Development of the Australian hospital patient experience question set for parents

BackgroundThe Australian Commission on Safety and Quality in Health Care developed the Australian Hospital Patient Experience Question Set to ask adult patients about their experience of inpatient care. This question set was not validated for paediatric care.AimTo adapt and validate the Australian Hospital Patient Experience Question Set for parents and carers of children who received inpatient care.MethodsInterviews with fourteen parents and carers were conducted. Content analysis was used to revise the question set and to identify experience specific to children and parents. The Question Set was revised, including three new questions to reflect parent experience. Content validity of each new question was assessed. Data was split and construct validity assessed using exploratory and confirmatory factor analysis (n = 1500).FindingsTwo main qualitative categories of care included ‘parent experience’ and ‘children being heard’. Emotional support was an integral aspect of parent experience. The revised question set (13-question, one-factor model of good fit) demonstrated construct validity (n = 500: Root Mean Square Error of Approximation = 0.042, Confirmatory Fit Index = 0.997, Tucker Lewis Index = 0.996, Composite reliability = 0.962).DiscussionThis study adds empirical support for a common measurement framework for experience of care in children's health services. Parents spoke of the value of having a parent and a child reported survey. The next step is for children to report on their own experience.ConclusionThe revised (parent-reported) question set provides a validated tool which reflects the unique experience of parents and facilitates consistent monitoring and improvement of patient experience in a paediatric inpatient setting.     

Exploring assessment policies for clinical practice: A scoping review of the literature

BackgroundAssessment of pre-registration nursing students in clinical practice is an essential process, ensuring students who graduate meet standards for practice and competently and safely care for patients under their care. However, such assessment remains challenging for individuals and organisations.AimWe aimed to investigate what is known about the application of clinical placement assessment policies guiding pre-registration nursing programmes.MethodsArskey and O’Malley’s five-stage method for scoping reviews was employed. Health and education databases were searched in July 2020 and December 2021. Identified papers were screened. The Joanna Briggs Institute’s critical appraisal tools were used to appraise the quality of the included articles. The Invitational Theory domains of people, processes, programmes, places, and policies were utilised to aid meaningful analysis of the findings.FindingsNineteen articles were appraised: eleven primary data studies, two that psychometrically tested a survey instrument, four discussion articles, and two literature reviews. Article quality varied widely. Three themes were identified: lack of processes around clinical practice, people and clinical practice, and policies and clinical practice.DiscussionAssessment within placement is complex and unique. Uncertainty permeates the literature around assessment of pre-registration students in clinical practice. There is a clear need to promote policies that highlight differences between theoretical and practice assessment, ensuring all stakeholders can access relevant governance processes that support patient safety.ConclusionMore empirical evidence is needed to develop policies and processes that reduce uncertainty and improve patient safety associated with student assessment within clinical placements.     

Bulk TiB2-Based Ceramic Composites with Improved Mechanical Property Using Fe–Ni–Ti–Al as a Sintering Aid

The densification behavior, microstructure and mechanical properties of bulk TiB₂-based ceramic composites, fabricated using the spark plasma sintering (SPS) technique with elements of (Fe–Ni–Ti–Al) sinter-aid were investigated. Comparing the change of shrinkage displacement of pure TiB₂ and TiB₂–5 wt% (Fe–Ni–Ti–Al), the addition of elements Fe–Ni–Ti–Al into TiB₂ can facilitate sintering of the TiB₂ ceramics. As the sintering temperature exceeds 1300 °C, the relative density does not significantly change. Alumina particles and austenite (Fe–Ni–Ti) metallic binder distributed homogeneously in the grain boundary of TiB₂ can inhibit the growth of the TiB₂ grains when the sintering temperature is below 1300 °C. The density and particle size of TiB₂ greatly influence the mechanical behavior of TiB₂–5 wt% (Fe–Ni–Ti–Al) composites. The specimen sintered at 1300 has the highest microhardness of 21.1 ± 0.1 GPa with an elastic modulus of 461.4 GPa. The content of secondary borides (M₂B, being M = Fe, Ni), which are more brittle than TiB₂ particles, can also influence the fracture toughness. The specimen sintered at 1500 °C has the highest fracture toughness of 6.16 ± 0.30 MPa·m^1/2 with the smallest M₂B phase. The results obtained provide insight into fabrication of ceramic composites with improved mechanical property.     

