Aligned or misaligned: Are public funding models for speech-language pathology reflecting recommended evidence? An exploratory survey of Australian speech-language pathologists

Government subsidised funding arrangements serve as an essential medium for families to access private speech-language pathology (SLP) services in Australia. This study aimed to investigate whether, from a provider perspective, contemporary public funding models (PFMs) align with best-available scientific evidence for management of children and young persons with swallowing and communication disorders within Australian private-practice settings. This exploratory study was distributed to paediatric speech-language pathologists throughout Australia via an online survey. A total of 121 valid surveys were completed by Australian speech-language pathologists with divergent career experiences. In comparing three familiar PFMs using mixed effects logistic regression models to estimate odds ratios, results indicated that perceived congruence with recommended scientific evidence for SLP management varied across PFMs: the odds of failing to align with scientific evidence was 4.92 times higher for Medicare's Chronic Disease Management Plan (MBS_CDMP) than for the National Disability Insurance Scheme; and 7.40 times higher in comparison to Medicare's Helping Children with Autism initiative. This study is the first to report on (in)congruence between PFMs that provide access to independent Australian SLP services for children and young persons and best available scientific evidence to inform clinical practice. Participants identified that: (a) four out of seven contemporary PFMs were unfamiliar to speech-language pathologists; and (b) MBS_CDMP initiative failed to align with the evidence-base for best scientific SLP management.

Communication self-efficacy and communication apprehension in a national sample of undergraduate nursing students: A cross-sectional study

AIM

The aim of this study was to explore communication apprehension and communication self-efficacy in undergraduate nursing students and identify factors that contribute to communication apprehension and communication self-efficacy.

BACKGROUND

Communication education and skills training is often incorporated into undergraduate nursing curricula; however, communication competence continues to be a problem for novice nurses. Communication apprehension is a concept that has been only minimally researched in nursing education and can have a negative impact on student communication readiness.

DESIGN

This study employed a cross-sectional design and surveyed a national sample of undergraduate nursing students between October 2022 and March 2023.

METHODS

An online survey was sent out to undergraduate nursing student members of the National Student Nurses Association as well as nursing education programs in 8 states and the District of Columbia. The survey was comprised of demographic questions, the Personal Report of Communication Apprehension, and the communication subscale of the Nursing Student Self-Efficacy Survey.

RESULTS

Approximately 22.1 % of the students had high communication apprehension, with the highest communication apprehension in public speaking and classroom communication. Communication self-efficacy scores ranged from 12 to 40, with a mean of 31.65 (SD = 6.28). Communication apprehension and communication self-efficacy were significantly negatively correlated. Positive and negative affect were significant predictors of communication apprehension. Affect, as well as current healthcare employment were significant predictors of communication self-efficacy. When controlling for all demographic, educational, and psychological variables, communication apprehension was a significant predictor of communication self-efficacy.

CONCLUSIONS

This study is one of the few to explore communication apprehension in undergraduate nursing students. Data demonstrated that communication apprehension is a prevalent problem for many nursing students. Communication apprehension was also found to be a significant predictor of communication self-efficacy after controlling for all other variables. Progression through nursing education did not show a correlation with a decrease in the students' communication apprehension or increase in communication self-efficacy. Given these findings, educational efforts aimed at reducing communication apprehension and enhancing students' school-related affect could contribute to an improvement in communication self-efficacy.

Modeling insufficient effort responses in mixed-worded scales

Surveys often add reverse-coded questions to monitor respondents with insufficient effort responses (IERs) but often wrongly assume that all respondents consistently answer all questions with full effort. By contrast, this study expanded the mixture model for IERs and ran a simulation via LatentGOLD to show the harmful consequences of ignoring IERs to positively and negatively worded questions: less test reliability, bias and less accuracy in slope and intercept parameters. We showed its practical application to two public data sets: Machiavellianism (five-point scale) and self-reported depression (four-point scale).

Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study

INTRODUCTION

Maternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes.

RESEARCH DESIGN AND METHODS

This paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration.

RESULTS

The quantitative results found that women achieved "at target" glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery.

CONCLUSIONS

The achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women's mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences.

Exploring the motivation of surgeons to lead juniors and the impact of their leadership on junior doctors motivation and leadership preference

PURPOSE

The purpose of this paper is to conceptualise a research study to examine leadership as a relational concept between leaders and followers. The context is within surgical practice examining how motivated consultant surgeons are to lead junior doctors and which type of leadership style they use. From a follower perspective, the motivation of junior doctors will be explored, and their leadership preferences will be correlated with those of the actual style of consultant surgeons.

DESIGN/METHODOLOGY/APPROACH

In this paper, the authors provide a detailed description of the methods for an international quantitative research study, exploring sequentially how motivated consultant surgeons are to lead and how leadership styles impact on the motivation of junior doctors. The objectives, method and data collection of this study are explained, and the justification for each method is described.

FINDINGS

The findings for this outline study illustrate how critical it is to redefine leadership as a relational concept of leader and follower to ensure adequate support is provided to the next generation of consultant surgeons. Without consideration of the relational model of leadership, attrition will continue to be a critical issue in the medical workforce.

RESEARCH LIMITATIONS/IMPLICATIONS

The research limitations are that this is a proposed quantitative study due to the need to collect a large sample of data from surgeons across the UK, Egypt and Germany. This research will have immense implications in developing new knowledge of leadership as a relational concept in medicine and healthcare. This study additionally will impact on how leadership is conceptualised in the curriculum for specialist surgical practice.

PRACTICAL IMPLICATIONS

The practical implications are that relational leadership is supportive of generating a supportive leadership culture in the workplace and generating more effective teamwork.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this is the first study of its kind to look at a relational model of leadership in surgical practice between consultant surgeons and surgical trainees. This study will also identify any specific country differences between the UK, Germany and Egypt.

A new quantitative insight: Interaction of polyethylene microplastics with soil - microbiome - crop

In this study, the interaction between primary/secondary PE MPs and soil - microbiome - crop complex system and PE MPs enrichment behavior in crops were studied by using the self-developed quantitative characterization method of Eu-MPs and in situ zymography. The results demonstrated for the first time the enrichment effect of micron-sized PE (> 10 µm) in crops, manifested as roots>leaves>stems. Primary PE MPs significantly increased soil TN, TC, SOM and β-glu activity and inhibited Phos activity. Age-PE MPs significantly reduced soil TN, TP, β-glu and Phos activities and also have significant inhibitory effects on plant height, stem diameter, and leaf dry weight of maize. Age-PE MPs significantly affected soil microbial diversity, mainly caused by bacterial genera such as UTCFX1, Sphingomonas, Subgroup-6 and Gemmatimonas. Age-PE MPs also affected some metabolism related to microbial community composition and maize growth, including Glycerolipid, Citrate cycle (TCA cycle), C5-Branched dibasic acid, Arginine and proline, Tyrosine metabolism, pentose phosphate pathway, Valine, leucine and isoleucine biosynthesis. These research results indicated that the PE MPs, which are widely present in farmland soils, can affect crop growth, soil microbial community and metabolic function after aging, thus affecting agroecosystems and terrestrial biodiversity.

Introducing the participant-generated experience and satisfaction (PaGES) index: a novel, longitudinal mixed-methods evaluation tool

BACKGROUND

Patient-Reported Outcomes or Experience Measures (PROMS / PREMS) are routinely used in clinical studies to assess participants' views and experiences of trial interventions and related quality of life. Purely quantitative approaches lack the necessary detail and flexibility to understand the real-world impact of study interventions on participants, according to their own priorities. Conversely, purely qualitative assessments are time consuming and usually restricted to a small, possibly unrepresentative, sub-sample. This paper, which reports a pilot study within a randomised controlled trial of induction of labour, reports the feasibility, and acceptability of the Participant-Generated Experience and Satisfaction (PaGES) Index, a new mixed qualitative / quantitative PREM tool.

METHODS

The single-sheet PaGES Index was completed by hypertensive pregnant women in two hospitals in Nagpur, India before and after taking part in the 'Misoprostol or Oxytocin for Labour Induction' (MOLI) randomised controlled trial. Participants recorded aspects of the impending birth they considered most important, and then ranked them. After the birth, participants completed the PaGES Index again, this time also scoring their satisfaction with each item. Forms were completed on paper in the local language or in English, supported by Research Assistants. Following translation (when needed), responses were uploaded to a REDCap database, coded in Excel and analysed thematically. A formal qualitative evaluation (qMOLI) was also conducted to obtain stakeholder perspectives of the PaGES Index and the wider trial. Semi-structured interviews were conducted with participants, and focus groups with researchers and clinicians. Data were managed using NVivo 12 software and analysed using the framework approach.

