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PubMedDate not supplied

The skills required for conducting a community psychiatric nursing assessment: a qualitative study.

The shift in focus from primarily institutionally based care, to community-based care, has highlighted the need for community psychiatric nurses with appropriate skills to care for clients experiencing mental illness within the community. This paper describes the results of a qualitative research project undertaken to examine the skills required by psychiatric nurses in conducting an assessment within the community. In depth interviews were conducted with a sample of six currently practising community psychiatric nurses, with differing levels of experience. The findings identified the main skills as: interpersonal skills; psychiatric nursing knowledge base; the ability to work with a variety of treatment modalities; and, literacy skills. The specific significance of these skills for the educational preparation of community psychiatric nurses is discussed.

Community Health Nursing↗
PubMed1998

Heterosexism and gay couples with HIV infection.

The purpose of this study was to explain the dynamic interplay between gay couples who were infected/affected by HIV infection and their social environments, as defined by heterosexism. Descriptive and analytic methods were used. The sample consisted of nine couples in which at least one man was diagnosed with symptomatic HIV infection or AIDS. Although study participants explained their experiences using the term "homophobia," their experiences as a family based on interpersonal commitment could also be understood in the context of heterosexism. Interpersonal commitment was a means to resist the constraints imposed by heterosexism.

Adaptation, Psychological↗
PubMed2002

Outcomes of a transcultural nursing immersion experience: confirmation of a dimensional matrix.

Schools of nursing are positioned to increase cultural awareness for students and potentially change practice. Dimensions of culturally focused field experiences were investigated to determine the relevancy of the dimensions of the Matrix for Personal and Professional Growth Through a Transcultural Immersion Experience. A questionnaire was developed and administered to two samples of nursing students following participation in an immersion experience. Results provided evidence of validation for major dimensions of the matrix, including situational predetermining factors, modifying factors, transitional factors, and outcomes of the matrix. The model for transcultural nursing immersion experiences was conceptualized, and propositions were generated.

Adult↗
PubMed2005

Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis.

CONTEXT: The global refugee crisis requires that researchers, policymakers, and clinicians comprehend the magnitude of the psychological consequences of forced displacement and the factors that moderate them. To date, no empirical synthesis of research on these issues has been undertaken. OBJECTIVE: To meta-analytically establish the extent of compromised mental health among refugees (including internally displaced persons, asylum seekers, and stateless persons) using a worldwide study sample. Potential moderators of mental health outcomes were examined, including enduring contextual variables (eg, postdisplacement accommodation and economic opportunity) and refugee characteristics. DATA SOURCES: Published studies (1959-2002) were obtained using broad searches of computerized databases (PsycINFO and PILOTS), manual searches of reference lists, and interviews with prominent authors. STUDY SELECTION: Studies were selected if they investigated a refugee group and at least 1 nonrefugee comparison group and reported 1 or more quantitative group comparison on measures of psychopathology. Fifty-six reports met inclusion criteria (4.4% of identified reports), yielding 59 independent comparisons and including 67,294 participants (22,221 refugees and 45,073 nonrefugees). DATA EXTRACTION: Data on study and report characteristics, study participant characteristics, and statistical outcomes were extracted using a coding manual and subjected to blind recoding, which indicated high reliability. Methodological quality information was coded to assess potential sources of bias. DATA SYNTHESIS: Effect size estimates for the refugee-nonrefugee comparisons were averaged across psychopathology measures within studies and weighted by sample size. The weighted mean effect size was 0.41 (SD, 0.02; range, -1.36 to 2.91 [SE, 0.01]), indicating that refugees had moderately poorer outcomes. Postdisplacement conditions moderated mental health outcomes. Worse outcomes were observed for refugees living in institutional accommodation, experiencing restricted economic opportunity, displaced internally within their own country, repatriated to a country they had previously fled, or whose initiating conflict was unresolved. Refugees who were older, more educated, and female and who had higher predisplacement socioeconomic status and rural residence also had worse outcomes. Methodological differences between studies affected effect sizes. CONCLUSIONS: The sociopolitical context of the refugee experience is associated with refugee mental health. Humanitarian efforts that improve these conditions are likely to have positive impacts.

Emigration and Immigration↗
PubMed2006

Temporal and venepuncture-related decline in circulating endothelial cell capture from mixed venous blood.

