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In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. Compared with the control group, the experimental group: returned to work sooner (MD –18 days, 95% CI –33 to –3); required fewer physiotherapy sessions (MD –7.4, 95% CI –13.1 to –1.6), rehabilitation consultations (MD –1.9, 95% CI –3.6 to 0.3) and plastic surgery consultations (MD –3.6, 95% CI –6.3 to –0.9); and had better short-term recovery of functional ability and pinch strength. In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. ACTRN12619000344190 [ABSTRACT FROM AUTHOR]

Globally, the nursing profession constitutes the largest proportion of the health workforce; however, it is challenged by widespread workforce shortages relative to need. Strategies to promote recruitment of the nursing workforce are well-established, with a lesser focus on strategies to alleviate the burden on the existing workforce. This burden may be exacerbated by the impact of low-value health care, characterised as health care that provides little or no benefit for patients, or has the potential to cause harm. Low-value health care is a global problem, a major contributor to the waste of healthcare resources, and a key focus of health system reform. Evidence of variation in low-value health care has been identified across countries and system levels. Research on low-value health care has largely focused on the medical profession, with a paucity of research examining either low-value health care or the de-implementation of low-value health care from a nursing perspective. The objective of this paper is to provide a scholarly discussion of the literature around low-value health care and de-implementation, with the purpose of identifying implications for nursing research. With increasing pressures on the global nursing workforce, research identifying low-value health care and developing approaches to de-implement this care, is crucial. [ABSTRACT FROM AUTHOR]

These 12 factors include: insufficient/incorrect patient education, insufficient/incorrect patient assessment, lack of consultation, insufficient/incorrect OTC product recommendation, discontinued medications, improper storage, expired medications, incorrect dosing (subtherapeutic/overdose), missing medications, drug-drug interactions/adverse drug reactions, therapeutic duplication, and inappropriate treatment duration. [Extracted from the article]

The article discusses the positive pain reduction outcomes of a personalized care pathway for chronic knee pain post-total knee replacement.

Previous studies have demonstrated that students who are engaged in learning tasks and make errors before receiving instruction on how to complete them, achieve better learning outcomes than students who first receive instruction and then complete the learning activities with the aim of avoiding errors. Although simulation literature often refers to errors as learning opportunities, to date, there is limited understanding of how pedagogical approaches that promote learning from errors can guide the design of simulation-based learning in healthcare education. To (a) present the Learning from Errors conceptual model; and (b) provide an example of how educators can use this model. The Learning from Errors model is drawn from critical elements of two pedagogical approaches, productive failure and error management training and pedagogical features of high-quality healthcare simulations. We describe the Learning from Errors model, which emphasises the need for adopting pedagogical methods that explicitly use errors as learning opportunities and ultimately inform simulation design. We then illustrate the application of this model to a simulation example. The model includes the following elements: i) normalisation of errors, ii) challenging simulation scenarios, iii) self-directed learning, iv) collaborative teamwork and v) comparison with best practice. This discussion paper presents the Learning from Errors conceptual model, an evidence-based approach that can assist educators in the design of simulations that embrace errors as a catalyst for learning. [ABSTRACT FROM AUTHOR]

• Importance of improved approaches to viral pathogen detection for human health care. • Limitations of traditional human virus detecting methods have been compared with biosensors. • Recent progresses towards paper-based diagnostic chips for detecting human viruses are reviewed. • Challenges and prospects of paper-based diagnostic chips for detecting viruses were summarized. Viruses cause various diseases in humans, and pose serious health risks to individuals and populations worldwide. As a result, various diagnostic procedures and methods have been developed to prevent, manage, and reduce the burden of viral diseases, each with its own benefits and drawbacks. Among these, paper-based diagnostic chips are becoming increasingly common because of their speed, accuracy, convenience, and economical and environmental friendliness. These paper-based diagnostic tests have ideal point-of-care (POC) diagnostic applications, particularly in personalized healthcare. Paper-based diagnostics have emerged as innovative and low-cost solutions for diagnosing viral diseases in remote and underdeveloped regions where traditional diagnostic methods are not readily available. These tests are easy to use, require minimal equipment, and can be performed by nonspecialized personnel, making them accessible even in resource-constrained settings. In this review, we discuss recent developments in paper-based diagnostic chips, the importance of improved methods for identifying viral pathogens, drawbacks of traditional detection techniques, and challenges and prospects of paper-based diagnostic chips for the detection of viruses. [ABSTRACT FROM AUTHOR]

The number of older people dying in long-term care facilities (LTCFs) is increasing globally, but care quality may be variable. A framework was developed drawing on empirical research findings from the Palliative Care for Older People (PACE) study and a scoping review of literature on the implementation of palliative care interventions in LTCFs. The PACE study mapped palliative care in LTCFs in Europe, evaluated quality of end-of-life care and quality of dying in a cross-sectional study of deceased residents of LTCFs in 6 countries, and undertook a cluster-randomized control trial that evaluated the impact of the PACE Steps to Success intervention in 7 countries. Working with the European Association for Palliative Care, a white paper was written that outlined recommendations for the implementation of interventions to improve palliative and end-of-life care for all older adults with serious illness, regardless of diagnosis, living in LTCFs. The goal of the article is to present these key domains and recommendations. Transparent expert consultation. International experts in LTCFs. Eighteen (of 20 invited) international experts from 15 countries participated in a 1-day face-to-face Transparent Expert Consultation (TEC) workshop in Bern, Switzerland, and 21 (of 28 invited) completed a follow-up online survey. The TEC study used (1) a face-to-face workshop to discuss a scoping review and initial recommendations and (2) an online survey. Thirty recommendations about implementing palliative care for older people in LTCFs were refined during the TEC workshop and, of these, 20 were selected following the survey. These 20 recommendations cover domains at micro (within organizations), meso (across organizations), and macro (at national or regional) levels addressed in 3 phases: establishing conditions for action, embedding in everyday practice, and sustaining ongoing change. We developed a framework of 20 recommendations to guide implementation of improvements in palliative care in LTCFs. [ABSTRACT FROM AUTHOR]

