about the quality of student descriptions of clinical experiences in a senior-level precepted clinical practicum. Providing students with more structure and guidance for consideration of clinical experiences, as well as thoughtful faculty feedback, can potentially enhance thinking and move students toward increased nursing competence. In this learning activity, a structured guide was used to facilitate reflection. The accompanying rubric was used to evaluate and communicate about progress in the development of student thinking and clinical judgment. AUTHORSReceived: February 4, 2006Accepted: April 12, 2006Ms. Nielsen and Ms. Jester are Instructors, Oregon Health & Science University, School of Nursing, and Ms. Stragnell is Instructor, University of Portland, School of Nursing, Portland, Oregon. Ms. Jester is also Community Health Nurse, Multnomah County Health Department, Portland, Oregon.Address correspondence to Ann Nielsen, MN, RN, Instructor, Oregon Health & Science University, School of Nursing, 3455 SW U.S. Veterans Hospital Road, Portland, OR 97239; e-mail: nielsena@ohsu.edu.

In today's complex, fast-paced world of hospital nursing, new graduate nurses do not have well-developed clinical judgment skills. Nurse preceptors are charged with bridging the gap between new graduates' learning in school and their autonomous practice as RNs. In one large, urban medical center in the U.S., a clinical judgment model and rubric were used as a framework for a new evaluation and orientation process. Preceptors of new graduate nurses who had used the former and new processes described their experiences using the framework. The findings indicated that having a structured framework provided objective ways to evaluate and help develop new graduate nurses' clinical judgment. It is hypothesized that academic clinical supervisors may find such a framework useful to prepare students for transition to practice.

To understand nursing role formation for students enrolled in an accelerated baccalaureate nursing program, end-of-term narrative reflections from 34 students were analyzed over the course of the 15-month program. Using thematic analysis, 4 major themes were identified: evolving role perception, extending nursing student-patient interaction, engaging with health care team and systems of care, and expanding clinical thinking.

We examined the conditions for health research at regional hospitals in Denmark. The study was conducted as an interview-based case study containing interviews with key persons at the governing level as well as medical doctors at the operating level. The results showed that the settings and opportunities regarding health research vary between university hospitals and non-university regional hospitals. However our findings indicate, that focusing on a long-term strategy to implement health research in regional hospitals will enable these to be more active in health research.

The aim of the study was to determine the incidences of anal cancer and high-grade anal intraepithelial neoplasia (AIN2/3) over time in Danish women and men. Describing the burden of anal cancer and AIN may be valuable in future evaluations of the human papillomavirus (HPV) vaccine. We included all anal cancers in the Danish Cancer Register in the period 1978-2008 and all cases of AIN2/3 in the Danish Registry of Pathology. Overall and age-, period- and histology-specific incidence rates were estimated. During the 30-year period, 2,187 anal cancers were identified, two thirds of which were in women. Between 1978-1982 and 2003-2008, the age-standardized incidence rate of anal cancer increased from 0.68 to 1.48 per 100,000 person-years in women and from 0.45 to 0.80 per 100,000 person-years in men. Although there is no systematic screening for AIN in Denmark, we nevertheless identified 608 cases of AIN2/3 during the study period. The average annual percentage change of 5% between 1998 and 2008 represents a steep increase in the incidence of AIN in both genders. Furthermore, the incidence rate of HPV-associated anal cancers increased significantly, whereas that of non-HPV-associated histological types levelled out or even declined during the 30 years of observation. In women, the increase in HPV-associated cancers was more pronounced among those under 60 years of age. Our findings indicate that vaccines against HPV might play an important role in the prevention of anal cancer and its precursor lesions.

In spite of the negative health effects associated with the use of analgesics, little is known about the prevalence of continuous regular use of analgesics or about the factors associated with their use. The objective of this article is to describe continuous regular use of acetaminophen, ibuprofen and aspirin in Denmark and to examine factors associated with their use.The study is based on data from two surveys and includes a random sample of women and men aged 18-45 years from the general Danish population. A total of 22,199 women (response rate 81%) and 23,080 men (response-rate 71%) were included in the study. Data was analyzed using multivariate logistic regression.More women than men reported a regular monthly use of acetaminophen, ibuprofen and aspirin during the past year. Acetaminophen was the most commonly used type of analgesic of which 20% of the women and 13% of the men reported a regular monthly use. Besides poor self-rated health, we found that increasing age, low level of education, living in lesser urbanized areas, smoking and being overweight were associated with a higher risk of having a continuous regular weekly use of acetaminophen, ibuprofen or aspirin.Continuous regular use of analgesics is generally prevalent amongst young Danish men and women. This study demonstrates social inequalities in the use of analgesics, which make this a potential area for intervention that deserves further attention.

