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Rationale, aims, and objectives: We consider the question "What should we do?" in the context of clinical research/practice. There are several steps along the way to providing a satisfactory answer, many of which have received considerable attention in the literature. We aim to provide a unified summary and explication of these "steps along the way". The result will be an increased appreciation for the meaning and structure of "actionable clinical knowledge". Methods: We review the literature to identify pertinent works dealing with evidence production and translation into actionable clinical knowledge. We draw from insights in this literature about various aspects of reasoning relevant to clinical questions and integrate these into a unified approach to the processes that lead to actionable clinical knowledge. Results: We collect, collate, and integrate some of the work by Bauer, Carper, Goldman, Haack, McHugh and Walker, and Upshur and colleagues and obtain guidelines to aid in the evidence‐to‐actionable‐clinical‐ knowledge transition. Conclusions: Clinical decision‐making is not infallible, and the steps we can take to minimize error are context dependent. Medical evidence, produced as it is by human effort, can never be perfect. We will be doing well by assuring that the evidence we use has been produced by a reliable process and is relevant to the question posed. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. OBJECTIVE: The aim of this study was to investigate factors affecting turnover of Asian foreign-educated nurses (FENs), which may lead to improvements in retention strategies. BACKGROUND: Asian FENs working in the United States have considerable rates of turnover. Little is known about which factors are related. METHODS: A cross-sectional design was used. A convenience sample (n = 201) of Asian FENs completed surveys by regular mail and through a website. Backward multivariable logistic regression was performed to identify factors associated with turnover in their 1st year of employment. RESULTS: Most participants were from the Philippines and Korea. Perceived quality of orientation predicted organizational-level turnover and trended toward predicting unit-level turnover. CONCLUSIONS: Healthcare institutions may benefit from developing organizational programs for FENs that are sensitive to their unique needs, in the interest of reducing rapid or early turnover and accompanying negative effects on hospital finances and patient care. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purposes of this study are to (1) describe the gap between expected and perceived organizational experiences among Asian foreign-educated nurses (FENs) in the United States and (2) to examine factors associated with turnover in their 1st year of employment. BACKGROUND: Little is known about factors associated with turnover among Asian FENs. METHODS: A cross-sectional design with a convenience sampling was conducted. Subjects (n = 201) responded either via Web-based or mail survey. A series of simple and multivariable logistic regressions were used. RESULTS: Expectations of FENs before organizational entry were significantly higher than their experiences. The FENs who reported less organizational responsibility than expected were more likely to leave their 1st employment to move to another organization or unit. CONCLUSION: This study may contribute to our understanding of the potential factors that assist or interfere with the organization's administrative retention plan for Asian FENs. [ABSTRACT FROM AUTHOR]

Graduate nursing education in the United States is undergoing major transformations, as a result of factors both within nursing and in the larger society. Objective: In this paper the authors examine the trends and factors that are influencing the changes, especially in doctoral education, for both nurse scientist and advanced practice preparation. Conclusion: The paper provides a background that serves as context, it gives an overview of the PhD and the DNP degrees, focusing on the recent changes and identifying the most compelling issues and concerns, ending with a series of recommendations. [ABSTRACT FROM AUTHOR]

The article discusses a study determining factors associated with health-related quality of life among Operating Engineers. The study showed multivariate linear regression analysis revealing that personal factors, such as old age, being married and depression as well as behavioral factors, including smoking and high body mass index were associated with poor health-related quality of life. The study concluded that operating engineers are at risk for poor health-related quality of life.

The implementation of evidence-based practice guidelines can be influenced by nurses' perceptions of the organizational safety culture. Shift-by-shift management of each nursing unit is designated to a subset of staff nurses (charge nurses), whom are often recruited as champions for change. The findings indicate that compared to charge nurses, noncharge nurses were more positive about overall perceptions of safety (P = .05) and teamwork (P < .05). Among charge nurses, significant differences were observed based on the number of years' experience in charge: perception of teamwork within units [F(3, 365) = 3.52, P < .01]; overall perceptions of safety, [F(3, 365) = 4.20,P < .05]; safety grade for work area [F(3, 360) = 2.61,P < .05]; number of events reported within the last month [F(3, 362) = 3.49, P < .05]. These findings provide important insights to organizational contextual factors that may impact effectiveness outcomes research in the future. [ABSTRACT FROM AUTHOR]

A number of issues and challenges in doctoral nursing education were presented at the biennial meeting of the International Network for Doctoral Education in Nursing in June 2007. The themes addressed included: global health workforce shortages and the aging of the nursing workforce; the need for more nursing doctoral programs; strengthening of the research training in doctoral programs, and the need for increased involvement of nurse leaders in the health and social policy arena. [ABSTRACT FROM AUTHOR]

