Transferability of Medication Administration Simulation Training to Clinical Settings

The study examines the impact of one-on-one simulation for medication administration (MA) on prelicensure student preparedness for and performance of MA in the clinical setting.We used a prospective quasi-experimental interventional study applying Kirkpatrick's model to the simulation experience addressing MA.Simulation increased student preparedness. Students' critical thinking and approach during the MA process were significantly higher in the clinical setting.One-on-one MA simulation is an effective educational method for improving student learning and performance in practice.     

Knowledge,facilitators and barriers to the practice of person-centred care in aged care workers: a qualitative study

The current study describes aged care workers' interpretation of the concept of person-centred care; and identifies the barriers that exist to impede its practice, and the facilitators that encourage person-centred care practice. Data were collected from interviews with aged care workers from two residential aged care facilities providing both high and low care for residents with and without physical and psychological issues based in Australia. Data were analysed to identify and explore categories of meaning for barriers and facilitators. Analysis is grounded in Brooker's VIPS framework for person-centred dementia care which is utilised as a comparative tool for analysing participants' understanding of person-centred care. Findings revealed that aged care workers have a reasonable but incomplete understanding of person-centred care. Insufficient time and residents' dementia behaviours acted as barriers to care workers' provision of person-centred care. Teamwork was found to facilitate person-centred care by increasing instrumental and relationship resources     

Dietary Bioactives: Establishing a Scientific Framework for Recommended Intakes

In the United States, dietary reference intakes describe the relations between nutrient intakes and indicators of adequacy, prevention of disease, and avoidance of excessive intakes among healthy populations for essential nutrients but not dietary bioactive components (DBCs), whose absence from the diet is presumably not deleterious to health (i.e., does not cause a deficiency syndrome). An appropriate framework is needed for establishing recommended intakes for which public health messages and food labeling for DBCs can be derived, because their putative health benefits may not be readily defined in the context of nutritional essentiality. In addition, a myriad of factors make determining their intake and status and investigating their discrete contributions to health particularly challenging. Therefore, the ASN Dietary Bioactive Components Research Interest Section felt it worthwhile to convene a special “hot topic” session at the 2014 Experimental Biology meeting to discuss this issue and serve as a call for future scientific dialogue on establishing a framework for recommended intakes of DBCs. This session summary captures the discussions and presentations that transpired during this session.     

The Tougher the Better: An Economic Analysis of Increased Payment Thresholds on the Performance of General Practices

We investigate whether and how a change in performance‐related payment motivated General Practitioners (GPs) in Scotland. We evaluate the effect of increases in the performance thresholds required for maximum payment under the Quality and Outcomes Framework in April 2006. A difference‐in‐differences estimator with fixed effects was employed to examine the number of patients treated under clinical indicators whose payment schedules were revised and to compare these with the figures for those indicators whose schedules remained unchanged. The results suggest that the increase in the maximum performance thresholds increased GPs' performance by 1.77% on average. Low‐performing GPs improved significantly more (13.22%) than their high‐performing counterparts (0.24%). Changes to maximum performance thresholds are differentially effective in incentivising GPs and could be used further to raise GPs' performance across all indicators. Copyright © 2013 John Wiley & Sons, Ltd.     

运用Mobley模型分析护理人员流失原因及对策

目的：运用Mobley模型分析护理人员流失的影响因素,为护理管理者有针对性地采取措施提供依据。方法采用问卷调查法对2011—2013年某三级甲等综合医院流失的护理人员基本情况和离职原因进行调查,并运用Mobley模型分析离职影响因素。结果影响因素中,非工作价值观及偶然因素所占比例最大（56．39％）,其次为工作满意度（21．81％）和组织内、外工作角色及收益预期（21．80％）。结论建立良好的工作环境,实行专业化的岗位管理,倡导“磁性”的管理理念,是提高护士工作满意度,稳定护理队伍的关键。     

Ethical implications of home telecare for older people: a framework derived from a multisited participative study

Context

Telecare and telehealth developments have recently attracted much attention in research and service development contexts, where their evaluation has predominantly concerned effectiveness and efficiency. Their social and ethical implications, in contrast, have received little scrutiny.

Objective

To develop an ethical framework for telecare systems based on analysis of observations of telecare‐in‐use and citizens’ panel deliberations.

Design

Ethnographic study (observation, work shadowing), interviews, older citizens’ panels and a participative conference.

Setting

Participants’ homes, workplaces and familiar community venues in England, Spain, the Netherlands and Norway 2008–2011.

Results

Older respondents expressed concerns that telecare might be used to replace face‐to‐face/hands‐on care to cut costs. Citizens’ panels strongly advocated ethical and social questions being considered in tandem with technical and policy developments. Older people are too often excluded from telecare system design, and installation is often wrongly seen as a one‐off event. Some systems enhance self‐care by increasing self‐awareness, while others shift agency away from the older person, introducing new forms of dependency.

Conclusions

Telecare has care limitations; it is not a solution, but a shift in networks of relations and responsibilities. Telecare cannot be meaningfully evaluated as an entity, but rather in the situated relations people and technologies create together. Characteristics of ethical telecare include on‐going user/carer engagement in decision making about systems: in‐home system evolution with feedback opportunities built into implementation. System design should be horizontal, ‘two‐way’/interactive rather than vertical or ‘one‐way’. An ethical framework for telecare has been developed from these conclusions (Table 1).     