RESULTS

Participants and researchers found the PaGES Index easy to complete and administer; mothers valued the opportunity to speak about their experience. Qualitative analysis of the initial 68 PaGES Index responses identified areas of commonality and difference among participants and also when comparing antenatal and postnatal responses. Theme citations and associated comments scores were fairly stable before and after the birth. The qMOLI phase, comprising 53 one-to-one interviews with participants and eight focus groups involving 83 researchers and clinicians, provided support that the PaGES Index was an acceptable and even helpful means of capturing participant perspectives.

CONCLUSIONS

Subjective participant experiences are an important aspect of clinical trials. The PaGES Index was found to be a feasible and acceptable measure that unites qualitative research's explanatory power with the comparative power of quantitative designs. It also offers the opportunity to conduct a before-and-after evaluation, allowing researchers to examine the expectations and actual experiences of all clinical trial participants, not just a small sub-sample. This study also shows that, with appropriate research assistant input, the PaGES Index can be used in different languages by participants with varying literacy levels.

TRIAL REGISTRATION

Clinical Trials.gov (21/11/2018) (NCT03749902).

Examining the mediating effect of job satisfaction on the relationship between leader-member exchange and safety behavior among Algerian healthcare workers

PURPOSE

This study aims to examine the long-term impact of leader-member exchange (LMX) on employee safety behavior. It proposes a conceptual model that includes the mediating role of job satisfaction (JS) in the relationship between LMX and safety behaviors, regarding safety compliance behavior (SCB) and safety participation behavior (SPB).

DESIGN/METHODOLOGY/APPROACH

Data were collected from 325 health-care workers across public hospitals in Algeria at three waves. Data were analyzed with partial least square structural equation modeling.

FINDINGS

The findings revealed that LMX positively influenced employees' job satisfaction. However, the relationship between LMX and SCB was found to be mediated by job satisfaction. LMX was not directly related to both dimensions of safety behavior, whereas JS was positively associated with safety compliance and safety participation.

ORIGINALITY/VALUE

This is the first paper, to the best of the authors' knowledge, to report on the significant mediating role of JS on the reciprocal process used to exchange resources between leaders and subordinates and safety behaviors among health-care workers, thereby filling an important research gap in existing literature.

Disclosure of genetic risk in the family: A survey of the Flemish general population

OBJECTIVES

Results from genomic sequencing often have implications not just for patients but also for their relatives. To date, there are no studies in Belgium exploring whether potential relatives would want to be informed of a genetic risk in the family and their preferences on different approaches to disclosure.

METHODS

We surveyed the attitudes of the Flemish general population (n = 407) towards receiving genetic information from their family members, including attitudes towards breaches in confidentiality, preferences for who communicates genetic risk and how the information is communicated, and policy approaches to nondisclosure.

RESULTS

Most participants wanted to be informed of their genetic risk and receive genetic testing to confirm their diagnosis. Most preferred to be informed of genetic risk by a close family member, but that when given the choice between a distant family member and a clinician, most participants preferred to be contacted by a clinician.

CONCLUSION

In Belgium there is currently no clear legal pathway for clinicians to directly initiate contact with at-risk relatives, but the responses from members of the Flemish population analyzed in this study indicate that this approach to disclosure of genetic risk deserves further consideration. Our findings indicate that the general population would support legislation allowing clinicians to inform relatives even in cases where the patient did not want to inform them. As this is not currently allowed in Belgium, policy alternatives should be considered.

Experiences of and recommendations on clinical trial design in Alzheimer's disease from the participant's point of view: a mixed-methods study in two clinical trial centers in the Netherlands

INTRODUCTION

In the context of the development of pharmaceutical interventions, expectations and experiences of participants are essential. Their insights may be particularly helpful to address the challenges of recruiting and retaining participants for Alzheimer's disease (AD) clinical trials. We examined clinical trial participants' experiences to optimize trial design in Alzheimer's disease (AD).

METHOD

In this mixed-methods study, we included adults who participated in sponsor-initiated AD trials at Brain Research Center, a clinical trial organization in the Netherlands. Participants (N = 71, age 69 ± 6.5, 54%F, 19 cognitively normal (CN), 19 mild cognitive impairment (MCI), and 33 AD dementia) first completed an online survey. Diagnostic group differences were investigated using chi-square tests or one-way ANOVAs. Next, a subsample (N = 12; 8 = CN, 4 = MCI) participated in focus groups to gain in-depth insight into their opinions on optimizing trial design from a participants' point of view. Audio recordings from focus group interviews were transcribed verbatim and analyzed by thematic content analysis by two independent researchers.

RESULTS

Most reported motives for enrolment included "to benefit future generations" (89%), followed by "for science" (66%) and "better monitoring" (42%). Frequent suggestions for increasing willingness to participate included a smaller chance to receive placebo (n = 38, 54%), shorter travel times (n = 27, 38%), and sharing individual results of different assessments (n = 57, 80%), as well as receiving trial results (n = 52, 73). Highest visual analogue burden scores (0-100) were found for the lumbar puncture (M = 47.2, SD = 38.2) and cognitive assessments (M = 27.2, SD = 25.7). Results did not differ between diagnostic groups, nor between patient and caregiver participants (all p-values>.05). Two additional themes emerged from the focus groups: "trial design," such as follow-up visit(s) after participating, and "trial center," including the relevance of a professional and empathic staff.

CONCLUSION

Relevant factors include expectation management and careful planning of high-burden assessments, provision of individual feedback, and prioritizing professionalism and empathy throughout conduct of the trial. Our findings provide insight into participants' priorities to increase willingness to participate and can be used to optimize trial success.

A Primer to Experimental and Nonexperimental Quantitative Research: The Example Case of Tobacco-Related Mouth Cancer

OBJECTIVES

To present a comprehensive overview of key constructs of experimental and nonexperimental quantitative research, drawing on one example case from cancer care.

DATA SOURCES

Published scientific articles, research textbooks, and expert advice were used in this article.

CONCLUSION

Quantitative research turns information collected about people or about processes into numerical data. Depending on the underlying purpose, the goal is to address questions that have to do with intervention, prognosis, causation, association, description, or assessment. In experimental research, an intervention is manipulated. True experimental research (randomized controlled trial) controls confounding variables via use of both randomization and a control group; quasi-experimental research misses one or both of these elements. In either case, the aim is to generate evidence to confidently say that an intervention is the true cause of an observed outcome. Nonexperimental research is multifaceted. Cohorts and case-control studies can be used to test cause-and-effect relationships where experimental research is unethical or impractical. Correlational research aims to explore possible associations (exploratory) or help anticipate outcomes (predictive) and, quite often, is the precursor of experimental research. Descriptive research (simple, comparative, survey, retrospective chart review) can be used to describe and assess situations, conditions, or behaviors.

IMPLICATIONS FOR NURSING PRACTICE

Understanding the different aims and goals of the different types of quantitative research can help increase capacity and confidence in understanding, appraising, and applying quantitative evidence among health care students, professionals, and novice researchers in the quest for the provision of quality cancer care.

An integrated model for predicting pupils' acceptance of artificially intelligent robots as teachers

Artificially intelligent robots as teachers (AI teachers) have attracted extensive attention due to their potential to relieve the challenge of global teacher shortage and realize universal elementary education by 2030. Despite mass production of service robots and discussions about their educational applications, the study of full-fledged AI teachers and children's attitudes towards them is quite preliminary. Here, we report a new AI teacher and an integrated model to assess how pupils accept and use it. Participants included students from Chinese elementary schools via convenience sampling. Questionnaires (n = 665), descriptive statistics and structural equation modeling based on software SPSS Statistics 23.0 and Amos 26.0 were carried out in data collection and analysis. This study first developed an AI teacher by coding a lesson design, course contents and Power Point with script language. Based on the popular Technology Acceptance Model and Task-Technology Fit Theory, this study identified key determinants of the acceptance, including robot use anxiety (RUA), perceived usefulness (PU), perceived ease of use (PEOU) and robot instructional task difficulty (RITD). Moreover, this study found that pupils' attitudes towards the AI teacher, which could be predicted by PU, PEOU and RITD, were generally positive. It is also found that the relationship between RITD and acceptance was mediated by RUA, PEOU and PU. This study holds significance for stakeholders to develop independent AI teachers for students.

