Coagulometer international sensitivity index (ISI) derivation,a rapid method using the prothrombin time/international normalized ratio (PT/INR) Line: a multicenter study

Summary. Background: The original WHO procedure for prothrombin time (PT) standardization has been almost entirely abandoned because of the universal use of PT coagulometers. These often give different international normalized ratio (INR) results from the manual method, between individual makes of instruments and with instruments from the same manufacture. Method A simple procedure is required to derive local INR with coagulometers. The PT/INR Line method has recently been developed using five European Concerted Action on Anticoagulation (ECAA) certified plasmas to derive local INR. This procedure has been modified to derive a coagulometer PT/INR Line providing International Sensitivity Index (ISI) and mean normal PT (MNPT) for coagulometers and give local INR. Results have been compared with conventional ISI calibrations at the same laboratories. Results: With human thromboplastins, mean ISI by local calibration was 0.93 (range: 0.77–1.16). With the PT/INR Line, mean coagulometer ISI was higher, for example 0.99 (0.84–1.23) but using the PT/INR Line derived MNPT there was no difference in local INR. Between‐centre INR variation of a certified validation plasma was reduced with human and bovine reagents after correction with local ISI calibrations and the PT/INR Line. Conclusion: The PT/INR Line–ISI with its derived MNPT is shown to provide reliable local INR with the 13 different reagent/coagulometer combinations at the 28 centres in this international study.     

Self‐efficacy and self‐care behavior of Malaysian patients with type 2 diabetes: a cross sectional survey

This study investigated the association between self‐efficacy and self‐care behavior to determine the degree of self‐efficacy and to examine differences in self‐efficacy according to patient variables, including state of health, of Malaysian patients with type 2 diabetes. The sample comprised 388 patients (respondents). We collected the data from December 2010 to February 2011. We found a significant positive relationship between self‐efficacy and self‐care behavior (r_s = 0.481, P < 0.001). The degree of self‐efficacy was moderately high (mean = 7.570). We found significant differences between self‐efficacy and education level (Wilk's Lambda = 0.918, F[12, 1008] = 2.779, P < 0.05), duration of diabetes (Wilk's Lambda = 0.954, F[8, 736] = 2.264, P < 0.05), other chronic conditions (Wilk's Lambda = 0.967, F[4, 383] = 3.304, P < 0.05) and diabetic complications (Wilk's Lambda = 0.963, F[4, 383] = 3.653, P < 0.05). Self‐efficacy can be used as a model to understand self‐care behavior. Individualized nursing interventions based on self‐efficacy theory should be utilized in high risk diabetic patients so as to assist and improve self‐care behavior.     

Effect of a review course on emergency medicine residents' self‐confidence

Objectives: Several organizations offer review courses designed to guide final‐year (postgraduate year five) residents' study for their certification examination. The effect of these courses on residents' confidence is unknown. Self‐confidence has been positively linked with examination performance. The present study measures the impact of a review course on fifth‐year emergency medicine residents' overall confidence and confidence in their: (i) knowledge and its application; (ii) planned study strategies to master the knowledge/application; and (iii) recognition that mastery of knowledge/application had been achieved. Methods: Before/after study. Over the initial 2 years, 46 postgraduate year five residents from all 12 Canadian emergency medicine programmes attended the course. They prospectively completed a pre‐/post‐course questionnaire on the above‐listed aspects of self‐confidence, for each of 22 clinical domains. A 5‐point Likert‐type scale was used for each question. Pre‐/post‐course means were compared using t‐tests for matched pairs. Results: Data were complete for 36 participants (78%). The course significantly increased residents' overall self‐confidence (mean difference 0.38, standard error of the mean [SEM] 0.06, P < 0.001), confidence in knowledge/application (mean difference 0.28, SEM 0.06, P < 0.001), in their study strategies to master knowledge/application (mean difference 0.48, SEM 0.08, P < 0.001) and in their recognition of knowledge/application mastery (mean difference 0.45, SEM 0.11, P < 0.001). Domains showing increased self‐confidence did not match domains specifically addressed in the course, suggesting that the course effects extend beyond the selected topics. Conclusions: A review course increased emergency medicine residents' self‐assessed confidence in their knowledge/application, in their study strategies and in their recognition of mastery, beyond the course specifics.     

