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Background:\ud \ud Providing effective weight management to adults with intellectual disabilities is necessary to challenge the high rates of obesity. The aim of this process evaluation was to explore the feasibility of conducting a full‐scale clinical trial of the TAKE 5 multi‐component weight management programme.\ud Methods:\ud \ud The study was a 12‐month pilot cluster‐randomised controlled trial. Adults with intellectual disabilities and obesity were randomised to either TAKE 5, which included an energy deficit diet (EDD) or Waist Winners Too, based on health education principles. A mixed‐methods process evaluation was conducted focussing on the reach, recruitment, fidelity, implementation, dose (delivered/received) and context.\ud Results:\ud \ud The study successfully recruited adults with intellectual disabilities. Both weight management programmes were delivered with high fidelity and implemented as intended. Only one weight management programme, TAKE 5, demonstrated potential efficacy in reducing body weight and body composition. The effectiveness was largely attributed to the EDD and social support from carers.\ud Conclusions:\ud \ud The extensive process evaluation illustrated that a full‐scale trial of a multi‐component programme including an EDD is feasible and an acceptable approach to weight management for adults with intellectual disabilities and obesity.

The objective of the study is to investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme. The study design is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with ‘caseness’ scoring ≥11 and severity ≥14. The participants were all patients who began a weight management programme between 1 October 2008 and 30 September 2009 (n = 1838). The setting was the Glasgow and Clyde Weight Management Service (GCWMS), a specialist multidisciplinary service, which aims to achieve a minimum of ≥5 kg weight loss. The results were as follows: patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment or intervention. Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socio-economically deprived and a higher proportion was female. There was a significant positive correlation between HADS anxiety and depression scores and increasing body mass index (r2 = 0.094, P

As the American Hispanic population grows, the need for health care services for individuals who do not speak English is becoming increasingly apparent. Spanish-speaking persons encounter difficulties accessing health care. This article focusses on the special needs of the Spanish-speaking individual in the health care system and presents strategies for providing culturally appropriate care.

When major economic indicators in Canada are reviewed, the economy of Canada would appear to be very healthy. However, in spite of these general economic indicators, poverty in Canada is growing. Growing poverty has profound implications for health care providers who must deal with the effect of poverty on the health of individuals. This article describes factors which are affecting poverty in Canada and implications for health care professionals.

Luck permeates every aspect of human behaviour. Thus, luck is an aspect of nursing care and client belief of which the nurse should be aware. Beliefs about luck will influence client compliance with recommendations for actions as well as influence actions the client selects in relation to health. Beliefs about luck will also influence actions the nurse may take when responding to clients.

As more and more clients with acquired immunodeficiency syndrome (AIDS) are encountered in health care agencies, it is important that the health care professional be well informed with current facts and information on treatment. Supportive care by the health professional is essential to assist the client in maintaining maximum quality of life and a sense of self-esteem and self-efficacy. It is important for the professional to be aware not only of the supportive care needed by clients but also of the safeguards necessary in such a high-risk profession.

The authors describe Luck of the Draw, a hands-on examination that can be used to test the clinical nursing skills of students or other health-related personnel. Faculty who have implemented this testing technique have found it to be highly superior to paper-pencil skills testing.

There are varied opinions on the commonness of self-talk. Some feel self-talk is engaged in more by persons who feel insecure and question their performance (Cauchon, 1994). Others feel self-talk is a process people use continually to describe and interpret the world, accurate or inadequate as the case may be. (Hansen, Rhode, and Wolf-Wilets, 1991; Braiker, 1989). Regardless of how much self-talk the nurse is aware of in interacting with clients and intrapsychically, it is important to assess thoughts for their logic or illogicality. Illogical thoughts should be replaced by positive words of encouragement, which will in turn raise the client's or nurse's self-concept and level of self-confidence. Making self-talk positive is always good nursing practice.

This article was written to help nurses assist elderly women adjusting to change and loss. It describes dynamics that may be present during change and loss such as loneliness and powerlessness. Specific strategies for communicating caring in the operating room are described.

Loneliness is a painful human experience to which spouses of the geriatric patient are particularly vulnerable. The nurse is frequently in a position to assess not only the patient but the spouse. When factors that may lead to loneliness are present, the nurse can intervene to prevent loneliness. When symptoms of loneliness are present in the spouse or patient, the nurse may act to alleviate disabling feelings of isolation.

Home care providers must assess clients for any difficulties they may have with adjusting to changes and losses in their lives. They should consider the possibility that clients may be depressed and at risk for suicide. Home care providers' attention to psychologic dynamics may help a client face the losses that accompany growing older with integrity rather than despair.

