Research for improving the health and well-being of the black community: implications for shaping a research agenda

Black Americans continue to experience a disproportionately poorer health status than the majority population. Research is one avenue that can help to identify both contributing and mediating factors related to this disparity. Black nurses are in a unique position to conduct research that will improve the health and well-being of Black Americans. This article addresses the need for Black nurses to become more actively involved in designing, conducting, and evaluating research, and identifies areas for consideration when shaping a research agenda for the Black community.

Critical appraisal of research literature by expert and inexperienced physical therapy researchers

BACKGROUND AND PURPOSE

In this study, critical appraisal skills of physical therapists who were inexperienced and expert researchers were compared and the effect of the following independent variables on the appraisal skills of novices was examined: years of physical therapy practice, postgraduate experience with research, level of comfort with research, journal reading habits, and content-specific expertise.

SUBJECTS AND METHODS

Four expert and 20 inexperienced researchers critiqued the same research article. A content analysis of the expert critiques was used to develop a set of 12 items of concerns about the study.

RESULTS

Experts identified a mean of 7.75 items of concern; novices identified a mean of 3.95 items. For 10 of the 12 items, a greater proportion of experts identified each concern compared with the novices. Novices had comparatively less difficulty identifying concerns with internal validity than they did identifying issues relating to construct validity. Only one of the variables--content-specific expertise--was associated with differences in critical appraisal skills among the novices.

CONCLUSION AND DISCUSSION

These finding suggest that analysis of construct issues in research articles is a more advanced skill than analysis of research design and that critical appraisal of research literature is enhanced by clinical experiences related to the subject of the research report.

Operative laparoscopy: American Association of Gynecologic Laparoscopists, 1993 membership survey

The American Association of Gynecologic Laparoscopists' 1993 membership survey on operative laparoscopy had 1205 respondents reporting 80,031 procedures. Diagnostic laparoscopy remains the most common procedure, followed by adhesiolysis and laparoscopically assisted vaginal hysterectomy. This survey was particularly designed to chronicle the rate of complications as increasingly complex laparoscopic procedures are performed.

Efficacy of Brahman breeding in the management of insecticide-resistant horn flies (Diptera: Muscidae) on beef cattle

The efficacy of Brahman breeding used as an alternative tactic to manage insecticide-resistant populations of adult horn flies, Haematobia irritans irritans (L.), was determined. Concentration-mortality bioassays done at Booneville and Hope, AR, in 1988 and 1989, respectively, showed that horn fly populations were resistant to diazinon, pirimiphos methyl, tetrachlorvinphos, and methoxychlor. Data showed loss of field efficacy for coumaphos and delnav. Mean horn fly counts on Braham cows were significantly lower than on Angus cows for all sampling dates in 1989 and 1990. Mean fly counts on Brahman x Angus cows were approximately intermediate to the two purebred mean fly counts. Brahman breeding caused significant reductions in the number of organophosphate-resistant horn flies, which had been equal to or greater than that obtained from continued spraying with organophosphate insecticides. The Brahman x Hereford cows, which have one-eighth greater Brahman breeding than the Brangus cows, had fewer horn flies on 48 of 56 sampling dates in 1988-1990 and significantly fewer flies on 37 sampling dates. The effectiveness of Brahman breeding in causing lower numbers of insecticide-resistant horn flies significantly increased as the percentage of Brahman breeding increased.

Operative hysteroscopy. American Association of Gynecologic Laparoscopists 1991 membership survey

The 1991 American Association of Gynecologic Laparoscopists membership survey on operative hysteroscopy had a total of 630 respondents (almost double the 1988 number) who reported performing 17,298 procedures as compared to 7,293 in 1988. Directed biopsy and endometrial ablation were the procedures reported most commonly. Endometrial ablation increased fivefold since 1988, and myomectomy increased fourfold. The majority of operative hysteroscopies were performed for a complaint of abnormal bleeding (73%). The most frequently reported complication was uterine perforation not requiring transfusion (11 per 1,000 procedures). The rate of water intoxication or pulmonary edema dropped from 3.4/1,000 in 1988 to 1.4/1,000 in 1991. However, some serious complications (eight laparotomies for bowel injury, three CO2 embolisms and three deaths) were reported for 1991.

