Understanding the impact of non-alcoholic steatohepatitis with metabolic comorbidities on adults: a real-world qualitative study

OBJECTIVE

Limited real-world evidence exists to better understand the patient experience of living with symptoms and impacts of non-alcoholic steatohepatitis (NASH). This study aimed to (1) describe patient-reported perspectives of NASH symptoms and impacts on patients' daily lives and (2) develop a patient-centered conceptual NASH model.

METHODS

A cross-sectional study using semi-structured qualitative interviews was conducted among adults (≥18 years) in the United States living with NASH. Eligible participants were diagnosed with NASH, had mild to advanced fibrosis (F1-F3), and no other causes of liver disease. The interview guide was informed by a targeted literature review (TLR) to identify clinical signs, symptoms, impacts, and unmet treatment needs of NASH. Participants described their experiences and perspectives around NASH and the symptoms, symptom severity/bother, and impact of NASH on their daily activities. Interviews were audio-recorded and transcribed verbatim for coding and thematic analysis.

RESULTS

Twenty participants (age: 42.4 years; female: 50.0%) were interviewed. Participants discussed their experience with NASH symptoms (most frequent: fatigue [75.0%]; weakness/lethargy [70.0%]) and impacts (most frequent: physical and psychological/emotional [70.0% each]; dietary [68.4%]). Participants considered most symptoms to be moderately severe or severe and moderately or highly bothersome. Findings from the TLR and qualitative interviews were incorporated into a conceptual model that describes patient-reported symptoms and impacts of NASH, clinical signs, risk factors, and unmet treatment needs.

CONCLUSION

Our study provides insights into patients' perspectives of NASH symptoms and their impact on their daily lives. These findings may guide patient-physician conversations, supporting patient-centered treatment decisions and disease management.

SWIPE: a conceptual, multi-perspective model for understanding and informing interventions for weight stigma in preconception, pregnancy, and postpartum

Weight stigma is salient across the preconception, pregnancy, and postpartum (PPP) periods because of prevailing prescriptive norms and expectations about weight and weight gain during the reproductive period. Weight stigma is associated with negative physical and psychological health outcomes for mother and child. A clearly defined, multi-level conceptual model for interventions, research, and policy is critical to mitigating the adverse effects of weight stigma in PPP populations. Conceptual models of weight stigma towards PPP women have advanced our understanding of this issue and guided evidence accumulation but there remains a gap in informing the translation of evidence into action. Guided by evidence-based paradigms for conceptual model development, this paper has two primary objectives. First, we review and summarise theories, frameworks, and models from the PPP population and general literature to inform our understanding of the development and perpetuation of weight stigma for PPP women. Second, we propose a novel comprehensive intervention-guiding conceptual model that draws from and synthesises across multiple disciplines - the SWIPE (Stigma of Weight In the PPP Experience) model. This conceptual model will help to plan coordinated, multi-layered, and effective strategies to reduce and ultimately eliminate weight stigma for PPP women.

Glycogen storage disease type III: a mixed-methods study to assess the burden of disease

Background

Glycogen storage disease type III (GSD III) is a rare inherited disorder that results from a glycogen debranching enzyme deficiency.

Objectives

The purpose of this research was to collect data on the signs, symptoms, and impacts of GSD III from the perspective of adult patients and caregivers of individuals with GSD III.

Design

Online survey and qualitative interviews.

Methods

Following institutional review board approval, adult patients and caregivers of children with GSD III were recruited through advocacy networks and clinical sites. If eligible, participants were consented, screened, and sent a survey and/or participated in a 60-min interview. The survey and interview included questions about family history, diagnosis, signs and symptoms, impacts, and management of GSD III. Conceptual models were developed following the analysis of results.

Results

In all, 29 adults and 46 caregivers completed the online survey and/or the interviews with 73 survey and 19 interview respondents. Adults and caregivers reported digestive, musculoskeletal, growth and physical appearance, and cardiac signs and symptoms. Liver conditions were reported by most respondents (83%). Adults and caregivers frequently reported impacts such as difficulty keeping up with peers (77%) and difficulty exercising/difficulty with physical activity (53%). Hypoglycemia was frequently reported in both adults and children, with more than half reporting hospitalizations due to hypoglycemia. Caregivers focused on hypoglycemia when reporting signs/symptoms that most interfere with their child's life and prevention of hypoglycemia as a desired outcome for an effective therapy. Adults most often reported muscle weakness as a top interfering symptom and the most important goal of a potential therapy. Impacts were also reported in activities of daily living, cognitive, emotional, work/school, and sleep domains.

Conclusion

Individuals with GSD III experience a broad spectrum of symptoms and disease impacts. There is an unmet need for therapies that improve metabolic control, reduce the burden of dietary management, reduce fatigue and liver problems, and improve muscle strength and function.

Resource Patchiness as a Resolution to the Food Paradox in the Sea

AbstractAverage concentrations of biota in the ocean are low, presenting a critical problem for ocean consumers. High-resolution sampling, however, demonstrates that the ocean is peppered with narrow hot spots of organism activity. To determine whether these resource aggregations could provide a significant solution to the ocean's food paradox, a conceptual graphical model was developed that facilitates comparisons of the role of patchiness in predator-prey interactions across taxa, size scales, and ecosystems. The model predicts that predators are more reliant on aggregated resources for foraging success when the average concentrations of resources is low, the size discrepancy between predator and prey is great, the predator has a high metabolic rate, and/or the predator's foraging time is limited. Size structure differences between marine and terrestrial food webs and a vast disparity in the overall mean density of their resources lead to the conclusion that high-density aggregations of prey are much more important to the survival of oceanic predators than their terrestrial counterparts, shaping the foraging decisions that are available to an individual and setting the stage on which evolutionary pressures can act. Patches of plenty may be rare, but they play an outsized role in behavioral, ecological, and evolutionary processes, particularly in the sea.

Exploring return to work barriers through the lens of model of human occupation. The NOW WHAT project

BACKGROUND

The challenges of returning to work after sickness absence demands a wide conceptual understanding of what hinders the employee's work participation. Thus, there is a need to know more about self-perceived barriers for Return to Work (RTW).

AIM

This study aimed to investigate RTW barriers experienced by employees on long-term sick leave, through the lens of the Model of Human Occupation (MOHO).

MATERIAL AND METHODS

The study was a large-scale qualitative interview study (n = 85) using semi-structured telephone interviews. Eligible participants had received sick leave benefits for between 6 months and 1.5 years. The data were analysed with quantitative and qualitative content analysis. A deductive approach using the MOHO concepts guided the analysis process.

RESULTS

The study generated 941 coded meaning units describing barriers for RTW, of which we were able to code 895 within the framework of MOHO. In the person-specific concepts, performance capacity barriers were most often described (n = 303), followed by volitional barriers (n = 165) and barriers related to habituation (n = 66). Barriers related to the environmental components amounted to 361. Barriers in the occupational environment was dominant (n = 214).

CONCLUSION

Experienced barriers related to both environmental components and person-specific concepts.

SIGNIFICANCE

The habituational and volitional perspective on barriers can contribute to the identification and communication of performance capacity-related barriers not previously identified.

Investigating the Conceptual Model of Child-Nature Interaction in Architectural Spaces Using Grounded Theory

OBJECTIVES

To explore factors affecting the quality of child-nature interaction (CNI) based on the views and desires of children themselves and to offer solutions and strategies to provide this kind of spaces.

BACKGROUND

CNI is one of the most important needs of children which causes very profound effects on the psyche of children from different aspects. Space and context that have the ability and characteristics to provide opportunities to establish this interaction have an important role in the cognitive and social development of children.

METHODS

The qualitative data were collected by draw-and-write technique from a study of 119 children aged 2-6 years from five nursery schools located in the city of Hamedan, Iran. Then, the qualitative data were coded based on the grounded theory using three main steps of open, axial, and selective coding and a conceptual model of CNI is provided by the MAXQDA software.

RESULTS

The conceptual model developed from CNI consisted of seven core categories: "intertwining with nature," "objective natural elements," "nature conservation," "colors," "exaggerated plant perceptions," "path perceptions," and "nature-home similarity."