Nursing care for patients with endometriosis and/or adenomyosis: A mixed methods systematic review protocol

BackgroundEndometriosis and adenomyosis are benign gynaecological conditions that can cause pain disorders, menstrual abnormalities, and fertility issues. Due to the variances of clinical presentations, a patient-centred care approach is needed to address the complex healthcare needs of individuals with endometriosis and/or adenomyosis. This approach can be achieved by nurses both independently, such as in nurse-led clinics, and in collaboration with other healthcare professionals.AimThe review aims to examine the nurse’s role in the delivery of care for patients with endometriosis and/or adenomyosis. An overall research question focuses on: ‘How do nurses deliver care for patients with endometriosis and/or adenomyosis?’MethodsA mixed methods systematic review will be undertaken using a convergent segregated design approach guided by the relevant Joanna Briggs Institute (JBI) methodology. A three-step search strategy will be applied across six databases to locate qualitative, quantitative, and mixed method studies which meet the inclusion criteria. At least two independent reviewers will be involved in screening, critical appraisal, and data extraction of included studies. Results will be tabulated and accompanied by a narrative summary.ConclusionExamination of the review topic and answering the research question will result in a synthesis of evidence of the nurse's role in the delivery of care for patients with endometriosis and/or adenomyosis. Recommendations may inform in the planning and development of the nurses’ role which has the potential to improve the quality of healthcare for patients with endometriosis and/or adenomyosis.     

<Emphasis Type="Italic">Pax7</Emphasis> and superior collicular polarity: insights from <Emphasis Type="Italic">Pax6 (Sey)</Emphasis> mutant mice

Pax genes are important modulators of CNS development. Pax7 and Pax6 polarise the neural tube and regionalise the brain. Pax7 is pivotal in specifying the superior colliculus/tectum, an important centre for integration of visuomotor responses and a target for Pax6 ⁺ retinal ganglion cell axons during retinocollicular mapping. Whilst initial Pax7-specification of the mesencephalon is well-established, a role in regulating polarity within the maturing mouse superior colliculus is yet to be defined, although already detailed for the chick tectum. We therefore quantified Pax7 cellular distribution and expression levels at three functionally distinct stages of superior collicular development, and analysed Pax7 expression in response to aberrant axonal input and altered forebrain/midbrain boundary placement in Pax6 mutant mice. Comparative expression profiles of ephrin-A2 and its co-localisation with Pax7 were determined in wildtype and Pax6 mutant mice. Results indicate that graded Pax7 expression in wildtype mice is perturbed in Pax6 mutant mice; changes manifest as a shift in polarity, loss of graded expression and dramatically reduced protein levels during RGC synaptogenesis. Ephrin-A2 expression is similarly altered. These results implicate Pax7 as an important determinant of polarity within the mouse superior colliculus, and suggest a role in retinotopic mapping.     

Attenuation of muscle damage by preconditioning with muscle hyperthermia 1-day prior to eccentric exercise

This study investigated the hypothesis that muscle damage would be attenuated in muscles subjected to passive hyperthermia 1 day prior to exercise. Fifteen male students performed 24 maximal eccentric actions of the elbow flexors with one arm; the opposite arm performed the same exercise 2–4 weeks later. The elbow flexors of one arm received a microwave diathermy treatment that increased muscle temperature to over 40°C, 16–20 h prior to the exercise. The contralateral arm acted as an untreated control. Maximal voluntary isometric contraction strength (MVC), range of motion (ROM), upper arm circumference, muscle soreness, plasma creatine kinase activity and myoglobin concentration were measured 1 day prior to exercise, immediately before and after exercise, and daily for 4 days following exercise. Changes in the criterion measures were compared between conditions (treatment vs. control) using a two-way repeated measures ANOVA with a significance level of P < 0.05. All measures changed significantly following exercise, but the treatment arm showed a significantly faster recovery of MVC, a smaller change in ROM, and less muscle soreness compared with the control arm. However, the protective effect conferred by the diathermy treatment was significantly less effective compared with that seen in the second bout performed 4–6 weeks after the initial bout by a subgroup of the subjects (n = 11) using the control arm. These results suggest that passive hyperthermia treatment 1 day prior to eccentric exercise-induced muscle damage has a prophylactic effect, but the effect is not as strong as the repeated bout effect.     