Laparoscopic sterilization. American Association of Gynecologic Laparoscopists 1991 membership survey

The 1991 membership survey of the American Association of Gynecologic Laparoscopists indicated more laparoscopic procedures than had been reported in the last survey, in 1988. The respondents reported 30,480 sterilizations, 41,160 diagnostic laparoscopies and 8,015 hysteroscopies. The distribution of sterilization by method of tubal occlusion has remained stable since 1985. Complications from diagnostic laparoscopy remain consistently higher than from sterilization. This year the complication rate for diagnostic procedures was higher than in any other year since 1976 (4.9 per 1,000 cases). One death was reported after sterilization and one after diagnostic laparoscopy.

Operative laparoscopy. American Association of Gynecologic Laparoscopists 1991 membership survey

The American Association of Gynecologic Laparoscopists 1991 membership survey on operative laparoscopy had a total of 878 respondents reporting 56,536 procedures, for a 1.5-fold increase over the number of procedures reported in 1988. The most frequent indication was pelvic pain (58% of procedures); next was infertility (42%). Laparoscopic management of ectopic pregnancy increased over twofold, from 1,914 cases in 1988 to 4,620 in 1991. As compared to the 1988 survey data, the rate of unintended laparotomy to manage hemorrhage, bowel or urinary tract injury may have increased, but the death rate remained low, 1.8 per 100,000 procedures.

Combined analysis of tall fescue steer grazing studies in the Eastern United States

The mixed-models procedure (MMP) was used to analyze pooled data sets from 12 independent studies conducted during the last 13 yr at nine locations in seven states to provide combined estimates of daily gains by beef steers (Bos taurus) grazing tall fescue (Festuca arundinacea Schreb.) pastures free of (E-) or infested (E+) at different levels with the endophytic fungus Acremonium coenophialum. Treatments included low-infestation (< or = 5% E+), moderate-infestation (> or = 20 to < or = 35% E+), and high-infestation (> or = 50 to < or = 97% E+) tall fescue pastures, and, in tall fescue-clover (Trifolium spp.) mixtures, pastures at the same E+ levels with approximately 25 and 10% clover in spring and summer stands, respectively. Spring, summer, and combined spring+summer data were analyzed separately. The MMP permitted estimation of the fixed effects of treatments over a broad inference space of future years and different tall fescue pastures over a wide geographic range; detected relationships that had not been apparent in the individual studies, such as the interactions between clover presence and E+ infestation levels; and provided a more coherent body of information than did the results obtained from each discrete study. Logistical and financial constraints that force undesirable compromises in the conduct of future grazing and other expensive or time-consuming research may be avoided by using MMP within the context of cooperative projects.

Single-Crystal Epitaxial Thin Films of the Isotropic Metallic Oxides Sr1-xCaxRuO3 (0 le x le 1)

Single-crystal epitaxial thin films of the isotropic metallic oxides Sr1-xCaxRuO(3) (0 </= x </= 1) were grown on miscut SrTiO(3)(100) substrates in situ by 90 degrees off-axis sputtering. These thin films exhibit low isotropic resistivities, excellent chemical and thermal stability, good surface smoothness, and high crystalline quality. Furthermore, the lattice parameters and magnetic properties can be varied by simply changing the strontium/calcium ratio. These epitaxial thin films, and their multilayer structures with other oxide materials, can be used for the fabrication of superconducting, ferroelectric, magneto-optic, and electro-optic devices.

Intrauterine intravascular transfusion for fetal haemolytic anaemia: the Western Australian experience

OBJECTIVE

To report the first four years' clinical experience with fetal intravascular blood transfusion for the treatment of fetal haemolytic anaemia in Western Australia.

SETTING

King Edward Memorial Hospital, Perth, which is the sole tertiary level perinatal centre in Western Australia with a referral base of approximately 25,000 pregnancies each year.

METHODS

Transfusion was by injection of packed cells from Rh-negative donors into the fetal umbilical vein near the site of insertion into the placenta. Fetal haemoglobin levels were measured before and after each transfusion. In most cases, the fetus was paralysed by intramuscular tubocurarine.

RESULTS

Sixty intravenous transfusions were performed in 20 pregnancies. At the time of the initial transfusion, the mean haemoglobin level was 5.8 g/dL (range, 2.5-8.5 g/dL) and six fetuses had signs of hydrops. The case survival rate was 80% and the procedure survival rate was 93%. Three of the deaths occurred in the first five cases. Caesarean section was performed during two of the procedures, one because of bleeding from the cord puncture site and one because of tamponade of the umbilical vessels.

CONCLUSION

Fetal intravascular transfusion is a highly effective treatment for fetal alloimmunisation and allows pregnancies to continue to term and to be delivered vaginally. However, the procedure may be difficult and requires a team approach with ready access to fetal monitoring and emergency caesarean section. Our results suggest that increasing experience of the team is a major factor in improved outcome.