Sexual Rehabilitation Services after Spinal Cord Injury: What Do Women Want?

Purpose: To explore and describe women’s experiences and concerns related to inpatient sexual rehabilitation.Participants: Twenty-four women who experienced traumatic SCI between 17 and 63 years of age. Methods: Semi-structured interviews with follow-ups were conducted on topics including amount and type of inpatient sexual education and counseling experiences, sexual concerns after injury, and suggestions regarding sexual rehabilitation approaches and activities.Results: Multiple themes emerged. Overarching themes included the importance of timing and honoring individual differences. Only two women reported receiving in-depth sexual rehabilitation services. Sexuality was not a priority soon after injury for a majority but assumed greater importance later. Participants believed sexuality should be broached during inpatient rehabilitation and introduced by the health professional. Reactions to healthcare professionals’ communication styles and behaviors were described.Conclusion: Participants’ feedback can help inform training and practice of rehabilitation professionals who w ork with women with SCI and other acquired disabilities. Concrete suggestions are offered.     

Couple’s Experiences of Relationship Maintenance and Intimacy in Acute Spinal Cord Injury Rehabilitation: An Interpretative Phenomenological Analysis

Sustaining a spinal cord injury (SCI) has a profound impact upon the individual with the injury, their family, and particularly their partner. This qualitative study explored the couple’s experience, with a focus on their perceptions of maintaining relationship intimacy during this period. Five heterosexual couples participated in semi-structured dyadic interviews, with each couple it was the male who had sustained a SCI. A thematic analysis was conducted on the interview data according to the principles of Interpretative Phenomenological Analysis. ‘We’, the couple, were an entity and engaged in the rehabilitation process as a unit although each partner made individual contributions. The couple gave each other unrivalled support during rehabilitation. Intimacy was expressed, and sustained, in many ways ranging from sharing a meal together through to sexual intimacy. However, the inpatient environment and health professionals often limited or inhibited the couple’s ability to engage intimately posing difficulties for their usual relationship maintenance practices; a lack of physical privacy and autonomy were major contributors. When health professionals behaved or communicated in ways that side-lined one partner, negative feelings about the health professional or rehabilitation process held by one partner became the shared feeling of the couple. Health professionals are encouraged to engage in client-centered care that includes partners as an integral component of the client’s rehabilitation. Doing so would help eliminate the loss of relationship autonomy that couples experience.     

Injury surveillance in construction: What is an “injury”, anyway?

BACKGROUND: Over the last decade, there has been a decline in injuries with days away from work in construction, associated with an increase in injuries with restricted work activity only. METHODS: We abstracted demographics, diagnosis, cause-of-injury, and hospital discharge information for 481 workers from one large construction project treated in an urban Emergency Department (ED). The project safety team provided data on all injuries from this site, including first aid cases. RESULTS: This site had fewer injuries with days away from work than expected from national rates. Two hundred and fifty-six injuries were reported on the OSHA log, and of those 93 entailed days away from work; 1,515 injuries were considered first aid/medical only. We used a sample of the data to estimate that the site classified as "recordable" 128 of the 481 ED-treated injuries from this site (27%). CONCLUSIONS: The pattern of injury varies depending on the subset of injuries examined. Lost time injuries, as reported in BLS data, record fewer lacerations and eye injuries, and more strains and sprains. No one surveillance system presents the full spectrum of occupational injury. Tracking all injuries allow early recognition of injury risks, and therefore can lead to more effective prevention.     

What is feedback in clinical education?

OBJECTIVE: Feedback is important in clinical education. However, the medical education literature provides no consensual definition of feedback. The aim of this study is to propose a consensual, research-based, operational definition of feedback in clinical education. An operational definition is needed for educational practice and teacher training, and for research into the effectiveness of different types of feedback. METHODS: A literature search about definitions of feedback was performed in general sources, meta-analyses and literature reviews in the social sciences and other fields. Feedback definitions given from 1995 to 2006 in the medical education literature are also reviewed. RESULTS: Three underlying concepts were found, defining feedback as 'information'; as 'reaction', including information, and as a 'cycle', including both information and reaction. In most medical education and social science literature, feedback is usually conceptualised as information only. Comparison of feedback definitions in medical education reveals at least 9 different features. The following operational definition is proposed. Feedback is: 'Specific information about the comparison between a trainee's observed performance and a standard, given with the intent to improve the trainee's performance.' CONCLUSIONS: Different conceptual representations and the use of different key features might be a cause for inconsistent definitions of feedback. The characteristics, strengths and weaknesses of this research-based operational definition are discussed.     

