bluuebunny/crossref_metadata_2025 huggingface dataset:
Feedback preferences of patients, professionals and health insurers in integrated head and neck cancer care
Authors: van Overveld Lydia F. J. , Takes Robert P. , Vijn Thomas W. , Braspenning Jozé C. C. , de Boer Jan P. , Brouns John J. A. , Bun Rolf J. , van Dijk Boukje A. C. , Dortmans Judith A. W. F. , Dronkers Emilie A. C. , van Es Robert J. J. , Hoebers Frank J. P. , Kropveld Arvid , Langendijk Johannes A. , Langeveld Ton P. M. , Oosting Sjoukje F. , Verschuur Hendrik P. , de Visscher Jan G. A. M. , van Weert Stijn , Merkx Matthias A. W. , Smeele Ludi E. , Hermens Rosella P. M. G.
Published: June 2017

Background

Audit and feedback on professional practice and health care outcomes are the most often used interventions to change behaviour of professionals and improve quality of health care. However, limited information is available regarding preferred feedback for patients, professionals and health insurers.

Objective

Investigate the (differences in) preferences of receiving feedback between stakeholders, using the Dutch Head and Neck Audit as an example.

Methods

A total of 37 patients, medical specialists, allied health professionals and health insurers were interviewed using semi‐structured interviews. Questions focussed on: “Why,” “On what aspects” and “How” do you prefer to receive feedback on professional practice and health care outcomes?

Results

All stakeholders mentioned that feedback can improve health care by creating awareness, enabling self‐reflection and reflection on peers or colleagues, and by benchmarking to others. Patients prefer feedback on the actual professional practice that matches the health care received, whereas medical specialists and health insurers are interested mainly in health care outcomes. All stakeholders largely prefer a bar graph. Patients prefer a pie chart for patient‐reported outcomes and experiences, while Kaplan‐Meier survival curves are preferred by medical specialists. Feedback should be simple with firstly an overview, and 1‐4 times a year sent by e‐mail. Finally, patients and health professionals are cautious with regard to transparency of audit data.

Conclusions

This exploratory study shows how feedback preferences differ between stakeholders. Therefore, tailored reports are recommended. Using this information, effects of audit and feedback can be improved by adapting the feedback format and contents to the preferences of stakeholders.
How does the side‐effect information in patient information leaflets influence peoples’ side‐effect expectations? A cross‐sectional national survey of 18‐ to 65‐year‐olds in England
Authors: Webster Rebecca K. , Weinman John , Rubin G. James
Published: June 2017

Objectives

To establish how the terms recommended by the European Commission to describe side‐effect risk in patient information leaflets (PILs) influences expectations of side‐effects and to identify factors associated with these side‐effect expectations.

Design

A cross‐sectional online survey was carried out by a market research company.

Setting

Data were collected in England between 18th March and 1st April 2016.

Participants

A total of 1003 adults aged between 18 and 65. Main outcome measures: Self‐reported expectation that the described side‐effects would affect participants if they took the medicine, measured on a likelihood scale from 1 (very unlikely) to 5 (very likely).

Results

Participants formed high expectations of side‐effects for “very common” and “common” side‐effects, with 51.9% and 45.0% of participants rating these as “very likely” or “likely” to happen to them, respectively. This fell to 8.1% for “uncommon,” 5.8% for “rare” and 4.1% for “very rare.” For each descriptor, higher expectations of side‐effects were more associated with women or being from an ethnic minority, or having less education, a household illness, high perceived sensitivity to medicines or negative beliefs about medicines.

Discussion

The current use of verbal descriptors to communicate side‐effect risk in PILs leads to high side‐effect expectations. These expectations could contribute to nocebo‐induced medication side‐effects experienced by patients. Additional work is required to identify ways to improve the way risk information is conveyed in PILs.
High expression of heat shock proteins and heat shock factor‐1 distinguishes an aggressive subset of clear cell renal cell carcinoma
Authors: Wu Pao‐Shu , Chang Yen‐Hwa , Pan Chin‐Chen
Published: June 2017

Aims

Heat shock proteins (HSPs) are a group of molecules induced by a variety of environmental and pathophysiological stresses, including cancer. HSPs are implicated in the regulation of apoptosis and immunity in neoplasm. Transcription factor heat shock factor 1 (HSF1) acts as the master regulator to control HSP expression, and is therefore involved in tumorigenesis. The purpose of this study was to evaluate the expression and clinicopathological relevance of HSPs and HSF1 in clear cell renal cell carcinoma (ccRCC).

Methods and results

The expression of HSP27, HSP60, HSP70, HSP90 and HSF1 was assessed in 428 cases of ccRCC using immunohistochemistry. High expression of HSP60 and HSP70 was correlated positively with grade and stage. High expression of HSF1 was correlated positively with stage. Univariate and multivariate analyses demonstrated that 216 patients (52%) with tumour expressing three or four markers in a panel of HSP60, HSP70, HSP90 and HSF1 had a significantly heightened risk for cancer‐specific mortality than tumours expressing fewer than three markers (P < 0.0001; concordance index, 0.81).