BACKGROUND: The quantification of circulating endothelial cells (CECs) in whole blood has evolved as a novel method for the assessment of endothelial function, although major methodological issues remain. We hypothesized that there is a temporal decline in CEC counts in static venesected blood and that venepuncture itself may lead to increased CEC detachment. METHODS: CEC isolation was performed using the immunobead method. For the temporal decline experiment, we included 52 patients presenting with acute coronary syndrome (ACS). We performed CEC counts immediately and at 4 and 24 h later. For the venepuncture decline experiment, we studied 40 patients with stable cardiovascular disease (CVD). CEC counts were determined from the first 4 mL of aspirated venous blood and compared with counts obtained from a subsequent 4 mL sample of blood after at least 7.5 mL of blood had been collected. RESULTS: Among the ACS patients there was a significant temporal decline in CEC counts in static venous blood over a 24 h period (p = 0.013). Among the patients with stable CVD, the median CEC counts obtained from the initial 4 mL of aspirated venous blood were significantly higher (by 32%) than that obtained from the later 4 mL of aspirated venous blood (p = 0.041). CONCLUSIONS: We demonstrated a significant temporal fall in CEC numbers in static venous blood over 24 h following venesection. Furthermore, we have shown that CEC counts are higher in the initial aspirated blood compared with that aspirated from the same needle subsequently. These data would have implications for how CEC determination is undertaken by researchers in studies related to ACS or CVD.

Adult↗
PubMed1995

Patterns of care survey results: treatment planning for carcinoma of the prostate.

PURPOSE: Treatment planning has been defined differently at various institutions to encompass tasks ranging from the initial evaluation of the patient to the delivery of the treatment as well as a more narrow view, focused primarily on isodose computation. To evaluate the impact of much of the new treatment-planning technology that has become available, it is necessary to define and develop recommended guidelines for the treatment-planning process. METHODS AND MATERIALS: The 1989 Patterns of Care Study (PCS) included questionnaires to access treatment planning practices currently in use for the entire census of oncology facilities in the United States. These questionnaires were developed by a consensus committee consisting of both physicists and radiation oncologists whose charge was to formulate a description of current treatment-planning practices. The description was based on the committee's experience and knowledge of the treatment-planning process considered to be widely available and in general use, as well as a review of the literature. From the description of the treatment-planning process, a set of guidelines for treatment planning was developed for prostate as well as each of the other disease sites included in the PCS. Data from the study defined the general structure, methodology, process, and tools used by each institution involved in the Patterns of Care Survey Study. National averages for all of the variables were calculated with weighted averages, with the weights reflecting the sample design and number of patients in the different types of facilities. The data were stratified according to academic, hospital, or free-standing facility and were compared with the Consensus Guidelines for Treatment Planning of the Prostate. DISCUSSION: Based on the consensus statement, the treatment-planning process was separated into the following categories: (a) Treatment-Planning Workup, (b) Treatment Plan Implementation, (c) Treatment Delivery, (d) Treatment Verification, and (e) Quality Assurance. The results from the survey were summarized for each category and compared with the consensus statement. CONCLUSIONS: Although there is an increasing trend toward using computed tomography (CT) information to acquire individualized patient data, volume definition and localization are often completed in the simulator without the direct use of CT information (47%). As more sophisticated beam arrangements and blocking are used, one needs to look at the full three-dimensional (3D) volume to ensure that there are no marginal misses due to blocking and beam arrangement. Improved and more widespread use of immobilization devices is also required with conformal treatments and reduced margins. The results of the survey helped to identify and establish the standard of practice for treatment planning of the prostate as well as to provide documentation for better defining a complete description of the treatment planning process. Well-documented guidelines will provide more consistent treatment of patients, which should have an impact on outcome.

Clinical Protocols↗
PubMed2004

POPED, a software for optimal experiment design in population kinetics.