Evidence‐Based Practice in Rural and Remote Clinical Practice: Where is the Evidence?

Objective: To critically review the evidence regarding barriers to implementing research findings in rural and remote settings, and the ways those barriers have been addressed. Design: A systematic review that included searching several electronic databases, Internet sites and reference lists of relevant articles, assessment of methodological quality of the studies, and data extraction and analysis where possible. Eligibility for the review was not limited by study design. Settings/Participants: Studies that reported on: (1) barriers to the implementation of evidence by health professionals in rural and remote areas, or (2) interventions for implementing evidence‐based practice or an element of evidence‐based practice in rural and remote areas. Results: There were no experimental data available on the implementation of research findings in rural and remote clinical settings. The small amounts of empirical research undertaken (surveys) showed that some of the problems experienced by general practitioners were exacerbated by rural and remote location, particularly with relation to isolation, lack of time and locum cover, and poor information technology infrastructure. Conclusion: There is a paucity of empirical literature on implementing evidence‐based practice in rural and remote settings. This is in contrast to the large amount of literature available on implementing evidence in other clinical settings. A clear finding from the literature was that getting evidence into practice needs to be context‐specific and yet very little research has been conducted into the rural and remote context. Research is needed into how evidence can be implemented in contextually specific ways in rural and remote areas. What is already known: There is a substantial body of literature about the barriers to implementing research findings into clinical practice and how to address these barriers. This literature includes many systematic reviews and even overviews of systematic reviews. One of the consistent findings of the literature is that the implementation of research findings needs to be context‐specific to have any chance of making lasting and worthwhile changes to practice. There is little work, however, on the context of rural and remote clinical practice. What this study adds: This study aimed to review the literature on the implementation of evidence based practice in rural and remote settings. No experimental studies were found and the limited empirical evidence from surveys found that the rural and remote context exacerbated some of the problems experienced by health professionals in other settings, particularly those related to lack of time, inability to get locum cover and poor and unreliable information technology infrastructure. More research is required to isolate the aspects of rural and remote practice that influence the uptake of research findings.     

What Happens to the Farm? Australian Farmers’ Experiences after a Serious Farm Injury

Objectives: To investigate the experiences of farmers on returning to farming following a serious farm-related injury.

Methods: Patients who had sustained major trauma on a farm in Victoria, Australia, were identified using the Victorian State Trauma Registry (VSTR). In depth, semistructured phone interviews were conducted with 31 participants. Interview data were subjected to thematic analysis to identify important recurring themes. Interviews continued until data saturation was achieved.

Results: Interviewees included self-employed full-time farmers, part-time farmers with a supplementary income, and agricultural employees. Analysis of participant responses connected to returning to farming after a serious farm-related injury identified five major interconnected themes: (i) effect on farm work, (ii) farming future, (iii) safety advocacy, (iv) changes to farming practices, and (v) financial ramifications.

Conclusion: Farmers who have sustained a serious farm-related injury are an important resource; their experiences and perspectives could assist in the development of educational and transitional support services from recovery back to working at a preinjury level, while ensuring farming production is sustainable during this period. Furthermore, farm safety programs can be enhanced by the engagement of farmers, such as participants in this study as advocates for improved farm safety practices.     

Editorial: What is a nutrient?

Nutrient:a substance that an organism must obtain from its surroundings for growth and the sustenance of life.In the old days of food composition work, we took certain comfort in the simple characterization of the food components we measured--they were nutrients. But if they were not nutrients, they could still be neatly classified as antinutrients, toxicants, or just interesting non-nutrients. Of course, components are not so simply characterized these days. Polyphenols, measured in at least two of the studies in this issue of JFCA, were referred to as antinutrients in the not-too-distant past. In recent years, we rarely see that kind of characterization. Many of the polyphenols are now characterized as beneficial bio-active non-nutrients, with the occasional suggestions that some could even be called nutrients. The same is true for isoflavones and coumestrol, for which we have more new data in this issue.A further confounding situation exists with functional characterizations of food components. Let's take what many papers in the scientific literature refer to as "antioxidant nutrients". The provitamin A carotenoids show up on this list, but some of the most potent antioxidant carotenoids cannot be classified this way because they have no provitamin A activity, i.e. they are not antioxidant nutrients.We also have the reverse situation. Any essential divalent cation, for example iron, can be an antinutrient or toxicant, by inducing deficiencies of other essential divalent cations even at therapeutic levels, or by straightforward poisoning at toxic levels. By preventing absorption of nutrients in a meal, dietary fibre or various fractions of dietary fibre are characterized as antinutrients.For these and other reasons, many scientists have called for, and some have created, new definitions for the word nutrient. From a chemical and physiological point of view this is reasonable. It is also reasonable from a research point of view. Is dietary analysis different from an exposure or risk assessment? Not really. Is a food composition database different from an additive, contaminant or toxicant database? No, not fundamentally. Do we miss assessment opportunities in clinical and epidemiological research by not having extensive compositional data--beyond nutrients--in our food databases? Surely we do.Some national food composition database developers are including many food components in their databases. As long as all the samples and values are properly documented, there is no down-side to this activity; there is huge potential benefit. The new edition of the German Food Composition and Nutrition Tables by Souci, Fachmann and Kraut, reviewed in this issue of JFCA, is a good example of printed tables presenting a more comprehensive picture of the chemical composition of foods. This is to be encouraged and applauded.     