Conclusions

Immunohistochemical examination of HSPs and HSF1 provides useful prognostic information that may contribute to the design of therapeutic strategies for patients with ccRCC.
The prevalence and composition of asset poverty in Canada: 1999, 2005, and 2012
Authors: Rothwell David , Robson Jennifer
Published: June 2017

A household is considered asset poor if its assets (financial assets or net worth, taken separately) are insufficient to maintain well‐being at a low‐income threshold for 3 months. We provide the first national‐level estimates of asset poverty for Canada, using the 1999, 2005, and 2012 cycles of the Survey of Financial Security, and juxtapose these estimates with income poverty. The analysis provides new insight into economic insecurity by showing that asset poverty rates are consistently two to three times higher than income poverty rates. In addition to the prevalence of asset poverty across socio‐demographic groups, we analyzed how the composition of the poor change over time. Age and geography shape the risk for asset poverty in distinct ways. We found that while education appears to play a comparable role in shaping both income poverty and asset poverty, immigration places Canadians at a relatively higher risk of income poverty but not asset poverty.

Key Practitioner Message: • Practitioners ought to consider assets as well as income in assessing economic vulnerability; • Asset poverty levels are 2–3 times higher than income poverty levels; • Certain groups (e.g., immigrants) may be income poor but maintain sufficient assets.
T follicular regulatory cells in mice and men
Authors: Maceiras Ana Raquel , Fonseca Valter R. , Agua‐Doce Ana , Graca Luis
Published: June 2017

It has long been known that CD4 T cells are necessary to provide help to B cells, triggering a germinal centre (GC) reaction where affinity maturation and isotype switching occur. However, the nature of the dedicated CD4 helper T cells, known as T follicular helper (Tfh), was only recently described. Here, we review the biology and function of the recently described T follicular regulatory (Tfr) cells, another CD4 T‐cell population also found within GCs but with regulatory function and characteristics. Tfr cells have been identified in mice and humans as simultaneously presenting characteristics of T follicular cells (namely CXCR5 expression) and regulatory T cells (including Foxp3 expression). These Tfr cells have been implicated in the regulation of the magnitude of the GC reaction, as well as in protection from immune‐mediated pathology.
Psychometric assessment of the cultural capacity scale Spanish version in Chilean nursing students
Authors: Cruz J.P. , Machuca Contreras F.A. , Ortiz López J.E. , Zapata Aqueveque C.A. , Vitorino L.M.
Published: June 2017

Aim

To assess the psychometric properties of the Cultural Capacity Scale Spanish version in Chilean nursing students.

Background

The increased diversity in healthcare facilities and the current shortage of local nursing workforce in Chile present a significant challenge to the nursing education to train future competent local nurses. To facilitate cultural competence development among Chilean nursing students, it is necessary to regularly assess their cultural competence, which necessitates a culturally adapted valid and reliable tool.

Methods

A convenience sample of 502 Chilean nursing students was surveyed in this cross‐sectional study using the culturally adapted scale. Reliability of the instrument was established by internal consistency and stability reliability, while validity was established by content and construct.

Results

The Cronbach's α value of the entire scale was 0.95, and the test–retest reliability was 0.85. The Corrected Item‐Total Correlations ranged from 0.45 to 0.78. The tool manifested an excellent content and construct validity. The exploratory factor analysis confirmed a single factor of the scale.

Discussion

The tool demonstrated evidence of internal consistency, stability reliability, content validity and construct validity. The study provided cross‐cultural evidence for the potential application of this scale in Chile and other Spanish‐speaking countries.

Conclusion

The Cultural Capacity Scale Spanish version demonstrated sound psychometric properties for assessing the cultural competence of Chilean nursing students.

Limitations

The sample was restricted to one university, and the tool was only used in Chilean nursing students.

Implications for nursing policy

The establishment of the Spanish version of the tool will facilitate accurate and timely monitoring of the cultural competence among Chilean nursing students and other Spanish‐speaking nursing students and nurses, which can inform the creation of nursing policies aimed at ensuring cultural competence development.
Oncogenesis in ovarian cancer
Authors: Børresen Anne‐Lise
Published: June 2017

Tumorigenesis is a multistep process involving mutations of dominantly acting proto‐oncogenes and mutations and loss‐of‐function mutations of tumor suppressor genes. Some of these mutations may be inherited, but most of them are acquired. Models for the sequential steps of the genetic changes involved in tumor development have been proposed for certain cancers, such as colon cancer. In the case of ovarian cancer, relatively little is known about the genetic events associated with the initiation or subsequent progression and metastases of the tumor. Cytogenetic analysis has revealed a high incidence of both structural and numerical chromosome changes, and the extent of these changes seems to increase with tumor progression. Oncogene activations of the proto‐oncogenes K‐ras, c‐myc and c‐erbB‐2 have been found more frequently in aggressive ovarian tumors and may be associated with poor survival. Tumor‐specific allele loss involving putative tumor suppressor genes has been observed for loci at chromosomes 11p, 17p, and 17q, ‐ loci commonly deleted in other cancers too. A relatively high incidence of allelic loss on chromosome 6q appears to be specific to ovarian carcinoma. Familial breast/ovarian cancer has been suggested to map to chromosome 8q. Recently we have found a germ‐line mutation in the tumor suppressor gene p53 in a family with breast‐ and ovarian cancers, indicating that this is the predisposing gene in this family. Genetic changes important for the etiology of ovarian cancers seem to involve both somatic mutations of oncogenes and somatic or germ‐line inactivation of tumor suppressor genes.
Intracellular actions of steroid hormones and their therapeutic value, including the potential of radiohalosteroids against ovarian cancer
Authors: Holt John A. , Scharl Anton , Kullander Stig , Beckmann Matthias W.
Published: June 2017