Abstract Nowadays, point-of-care testing (POCT) techniques have achieved flourishing development in human health monitoring, where paper-based POCT platforms have exhibited superior properties of low cost, easy accessibility and eco-friendliness. For fabrication of paper-based POCT platforms, the pen-on-paper (PoP) strategies through directly writing desired functional materials on paper have been creatively developed in recent years. The PoP strategies are characterized by simplicity, rapid prototyping and do-it-yourself capability, and are also likely to realize scalable manufacturing through integration with software-controlled plotter. In this review, we firstly introduce various kinds of papers and pens employed in the PoP strategies, and then summarize the state-of-art advances of PoP strategies for making paper-based POCT platforms. Subsequently, we discuss the representative applications of PoP strategies for human health monitoring. Conclusions, current challenges and future perspectives of the PoP strategies for human health related POCT uses are finally given. Highlights • A variety of pens and papers involved in pen-on-paper (PoP) strategies are summarized. • The state-of-art of PoP strategies in realizing key steps involved in construction of POCT platforms are reviewed. • Representative applications of PoP strategies in human health monitoring are discussed. • Possible roadmaps can be oriented to move PoP strategies a giant step forward for human health. [ABSTRACT FROM AUTHOR]

Introduction: The requirement for medical services fluctuates. This study was carried out in order to attempt to extrapolate the service requirements for various cardiology services at Mater Dei Hospital, Malta over the coming five years, based on service demands from previous years.Methods: Past annual data was obtained from hospital records for various services (to 2017). Linear regression was carried out using a bespoke Excel™ spreadsheet in order to extrapolate possible services requirements up to 2022.Results: All services are expected to increase, with forecasts ranging between 41 and 354%, depending on services being considered.Discussion: It is easy to "get on with it" and perform the work required at the workplace but this study has shown that it is equally important to anticipate demands lest lack of planning leads to long and important waiting lists for critical diagnostics and treatments. Health care provision requirements are increasing worldwide. Even using conservative estimates and in the absence of the creation of new services, the demands for extant services are likely to continue to grow. Unless medium term plans are made for hardware, software, physical space and staffing, and the funding thereof, waiting lists for investigations in this speciality are bound to rise. This may be mitigated by novel treatments but since these cannot be predicted, it would be safer and wiser to plan ahead lest we are overwhelmed. This paper has also shown how WASP (Write a Scientific Paper) precepts can be applied to elegantly study a problem and write up a paper. [ABSTRACT FROM AUTHOR]

Abstract Point-of-care testing (POCT) is a simple, rapid and cost-efficient diagnostic method in settings where clinical resources are limited, developing countries for instance, and an essential tool for controlling infectious diseases. Previously, we developed a centrifugal-based separation-free visual detection system (SPIN-DNA) for human papillomavirus (HPV) DNA. However, this gel column-based detection system requires a centrifugation device to separate DNA-bound beads from free beads. It would be more feasible in resource-limited settings to employ a smaller force, such as a capillary force, for lateral flow assay. For this purpose, here we describe a paper-based method for separating amplified DNA that we developed. Visualization of amplified DNA to the naked eye using magnetic beads was achieved, without additional centrifugation, addition of capturing DNA probes, incubation time, or dilution. This simple visualized detection method of target DNA (PASS-DNA) was applied for HPV DNA in this study. The detection sensitivity of PASS-DNA was at least 101 copies/mL of HPV DNA, and the results of PASS-DNA showed perfect agreement with those obtained using the Roche Cobas 4800 HPV test (n = 30). No prolonged incubation times or washing steps are required with PASS-DNA; rather, the method involves one mixing step followed by loading the solution onto the paper. In addition, no absorbent pad is needed to provide a capillary driving force. This paper-based DNA detection system could accelerate the development of molecular POCT with further improvements and integration with sample preparation and DNA isolation and amplification in resource-limited settings. [ABSTRACT FROM AUTHOR]