Clarifying self‐harm through evolutionary concept analysis

Scand J Caring Sci; 2010; 24; 610–619
Clarifying self‐harm through evolutionary concept analysis Clarification of the concept self‐harm is needed in order to enable research and theory development and facilitate the development and evaluation of medical interventions and nursing care for individuals who self‐harm. This study presents such a conceptual analysis. Articles from 1997 to 2007 were sought from the Medline, PubMed, Cinahl, and PsychINFO search engines by entering the search words ‘self‐harm’, ‘self‐harming’, and ‘psychiatric care’. 25 medicine and 23 nursing science articles were chosen for inclusion and analysed. Rodgers’ evolutionary concept analysis process was used to delineate and clarify the concept’s context, surrogate terms, antecedents, attributes, and consequences, as well as to determine implications for further research. Attributes of self‐harm may include repetitive injury of mouth or exterior body, that is to say the infliction of physical pain to alleviate mental pain, and time spent self‐harming. Antecedents may be gender, mental pain, substance abuse and relational problems. Consequences often include the need for medication and help with altering coping behaviour. Some self‐harm patients met with negative attitudes from nurses. Individualized care and treatment is recommended. Accordingly, inter‐professional collaboration and postgraduate education is needed in order to provide better care and treatment for self‐harm patients. Furthermore, better understanding is needed to help enable health care personnel understand why individuals self‐harm. The conceptual analysis presented in this study may be helpful as regards theory development within this still rather unexplored field.     

New measures of diabetes self‐care agency,diabetes self‐efficacy,and diabetes self‐management for insulin‐treated individuals with type 2 diabetes

Aims and objectives. To develop and refine three new scales that measure diabetes self‐care agency, diabetes self‐efficacy and diabetes self‐management to reflect the American Diabetes Association current standards of diabetes care and the American Association of Diabetes Educators self‐care behaviours. And, to establish the clarity, consistency and content validity of the scales. Background. There is a need to have valid and reliable instruments or scales to assess an individual’s diabetes self‐care agency, self‐efficacy and self‐management to plan appropriate interventions that can be effective in improving glycaemic control and delaying or preventing diabetes‐related complications. Design. A methodological design was used to conduct this study. Methods. Ten clinicians and 10 insulin‐treated individuals with type 2 diabetes (T2DM) from a diabetes care center in the southern USA participated in this study. Analysis consisted of inter‐rater agreement to determine clarity and consistency with standards of diabetes care and content validity of individual items on the scales (I‐CVI) and the overall scales (S‐CVI/Ave) to determine relevance for current diabetes care practice. Results. All I‐CVI and S‐CVI/Ave of the DSES exceeded the minimum acceptable criteria. All I‐CVI and the S‐CVI of the DSMS also exceeded the minimum accepted criteria, except for one item that had I‐CVI = 0·70. Evaluation of the items and the directions of the scales by the sample of insulin‐treated individuals with T2DM exceeded the minimum criteria of 80% inter‐rater agreement. Relevance to research and clinical practice. Further psychometric testing of the scales with samples of insulin‐treated individuals with diabetes is warranted and will lay the groundwork for further research and clinical practice to enhance the capability, confidence and actual performance of diabetes self‐management activities among insulin‐treated individuals with T2DM. Conclusions. The scales can be used by diabetes care providers to assess and follow‐up individuals with diabetes who need intense case management. They also can be the measures of choice to conduct future research to test the effects of interventions among insulin‐treated individuals with T2DM.     

Contraceptive self‐efficacy and contraceptive knowledge of Hong Kong Chinese women with unplanned pregnancy

Aim and objectives. The purpose of this study was to explore contraceptive practice, the level of knowledge and self‐efficacy of contraception among Chinese women with unplanned pregnancy and to determine the relationships between these variables. Background. The construct of self‐efficacy can be employed as a theory to design a nursing intervention to prevent sexually active women from unplanned pregnancy. Only a few western studies have investigated the relationships between self‐efficacy and contraception behaviour yet none targeted at the Chinese population. Design. Cross‐sectional survey. Methods. This study employed a cross‐sectional survey design. A convenience sample of 117 eligible Chinese females completed all the questionnaires, which included the Chinese version of the Contraceptive Self‐efficacy Scale and Contraceptive Knowledge Scale. Results. The findings in this study suggested that younger, unmarried women at the lower income group, who adopted male condoms are at risk for unplanned pregnancy. The sample demonstrated an above medium level of knowledge and self‐efficacy in contraception. However, no significant relationship was found between contraceptive self‐efficacy and knowledge (p>0·05). Conclusions. Contraceptive obstacles were revealed by participants’ moderate level of contraceptive self‐efficacy and contraceptive knowledge. The relationship between contraceptive knowledge of specific methods and contraceptive self‐efficacy need further exploration in future studies. Relevance to clinical practice. The dominant use of male condoms by the sample of this study sheds light on future direction in the development of educational programmes and contraceptive promotion strategies appropriate for women with unplanned pregnancy.     