Women of Mexican descent living in the United States raise children who use health care services. What do immigrant Mexican mothers expect from children's health care services? And how do their expectations for children's health services compare to acculturated Mexican American mothers' expectations? This focused ethnographic study, based on repeated interviews with 28 mothers of varying acculturation levels, describes their expectations and experiences with children's health care services in the United States. Findings support a shared core of expectations for both Mexican immigrant and Mexican American mothers, and differences in health care access and financing, time spent in health care encounters, and cultural and linguistic expectations for care. Health care providers can use this information to approach Mexican-descent mothers and children with their expectations in mind, and craft a negotiated plan of care congruent with their expectations. [ABSTRACT FROM AUTHOR]

Nurses in acute care hospitals report that situations in their wok setting and profession are in dire need of repair. Although they waiver on their intention to remain in their institution and nursing, they do not waiver on their selected resolution to nursing's shortage. A total of 787 staff nurses in eight geographically and demographically diverse states responded and were asked to select the ‘Top 5’ actions they thought would improve nursing and decrease the shortage. Creating career ladders was endorsed by most respondents (85%) with increasing pay endorsed by the fewest (33%). When selecting the single most important action, they reversed the order—increased pay was the most endorsed (26%), and creating career ladders and increased educational opportunities were endorsed by less than 1%. Nurses appeared to be concerned about the profession in general; however, when asked the ‘most important’ thing to do, an age-old action was selected—increase pay. [ABSTRACT FROM AUTHOR]

Workplace violence occurs in many different contexts, including academic settings. However, the types of violence that make headlines are less common than the everyday behaviors that, left unchecked, may lead to extreme situations. This article describes how a school of nursing developed a program of workplace violence prevention, intervention, and response. Descriptions of the program, definitions, and workplace violence resources are included. [ABSTRACT FROM AUTHOR]

Suggests the application of theory-guided, evidence-based reflective practice at the core of nursing education and practice. Definition of evidence-based medicine; Components of reflective practice; Types of practice inquiry foci developed to address future issues in nursing and healthcare.

Information about a symposium on patient safety and the nursing shortage held at the University of Michigan in Ann Arbor, Michigan. The symposium was dedicated to the nursing leader and Dean of the University of Michigan School of Nursing, Ada Sue Hinshaw. The symposium featured nursing and health care experts including Patricia A. Grady, Director of the National Institute of Nursing Research and Suzanne L. Feetham of the Department of Health and Human Services.

Rationale, aims and objectives: McHugh and Walker introduced a model of knowledge to demonstrate that EBM is a form of scientism that ignores important sources of knowledge thereby impairing the practice of medicine. We study the development of this model and explore additional applications. Methods: Review of the relevant literature and identification of possible areas for fruitful application. Results: We show that the McHugh and Walker model is closely related to the model of evidence considered earlier by Upshur et al. We also indicate that the utility of this model is not limited to showing scientism distorts clinical practice. Several representative applications are identified, including psychotherapy, the Salk polio vaccine trial, and the placebo effect. Conclusions: Priority should be given to Upshur et al for the development of a model that has far‐reaching application to medical epistemology. It is shown that all four of the types of evidence considered—qualitative/personal, qualitative/general, quantitative/general, and quantitative/personal—are required to adequately characterize epistemology in medical research and practice. [ABSTRACT FROM AUTHOR]

Appropriate and woman-led health care for displaced women is essential to respecting basic human rights. In this article, we describe the results of an analysis of the association between mental health and reproductive health service use from a sample of Congolese refugee women residing in short- and long-term camps in Rwanda, with a post-hoc qualitative potion added to expand upon the data-based results. Our findings suggest that structural factors including health policy initiatives affect or even inhibit individual care choices. [ABSTRACT FROM AUTHOR]

Background and purpose: The detection of common mental disorders in humanitarian crisis settings requires a screening tool that is feasible to use as well as sensitive and specific. The Self-Report Questionnaire, developed by the World Health Organization in 1994 to detect presence or absence of common mental health disorders, has frequently been used among conflict-affected and refugee populations. Our goal was to identify a highly predictive and reliable subset of items to serve as a screening tool that can be used in busy, over-crowded, and low-resource primary health care settings to identify women who need mental health attention. Methods: We analyzed the responses on a version of the Self-Report Questionnaire expanded to include two suicidality items from 810 displaced women living in refugee camps in Rwanda. Screening items were selected and evaluated for predictive ability using logistic regression in a cross-validation process, sensitivity and specificity using receiver operating characteristic curve analysis, and internal consistency analysis. Results: A five-item screening tool resulted. Those items are ''Do you feel unhappy?'', Do you feel easily nervous, tense, or worried?'', ''Have you lost interest in things?'', ''Do you have trouble thinking clearly?'' and ''Has the thought of ending your life been on your mind?''. Conclusion: The Self-Report Questionnaire-5 may be an important tool for identifying common mental disorders as well as suicide ideation and behaviors when assessing mental health among women in crisis situations. Further evaluation of this tool is warranted. [ABSTRACT FROM AUTHOR]