Risk for mental illness following exposure to violence and threats among newly arrived refugees

OBJECTIVE

There is an association between pre-migration exposure to threats and violence, and the risk for mental illness among newly arrived refugees (NAR). The aim of this study is therefore to investigate the effect of pre-migration violent and threatening experiences on the mental health of NAR in Sweden. The participants were recruited between February 2015 and February 2016, undergoing the naturalisation process in Sweden. In total, 681 questionnaires were returned (response rate of 39.5%).

RESULTS

The results showed that almost 50% of the sample were at risk for mental illness. Analysis of pre-migration exposure to violence or threats, and risk for mental illness, showed a significant odds ratio for violence as well as for threats. Analysing men and women separately resulted in a significant odds ratio for women for pre-migration threats. For men, pre-migration violence and threats were significantly associated with the risk for mental illness. The host society receiving NAR must screen for mental illness and be prepared to provide support and care for refugees who were exposed to violence or threats, and who are subsequently at risk for mental illness. This must be considered in order to improve health and subsequently the social integration of refugees.

Conceptualizing eating disorder recovery research: Current perspectives and future research directions

BACKGROUND

How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the "what" of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the "how" of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an overview of the ED field's current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological "toolkits" in order to form a more complete picture of recovery. BODY: This paper examines commonly used methodologies in research, and explores how incorporating different perspectives can add to our understanding of the recovery process. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) suggest that broadening our methodological "toolkits" could spur more nuanced and specific insights about ED recoveries. We propose a potential future research model that would ideally have a multi-methods design, incorporate different perspectives (e.g., expanding recruitment of diverse participants, including supportive others, in study co-creation), and a longitudinal course (e.g., capturing cognitive and emotional recovery, which often comes after physical). In this way, we hope to move the field towards different, more comprehensive, perspectives on ED recovery.

CONCLUSION

Our current perspectives on studying ED recovery leave critical gaps in our knowledge about the process. The traditional research methodologies impact our conceptualization of recovery definitions, and in turn limit our understanding of the phenomenon. We suggest that we expand our range of methodologies, perspectives, and timeframes in research, in order to form a more complete picture of what is possible in recovery; the multiple aspects of an individual's life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin, and successfully continue, their ED recovery process.

More than just a number of publications: Unity Index, an alternative "ranking" for bibliometric analyses

This paper presents the unity index- an index designed in response to the call to find a more holistic way to assess scientific production. In this case, the scientific production is understood from a multivariate perspective using existing measurements, such as the number of publications, the number of, and the H-Index. It can be used especially when generating or assessing production in bibliometric studies. The index consists of a 3-part point system where points are assigned to the authors based on their position in the rank of the 3 traditional indicators for production, acceptance and impact. The index is calculated by attributing 1 point to the author with most published articles and increasing the number of points attributed by 1 to all the subsequent authors. The same point attribution is done to the remaining 2 indicators, acceptance -citations- and impact -h-index-. In the presented method, 3 different means of calculation are shared. Finally, the method is validated and different ways to analyze the results and generate insights are suggested.•The Unity Index offers a new way to assess scientific production from a multivariate perspective.•The index can be calculated easily using MS Excel formulas, but automatic ways of calculation are also easily available.•Bibliometric studies can profit from a less linear way to analyze the information and generate more insightful information and guide the research.

Quantitative data collection approaches in subject-reported oral health research: a scoping review

Background

This scoping review reports on studies that collect survey data using quantitative research to measure self-reported oral health status outcome measures. The objective of this review is to categorize measures used to evaluate self-reported oral health status and oral health quality of life used in surveys of general populations.

Methods

The review is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) with the search on four online bibliographic databases. The criteria include (1) peer-reviewed articles, (2) papers published between 2011 and 2021, (3) only studies using quantitative methods, and (4) containing outcome measures of self-assessed oral health status, and/or oral health-related quality of life. All survey data collection methods are assessed and papers whose methods employ newer technological approaches are also identified.

Results

Of the 2981 unduplicated papers, 239 meet the eligibility criteria. Half of the papers use impact scores such as the OHIP-14; 10% use functional measures, such as the GOHAI, and 26% use two or more measures while 8% use rating scales of oral health status. The review identifies four data collection methods: in-person, mail-in, Internet-based, and telephone surveys. Most (86%) employ in-person surveys, and 39% are conducted in Asia-Pacific and Middle East countries with 8% in North America. Sixty-six percent of the studies recruit participants directly from clinics and schools, where the surveys were carried out. The top three sampling methods are convenience sampling (52%), simple random sampling (12%), and stratified sampling (12%). Among the four data collection methods, in-person surveys have the highest response rate (91%), while the lowest response rate occurs in Internet-based surveys (37%). Telephone surveys are used to cover a wider population compared to other data collection methods. There are two noteworthy approaches: 1) sample selection where researchers employ different platforms to access subjects, and 2) mode of interaction with subjects, with the use of computers to collect self-reported data.

Conclusion

The study provides an assessment of oral health outcome measures, including subject-reported oral health status and notes newly emerging computer technological approaches recently used in surveys conducted on general populations. These newer applications, though rarely used, hold promise for both researchers and the various populations that use or need oral health care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02399-5.

Efficient removal of cadmium by salts modified-biochar: Performance assessment, theoretical calculation, and quantitative mechanism analysis

Modified biochar is a feasible adsorbent to solve cadmium pollution in water. However, few studies could elucidate the mechanism of cadmium adsorption by biochar from a molecular perspective. Furthermore, traditional modification methods are costly and have the risk of secondary contamination. Hence, several environmentally friendly sodium salts were used to modify the water chestnut shell-based biochar and employ it in the Cd²⁺ adsorption in this work. The modification of sodium salt could effectively improve the specific surface area and aromaticity of biochar. Na₃PO₄ modified biochar exhibited the highest Cd²⁺ adsorption capacity (112.78 mg/g). The adsorption of Cd²⁺ onto biochar was an endothermic, monolayer, chemisorption process accompanied by intraparticle diffusion. Microscopically, the enhancement of aromatization after modification made Cd²⁺ more likely to interact with the regions rich in π electrons and lone pair electrons. This study provided a new research perspective and application guidance for heavy metal adsorption on biochar.

More I than we - the effect of organisational identification in the Australian aged care workforce

PURPOSE

This paper aims to determine the effects of leadership style (LS) on organisational identification (OID) in aged care provider organisations to inform talent management strategies for the sector, which has quite severe workforce shortages.

DESIGN/METHODOLOGY/APPROACH

This paper reports on a mixed-methods study. Study 1 was quantitative in approach that measured responses to an online questionnaire containing the Multifactor Leadership Questionnaire and the Identification with a Psychological Group scale. The analytical strategy provided results that demonstrated the socio-demographic characteristics of the sample, the reliability and distributions of data and calculated the correlations between the factors of the deployed tools. The relationship between the factors that comprise both tools was measured, and any differences between the two natural groups were labelled leaders and raters. Study 2 was qualitative in approach, using interpretive phenomenological analysis to provide an in-depth analysis of phenomena.

FINDINGS

The results and findings of this study are that OID was not evident in the quantitative or qualitative samples. There are recommendations for future research relating to the social capital of organisations and the use of social media to determine how these could be harnessed in support of workforce recruitment and retention strategies.

RESEARCH LIMITATIONS/IMPLICATIONS

This research was conducted in Australia with participants from the workforces of aged care providers in three eastern states of Australia. The results and findings may be limited to the Australian aged care context. The researcher evaluated the limitations of this research relating to: Methodology: There may be an overstatement of the strength of the relationships between variables among those motivated to participate in the survey in the quantitative study; Transferability: The qualitative study required the researcher to be thorough in describing the research context, and it may be that those who wish to transfer the results of this study to a different context are responsible for making the judgement on the suitability of the transfer; Credibility: The qualitative analysis was not designed to directly reflect a relationship between each leader and their direct report raters' experiences; and Confirmability: The researcher maintained an awareness and openness to the dynamism of the results. Frequent reflection and self-criticism about preconceptions that may have affected the research were recorded in field notes after each interview.

PRACTICAL IMPLICATIONS

Aged care providers who must compete in the labour market for staff may use the results and findings of this research to inform recruitment and retention strategies relating to brand recognition and loyalty and social capital strategies.

SOCIAL IMPLICATIONS

Providing an appropriate, skilled and well-led workforce will assist in providing the appropriate level of aged care service at a high standard of quality and safety that will benefit the community as a whole.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this paper reports on original research conducted following ethical clearance in part fulfilment of a successful conferral of a Doctor of Philosophy programme. After an extensive search of the literature, no research reports returned that examined LS and OID in the aged care service provision.