Population kinetic analysis is the methodology used to quantify inter-subject variability in kinetic studies. It entails the collection of (possibly sparse) data from dynamic experiments in a group of subjects and their quantitative interpretation by means of a mathematical model. This methodology is widely used in the pharmaceutical industry (where it is termed "pharmacokinetic population analysis") and recently it is becoming increasingly used in other areas of biomedical research. Unlike traditional kinetic studies, where the number of subjects can be quite small, population kinetic studies require large numbers of subjects. It is, therefore, of great interest to design these studies in the most efficient manner possible, to maximize the information content provided by the data. In this paper we propose an algorithm and a computer program, POPED, for the optimal design of a population kinetic experiment. In particular, the number of samples for each subject and the design of the individual sampling strategies, i.e. the number and location of the time points at which the output variable is sampled, will be considered. Among the various criteria proposed in the literature, D and ED optimality are the ones implemented in our software program, since they are the most widely used. A brief description of the techniques employed to perform design optimization is given, together with some details on their actual implementation. Some examples are then presented to show the program usage and the results provided.

Algorithms↗
PubMedDate not supplied

Analyzing planned maintenance (PM) inspection data by failure mode and effect analysis methodology.

There is no question that medical devices are becoming more reliable. However, we have had some difficulty finding a satisfactory method for providing persuasive documentary evidence that this improved reliability will allow us to relax our traditional planned maintenance (PM) practices without compromising patient safety. The acceptance and increasing use of Failure Mode and Effect Analysis (FMEA) by several of the oversight agencies, including the Joint Commission on Accreditation of Healthcare Organizations, provides us with an important opportunity to take another shot at this vexing problem. Using this proven FMEA methodology and some relatively simple rules to quantify the results of the routine PM inspections that all healthcare providers are still performing in considerable abundance, we have developed a method that allows us to reduce the test results to a simple, single measure (the Risk Score) that can be used to characterize the effectiveness and levels of safety of our current PM regimens. When tested on theoretical data and a sample of real PM inspection results, the method provides answers that seem reasonable. Although it will probably require some modification as we begin the standardized data gathering and gain working experience, it is our hope that this new approach will become generally accepted within the industry. This kind of positive response should enable us to persuade the various accrediting and licensing agencies to similarly accept the concept.

Documentation↗
PubMed1990

The psychological functions of preadolescent peer activities.

The psychological functions of preadolescent peer activities were assessed by examining activity-related prescriptions and prescriptions for peer behavior. 91 fifth- and sixth-grade children (48 girls) kept week-long diaries of important peer activities and liked and disliked behaviors performed by peers in the activities. 81 other fifth- and sixth-grade children (40 girls) rated the importance and prevalence of each activity and indicated which of several positive and negative behaviors they would most like or dislike to happen in 10 of the activities. Results indicate that collectively, the activities sampled serve 3 main functions based on their prescriptive and prescriptive behavioral profiles: (a) they provide a context for sociability, enhancement of relationships, and a sense of belonging; (b) they promote concern for achievements and integrity of the self; and (c) they provide opportunities for instruction and learning. Not all activities serve all functions, however, and children may require exposure to a variety of activities to accrue a full range of psychological experiences. The findings also illustrate the potential importance of activity-related information for discerning the meaning and evaluating the effectiveness of social behavior. The advantages of the methodology are discussed.

Child↗
PubMed1998

HIV risk behavioral surveillance: a methodology for monitoring behavioral trends.

OBJECTIVE: This article summarizes issues and recommendations for conducting HIV risk behavioral surveillance surveys (BSS) based on experiences from ten BSS projects in eight countries in Asia and Africa. BACKGROUND: BSS consists of systematic and repeated cross-sectional surveys of HIV and sexually transmitted disease-related behaviors, with other knowledge and attitudinal variables added where appropriate. Its major purpose and utility is in detecting trends among selected vulnerable and high-risk population groups whose behavioral change can have the most impact on the epidemic. BSS is also useful for tracking trends in behaviors over time in regions exposed to HIV prevention activities, as a contributing component to the comprehensive monitoring and evaluation of interventions. RECOMMENDATIONS: (i) implement BSS as an essential adjunct to HIV/STD epidemiological surveillance; (ii) use BSS for evaluation purposes in combination with process data and triangulate results with qualitative research; (iii) choose sentinel groups based on epidemiological considerations, evaluation and monitoring needs, representative sampling frames, and political and cultural considerations; (iv) maintain 1-year intervals between survey waves for most groups in order to provide yearly updates on behavioral trends for programmatic adjustments; (v) use internationally standardized indicators and question wording; (vi) maintain strict quality control standards to enhance data validity and reliability; and (vii) develop a clear dissemination strategy during BSS design to increase the likelihood of utilization of BSS results. CONCLUSION: BSS represents a cost-effective way to determine whether programmatic behavioral targets and goals are being met, to identify persisting risk behaviors over time, and to indicate whether new intervention approaches are necessary.