Psychometric testing of the healthy eating and physical activity self‐efficacy questionnaire and the healthy eating and physical activity behavior recall questionnaire for children

1 Purpose

The purpose of this study was to develop and assess the psychometric properties for two related questionnaires: the Healthy Eating and Physical Activity Self‐Efficacy Questionnaire for Children (HEPASEQ‐C) and the Healthy Eating and Physical Activity Behavior Recall Questionnaire for Children (HEPABRQ‐C).

2 Design and Methods

HEPASEQ‐C and HEPABRQ‐C were administered to 517 participating children with 492 completing. Data were analyzed to evaluate for reliability and validity of the questionnaires.

3 Results

Content validity was established through a 10‐person expert panel. For the HEPASEQ‐C, item content validity index (CVI) ranged from 0.80 to 1.00. The CVI for the total questionnaire was 1.0. All HEPASEQ‐C items loaded on a single factor. Cronbach's alpha was deemed acceptable (.749). For the HEPABRQ‐C, item CVI ranged from 0.88 to 1.00. CVI for the total questionnaire was 1.0. Pearson product moment correlation between HEPASEQ‐C and HEPABRQ‐C scores was significant (r = .501, p = .000).

4 Practice Implications

The HEPASEQ‐C and HEPABRQ‐C are easily administered and provide helpful insights into children's self‐efficacy and behavior recall. They are easy to use and applicable for upper elementary school settings, in clinical settings for individual patients, and in health promotion settings.     

Limb derived cells as a paradigm for engineering self‐assembling skeletal tissues

Mimicking developmental events has been proposed as a strategy to engineer tissue constructs for regenerative medicine. However, this approach has not yet been investigated for skeletal tissues. Here, it is demonstrated that ectopic implantation of day‐14.5 mouse embryonic long bone anlagen, dissociated into single cells and randomly incorporated in a bioengineered construct, gives rise to epiphyseal growth plate‐like structures, bone and marrow, which share many morphological and molecular similarities to epiphyseal units that form after transplanting intact long bone anlage, demonstrating substantial robustness and autonomy of complex tissue self‐assembly and the overall organogenesis process. In vitro studies confirm the self‐aggregation and patterning capacity of anlage cells and demonstrate that the model can be used to evaluate the effects of large and small molecules on biological behaviour. These results reveal the preservation of self‐organizing and self‐patterning capacity of anlage cells even when disconnected from their developmental niche and subjected to system perturbations such as cellular dissociation. These inherent features make long bone anlage cells attractive as a model system for tissue engineering technologies aimed at creating constructs that have the potential to self‐assemble and self‐pattern complex architectural structures.     

Training staff to promote self‐management in people with intellectual disabilities

Background

People with intellectual disabilities have increasing difficulties managing their daily affairs. This study examined the effectiveness of a staff training, which teaches staff to promote self‐management in people with intellectual disabilities.

Method

Effectiveness was assessed with questionnaires addressing clients’ (n = 26) independence and self‐reliance, support needs and challenging behaviour, using a pre–posttest control group design. Additionally, focus groups were conducted with trained staff members 6 months after the training.

Results

In the long term, the intervention group showed a significant increase in independence and self‐reliance, in contrast to the comparison group. No effect was found on support needs and challenging behaviour. Trained staff members reported limited benefits of the training, but had noticed changes in their attitude and method of working afterwards.

Conclusions

Further self‐management research is required to investigate how independence and self‐reliance can be promoted more effectively in this population. Future trainings should carefully consider their content, format, and implementation.     

Hydrogels as feeder‐free scaffolds for long‐term self‐renewal of mouse induced pluripotent stem cells

Expanding undifferentiated induced pluripotent stem (iPS) cells in vitro is a basic requirement for application of iPS cells in both fundamental research and clinical regeneration. In this study, we intended to establish a simple, low cost and efficient method for the long‐term self‐renewal of mouse induced pluripotent stem (miPS) cells without using feeder‐cells and adhesive proteins. Three scaffolds were selected for the long‐term subculture of miPS cells over two months starting from passages 14 to 29: 1) a gelatin coated polystyrene (Gelatin‐PS) that is a widely used scaffold for self‐renewal of mouse embryonic stem (mES) cells; 2) a neutral hydrogel poly(N,N‐dimethylacrylamide) (PDMAAm); and 3) a negatively charged hydrogel poly(2‐acrylamido‐2‐methyl‐propane sulfonic acid sodium salt) (PNaAMPS). Each passaged miPS cells on these scaffolds were cryopreserved successfully and the revived cells showed high viability and proliferation. The passaged miPS cells maintained a high undifferentiated state on all three scaffolds and a high level of pluripotency by expressing differentiation markers in vitro and forming teratomas in SCID mice with derivatives of all three germ layers. Compared to Gelatin‐PS, the two hydrogels exhibited much better self‐renewal performance in terms of high proliferation rate and level of expression of undifferentiated gene markers as well as efficiency in pluripotent teratoma formation. Furthermore, the PNaAMPS hydrogel demonstrated a slightly higher efficiency and simpler operation of cell expansion than the PDMAAm hydrogel. To conclude, PNaAMPS hydrogel is an excellent feeder‐free scaffold because of its simplicity, low cost and high efficiency in expanding a large number of miPS cells in vitro. Copyright © 2012 John Wiley & Sons, Ltd.     