Objectives: To identify the current challenges and opportunities in compensation and recognition for pharmacist-provided immunizations across the lifespan and to establish guiding principles for pharmacist-provided immunization compensation and recognition. Data sources: 22 stakeholders gathered on June 29, 2011, at the American Pharmacists Association (APhA) headquarters in Washington, DC, for a meeting on immunization compensation that was convened by APhA and the Academy of Managed Care Pharmacy. Participants included representatives from community pharmacy practices (chain, grocery, and independent), employers, national consumer health and advocacy organizations, national pharmacy and public health organizations, health plan representatives, pharmacy benefit managers, and health information technology, standards, and safety organizations. Key immunization leaders from TRICARE Management Activity, the Centers for Medicare & Medicaid Services, the National Vaccine Program Office of the Department of Health & Human Services, and the Centers for Disease Control and Prevention (CDC) also participated in the meeting. Summary: The increased numbers of pharmacists providing vaccination services and the availability of pharmacist-provided immunizations to populations in need of vaccines has continued to increase. This has resulted in a rise in the percentage of patients who receive vaccines at pharmacies. Pharmacists are now working to leverage their ability to identify people with key risk factors (e.g., diabetes, heart disease or previous myocardial infarction), encourage them to receive their CDC-recommended vaccinations, and administer the required vaccine. Challenges and opportunities in compensation and recognition for pharmacist-provided immunizations across the adult lifespan persist. Variability in state practice acts, reimbursement and compensation processes and systems, and mechanisms for documentation of vaccine services create substantial differences in how pharmacist-provided immunizations are delivered throughout the United States. Conclusion: Pharmacist-provided immunizations are clinically sound, are cost effective, are readily accessible, and support our nation's public health goals. Pharmacists have demonstrated that patient vaccination rates have improved through expansion of pharmacist-provided immunizations. The profession should continue efforts to collaborate with other immunization stakeholders and expand a pharmacist scope of practice that is built around a uniform and recognized standard of immunization provision and that supports the provision of all CDC-recommended vaccines through pharmacy-provided immunizations. [ABSTRACT FROM AUTHOR]

The article discusses a study that aims to develop an improved risk evaluation and mitigation strategies (REMS) system for the most effective and safest patient medication use and the least burden on the health care delivery system. It reports on the lack of standardization among various REMS programs, which lack poses challenges for health care providers. Among the topics taken up are effective provider interventions, improving REMS standardization and communication models, and ensuring a sustainable business model for REMS-related provider activities.

Objective: To convene a group of expert stakeholders to develop recommendations for standardizing systems for the implementation of risk evaluation and mitigation strategies (REMS). Data sources: On July 15, 2009, the American Pharmacists Association convened an expert panel of stakeholders to explore standardized solutions to REMS development and implementation. Meeting participants included pharmacists from various practice settings, physicians, researchers, patient advocates, and a nursing delegate, and the meeting was observed by a U.S. Food and Drug Administration representative. The stakeholders' recommendations were combined with themes arising from discussion of their experiences with existing REMS, and a review of the literature on REMS and risk management was performed by the author. Summary: A systematic, standardized REMS process that balances the need to control the risks of medications with the need to minimize the impact on patient access is required. A standardized REMS system could address various aspects of development and implementation, including the creation of specific REMS "levels," centralized systems for data management and program structure, public education, individualized patient education, provider education, access to medications, pilot testing, outcomes monitoring, and quality of care. Conclusion: Several strategies to streamline the development and implementation of a REMS system are feasible. Incorporating such strategies is necessary to manage the rapidly growing number of individual and diverse REMS programs that patients and health care providers must navigate. Furthermore, a standardized REMS system could be used to improve quality of care and support patient education and empowerment. [ABSTRACT FROM AUTHOR]

Background: Lung cancer staging system proposed in 2007 adopts detailed tumor size cut-off values. Alternatively, visceral pleural invasion is deemed an important prognosticator, but has not been easily incorporated into the staging system. Methods: We studied 1,245 patients with resected nonsmall-cell lung cancer. Among patients with current pathologic stage IB (pT2N0M0) disease, those with worse prognosis were reclassified as stage IIA based on tumor size and degree of visceral pleural invasion defined by the Japan Lung Cancer Society: P0 = no pleural involvement beyond elastic layer; P1 = infiltration beyond elastic layer without exposure to pleural surface; and P2 = exposure to pleural surface. Results: The current pT2 category was divided into five groups based on size (≤ 3, > 3 to ≤ 5, and > 5 cm) and degree of visceral pleural invasion (P0-1 or P2). Five-year survival rates in patients with P0-1 tumors greater than 3 cm to 5 cm or less were significantly better (59.5%) than those with tumors greater than 5 cm or P2 tumors (37.5% to 47.3%; p = 0.0014); we defined these two groups as T2a and T2b, respectively, and classified T2aN0M0 as stage IB and T2bN0M0 as stage IIA together with the current T1N1M0. Five-year survival rates for the modified IB and IIA diseases were 70.6% and 60.4%, respectively (p = 0.0414). Conclusions: Modified subcategorization of the pT2 category resulted in T2a (> 3 to ≤ 5 cm and P0-1) and T2b (> 5 cm or P2). Detailed assessment of the degree of visceral pleural invasion could provide more information on tumor characteristics and complement the pathologic staging of lung cancer. [Copyright &y& Elsevier]

Future ophthalmologists will need to have broad skills to thrive in complex health care organizations. However, training for ophthalmologists does not take advantage of all of the postgraduate years (PGYs). Although the traditional residency years seem to have little excess capacity, enhancing the internship year does offer an opportunity to expand the time for ophthalmology training in the same 4 PGYs. Integrating the internship year into residency would allow control of all of the PGYs, allowing our profession to optimize training for ophthalmology. In this white paper, we propose that we could capture an additional 6 months of training time by integrating basic ophthalmology training into the intern year. This would allow 6 additional months to expand training in areas such as quality improvement or time for “mini-fellowships” to allow graduates to develop a deeper set of skills. [ABSTRACT FROM AUTHOR]

Summary: This paper is an attempt to convey in a lucid way how to go about writing a scientific article for publication in an appropriate journal. Topics covered are: a) reasons to write a paper b) types of papers c) asking a question and formulating an hypothesis d) the complex series of steps necessary before you begin your study e) additional considerations once your study is complete f) the process of writing the paper and g) writing skills. In the concluding remarks I comment on the possibility of rejection of your submission which should not be taken personally. If this does occur it should not deter you from contributing to medical science. [ABSTRACT FROM AUTHOR]

The article inform people with chronic oedema of the leg and cellulitis, is compression therapy is effective than conservative treatment at reducing recurrence of cellulitis, hospital admission and leg volume.