The biological activities of steroid hormones are effected via intracellular receptors. The receptors are part of a ligand‐activated family of transcription regulator proteins that are critical for steroid‐regulated cell differentiation. With recombinant cDNA technology, yeast and cultured animal cells can be made to express mammalian cDNA steroid receptors from cDNA clones that contain deletions and substitutions. Among the leading problems addressed in these models is the characterization of sequences that promote association or interaction with other transcription regulating molecules, including oncogene products. Recently it has been found that heat shock proteins may serve not only to stabilize the receptor proteins but also to precondition the activation imparted by ligand binding. Aberrant receptor proteins can be found in ovarian cancer. Whether aberrant receptor proteins are associated with transformation in general or with a variable clinical response to steroidal or anti‐steroidal therapy is not known. Even after chemotherapy, steroid receptors are expressed in the metastases of ovarian cancers seen clinically, and they may have potential uses for localization and treatment of receptor‐rich cancers. Radioligand pharmaceuticals appropriate for imaging or for site‐directed radiocytotoxicity can be sequestered to the nuclei of receptor‐rich cancers. Initial clinical imaging and therapy trials with such pharmaceuticals have been approved and begun. In the use of halogenated estrogen radiopharmaceuticals, liver metabolism and enterohepatic recirculation are important considerations. Ascites prolongs retention of a radiohalogenated estrogen in the abdominal cavity. Distant metastases have been localized with [l23I]‐estrogen in breast cancer patients in pre‐operative procedures. Receptor‐mediated cytotoxicity occurs when estrogen receptor radioligand pharmaceuticals that are Auger electron emitters are used in vitro.
Role of carboplatin in ovarian cancer
Authors: Ozols Robert F.
Published: June 2017

Carboplatin is a cisplatin analog that causes less nephrotoxicity, neurotoxicity and nausea and vomiting than its parent compound. In prospective clinical trials, carboplatin has been shown to be as active, but less toxic, than cisplatin in previously untreated patients with advanced ovarian cancer. However, carboplatin has not led to improved survival, compared with cisplatin. Studies are in progress to reduce the dose‐limiting myelo‐suppression of carboplatin in order to increase the dose intensity. In addition, new carboplatin combinations are also to be evaluated in clinical trials. The molecular basis for resistance to platinum compounds is also undergoing study and future clinical trials will evaluate modulations of resistance.
Aminoterminal propeptide of type III procollagen in ovarian cancer
Authors: Risteli Leila , Risteli Juha , Puistola Ulla , Tomás Candido , Zhu Guo‐Guang , Kauppila Antti
Published: June 2017

The concentration of the aminoterminal propeptide of type III procollagen (PIIINP) in serum is a measure of the activity of the metabolism of type III collagen, which is a major constituent of soft connective tissues and of the connective tissue stroma of solid tumours. In advanced ovarian carcinoma, serum PIIINP serves as a tumour‐associated antigen, its changes reflecting and preceding changes in the clinical behaviour of the malignancy. Elevated values of serum PIIINP are also observed in endometrial and cervical malignancies, though less frequently than in ovarian tumours. Very high concentrations of PIIINP are found in ovarian carcinoma ascites, suggesting an ongoing fibroproliferative reaction in the peritoneal cavity as a response to the tumour.
Radio‐immunotargeting in experimental animal models of intraperitoneal cancer
Authors: Fjeld J. G. , Vergote I. , De Vos L. , Nustad K.
Published: June 2017

The field of immunotargcting, and the challenges met when this technique is applied in experimental animals or in patients, are reviewed. Even with highly specific monoclonal antibodies, non‐specific uptake in normal tissues and high background level of unbound radioactivity in blood and extravascular body fluids remain significant problems. Further experimental work in animal model systems is needed to bring this technique from the state of being an experimental method, with limited clinical application, to a routine diagnostic or therapeutic method. Different animal models are available, and their potential for elucidation of the various methodological problems in radio‐immunotargeting are discussed in the present paper. In our laboratory, two intraperitoneal models were devised, having relevance for gynecologic and other forms of intraperitoneal malignancies. These models were elaborated with special emphasis on the possibility for exact measurement of important parameters in immunotargcting reactions. In the first model, hybridoma cells are inoculated intraperitoneally to mimic intraperitoneal carcino‐matosis, and the monoclonal antibody produced by the hybridoma is used as serum tumor marker. In the second model the tumor cells are contained within intraperitoneally implanted micropore chambers, resembling a localized tumor. An artificial tumor like this allows control with the antigen load in the target, and measurement of the concentration of the injected antibody in the fluid within the target.
Intensive prolonged exposure treatment for adolescent complex posttraumatic stress disorder: a single‐trial design
Authors: Hendriks Lotte , de Kleine Rianne A. , Heyvaert Mieke , Becker Eni S. , Hendriks Gert‐Jan , van Minnen Agnes
Published: June 2017

Background

The current study evaluated the effectiveness and safety of intensive prolonged exposure (PE) targeting adolescent patients with complex posttraumatic stress disorder (PTSD) and comorbid disorders following multiple interpersonal trauma.