Using an interprofessional competency framework to enhance collaborative pediatric nursing education and practice

Background

Interprofessional education (IPE) provides healthcare students with the knowledge and skills necessary to provide safe and effective collaborative care in a variety of clinical settings. Inclusion of IPE in nursing curricula is required for program accreditation in Canada; a variety of learning strategies at varied levels are used to meet this requirement. As this formal requirement only occurred over the last decade, development, facilitation, and evaluation of IPE interventions are ongoing.

Purpose

The purpose of this study was to examine if exposure to an introductory IPE activity influenced third-year undergraduate nursing students’ perceived ability to practice competent interprofessional collaboration (IPC).

Methods

The introductory IPE activity included ten-hours of interactive lectures and related case studies, grounded in the National Interprofessional Competency Framework, delivered by various healthcare professionals in a third-year nursing theory and clinical course. Following completion of the courses, quantitative data were collected via the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) which was used to evaluate nursing students’ change in competencies for IPC. Frequencies, percentages, and means were used to analyze the demographic data, the Cronbach’s alpha coefficient was used to evaluate the internal reliability of the ICCAS, and paired t-tests were conducted to measure the difference from pre- to post-participation for all 20 items and 6 subscales of the ICCAS.

Results

Study participants (n = 111) completed the ICCAS at the end of the courses to measure change in six competencies. The survey results indicated improvements in all competencies following the IPE activity.

Conclusions

The significant findings demonstrate that exposure to introductory IPE activities, involving nursing students and other healthcare professionals, hold promise for enhancing IPC in pediatric clinical settings. These findings can be used to inform the development of formal IPE interventions.

Problematic muscularity-oriented behaviors: Overview, key gaps, and ideas for future research

Problematic muscularity-oriented behaviors, such as excessive weightlifting and muscle-building supplement and substance use (e.g., creatine, steroids), are common among young people, particularly boys and men. Theoretical models of eating disorders, and their constructs, are helpful in conceptualizing a number of risk factors that may increase the likelihood of developing problematic muscularity-oriented behaviors; however, these models lack a clear delineation of the factors that may specifically lead to the initiation and pursuit of these behaviors. This paper provides a brief overview of the theoretical models that have usefully framed research on problematic muscularity-oriented behaviors and the risk factors that been identified through this work. In addition, it identifies gaps related to understanding the factors leading to the initiation and continued or discontinued engagement in these behaviors, and it provides ideas for future research to help fill these gaps. Understanding the ways in which risk factors combine sequentially and interactively, to produce pathways to problematic muscularity-oriented behaviors is crucial for researchers to strengthen theoretical understandings of these behaviors, to inform intervention efforts, and guide policy and practice to decrease their rates among youth.

[Health- and disease-related data of inpatients in palliative care units of the Comprehensive Cancer Centers and other hospitals in comparison-Data from the Hospice and Palliative Care Register]

BACKGROUND

The National Hospice and Palliative Registry is a database for palliative care facilities documenting a core data set for quality assurance and scientific evaluations.

OBJECTIVES

The study aims identifying differences between patients in palliative care units treated in Comprehensive Cancer Centers (CCC) or other hospitals (OH) focussing on sociodemographic and health/disease-related characteristics.

METHODS

Descriptive data analysis using IBM SPSS Statistics 21 included patients treated from 2014 to 2018. Comparisons included sociodemographic data, diagnoses, ECOG status and treatment duration.

RESULTS

12,922 patient data were analyzed (CCC n = 4975/OH = 7947). In CCCs 79.8% had a tumor diagnosis, in other hospitals 85.1%. The proportion of patients with ECOG 4 was higher in CCCs than in other hospitals. The average length of stay in CCCs was 12.6 days, in other hospitals 11.3 days (p = 0.023).

CONCLUSIONS

Data show differences between patients in palliative care implicating CCCs treating more complex palliative care patients than other hospitals.

Failure to fail - Factors affecting faculty decisions to pass underperforming nursing students in the clinical setting: A quantitative study

AIM

The purpose of the study was to explore the relationship between face-implicating factors and faculty's likelihood of failing students in the clinical setting who do not meet passing criteria.

BACKGROUND

Clinical nursing faculty members struggle to assign failing grades to underperforming students in the clinical setting; this is known as failure to fail. Qualitative literature has revealed common factors for failure to fail; however, quantitative studies are required to determine the extent to which those factors affect faculty's decision-making process.

DESIGN

A quantitative, descriptive design was used.

METHODS

Snowball sampling was used to recruit participants from CCNE- and ACEN-accredited nursing programs to complete an online survey. There were 353 responses to the survey (a 30% return rate) and 327 usable responses. Eligibility criteria included pre-licensure nursing faculty members who had taught in the clinical setting within the past three years. The tool used for the study was adapted from Dibble's (2014) tool, which explored face-implicating factors' impact on the transmission of bad news.

RESULTS

Respondents who did not commit failure to fail (F2FN) disagreed more strongly with every survey item than those who committed failure to fail (F2FY). The differences in mean scores were compared and 64% of those differences were statistically significant (p < 0.05). Respondents who did not commit failure to fail were less affected by the face-implicating factors than those who committed failure to fail.

CONCLUSIONS

the null hypothesis was rejected; a direct connection was found between face-implicating factors and faculty's likelihood of passing students in the clinical setting who do not meet passing criteria.

[Agricultural work and migration in Spain: socio-labour precariousness and health (AGROMISALUD project)]

OBJECTIVE

To assess the influence of job insecurity and social exclusion on the health of migrant men and women working in the agricultural sector in Spain.

METHOD

Qualitative and quantitative data will be collected in four Spanish autonomous regions (Catalonia, La Rioja, Murcia, and Andalusia) between 2021 and 2022. First, semi-structured personal interviews with at least 40 professional key informants or experts (from NGOs, associations, health, social services, trade unions, agricultural cooperatives, politics, and cultural mediators). Second, semi-structured personal interviews combined with participatory techniques (body mapping and photovoice) will be conducted with 40 migrant men and women working in agriculture. Thirdly, a cross-sectional study with an estimated sample of 400-500 migrants working in agriculture, based on the National Health Survey and the Living Conditions Survey.

Can the water-saving potential of industrial sectors be quantified? An empirical approach applied on chemical and steel industries of Tianjin and Zhejiang provinces, China

Although there has been increasing research on water saving in China's industrial sector, with the proposal of different methods and enriching perspectives, not much has been studied about the sector's water-saving potential (WSP), especially in terms of a quantitative analysis. In this paper, a quantitative WSP model is proposed based on (a) economic costs minimization, (b) diffusion of water-saving technologies, (c) progressive water price policies, and (d) data availability. To transform exogenous variables into endogenous ones, we assumed technology depreciation and designed a water trading mechanism in a policy-limited scenario. By analysing the data of 2015, the WSP of chemical and steel industries in Tianjin was estimated as 16.128 MCM and 1.914 MCM with technology penetration and strict progressive water prices, while the WSP in Zhejiang province was estimated as 17.541 MCM and 3.108 MCM with the same level of technology penetration. This study could be a reference point for further research on evaluation of WSP of other industrial sectors and guide governments in drafting water-saving policies.

Bullying perpetration and victimization in elementary school students diagnosed with attention-deficit/hyperactivity disorder

Previous research has found that attention-deficit/hyperactivity disorder (ADHD) in children is related to bullying perpetration. This study examined the correlation between ADHD and bullying perpetration, and aimed to identify which factors, including bullying victimization, predicted bullying. Forty-nine elementary school students, aged 6-12, participated voluntarily in a comparative study between children with ADHD and non-ADHD control children; none of them had previously undergone psychiatric treatment. Both parents' and participants' social demographic information (gender, age) and clinical variables were obtained from self-report questionnaires. The participants' bullying victimization experience, impulsivity, and parents' history of ADHD had significant relationships with bullying. The status of ADHD and other self-reported scales had no significant relationships with bullying. The association between bullying victimization and bullying perpetration was notable among all factors examined. This was consistent with the claims of prior studies that past victimization led to perpetration of bullying. Therefore, it seems that when treating victims of bullying, care should be taken, through proper intervention, to ensure the incident is neither repeated nor replicated. Characteristics associated with ADHD, including impulsivity and parents' history of ADHD, were significantly related to bullying. However, we could not confirm our hypothesis that ADHD itself might be associated with bullying behavior.

