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Background: Diagnosis and treatment of cancer and blood disorders in childhood, adolescence and young adulthood has a significant impact on patients and families. The Psychosocial Standards of Care project, initiated in 2012, resulted in 15 Psychosocial Standards (PSS) that guide the care patients and families receive throughout treatment. As members of the multidisciplinary psychosocial care team, music therapists play an important role in the advancing the PSS. Most surveys have focused on other commonly provided services (e.g., social work, child life), leaving gaps in our understanding about the availability and use of music therapy services to advance PSS. This paper offers an initial description of how music therapy services contribute to the provision of care under these Standards. Methods: We analyze how music therapy services promote PSS through synthesis of a music therapy clinical practice survey, published literature, and scope of practice documents. A brief overview of music therapy services structure, PSS that music therapy services currently address, and two clinical program descriptions are included. Results: Music therapy services address 9 of the 15 PSS and are well integrated within the larger program of psychosocial care. Findings suggest integration of music therapy services can help ensure personalized, comprehensive care and efficient use of often-limited psychosocial care resources. Discussion: Nurses, as members of the psychosocial and medical teams are uniquely positioned to identify patient and family care needs and refer patients for services. Understanding how music therapy services address PSS and most importantly, the needs of patients and families, will optimize their care.

Broadly neutralizing antibodies (bNAbs) may constitute an essential component of a protective vaccine against HIV-1, yet no immunogen has been able to elicit them. To characterize the development of bNAbs in HIV-1 subtype C infected individuals, a panel of 18 Env-pseudotyped viruses was used to screen 18 study participants. The specificity of plasma neutralization was mapped against Env mutants and MPER chimeras. Envelope (env) gene sequence evolution was characterized by single genome amplification and sequencing. Three out of eighteen individuals developed broad plasma neutralizing activity (>60% breadth). Two of the three participants may target epitopes comprising glycans at position 276 of the D loop in the CD4 binding site and 332 glycan supersite, respectively. Deletion of these glycans was associated with neutralization resistance. Our study describes the kinetics of the development of plasma neutralizing activity and identified amino acid residue changes suggestive of immune pressure on putative epitopes. The study enhances our understanding of how neutralization breadth develops in the course of HIV-1 subtype C infection.

This article critically examines definitions of policy ‘success’ in the context of historical Indigenous higher education policy in the Northern Territory (NT), Australia. We begin by summarising a...

L’éthique professionnelle est une compétence importante pour les professionnels qui œuvrent dans le domaine de la santé. Chez les orthophonistes, plus spécifiquement, l’élargissement constant du champ de pratique et la complexification des besoins de la population vieillissante font en sorte que ces professionnels sont confrontés à davantage de questionnements de nature éthique. Pourtant, la littérature scientifique démontre que les orthophonistes ne se sentent pas adéquatement préparés à résoudre des enjeux de nature éthique. L’objectif général de cette étude était d’examiner l’état de la formation en éthique professionnelle dans tous les programmes canadiens qui offrent une formation en orthophonie. Afin de répondre à cet objectif, un sondage a été envoyé aux directeurs des onze programmes universitaires canadiens en orthophonie. Trois programmes ont répondu au sondage. Les principaux résultats obtenus suggèrent que l’éthique professionnelle est un sujet enseigné à l’intérieur de différents cours des cursus universitaires canadiens en orthophonie. Malgré tout, le pourcentage consacré à celui-ci à l’intérieur des cours s’avère faible et difficile à bien estimer. Ces résultats offrent un premier éclairage sur la quantité et la qualité des cours portant sur l’éthique professionnelle offerts dans les différents programmes canadiens d’orthophonie, de même que sur les méthodes pédagogiques utilisées., Professional ethics is an important skill for professionals who work in the area of health. For speech-language pathologists specifically, the constant widening of the field of practice and the increasing complexity of the needs of the aging population expose professionals to more ethical questioning. Yet, the scientific literature demonstrates that speech-language pathologists do not feel properly prepared to solve ethical issues. The main objective of this study was to examine the situation of ethics training in all Canadian programs that offer speech language pathology training. In order to meet this objective, a survey was sent to the directors of the eleven Canadian university programs in speech-language pathology. Three programs responded to the survey. The main results obtained suggest that professional ethics is a subject taught within different courses in Canadian university speech-language programs. Nevertheless, the percentage dedicated to ethics inside the courses is low and difficult to clearly estimate. These results shed light on the quantity and quality of professional ethics courses offered in the various Canadian speech-language programs, as well as on the teaching methods used.