CONCLUSIONS

To reach an optimal CNI within architectural spaces, thus children should have a sense of belonging to nature, be engaged in it, and protect surrounding natural elements. It is of utmost importance to reflect on some points, such as colors, familiar signs, scales, natural elements, the boundary between natural environments and interior spaces, and natural element circulation and placement in designing and planning spaces made specifically for children.

End-of-Life Care Planning in Diverse Individuals Across Age Groups: A Proposed Conceptual Model of Nursing

BACKGROUND

End-of-life planning helps nurses meet the needs of their patients at a crucial time of life.

PURPOSE

This article presents a conceptual model of end-of-life care planning for nurses, especially those in palliative and hospice care, focusing on holistic nursing views.

METHODS

Based on a literature review, we developed a new conceptual model illustrating the concepts and dimensions of end-of-life care planning among diverse individuals across countries, life spans and age groups, ethnographies, and residential statuses.

RESULTS

This conceptual model includes 3 concepts: personal factors, stakeholders, and environmental and social factors. Each concept encompasses multiple dimensions. The concepts are interrelated and directly related to end-of-life care planning.

CONCLUSION

This work addresses the need for a comprehensive end-of-life care planning model and can help enhance the quality of end-of-life care. This article identifies implications for nursing education, practice, and research.

Are We Any Closer to Understanding How Chronic Pain Develops? A Systematic Search and Critical Narrative Review of Existing Chronic Pain Vulnerability Models

Identifying biopsychosocial factors underlying chronic pain vulnerability is essential for the design of preventative efforts. Multiple chronic pain vulnerability models exist, however, there is a lack of comprehensive evaluation of these models in the literature, potentially due to the lack of guidelines that specify the criteria by which these types of work should be assessed. In this work, we created evaluation criteria (based on the general goals of conceptual models), and we then used them to critically review the chronic pain vulnerability models available in the current peer-reviewed literature (identified through a systematic search). Particularly, we evaluated the models on the basis of conceptual clarity/specificity of measures, depth of description of aetiological and mechanistic factors, use of a whole system approach, and quality of the evidence associated with the models. We found nine conceptual models that have been explored in detail (eg, fear avoidance model, diathesis-stress model). These models excel at clarity and are supported mostly by self-report evidence of a psychological nature (anxiety sensitivity, pain catastrophizing, etc.), but provide little explanation of mechanistic and aetiological factors. In the future, models could be improved by complementing them with proposals from other models and exploring potential causal factors and mechanisms maintaining the condition. This task could be carried out through prospective cohort studies, and computational approaches, amongst others.

Qualitative Assessment of Key Implementation Factors in a Faith-Based Response to Intimate Partner Violence

BACKGROUND

Faith-based organizations (FBOs) have a scant history in the literature of implementing intimate partner violence (IPV) initiatives, though many members of faith communities consider it an important issue. Furthermore, the limited studies on this topic have not explored organizational factors that are important in the implementation of such efforts.

PURPOSE

To investigate factors that influence the implementation of IPV prevention and response by one Catholic organization at both diocesan and parish levels.

METHODS

We conducted sixteen semi-structured interviews with members of Archdiocese of Chicago Domestic Violence Outreach (ACDVO) leadership. Using deductive content analysis, we drew on all 14 constructs and sub-constructs from the inner setting domain of the Consolidated Framework for Implementation Research (CFIR) for coding transcripts and characterizing factors influencing implementation success.

RESULTS

Seven CFIR constructs were useful in identifying factors that influenced implementation success of ACDVO. At the diocesan level, the organization's leadership structure, their driven culture, and in-kind available resources propelled their work. At the level of parish ministries, successful implementation was facilitated by networking and communication among parishes. At the diocesan-level, access to knowledge and information through ACDVO's Parish Support Committee, compatibility with parish values, leadership engagement, and available resources from parishes supported implementation.

CONCLUSIONS

We identified modifiable and reproducible inner setting factors that influence implementation of a Catholic IPV initiative at the diocesan-level and support parish ministries in their local activities. Future work should validate these findings in other dioceses and examine non-Catholic FBO settings.

Development of a Conceptual Model to Understand Disease Burden in Patients With Systemic Lupus Erythematosus and Organ Damage

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can lead to irreversible organ damage (OD). Data describing the patient burden of OD, as compared with SLE without OD, are limited. Objective: To develop a comprehensive conceptual model describing the burden experienced by patients living with SLE-associated OD. Methods: There were three phases to this qualitative study. First, a targeted literature review was conducted to inform a draft conceptual model. Second, key opinion leaders (KOLs) were interviewed to assess the draft conceptual model and help shape patient interview materials. Third, patients of different demographic backgrounds from across the United States were interviewed individually to gather their perspectives on living with SLE-associated OD. Data from concept elicitation interviews with KOLs and patients were coded and analyzed using NVivo software to identify the key concepts of the overall patient burden of SLE-associated OD. Findings from the KOL and patient interviews were used to finalize the conceptual model. Results: KOLs highlighted that SLE-associated OD carried a higher rate of mortality than SLE alone. Participants with SLE-associated OD (n = 40) experienced detrimental impacts across 4 areas of their lives: physical, cognitive, psychosocial functioning, and economic and work-related well-being. Physical impacts were described by all participants, often affecting their ability to perform everyday tasks. Many also described deterioration of cognitive functioning. Almost all participants experienced emotional impacts and challenges to their relationships and social lives resulting from living with SLE-associated OD. Additionally, SLE-associated OD imposed an economic burden including increased healthcare costs. SLE-associated OD had a more severe and debilitating impact on all aspects of the patient's quality of life than SLE prior to OD development, including further limitations in activities of daily living after the development of OD. Discussion: Study findings guided the development of a comprehensive conceptual model that fully represents the patient experience of living with SLE-associated OD, highlighting the additional burden of OD when compared with SLE alone. Conclusions: The conceptual model will inform improvements in disease management, which may result in better patient outcomes and aid development of clinical outcome assessments of disease burden.

Conceptual model for progression of oral cancer - our perspective

Oral cancer was and still is an underestimated disease in terms of incidence and mortality rates. As a result, requires early detection and urgent prevention. This article describes a framework that covers the significant stages of conceptual development of oral cancer. Conceptual model is useful in understanding the pathogenesis and understand the disease processes. This article signifies information on various aspects of perspective risk and the role played by it. Article covers the following aspects: what are the perspective risks, what changes it causes to normal cell, what are the direct and indirect effects on normal cell, cellular changes seen with normal cell when affected with perspective risk, transformation of normal cell to oral potentially malignant disorders (OPMD) and changes seen during transformation into cancer. Understanding the conceptual model of oral cancer transformation will be a paradigm shift in future research in the field and early management of oral cancer, which will reduce the disease burden on the nation.

Development of an integrated conceptual model of multiple sclerosis spasticity

PURPOSE

Spasticity is common in multiple sclerosis (MS), often leading to functional limitations and disability. We developed a conceptual model of spasticity in MS integrating expert opinion, recent literature, and experiences of clinicians and people with MS spasticity.

METHODS

A conceptual model was developed based on a targeted literature review of articles published between 2014 and 2019, followed by input from clinicians, then input from participants with MS spasticity. Multidisciplinary experts on spasticity provided guidance at each step.

RESULTS

Key concepts of the integrated spasticity conceptual model included: moderators; triggers; modifiers; treatment; objective manifestations; subjective experience; physical, functional, social, and emotional/psychological impacts; and long-term consequences. Participants with MS spasticity most frequently endorsed spasms, tightness, and pain as descriptors of spasticity. Some participants with MS spasticity had difficulty distinguishing spasticity from other MS symptoms (e.g. muscle weakness). Some triggers, emotional/psychological impacts, and long-term consequences of spasticity reported by participants with MS spasticity were not previously identified in the published literature.

CONCLUSIONS

This conceptual model of spasticity, integrating published literature with the experience of clinicians, people with MS spasticity, and experts, demonstrates the complex, multidimensional nature of MS spasticity. This model may be used to improve clinician-patient dialogue, research, and patient care.

