Substitute Consent for Research Involving the Elderly: A Comparison Between Quebec and France

The authors first describe the rules enacted in Quebec and France to protect adults with decisional impairment who may be approached by investigators to participate in research protocols. They then present two consecutive postal surveys conducted among Quebec and French researchers in aging and designed to (1) assess their knowledge of the legal provisions implemented to protect decisionally incapable adults, (2) elicit their opinions regarding the person best suited to provide substitute consent for research participation, and (3) document their conduct related to obtaining consent for prospective subjects with impaired decisional capacity. Knowledge of the legislation governing substitute consent was poor, even more so among French than Quebec researchers (p < 0.001). In both samples, the majority of respondents felt that the substitute decision-maker does not have to be legally appointed when the study poses little risk to the participant. Practice data revealed a certain discrepancy between the conduct of researchers in aging and the legal provisions regarding consent for research purposes that prevail in their jurisdictions. These findings underscore the need to better educate clinical investigators about existing measures to protect prospective subjects who lack decisional capacity. They also provide some support for allowing close relatives to consent to research participation on behalf of older adults who are unable to consent by themselves and have not been appointed a legal representative.     

Health care worker opinions on use of isolation precautions in long-term care facilities

To address controversies surrounding contact isolation precautions in skilled nursing facilities (SNF), we surveyed 356 nurses and nurses' aides from 7 SNFs on their opinions regarding benefits and harms of contact isolation precautions. Whereas a majority of health care workers believed that contact isolation reduces transmission of antibiotic-resistant organisms, they were also concerned about potentially harmful consequences to the SNF residents including depression and isolation.     

Management of skin toxicity associated with cetuximab treatment in combination with chemotherapy or radiotherapy

Background.

Cetuximab was demonstrated by clinical trials to improve response rate and survival of patients with metastatic and nonresectable colorectal cancer or carcinoma of the head and neck. Appropriate management of skin toxicity associated with epidermal growth factor receptor inhibitor (EGFR-i) therapy is necessary to allow adequate drug administration and to improve quality of life and outcomes.

Methods.

A group of Italian Experts produced recommendations for skin toxicity management using the RAND/UCLA Appropriateness Method. Statements were generated on the basis of a systematic revision of the literature and voted twice by a panel of 40 expert physicians; the second vote was preceded by a meeting of the panelists.

Results.

Skin toxicity included skin rash, skin dryness, pruritus, paronychia, hair abnormality, and mucositis. Recommendations for prophylaxis and therapeutic interventions for each type of toxicity were proposed.

Conclusions.

Interventions that were considered appropriate to improve compliance and outcomes of cancer patients treated with EGFR-i were identified.     

How do women feel about being weighed during pregnancy? A qualitative exploration of the opinions and experiences of postnatal women

Objectiveto explore routine weighing in antenatal care and weight management in pregnancy with women who have been weighed during pregnancy.Designa qualitative study utilising semi-structured telephone interviews, and thematic analysis.Settingparticipants resided in Dublin, Ireland and had been weighed during pregnancy.Participantsindividual telephone interviews conducted with ten postpartum women (nine months postpartum).Findingsexperiences of routine weighing were positive, and participants believed it should be part of standard antenatal care. Several benefits to routine weighing were cited, including providing reassurance and minimising postpartum weight retention. It was felt that there was a lack of information provided on gestational weight gain and healthy lifestyle in pregnancy, and that healthcare professionals are ideally placed to provide this advice. Increased information provision was seen as a method to improve healthy lifestyle behaviours in pregnancy.Key conclusions and implications for practicethese findings contribute to the current debate about the re-introduction of routine weighing throughout pregnancy (Allen-Walker et al., 2016). Women stated that they expected to be weighed during pregnancy and, contrary to previous claims, there was no evidence that routine weighing during antenatal care caused anxiety. From discussions it was clear that women desired more information on gestational weight gain and a healthy lifestyle, and felt that health professionals should provide this.     

Attitudes of Dutch, German and Swiss nursing staff towards physical restraint use in nursing home residents, a cross-sectional study

Objective

To investigate the attitudes of nursing staff towards restraint measures and restraint use in nursing home residents, and to investigate if these attitudes are influenced by country of residence and individual characteristics of nursing staff.

Methods

A questionnaire on attitudes regarding restraints (subscales: reasons, consequences, and appropriateness of restraint use) and opinions regarding the restrictiveness of restraint measures and discomfort in using them was distributed to a convenience sample of nursing staff in The Netherlands (n = 166), Germany (n = 258), and Switzerland (n = 184).