Music therapy clinicians bring an important perspective to the design and conduct of clinically meaningful studies. Unfortunately, there continue to be roadblocks that hinder clinician involvement in research and the development of successful partnerships between academic researchers and practicing clinicians. To help grow clinician involvement, it is important that research teams share their experiences. As such, the purpose of this qualitative study was to share music therapists’ perspectives about their experience of working as a research clinician on a large multisite randomized controlled trial. 10 board-certified music therapists provided written responses to 6 data-generating questions about: (a) reasons for participating, (b) perceived challenges and benefits, (c) experiences of quality assurance monitoring, (d) professional growth, (e) value of research, and (f) advice for clinicians considering research involvement. Using thematic content analysis, we identified primary themes and subthemes for each question (20 themes; 30 subthemes). Qualitative analysis revealed not only common challenges, such as reconciling clinical and research responsibilities, but also benefits, including continued professional growth, greater understanding of research processes, and research participation as a way to advocate and advance the profession. Finally, for clinicians interested in becoming involved in research, therapists noted the importance of having workplace support from a mentor, supervisor, and/or administrator; seeking out available resources; and knowing roles and responsibilities before initiating research involvement. Findings offer important insight and recommendations to support the involvement of clinicians in research and support further exploration of clinician involvement in dissemination efforts to improve translation and uptake of research into practice.

Anaphylaxis is an acute, potential life-threatening systemic allergic reaction that may have a wide range of clinical manifestations. Severe anaphylaxis and/or the need for repeated doses of epinephrine to treat anaphylaxis are risk factors for biphasic anaphylaxis. Antihistamines and/or glucocorticoids are not reliable interventions to prevent biphasic anaphylaxis, although evidence supports a role for antihistamine and/or glucocorticoid premedication in specific chemotherapy protocols and rush aeroallergen immunotherapy. Evidence is lacking to support the role of antihistamines and/or glucocorticoid routine premedication in patients receiving low- or iso-osmolar contrast material to prevent recurrent radiocontrast media anaphylaxis. Epinephrine is the first-line pharmacotherapy for uniphasic and/or biphasic anaphylaxis. After diagnosis and treatment of anaphylaxis, all patients should be kept under observation until symptoms have fully resolved. All patients with anaphylaxis should receive education on anaphylaxis and risk of recurrence, trigger avoidance, self-injectable epinephrine education, referral to an allergist, and be educated about thresholds for further care.

[Extract] The appropriate conduct of health research in Indigenous communities is an ongoing topic of discussion, underpinned by ethical, epistemological and methodological issues. Data collected, analysed and disseminated from research in Indigenous communities has typically met the needs of the researcher first, with Indigenous communities often playing a passive role in the research process. Australia's National Health and Medical Research Council's (NHMRC) 'Road Maps I and II: Strategic Framework for Improving Aboriginal and Torres Strait Islander Health through Research' provide researcher guidelines to ensure the needs and concerns of Indigenous Australian (Aboriginal and Torres Strait Islander) communities are met. The guidelines' six principles relate to ethical research with the overall objective of making research relevant to the peoples and communities involved (see Table 1).

BACKGROUND: Falls prevention in "real-life" clinical practice is a complex undertaking. Nurses play an active and essential role in falls prevention. AIM: This discussion paper presents a picture of the nurse as a bricoleur in falls prevention, requiring knowledge in many areas and the ability to perform multiple diverse tasks. METHODS: Building on a qualitative case study with nurses at various levels in three acute care facilities, this paper posits that the concept of nurse as bricoleur has the potential to broaden our understanding of the complexity of falls prevention. FINDINGS: The nurse as bricoleur within the Promoting Action Research in Health Services framework as the provider of person- or patient-centered evidence-based care is conceptualized. Within this framework, the nurse uses his or her professional knowledge or clinical experience while considering research, local data, and information, and the patient's experience and preferences to provide this care, the bricolage. Each of these areas is discussed as well as the impact on the nurse when a fall does occur. LINKING EVIDENCE TO ACTION: Recognizing this complexity of the nurses' world has important implications for both service delivery and education, including preparation of students, and the implementation of new organizational initiatives and supports for nurses when falls do occur despite the best efforts of all involved. Language: en

Although the use of qualitative case study research has increased during the past decade, researchers have primarily reported on their findings, with less attention given to methods. When methods were described, they followed the principles of Yin; researchers paid less attention to the equally important work of Stake. When Stake’s methods were acknowledged, researchers frequently used them along with Yin’s. Concurrent application of their methods did not take into account differences in the philosophies of these two case study researchers. Yin’s research is postpositivist whereas Stake’s is constructivist. Thus, the philosophical assumptions they used to guide their work were different. In this article we describe how we used Stake’s approach to explore the implementation of a falls-prevention best-practice guideline. We focus on our decisions and their congruence with Stake’s recommendations, embed our decisions within the context of researching this phenomenon, describe rationale for our decisions, and present lessons learned.

