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Current research activity in the measurement of thorium and the identification of future research needs.

A pre-requisite in the setting and enforcement of regulatory limits for exposure to thorium in the workplace is that thorium and its progeny can be accurately measured. Literature surveys have shown that the majority of thorium measurements were performed using either a radiochemical technique, such as alpha or gamma spectroscopy, or ICP-MS. For many methods. there was a separation step to isolate and pre-concentrate thorium from the sample matrix. Thorium was most commonly measured in geological matrices and industrial materials. A survey of current research activity was performed through distribution of a questionnaire to laboratories and national centres. From the rcsponses, four areas of current activity were identified: (i) development of methods for low level thorium determination, (ii) biological monitoring and metabolism of thorium, (iii) environmental monitoring for thorium, and (iv) health risks from X ray contract media. Two key areas for priority research were identified by the thorium Thematic Network: namely sample preparation methods and for traceable standards and reference materials for thorium analysis.

Environmental Exposure↗

Living with postpartum depression: the father's experience.

PURPOSE: To derive a deeper understanding of postpartum depression (PPD) and its impact on the family through the experiences of fathers whose spouses suffered from this disorder. DESIGN: Phenomenology. METHODS: Eight men were interviewed. Interviews were recorded on audio tape and transcribed verbatim. Thematic analysis conducted within an interdisciplinary phenomenological research group led to a description of the experiences and emotions involved. RESULTS: Respondents in this study revealed a major disruption in their lives and in their relationship with their wives as a result of PPD. The men experienced fear, confusion, and much concern for their spouses, and felt unable to help them in overcoming PPD. The inability to "fix the problem" created frustration and anger. The majority of the respondents reported that they made many sacrifices to hold the relationship and the family together. Even though the PPD improved over time, fathers were left to face an uncertain future with a spouse who seemed to be very different from the person they had previously known. CLINICAL IMPLICATIONS: Health care professionals need to design interventions that are more supportive of men, for men also suffer when their spouses experience PPD.

Adaptation, Psychological↗

Nurses' and patients' perceptions of expert palliative nursing care.

AIM: This paper reports a study of the perceptions of patients and nurses of palliative care and, in particular, the concept of the expert palliative nurse. BACKGROUND: Palliative care is a growing specialty and is practised globally. There is, however, limited information on patients' views about palliative care. While the idea of expertise in nursing is not new, few studies have explored the concept of the expert nurse in palliative care. Some evidence exists on palliative nurses' perceptions of their care, that it is supportive and involves maintaining therapeutic relationships with patients. Facing a terminal illness has been identified as a stressful and fearful experience that affects all aspects of life. It has also been revealed that dying patients may have unmet care needs, mainly in the areas of pain and symptom control, emotional support, and spending time alone. METHODS: A phenomenological study was carried out, using in-depth interviews and thematic content analysis. A convenience sample of 22 Registered Nurses and 22 dying patients was interviewed in 1996-1997. FINDINGS: Dying patients had a desire to maintain independence and remain in control. Palliative care nurses experienced both effective and ineffective interpersonal communication, the building of therapeutic relationships with dying patients and attempting to control patients' pain and distressing symptoms. Patients and nurses agreed that the two most important characteristics of an expert palliative nurse were interpersonal skills and qualities such as kindness, warmth, compassion and genuineness. CONCLUSION: Although the study was conducted in the United Kingdom, the findings have relevance for palliative care practice globally in terms of dependence, issues of patient choice, nurses being interpersonally skilled and building therapeutic relationships with patients.

Attitude of Health Personnel↗

In the absence of evidence, who chooses? A qualitative study of patients' needs after treatment for colorectal cancer.

OBJECTIVES: To identify the range of patient pathways following surgery for colorectal cancer and explore patients' needs and preferences for follow-up. METHODS: A survey of hospitals within the UK Colorectal Cancer Services Collaborative and qualitative thematic analysis of 39 in-depth narrative interviews with colorectal cancer patients. Participants volunteered or were contacted through hospital consultants, support groups and general practitioners (GPs). Most of the interviews were collected in respondents' homes, throughout the UK. RESULTS: Thirty-five (70%) hospitals supplied details of their follow-up regime. There was a wide variation: only three hospitals specifically stated that patients were given a choice about the type of follow-up. The patients' interviews highlighted their need for a responsive GP and realistic information about recovery, resources and diet. Choice is particularly important because patients differ in their views of the benefits of hospital follow-up. CONCLUSIONS: The absence of evidence about what constitutes ideal clinical follow-up for colorectal cancer is reflected in current hospital practice. In such circumstances, the preferences of individual patients are particularly important. Not all patients want repeated specialist investigations but those without stomas, and therefore no access to a stoma nurse, need another source of advice about recovery and long-term practical help. Follow-up care organised by GPs may be acceptable to many patients. We suggest a list of topics for GPs to discuss with their patients about follow-up. The needs described by patients are not extensive and could often be met by existing resources.