Contextualizing Flexible Nonlinear Periodization as a Person-Adaptive Behavioral Model for Exercise Maintenance

There is a growing focus on developing person-adaptive strategies to support sustained exercise behavior, necessitating conceptual models to guide future research and applications. This paper introduces Flexible nonlinear periodization (FNLP) - a proposed, but underdeveloped person-adaptive model originating in sport-specific conditioning - that, pending empirical refinement and evaluation, may be applied in health promotion and disease prevention settings. To initiate such efforts, the procedures of FNLP (i.e., acutely and dynamically matching exercise demand to individual assessments of mental and physical readiness) are integrated with contemporary health behavior evidence and theory to propose a modified FNLP model and to show hypothesized pathways by which FNLP may support exercise adherence (e.g., flexible goal setting, management of affective responses, and provision of autonomy/variety-support). Considerations for future research are also provided to guide iterative, evidence-based efforts for further development, acceptability, implementation, and evaluation.

An Evaluation of the Multifactorial Model of Cancer-Related Cognitive Impairment

BACKGROUND

Up to 45% of patients report cancer-related cognitive impairment (CRCI). A variety of characteristics are associated with the occurrence and/or severity of CRCI. However, an important gap in knowledge of risk factors for CRCI is the relative contribution of each factor. The multifactorial model of cancer-related cognitive impairment (MMCRCI) is a conceptual model of CRCI that can be used to evaluate the strength of relationships between various factors and CRCI.

OBJECTIVES

The purpose of this study was to use structural regression methods to evaluate the MMCRCI using data from a large sample of outpatients receiving chemotherapy ( n = 1,343). Specifically, the relationships between self-reported CRCI and four MMCRCI concepts (i.e., social determinants of health, patient-specific factors, treatment factors, and co-occurring symptoms) were examined. The goals were to determine how well the four concepts predicted CRCI and determine the relative contribution of each concept to deficits in perceived cognitive function.

METHODS

This study is part of a larger, longitudinal study that evaluated the symptom experience of oncology outpatients receiving chemotherapy. Adult patients were diagnosed with breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding 4 weeks; were scheduled to receive at least two additional cycles of chemotherapy; were able to read, write, and understand English; and gave written informed consent. Self-reported CRCI was assessed using the attentional function index. Available study data were used to define the latent variables.

RESULTS

On average, patients were 57 years of age, college educated, and with a mean Karnofsky Performance Status score of 80. Of the four concepts evaluated, whereas co-occurring symptoms explained the largest amount of variance in CRCI, treatment factors explained the smallest amount of variance. A simultaneous structural regression model that estimated the joint effect of the four exogenous latent variables on the CRCI latent variable was not significant.

DISCUSSION

These findings suggest that testing individual components of the MMCRCI may provide useful information on the relationships among various risk factors, as well as refinements of the model. In terms of risk factors for CRCI, co-occurring symptoms may be more significant than treatment factors, patient-specific factors, and/or social determinants of health in patients receiving chemotherapy.

Exploring the impact of caring for an individual with neurogenic orthostatic hypotension: a qualitative study

Aim: This study aimed to explore the impact of caring for an individual with neurogenic orthostatic hypotension (nOH). Methods: Informal caregivers of individuals with nOH and either Parkinson's disease, multiple system atrophy, pure autonomic failure or dementia with Lewy bodies completed semi-structured interviews. Data were analyzed using thematic analysis; the identified concepts were used to develop a conceptual model. Results: Twenty informal caregivers were interviewed. Analysis identified several areas of caregiver impact due to nOH including impact on their time, particularly a need to supervise the patient to prevent falls as well as a lack of freedom and negative physical, work and social impacts. Many reported negative emotional impacts, including worry, stress or fear about the patient falling, depression and frustration. The conceptual model shows the relationships between concepts. Conclusion: The results highlight the wide-ranging impact of nOH, and the specific impact of the fear of falls on informal caregivers' lives.

Development of an Evidence-Based Conceptual Model of the Health Care Sector Under Digital Transformation: Integrative Review

BACKGROUND

Digital transformation is currently one of the most influential developments. It is fundamentally changing consumers' expectations and behaviors, challenging traditional firms, and disrupting numerous markets. Recent discussions in the health care sector tend to assess the influence of technological implications but neglect other factors needed for a holistic view on the digital transformation. This calls for a reevaluation of the current state of digital transformation in health care. Consequently, there is a need for a holistic view on the complex interdependencies of digital transformation in the health care sector.

OBJECTIVE

This study aimed to examine the effects of digital transformation on the health care sector. This is accomplished by providing a conceptual model of the health care sector under digital transformation.

METHODS

First, the most essential stakeholders in the health care sector were identified by a scoping review and grounded theory approach. Second, the effects on these stakeholders were assessed. PubMed, Web of Science, and Dimensions were searched for relevant studies. On the basis of an integrative review and grounded theory methodology, the relevant academic literature was systematized and quantitatively and qualitatively analyzed to evaluate the impact on the value creation of, and the relationships among, the stakeholders. Third, the findings were synthesized into a conceptual model of the health care sector under digital transformation.

RESULTS

A total of 2505 records were identified from the database search; of these, 140 (5.59%) were included and analyzed. The results revealed that providers of medical treatments, patients, governing institutions, and payers are the most essential stakeholders in the health care sector. As for the individual stakeholders, patients are experiencing a technology-enabled growth of influence in the sector. Providers are becoming increasingly dependent on intermediaries for essential parts of the value creation and patient interaction. Payers are expected to try to increase their influence on intermediaries to exploit the enormous amounts of data while seeing their business models be challenged by emerging technologies. Governing institutions regulating the health care sector are increasingly facing challenges from new entrants in the sector. Intermediaries increasingly interconnect all these stakeholders, which in turn drives new ways of value creation. These collaborative efforts have led to the establishment of a virtually integrated health care ecosystem.

CONCLUSIONS

The conceptual model provides a novel and evidence-based perspective on the interrelations among actors in the health care sector, indicating that individual stakeholders need to recognize their role in the system. The model can be the basis of further evaluations of strategic actions of actors and their effects on other actors or the health care ecosystem itself.

[Influence of Typhoon Nangka Process on Ozone Pollution in Hainan Island]

In order to explore the influence of the 2016 typhoon Nangka on ozone (O₃) concentration in Hainan Island, this study employed correlation analysis and backward trajectory simulated methods, using the hourly air quality monitoring data, meteorological data, EAR5 reanalysis data, and bright temperature (TBB) infrared from the Himawari-8 satellite from October 10 to 14, 2020. The results showed that, during the typhoon process from October 11 to 13, the O₃-8h (maximum of 8 hours sliding average) concentration exceeded the standard. The averaged ρ(O₃-8h) of Hainan Island reached its peak value (130.5 μg·m^-3) in October 12, 2020, with the O₃-8h concentration exceeding the standard in four cities and counties, in which Lingao County reached the highest concentration of 198.44 μg·m^-3. During the typhoon process, the hourly O₃ concentration was negatively correlated with precipitation, relative humidity, and wind speed and positively correlated with air pressure and air temperature. Moreover, the correlation coefficients between O₃ with precipitation, air pressure, and relative humidity exceeded the 99.9% confidence level. The southeastern coastal provinces of China were the main contribution source area for this ozone pollution process on Hainan Island. Affected by the downdraft inside the western Pacific subtropical high (WPSH) and the downdraft outside the circumference of typhoon Nangka, vertical transport in the atmosphere appeared over the contribution source area. The meteorological conditions were favorable for atmospheric photochemical reactions. Air pollutants were transported to Hainan Island along the northeast airflow around the typhoon, resulting in the occurrence of an O₃ pollution event. In addition, this study built a weather conceptual model of O₃ pollution in Hainan Island affected by typhoon Nangka, which can be used as a reference for the joint pollution prevention and control by air pollution prediction, early warning, and environmental management departments.

Development of the Cold Agglutinin Disease Symptoms and Impact Questionnaire (CAD-SIQ)

OBJECTIVES

Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia. This study aimed to identify disease-related symptoms and impacts important to patients with CAD, and to develop a novel CAD-specific patient-reported outcome measure.

METHODS

Adults with CAD were randomly selected from a United States patient panel to participate in concept elicitation (CE) interviews to identify important symptoms and impacts or cognitive debriefing (CD) interviews to assess the comprehension and relevance of the draft item set.

RESULTS

Overall, 37 adults were included (mean [range] age 67.2 [35-87] years). In CE interviews (n = 16), the most frequently reported CAD-related symptoms were reactions to cold environments and fatigue (both 93.8%). CAD had negative impacts on enjoyable activities (81.3%) and daily activities (75.0%). Following CE, standard survey methodological principles were used to develop a draft item pool of 14 concepts. Items were refined through three iterative rounds of CD interviews (n = 21), yielding 11 final items: fatigue; cold sensitivity; dyspnea; wearing extra clothing; limited physical, social, and enjoyable activities; difficulty with usual activities; mood; frustration; and anxiety/stress.