Africa↗
PubMed1989

Consecutive radiofluorography and silver staining of two-dimensional gel electrophoretograms: application in determining the biosynthesis of serum and tissue proteins.

The methodology for conventional radiofluorography of two-dimensional gels, followed by rehydration of the gel and subsequent silver staining, is described. The image obtained by radiofluorography is referred to as biosynthetic image, and the image obtained by silver staining as constitutive image. Since the two images are already in close register (the same gel), reliable identification of polypeptides by the two different assays is possible, and the comparison provides valuable information on the catabolism of each entity. The utility of this procedure is illustrated in experiments involving a labeling with L-[35S]methionine of an entire mouse. Both serum and tissue samples were analyzed by two-dimensional gel electrophoresis with the aim of determining several categories of polypeptides in terms of their biosynthetic rates and their composition.

Animals↗
PubMed1994

Island living: the experience of loneliness in a psychiatric hospital.

The purpose of this study was to examine perceptions of loneliness among psychiatric patients. The sample included 12 adults receiving treatment in a psychiatric facility. Data consisted of audiotaped semistructured interviews. Ten empirical categories resulted. Further analysis of empirical data provided a description of psychiatric patient's experiences of loneliness. The metaphor of living on an island illustrated the core category. Subcategories included escape attempts and surviving tidal waves.

Adaptation, Psychological↗
PubMed1994

Methodological variables during analysis of in vivo cerebellar cyclic GMP, an indirect marker of nitric oxide release.

In light of the recent recognition of the physiological significance of nitric oxide, there is considerable interest in the methodological variables that can confound the results of the cerebellar cGMP analysis from in vivo experiments. In this study, using male Swiss Webster mice, the effect of such methodological variables as 1) weight of the animals; 2) tissue extraction procedures used in radioimmunoassay for cGMP; and 3) the commercial source of the assay kit on, harmaline-, pentylenetetrazole- or SNAP-induced increase in cerebellar cGMP in vivo were evaluated. Results indicate that mice in the 15- to 19-g weight range are most sensitive and best suited for in vivo drug effects on cerebellar cGMP. Furthermore, for the extraction of cerebellar cGMP, use of ice-cold 0.5N hydrochloric acid and subsequent dilution of the sample in assay buffer is the simplest and fastest method. Present data also indicate that the source of the radioimmunoassay kit has a significant effect on the cerebellar cGMP results. Based on the present results, the protocol developed and the guidelines drawn are timely and of high practical significance for research in the area of pharmacology of nitric oxide.

Animals↗
PubMed1999

Usefulness of the frequency data of the fourier transform infrared spectra to evaluate the degree of oxidation of edible oils.

The oxidation process of 13 edible oil samples with different proportions of oleic, linoleic, and linolenic acyl groups has been studied using Fourier transform infrared spectroscopy. The oxidation experiments were carried out by heating the samples in a convection oven at 70 degrees C. Duplicate spectra were recorded from a film of pure oil between two disks of KBr for each sample every day during the course of the oxidation, and frequency data of each band of the spectrum were collected automatically. Changes in the values of the frequency of most of the bands of the spectra were observed. The shiftings of the frequency value of specific bands allowed one to distinguish between the different stages of the oxidation process and to establish the oxidation degree of each oil sample. This methodology could be useful to evaluate the oxidative stability of edible oils in a simple, fast, and accurate way.

Oxidation-Reduction↗
PubMed1992

Analytical method comparison based upon statistical power calculations.

Testing for the equivalence of results generated by different analytical methodology is a common practice in the pharmaceutical sciences. Methodology changes are implemented for both scientific and economic reasons during a scientific study. Thus, the need to demonstrate the appropriateness of considering data generated by distinct methods as part of a single information population arises. This paper describes a rapid and simple approach to the statistical design and interpretation of method comparison experiments. The approach presented is based upon a statistical power calculation technique, a knowledge of the variability associated with the methods to be compared and the criteria for equivalence (the limits within which differences become immeasurable or, for practical purposes, insignificant). Reference tables are included which show necessary sample sizes for comparison experiments for common combinations of these three variables.

