Supporting biosciences in the nursing curriculum: development and evaluation of an online resource

AIMS: The aim of this project was to develop and evaluate an online resource designed to improve the biosciences knowledge of preregistration nursing students. BACKGROUND: A number of studies have identified lack of biological subject knowledge and anxiety about studying biosciences as serious problems for nursing students. The availability of a contextualized biological information resource prior to and early in their studies might help to reduce this fear and anxiety. METHODS: The project used an action research approach, involving an initial analysis of the extent of the problems with biosciences encountered by our nursing students, followed by the development and evaluation of a biology-based open learning resource (entitled Headstart) in collaboration with preregistration nursing students and nurse educators. FINDINGS: The students in this study expressed a high level of concern about studying biology, and perceived this to be the most difficult aspect of their nursing programme (significantly more difficult than nursing practice). A significant correlation was also found between previous level of biological qualification and confidence in passing module tests. Evaluation of the new online resource illustrated the willingness of nursing students to use such a package, and general approval of its content and mode of delivery, despite a number of problems related to computer access and students' inexperience with information technology. CONCLUSIONS: This project has provided further evidence of the need for additional resources in biosciences for nursing students. It has also illustrated the way in which a targeted online resource has the potential to provide substantial benefits in terms of supporting the nursing curriculum. Whilst further evaluation is needed, the findings suggest that Headstart has the potential to address a number of issues identified both by this study and by previous research in nurse education.     

An integrative research review of preventive home visits among older people – is an individual health resource perspective a vision or a reality?

This study has two aims: (i) to explore and evaluate the health-promoting effect of preventive home visit (PHV) by analysing the activities conducted during the PHV and the reported results, and (ii) to critically analyse if PHV is characterized by an individualized health resource perspective. The material was compiled through a systematic literature search in the databases Ebsco, CINAHL, Medline, Science Direct and CSA from the period 1984 to 2004. The result of the systematic database search was a total number of 49 scientific research articles, of which 18 are included in this study. The analysing method was a four-step integrating research review. The review describes the following content concerning (i) activities during home visits: screening, observation and evaluation, guidance, support, referral to care and other services, follow-up and individual aim; (ii) positive effects: reduced mortality, improved ability to function, improved life quality, improved subjective health, fewer admittances for care, older people's experiences of home visits and increased knowledge on health and (iii) unclear/negative effects: admittance to care, no effect on mortality, unaffected ability to function, unaffected general health and uninfluenced life quality. PHVs had been implemented based on an individual perspective in a total of 13 studies out of 18. The focus on sickness was surprisingly clear, and in 10 studies out of 18 a health resource perspective was lacking. The effects of PHVs have been questioned. Despite this, current research results imply that this method has a positive affect on older people's health and well-being. This form of care must still be developed to include extensive screenings and interventions, as well as a health resource perspective where the starting point during every home visit is the older person's individual needs and wishes.     

Written patient information: a review of the literature*

In the United States during the 1940s Flesch and Gunning pioneered the movement to improve the comprehensibility of government documents Since that time the provision of comprehensible information to the general public has become increasingly important Indeed, most computer programs have the facility to assess what percentage of the population will understand certain forms of written information Vast quantities of written patient information have been produced over the decades and more are being produced daily This literature review sets out to provide an insight into the studies which have looked at the value and purpose of such literature Considering the amount of written patient information in existence the amount of research into this interesting subject is small Many concepts have to be considered Is this information of any use to patients? Can they understand and recall it and does it increase compliance? Are patients satisfied with the amount, quality and detail of written information? If health professionals are to inform their patients fully, written information is an area which should be more fully researched for ethical, quality and economic reasons     

Use of general clinical research centers for nursing research

This study examines to what extent academic nursing faculty members understand the purpose of general clinic research centers (GCRCs) and use this resource in their programs of research. GCRCs provide a controlled research-oriented infrastructure to conduct safe, innovative, and multidisciplinary studies. Survey questionnaires were sent to associate deans of research at schools of nursing accredited by the Commission on Collegiate Nursing Education or the National League for Nursing Accrediting Commission within 60 miles of a GCRC. They were asked to distribute questionnaires to 20% of faculty members. Of the 186 nurse faculty members responding, 85% had not conducted research at a GCRC as a principal investigator and 69% of the sample reported that their colleges or universities do not make information about GCRCs available to new faculty. Making greater use of this valuable resource allows nurse researchers to become more involved in developing new knowledge and testing interventions and in psychological and physiologic measurements, thus doing more to fulfill the mission of nursing research and increasing the involvement of nurses in the broader community of health science research.     