Validity arguments for patient-reported outcomes: justifying the intended interpretation and use of data

BACKGROUND

Contrary to common usage in the health sciences, the term "valid" refers not to the properties of a measurement instrument but to the extent to which data-derived inferences are appropriate, meaningful, and useful for intended decision making. The aim of this study was to determine how validity testing theory (the Standards for Educational and Psychological Testing) and methodology (Kane's argument-based approach to validation) from education and psychology can be applied to validation practices for patient-reported outcomes that are measured by instruments that assess theoretical constructs in health.

METHODS

The Health Literacy Questionnaire (HLQ) was used as an example of a theory-based self-report assessment for the purposes of this study. Kane's five inferences (scoring, generalisation, extrapolation, theory-based interpretation, and implications) for theoretical constructs were applied to the general interpretive argument for the HLQ. Existing validity evidence for the HLQ was identified and collated (as per the Standards recommendation) through a literature review and mapped to the five inferences. Evaluation of the evidence was not within the scope of this study.

RESULTS

The general HLQ interpretive argument was built to demonstrate Kane's five inferences (and associated warrants and assumptions) for theoretical constructs, and which connect raw data to the intended interpretation and use of the data. The literature review identified 11 HLQ articles from which 57 sources of validity evidence were extracted and mapped to the general interpretive argument.

CONCLUSIONS

Kane's five inferences and associated warrants and assumptions were demonstrated in relation to the HLQ. However, the process developed in this study is likely to be suitable for validation planning for other measurement instruments. Systematic and transparent validation planning and the generation (or, as in this study, collation) of relevant validity evidence supports developers and users of PRO instruments to determine the extent to which inferences about data are appropriate, meaningful and useful (i.e., valid) for intended decisions about the health and care of individuals, groups and populations.

An exploratory study to investigate alcohol consumption among breast-feeding mothers

OBJECTIVE

We examined the likelihood of breast-feeding mothers consuming alcohol according to several socio-demographic factors.

DESIGN

We carried out secondary data analyses using participant information obtained from a cross-sectional survey designed to capture the dietary habits of UK infants aged 4-18 months.

SETTING

Data concerning breast-feeding mothers' social and domestic circumstances and alcohol consumption were drawn from the 2011 Diet and Nutrition Survey of Infants and Young Children.

PARTICIPANTS

Complete data from 2683 breast-feeding mothers were included, and further analyses were carried out on those who continued to drink alcohol (n 227).

RESULTS

Logistic regression enabled the identification of social factors associated with breast-feeding and continued alcohol consumption among mothers. Several social factors were found to influence the likelihood of breast-feeding mothers drinking alcohol. For example, older mothers, mothers with partners who drank alcohol, those with higher educational attainment and household income and those who consumed alcohol whilst pregnant were more likely to continue to drink alcohol. Mothers' breast-feeding infants older than 12 months were less likely to drink alcohol than those feeding infants aged 4-6 months.

CONCLUSIONS

Evidence suggests that social circumstances influence the likelihood of alcohol use among mothers who are breast-feeding. Greater understanding of mothers' decision making with respect to the continuation or discontinuation of alcohol use whilst breast-feeding, according to the social context in which they live, is warranted.

Satisfaction with the clinical practice among nursing students using regression models and qualitative comparative analysis

BACKGROUND

Clinical practice is considered fundamental in nursing studies for the effective education of nurses and students' satisfaction. Both the clinical environment and the clinical educator are key factors in students´ satisfaction.

OBJECTIVES

To analyze the influence of the socio-demographic variables of clinical educators and nursing students on satisfaction with the clinical practice.

DESIGN

This was an observational, cross-sectional study.

SETTINGS

A clinical practice course at a private university in Valencia, Spain.

PARTICIPANTS

The study included 527 nursing students enrolled on the clinical practice, supervised by 187 clinical educators.

METHODS

Two statistical methodologies were used for data analysis: hierarchical regression models (HRM) and fuzzy-set qualitative comparative analysis model (fsQCA).

RESULTS

The results indicate that sociodemographic variables such as sex, being a woman, and being in the second grade year group, influence student satisfaction in both methodologies.

CONCLUSIONS

According to our results, establishing specific academic plans for students in higher years (3rd and 4th) could improve nursing students' satisfaction with their clinical practice. Adequate training of students is a key factor in the provision of high-quality nursing care.

The Bachelor's thesis in nursing: Characteristics and students' approach and satisfaction

AIM

The aim of the study was to describe the characteristics of the Bachelor's thesis of fourth-year nursing students at a Spanish public university, the criteria that students used to choose a topic and students' degree of satisfaction after completing the Bachelor's thesis.

DESIGN

Quantitative study.

METHODS

We examined 420 Bachelor's theses carried out from 2013 to 2018 and conducted an online survey among fourth-year students in the 2017-18 and 2018-19 academic years (81 completed questionnaires).

RESULTS

The Bachelor's thesis took the form of a research proposal. The most frequent proposal type was a qualitative hospital-based study whose objective was to understand the experiences of adult or adolescent patients, close family members, or nurses. Students chose topics for personal reasons. Most participants reported feeling satisfied with the knowledge and skills acquired.

CONCLUSIONS

Students completing a Bachelor's thesis in the form of a research proposal have the potential to transfer their research skills to their nursing practice.

Stopping healthcare misinformation: The effect of financial incentives and legislation

Fake news and misinformation have become a major social issue. And yet, many researchers concern primarily about political misinformation, leaving healthcare misinformation less emphasized. Nevertheless, healthcare misinformation may create consequences such as delayed diagnosis or treatment of patients or even public health crisis. We conducted an online experiment to test the role of financial incentives and legislation on disseminating online healthcare misinformation. Our findings revealed that financial incentives have a positive but diminishing impact on the likelihood of sharing online healthcare information regardless of validity. However, financial incentives have a stronger impact on attracting readers to share healthcare misinformation that they perceived to be fake. Surprisingly, legislation may deter the sharing of healthcare information that users perceive to be true but cannot deter them from sharing the healthcare misinformation they perceive to be fake. We also provided some practical implications for formulating measures of battling against healthcare misinformation for policymakers.

Using multiple linear regression in pharmacy education scholarship

OUR SITUATION

There has been an increased interest in regression techniques within pharmacy education to allow researchers to determine variables that may predict a specific outcome (e.g., predicting student scores on the Pharmacy Curriculum Outcomes Assessment). This article has been tailored for individuals who are interested in learning more about multiple linear regression as a data analysis tool and its potential utility in pharmacy education research.

METHODOLOGICAL LITERATURE REVIEW

Within this section, the basic steps of regression are outlined, starting with correlational analysis before progressing to simple linear regression and multiple regression. Key terms needed to understand and interpret regressions are also discussed.

OUR RECOMMENDATIONS AND THEIR APPLICATIONS

Nine practical recommendations are provided to help researchers better understand and implement regression analyses in their studies.

POTENTIAL IMPACT

Regression analyses could be helpful in advancing pharmacy educational scholarship by enabling scholars to better understand variables that may predict specific outcomes such as student achievement or program retention.

Changing research culture toward more use of replication research: a narrative review of barriers and strategies

OBJECTIVE

The aim of this paper is to review the literature on barriers to conducting replication research and strategies to increase its use and promotion by researchers, editors, and funders.

STUDY DESIGN AND SETTING

This review was part of a larger meta-narrative review aimed at conducting a concept analysis of replication and developing a replication research framework. A combination of systematic and snowball search strategies was used to identify relevant literature in multiple research fields. Data were coded and analyzed using the Theoretical Domains Framework for barriers to replication and the behavior change wheel for solutions.

RESULTS

In total, 153 papers were included in this narrative review. Multiple barriers limit the use of replication research by researchers, editors, and funders. Many of the barriers were related to knowledge and skills of all these actors. Social influences and the research environmental context were also described as not supportive. Multiple strategies were proposed to create positive outcomes expectations, reinforcement, and structural changes in the physical and social context of research.

CONCLUSION

A social change involving advisory groups, research organizations, and institutions is required to establish new norms that will value, promote, support, and reward replication research.

A quantitative assessment of the parameters of the role of receptionists in modern primary care using the work design framework

BACKGROUND

Amidst increased pressures on General Practice across England, the receptionist continues to fulfil key administrative and clinically related tasks. The need for more robust support for these key personnel to ensure they stay focussed and motivated is apparent, however, to be effective a more systematic understanding of the parameters of their work is required. Here we present a valuable insight into the tasks they fulfil, their relationship with colleagues and their organisation and their attitudes and behaviour at work collectively defined as their 'work design'.

METHODS

Our aim was to quantitatively assess the various characteristics of receptionists in primary care in England using the validated Work Design Questionnaire (WDQ) a 21 point validated questionnaire, divided into four categories: task, knowledge and social characteristics and work context with a series of sub-categories within each, disseminated online and as a postal questionnaire to 100 practices nationally.