CONCLUSIONS

The novel 11-item CAD-Symptoms and Impact Questionnaire provides a measure of the symptoms and impacts of CAD that are important to patients.

Multifactorial Model of Dyspnea in Patients With Cancer

PROBLEM IDENTIFICATION

Dyspnea is a common and distressing symptom for patients with cancer. Although the risk factors for dyspnea in patients with cancer are likely to be multifactorial, a comprehensive description of these risk factors and associated mechanisms is not available in the extant literature.

LITERATURE SEARCH

A search of all relevant databases, including Cochrane Library, PubMed®, Embase®, Web of Science, and CINAHL®, was done from January 2009 to May 2022. Case-control and cohort studies that had either a cross-sectional or longitudinal design, as well as randomized controlled trials, were included in the review. Peer-reviewed, full-text articles in English were included. Nineteen studies reported on risk factors for dyspnea.

DATA EVALUATION

The methodologic quality of each study was examined using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

SYNTHESIS

A number of factors can influence the occurrence and severity of dyspnea. Using the Mismatch Theory of Dyspnea as the central core of this Multifactorial Model of Dyspnea in Patients With Cancer, the factors included in this conceptual model are person, clinical, and cancer-related factors, as well as respiratory muscle weakness, co-occurring symptoms, and stress.

IMPLICATIONS FOR PRACTICE

The Multifactorial Model of Dyspnea in Patients With Cancer can be used by clinicians to evaluate for multiple factors that contribute to dyspnea and to develop individualized and multilevel interventions for patients experiencing this symptom.

Multifactorial Model of Dyspnea in Patients With Cancer

PROBLEM IDENTIFICATION

Dyspnea is a common and distressing symptom for patients with cancer. Although the risk factors for dyspnea in patients with cancer are likely to be multifactorial, a comprehensive description of these risk factors and associated mechanisms is not available in the extant literature.

LITERATURE SEARCH

A search of all relevant databases, including Cochrane Library, PubMed®, Embase®, Web of Science, and CINAHL®, was done from January 2009 to May 2022. Case-control and cohort studies that had either a cross-sectional or longitudinal design, as well as randomized controlled trials, were included in the review. Peer-reviewed, full-text articles in English were included. Nineteen studies reported on risk factors for dyspnea.

DATA EVALUATION

The methodologic quality of each study was examined using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

SYNTHESIS

A number of factors can influence the occurrence and severity of dyspnea. Using the Mismatch Theory of Dyspnea as the central core of this Multifactorial Model of Dyspnea in Patients With Cancer, the factors included in this conceptual model are person, clinical, and cancer-related factors, as well as respiratory muscle weakness, co-occurring symptoms, and stress.

IMPLICATIONS FOR PRACTICE

The Multifactorial Model of Dyspnea in Patients With Cancer can be used by clinicians to evaluate for multiple factors that contribute to dyspnea and to develop individualized and multilevel interventions for patients experiencing this symptom.

A conceptual model for building program sustainability in public health settings: Learning from the implementation of the program sustainability action planning model and training curricula

Background

The emergence of implementation science has driven an increase in research examining the implementation of evidence-based programs and policies. However, there has been less attention through program sustainability. To achieve the full benefit of investment in program development and implementation, there must be an understanding of the factors that relate to sustainability; additionally, there is a need for a robust set of tools and trainings to support strategic long-term program sustainability. This paper presents results of our sustainability training intervention and a new conceptual model of sustainability. The proposed conceptual model builds upon the intervention design, further specifying the implementation strategy, strategy-mechanism linkages, and effect modifiers.

Methods

This research is part of the larger randomized control trial evaluating the effectiveness of the Program Sustainability Action Planning Model and Training Curricula. Specifically, this multimethod study establishes a conceptual model for program sustainability and related capacity-building interventions. The training intervention was delivered through workshops and technical assistance to 11 state tobacco control programs, principally entailing the development and implementation of a sustainability action plan. We utilize descriptive statistics and participant perspectives to evaluate the training intervention and propose an empirically-grounded conceptual model for sustainability capacity-building interventions in public health settings.

Results

Participants found intervention components (workshop, workbook, instructor and resources) to be effective. Overall, participants found the intervention improved their ability to develop sustainability action plans and assess their program and partners. Throughout the study, program managers emphasized the importance of the workshop in providing direction for their sustainability work and the value of robust, ongoing technical assistance. Program managers identified several factors that interfered with intervention reception including staff turnover, competing priorities, partnership challenges, and the COVID-19 pandemic.

Conclusion

The present study documents the development and implementation of a novel Program Sustainability Action Planning Model and Training Curricula, one of the first interventions designed to improve program sustainability. In addition, we present an empirically-grounded conceptual model for program sustainability. Considering the paucity of research in this understudied and undefined topic area, this is an important contribution that can serve as a framework for similar intervention designs and implementation efforts. Clinical Trail Registration: ClinicalTrails.gov identification number is NCT03598114.

A Conceptual Model to Strengthen Integrated Management of HIV and NCDs among NIMART-Trained Nurses in Limpopo Province, South Africa

Integrated management of human immune deficiency virus (HIV) and non-communicable diseases (NCDs) in primary health care facilities remains a challenge. Despite research that has been conducted in South Africa, it is evident that in Limpopo Province there are slits in the implementation thereof. There is a need to develop a conceptual model to guide in strengthening the clinical competence of nurse-initiated management of antiretroviral therapy (NIMART)-trained nurses to implement the integrated management of HIV and NCDs to improve clinical outcomes of patients with the dual burden of diseases in Limpopo Province, South Africa. This study aimed to develop a conceptual model to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses to improve clinical outcomes of patients with the dual burden of communicable and non-communicable diseases in Limpopo Province, South Africa. An explanatory, sequential, mixed-methods research design was followed. Data were collected from patient records and the skills audit of 25 Primary Health Care (PHC) facilities and from 28 NIMART trained nurses. Donabedian's structure process outcome model and Miller's pyramid of clinical competence provided a foundation in the development of the conceptual model. The study revealed a need to develop a conceptual model to strengthen the implementation of integrated HIV and NCDs implementation in PHC, as evidenced by differences in the management of HIV and NCDs. Conclusion: The study findings were conceptualised to describe and develop a model needed to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses working in PHC facilities. The study was limited to Limpopo Province; the model must be implemented in conjunction with the available frameworks to achieve better clinical outcomes.

The Multifactorial Model of Cancer-Related Cognitive Impairment

PROBLEM IDENTIFICATION

Cancer-related cognitive impairment (CRCI) is common and is associated with cancer and its treatments. Evidence suggests that the causes are multifactorial, but the field is lacking a comprehensive conceptual model of CRCI to summarize existing knowledge and provide a way to understand and predict causal links, as well as to generate hypotheses.

LITERATURE SEARCH

PubMed® and Google Scholar™ were searched, and 130 articles demonstrated several lacking factors needed for a more comprehensive CRCI model.

DATA EVALUATION

The new multifactorial model of CRCI includes social determinants of health, patient-specific factors, co-occurring symptoms, treatment factors, and biologic mechanisms.

SYNTHESIS

The multifactorial model of CRCI is based on established and emerging evidence. This model is inclusive of all cancer types and associated treatments.

IMPLICATIONS FOR NURSING

Although it would be ideal to evaluate all the concepts and components in this model in a comprehensive fashion, investigators with existing datasets could evaluate portions of the model to determine directionality for some of the proposed relationships. The new model can be used to design preclinical and clinical studies of CRCI. Knowledge of the occurrence of CRCI and factors that contribute to this symptom will allow nurses to perform assessments of modifiable and nonmodifiable risk factors.