A quiz concerning the Chronic Obstructive Pulmonary Disease is presented.

The article reflects on standard management for children with symptomatic joint hypermobility for improving pain. Topics include The non-pharmacological trials often consist of multi-component interventions; active ingredients are sometimes difficult to isolate and the final intervention may substantially differ from the planned intervention; and recommend explicitly describing the components, including whether it was standardized and the adherence rates to the protocol and to the intervention.

Abstract: Objective: To assess whether a user-centred prototype clinical decision support system (CDSS) providing patient-specific advice better supports healthcare practitioners in terms of (a) types of usability problems detected and (b) effective and efficient retrieval of childhood cancer survivor's follow-up screening procedures compared to an expert-driven paper-based guideline. Methods and materials: A user-centred design (UCD) process was employed to design a prototype CDSS. Usability problems in information retrieval with the paper-based guideline were assessed by think-aloud analysis with 13 participants. Both simple and more complex tasks were applied. The analysis provided input for the UCD process of the prototype. The usability of the prototype CDSS was subsequently evaluated by think-aloud analysis with the same participants. Usability problems of the paper-based guideline and the prototype CDSS were compared by using the classification of usability problems scheme. In addition, efficiency (time to complete task) and effectiveness (completeness of retrieved screening procedures) of information retrieval of participants in the expert-driven paper-based guideline and the user-centred prototype CDSS were compared. Results: Usability problems in both the paper-based guideline and the CDSS prototype were mainly classified as ‘incongruent with participants’ mental model’. The prototype CDSS reduced this type of problem from 17 to 6 problems. The time to perform simple information retrieval tasks increased by 58s when using the prototype CDSS, however, it resulted in a 58% improvement in task completeness compared to the paper-based guideline. The time to perform complex scenarios decreased by 3:50min with the prototype CDSS, with 17% higher completeness compared to the paper-based guideline. Conclusion: Analysis showed that usability problems experienced by healthcare practitioners when using a paper-based guideline could be overcome by implementing the guideline in a user-centred CDSS design. Although different types of usability problems were experienced with the prototype CDSS, they did not inhibit effective and efficient performance of tasks in the system. The usability problem analysis of the paper-based guideline effectively supported comparison of usability problems found in the two information retrieval systems and it supported the UCD of the CDSS. [Copyright &y& Elsevier]

Highlights: [•] Assessment documentation practices are varying across aged care organizations. [•] EHRs produce higher amount and more comprehensive assessment data. [•] Electronic assessment forms are better signed and dated than the paper forms. [•] EHRs need to improve the completeness and timeliness of assessment documentation. [ABSTRACT FROM AUTHOR]

Paper diaries are commonly used in health care and clinical research to assess patient experiences. There is concern that patients do not comply with diary protocols, possibly invalidating the benefit of diary data. Compliance with paper diaries was examined with a paper diary and with an electronic diary that incorporated compliance-enhancing features. Participants were chronic pain patients and they were assigned to use either a paper diary instrumented to track diary use or an electronic diary that time-stamped entries. Participants were instructed to make three pain entries per day at predetermined times for 21 consecutive days. Primary outcome measures were reported vs actual compliance with paper diaries and actual compliance with paper diaries (defined by comparing the written times and the electronically-recorded times of diary use). Actual compliance was recorded by the electronic diary. Participants submitted diary cards corresponding to 90% of assigned times (±15 min). However, electronic records indicated that actual compliance was only 11%, indicating a high level of faked compliance. On 32% of all study days the paper diary binder was not opened, yet reported compliance for these days exceeded 90%. For the electronic diary, the actual compliance rate was 94%. In summary, participants with chronic pain enrolled in a study for research were not compliant with paper diaries but were compliant with an electronic diary with enhanced compliance features. The findings call into question the use of paper diaries and suggest that electronic diaries with compliance-enhancing features are a more effective way of collecting diary information. [Copyright &y& Elsevier]

Paediatric malignancies are a challenge for the radiation oncologist due to their rarity, the great variety of histological types, and the complexity of treatment concepts that evolve over time. The Paediatric Radiation Oncology Society (PROS) is the only internationally operating society for paediatric radiation oncology. The objectives of PROS are to set a world-wide standard of excellence with respect to radiation oncology aspects in curing children and adolescents with cancer, to provide a forum for communication between radiation oncologists, and to exchange information with all professionals involved in the management of paediatric and adolescent cancer. Challenges include the need to promote education and support practice in low and middle income countries (LMIC) as well as the cost and availability of modern treatment technologies for all but most especially these countries. Collaborations with other societies that include for example the education programmes provided jointly with ESTRO, and the upgraded technical platform of the PROS web site offer new possibilities to enhance the efficacy of PROS in education and support of paediatric radiation oncology practice world-wide. PROS has made an important contribution to the management of childhood malignancies over the past decade and new and developing collaborations between PROS and other societies or organizations will ultimately lead to a reduction in world-wide health care inequalities. [ABSTRACT FROM AUTHOR]