The carbonyl-C, carbonyl-O, and leaving-S kinetic isotope effects (KIEs) were determined for the hydrolysis of formylthiocholine. Under acidic conditions, 13kobs = 1.0312, 18kobs = 0.997, and 34kobs = 0.995; for neutral conditions, 13kobs = 1.022, 18kobs = 1.010, and 34kobs = 0.996; and for alkaline conditions, 13kobs = 1.0263, 18kobs = 0.992, and 34kobs = 1.000. The observed KIEs provided helpful insights into a qualitative description of the bond orders in the transition state structure. [ABSTRACT FROM AUTHOR]

Purpose: Although farm operators have frequent exposure to hazardous noise and high rates of noise-induced hearing loss, they have low use of hearing protection devices (HPDs). Women represent about one-third of farm operators, and their numbers are climbing. However, among published studies examining use of HPDs in this worker group, none have examined gender-related differences. The purpose of this study was to examine gender-related differences in use of hearing protection and related predictors among farm operators.Materials and Methods: Data previously collected at farm shows and by telephone were analyzed using t-tests and generalized linear model with zero inflated negative binomial (ZINB) distribution.Findings: The difference in rate of hearing protector use between men and women farm operators was not significant. There was no difference between men and women in most hearing protector-related attitudes and beliefs.Conclusion: Although men and women farm operators had similar rates of use of hearing protectors when working in high-noise environments, attitudes about HPD use differed. Specifically, interpersonal role modeling was a predictor of HPD use among women, but not for men. This difference suggests that while farm operators of both genders may benefit from interventions designed to reduce barriers to HPD use (e.g., difficulty communicating with co-workers and hearing warning sounds), farm women have unique needs in relation to cognitive-perceptual factors that predict HPD use. Women farm operators may lack role models for use of HPDs (e.g., in peers and advertising), contributing to their less frequent use of protection. [ABSTRACT FROM AUTHOR]

Formylthiocholine (FTC) was synthesized and found to be a substrate for nonenzymatic and butyrylcholines-terase (BChE)-catalyzed hydrolysis. Solvent (D2O) and secondary formyl-H kinetic isotope effects (KIEs) were measured by an NMR spectroscopic method. The solvent (D2O) KIEs are D1Ok = 0.20 in 200 mM HCl D2Ok = 0.81 in 50 mM HCl, and D2Ok - 4.2 in pure water. The formyl-H KIEs are Dk = 0.80 in 200 mM HC1, Dk = 0.77 in 50 mM HC1, Dfc = 0.75 in pure water, Dk = 0.88 in SO mM NaOH, and D(V/K) = 0.89 in the BChE-catalyzed hydrolysis in MES buffer at pH 6.8. Positional isotope exchange experiments showed no detectable exchange of O into the carbonyl oxygen of FTC or the product, formate, under any of the above conditions. Solvent nucleophile-O KIEs were determined to be ' k = 0.9917 under neutral conditions, 18fc = 1.0290 (water nucleophile) or 18fc = 0.989 (hydroxide nucleophile) under alkaline conditions, and i8(V/K) = 0.9925 for BChE catalysis. The acidic, neutral, and BChE-catalyzed reactions are explained in terms of a stepwise mechanism with tetrahedral intermediates. Evidence for a change to a direct displacement mechanism under alkaline conditions is presented. [ABSTRACT FROM AUTHOR]

Blue collar workers generally report high job stress and are exposed to loud noises at work and engage in many of risky health behavioral factors, all of which have been associated with poor sleep quality. However, sleep quality of blue collar workers has not been studied extensively, and no studies have focused Operating Engineers (heavy equipment operators) among whom daytime fatigue would place them at high risk for accidents. Therefore, the purpose of this study was to determine variables associated with sleep quality among Operating Engineers. This was a cross-sectional survey design with a dependent variable of sleep quality and independent variables of personal and related health behavioral factors. A convenience sample of 498 Operating Engineers was recruited from approximately 16,000 Operating Engineers from entire State of Michigan in 2008. Linear regression was used to determine personal and related health behavior factors associated with sleep quality. Multivariate analyses showed that personal factors related to poor sleep quality were younger age, female sex, higher pain, more medical comorbidities and depressive symptoms and behavioral factors related to poor sleep quality were nicotine dependence. While sleep scores were similar to population norms, approximately 34 % (n = 143) showed interest in health services for sleep problems. While many personal factors are not changeable, interventions to improve sleep hygiene as well as interventions to treat pain, depression and smoking may improve sleep quality resulting in less absenteeism, fatal work accidents, use of sick leave, work disability, medical comorbidities, as well as subsequent mortality. [ABSTRACT FROM AUTHOR]