Defining the Connotations of Oral Health Literacy Using the Conceptual Composition Method

Due to advancements in research, the concept of oral health literacy (OHL) has become rich in connotations, with over 250 definitions present in the literature and government and organizational reports. The diversity of OHL definitions and connotations not only produces conflicting results but also limits the production of accurate OHL measurement and assessment tools while simultaneously hindering the construction of health literacy intervention policies. To clarify the connotations of OHL and establish a scientific basis for evaluation, we conducted a systematic review, searching and analyzing the literature related to the conceptual connotations of OHL. Additionally, we extracted basic, methodological, and OHL conceptual connotation information from the literature. With reference to the review framework, we classified the conceptual connotations of OHL into antecedents of OHL, the core of OHL, mediators, and outcomes of OHL. The comprehensive conceptual connotations of OHL were obtained through a systematic review and concept mapping based on the related literature. Our analysis revealed that the antecedents of OHL can be classified in two categories: personal factors and external factors. The core conceptual connotations of OHL include three core dimensions (with 16 subdimensions): (1) basic skills-literacy, reading comprehension, numeracy, hearing, oral expression, communication, and knowledge; (2) information-related abilities-information acquisition, information understanding, information communication, information evaluation, information utilization, and information decision-making; and (3) oral health maintenance abilities-interpersonal skills, self-regulation, and goal achievement. The mediator of these connotations is oral health behaviors, with oral health being the result of OHL. This study further clarifies the conceptual connotations of OHL, serving as a reference for future OHL-related studies.

Young Adults' Perception of Forests Using Landscape-Image-Sketching Technique: A Case Study of Changsha, Central China

The forest-landscape image is the bridge for communication between human beings and the forest. The aim of this paper is to construct the landscape-image conceptual model from the personal perception of the forest, with what people are looking at and how they are viewing themselves as a part of the forest. This research constructed a forest-landscape image by young adults by utilizing the landscape-image-sketching technique and selecting 140 young adults who had lived in Changsha, Central China for ten years, using convenience sampling, during April and May 2018. The results demonstrated that the forest was considered as the people's life world, as rural scenery around the respondents' homes, instead of the perception of the objective forest, an important habitat for animals and a limited resource supplier for human living. In fact, the natural values of the forest, such as the ecological and aesthetic values, received more attention than the social ones of the forest, including the life, production, and cultural values. Finally, it is important to raise the public's awareness of the objective entity of the forest and to guide the variety of experiences for the respondents in the forest.

Transforming acute pain management in children: A concept analysis to develop a new model of nurse, child and parent partnership

OBJECTIVES

To identify the core components of acute pain management in children, re-conceptualise the process and update the existing model to inform nursing research and clinical practice.

BACKGROUND

Acute pain in hospitalised children remains suboptimal, despite extensive nursing research and education. Improvements require a patient-centred approach and a conceptual model which includes the role of parents and partnership.

DESIGN

Using Rodgers' Evolutionary method, a concept analysis was conducted to define the core components for effective acute pain management in children.

METHODS

A scoping review of peer-reviewed literature from 1990 through 2020 was conducted using the terms "pain management," "pain control," "pain treatment," "multi modal," and "concept*". Abstracts from 85 articles were initially reviewed with 30 articles retained for analysis. Core concepts were identified, defined and synthesised. The PRISMA 2020 checklist was used.

RESULTS

A new model was developed from a synthesis of past work which incorporates the role of parents, the complexity of the process and definitions for shared decision-making. Trust, safety, collaborative communication and genuine partnership were identified as the core components for effective pain management in children, with the triadic relationship of nurses, patients and parents in genuine partnership foundational to the nursing process.

CONCLUSION

The new model for acute pain management in children transforms the nurse's role from gatekeeper to facilitator, shifting the process from nurse driven to patient-centred. The new collaborative model will promote shared decision-making for individualised pain assessments, interventions and evaluations.

RELEVANCE TO CLINICAL PRACTICE

Establishing the nurse, child, parent partnership as an essential foundation to pain management has the potential to expand pain assessments, optimise treatment selections, advancing clinical practice, patient outcomes and nursing science. No Patient or Public Contributions were included in this paper as this was a concept analysis pulling from past works.

A multilevel developmental psychopathology model of childbirth and the perinatal transition

Despite recent applications of a developmental psychopathology perspective to the perinatal period, these conceptualizations have largely ignored the role that childbirth plays in the perinatal transition. Thus, we present a conceptual model of childbirth as a bridge between prenatal and postnatal health. We argue that biopsychosocial factors during pregnancy influence postnatal health trajectories both directly and indirectly through childbirth experiences, and we focus our review on those indirect effects. In order to frame our model within a developmental psychopathology lens, we first describe "typical" biopsychosocial aspects of pregnancy and childbirth. Then, we explore ways in which these processes may deviate from the norm to result in adverse or traumatic childbirth experiences. We briefly describe early postnatal health trajectories that may follow from these birth experiences, including those which are adaptive despite traumatic childbirth, and we conclude with implications for research and clinical practice. We intend for our model to illuminate the importance of including childbirth in multilevel perinatal research. This advancement is critical for reducing perinatal health disparities and promoting health and well-being among birthing parents and their children.

Reflection at work - A conceptual model and the meaning of its components in the domain of VET teachers

Professional development requires reflection. However, a conceptual model that considers the different perspectives on reflection remains missing. Regarding reflection, three different research streams can be distinguished: (I) an individual action-process-perspective, (II) a critical perspective, and (III) a social-relatedness perspective. From these three streams, important components are derived in the present study and integrated into one conceptual model. This model contains the individual and contextual components which influence reflection and considers reflection to be a process containing mutually influencing emotion, motivation, and cognition which can lead to various outcomes such as performance and, consequently, innovation. For illustrating the meaning of the model's components in a specific professional context, we used data from an interview study with eight teachers of vocational schools. The conceptual model can serve as a basis for further research on reflection in all kinds of work contexts and be used to foster professional development, for instance by developing interventions to foster reflection.

A Conceptual Model of Home-Based Cardiac Rehabilitation Exercise Adherence in Patients with Chronic Heart Failure: A Constructivist Grounded Theory Study

PURPOSE

This study aimed to explore a conceptual model of home-based cardiac rehabilitation exercise adherence and reveal its internal behavioral logic.

PATIENTS AND METHODS

A constructivist grounded theory design was adopted to explore the conceptual model of home-based cardiac rehabilitation exercise adherence. Semi-structured interviews were completed to collect qualitative data for constructing the conceptual model. The theoretical saturation and validation strategies were adopted to demonstrate the adequacy of qualitative data. A three-level coding procedure with constant comparisons was completed to analyze this qualitative data.

RESULTS

A total of 21 patients with chronic heart failure were recruited in this study. As a result of this study, 32 initial codes, 12 category codes, and four core categories were extracted, namely, seeking supports, rehabilitation exercise, exercise monitoring and information feedback. According to the internal behavioral logic, the conceptual model of home cardiac rehabilitation exercise adherence was finally formed. In this closed-chain model, seeking supports is the initial adherence behavior, and rehabilitation exercise is the core adherence behavior, and exercise monitoring is the key adherence behavior, and information feedback is the driving adherence behavior.

CONCLUSION

The conceptual model of home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was developed, revealing its internal behavioral logic and providing theoretical references for developing relevant clinical research tools with comprehensive coverage and identifying weak links.

Engaging the creative heArts of nurse educators: a novel conceptual model

OBJECTIVES

Nurse educators are increasingly challenged in preparing future nurses to be creative thinkers. The purpose of this innovative quality improvement initiative is to share nursing students' interpretations of the value arts-based pedagogy (ABP) brings to their nursing practice.

METHODS

Braun and Clarke's approach to thematic analysis was utilized to identify and report patterns of ideas within learners' interpretations of engaging in an ABP assignment.

RESULTS

The analysis of students' interpretations led to the creation of a novel conceptual model to encourage and support nurse educators in the use of innovative ABP approaches.

CONCLUSIONS

ABP can be seamlessly integrated within teaching and learning methodologies to cultivate meaningful student learning.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

The intent of the conceptual model is to encourage and support nurse educators in the use of innovative ABP approaches designed for engaging nursing students in active, creative, and challenging learning environments.