Abstract: The chemical diagnosis of tyrosinemia type I generally involves the detection of succinylacetone (SA) in patient urine. However, 5-aminolevulinate (5ALA), which accumulates due to succinylacetone''s inhibition of porphyrin synthesis, can also be used as diagnostic metabolites. Here we examined the stabilities of these markers on dried urine filter paper. After two weeks at room temperature, the succinylacetone was 10% of its original level, but over 80% of 5-aminolevulinate remained. Thus, although insufficient succinylacetone was recovered from dried urine filter paper to diagnose tyrosinemia type I, 5-aminolevulinate was readily detected, permitting the diagnosis. [Copyright &y& Elsevier]

Background: Patients’ perspectives provide valuable information on quality of care. This study evaluates the feasibility and validity of Internet administration of Service Satisfaction Scale for Cancer Care (SCA) to assess patient satisfaction with outcome, practitioner manner/skill, information, and waiting/access.Patients and methods: Primary data collected from November 2007 to April 2008. Patients receiving cancer care within 1 year were recruited from oncology, surgery, and radiation clinics at a tertiary care hospital. An Internet-based version of the 16-item SCA was developed. Participants were randomised to Internet SCA followed by paper SCA 2 weeks later or vice versa. Seven-point Likert scale responses were converted to a 0–100 scale (minimum–maximum satisfaction). Response distribution, Cronbach’s alpha, and test–retest correlations were calculated.Results: Among 122 consenting participants, 78 responded to initial SCA. Mean satisfaction scores for paper/Internet were 91/90 (outcome), 95/94 (practitioner manner/skill), 89/90 (information), and 86/86 (waiting/access). Response rate and item missingness were similar for Internet and paper. Except for practitioner manner/skill, test–retest correlations were robust r = 0.77 (outcome), 0.74 (information), and 0.75 (waiting/access) (all P < 0.001).Conclusions: Internet SCA administration is a feasible and a valid measurement of cancer care satisfaction for a wide range of cancer diagnoses, treatment modalities, and clinic settings. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: To compare physicians'' treatment and referral decisions for total knee arthroplasty (TKA) for standardized patients with matching paper patients. Study Design and Setting: Sixty-seven physicians (38 family physicians and 29 orthopedic surgeons) performed blinded assessments of two standardized patients (one man and one woman) with moderate knee osteoarthritis and otherwise identical clinical scenarios differing only in gender, and consented to including their data. Standardized patients recorded physicians'' recommendations (yes/no) to refer for, or perform, TKA. Sixty physicians provided their treatment recommendations to matching paper patients. Results: Recommendation rates for both the male and the female standardized patients (67% and 32%, respectively) were lower compared with the matching paper patients (80% and 67%, respectively). Physicians were more likely to recommend TKA to a man than to a woman when presented with standardized patients (odds ratio, 4.2; 95% confidence interval [CI]=2.4–7.3; P <0.001). In contrast, patients'' gender did not affect the same physicians'' recommendations regarding referral for, or performing, TKA for the matching paper patients (odds ratio, 2.0; 95% CI=0.9–4.6; P =0.101). Conclusion: Unlike their treatment recommendations for standardized patients, the same physicians'' treatment and referral decisions for paper patients were not influenced by patients'' gender, suggesting that paper patients are not a sensitive method of assessing physician bias. [Copyright &y& Elsevier]

Abstract: This paper explores the nature of the nursing contribution to chronic disease management (CDM) and identifies a number of key nursing activities within CDM both at the individual patient and care system levels. The activities were identified following a detailed review of the literature (160 reports and studies of nursing practice) relating to three tracer disorders: diabetes, chronic obstructive pulmonary disease and multiple sclerosis. The paper examines these activities collectively to generate models expressing some of the core functions of nursing within CDM. The paper illustrates some of the changing characteristics of nursing roles within CDM. More fundamentally, the paper questions the position of nursing in relation to the technologies that define CDM systems and proposes four levels of contribution: the nurse as technology; the nurse as technologist; the nurse as system engineer; and the nurse as architect. These different levels reflect distinctions in the nature of the nursing gaze and power relations within the health care workforce. The paper also highlights how nurses are failing to develop the evidence for their practice in CDM. The paper concludes that there is a need for some clear principles to guide clinical practice and encourage innovation in CDM. It is argued that the principles should not be rule-bound but define a distinctive nursing gaze that will position the nursing profession within the health care system and in relation to other professions. The gaze should incorporate the needs of the individual patient and the care system that they inhabit. [Copyright &y& Elsevier]