Background Globally, falls are the second leading cause of unintentional injury. In Canada, falls that occur in hospitals have been ranked second as an area of patient safety concern. Many Canadian hospitals seeking to achieve patient safety, accreditation and resource containment goals are implementing evidence-based practices in fall prevention. However, best practices are reported to be only variably effective in reducing hospital fall rates, indicating a potential gap in our understanding of the implementation process. This study was designed to provide insight into the real world of implementation of best practices in fall prevention in acute care Canadian hospitals. Approach Using case study methodology, ninety-five administrative and point-of-care nurses at three hospitals participated in interviews or focus groups and provided documents and artifacts that described their implementation of a falls prevention guideline. Findings and implications Four recommendations with potential to guide others in fall prevention were identified: (1) the need to listen to and recognize the expertise and clinical realities of staff, (2) the importance of keeping the implementation process simple, (3) the need to recognize that what seems simple becomes complex when meeting individual patient needs, and (4) the need to view the process as one of continuous quality improvement.

Falls prevention in "real-life" clinical practice is a complex undertaking. Nurses play an active and essential role in falls prevention.This discussion paper presents a picture of the nurse as a bricoleur in falls prevention, requiring knowledge in many areas and the ability to perform multiple diverse tasks.Building on a qualitative case study with nurses at various levels in three acute care facilities, this paper posits that the concept of nurse as bricoleur has the potential to broaden our understanding of the complexity of falls prevention.The nurse as bricoleur within the Promoting Action Research in Health Services framework as the provider of person- or patient-centered evidence-based care is conceptualized. Within this framework, the nurse uses his or her professional knowledge or clinical experience while considering research, local data, and information, and the patient's experience and preferences to provide this care, the bricolage. Each of these areas is discussed as well as the impact on the nurse when a fall does occur.Recognizing this complexity of the nurses' world has important implications for both service delivery and education, including preparation of students, and the implementation of new organizational initiatives and supports for nurses when falls do occur despite the best efforts of all involved.

En este artículo se analiza la información histórica de dos sismos —el del 12 de julio de 1785 y el del 31 de agosto de 1917— que causaron un fuerte impacto en Bogotá. Además de las implicaciones para la amenaza sísmica de Bogotá, estos eventos son interesantes puesto que estudios previos han ubicado sus epicentros en zonas donde no hay evidencias de actividad tectónica reciente. Los nuevos registros históricos documentales encontrados en este estudio contienen datos relacionados con daños y efectos en diferentes poblaciones, los cuales se organizaron y analizaron para obtener registros de intensidad. La distribución de las intensidades resultantes, superpuestas con las fuentes sismogénicas, sugieren nuevas zonas epicentrales para estos sismos.

BackgroundInterventions for dietary and physical activity changes in obese adults may be less effective for participants with additional obesity-related risk factors and co-morbidities than for otherwise healthy individuals. This study aimed to test the feasibility and acceptability of the recruitment, allocation, measurement, retention and intervention procedures of a randomised controlled trial of an intervention to improve physical activity and dietary practices amongst obese adults with additional obesity related risk factors.MethodPilot single centre open-labelled outcome assessor-blinded randomised controlled trial of obese (Body Mass Index (BMI)≥30 kg/m2) adults (age≥18 y) with obesity related co-morbidities such as type 2 diabetes, impaired glucose tolerance or hypertension. Participants were randomly allocated to a manual-based group intervention or a leaflet control condition in accordance to a 2∶1 allocation ratio. Primary outcome was acceptability and feasibility of trial procedures, secondary outcomes included measures of body composition, physical activity, food intake and psychological process measures.ResultsOut of 806 potentially eligible individuals identified through list searches in two primary care general medical practices N = 81 participants (63% female; mean-age = 56.56(11.44); mean-BMI = 36.73(6.06)) with 2.35(1.47) co-morbidities were randomised. Scottish Index of Multiple Deprivation (SIMD) was the only significant predictor of providing consent to take part in the study (higher chances of consent for invitees with lower levels of deprivation). Participant flowcharts, qualitative and quantitative feedback suggested good acceptance and feasibility of intervention procedures but 34.6% of randomised participants were lost to follow-up due to overly high measurement burden and sub-optimal retention procedures. Participants in the intervention group showed positive trends for most psychological, behavioural and body composition outcomes.ConclusionsThe intervention procedures were found to be acceptable and feasible. Attrition rates were unacceptably high and areas for improvements of trial procedures were identified.Trial registrationControlled-Trials.com ISRCTN90101501.