School Built Environments and Bullying Behaviour: A Conceptual Model Based on Qualitative Interviews

Interest in how the school built environment impacts bullying behaviour has gained momentum in recent years. While numerous studies have identified locations within schools where bullying frequently occurs, few studies have investigated the potential conceptual pathways linking school locations to bullying behaviour. This study aimed to (i) identify school built environment factors that may prevent or facilitate bullying behaviour in primary and secondary schools; and (ii) develop a conceptual model of potential pathways between the school built environment and bullying behaviour for future anti-bullying intervention research. Seventy individual semi-structured interviews were conducted between May and December 2020, with policymakers (n = 22), school staff (n = 12), parents (n = 18), and students (n = 18). School staff, parents and students, were recruited from six metropolitan primary and secondary schools in Perth, Western Australia. Interviews were conducted online and face-to-face using semi-structured interview guides. A thematic analysis was undertaken. Participants identified school bullying locations (e.g., locker areas, bathrooms, corridors) and built environment factors linked to bullying behaviour via (i) visibility and supervision; (ii) physical and psychological comfort and safety; and (iii) social-emotional competencies. The findings have policy and practice implications regarding the design of school built environments to prevent bullying behaviour.

A model to understand antecedents of nursing attitudes and perceptions influencing outcomes of patients with SUD

INTRODUCTION

Substance use disorder (SUD) is a persistent and long-standing public health issue in the United States. While SUD is medically considered a chronic illness, it is also one that is viewed as self-inflicted, thereby resulting in judgmental attitudes and stigmatization from care providers, specifically from nurses.

DESIGN

In 2020, the authors completed an analytical cross-sectional study that included open-ended questions to examine nurses' knowledge and attitudes toward caring for patients with SUD across practice settings.

METHODS

A conceptual model was constructed by examining original study data and published literature on SUD, re-analyzing themes, determining constructs and variables, then coming to a consensus on critical aspects of the model.

CONCLUSION

The resulting conceptual model highlights antecedents of nursing behaviors that directly affect patient care outcomes, providing a roadmap to improving patient outcomes.

CLINICAL RELEVANCE

Understanding antecedents that affect nurses' attitudes and perceptions of patients with SUD highlights changes that can influence patient outcomes.

Addressing social inequity through improving relational care: A social-ecological model based on the experiences of migrant women and midwives in South Wales

BACKGROUND

Migrant and ethnic inequalities in maternal and perinatal mortality persist across high-income countries. Addressing social adversity and inequities across the childbirth trajectory cannot be left to chance and the good intentions of practitioners. Robust, evidence-based tools designed to address inequity by enhancing both the quality of provision and the experience of care are needed.

METHODS

An inductive modelling approach was used to develop a new evidence-based conceptual model of woman-midwife relationships, drawing on data from an ethnographic study of relationships between migrant Pakistani women and midwives, conducted between 2013 and 2016 in South Wales, UK. Key analytic themes from early data were translated into social-ecological concepts, and a model was developed to represent how these key themes interacted to influence the woman-midwife relationship.

RESULTS

Three key concepts influencing the woman-midwife relationship were developed from the three major themes of the underpinning research: (1) Healthcare System; (2) Culture and Religion; and (3) Family Relationships. Two additional weaving concepts appeared to act as a link between these three key concepts: (1) Authoritative Knowledge and (2) Communication of Information. Social and political factors were also considered as contextual factors within the model. A visual representation of this model was developed and presented.

CONCLUSIONS

The model presented in this paper, along with future work to further test and refine it in other contexts, has the potential to impact on inequalities by facilitating future discussion on cultural issues, encouraging collaborative learning and knowledge production and providing a framework for future global midwifery practice, education and research.

PATIENT OR PUBLIC CONTRIBUTION

At the outset of the underpinning research, a project involvement group was created to contribute to study design and conduct. This group consisted of the three authors, an Advocacy Officer at Race Equality First and an NHS Consultant Midwife. This group met regularly throughout the research process, and members were involved in discussions regarding ethical/cultural/social issues, recruitment methods, the creation of participant information materials, interpretation of data and the dissemination strategy. Ideas for the underpinning research were also discussed with members of the Pakistani community during community events and at meetings with staff from minority ethnic and migrant support charities (BAWSO, Race Equality First, The Mentor Ring). Local midwives contributed to study design through conversations during informal observations of antenatal appointments for asylum seekers and refugees.

The association between hand disease severity and fatigue in individuals with systemic sclerosis: a scoping review

BACKGROUND

Hand disease severity in people with systemic sclerosis (SSc) arises from connective tissue and vascular changes causing functional limitations, pain, and disability. Fatigue is not well-understood in SSc and reported to be highly distressing. It is not known how fatigue relates to these disease changes. The objective of this study was to identify which elements of hand disease severity contribute to fatigue in individuals with SSc.

METHODS

Five online databases and Google Scholar were searched to identify publications through 2021 presenting data related to hand disease severity and fatigue.

RESULTS

Five articles met the inclusion criteria. The samples were 72-91% female, and 35-100% with diffuse SSc. Measures of disease severity included skin thickening (modified Rodnan score), joint involvement (mobility, tenderness, swelling), and digital ulcers. Fatigue was measured by various self-report. Joint involvement was strongly associated with fatigue. Skin thickening weakly associated with fatigue. The perceived interference of digital ulcers in daily activities was related to fatigue.

CONCLUSIONS

Few studies have examined how fatigue relates to hand disease severity. While joint involvement was associated with fatigue over time and in cross-sectional studies, digital ulcers may be associated with fatigue indirectly. A conceptual model is proposed with implications for future research.Implications for RehabilitationStructural disease changes that manifest in the hands, is often associated with pain, disability, and fatigue in SSc.Fatigue is one of the most distressing symptoms of SSc and reported by 61-90% of individuals with SSc, but is not well characterized.Of measures of hand disease severity, joint involvement (contractures, swollen and tender joints) is most associated with fatigue in individuals with SSc and more so if pain is involved.A better understanding of the physiological features of disease and fatigue could provide insight into development of fatigue management interventions and help rheumatology providers work with patients to manage their fatigue.Rehabilitation assessments and interventions for hand disability need to be considered as important elements in improving all elements of quality of life for individuals with systemic sclerosis.

Designing a conceptual model for the formation of unsafe antisocial behaviors in motor vehicle drivers: a grounded theory study

BACKGROUND

Many accidents caused by vehicles are the result of improper driving behavior. Use the vehicle in an antisocial form has led to a phenomenon called driving violence. Antisocial behavior while driving has a potential risk to other road users. This study aims to explain the conceptual framework of the formation of unsafe antisocial behaviors in the road traffic field.

METHODS

This qualitative grounded theory study was conducted with exploratory methods. 31 participants were included in this study. Purposeful and theoretical sampling was used in this study. The data collection process was semi-structured interviews. Codes, subcategories, and categories were extracted by the inductive process and analyzed by Corbin and Strauss approach. Trustworthiness criteria were used to assure the quality of the results. The data analysis process continued until there were no new concepts.

RESULTS

A conceptual model was developed to explain the different relationships between the main categories extracted from the study. 10 main categories with 44 subcategories were extracted. Categories include cultural factors, educational factors, rules, economic factors, psychological factors, infrastructure weakness, poor socialization of individuals, violent driving, reduced social welfare and reduced traffic safety.

CONCLUSIONS

The people's socialization weakness in society was considered as the core concept in the process of formation of these behaviors. The conceptual model obtained from this study can be used in developing prevention programs and identifying the required interventions Considering the negative consequences caused by this type of behavior, its prevention should be the focus of road traffic policy makers.

Towards a New Conceptual Model for Nurses' Organizational Well-being: An Integrative Review

AIM

To summarize conceptual models of nurses' organizational well-being and identify common variables among them.

BACKGROUND

To understand how the characteristics of an organizational context affect workers' well-being, numerous conceptual models have been developed. Such models have been conceptualized in various working contexts other than healthcare, and not always considering the particularities of the profession of nursing. Evaluation This integrative review was conducted using the resources of PubMed, CINAHL, Scopus and the Cochrane Library, up until March 2022, and by applying a modified version of Cooper's five-stage methodology, in accordance with the PRISMA guideline. Key issues Six reference models focused on different organizational variables and used to evaluate nurses' organizational well-being were identified: the Effort-Reward Imbalance (ERI) model, the Job Demands-Resources (JD-R) model, the Utriainen et al. model, the Demands-Resources and Individual-Effects (DRIVE) model, the Well-Being, Health-Promoting Lifestyle and Work Environment Satisfaction (WHS) model, and the Nursing Worklife Model (NWM).