Abstract: This paper is a discussion of the importance of choosing appropriate methodologies to research the breastfeeding experience of women in the United Kingdom. Despite a plethora of research emphasising the benefits of breastfeeding to maternal and infant health, there is a relative dearth of research from the United Kingdom about women''s experiences of breastfeeding. In order to understand the inherent complexities of successfully promoting and supporting breastfeeding, a mothers’ breastfeeding experience must be examined within her specific context. This is increasingly recognised as a vital tool in providing effective support by health care professionals in extending breastfeeding duration. As such, this highlights the importance that appropriate methodologies are chosen through which to explore this phenomenon from the perspective of those experiencing it. This paper debates the importance of philosophical lines of enquiry in relation to breastfeeding research, and argues that engaging with ontological perspectives would offer opportunities for researchers to engage with women''s understanding of breastfeeding in today''s society. A hermeneutic phenomenological approach that is informed from feminist methodologies is deemed the most appropriate in researching mothers’ views of breastfeeding. [Copyright &y& Elsevier]

Abstract: The Ugandan Ministry of Health emphasises the pivotal position of women in securing the nation''s health. Drawing on the concept of therapeutic landscapes, this paper explores media constructions of health in Uganda in order to question what role these may play in creating or undermining a ‘therapeutic landscape’ which supports women''s empowerment in a health context. The paper argues for the importance of understanding discursively constructed notions of health in order to ground the promotion of a health care strategy in the everyday lives and discourses of the users implicated. Given the Ugandan government''s current drive to both empower women and push an agenda of formally provided health care, this paper provides an exploratory analysis of how far newspapers facilitate or hinder this vision. [Copyright &y& Elsevier]

Abstract: There is an explosion in the numbers of nurse authors exploring new and exciting opportunities to understand genomic medicine because of international success on The Human Genome Project. Objectives: The primary purpose of this paper is to spotlight and to promote collaborative interdisciplinary and international nursing research within genetics and genomics. Design: Review of the literature. Data sources: Research in nursing pertaining to genetics and genomics, policy statements, and opinion papers. Review methods: Synthesis of the literature in four areas: genetic nursing research, genomic medicine, barriers to international collaboration, and elements that foster international collaboration. Results: Genetics and genomic medicine have implications for virtually all diseases in all health care settings in developed and still developing nations. Research in nursing, genetics and genomics is scarce. There is a gap in nursing literature about how to address barriers to foster international collaboration. Conclusions: The authors who have engaged in international collaboration offer a tentative road map for establishing and assessing the progress of research collaboration. New funding mechanisms to support international nursing research in this area are needed. [Copyright &y& Elsevier]

Abstract: Practice Papers are evaluative summaries of scientific and/or evidence-based topics. They are meant to provide key opportunities for critical reasoning on timely topics and quality improvement in dietetics practice and to include peer-reviewed perspectives from content practitioners and other experts. How does a practice topic become a Practice Paper? Proposals may be generated by any member of the American Dietetic Association via submission of a topic identification proposal, which may be obtained by contacting ADA headquarters at 800/899-4835 or ppapers@eatright.org. The Association Positions Committee oversees the development of Practice Papers and welcomes proposals from members. [Copyright &y& Elsevier]

The article presents a synopsis on breathing retraining programs that can improve health-related quality of life in people with asthma. Topics discussed include pharmacological treatment is effective in Asthma; produce such substantial improvement in asthma-related quality of life in people; and breathing retraining did not improve pathophysiological outcomes such as clinical control.

Abstract: Aim: In light of debates arising from recent developments in Irish nursing education, this paper analyses tensions in the positioning of nursing in academia in terms of notions of the sacred and profane, and the symbolic boundaries between them, and discusses the implications of this analysis for nurse academics’ identities. Background: The entry of nursing education to the higher education sector has occurred against a discursive backcloth of opposition which constructs nursing work as either sacred, and under threat from the academy, or profane, and unworthy of a place in it. Method: Conceptual resources derived from the work of Basil Bernstein are deployed to analyse the forces driving the loom weaving this discursive backcloth. These forces are conceptualised as deriving from deep-seated fears and anxieties sparked by changes in the strength of symbolically important boundaries between constructions of the sacred and profane in the fields of nursing and higher education. These constructions are explicated. Findings: Bernstein regards secure academic identities as inhering in strong boundaries between disciplines and between the fields of education and work. The transfer of nursing education from health to the higher education sector and nurse academics’ attempts to articulate a nursing-discipline specific knowledge base can be understood in these terms. This analysis challenges nurse academics who promote disciplinary eclecticism and those who legitimate academic nursing principally in terms of the acquisition of generic and transferable lifelong learning skills. Conclusions: To counter a discourse that constructs them as a profane presence in higher education, some nurse academics have articulated a discourse of legitimation that constructs (academic) nursing as a sacred endeavour. Whether this can provide the grounds of their legitimacy and the basis of their careers as distinctively nursing academics is unclear at this stage of nursing''s development as an academic discipline. [Copyright &y& Elsevier]

Abstract: The current evidence-based practice (EBP) movement in healthcare emphasizes that clinical decision making should be based on the “best evidence” available, preferably the findings of randomized clinical trials. Within this context qualitative research findings are considered to have little value and the old debate in nursing has been re-ignited related to whether qualitative versus quantitative research findings provides the best empirical evidence for nursing practice. In response to this crisis qualitative scholars have been called upon by leaders in the field to clarify for outsiders what qualitative research is and to be more explicit in pointing out the utility of qualitative research findings. In addition, attention to “quality” in qualitative research has been identified as an area worthy of renewed focus. Within this paper two key problems related to addressing these issues are reviewed: disagreement not only among “outsiders” but also some nursing scholars related to the definition of “qualitative research”, and a lack of consensus related how to best address “rigor” in this type of inquiry. Based on this review a set of standard requirements for qualitative research published in nursing journals is proposed that reflects a uniform definition of qualitative research and an enlarged yet clearly articulated conceptualization of quality. The approach suggested provides a framework for developing and evaluating qualitative research that would have both defensible scholarly merit and heuristic value. This will help solidify the argument in favor of incorporating qualitative research findings as part of the empirical “evidence” upon which evidence-based nursing is founded. [Copyright &y& Elsevier]