Methods

Ten adolescents meeting full diagnostic criteria for PTSD were recruited from a specialized outpatient mental health clinic and offered a standardized intensive PE. The intensive PE consisted of three daily 90‐min exposure sessions delivered on five consecutive weekdays, followed by 3 weekly 90‐min booster sessions. In a single‐trial design, the participants were randomly allocated to one of five baseline lengths (4–8 weeks) before starting the intensive PE. Before, during, and after intensive PE completion, self‐reported PTSD symptom severity was assessed weekly as a primary outcome (a total of 21 measurements). Furthermore, clinician‐administered PTSD diagnostic status and symptom severity (primary outcome), as well as self‐reported comorbid symptoms (secondary outcomes), were assessed at four single time points (baseline‐to‐6‐month follow‐up).

Results

Time‐series analyses showed that self‐reported PTSD symptom severity significantly declined following treatment (p = .002). Pre‐postgroup analyses demonstrated significant reductions of clinician‐administered PTSD symptom severity and self‐reported comorbidity that persisted during the 3‐ and 6‐month follow‐ups (all ps < .05), where 80% of adolescents had reached diagnostic remission of PTSD. There was neither treatment dropout nor any adverse events.

Conclusions

The results of this first proof of concept trial suggest that intensive PE can be effective and safe in an adolescent population with complex PTSD, although the gains achieved need to be confirmed in a randomized controlled trial.
Effect of two different polishing systems on fluoride release, surface roughness and bacterial adhesion of newly developed restorative materials
Authors: Bayrak Gokcen Deniz , Sandalli Nuket , Selvi‐Kuvvetli Senem , Topcuoglu Nursen , Kulekci Guven
Published: June 2017

Objectives

To evaluate the effects of two different polishing systems on fluoride release, surface roughness and bacterial adhesion of five restorative materials

Materials and Methods

The study groups were comprised of five different restorative materials, Beautifil II (B); GCP Glass Fill (G); Amalgomer CR (A); Dyract XP (D); Fuji IX GP (F) and 21 specimens were prepared from each material. Each group was divided into three subgroups according to the polishing system: Mylar (control) (C), Sof‐lex (S), and Enhance‐Pogo (EP). The amount of fluoride release was measured using a fluoride ion‐selective electrode and surface roughness was investigated with a profilometer. Bacterial adhesion on the materials was evaluated by optical density readouts for S.mutans on a spectrophotometer.

Results

The highest amount of fluoride was released from specimens in the S subgroup of group G during all measurement days. Surface roughness values were significantly lower in subgroup C than the other polishing systems in all study groups except group G (P < .05). Group A displayed significantly higher surface roughness values than the other material groups in both subgroups (S and EP) (P < .01). Highest bacterial adhesion was observed in the EP subgroup of group A.

Conclusions

Polishing promoted a significant increase of fluoride release on restorative materials especially in glass ionomer‐based materials.

CLINICAL SIGNIFICANCE

This article stated that polishing promoted a significant increase of fluoride release on restorative materials especially in glass ionomer‐based materials. Further, proper polishing systems must be chosen according to the structure and composition of materials to provide the best clinical benefits in terms of fluoride release, surface roughness and bacterial adhesion.
Soluble CD163 and mannose receptor associate with chronic hepatitis B activity and fibrosis and decline with treatment
Authors: Laursen Tea Lund , Wong Grace Lai‐Hung , Kazankov Konstantin , Sandahl Thomas , Møller Holger Jon , Hamilton‐Dutoit Stephen , George Jacob , Chan Henry Lik‐Yuen , Grønbæk Henning
Published: June 2017

Background and Aim

Liver macrophages are activated in chronic hepatitis B virus (CHB) infection and play a pivotal role in hepatic inflammation and fibrosis. However, their role during antiviral treatment is unclear. The soluble (s) macrophage activation markers, sCD163 and mannose receptor (sMR), are released during liver damage, and their serum levels reflect liver disease severity and portal hypertension. We aimed to investigate associations between sCD163 and sMR and histopathological activity and fibrosis and changes in sCD163, sMR, and hepatic CD163‐expression following antiviral treatment in CHB patients.

Methods

We assessed Ishak histological necroinflammatory activity and fibrosis scores in liver biopsies from 254 CHB patients and serially in 71 patients before and after nucleoside‐analogue treatment. Liver CD163‐expression was semi‐quantitatively determined by immunohistochemistry and serum sCD163 and sMR measured by enzyme‐linked immunosorbent assays.