An introduction to the basic principles of health economics for those involved in the development and delivery of headache care

Against a background of increasing demands on limited resources, health economics is gaining an increasing impact on decision making and a basic understanding of the subject is important for all those involved in headache research and service delivery at whatever level. This paper is not intended as a review of the literature in the area of headache economics but discusses some general principles of health economics from the perspective of headache, with a focus on cost of illness studies and economic evaluation.     

The effect of therapy on the mental health of the elderly

This research synthesis was undertaken to study the effects of treatment on the mental health of elderly people. Forty-one controlled studies were analyzed using meta-analytic techniques. Type of treatment along with subject, therapist, setting, and methodological characteristics of the studies were identified and their contributions to mental health outcomes measured. Results indicated that the mean outcome of the experimental group, treated with any type of treatment improved from the fiftieth percentile to the seventieth percentile relative to the mean of the untreated control groups. This research synthesis supports the belief that, in general, treatment is effective in enhancing the mental health of the elderly.     

Profile: frail elderly women, maintaining independence

While several published studies have examined the interactions of health status and social support in the general population or elderly segment of the population, there has been no reported study that specifically examines the health status and social support of frail elderly women, aged 85 years and older. This study reports on the findings of a research study that examined a group of frail elderly women, residing in the community. It focuses on why and how these women are able to live independently. The relationships between health status and social support and between health status and the process of ageing are explored. The study reveals the importance of social support assessments of this group as a prerequisite to effective health care policy, professional health education programmes, and community resource development.     

Telephone focus groups in physiotherapy research: Potential uses and recommendations

The use of telephone focus groups as a research approach within health-related qualitative studies is emerging as a method of choice for some researchers. A variety of research applications of the telephone focus group method have been used within health settings over the last 10 years and have typically investigated specific health conditions, training needs, and resource development, as well as health practices and knowledge; these are all issues and contexts applicable to physiotherapy and rehabilitation research. The aim of this review is to explore the use of the telephone focus group methodology, update knowledge on its use in disciplines relevant to physiotherapy, and provide potential users with key information to conduct a telephone focus group. We advocate incorporating recent advances in telephone technology into focus group methodology for physiotherapy and rehabilitation studies, which may benefit from wider geographical representation, increased participation rates, and discussion of sensitive issues. We suggest that the telephone focus group could become a practical and valuable methodology for physiotherapy and rehabilitation researchers.     

Collection and local use of accident and emergency hospital data in England.

OBJECTIVE: To obtain information on the collection and local use of accident and emergency data. METHODS: A postal questionnaire was sent to 248 English accident and emergency (A&E) departments. Responses were obtained from 217 (88%). RESULTS: Only 87 (40%) of departments were fully computerised, with 109 (50%) using manual systems, and 21 (10%) a mixture of both. Significantly more computerised departments reported that they undertook studies (epidemiological, accident prevention, and resource management) than non-computerised departments. Only limited information on the types of injury studied was provided. The most common topics were childhood accidents, road traffic accidents, and poisonings. Staff in 45 departments (21%) reported membership of safety organisations. Around 90% of departments reported that they notified general practitioners and health visitors of their patients' attendance, usually within 3 d of the event. CONCLUSIONS: Computerisation appears to help the collection of A&E data for public health research. There is scope to increase the involvement of public health and other workers in epidemiological studies using A&E data. A&E departments should themselves become more involved with local safety organisations.     

Recruiting vulnerable populations for research: revisiting the ethical issues.

The successful recruitment of participants is essential to the research process. To increase the rate of subject participation, investigators have to rely on help from health care providers who often serve as gatekeepers to potential research study subjects. These well-meaning professionals may limit subject participation in a study involving vulnerable populations under the guise of protecting these individuals from harm. We describe some of the characteristics of vulnerable populations affecting their recruitment into research studies. We examine the ethical conflicts that occur when health care professionals control access to these subjects during recruitment for research studies. Finally, we discuss the implications for practice and research designed to protect the rights of vulnerable populations participating in research. We identify collaboration and dialogue between researchers, health care providers, and members of the potential subject populations as most important in recruiting sufficient numbers of subjects to ensure the scientific merit of the study.     