Abstract: The aim of this paper is to provide a comprehensive overview of ethnomethodology and explore its usefulness as a methodology for nursing. Ethnomethodology was conceived through the writings of Harold Garfinkel, an American Sociologist in 1967. The influence of phenomenology, sociology and writings of the linguistic philosopher Wittengenstein is evident in this methodology. In the 1970s, it was both heralded by some as a threat to sociology and by others as a welcome development borne out of the dissatisfaction with positivist paradigm research. It is a methodology that has been utilised not only by sociologists but also by many health care disciplines. However, its utilisation by nurse researchers has not been widespread. [Copyright &y& Elsevier]

Abstract: Nurses globally are required and expected to report nursing errors. As is clearly demonstrated in the international literature, fulfilling this requirement is not, however, without risks. In this discussion paper, the notion of ‘nursing error’, the practical and moral importance of defining, distinguishing and disclosing nursing errors and how a distinct definition of ‘nursing error’ fits with the new ‘system approach’ to human-error management in health care are critiqued. Drawing on international literature and two key case exemplars from the USA and Australia, arguments are advanced to support the view that although it is ‘right’ for nurses to report nursing errors, it will be very difficult for them to do so unless a non-punitive approach to nursing-error management is adopted. [Copyright &y& Elsevier]

Abstract: Many now claim that maintaining or improving the quality of life is the essence of healthcare (i.e. care and/or treatment that improves the patients’ quality of life). Interest in QL, however, stems from increasing recognition that individuals are an integrated whole rather than a series of disconnected parts or disease states. Though this represents a significant change from the past—when the emphasis lay solely on physical or medical condition—it is not, in itself, meaningful unless reliable and valid ways of evaluating the human aspects of the experience can be identified (i.e. quality of life). As quality of life (QL) is seen as a positive state, a desirable outcome of healthcare interventions, it has gained credence as an appropriate outcome measure and has intuitive appeal. Indeed, it is suggested that, because of its close relationship to mortality, self-perceived QL may be the most important outcome of both acute and, particularly, chronic disease. Lack of consensus about its meaning has, however, resulted in ambiguity and, therefore, difficulties in its measurement reflecting, in turn, the difficulty in identifying the components of this multifaceted concept. This paper explores these issues and questions whether we are, in fact, attempting to measure something that cannot truly be measured. [Copyright &y& Elsevier]

A lack of recent improvement in survival in teenagers and young adults (TYA) with bone tumours may be linked to a lack of trial recruitment and specialist care, poor concordance with therapy, and/or TYA-specific pharmacology. To overcome these challenges, working together to create collaborative care between adult and paediatric experts in bone sarcoma is neccessary, to meet TYA patients' needs.Teenagers and young adults (TYA) cancer contributes substantially to morbidity and mortality in a population with much to offer society. TYA place distinct challenges upon cancer care services, many reporting feeling marginalized and their needs not being met in adult or paediatric cancer services. Bone tumours such as osteosarcoma and Ewing sarcoma, because of their age at presentation and the complexity of their care, are where challenges in managing (TYA) with cancer have often been most readily apparent. Bone sarcomas may be managed by paediatric or medical oncologists, and require fastidious attention to protocol. A lack of recent improvement in survival in TYA with bone tumours may be linked to a lack of specialist care, poor concordance with therapy in some situations and TYA-specific pharmacology. Participation in clinical trials, particularly of young adults, is low, hindering progress. All these requirements may be best met by a concerted effort to create collaborative care between adult and paediatric experts in bone sarcoma, working together to meet TYA patients' needs. [ABSTRACT FROM AUTHOR]

Abstract: It is the position of the American Dietetic Association that the quality of life and nutritional status of older adults residing in health care communities can be enhanced by individualization to less-restrictive diets. The Association advocates the use of qualified registered dietitians (RDs) to assess and evaluate the need for nutrition care according to each person''s individual medical condition, needs, desires, and rights. Dietetic technicians, registered, provide support to RDs in the assessment and implementation of individualized nutrition care. Individual rights and freedom of choice are important components of the assessment process. An RD must assess each older adult''s risks vs benefits for therapeutic diets. Older adults select housing options that provide a range of services from minimal assistance to 24-hour skilled nursing care. Food is an important part of any living arrangement and an essential component for quality of life. A therapeutic diet that limits seasoning options and food choices can lead to poor food and fluid intake, resulting in undernutrition and negative health effects. Including older individuals in decisions about food can increase the desire to eat and improve quality of life. The expansion of health care communities creates a multitude of options for RDs and dietetic technicians, registered, to promote the role of good food and nutrition in the overall quality of life for the older adults they serve. [Copyright &y& Elsevier]