RESULTS

Seventy participants completed the WDQ, 54 online and 16 using the postal questionnaire with the response rate for the latter being 3.1%. The WDQ suggested receptionists experience high levels of task variety, task significance and of information processing and knowledge demands, confirming the high cognitive load placed on receptionists by performing numerous yet significant tasks. Perhaps in relation to these substantial responsibilities a reliance on colleagues for support and feedback to help negotiate this workload was reported.

CONCLUSION

The evidence of our survey suggests that the role of modern GP receptionists requires an array of skills to accommodate various administrative, communicative, problem solving, and decision-making duties. There are ways in which the role might be better supported for example devising ways to separate complex tasks to avoid the errors involved with high cognitive load, providing informal feedback, and perhaps most importantly developing training programmes.

Using artificial intelligence methods to assess academic achievement in public high schools of a European Union country

Understanding academic achievement (AA) is one of the most global challenges, as there is evidence that it is deeply intertwined with economic development, employment, and countries' wellbeing. However, the research conducted on this topic grounds in traditional (statistical) methods employed in survey (sample) data. This paper presents a novel approach, using state-of-the-art artificial intelligence (AI) techniques to predict the academic achievement of virtually every public high school student in Portugal, i.e., 110,627 students in the academic year of 2014/2015. Different AI and non-AI methods are developed and compared in terms of performance. Moreover, important insights to policymakers are addressed.

Exploring the link between structural empowerment and job satisfaction through the mediating effect of role stress: A cross-sectional questionnaire study

BACKGROUND

Role stress (ambiguity and conflict) is a major psychosocial risk at work negatively associated with job satisfaction in the nursing context. According to Kanter's empowerment theory, high levels of structural empowerment reduce role stress, so role ambiguity and conflict could be potential mediators of the relationship between empowerment and job satisfaction.

OBJECTIVE

The aim of this study was to analyze the relationships between structural empowerment, role stress (ambiguity and conflict), and job satisfaction, assuming the mediating role of role stress on the relationship between structural empowerment and job satisfaction.

DESIGN

A cross-sectional design was utilized, using questionnaires for data collection and convenience sampling.

SETTING(S)

Private health care organizations in southern Portugal.

PARTICIPANTS

One hundred and twenty-four registered nurses (sample 1) and one hundred and thirty certified nursing assistants (sample 2) completed self-report measures of structural empowerment, role stress, and job satisfaction.

METHODS

Mediation analysis was performed using linear regression models and the bootstrapping method. Bias-Corrected confidence intervals (95%) were calculated for the study of direct and indirect effects.

RESULTS

In both samples, structural empowerment, role ambiguity, and role conflict were significant predictors of job satisfaction. Both ambiguity and role conflict partially mediated the effect of structural empowerment on job satisfaction. The effect mediated by ambiguity was greater than the effect mediated by role conflict in both registered nurses and certified nursing assistants.

CONCLUSIONS

Two processes could explain the effect of structural empowerment on job satisfaction in the nursing context: a direct effect generating experiences and perceptions of power in professionals; and an indirect effect reducing role stress levels in the workplace. The creation of empowering workplaces which clarify work roles and functions of nursing staff should be a priority issue for health managers and nurse executives.

Perception, attitude, and demand for Korean medicine and Western medicine collaborative treatment of medical occupational groups in Korea: A scoping review

Background

In Korea, there exists a dual medical license system whereby both traditional Korean medicine and Western medicine doctors practice independently. In 2009, via medical law revision, cross employment was allowed to activate Korean medicine and Western medicine collaborative treatment (KWCT). Despite its several advantages, there are several barriers to a well-organized KWCT. To activate KWCT, we investigated perception, attitude, demand of medical occupational groups and research gap via scoping review.

Methods

Scoping review is an emerging methodology for knowledge synthesis adopting the Arksey and O’Malley framework. The research question was “What is known about perception, attitude, demand, and research gap on KWCT?” We searched articles published from 2009 to 2019 in 7 Korean and 4 English databases. We conducted descriptive and qualitative thematic analysis and presented the research gap.

Results

From 1,305 articles, 6 quantitative and 3 qualitative studies were included. In quantitative studies, perception and attitude of medical occupational groups did not change markedly. For better perception and attitude, experiencing, mutual understanding, and respect should precede. Academic exchange, education, supporting KWCT research and legal/institutional/administrative support is also important. In qualitative studies, education course, guidelines, trust, safety, academic integration, and scientification were also required. We found several research gaps about KWCT especially detailed on-site demand and activation strategy about KWCT.

Conclusion

We investigated perception, attitude, and demand on KWCT. Based on research gap in our scoping review, quantitative studies using validated questionnaire and in-depth interview are needed to identify on-site demand to improve KWCT implementation.

Protocol registration

https://www.researchregistry.com/(reviewregistry830)

Parents' experiences and information needs related to childhood fever: A systematic review

OBJECTIVE

To synthesize current evidence about experiences and information needs of parents/caregivers managing pediatric fever.

METHODS

We used systematic review methodology with an a priori protocol. We searched Medline, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global, from 2000 to May 2018.

RESULTS

We included thirty-six studies (n = 29 quantitative, n = 7 qualitative; 15,727 participants). Quantitative data contained four themes; 1) caregivers seek information about pediatric fever, 2) low knowledge is coupled with misconceptions and anxiety, 3) fever assessment and management practices vary, 4) demographic factors (e.g., ethnicity, age, socioeconomic status, education) influence information needs and health practices. Qualitative data contained three themes; 1) tension between logic and emotion, 2) responsibility contrasted with sense of vulnerability, 3) seeking support and information to build confidence.

CONCLUSION

Parents often overestimate the risks associated with pediatric fever and struggle to make decisions during a child's febrile illness - leading to caregiving actions that may not reflect current clinical recommendations. Parents seek knowledge about how to care for a febrile child at home and what indicators should prompt them to seek medical attention.

PRACTICE IMPLICATIONS

In addition to providing clear, reliable information, interventions that address educational, pragmatic, and emotional domains may be effective in supporting parents.

Exploring the applicability of the pregnancy and childbirth outcome set: A mixed methods study

OBJECTIVE

The International Consortium for Health Outcomes Measurement developed the Pregnancy and Childbirth (PCB) outcome set to improve value-based perinatal care. This set contains clinician-reported outcomes and patient-reported outcomes. We validated the set for use in the Netherlands by exploring its applicability among all end-users prior to implementation.

METHODS

A mixed-methods design was applied. A survey was performed to assess patients (n = 142), professionals (n = 134) and administrators (n = 35) views on the PCB set. To further explore applicability, separate focus groups were held with representatives of each of these groups.

RESULTS

The majority of survey participants agreed that the PCB set contains the most important outcomes. Patient-reported experience measures were considered relevant by the majority of participants. Perceived relevance of patient-reported outcome measures varied. Main themes from the focus groups were content of the set, data collection timing, implementation (also IT and transparency), and quality-based governance.

CONCLUSION

This study supports suitability of the PCB outcome set for implementation, evaluation of quality of care and shared decision making in perinatal care.

PRACTICE IMPLICATIONS

Implementation of the PCB set may change existing care pathways of perinatal care. Focus on transparency of outcomes is required in order to achieve quality-based governance with proper IT solutions.

End-of-life decision making by Austrian physicians - a cross-sectional study

BACKGROUND

Austria has recently been embroiled in the complex debate on the legalization of measures to end life prematurely. Empirical data on end-of-life decisions made by Austrian physicians barely exists. This study is the first in Austria aimed at finding out how physicians generally approach and make end-of-life therapy decisions.

METHODS

The European end-of-life decisions (EURELD) questionnaire, translated and adapted by Schildmann et al., was used to conduct this cross-sectional postal survey. Questions on palliative care training, legal issues, and use of and satisfaction with palliative care were added. All Austrian specialists in hematology and oncology, a representative sample of doctors specialized in internal medicine, and a sample of general practitioners, were invited to participate in this anonymous postal survey.

RESULTS

Five hundred forty-eight questionnaires (response rate: 10.4%) were evaluated. 88.3% of participants had treated a patient who had died in the previous 12 months. 23% of respondents had an additional qualification in palliative medicine. The cause of death in 53.1% of patients was cancer, and 44.8% died at home. In 86.3% of cases, pain relief and / or symptom relief had been intensified. Further treatment had been withheld by 60.0%, and an existing treatment discontinued by 49.1% of respondents. In 5 cases, the respondents had prescribed, provided or administered a drug which had resulted in death. 51.3% of physicians said they would never carry out physician-assisted suicide (PAS), while 30.3% could imagine doing so under certain conditions. 38.5% of respondents supported the current prohibition of PAS, 23.9% opposed it, and 33.2% were undecided. 52.4% of physicians felt the legal situation with respect to measures to end life prematurely was ambiguous. An additional qualification in palliative medicine had no influence on measures taken, or attitudes towards PAS.