Nurses have been volunteering to provide direct patient care in developing countries for several decades. As a result, countries have begun to develop their health care workforce capacity and standards of care, but educational and professional development needs have emerged. Global partnerships involving volunteers can assist developing countries to fulfill these needs, but little literature focuses on maximizing volunteers' experiences. Through global partnerships and collaboration, the leadership and academic capacity of nurses and other health care professionals in developing countries can be enhanced. In Cambodia specifically, the Khmer Rouge executed many educated health care personnel in the late 1970s, effectively eliminating a generation of mentors and leaders that could facilitate the professional development of the current workforce. One outcome may be the dearth of baccalaureate and graduate nursing programs in Cambodia. Two teams of U.S. volunteers and one of their Cambodian partners, a nursing education coordinator at a nongovernmental children's hospital, offer their experiences in collaborating, including the mutual benefits to both of such a partnership and the lessons learned. The authors will delineate several exemplars from their experiences of teaching and professional development.

The aim of our study was to assess the overall trends in the incidence of head-and-neck cancer (HNC) among Danish men and women in 1978-2007, to describe the distribution and incidences of HNCs at different anatomical sites, and to determine whether the incidence of human papillomavirus (HPV)-associated cancers is increasing. Data were extracted from the nationwide Cancer Registry database. To assess the possible impact of HPV infection, the sites of squamous cell carcinomas were categorized as HPV-associated, potentially HPV-associated or HPV-unrelated. In total, 26,474 incident cases were identified and the overall incidence increased throughout the period. Significantly increasing incidence rates were notably seen for tumors in the oral cavity (2.2% per year), tonsils (4.8% per year), oropharynx (3.5% per year) and hypopharynx (4.4% per year). A significantly decreasing incidence of lip cancer was observed among men (-5.0% per year). Cancers at HPV-associated sites (n = 3650) showed strongly increasing incidence rates, primarily in individuals < 60 years. In contrast, HNCs at sites not related to HPV infection showed a significant decrease (in men) or virtually no change in incidence (in women). Our results suggest a marked impact of HPV infection on the epidemiology of HNCs in Denmark. HPV16 is the type most often found in HNCs; thus, the recent introduction of vaccination against HPV may in the future prevent HPV-associated cancers of the head and neck.

Persisting human papillomavirus (HPV) infection is a critical step in cervical carcinogenesis. This study was conducted to determine the type-specific HPV persistence and risk factors for persistence of high-risk HPV infections in a large cohort of Danish women. The study was based on a population-based prospective cohort study of women aged 20-29 years. Participants were interviewed and underwent two gynecological examinations 2 years apart. Women with Hybrid Capture 2 results at enrolment and a follow-up visit were included in the analysis (n = 7,418). Persistence was defined as positivity for the same high-risk HPV type at both examinations. Overall, 4.2% of the women had persistent HPV infection, accounting for 26.9% of the initially HPV-positive women. HPV 16, HPV 58, and HPV 31, all from species group alpha 9, were the most persistent types; however, other high-risk HPV types that are detected rarely in cancer cases were also likely to persist. The number of high-risk HPV types and detection of HPV 16 infection at baseline and ever use of oral contraceptives increased the risk for persistence. The risk factor analyses also showed that use of an intrauterine device decreased the risk for persistent high-risk HPV infection among women with one high-risk HPV type at baseline. No association was found with viral load or smoking. In conclusion, persistent high-risk HPV infection, especially HPV 16 persistence, was common among women positive for high-risk HPV.

Purpose Widespread use of and serious adverse effects associated with use of analgesics accentuates the need to consider factors related to analgesic use. The objective of this study was to describe continuous regular analgesics use and examine factors associated with a continuous regular analgesic use. Methods The study was based on data from two surveys and included a random sample of women and men aged 18–45 years from the general Danish population. Information on analgesics use, self-rated health, demographic and lifestyle factors was collected using a self-administered questionnaire. A total of 28 000 women and 33 000 men were invited to participate and 22 199 women (response-rate 81.4%) and 23 080 men (response-rate 71.0%), respectively, were included in the study. Data were analyzed using multivariate logistic regression. Results We found that 27% of the women and 18% of the men reported a regular monthly use of at least seven analgesic tablets during the last year (continuous regular analgesics use). Besides poor self-rated health we found in both sexes that increasing age, poor self-rated fitness, and smoking were related to a continuous regular analgesics use. Nulliparity, low level of education, overweight/obesity, binge drinking, and abstinence were associated with a continuous regular analgesics use for women, while underweight and marital/cohabiting status were associated with a continuous regular analgesics use only for men. Conclusions Regular monthly analgesic use during the last year was generally prevalent. Besides self-rated health, several socio-demographic and lifestyle factors were associated with a continuous regular analgesic use, although with some gender differences. Copyright © 2009 John Wiley & Sons, Ltd.