We present a novel reasoning calculus for Description Logics (DLs)-knowledge representation formalisms with applications in areas such as the Semantic Web. In order to reduce the nondeterminism due to general inclusion axioms, we base our calculus on hypertableau and hyperresolution calculi, which we extend with a blocking condition to ensure termination. To prevent the calculus from generating large models, we introduce "anywhere" pairwise blocking. Our preliminary implementation shows significant performance improvements on several well-known ontologies. To the best of our knowledge, our reasoner is currently the only one that can classify the original version of the GALEN terminology. © Springer-Verlag Berlin Heidelberg 2007.

OBO is an ontology language that has often been used for modeling ontologies in the life sciences. Its definition is relatively informal, so, in this paper, we provide a clear specification for OBO syntax and semantics via a mapping to OWL. This mapping also allows us to apply existing Semantic Web tools and techniques to OBO. We show that Semantic Web reasoners can be used to efficiently reason with OBO ontologies. Furthermore, we show that grounding the OBO language in formal semantics is useful for the ontology development process: using an OWL reasoner, we detected a likely modeling error in one OBO ontology. © 2008 Springer-Verlag Berlin Heidelberg.

Role play is a useful teaching strategy for nursing education. This strategy can simulate patient behaviors, as well as demonstrate nursing interventions that students must learn to be clinically competent. Role play is a dramatic technique that encourages participation to improvise behaviors that may be encountered in nurse-patient situations. Using this technique, participants may test behaviors and decisions in an experimental atmosphere without risk of negative effects in a relationship. Role play is useful in developing cultural competence because participants may experience diverse roles. Cultural competence is the ability to care for patients in a culturally sensitive and appropriate manner. In role play, students may participate as culturally diverse patients or as nurses encountering patients from different cultures. Various teaching strategies facilitate successful use of role play in the classroom, including defining a time frame, selected roles, specific objectives, references, and grading criteria. Tb optimize learning, the importance of exploration and analysis must be emphasized. Many benefits and potential problems accompany use of role play.

Summary Family members, residents, and care givers often react negatively when perfection is demanded by the geriatric patient. This type of reaction presents a challenge to the nurse providing care. When a geriatric patient is perfectionistic, it is important to step back, to observe and assess, and to plan appropriate strategies that will facilitate the patient's adjustment. When the behavior is related to situational stressors, it may be appropriate to respond to the stressors and ignore the behavior. When the behavior results from a feeling of loss of control and powerlessness, intervention should be directed in that direction. In any case, actions of the nurse should respond to the patient's need for self-esteem and improved ability to cope with the environment. Responding to the perfectionistic geriatric patient presents a particular challenge to the nurse in long-term care, and the nurse's strategic intervention can significantly increase the patient's ability to adjust to the ongoing changes that accompany the aging process.

For many clients in home care with chronic illness the real work of getting well involves learning to adjust to chronic illness and to disability. Learning to adjust to disability by maximizing the abilities and qualities that are present can mean overcoming otherwise very significant problems while still maintaining a high quality of life. Home care providers play an important role in helping clients and their families optimize functioning to do the real work of getting “well.”

Clients with chronic disability often define themselves in terms of their sick role. Today, many healthcare professionals and laypersons alike prefer to view the individual as a unified whole striving toward high-level wellness. Thus, a client may be diagnosed with a physical illness, a chronic illness, or a disability but may still work to attain high-level wellness by functioning in an integrated way with the environment. This article describes the client with chronic disability in relation to high-level wellness and provides techniques nurses can use to facilitate a client's positive adjustment.

Home care and hospice nurses constantly face stressful situations with patients and caregivers, working from the field and meeting the expectations of the workplace and their own personal and family goals. This article explores the many ways humor can be used by the nurse in relieving stressors encountered every day.

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A two-part study was undertaken to determine if all patients with uncomplicated ureteric colic require admission. The analgesic requirements and outcome in 31 patients admitted with ureteric colic were assessed; 20/31 (64%) required no further analgesia after admission and 8/31 (26%) required only oral/rectal analgesia. In the second part of the study a protocol was introduced allowing patients with no complicating factors to be discharged directly from the A&E department. Of 58 patients seen in the A&E department, 29 were discharged for outpatient follow-up. Of these patients, 19 required no additional acute hospital treatment, five returned for further parenteral analgesia but outside the time they would have stayed in hospital under our previous protocol (ie beyond 48 h) and three returned within 48 h of their first attendance with pain which had not responded to oral analgesics. No patient discharged from A&E subsequently required intervention for obstruction or infection. We conclude that it is not necessary to admit patients with uncomplicated ureteric colic if the initial colic has been relieved and there is adequate social support.