CONCLUSIONS

The majority of doctors perform symptom control in terminally ill patients. PAS is frequently requested but rarely carried out. Attending physicians felt the legal situation was ambiguous. Physicians should therefore receive training in current legislation relating to end-of-life choices and medical decisions. The data collected in this survey will help political decision-makers provide the necessary legal framework for end-of-life medical care.

Problem gambling and support preferences among Finnish prisoners: a pilot study in an adult correctional population

Purpose

The purpose of this paper is to explore the prevalence of potential problem gambling among Finnish prisoners; the associations between problem gambling and demographics, substance use and crime-related factors; and problem gamblers’ support preferences.

Design/methodology/approach

Prisoners (n=96) from two Finnish prisons were recruited between December 2017 and January 2018. The estimated response rate was 31 percent. Gambling problems were measured using the Brief Biosocial Gambling Screen. The participants were asked to report their gambling both for one year prior to their incarceration and for the past year. The independent variables were demographics (age, gender and marital status), substance use (alcohol, smoking and narcotics) and crime-related factors (crime type, prison type and previous sentence). Statistical significance (p) was determined using Fischer’s exact test.

Findings

Past-year pre-conviction problem gambling prevalence was 16.3 percent and past-year prevalence 15 percent. Age, gender, smoking, alcohol or illicit drug use were not associated with past-year problem gambling before sentencing. One-third of the prisoners (33.3 percent) who were sentenced for a property crime, financial crime or robbery were problem gamblers. One-quarter (24 percent) of all participants showed an interest in receiving support by identifying one or more support preferences. The most preferred type of support was group support in its all forms.

Research limitations/implications

It is recommended that correctional institutions undertake systematic screening for potential problem gambling, and implement tailored intervention programs for inmates with gambling problems.

Originality/value

This study provides a deeper understanding of problem gambling in prisons. Problem gambling is associated with crime and also seems to be linked with serving a previous sentence. Early detection and tailored interventions for problem gambling may help to reduce reoffending rates.

Knowledge and experience of a cohort of HIV-positive and HIV-negative Ghanaian women after undergoing human papillomavirus and cervical cancer screening

Background

Cervical cancer is the most common cancer in women in Ghana, but knowledge and experience of women who have had cervical screening is under-evaluated. This study examined knowledge and understanding of HPV and cervical cancer and evaluated experiences of screening in a cohort of women of mixed HIV status.

Methods

This was a mixed methods study using questionnaires and focus group discussions, with a knowledge score constructed from the questionnaire. HIV-positive and HIV-negative women were recruited from a larger cervical screening study in Ghana and were interviewed 6 months after receiving screening. Quantitative data was analyzed and triangulated with qualitative data following thematic analysis using the framework approach.

Results

A total of 131 women were included (HIV-positive, n = 60). Over 80% of participants had a knowledge score deemed adequate. There was no difference between HIV-status groups in overall knowledge scores (p = 0.1), but variation was seen in individual knowledge items. HIV-positive women were more likely to correctly identify HPV as being sexually-transmitted (p = 0.05), and HIV negative women to correctly identify the stages in developing cervical cancer (p = < 0.0001).

HIV-positive women mostly described acquisition of HPV in stigmatising terms. The early asymptomatic phase of cervical cancer made it difficult for women to define “what” cancer was versus “what” HPV infection was. All women expressed that they found it difficult waiting for their screening results but that receiving information and counselling from health workers alleviated anxiety.

Conclusions

Knowledge of women who had participated in a cervical screening study was good, but specific misconceptions existed. HIV-positive women had similar levels of knowledge to HIV-negative, but different misconceptions. Women expressed generally positive views about screening, but did experience distress. A standardized education tool explaining cervical screening and relevance specifically of HPV-DNA results in Ghana should be developed, taking into consideration the different needs of HIV-positive women.

Predicting hospital transfers among nursing home residents in the last months of life

BACKGROUND

Concerns have been raised over the practice of transferring nursing home residents to hospital at their end of life.

OBJECTIVE

To examine the family and facility factors that may influence the decision to transfer nursing home residents to hospital in the last month of life.

RESEARCH DESIGN

Secondary data analysis includes a sample of 119 bereaved family members from 21 nursing homes located in Central Canada.

METHOD

A binary logistic regression analysis was conducted to explore the predictors for hospital transfers.

RESULTS

Terminal hospital transfers were common: 70% of nursing home residents were sent to hospitals in the last month of their life, and the likelihood of terminal hospital transfers increased by having an adult child as decision-maker (odds ratio (OR) = 5.03; 95% confidence interval (CI) = 1.6, 16; significance level/probability value (p) = 0.007) or having a lower family income (OR = 2.9; 95% CI =1.1, 2.9; p = 0.027). Discussion and implications: The identified predictors for terminal hospital transfers are helpful in targeting and developing interventions to improve end-of-life care. Particular emphasis should therefore be placed on targeting families with low income and children of the nursing home residents for educational initiatives such as advance care planning awareness, in order to prevent terminal hospital transfers. It is hoped that policy-makers and practitioners can start addressing the findings of this study to reduce terminal hospital transfers at end of life and promote quality end-of-life care in nursing homes.

Outcomes of the "STEPS" HIV prevention training program for young males in the penitentiary institution, Ukraine

Purpose Ukraine has one of the fastest growing HIV epidemics globally. Due to their engagement in high-risk behaviors, adolescents and emerging adults involved with the penitentiary system are at a particularly high risk of HIV-acquisition. To address the epidemic, young males (aged 14 to 20 years) in penitentiary institutions across Ukraine participated in a ten-week, group-based HIV-prevention intervention (STEPS). The paper aims to discuss these issues. Design/methodology/approach The authors analyzed clinical and programmatic services data collected as part of an evaluation of the STEPS intervention. Paired t-tests and χ² were used to examine pre- and post-intervention differences in HV knowledge, attitudes, and risk behaviors and alcohol and other drug use knowledge. Findings In total, 105 male youths participated in the ten-session STEPS intervention. At baseline, males reported high frequencies of risk behaviors (e.g. unprotected sexual activity, injection drug use), moderate levels of HIV-related knowledge, and negative attitudes toward HIV and people living with HIV. At follow-up (immediately following the last STEPS session), participants' HIV-related knowledge substantially improved and participants tended to have more favorable attitudes toward HIV. Research limitations/implications Outcomes suggest that knowledge and attitudes about HIV among Ukrainian incarcerated youth can improve as a result of group-based HIV-prevention intervention. Originality/value In Ukraine, individuals involved with the criminal justice system are one of the populations most-at-risk for HIV; criminal justice-involved adolescents and young adults are disproportionately affected by the HIV epidemic. Research among this sub-population is limited. This study aims to address this gap by evaluating an on-going group-based HIV-prevention program designed to reduce adolescent risk of HIV.

[Universalization, parity and evolution of the demand of epidural analgesia in labor in Andalusia (Spain)]

OBJECTIVE

Assess whether the universalization of epidural analgesia supplied in hospitals of the Andalusia Public Health Service (SSPA) has ended up with the inequalities shown in previous studies regarding to their demand: the percentage of women who rejected epidural analgesia was higher among the users having low educational level, lower income and working as housekeeper.

METHOD

The data are based on satisfaction surveys conducted by the Institute for Advanced Social Studies amongst of SSPA users. This survey includes a section aimed at women attended in labor (N = 21,300). The hierarchical segmentation analysis shows which variables are the ones that discriminate most in the usage of epidural analgesia. Subsequently, through a model of binary logistic regression we analyze which socio-demographic variables are significant (2012) and how its impact is on the choice of epidural analgesia in childbirth.

RESULTS

Overall, the socio-demographic variables of the users are statistically significant in the demand or not of epidural analgesia during labor. However, the detailed analysis of the last year (2012) shows that none of the socio-demographic variables introduced in the model has a significant effect on the decision of using epidural analgesia.

CONCLUSIONS

The process of universalization of epidural anesthesia in childbirth has ended with social inequalities in their use, that is, with those differences that are not due to a real choice but are induced by socio-cultural characteristics of women.