Results

Before treatment, the mean levels of sCD163 and sMR were 3.57 (SD 1.72) mg/L and 0.35 (0.12) mg/L. sCD163 and sMR increased with histological inflammatory activity (sCD163: r = 0.46, P < 0.00001; sMR: r = 0.48, P < 0.00001) and correlated positively with fibrosis (sCD163: OR 1.16, 95% CI:1.03–1.31; sMR: OR 1.34, 95% CI:1.13–1.59); both were markers of fibrosis independent of other biochemical parameters and risk factors. Antiviral treatment significantly reduced sCD163 (3.76 [1.46] vs 2.31 [0.95], P < 0.00001), sMR (0.37 [0.1] vs 0.29 [0.07], P < 0.00001) and hepatic CD163‐expression (P = 0.0002).

Conclusion

The macrophage activation markers sCD163 and sMR were associated with activity and fibrosis in liver biopsies from CHB patients. Both serum markers decreased with antiviral treatment, along with decreased hepatic CD163 expression.
Clinical validation of the nursing diagnosis of ineffective protection in haemodialysis patients
Authors: de Sá Tinôco Jéssica Dantas , de Paiva Maria das Graças Mariano Nunes , de Queiroz Frazão Cecília Maria Farias , Lucio Kadyjina Daiane Batista , Fernandes Maria Isabel da Conceição Dias , de Oliveira Lopes Marcos Venicios , de Carvalho Lira Ana Luisa Brandão
Published: June 2017

Aims and objectives

To evaluate the clinical validity of indicators of the nursing diagnosis of “ineffective protection” in haemodialysis patients.

Background

Haemodialysis patients have reduced protection. Studies on the nursing diagnosis of “ineffective protection” are scarce in the literature. The use of indicators to diagnose “ineffective protection” could improve the care of haemodialysis patients. The clinical usefulness of the indicators requires clinical validation.

Design

This was a diagnostic accuracy study.

Method

This study assessed a sample of 200 patients undergoing haemodialysis in a reference clinic for nephrology during the first half of 2015. Operational definitions were created for each clinical indicator based on concept analysis and content validation by experts for these indicators. Diagnostic accuracy measurement was performed with latent class analysis with randomised effects.

Results

The clinical indicator of “fatigue” had high sensitivity (p = .999) and specificity (p = 1.000) for the identification of “ineffective protection.” Additionally, “maladaptive response to stress” (p = .711) and “coagulation change” (p = .653) were sensitive indicators. The main indicators that showed high specificity were “fever” (p = .987), “increased number of hospitalisations” (p = .911), “weakness” (p = .937), “infected vascular access” (p = .962) and “vascular access dysfunction” (p = .722).

Conclusion

A set of nine clinical indicators of “ineffective protection” were accurate and statistically significant for haemodialysis patients. Three clinical indicators showed sensitivity, and six indicators showed specificity.

Relevance to clinical practice

Accurate measures for nursing diagnoses can help nurses confirm or rule out the probability of the occurrence of “ineffective protection” in patients undergoing haemodialysis.
The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study
Authors: Schwarz Maria , Coccetti Anne , Murdoch Allison , Cardell Elizabeth
Published: June 2017

Aims and objectives

To determine presence of clinical complications related to dysphagia and to explore their operational outcomes.

Background

Dysphagia is a common complication of stroke. The management of poststroke dysphagia is multidisciplinary with nurses playing a key role in screening for dysphagia risk, monitoring tolerance of food and fluids and checking for the development of complications such as fever, dehydration and change in medical status. Dysphagia often results in further complications including aspiration pneumonia and the need for nasogastric feeding. Dysphagia‐related complications have been shown to have a significant impact on morbidity and mortality, length of stay and cost of admission.

Design

Retrospective cohort study.

Methods

A total of 110 patients presenting with an ischaemic stroke were chart‐audited.

Results

Aspiration pneumonia poststroke was found to be significantly associated with increased overall length of stay, poorer functional outcomes poststroke as well as being associated with a high risk of mortality. The presence of a nasogastric tube was also associated with reduced functional outcomes poststroke and increased risk of death.

Conclusion

High prevalence and cost of complications associated with stroke highlight the complexity of providing nursing and allied health care to this patient population. This provides a snapshot of dysphagia‐related complications experienced by stroke patients.

Relevance to clinical practice

This paper highlights that poststroke complications can significantly impact on patient outcomes and operational factors such as cost of admission; therefore, poststroke care requires a multidisciplinary approach to management. Furthermore, preventing and managing complications poststroke is a key element of nursing care and has the potential to significantly reduce incidence of mortality, length of stay and cost of hospital admission.
To break the weight gain—A qualitative study on the experience of school nurses working with overweight children in elementary school
Authors: Thorstensson Stina , Blomgren Carola , Sundler Annelie J. , Larsson Margaretha
Published: June 2017

Aims and objectives

To describe the experiences of school nurses working with overweight schoolchildren.

Background

School nurses play an important role in health promotion of overweight children. Lifestyle changes and interventions to address being overweight can improve health outcomes and decrease the risk for future health problems.

Design

A descriptive and qualitative design with a phenomenological approach was used. Data were gathered through interviews with school nurses working with overweight schoolchildren in Swedish elementary school; the data were subsequently analysed for meanings.