Results

In general, nursing staff held rather neutral opinions regarding the use of physical restraints, but assessed the use of restraints as an appropriate measure in their clinical practice. Gender and age were not related to attitudes of nursing staff, but we did find some differences in attitudes between nursing staff from the different countries. Dutch nursing staff were most positive regarding the reasons of restraint use (p < 0.01), but were less positive than German and Swiss nursing staff regarding the appropriateness of restraint use (p < 0.01). Swiss nursing staff were less positive than German nursing staff regarding the appropriateness of restraint use (p < 0.01). Nursing staff with longer clinical experience showed a more negative attitude towards restraint use than nursing staff with less experience (p < 0.05) and charge nurses had the least positive attitude towards restraint use (p < 0.05).Opinions regarding restraint measures differed between the three countries. The use of bilateral bedrails was considered as a moderate restrictive measure; the use of belts was rated as the most restrictive measure and nursing staff expressed pronounced discomfort on the use of these measures.

Conclusions

Nursing staff from three European countries have different attitudes and opinions regarding the use of physical restraints. The results underline the importance of more tailored, culturally sensitive interventions to reduce physical restraints in nursing homes.     

Professional changes induced by a redesigned immunization supply chain in the Comé Health Zone,Benin

At the end of 2013, the Government of Benin and Agence de Médecine Préventive (AMP) launched a demonstration project in Comé Health Zone (HZ) to optimize the vaccine supply chain. A key part of the demonstration project was the creation of an “informed push model” of vaccine distribution supported by a new logistician position at the health zone (district) level. At the conclusion of the demonstration project in 2015, the authors conducted an anthropological study consisting of semi-structured interviews with 62 participants to assess how the new model changed the professional identities, roles, responsibilities, and practices of personnel involved in vaccine management during and just after the demonstration project end in Comé HZ. The study found that health workers considered the logistician as a key player in enabling them to perform their public health mission, notably by improving knowledge and practices in vaccine management, providing supportive supervision, and improving the availability of vaccines and other supplies so that immunization sessions could occur more reliably and professionally within the communities they served. The demonstration project was widely accepted among study participants. The study was approved by the Cotonou Ethics Committee (CER-ISBA No. 56 dated 09/04/2015).     

Faculty Opinions不同评价条件下论文多元评价指标差异性及相关性分析

【目的】 结合论文社会影响力和学术影响力指标,研究Faculty Opinions中不同学科的同行评议指标、评价星级、评价标签之间的差异性和相关性,发掘其中隐含的关联。【方法】 以Faculty Opinions指标为基础,分别获取社会影响力和学术影响力的代表性指标,分别运用非参数独立样本Kruskal-Wallis秩和检验和斯皮尔曼相关性分析方法进行统计分析。【结果】 Faculty Opinions临床实践类研究评价星级相对较低,而基础理论类研究更容易获得较高评价。不同学科按照评价标签和评价星级分组,社会影响力指标和学术影响力指标的分布均具有差异性。同行评议的推荐得分、推荐次数、评价标签和评价星级与社会影响力和学术影响力各指标之间多数呈现低相关或不相关。【结论】 同行评议、社会影响力、学术影响力各类指标对于科技论文的评价结果不尽相同,有必要采取多元化指标从多维度、多范畴、多角度进行综合分析及评价。     

Injury risk profile of amateur Irish women soccer players and players’ opinions on risk factors and prevention strategies

ObjectiveTo explore injury profile, opinions on risk factors and injury prevention, among Irish amateur women soccer players.DesignA cross-sectional online survey. Setting: Irish amateur winter league.ParticipantsActive players ≤18 years of age.Main outcomesDifferences were found between injured and uninjured groups, and risk factors that significantly predict soccer injury were identified.Results168 injuries were reported by 83 respondents during the winter season. An increased prevalence of competition anxiety was observed in (53.8%:n = 85 of respondents) compared to other risk factors. There was a negative association between injuries and players' general health state (OR = 0.820, 95% CI 0.7–0.9, p = 0.007). Players’ knowledge about some risk factors including playing position, joint hypermobility, and playing during menses contradicts current evidence. 50%; n = 67 of the respondents had not received any education on injury risk or prevention.ConclusionThis study identified that Irish amateur women soccer players that responded have different characteristics, prevalence of risk factors and injury profiles to women players from different levels and countries. The findings suggest that some players may not be aware of the existing evidence base pertaining to common risk factors for injury. Further research is required to confirm the findings and explore the implementation of injury prevention strategies.     

不同专家对青年教师专业素质结构的观点比较

目的 比较不同身份专家(医学教育专家、医学教育管理干部和青年教师)对青年教师专业素质构成的看法,为青年教师完善自身素质提供参考.方法 通过文献回顾、小型专家会议,初步建立青年教师专业素质结构体系,进行专家函询,比较不同专家的看法.结果 在青年教师专业素质构成的一级指标比较中(Kendall协和系数W＝0.944,P=0...