An update on the "empirical turn" in bioethics: analysis of empirical research in nine bioethics journals

Background

A review of literature published a decade ago noted a significant increase in empirical papers across nine bioethics journals. This study provides an update on the presence of empirical papers in the same nine journals. It first evaluates whether the empirical trend is continuing as noted in the previous study, and second, how it is changing, that is, what are the characteristics of the empirical works published in these nine bioethics journals.

Method

A review of the same nine journals (Bioethics; Journal of Medical Ethics; Journal of Clinical Ethics; Nursing Ethics; Cambridge Quarterly of Healthcare Ethics; Hastings Center Report; Theoretical Medicine and Bioethics; Christian Bioethics; and Kennedy Institute of Ethics Journal) was conducted for a 12-year period from 2004 to 2015. Data obtained was analysed descriptively and using a non-parametric Chi-square test.

Results

Of the total number of original papers (N = 5567) published in the nine bioethics journals, 18.1% (n = 1007) collected and analysed empirical data. Journal of Medical Ethics and Nursing Ethics led the empirical publications, accounting for 89.4% of all empirical papers. The former published significantly more quantitative papers than qualitative, whereas the latter published more qualitative papers. Our analysis reveals no significant difference (χ2 = 2.857; p = 0.091) between the proportion of empirical papers published in 2004–2009 and 2010–2015. However, the increasing empirical trend has continued in these journals with the proportion of empirical papers increasing from 14.9% in 2004 to 17.8% in 2015.

Conclusions

This study presents the current state of affairs regarding empirical research published nine bioethics journals. In the quarter century of data that is available about the nine bioethics journals studied in two reviews, the proportion of empirical publications continues to increase, signifying a trend towards empirical research in bioethics. The growing volume is mainly attributable to two journals: Journal of Medical Ethics and Nursing Ethics. This descriptive study further maps the still developing field of empirical research in bioethics. Additional studies are needed to completely map the nature and extent of empirical research in bioethics to inform the ongoing debate about the value of empirical research for bioethics.

The use of empirical research in bioethics: a survey of researchers in twelve European countries

BACKGROUND

The use of empirical research methods in bioethics has been increasing in the last decades. It has resulted in discussions about the 'empirical turn of bioethics' and raised questions related to the value of empirical work for this field, methodological questions about its quality and rigor, and how this integration of the normative and the empirical can be achieved. The aim of this paper is to describe the attitudes of bioethics researchers in this field towards the use of empirical research, and examine their actual conduct: whether they use empirical research methods (and if so, what methods), and whether (and how) they have made attempts at integrating the empirical and the normative.

METHODS

An anonymous online survey was conducted to reach scholars working in bioethics/biomedical ethics/ethics institutes or centers in 12 European countries. A total of 225 bioethics researchers participated in the study. Of those, 200 questionnaires were fully completed, representing a response rate of 42.6%. The results were analysed using descriptive statistics.

RESULTS

Most respondents (n = 175; 87.5%) indicated that they use or have used empirical methods in their work. A similar proportion of respondents (61.0% and 59.0%) reported having had at least some training in qualitative or quantitative methods, respectively. Among the 'empirical researchers', more than a fifth (22.9%) had not received any methodological training. It appears that only 6% or less of the 'empirical researchers' considered themselves experts in the methods (qualitative or quantitative) that they have used. Only 35% of the scholars who have used empirical methods reported having integrated empirical data with normative analysis, whereas for their current projects, 59.8% plan to do so.

CONCLUSIONS

There is a need to evaluate the current educational programs in bioethics and to implement rigorous training in empirical research methods to ensure that 'empirical researchers' have the necessary skills to conduct their empirical research in bioethics. Also imperative is clear guidance on the integration of the normative and the empirical so that researchers who plan to do so have necessary tools and competences to fulfil their goals.

Nurse and patient factors that influence nursing time in chest tube management early after open heart surgery: A descriptive, correlational study

PURPOSE

Determine nurse characteristics and patient factors that affect nurses' time in managing chest tubes in the first 24-hours of critical-care stay.

DESIGN

Prospective, descriptive.

METHODS

Cardiovascular critical-care nurses and post-operative heart surgery patients with chest tubes were enrolled from a single center in Ohio. Nurses completed case report forms about themselves, comfort and time in managing chest tubes, chest tube placement and management factors. Analysis included correlational and comparative statistics; Bonferroni corrections were applied, as appropriate.

RESULTS

Of 29 nurses, 86.2% were very comfortable managing chest tubes and oozing/non-secure dressings, but only 41.4% were very comfortable managing clogged chest tubes. Of 364 patients, mean age was 63.1 (±12.3) years and 36% had previous heart surgery. Total minutes of chest tube management was higher with≥3 chest tubes, tube size <28 French, and when both mediastinal and pleural tubes were present (all p<0.001). In the first 4-hours, time spent on chest tubes was higher when patients had previous cardiac surgeries (p≤0.002), heart failure (p<0.001), preoperative anticoagulant medications (p=0.031) and reoperation for postoperative bleeding/tamponade (p=0.005).

CONCLUSIONS

Time to manage chest tubes can be anticipated by patient characteristics. Nurse comfort with chest tube-related tasks affected time spent on chest tube management.

Revisiting the quantitative-qualitative-mixed methods labels: Research questions, developments, and the need for replication

The goal of science is to establish laws and principles that can help us explain phenomena in our world and universe in a systematic manner and, in many cases, how we may be able to predict and/or influence these phenomena. In this endeavour, qualitative and quantitative research methods can provide us with useful tools. However, these methods have been assigned several unconstructive labels that, although perceived as useful anchors, can result in ill-founded choices of methods used in a study. This article discusses several of these frequently encountered labels and argues that they may contribute to a continued quantitative-qualitative divide, as we have witnessed in the field of medical education, but are not constructive for the practice of science. To establish laws and principles, we need well-designed scientific studies and replications of these studies. Regardless of which methods we use, to enable replication, we need to document all choices and decisions made throughout a study.

Dignity and autonomy in the care for patients with dementia: Differences among formal caretakers of varied cultural backgrounds and their meaning

BACKGROUND

A key message in the World Health Organization report on dementia (2012) emphasizes this disease as a top priority in public health and the need to improve professional attitudes to patients with dementia, while acknowledging that the workforce in dementia care is becoming increasingly diverse culturally.

AIMS

To trace whether there are substantial gaps between formal caretakers from different cultural groups (Israeli born Jews [Sabras], Israeli Arabs [Arabs] and migrants from Russia [Russians]) regarding their stances on the human dignity and autonomy of patients with dementia, as well as understand the meaning of these gaps.

DESIGN & METHOD

quantitative analysis utilizing questionnaires that were filled-out by approximately 200 caretakers from the different cultural groups, working in a nursing home or a hospital.

RESULTS

In nursing homes, substantial differences were found in the attitudes to human dignity and autonomy of patients with dementia between Russian and Arab as well as Sabra caretakers. In the hospital, there was no influence for the ethno-culture variable on dignity or autonomy.

CONCLUSION

Contrary to past research, in nursing homes, significant differences were found between certain ethno-cultural groups (Arabs and Russians) regarding their stance towards the dignity of patients with dementia. Arab caretakers hold a conception of dignity and autonomy that resonates strongly with person-centered care and outweighs institutional settings as well as may be related to the fostering of virtues.

[Self-perception of health care team leaders in Andalusia. A quantitative and qualitative study]

OBJECTIVE

To determine the perception and self-assessment on leadership among health care team leaders in Andalusia.

MATERIAL AND METHODS

Design: Exploratory descriptive study using quantitative and qualitative methodology, developed between 2013 and 2015, using a questionnaire and semi-structured interviews.

PLACE

Andalusia.

PARTICIPANTS

All health managers from the Primary Care Management Units and Health Management Areas of the Departments of Paediatrics, Emergency and Internal Medicine, for the quantitative study. A purposive sample of 24 health managers was used for the qualitative study.

METHODS

Descriptive statistical study and bivariate analysis of comparison of means. Content analysis of the semi-structured interviews: Codification, category tree, and triangulation of results.

RESULTS

The best self-assessment dimension relates to support, and the worst to considering oneself as a 'good leader'. The definition of a 'good leader' includes: Honesty, trust, and attitudes of good communication, closeness, appreciation, and reinforcement of the health team members. Different leadership styles were perceived. Main difficulties for leadership are related to the economic crisis and the management of personal conflicts.

CONCLUSIONS

Health managers describe an adaptive leadership style, based on personal and professional support, and using communication as the main cohesive element for the team project. More studies on leaders' perspectives are important, in order to better understand their experiences, needs and expectations.