Results

Working with overweight children was perceived as demanding and challenging by the school nurses who found conversations on this topic emotionally loaded and complex. In addition, the school nurses needed to be sensitive and supportive to succeed in their support for a healthier everyday life for the schoolchildren. It was stated as important to find ways to break the child's weight gain and to cooperate with the parents in this work. The children's decrease in weight was experienced to be more successful when making small, step‐by‐step changes together with the child and his or her parents.

Conclusions

This study concludes that health talks about being overweight may be a challenge for school nurses. Strategies used to manage and succeed in this work included engaging in motivational conversations, working step by step and cooperating with the child's parents. Furthermore, the nurses experienced that they needed to provide emotional support for overweight children during school time.

Relevance to clinical practice

The school nurses’ health promotion needs to focus on how to break weight gain in overweight children. In this work, the nurses’ sensitiveness seems pivotal. Further research is needed on school nurses’ work with health promotion and support of overweight children concerning how to perform efficient communication and cooperation with the children and their parents.
Older patients with late‐stage COPD: Their illness experiences and involvement in decision‐making regarding mechanical ventilation and noninvasive ventilation
Authors: Jerpseth Heidi , Dahl Vegard , Nortvedt Per , Halvorsen Kristin
Published: June 2017

Aims and objectives

To explore the illness experiences of older patients with late‐stage chronic obstructive pulmonary disease and to develop knowledge about how patients perceive their preferences to be taken into account in decision‐making processes concerning mechanical ventilation and/or noninvasive ventilation.

Background

Decisions about whether older patients with late‐stage chronic obstructive pulmonary disease will benefit from noninvasive ventilation treatment or whether the time has come for palliative treatment are complicated, both medically and ethically. Knowledge regarding patients' values and preferences concerning ventilation support is crucial yet often lacking.

Design

Qualitative design with a hermeneutic–phenomenological approach.

Methods

The data consist of qualitative in‐depth interviews with 12 patients from Norway diagnosed with late‐stage chronic obstructive pulmonary disease. The data were analysed within the three interpretative contexts described by Kvale and Brinkmann.

Results

The participants described their lives as fragile and burdensome, frequently interrupted by unpredictable and frightening exacerbations. They lacked information about their diagnosis and prognosis and were often not included in decisions about noninvasive ventilation or mechanical ventilation.

Conclusion

Findings indicate that these patients are highly vulnerable and have complex needs in terms of nursing care and medical treatment. Moreover, they need access to proactive advanced care planning and an opportunity to discuss their wishes for treatment and care.

Relevance to clinical practice

To provide competent care for these patients, healthcare personnel must be aware of how patients experience being seriously ill. Advanced care planning and shared decision‐making should be initiated alongside the curative treatment.
Jordanian nurses’ perception and interventions related to promoting smoking cessation
Authors: Khalaf Inaam A , Abu‐Moghli Fathieh A , LaRocco Susan A , Al‐Maharma Dua’ Y
Published: June 2017

Aims and objectives

To determine nurses’ perceptions related to smoking cessation, health promotion and interventions provided to hospitalised patients.

Background

Smoking is a major health problem in Jordan. The cost for treating smoking‐related health conditions is a significant strain on the healthcare system. Nurses are in an ideal position to encourage smoking cessation. Little is known about Jordanian nurses’ perceptions related to smoking cessation issues.

Methods

A qualitative design was used to collect data from 22 Jordanian nurses using focus groups. Purposive sampling was used to select the study participants. Content analysis was conducted, to determine themes related to the research questions.

Results

Nurses indicated that smoking cessation counselling is important. However, they did not feel that their counselling was very effective. Nurses indicated that the presence of a well‐defined hospital policy regarding smoking was a facilitator to smoking cessation and antismoking clinics would also help to decrease smoking. Challenges to nurses’ interventions included lack of hospital policy, lack of time and nurses who smoke could not be role models or provide effective counselling. Regarding decreasing smoking in Jordan, nurses had suggestions that included scare techniques and increasing taxes on cigarettes as well as enforcing policies that prevent cigarette sales to children under 16.

Conclusions

Nurses are well aware of the hazards of smoking and indicate a belief that encouraging smoking cessation is an appropriate activity. Changes in smoking rules and the enforcement of rules, as well as increased public health efforts related to smoking cessation, are necessary to decrease smoking prevalence in Jordan.

Relevance to clinical practice

Training in smoking cessation counselling and increased awareness of the resources may increase nurses’ ability to have an impact on decreasing the smoking prevalence in Jordan.
Experiences of registered nurses transitioning from employment in acute care to primary health care—quantitative findings from a mixed‐methods study
Authors: Ashley Christine , Halcomb Elizabeth , Brown Angela , Peters Kath
Published: June 2017

Aims and objectives

To describe the experiences of registered nurses who transition from acute to primary health care (PHC) employment.

Background

Internationally the provision of health care in PHC settings is increasing. Nurses are moving from acute care employment to meet the growing demand for a PHC workforce. However, little is known about the transition experiences of these nurses.