CONCLUSION

There is no consensus in the nursing literature on an all-encompassing conceptual model of nurses' organizational well-being, or on working environment characteristics to be studied or monitored for defining nurses' well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

Coming to a consensus on the definition of a nurses' organizational well-being model and its variables would facilitate nursing management in monitoring and intervening on nurses' work-life quality, and in improving nursing performance and caring outcomes.

Thoughts About Health Policies

This essay is about health policies. Included are the definition of health policy, the descriptions of the concepts of a conceptual model of nursing and health policy, and examples of various sources of health policies. A central thesis of this essay is that practice guidelines are largely unrecognized as health policies. This thesis provides the connection between the abstract idea of a health policy and what is done in nursing practice. The essay concludes with examples of research questions about nursing and health policies.

Applications of conceptual models from lifecourse epidemiology in ecology and evolutionary biology

In ecology and evolutionary biology (EEB), the study of developmental plasticity seeks to understand ontogenetic processes underlying the phenotypes upon which natural selection acts. A central challenge to this inquiry is ascertaining a causal effect of the exposure on the manifestation of later-life phenotype due to the time elapsed between the two events. The exposure is a potential cause of the outcome-i.e. an environmental stimulus or experience. The later phenotype might be a behaviour, physiological condition, morphology or life-history trait. The latency period between the exposure and outcome complicates causal inference due to the inevitable occurrence of additional events that may affect the relationship of interest. Here, we describe six distinct but non-mutually exclusive conceptual models from the field of lifecourse epidemiology and discuss their applications to EEB research. The models include Critical Period with No Later Modifiers, Critical Period with Later Modifiers, Accumulation of Risk with Independent Risk Exposures, Accumulation of Risk with Risk Clustering, Accumulation of Risk with Chains of Risk and Accumulation of Risk with Trigger Effect. These models, which have been widely used to test causal hypotheses regarding the early origins of adult-onset disease in humans, are directly relevant to research on developmental plasticity in EEB.

A Nuclei-Based Conceptual Model of (Eco)evolutionary Dynamics in Fungal Heterokaryons

Filamentous fungi are characterised by specific features, such as multinuclearity, coexistence of genetically different nuclei and nuclear movement across the mycelial network. These attributes make them an interesting, yet rather underappreciated, system for studying (eco)evolutionary dynamics. This is especially noticeable among theoretical studies, where rather few consider nuclei and their role in (eco)evolutionary dynamics. To encourage such theoretical approaches, we here provide an overview of existing research on nuclear genotype heterogeneity (NGH) and its sources, such as mutations and vegetative non-self-fusion. We then discuss the resulting intra-mycelial nuclear dynamics and the potential consequences for fitness and adaptation. Finally, we formulate a nuclei-based conceptual framework, which considers three levels of selection: a single nucleus, a subpopulation of nuclei and the mycelium. We compare this framework to other concepts, for example those that consider only the mycelium as the level of selection, and outline the benefits of our approach for studying (eco)evolutionary dynamics. Our concept should serve as a baseline for modelling approaches, such as individual-based simulations, which will contribute greatly to our understanding of multilevel selection and (eco)evolutionary dynamics in filamentous fungi.

Root grafts matter for inter-tree water exchange - a quantification of water translocation between root grafted mangrove trees using field data and model based indication

BACKGROUND AND AIMS

Trees interconnected through functional root grafts can exchange resources, but the effect of exchange on trees remains under debate. A mechanistic understanding of resources exchange via functional root grafts will help understand their ecological implications for tree water exchange for individual trees, groups of trees, and forest stands.

METHODS

To identify the main patterns qualitatively describing the movement of sap between grafted trees, we reviewed available literature on root grafting in woody plants that focus on tree allometry and resource translocation via root grafts. We then extended the BETTINA model, which simulates mangrove (Avicennia germinans) tree growth on the individual tree scale, in order to synthesize the available empirical information. Using allometric data from a field study in mangrove stands, we simulated potential water exchange and analyzed movement patterns between grafted trees.

KEY RESULTS

In the simulations, relative water exchange ranged between -9.17 and 20.3 %, and was driven by gradients of water potential, i.e. differences in tree size and water availability. Moreover, the exchange of water through root grafts alters the water balance of trees and their feedback with the soil: grafted trees that receive water from their neighbors reduce their water uptake.

CONCLUSIONS

Our individual-tree modelling study is a first theoretical attempt to quantify root graft-mediated water exchange between trees. Our findings indicate that functional root grafts represent a vector of hydraulic redistribution, helping to maintain the water balance of grafted trees. This non-invasive approach can serve as a fundament for designing empirical studies to better understand the role of grafted root interaction networks on a broader scale.

[The advanced practice nurse as a health care influencer]

The skills that advanced practice nurses use with patients, health care professionals and within the health care system enable them to exercise real leadership. The use of conceptual models and theories in nursing, tools for tracking and valuing clinical judgment, and nursing diagnoses and other concepts are essential to guaranteeing their disciplinary identity and ensuring interprofessional collaboration.

How Individuals With Low Back Pain Conceptualize Their Condition: A Collaborative Modeling Approach

Low back pain (LBP) is complex. This study aimed to use collaborative modeling to evaluate conceptual models that individuals with LBP have of their condition, and to compare these models with those of researchers/clinicians. Twenty-eight individuals with LBP were facilitated to generate mental models, using "fuzzy cognitive maps," that represented conceptualization of their own LBP and LBP "in general." "Components" (ie, causes, outcomes and treatments) related to pain, disability and quality of life were proposed, along with the weighted "Connections" between Components. Components were classified into thematic categories. Weighting of Connections were summed for each Component to judge relative importance. Individual models were aggregated into a metamodel. When considering their own condition, participants' models included 19(SD = 6) Components and 43(18) Connections with greatest weight on "Biomechanical" components. When considering LBP in general, models changed slightly. Patient models contrasted the more complex models of researchers/clinicians (25(7) Components; 77(42) Connections), with most weight on "Psychological" components. This study provides unique insight into how individuals with LBP consider their condition, which is largely biomedical and narrower than clinician/researcher perspectives. Findings highlight challenges for changing public perception of LBP, and provide a method with potential utility to understand how individuals conceptualize their condition. PERSPECTIVE: Collaborative modeling was used to understand how individuals with low back pain conceptualize their own condition, the condition in general, and compare this with models of expert researchers/clinicians. Data revealed issues in how individuals with back pain conceptualize their condition, and the method's potential utility for clinical evaluation of patients.

Optimization of Spatial Pattern of Land Use: Progress, Frontiers, and Prospects

Due to high-intensity human disturbance and rapid climate change, optimizing the spatial pattern of land use has become a pivotal path to restoring ecosystem functions and realizing the sustainable development of human–land relationships. This review uses the literature analysis method combined with CiteSpace to determine current research progress and frontiers, challenges, and directions for further improvement in this field. The main conclusions include the following: (a) research on the optimization of spatial pattern of land use has transformed from pattern description orientation to sustainable development orientation to ecological restoration orientation. Its research paradigm has changed from pattern to function to well-being; (b) the research frontier mainly includes spatial pattern of land use that takes into account the unity of spatial structure and functional attributes, the ecological mechanism and feedback effect of change in spatial pattern of land, the theoretical framework and model construction of land use simulation and prediction based on multiple disciplines and fields, and the adaptive management of sustainable land use in the context of climate change; (c) based on current research challenges, we integrate the research on landscape ecology and ecosystem service flows to develop an “element sets–network structure–system functions–human well-being” conceptual model. We also propose the strengthening of future research on theoretical innovation, spatiotemporal mechanism selection, causal emergence mechanism, the transformation threshold, and uncertainty. We provide innovative ideas for achieving sustainable management of land systems and territorial spatial planning with the aim of improving the adaptability of land use spatial optimization. This is expected to strengthen the ability of land systems to cope with ecological security and climate risks.

Veteran Engagement in Health Services Research: a Conceptual Model

With 20 million living veterans and millions more immediate family members, and approximately 9 million veterans enrolled in the nationally networked VA healthcare system, representing the interests and needs of veterans in this complex community is a substantial endeavor. Based on the importance of engaging Veterans in research, the VA Health Services Research and Development (HSR&D) Service convened a Working Group of VA researchers and Veterans to conduct a review of patient engagement models and develop recommendations for an approach to engage Veterans in health research that would incorporate their unique lived experiences and interests, and their perspectives on research priorities. The Working Group considered the specific context for Veteran engagement in research that includes other VA stakeholders from the operational and clinical leadership of the VA Health Administration (VHA). The resulting model identifies the range of potential stakeholders and three domains of relevant constructs-processes expected to facilitate Veteran engagement in research with other stakeholders, individual stakeholder and external factors, and outcomes. The expectation is that Veteran engagement will benefit research to policy and practice translation, including increasing the transparency of research and producing knowledge that is readily accepted and implemented in healthcare.