Math anxiety,self‐efficacy,and ability in British undergraduate nursing students

Nurses need to be able to make drug calculations competently. In this study, involving 229 second year British nursing students, we explored the influence of mathematics anxiety, self‐efficacy, and numerical ability on drug calculation ability and determined which factors would best predict this skill. Strong significant relationships (p < .001) existed between anxiety, self‐efficacy, and ability. Students who failed the numerical and/or drug calculation ability tests were more anxious (p < .001) and less confident (p ≤ .002) in performing calculations than those who passed. Numerical ability made the strongest unique contribution in predicting drug calculation ability (beta = 0.50, p < .001) followed by drug calculation self‐efficacy (beta = 0.16, p = .04). Early testing is recommended for basic numerical skills. Faculty are advised to refresh students' numerical skills before introducing drug calculations. © 2012 Wiley Periodicals, Inc. Res Nurs Health 35:178–186, 2012     

Concept analysis of self‐mutilation

Title. Concept analysis of self‐mutilation. Aim. This paper is a report of a concept analysis to define and describe self‐mutilation. Background. Although there has been an increased interest in self‐mutilation, as evidenced by recent publication of opinion literature, anecdotal reports and a few clinical studies, the concept has not been well developed to guide nursing research and interventions. Method. Definitions and uses of self‐mutilation were obtained in a comprehensive review of the health, psychology and education literature up to April 2007 to identify the defining attributes, antecedents and consequences. Walker and Avant’s concept analysis strategy was the organizing framework. Findings. Self‐mutilation is the intentional act of tissue destruction with the purpose of shifting overwhelming emotional pain to a more acceptable physical pain. Antecedents of self‐mutilation are impaired coping skills and an unhealthy response to situations that cause unbearable emotional stress. Limited research suggests that risk factors for self‐mutilation may be White race, adolescent age, female sex and history of sexual abuse as a child. Although self‐mutilation allows the individual to gain control over emotions and provides a diversion from emotional pain, a release of endorphins after the physical damage that contributes to the feeling of relief supports an addictive maladaptive coping cycle of pain, relief, shame and self‐hate. Conclusion. The theoretical definition of the concept of self‐mutilation offers the basis for nurses to develop interventions to provide competent care when discovering injuries that are self‐inflicted.     

A technology‐based information and coaching/support program and self‐efficacy of Asian American breast cancer survivors

Women's self‐efficacy for coping with breast cancer is one of the key factors that lead to successful breast cancer survivorship. Due to the cultural stigma linked to breast cancer (e.g., breast cancer is a genetic disease), Asian Americans are known as a high‐risk group within breast cancer survivors. However, healthcare providers are challenged to promote women's self‐efficacy while considering their cultural beliefs and attitudes. In this study, the efficacy of a technology‐based information and coaching/support program was examined in improving self‐efficacy for coping with breast cancer among Asian American survivors. A randomized repeated measures control group study was conducted with 67 Asian American breast cancer survivors. The questions on background characteristics, the Personal Resource Questionnaire, the Perceived Isolation Scale, the Supportive Care Needs Survey Short Form 34, and the Cancer Behavior Inventory were used. The data were analyzed using repeated measurement analyses, χ² tests, and decision tree analyses. There were significant increases in the self‐efficacy scores of both control and intervention groups over time (p = .017). However, the increase in the control group's self‐efficacy scores was only up to post 1 month, and there was a decrease in the scores by post 3 months. When the participants were divided into high and low‐change groups based on the changes in their self‐efficacy scores for 3 months, the intervention group had more participants who belonged to the high‐change group (p = .036). The technology‐based intervention was effective in improving self‐efficacy for coping with breast cancer among Asian American breast cancer survivors.     