Background: Patient-reported outcomes (PROs) are the consequences of disease and/or its treatment as reported by the patient. The importance of PRO measures in clinical trials for new drugs, biological agents, and devices was underscored by the release of the US Food and Drug Administration's draft guidance for industry titled “Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims.” The intent of the guidance was to describe how the FDA will evaluate the appropriateness and adequacy of PRO measures used as effectiveness end points in clinical trials... [ABSTRACT FROM AUTHOR]

Abstract: The British government''s involvement in overseas nurse recruitment originated in its imperial past when the Colonial Nursing Service was established in 1940 by the Colonial Office to unify the administration of British nurse appointments across the Empire. The Colonial Office unified recruitment arrangements for colonial nursing posts, effectively creating an imperial market in nursing labour, which arguably set the historical precedent for the greater flow of international nurse recruitment from and to the United Kingdom (UK). The recent implementation of the Nursing and Midwifery Council''s Overseas Nurses Programme to regulate the registration route for international nurse recruits to the UK is symptomatic of growing international nurse migration. In a globalising marketplace, overseas nurse recruitment remains a significant supply factor in meeting the staffing needs of the National Health Service (NHS) in the UK. The continuities between the historical case of the Colonial Nursing Service and the current prevalence of transnational nurse migration highlight a pervading tension between the professional agenda of nursing and recruiters’ and governments’ responses to market pressures. [Copyright &y& Elsevier]

In Egypt access of the entire population to health care services and medications is still a challenging step, with high out of pocket expenditure that reaches 60%. A lot of medications and diagnostic services are still not publicly covered like biological, targeted therapies and many biomarkers tests, and although the government initiated a co-payment program, there is a still a gap in providing eligible patients with full course of therapy. [Extracted from the article]

Abstract: What will be the future of internal medicine in Europe? Because of rapidly growing concerns regarding the position of internal medicine in many European countries, the European Federation of Internal Medicine (EFIM) has established a working group to analyze the situation. Being well aware of the variation in working practices in the different countries, the members of the group used an “all-European” approach to answer the following questions: [•] Are there problems for internal medicine? If so, what are these problems and why? [•] Why do the health care systems in the European countries need internal medicine? [•] Why do patients need internal medicine? [•] What needs to be done? Internal medicine is the modern, clinical, and scientific medical discipline that is responsible for the care of adult patients with one or more complex, acute, or chronic illnesses. Internal medicine is the cornerstone of an integrated health care delivery service that is needed today. Decision-makers in politics and hospitals, insurers, journalists, and the general public need a better understanding of what internal medicine can offer to the health care system and to the individual patient. [Copyright &y& Elsevier]

Background Prosthodontic Rehabilitation of Treated Maxillofacial Trauma Cases by Evaluating Occlusal Force Distribution Using Computerized Occlusal Analysis. Method 30 patients were selected for the study. 15 normal and 15 treated trauma patients were subjected to T Scan analysis and evaluated for the occlusal force distribution. Results The results take into consideration the two parameters. Firstly the largest articulating paper mark (photographed) and secondly the T scan of the same patient. Comparison was made between the largest articulating paper mark and highest force tooth in the quadrant using T Scan. The matches and no matches were then tabulated for statistical analysis assessing the frequency of the matches to the no matches. Conclusion The ultimate advantage of a T Scan III analysis is that it can detect the amount of force as well as location of the highest intensity contacts of a single tooth which is very specific. [ABSTRACT FROM AUTHOR]

Summary: Three separate but related ideas build on van Deventer’s concept of the “meta-placebo” effect in which placebo effects are hypothesized to help patients even when patients know they are receiving a placebo. First, a method is proposed to experimentally validate the meta-placebo effect without lying to experimental subjects. Second, the idea of a meta-placebo is extended to a condition where patients experience many of the elements of placebo treatments that are hypothesized to cause placebo benefits, such as an optimistic prognosis by a doctor, but patients do not actually take a placebo pill: a “curabo effect”. The final section proposes that patients might be able to experience enough placebo- and -curabo-related treatment elements to gain a beneficial effect without either a pill or a doctor. Instead, simply having the knowledge that one can derive medical benefit from placebo, meta-placebo, and -curabo treatments, and without medicine, might in itself suffice to cause some to feel better: the hypothesized meta-meta-placebo and -curabo (or “meta-bo,” for short) effect. [Copyright &y& Elsevier]

Objective: To investigate whether the use of the think-aloud method with propositional analysis could be helpful in the design of a Clinical Decision Support System (CDSS) providing guideline recommendations about long-term follow-up of childhood cancer survivors.Materials and Methods: The think-aloud method was used to gain insight into healthcare professionals' information processing while reviewing a paper-based guideline. A total of 13 healthcare professionals (6 physicians and 7 physician assistants) prepared 2 fictitious patient consults using the paper-based guideline. Propositional analysis was used to analyze verbal protocols of the think-aloud sessions. A prototype CDSS was developed and a usability study was performed, again with the think-aloud method.Results: The analysis revealed that the paper-based guideline did not support healthcare practitioners in finding patient-specific recommendations. An information processing model for retrieving recommendations was developed and used as input for the design of a CDSS prototype user interface. Usability analysis of the prototype CDSS showed that the navigational structure of the system fitted well with healthcare practitioners' daily practices.Conclusions: The think-aloud method combined with propositional analysis of healthcare practitioners' verbal utterances while they processed a paper-based guideline was useful in the design of a usable CDSS providing patient-specific guideline recommendations. [ABSTRACT FROM AUTHOR]