The complexities of interviewing Italo-Australian men about sensitive health issues

The increase in the incidence of prostate cancer in Australia has been followed by an increase in prostate cancer awareness among Australian adults. However, men's level of knowledge on the subject has never been systematically assessed (Laws et al, 2000). It was postulated by Laws et al., (2000) that many men from Non English Speaking Cultures (NESC) experience language and cultural difficulties that would ultimately impinge on their ability to access information about prostate problems. In exploring 'The knowledge and attitudes of Italo-Australian men toward prostate cancer' the researchers became aware that the majority of interviewees (n=20) were reluctant to divulge information on all aspects of the topic (Drummond et al., 2001). This report highlights the importance of using a reflexive phase within the research process as a means of identifying factors that can, in part, explain the paucity of data and act a basis for developing strategies to overcome the problem. The research subsequently evolved to incorporate a secondary research question. 'Why were the men at interview so reluctant to speak of general health problems and health problems related to prostatic dysfunction?' A focus group comprised of Italo-Australian men was used to explore gender and culturalfactors, perceived by the researchers as, restricting theflow of information. Several barriers thought to be limiting the release of information were confirmed. We conclude that our findings will have implications for other researchers wanting to maximise their chances of accessing information rich datafrom the experiences of men from NESCs.     

HIPAA's Preconsent: Impact on Study Validity

The Health Insurance Portability and Accountability Act (HIPAA) regulations added potential validity threats to clinical studies. The HIPAA regulations, using the principle of patient autonomy were designed to increase patient's control over the all health related information. The Department of Health and Human Services did not identify rules related to research regulations believing HIPAA regulations facilitate investigations through use of de-identified information. Yet, under HIPAA guidelines, health care agencies can not allow access because of the need to obtain a patient's prior permission to release raw data. The problem of how to conduct investigations in the face of the HIPAA "Privacy Rule" raises concerns for effects on subject recruitment and selection. This paper examines the impact of obtaining a HIPAA preconsent on subject recruitment, selection, and subject characteristics, and offers strategies for addressing the validity threats associated with the HIPAA regulations. J Am Psychiatr Nurses Assoc, 2008; 14(3), 225-230. DOI: 10.1177/1078390308319224.     

Frequent attenders in general practice: quality of life,patient satisfaction,use of medical services and GP characteristics

Objectives - To describe where patients in Danish general practice get information about health and disease, particularly how patients prepare for a visit to their GP, with special reference to use of the Internet. Design - Structured interviews. Setting - Four Danish general practices. Patients - 93 consecutive patients after visiting their GP. Main outcome measures - The patient's report about use of the Internet and different mass media in preparation for the consultation. Results - Only two patients never looked for health information. Of all patients, 20% had used the Internet to get health information, 8% because of the current visit, i.e. a third of all with Internet access had used it because of the current visit. Women used the sources of information more than men did. Personal contact with family, friends or neighbours was the most commonly used source. Conclusion - The Internet is used in direct preparation for a visit to the general practitioner. The vast majority of patients use the mass media for information. In general practice, the main source of information on a health-related subject is personal contact with family and friends.     

Community-based participatory research (CBPR) approach to study children's health in China: experiences and reflections

Background

Community-based participatory research principles have been successfully applied to public health research in U.S. settings. While there is a long history of collaboration between government and communities in China, to date, community-based participatory research has not been used in children's environmental health studies.

Method

This article describes how community-based participatory research principles were applied by an international research group to the China Jintan Child Cohort Study, a longitudinal study of malnutrition and lead exposure on cognitive and neurobehavioral development. Challenges emerged and lessons learned from implementing the study were discussed and recommendations were presented.

Conclusion

We conclude that the community-based participatory research model can be applied in conducting and promoting environmental health research in China and researchers should be prepared for special challenges and cultural constraints in the implementation of the research in regards to human subject regulations, information dissemination, and culture.     

Resting heart rate and relation to disease and longevity: past,present and future

Assessment of heart rate has been used for millennia as a marker of health. Several studies have indicated that low resting heart rate (RHR) is associated with health and longevity, and conversely, a high resting heart to be associated with disease and adverse events. Longitudinal studies have shown a clear association between increase in heart rate over time and adverse events. RHR is a fundamental clinical characteristic and several trials have assessed the effectiveness of heart rate lowering medication, for instance beta-blockers and selective sinus node inhibition. Advances in technology have provided new insights into genetic factors related to RHR as well as insights into whether elevated RHR is a risk factor or risk marker. Recent animal research has suggested that heart rate lowering with sinus node inhibition is associated with increased lifespan. Furthermore, genome-wide association studies in the general population using Mendelian randomization have demonstrated a causal link between heart rate at rest and longevity. Furthermore, the development in personal digital devices such as mobile phones, fitness trackers and eHealth applications has made heart rate information and knowledge in this field as important as ever for the public as well as the clinicians. It should therefore be expected that clinicians and health care providers will be met by relevant questions and need of advice regarding heart rate information from patients and the public. The present review provides an overview of the current knowledge in the field of heart rate and health.     