What is recovery in adolescent anorexia nervosa?

OBJECTIVE: The principal aim of this study is to describe the types of problems faced in defining recovery from anorexia nervosa (AN) as well as to illustrate the magnitude that various definitions have on recovery rates for AN. METHOD: Comparative rates of recovery from AN using a range of definitions (percent ideal body weight, psychological recovery, and combinations of these variables) were calculated using long-term outcome data from a study of adolescents treated for AN. In addition, a Kaplan-Meier survival analysis was used to model recovery over the long-term follow-up period. RESULTS: Recovery rates varied highly, depending on the definition used, from 57.1% to 94.4%. Using survival analysis, the mean time to remission for weight (>85% ideal body weight) was 11.3 months, significantly shorter than for Eating Disorder Examination score recovery at 22.6 months (log rank = 16.1, p = 0.0001). CONCLUSION: Agreement of definitions of recovery may be dependent on specific goals of a particular study or treatment; however, in order to compare and contrast categorical outcomes, a consistent definition of recovery is needed in the literature. Both weight and psychological symptoms appear to be important in a definition of recovery.     

What is urban in the contemporary world?

Central concepts of contemporary life such as politics, civilization, and citizenship derive from the city's form and social organization. The city expresses the socio-spatial division of labor, and Henri Lefebvre proposes to view its transformation within a continuum from the political city to the urban, whereby it completes its domination over the countryside. The city's transformation into the urban takes place when industry brings production (and the proletariat) into that space of power. The city, locus of surplus, power, and the fiesta, a privileged scenario for social reproduction, was subordinated to the industrial logic and underwent a dual process: its centrality imploded, and its outskirts exploded on surrounding areas through the urban fabric, bearing with it the seeds of the polis and civitas. The urban praxis, formerly restricted to the city, re-politicized social space as a whole. In Brazil, the urban has its origins in the military governments' centralizing and integrating policies, following Vargas's expansionism and Kubitschek's developmental interiorization (or occupation of the hinterlands). Today, urban-industrial processes impose themselves over virtually all social space, in contemporary extended urbanization.     

What is new in chronic myeloid leukaemia?

Chronic myeloid leukaemia is a relatively rare condition, though it has stimulated widespread interest as a consequence of both the stem cell basis and the success of rationally designed therapies. This review will outline some of the issues involving the aetiology of the disease and how this relates to current and future therapies.     

Buddies in Bad Times? The Role of Co-workers After a Work-Related Injury

Introduction Co-workers can play an important role after a work-related injury. They can provide details about the circumstances of an accident, offer emotional support to the injured worker and help with job tasks upon a co-worker’s return to work (RTW). Working with an injured co-worker, however, can also strain work relationships and increase workload. The purpose of this study was to determine the role that co-workers play after a work-related injury and during the RTW process in the unionized, electrical construction sector. Methods We conducted two focus groups with injured electricians and union representatives. We also interviewed co-workers who had worked with someone who had been injured in the course of employment. We examined the role that co-workers can play after a work-related injury and some of the factors facilitating and hindering co-worker support. Results The structure of work in the electrical sector—a focus on cost-cutting and competition, job insecurity, perceptions of “different camps” among co-workers, little modified work and poor formal communication—can impede co-worker support and contribute to making injured workers’ experiences difficult. Management can play an important role in setting an example for how injured workers are regarded and treated. Conclusions Future research should explore how workers can better be supported after a work-related injury and during the RTW process.     

What is the payoff in computerized appointment scheduling?

Is your group experiencing difficulty in the area of patient appointment scheduling? By changing from a manual method to a system of on-line computerized appointment scheduling, you will not only realize the value of consistent scheduling, but also the benefits of credit control and a reduction of time-consuming error correction. The process that this group went through in developing a computerized system to meet their specific needs is especially relevant to larger group practices. However, there are systems available that can fulfill the needs of any size group.