Recovery Camp: Assisting consumers toward enhanced self‐determination

Mental health consumers are often socially isolated and may lack the basic leisure competencies which serve as a critical building block for community (re)integration. Therapeutic recreation (TR), as a treatment modality for people with mental illness, is yet to be fully embraced in the Australian health‐care setting, despite having a strong historical foundation in North America. A team of academics created a TR experience, termed Recovery Camp, which was designed to collectively engage consumers and future health professionals drawn from a range of discipline areas. The 2014 Recovery Camp was staged over a five day period and involved 28 adult consumers living with mental illness. Consumers undertook a diverse range of experiential recreation activities engineered to facilitate individual engagement and to encourage the development of positive therapeutic relationships and teamwork. The camp atmosphere was deliberately community‐based and recovery‐oriented, valuing the lived experience of mental illness. Using a 2 × 3 design involving a camp and comparison group, the study sought to examine the influence of a TR programme on the self‐determination of individuals with a mental illness. Those who participated in the Recovery Camp reported an increase in awareness of self and perceived choice post‐camp, relative to the comparison group. While this difference remained significant for awareness of self at three‐month follow‐up, there was no significant difference in perceived choice between the two groups at follow‐up. Study findings serve to support the role of recreation within a recovery framework to positively change the health‐related behaviour of mental health consumers.     

Effect of a creative‐bonding intervention on Taiwanese nursing students' self‐transcendence and attitudes toward elders

Nursing students worldwide have little interest in caring for a growing elder population. The purpose of this study, based on self‐transcendence theory, was to test the effectiveness of a creative‐bonding intervention (CBI) to promote self‐transcendence and positive attitudes towards elders in Taiwanese nursing students. A quasi‐experimental design was used to compare a CBI group (n = 100) with a friendly visit (FV) control group (n = 94). ANCOVA results indicated that after the intervention, the CBI group had significantly more positive attitudes towards elders than the FV group. Nursing school faculty may want to promote art‐making activities between students and elders to foster students' interest in elder care. © 2008 Wiley Periodicals, Inc. Res Nurs Health 32:204–216, 2009     

Novel analysis of clinically relevant diagnostic errors in point‐of‐care devices

Summary. Background: To ensure proper clinical decision‐making and avoid preventable harm, the quality of point‐of‐care (POC) device measures is routinely assessed. Traditional analyses may not reveal clinically important diagnostic errors. Objectives: To compare results between a novel analytic framework and traditional analyses. Methods: Patients in four anticoagulation clinics provided two measures of the International Normalized Ratio (INR) at the same visit as part of routine quality assurance: one via a venous sample and one fingerstick. These were assessed with Hemochron POC devices. Traditional, quarterly, quality assurance assessments emphasized correlation analysis. The novel analysis used enhanced graphics and a validated assessment of clinical decision‐making. Results: 1518 paired INRs were analyzed. The correlation between the POC and laboratory assessments ranged between 0.84 and 0.91. Traditional quality assurance showed that the Hemochron devices were acceptable for continued use in each quarterly analysis. Enhanced graphical analysis demonstrated that the Hemochron devices never reported seven common INR values. The Hemochron devices systematically inflated values < 3 and deflated values > 4, biasing results towards the target INR range. Consequently, the Hemochron devices lead to a different clinical decision than the clinical laboratory measure in 31% of cases (458/1466; 95% confidence interval [CI] 29–34). When the reference INR was low, the Hemochron devices would not result in appropriate dose increases in 52% of cases (95% CI 48–56), placing these patients at risk for a significant adverse drug event. Conclusions: Our novel, clinically relevant analysis revealed previously undetected deficiencies in our POC INR devices, and our approach should be adopted by industry, regulators, and institutions.     

Effects of a community‐based intervention on cardio‐metabolic risk and self‐care behaviour in older adults with metabolic syndrome

This pilot study was performed to investigate the effects of a community‐based intervention (CBI) on cardio‐metabolic risk and self‐care behaviour in 92 older adults with metabolic syndrome at public health centres in Suwon, Korea. A prospective, pretest and posttest, controlled, quasi‐experimental design was used. The older adults in the intervention group participated in an 8‐week intensive lifestyle counselling, whereas those in the control group received usual care. The mean (standard deviation) age of the participants was 71.4 (4.43) years ranging from 60 to 84, and 75.0% of the participants were female. The intervention group at 8 weeks showed significant reduction in waist circumference by ?1.35 cm (P < 0.001) and improved self‐care behaviour (+ 5.17 score, P < 0.05) and self‐efficacy (+ 4.84 score, P < 0.001) when compared with the control group. The percentages of those who successfully completed the targeted behavioural modification were 71.7% for exercise and 52.2% for dietary control in the intervention group at 8 weeks. This pilot study provided evidence of the beneficial impact of the CBI for Korean older adults with metabolic syndrome.