Do grandparents influence parents’ decision to vaccinate their children? A systematic review

The global reduction in childhood infectious diseases since the 1960s is primarily due to the success of extensive worldwide immunisation campaigns. However, the universal vaccination coverage program appears to have lost momentum in the wake of negative, unfounded claims about the safety of vaccines. While parents of the 21st century have little first-hand knowledge of devastating childhood diseases, grandparents are more likely to remember family and community members who were afflicted. In the current age of vaccine hesitancy and science scepticism, where research-informed arguments are not always persuasive, grandparents, through their experience of the diseases, may positively influence paediatric vaccine uptake. This paper reviews the literature investigating potential direct or indirect influences of grandparents on parents’ decisions to vaccinate their children. A database search using the keywords immunisation, vaccination, children and grandparents resulted in 1988 articles. Titles were screened for relevance and seventy-seven results were retained. After the abstracts were read, only five articles that either explored paediatric vaccines, factors promoting and/or inhibiting paediatric vaccine use and decision-making strategies were reviewed. One paper located through Google Scholar, which failed to show up on database searches, was also retained for a total of six papers. While none of the six papers set out to explore the impact of grandparents on vaccine uptake, they found that grandparents were involved to varying degrees in paediatric vaccine uptake within young families. The research clearly showing that grandparents, and older people more generally, promote vaccination uptake is not currently available. The dearth of literature shows the need for research exploring the perceived and real influences of grandparents on childhood vaccination. This will establish whether grandparents’ memory and knowledge of preventable childhood infectious diseases could be harnessed as a public health measure to counteract the current, ill-informed, negative attention on paediatric vaccines.     

Under-reporting of energy intake in elderly Australian women is associated with a higher body mass index

Objectives

Identify the extent of under-reporting of energy intake and the characteristics associated with implausible intakes in elderly women.

Design

Dietary intake was assessed using a 3-day weighed food record. Protein intake was validated by 24-hour urinary nitrogen. To examine under-reporting, participants were grouped according to their energy intake and compared to the Goldberg cut-off equation. Logistic regression was performed to assess the influence of body mass index (BMI) and social-demographic factors on under-reporting.

Setting

Community dwelling elderly women from Perth, Western Australia.

Participants

217 elderly women aged 70–80 years.

Results

Under-reporters had a higher physical activity level (p<0.001) compared with acceptable-reporters. The under-reporters also had a higher body weight (p=0.006), body mass index (BMI) (p=0.001), waist (p=0.011), hip circumference (p<0.001), whole body fat mass (p<0.001) and percentage body fat (p<0.001) than acceptable-reporters. Under-reporters had a significantly lower intakes of protein, fat, carbohydrate and alcohol (p<0.001) and fewer reported food items, compared with acceptable reporters. However, 24-hour urinary nitrogen was only marginally different between the two groups (p=0.053). Participants with a higher BMI were more likely to under-report their energy intake (BMI=25–29.9: odds ratio=2.98[95% CI=1.46–6.09]; BMI≥30: 5.84[2.41–14.14]).

Conclusion

Under-reporting energy intake in elderly women was associated with a higher BMI, body fat and higher self-reported physical activity levels. A higher BMI (≥25) appears to be most significant factor in determining if elderly women will underreport their food intake and may be related to body image. These results have implications for undertaking surveys of food intake in elderly women.