Design

A sequential mixed‐methods study comprising a survey, and semi‐structured interviews. This study reports on survey findings relating to the transition experience.

Methods

Convenience and snowballing techniques were used to recruit 111 registered nurses who had transitioned from Australian acute settings to PHC employment within the last 5 years. An online survey gathered data relating to personal and professional demographics, type of PHC setting and transition experiences.

Results

Most respondents (n = 90, 81.1%) reported receiving some orientation, although the length and content varied considerably. Those working in metropolitan locations were more likely to report concerns associated with their orientation, with respondents from rural or remote locations more likely to have access to a preceptor than city/metropolitan respondents. Just under half of respondents found prioritising workload (n = 47; 42.7%) or organisational knowledge (n = 45; 40.9%) difficult or very difficult, and 47.7% (n = 53) felt isolated or unsupported. 49.5% (n = 55) reported being overwhelmed with the new role either sometimes or regularly. Barriers to transitioning successfully included limited employer support to attend professional development activities.

Conclusions

Availability of specific support measures may assist in the transition process. Findings from our study should be considered by employers when recruiting nurses new to PHC, and when designing orientation and ongoing education programmes.

Relevance to clinical practice

This study highlights the challenges faced by nurses who transition from acute care into PHC employment. Understanding the barriers and facilitators to successful transitions enhances the process for future recruitment and retention of PHC nurses. This evidence can inform managers, educators and policymakers in developing support programmes for nurses moving into PHC.
Clean catch urine collection: Time taken and diagnostic implication. A prospective observational study
Authors: Tosif Shidan , Kaufman Jonathan , Fitzpatrick Patrick , Hopper Sandy M , Hoq Monsurul , Donath Susan , Babl Franz E
Published: June 2017

Aim

Clean catch urine (CCU) collection is commonly used in pre‐continent children. CCU can be time‐consuming and specimens may be contaminated. Our aim was to determine the time taken for CCU attempts and to describe the success of this method in diagnosing or excluding urinary tract infection.

Methods

Prospective observational study of CCU in pre‐continent children aged 2–48 months in the emergency department. Time taken until urine collection, ‘successful’ (voided and caught), ‘missed’ (voided not caught) or the procedure ‘stopped’, were recorded and urine culture results analysed.

Results

Two hundred and seventeen children (131 (60%) male) were enrolled. There were a total of 247 attempts at CCU. For the first attempt, the median collecting time was 30.5 min (interquartile range (IQR) 11–66). Outcome was ‘successful’ in 64% (95% confidence intervals (CI) 58–70%), ‘missed’ in 16% (95% CI 11–20%) and ‘stopped’ in 20% (95% CI 15–26%). Median time if ‘successful’ was 25 min (IQR 7–46.5), ‘missed’ 27 min (IQR 11.6–59) and 71 min (IQR 42.5–93) when ‘stopped’. One hundred and sixty children had successful CCU collection, 129 were sent for culture. Fifty of 129 (39%) cultures were contaminated. If all urine specimens caught were sent for culture, the estimated yield of an uncontaminated urine specimen was 45%. Contamination was not related to time taken for CCU.

Conclusions

CCU is time‐consuming, frequently unsuccessful and contaminated, resulting in a low overall diagnostic yield. Clinicians could expect a 45% chance of obtaining a definitive urine sample from this method overall.
The gingival biotype in a cohort of Chinese subjects with and without history of periodontal disease
Authors: Liu F. , Pelekos G. , Jin L. J.
Published: June 2017

Objective

The present study aimed to determine the gingival biotype in Chinese subjects with and without a history of periodontal disease.

Material and Methods

Thirty periodontally healthy subjects and 20 subjects with treated chronic periodontitis were recruited. The mid‐buccal gingival thickness of upper central and lateral incisors was measured by a customized caliper in all subjects. The crown length and crown width of these teeth were recorded in the healthy group, while gingival recession was measured in the periodontitis group. These outcome measures were compared among the groups and sub‐groups, and the correlation of gingival biotypes with clinical parameters was analyzed.

Results

The mean thickness of gingiva in the 30 periodontally healthy subjects was 1.05±0.31 mm (0.47‐1.57 mm). The males exhibited a greater crown length than the females (P<.05). No significant correlation was found between gingival thickness and the crown width to crown length ratio. The mean gingival thickness at the 80 sites measured in the 20 periodontitis subjects was 0.89±0.29 mm (0.33‐1.56 mm). Overall, gingival biotype as measured by gingival thickness was significantly correlated with gingival recession (r=−.240, P=.032), while a stronger correlation was found among the 42 sites with bleeding on probing prior to periodontal treatment (r=−.382, P=.013).