Chemistry Techniques, Analytical↗
PubMedDate not supplied

Institute for Health Care Improvement Collaborative Trial to improve process times in an Australian emergency department.

This study describes an Australian emergency department's (ED) experience with a quality improvement methodology from the USA. The Institute for Health Care Improvement (IHI) conducts collaboratives between clinical groups with similar interests, in this case ED. Their quality improvement model is described. Our involvement with the IHI showed the model to be transferable outside the USA. In applying the model to operational and clinical projects we were successful in meeting our goals to reduce clinical times: for time to analgesia (P= 0.34), time to thrombolysis (P= 0.30) and time to antibiotics in neutropenic patients (P= 0.015). We were unable to reach statistical significance in improvements due to the small sample sizes and sampling techniques. Changes in operational times were not clinically significant but almost reached statistical significance (e.g. median total length of stay in the ED fell 4 min (P= 0.06)). The near statistical significance of a small change was due to the large numbers of patients sampled.

Academies and Institutes↗
PubMed1997

Methodological limitations of the ESRD Core Indicators Project: an ESRD network's experience with implementing an ESRD quality survey. Medical Review Board of the ESRD Network of New England.

ESRD Network Number 1, composed of Maine, New Hampshire, Vermont, Massachusetts, Connecticut, and Rhode Island, developed a Network Core Indicator Pilot Project using the dialysis units represented on the Medical Review Board. Network 1's Core Indicator Pilot Project aimed to (1) estimate the proportion of end-stage renal disease (ESRD) patients in Network 1 receiving hemodialysis treatments associated with a urea reduction ratio less than 60% to 65%, (2) elucidate the patient characteristics associated with a hemodialysis dose less than 65%, (3) define the processes in the delivery of hemodialysis that limit the provision of an adequate dialysis dose, and (4) initiate the routine collection of measures of dialysis dose, the analysis of those data, and feedback to the participating dialysis units. In the course of the Core Indicator Pilot Project, we observed little uniformity in the sampling method for the postdialysis blood urea nitrogen sample. Thirty-three percent of the hemodialysis units reported that this critical blood sample was drawn immediately before the dialysis treatment was terminated; 25% were obtained immediately at the end of the dialysis treatment and 42% drew the sample > or = 5 minutes after all blood was reinfused to the patient. Especially in the presence of unappreciated blood recirculation in the angioaccess or postdialysis urea rebound, the lack of standardization in obtaining this critical blood sample to support the urea reduction ratio calculation greatly compromises any comparisons of performance across dialysis facilities and may jeopardize patient care. Future ESRD quality improvement efforts must focus not only on the results of the outcome measure but also on the process by which the measure is achieved. These fundamental principles of quality assessment should be considered by policy specialists, payers, providers, and developers of clinical practice guidelines.

Adolescent↗
PubMed2005

The use of (14)C tracer technique to assess the functional response of zooplankton community grazing to toxic impact.

The use of functional endpoints in risk assessment of pollutants for marine pelagic communities is scarce, especially for the function of zooplankton communities. This work presents a rapid, inexpensive and ecologically relevant technique to assess the effect of toxic compounds on the grazing rates of zooplankton communities. The combination of a (14)C-tracer labelling technique with a fast (< 3 h) and representative sub-sampling and handling makes it possible to measure changes in food uptake of freshly collected natural zooplankton communities in a short-term assay. The methodology is described and its validity is determined by a full account of the fate of isotope tracers (up to 15% taken up by zooplankton). Egg production of Acartia tonsa cultures exposed to DCOI yielded EC(50) values of 118+/-33 nM DCOI after three days, where EC(50) values from grazing of natural zooplankton communities was 136+/-29 nM DCOI, indicating that grazing was the more sensitive variable. Finally the method was tested in a mesocosm experiment designed to evaluate the toxicity of the antifouling compound zinc pyrithion (ZPT) with an EC(50) value of 17 nM ZPT (SD=3.3 nM, n=3). The method was found to be reproducible both at the community (CV=8-39%) and individual level (CV=23-53%), and could detect small changes in response to a toxicant in a natural pelagic system. The use of natural communities in combination with the fast and cost-effective procedure makes this technique a powerful tool in risk assessment, where lack of ecological relevance or reproducible results often results in unwanted high uncertainties.

Animals↗