Lifespan and reproduction in Drosophila: New insights from nutritional geometry

Modest dietary restriction (DR) prolongs life in a wide range of organisms, spanning single-celled yeast to mammals. Here, we report the use of recent techniques in nutrition research to quantify the detailed relationship between diet, nutrient intake, lifespan, and reproduction in Drosophila melanogaster. Caloric restriction (CR) was not responsible for extending lifespan in our experimental flies. Response surfaces for lifespan and fecundity were maximized at different protein-carbohydrate intakes, with longevity highest at a protein-to-carbohydrate ratio of 1:16 and egg-laying rate maximized at 1:2. Lifetime egg production, the measure closest to fitness, was maximized at an intermediate P:C ratio of 1:4. Flies offered a choice of complementary foods regulated intake to maximize lifetime egg production. The results indicate a role for both direct costs of reproduction and other deleterious consequences of ingesting high levels of protein. We unite a body of apparently conflicting work within a common framework and provide a platform for studying aging in all organisms.     

不同头位吞咽不同黏度液体食物对健康成人舌骨上肌群表面肌电的影响

目的 探讨不同头位吞咽不同黏度液体食物对健康成人舌骨上肌群表面肌电的影响。 方法 随机选取健康受试者20例,按随机数字表法设置的顺序,依次采用3种头位吞咽5种浓度的食物,每口量均为5 ml,实时记录每次吞咽时左、右侧舌骨上肌群的表面肌电信号。对原始肌电信号进行处理后,分析不同黏度和头位对舌骨上肌群激活水平影响的主效应,再采用简单效应分析确定黏度、头位和舌骨上肌群激活水平的交互效应。 结果 不同头位或不同黏度的主效应均存在差异,差异均有统计学意义（P＜0.05）。右转头位和右侧屈头位吞咽同黏度液体食物时,左侧舌骨上肌群净振幅值均高于右侧舌骨上肌群,差异均有统计学意义（P＜0.05）。吞咽同黏度液体食物时,在中立位、右转头位、右侧屈头位,左侧舌骨上肌群的净振幅值依次增高,差异均有统计学意义（P＜0.05）。在吞咽同黏度（0～3级）的液体食物时,右转头位右侧舌骨上肌群的净振幅值低于中立位和右侧屈头位,差异均有统计学意义（P＜0.05）。在吞咽4级的液体食物时,右侧屈头位右侧舌骨上肌群的净振幅值高于中立位和右转头位,差异均有统计学意义（P＜0.05）。右转头位吞咽0级液体食物时,左侧舌骨上肌群净振幅值显著低于吞咽1～4级的液体食物,差异均有统计学意义（P＜0.05）。右侧屈头位吞咽0级液体食物时,左侧舌骨上肌群净振幅值显著低于吞咽2～4级液体食物,吞咽1级液体食物时,左侧舌骨上肌群净振幅值显著低于吞咽3～4级的液体食物,差异均有统计学意义（P＜0.05）。右侧屈头位吞咽4级的液体食物时,右侧舌骨上肌群净振幅值高于吞咽0～1级的液体食物,吞咽3级液体食物时,右侧舌骨上肌群净振幅值高于吞咽1级的液体食物,差异均有统计学意义（P＜0.05）。 结论 吞咽时采用不同的头位和黏度,可不同程度地影响舌骨上肌群的收缩。     

The emergent dynamics of isotype switch

The supplanting of the 1° IgM response by the 2° isotype-switched response is one of the best known phenomena of immune system dynamics. Given that the conditions determining which B cells will switch isotype and which ones will not are intrinsic to the entities of the immune system, it should be possible to predict the effects that the small-scale (e.g. molecular) properties have on the large scale dynamics of isotype switch. However, in practice, it is notoriously difficult to predict large scale, emergent effects from small scale conditions. Thus, it is unclear what effects (if any), mutation, IgM avidity and chronic immunization exert on isotype switch. To explore these effects, we have constructed a model of isotype switch. With this model, a modified version of the IMMSIM cellular automaton, we are able to alter small scale parameters at will and thus determine the conditions that lead to the observed large scale dynamics of isotype switch. We show that isotype switch is stabilized by high-IgM avidity, affinity/isotype-dependent cell division, and, surprisingly, mutation. We also demonstrate that chronic immunization leads, in our model, to a severe depletion of the IgM response even while the IgG response remains normal.     

1 + 1 = 3? The systematic development of a theoretical and evidence-based tailored multimedia intervention to improve medication adherence

Objective

To describe the development of a theoretical and evidence-based tailored multimedia intervention to improve medication intake behavior in patients with inflammatory bowel disease (IBD). The intervention integrates interpersonal and technology-mediated strategies with the expectation that this will work synergistically.

Methods

The development followed the Medical Research Council's framework. Three literature reviews and three pre-tests among 84 IBD patients and eight nurses were conducted to guide the development of the intervention. A feasibility study was carried out among four nurses and 29 patients.

Results

The components include: (1) an online preparatory assessment (OPA); (2) tailored interpersonal communication; and (3) tailored text messaging. To support the development, the feasibility was tested. Results indicated that the OPA was comprehensive and could be a helpful tool for both patients and nurses to prepare for the consultation. The training was evaluated as being instructive and applicable with a mean mark of 8.5. Of the developed messages, 65.6% received positive evaluations and were used in the intervention.

Conclusion

By applying the framework, we were able to describe the logic behind the development of a tailored multimedia intervention to improve medication intake behavior.

Practice implications

This study could serve as a guide for the development of other health interventions.