Primer on medical genomics. Part XIII: Ethical and regulatory issues

Ethics in the new genomics era has become an increasingly complex subject that often arouses passion and confusion. Although 50 years have elapsed since the elucidation of the DNA molecule, the recent near-complete sequencing of the human genome has sharply accelerated the incorporation of genetics into the medical mainstream. Along with these scientific advances, however, have surfaced challenges, liabilities, and issues regarding the processing and management of genetic information as they relate to core ethical principles such as respect for autonomy, beneficence, nonmaleficence, and justice. Institutions and state and federal governments have initiated systematic and preemptive measures in education, resource development, and protective legislation to address these cardinal ethical issues. Genetic research is also being scrutinized carefully by institutional review boards, an activity that should not be perceived as being adversarial but rather as a protective shield for investigators and research participants alike. Ultimately, it is hoped that genomics medicine will diminish rather than enhance existing sex-, race-, and socioeconomic class-based inequities in health care access and delivery. This article describes some but not all aspects of the ethical, legal, and social implications of genomics in clinical practice.     

Future directions in behavioral headache research: applications for an evolving health care environment

Three decades of research has produced effective behavioral treatments for migraine and tension-type headache, yet the full fruition of this research has not been realized. Further development and dissemination of behavioral treatments is needed to impact the large numbers of those with headache who potentially could benefit from these interventions. At the same time, an evolving health care environment challenges researchers and providers to employ greater efficiency and innovation in managing all chronic disorders. Hopefully, the recently published clinical trials guidelines for behavioral headache research will serve as a catalyst for production of quality empiricism that, in turn, will generate enhanced behavioral strategies and will optimize health care resource utilization. This article describes 10 areas of critical needs and research priorities for behavioral headache research, including: replication and extension of seminal studies using improved methodology; analysis of barriers to implementation of behavioral treatments; development of referral and treatment algorithms; behavioral compliance facilitation with medical interventions; development of a headache self-management model; integration of behavioral intervention within traditional medical practice; identification and management of comorbid psychopathology among headache patients; prevention of disease progression; analysis of behavioral therapeutic mechanisms, and development of innovative treatment formats and applications of information technologies.     

Recherche en réanimation: consentement et information. Partie II: aspects pratiques et juridiques

According to Law 2004-806 of the French Public Health Code, any subject enrolled in medical research has to provide consent. The way of giving consent depends on the type of research. Accordingly, with respect to research in humans, interventional biomedical studies require written and freely signed well-informed consent, whereas observational and current care interventional studies require simple information, the person being given the option to refuse participation. Intensivists rarely draw up consent forms but often write the information note on research. This information note is designed for the layperson and therefore has to be honest, explanatory, and easily understandable. Approval of the research by the French Intensive Care Society??s Ethics Committee is highly recommended in order to publish the research results in international journals. However, its recommendation is advisory and deals only with ethical considerations. It does not exempt investigators from legal and regulatory duties.     

Foundations of shared decision making and examples of its application in rehabilitation

Enhanced patient participation in health care is demanded due to better knowledge of patients about diseases and their treatment, due to more treatment strategies in the course of scientific progress, due to ethical and legal considerations, and due to study results. With shared decision-making (SDM) a method was defined for the medical interview to involve patients in treatment decisions. Process steps for orientation are available for the procedure of the medical encounter. Transfer of shared decision-making into health care can be realized through three strategies, i. e., by physician training to enhance physicians' competencies in medical encounter, by decision aids for better information and preparation for decision making, and by patient education. For examination and fostering of SDM in German health care the German Ministry of Health initiated a research consortium in the years 2001 to 2007 called "Patient as a partner in medical decision making". In an additional research consortium of the German Ministry of Education and Research, the German Pension Insurance scheme as well as the associations of statutory and private health insurance, various projects for health services research on the subject of "Chronic Diseases and Patient Orientation" will be funded starting in 2008. This initiative with a focus on rehabilitation will foster studies about need-specific patient information, training programmes for chronically ill patients, and about the organisation of a more participative structure of health care delivery.