Conclusion

This study shows that gingival biotype measured by gingival thickness in subjects with treated periodontitis is significantly correlated with gingival recession. Further study could clarify the clinical implications of gingival biotype in the management of periodontal patients.
Subjective insomnia symptoms and sleep duration are not related to hypothalamic–pituitary–adrenal axis activity in older adults
Authors: van Neijenhof Rian J. G. Peters , van Duijn Erik , Van Den Berg Julia F. , de Waal Margot W. M. , van der Mast Roos C. , Comijs Hannie C.
Published: June 2017

Insomnia symptoms are highly prevalent in depressed older adults. This study investigates the association between hypothalamic–pituitary–adrenal (HPA) axis activity and symptoms of insomnia, respectively, sleep duration among 294 depressed and 123 non‐depressed older adults of the Netherlands Study of Depression in Older people (NESDO) study. Insomnia symptoms were defined as clinically relevant when having a score ≥ 10 points on the Women's Health Initiative Insomnia Rating Scale (WHIIRS). Sleep duration was categorized in short (≤ 6 h per night), normal (7–8 h per night) and long (≥ 9 h per night) duration. Salivary cortisol levels were used to assess the following cortisol parameters for HPA axis activity: area under the curve with respect to the increase (AUCi) and to the ground (AUCg), diurnal slope, evening cortisol level and dexamethasone suppression ratio. Clinically relevant insomnia symptoms were present in 46% of the participants. Thirty‐two per cent of the participants were short sleepers, whereas 16% were long sleepers. However, univariate analyses showed no differences in any of the HPA axis parameters between people with and without insomnia symptoms or between the three groups with different sleep duration. In addition, no significant interaction was found between a diagnosis of depression or the severity of depressive symptoms and any of the cortisol parameters in relation to insomnia symptoms or sleep duration.
Investigation of an N‐Terminal Prohormone of Brain Natriuretic Peptide Point‐of‐Care ELISA in Clinically Normal Cats and Cats With Cardiac Disease
Authors: Harris A.N. , Beatty S.S. , Estrada A.H. , Winter B. , Bohannon M. , Sosa I. , Hanscom J. , Mainville C.A. , Gallagher A.E.
Published: June 2017

Background

N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP) concentrations may be increased in cats with various cardiac disorders. The point‐of‐care (POC) ELISA assay uses the same biologic reagents as the quantitative NT‐proBNP ELISA. Previous studies have evaluated the sensitivity and specificity of the POC ELISA in cats with cardiac disease.

Objectives

To prospectively evaluate the diagnostic utility of the POC ELISA in a select population of cats.

Animals

Thirty‐eight client‐owned cats presented to the University of Florida Cardiology Service for cardiac evaluation. Fifteen apparently healthy cats recruited as part of another study.

Methods

Physical examination and echocardiography were performed in all cats. The POC ELISA was assessed visually as either positive or negative by a reader blinded to the echocardiographic findings, and results were analyzed relative to quantitative assay results.

Results

Twenty‐six cats were diagnosed with underlying cardiac disease, and 27 cats were considered free of cardiac disease. Cats with cardiac disease included: 21 with hypertrophic cardiomyopathy, 2 with unclassified cardiomyopathy, 2 with restrictive cardiomyopathy, and 1 with 3rd degree atrioventricular (AV) block. The POC ELISA differentiated cats with cardiac disease with a sensitivity of 65.4% and specificity of 100%.

Conclusions and Clinical Importance

The POC NT‐proBNP ELISA performed moderately well in a selected population of cats. A negative test result cannot exclude the presence of underlying cardiac disease, and a positive test result indicates that cardiac disease likely is present, but further diagnostic investigation would be indicated for a definitive diagnosis.
The sociolinguistics of globalizing China
Authors: Gao Shuang
Published: June 2017

The sociolinguistics of globalization has emerged as an important research paradigm in response to the challenges of global social change. As a country undergoing some of the most drastic changes during the past few decades, China provides a rich site for exploring the issue of language and globalization empirically and theoretically. This article seeks to map out the new socio‐cultural values being produced or re‐conceptualized in the process of China's transformation, with a view to understand the materiality of language use under the current conditions of global economy and geopolitics. It reviews recent research mainly from four perspectives: identity, social stratification and consumerism; English and neoliberal globalization; diversity, ethnicity and race; state and nationalism, and concludes with suggestions for future research.
Regional citrate anticoagulation in membrane based plasma exchange: Safety, efficacy and effect on calcium balance
Authors: Christiadi Daniel , Mercado Chari , Singer Richard
Published: June 2017

Aim

To assess the efficacy, safety and calcium balance of a membrane based regional citrate anticoagulation plasma exchange protocol.

Methods

This was an observational, prospective, single centre study of membrane separation plasma exchange using regional citrate anticoagulation. It was performed using a fixed dose pre‐filter citrate infusion that was based on the plasma flow rate. Patients received a post filter calcium infusion that was modified during treatment based on systemic ionized calcium monitoring. Post filter ionized calcium was not assessed. Safety and efficacy were assessed by extraction of clinical events and laboratory data contemporaneously recorded in electronic health records.

Results

Thirty‐six sessions in five patients were performed. No patients developed symptomatic hypocalcaemia, and no patient had a recorded ionized calcium below 0.81 mmol/L. Filter clotting occurred in two sessions. The mean net calcium gained was 9.6 ± 1.8 mmol per session.

Conclusion

Regional citrate anticoagulated membrane separation plasma exchange can be performed safely and effectively without the need for post filter ionized calcium monitoring. The algorithm employed resulted in a net calcium gain.