How do peer support interventions for the self-management of chronic pain,support basic psychological needs? A systematic review and framework synthesis using self-determination theory

ObjectiveTo identify how peer support interventions, for self-management of chronic pain, support basic psychological needs from a self-determination theory (SDT) perspective, using a systematic review.MethodsTen databases were searched for studies reporting qualitative research about peer interactions in pain management interventions. ‘Best fit’ framework synthesis methodology was applied to identify strategies that support the satisfaction of competence, autonomy and motivation. These were matched to definitions of strategies provided by standardised taxonomies.Results18 studies were selected for inclusion. The synthesis resulted in a conceptual model, identifying 12 peer strategies that support psychological needs for self-management of chronic pain; 10 overlapped with existing taxonomies.ConclusionThis was the first known attempt to synthesise evidence about peer support strategies for people living with pain, using SDT as an a priori framework. The model demonstrates commonality between the motivation-promoting processes of peer support and those of other behaviour change interventions and identifies additional unique strategies provided by peers. This systematic classification of peer support strategies provides a means for future study of the efficacy and comprehensiveness of peer interventions.Practice implicationsThe model could assist healthcare professionals and support groups to optimise the potential of peer processes.     

The NTID speech recognition test: NSRT®

Objective: The purpose of this study was to collect and analyse data necessary for expansion of the NSRT item pool and to evaluate the NSRT adaptive testing software. Design: Participants were administered pure-tone and speech recognition tests including W-22 and QuickSIN, as well as a set of 323 new NSRT items and NSRT adaptive tests in quiet and background noise. Performance on the adaptive tests was compared to pure-tone thresholds and performance on other speech recognition measures. The 323 new items were subjected to Rasch scaling analysis. Study sample: Seventy adults with mild to moderately severe hearing loss participated in this study. Their mean age was 62.4 years (sd = 20.8). Results: The 323 new NSRT items fit very well with the original item bank, enabling the item pool to be more than doubled in size. Data indicate high reliability coefficients for the NSRT and moderate correlations with pure-tone thresholds (PTA and HFPTA) and other speech recognition measures (W-22, QuickSIN, and SRT). Conclusion: The adaptive NSRT is an efficient and effective measure of speech recognition, providing valid and reliable information concerning respondents’ speech perception abilities.     

Maximising survival: The main concern of women with hereditary breast and ovarian cancer who undergo genetic testing for BRCA1/2

PurposeLittle is known about how women with hereditary breast and/or ovarian cancer who test positive for a BRCA gene manage the impact of a positive test result on their everyday lives and in the longer term. This study defined the experience and needs of women with hereditary breast and ovarian cancer and a positive BRCA test over time.MethodsA grounded theory approach was taken using qualitative interviews (n = 49) and reflective diaries. Data collected from December 2006 until March 2010 was analysed using the constant comparative technique to trace the development of how women manage their concerns of inherited cancer.ResultsA four stage substantive theory of maximising survival was generated that defines the experience of women and how they resolve their main concerns. The process of maximising survival begins prior to genetic testing in women from high risk families as they expect to get a cancer diagnosis at some time. Women with cancer felt they had experienced the worst with a cancer diagnosis and altruistically tested for the sake of their children but a positive test result temporarily shifted their focus to decision-making around their personal health needs.ConclusionThis study adds to clinical practice through raising awareness and adding insights into how women cope with living with inherited cancer risk and the personal and familial ramifications that ensue from it. A clear multi-professional structured care pathway for women from genetic testing result disclosure to undergoing risk-reducing surgery and/or surveillance should be developed.     

A reliable method for measuring proximal tibia and distal femur bone mineral density using dual-energy X-ray absorptiometry

PurposeTo assess the intra- and inter-rater reliability of a standardized protocol for measuring proximal tibia and distal femur bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA).MethodsTen able-bodied individuals (7 males) participated in this study. During one measurement session, the knee of each participant was scanned twice by rater 1 using DXA. Both scans were analyzed twice by rater 1 as well as once by a second rater. Intraclass correlation coefficients (ICCs), standard error of measurements (SEMs) and smallest detectable differences (SDDs) were calculated for the outcome measures proximal tibia and distal femur BMD. A decision study was performed to determine the effect of study protocol adjustments (i.e. increasing the number of scan repetitions, or scan analyses by the same rater) on SEM and SDD values.ResultsHigh intra- and inter-rater ICCs (0.97–0.98) were found for both proximal tibia and distal femur BMD. Low SEMs (0.017–0.028 g/cm²) and SDDs (0.047–0.077 g/cm²) were found, with a slightly better result for proximal tibia BMD. Increasing the number of scan analyses by the same rater did not markedly reduce SEM and SDD values, while increasing the number of scan repetitions did.ConclusionsProximal tibia and distal femur BMD can be reliably assessed with this method.     

失眠体质类型与经络检测仪辅助诊断的相关性研究

目的:对169例失眠人群的体质分布特点进行调查研究。利用中医经络检测仪对失眠人群进行检测,研究其各条经络电能量值与体质类型的相关性,为失眠的中医分型诊断及随后的治疗提供客观的依据。方法:收集门诊符合《2012年中国成人失眠诊断与治疗指南》的人群,根据《中医体质分类判定标准》判定其体质类型。用中医经络检测仪对不同体质人群人体十二经络原穴部位进行测量。结果:通过研究发现,获得的体能、代谢、心肾、筋骨状态的均值在不同体质人群中有不同程度的波动。其中阴虚质者的体能状态最高,阳虚质者最低;阳虚质者代谢状态最高,阴虚质者最低;阳虚质者心肾状态最高,气虚质者最低;阴虚质者筋骨状态最高,血瘀质者最低。结论:失眠人群的中医体质类型及不同证型与中医经络检测仪中的体能状态、代谢状态、心肾状态、筋骨状态存在相关性。     

基于King达标理论的实习护生行为目标达成度评价

目的:以King达标理论为基础理论框架,探讨和分析中、高职护生实习期间的本专业行为目标达成度及其影响因素,以便更好地指导临床护理教学。方法:采用便利抽样方式抽取实习中、高职护生204名,采用具有较好信效度的中文版护士行为目标达成度评价量表(NPGA)进行测评。结果:58.67%的护生认为自身护理行为水平较低,未达成预期目标,34.69%的护生认为自身护理行为需要改善;高职护生行为目标达成度水平总体高于中职护生(P0.05)。结论:目前临床实习的中、高职护生均对自身护理行为不甚满意,专业行为目标达成度不够,需要医院及学校在临床实践教学方面给予更多的关注与支持。     

系统观在龋病病因研究中的体现

龋病病因是口腔医学爱们多年来的探索重点之一,20世纪．60,70年代提出的“四联因素”学说已被逐步证实,并逐渐得到公认,因为它是在系统观点的指导下形成的,本文就龋病病因学理论中的系统观点进行了较为详细的分析与阐释。