What Determines Vaccine Hesitancy: Recommendations from Childhood Vaccine Hesitancy to Address COVID-19 Vaccine Hesitancy

Vaccine hesitancy is a prevalent and ongoing issue. However, due to the COVID-19 pandemic, additional attention has been brought to the topic of vaccine hesitancy. Vaccine hesitancy is a threat to the population's health globally. This article aims to acquire insights from previous literature to determine what works to increase vaccine uptake and how we can apply this knowledge to increase COVID-19 vaccine uptake. Research has focused chiefly on childhood vaccination and the hesitancy of caregivers. After conducting an extensive literature review, we have created a conceptual model of indicators that influence vaccine uptake for health providers and caregivers, which can also be used for vaccine recipients. Overall, the reasons for vaccine hesitancy are complex; therefore, a multifaceted approach is needed to address it. Understanding the factors that affect vaccine hesitancy will aid in addressing hesitancy and, in turn, lead to an increase in vaccine uptake.

Conceptual Model of Emergency Department Utilization among Deaf and Hard-of-Hearing Patients: A Critical Review

Deaf and hard-of-hearing (DHH) populations are understudied in health services research and underserved in healthcare systems. Existing data indicate that adult DHH patients are more likely to use the emergency department (ED) for less emergent conditions than non-DHH patients. However, the lack of research focused on this population’s ED utilization impedes the development of health promotion and quality improvement interventions to improve patient health and quality outcomes. The purpose of this study was to develop a conceptual model describing patient and non-patient (e.g., community, health system, provider) factors influencing ED utilization and ED care processes among DHH people. We conducted a critical review and used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The resulting Conceptual Model of Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients provides predisposing, enabling, and reinforcing factors influencing DHH patient ED care seeking and ED care processes. The model highlights the abundance of DHH patient and non-DHH patient enabling factors. This model may be used in quality improvement interventions, health services research, or in organizational planning and policymaking to improve health outcomes for DHH patients.

Reverse supply chain conceptual model for construction and demolition waste

Construction and demolition waste (CDW) substantially contributes to environmental degradation because of its intrinsic characteristics of fast and high generation volume, low recycling rate, and low revenue margins. A systemic problem is that recycling facilities are not usually a part of a reverse supply chain (RSC) specific for CDW. This makes the recovery process costs prohibitive, especially where companies are unable to receive and process large volumes of waste continuously. This paper presents a systematic analysis of the extant literature and utilizes the results accrued to develop a conceptual RSC model for CDW. In so doing, the research seeks to provide clarity on this phenomenon, while simultaneously stimulating wider academic discourse and further research endeavours. A mixed philosophies epistemological design was adopted using both interpretavism and constructivism to undertake a qualitative systematic analysis of the literature. A process diagram was produced to represent the conceptual model (CM) and thematically group the nodes into three key swim lanes that delineate the boundaries between distribution, manufacturing, and sourcing and warehousing processes. Within each swim lane, stakeholders were incorporated as key actors. A further layer of nuanced complexity was added to illustrate the key actors involved in the process, government strategies, and activity flow paths. This novel CM offers both practical and theoretical contributions to existing knowledge and signposts a future research direction. Such work will demystify reverse logistics for managing CDW, and assist government policy-makers to develop informed policies that reduce the negative environmental impact of construction activities.

The impact of caring for an individual with aromatic l-amino acid decarboxylase (AADC) deficiency: a qualitative study and the development of a conceptual model

BACKGROUND

Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare neurological condition, associated with a wide range of symptoms and functional issues, such as profound motor impairment and learning disability. Most individuals with AADC deficiency are completely dependent on their caregivers. This study explored the impact of caring for an individual with AADC deficiency.

METHODS

Qualitative interviews were conducted with caregivers of individuals with AADC deficiency in Italy, Portugal, Spain and the United States. An interview guide was developed with input from clinical experts and caregivers and included questions on the impact of caring for an individual with AADC deficiency. Interviews were conducted by telephone/videoconference and were recorded and transcribed. Data were analysed using thematic analysis.

RESULTS

Fourteen caregivers took part who provided care to 13 individuals with AADC deficiency aged 1-15 years. Caregivers reported that their lives centred around the individual with AADC deficiency, due to their need for 24-hour care and regular healthcare appointments. They reported both proximal impacts (impact on time, planning, physical health and emotional wellbeing), and distal impacts (impact on social/leisure activities, relationships, work and finances). These concepts and relationships were illustrated in a conceptual model.

CONCLUSIONS

This is the first qualitative study to report on the experience of caring for an individual with AADC deficiency. Caregivers reported that caring had a substantial multifaceted impact on their lives. These findings highlight the importance of considering the caregiver experience when evaluating the burden of AADC deficiency.

Medication Adherence: Expanding the Conceptual Framework

Interventions targeting traditional barriers to antihypertensive medication adherence have been developed and evaluated, with evidence of modest improvements in adherence. Translation of these interventions into population-level improvements in adherence and clinical outcomes among older adults remains suboptimal. From the Cohort Study of Medication Adherence among Older adults (CoSMO), we evaluated traditional barriers to antihypertensive medication adherence among older adults with established hypertension (N = 1,544; mean age = 76.2 years, 59.5% women, 27.9% Black, 24.1% and 38.9% low adherence by proportion of days covered (i.e., PDC <0.80) and the 4-item Krousel-Wood Medication Adherence Scale (i.e., K-Wood-MAS-4 ≥1), respectively), finding that they explained 6.4% and 14.8% of variance in pharmacy refill and self-reported adherence, respectively. Persistent low adherence rates, coupled with low explanatory power of traditional barriers, suggest that other factors warrant attention. Prior research has investigated explicit attitudes toward medications as a driver of adherence; the roles of implicit attitudes and time preferences (e.g., immediate vs. delayed gratification) as mechanisms underlying adherence behavior are emerging. Similarly, while associations of individual-level social determinants of health (SDOH) and medication adherence are well reported, there is growing evidence about structural SDOH and specific pathways of effect. Building on published conceptual models and recent evidence, we propose an expanded conceptual framework that incorporates implicit attitudes, time preferences, and structural SDOH, as emerging determinants that may explain additional variation in objectively and subjectively measured adherence. This model provides guidance for design, implementation, and assessment of interventions targeting sustained improvement in implementation medication adherence and clinical outcomes among older women and men with hypertension.

A conceptual model of oro-facial health with an emphasis on function

The individual inclination to lead an autonomous life until death is associated with requirements that may be of physiological, psychosocial and environmental nature. We aim to describe a conceptual oro‐facial health model with an emphasis on oro‐facial function, taking the domains of quality of life and patient‐centred values into account. In the context of oro‐facial function, the requirements of life are met when the oro‐facial system is in a fit state. ‘Fitness of the oro‐facial system, that is oro‐facial health, is a state that is characterised by an absence of, or positive coping with physical disease, mental disease, pain and negative environmental and social factors. It will allow natural oro‐facial functions such as sensing, tasting, touching, biting, chewing, swallowing, speaking, yawning, kissing and facial expression’. In the presented conceptual model of oro‐facial health, it is postulated that each individual has present and future potentials related to biological prerequisites and resources that are developed by an individual through the course of life. These potentials form the oro‐facial functional capacity. When the individual potentials together do not meet the requirements of life anymore, dysfunction and disease result. The oro‐facial system is subject to physiological ageing processes, which will inevitably lead to a decrease in the oro‐facial functional capacity. Furthermore, comorbid medical conditions might hamper oro‐facial function and, alongside with the ageing process, may lead to a state of oral hypofunction. Currently, there is a lack of widespread, validated, easy‐to‐use instruments that help to distinguish between states of oro‐facial fitness as opposed to oral hypofunction. Clearly, research is needed to establish adequate, validated instruments alongside with functional rehabilitation procedures.