This article reports on a study of whether breast cancer prognosis can be refined through combining genomic information with clinical and pathological risk factors. The article describes the retroactive study of early-stage breast carcinoma patients and the predictors that were applied to characterize relevant information. The study concluded that gene expression signatures can be used for refining prognosis, but that more studies will be needed to determine their value for individualizing therapeutic strategies. The article also discusses the prognosis of cancer in general, the effect of genomic technology on clinical decisions, and the role of chemotherapy and radiotherapy in cancer treatment.

Background: A major challenge in oncology is the selection of the most effective chemotherapeutic agents for individual patients, while the administration of ineffective chemotherapy increases mortality and decreases quality of life in cancer patients. This emphasizes the need to evaluate every patient's probability of responding to each chemotherapeutic agent and limiting the agents used to those most likely to be effective. Methods and Results: Using gene expression data on the NCI-60 and corresponding drug sensitivity, mRNA and microRNA profiles were developed representing sensitivity to individual chemotherapeutic agents. The mRNA signatures were tested in an independent cohort of 133 breast cancer patients treated with the TFAC (paclitaxel, 5-fluorouracil, adriamycin, and cyclophosphamide) chemotherapy regimen. To further dissect the biology of resistance, we applied signatures of oncogenic pathway activation and performed hierarchical clustering. We then used mRNA signatures of chemotherapy sensitivity to identify alternative therapeutics for patients resistant to TFAC. Profiles from mRNA and microRNA expression data represent distinct biologic mechanisms of resistance to common cytotoxic agents. The individual mRNA signatures were validated in an independent dataset of breast tumors (P = 0.002, NPV = 82%). When the accuracy of the signatures was analyzed based on molecular variables, the predictive ability was found to be greater in basal-like than non basal-like patients (P = 0.03 and P = 0.06). Samples from patients with co-activated Myc and E2F represented the cohort with the lowest percentage (8%) of responders. Using mRNA signatures of sensitivity to other cytotoxic agents, we predict that TFAC non-responders are more likely to be sensitive to docetaxel (P = 0.04), representing a viable alternative therapy. Conclusions: Our results suggest that the optimal strategy for chemotherapy sensitivity prediction integrates molecular variables such as ER and HER2 status with corresponding microRNA and mRNA expression profiles. Importantly, we also present evidence to support the concept that analysis of molecular variables can present a rational strategy to identifying alternative therapeutic opportunities. [ABSTRACT FROM AUTHOR]

Phospholipid-like copolymers based on 2-(methacryloyloxyethyl) phosphorylcholine were synthesised using monomer-starved free radical polymerisation methods and incorporating cationic charge in the form of the choline methacrylate monomer in amounts varying from 0 to 30 wt%, together with a 5 wt% silyl cross-linking agent in order to render them water-insoluble once thermally cured. Characterisation using a variety of techniques including nuclear magnetic resonance spectroscopy, high-pressure liquid chromatography and gel permeation chromatography showed the cationic monomer did not interfere with the polymerisation and that the desired amount of charge had been incorporated. Gravimetric and differential scanning calorimetry methods were used to evaluate the water contents of polymer membranes cured at 70°C, which was seen to increase with increasing cation content, producing materials with water contents ranging from 50% to 98%. Surface plasmon resonance indicated that the coatings swelled rapidly in water, the rate and extent of swelling increasing with increasing cation level. Dynamic contact angle showed that coatings of all the polymers possessed a hydrophobic surface when dry in air, characteristic of the alkyl chains expressed at the surface (>100° advancing angle). Rearrangement of the hydrophilic groups to the surface occurred once wet, to produce highly wettable surfaces with a decrease in advancing angle with increasing cation content. Atomic force microscopy showed all polymer films to be smooth with no features in topographical or phase imaging. Mechanical properties of the dry films were also unaffected by the increase in cation content. [Copyright &y& Elsevier]

A letter to the editor is presented in response to the article "Gene Expression Signatures, Clinicopathological Features, and Individualized Therapy in Breast Cancer," by CR Acharya and colleagues in the April 2, 2008 issue.