Adult↗

Systematic reviews and their application to research in speech and language therapy: a response to T. R. Pring's 'Ask a silly question: two decades of troublesome trials' (2004).

BACKGROUND: The advent of evidence-based healthcare has seen a rise in the use of systematic reviews to bring together the findings from research studies. The use of systematic reviews in speech and language therapy (SLT) was criticized in this journal in 2004 by T. R. Pring. It was claimed that their findings are misleading due to the potential inclusion of biased data, and uninformative due to a lack of detail in the reporting of interventions. It is argued that outcome research should be carried out in a series of phases in which small-scale research precedes large-scale research. This, it is argued, is most likely to demonstrate statistically significant effects and also help to ensure that therapies become sufficiently defined so that clinicians can apply them in practice. AIMS: This paper argues that the above criticism of systematic reviews is based on a narrow conception of their capabilities: on the popular misapprehension that all systematic reviews answer effectiveness questions using only experimental studies and contain meta-analyses. Different methods for systematic reviews are described and their application within clinical outcome research is discussed with reference to a phased structure for empirical enquiry. MAIN CONTRIBUTION: Systematic reviews seek to identify and synthesize information within a given topic area. They are used to answer a wide range of research questions and the studies they include are not limited exclusively to experimental designs. Methods of synthesis can include both statistical approaches, such as meta-analysis, and 'qualitative' approaches, such as meta-ethnography and thematic analysis. Knowledge of the current state of research is essential for a sequentially phased approach within outcome research to operate. Since systematic reviews are summaries of research activity, they can provide this knowledge and should therefore be considered a valuable tool within outcome research. CONCLUSIONS: A systematic review using 'qualitative' and/or statistical methods for combining studies can be carried out within or across any of the phases within outcome research. Far from being uninformative, this can help bring together what is, and what is not, known and indicate the kinds of therapies that may be beneficial in the clinical setting and therapies which would benefit from further research and development.

Evidence-Based Medicine↗

The molecular mechanism of cuproptosis and research progress in pancreatic diseases.

PURPOSE: Cuproptosis has been proven to be a novel mode of cell death, distinct from other types of cell death such as necrosis, ferroptosis, pyroptosis, and apoptosis. This study aims to systematically review the molecular mechanisms of cuproptosis in recent years and its research progress in pancreatic diseases. METHODS: By searching PubMed and Web of Science databases, 113 key literatures were included for thematic analysis, covering the molecular mechanism of cuproptosis and its role in the occurrence and development of pancreatic cancer, acute and chronic pancreatitis, diabetes, pancreatic cyst, pancreatic injury and pancreatic neuroendocrine tumor. RESULTS: Cuproptosis refers to the accumulation of copper ions in cells, which leads to instability of ferritin and aggregation of acylated proteins, resulting in oxidative stress-related cell death. Recent studies have shown that cuproptosis plays an important role in the occurrence and development of various pancreatic diseases, such as pancreatic cancer, acute and chronic pancreatitis, diabetes, pancreatic cysts, pancreatic injuries and pancreatic neuroendocrine tumor. The inducers of cuproptosis, such as disulfiram, chloroquinolones, and perilla phenols, alleviate pancreatic cancer by promoting cell cuproptosis. Copper chelators such as tetraethylenepentamine and tetrathiomolybdate promote the recovery of pancreatic injury by inhibiting cell cuproptosis. CONCLUSIONS: Cuproptosis plays a crucial role in the pathogenesis of pancreatic diseases. Further research on the cuproptosis pathway may become a potential target for the treatment of pancreatic diseases.

Animals↗

Nurse-led titration models of care for heart failure reduced ejection fraction: a systematic narrative review of characteristics, patient outcomes, and healthcare resource utilization.

AIMS: Nurse-led titration (NLT) models of care assist with delivery of guideline directed medical therapy for patients with heart failure with reduced ejection fraction (HFrEF). Effectiveness of NLT is established but there is limited information of characteristics of models, patient outcomes and healthcare resource utilization. To build upon the existing evidence by providing a systematic narrative review of the literature of NLT of medications for patients with HFrEF. This review syntheses characteristics of NLT models of care, patient outcomes and healthcare resource utilization. METHODS AND RESULTS: A systematic narrative literature review with systematic search strategy, identification of results, thematic analysis and narrative synthesis. A search was conducted from 2012 to 2025 in Medline, Cinahl complete, Embase and Cochrane. Sixteen studies of NLT models of care were identified from 1944 screened records. Characteristics of models of care were participation of nurses, multidisciplinary teams, follow-up and common features of service delivery. Patient outcomes of mortality were favourable for those that received NLT. There is some evidence of changes in healthcare resource utilization; studies in which the NLT groups received more HF nurse visits and greater HF medication use also reported reduced rehospitalizations. CONCLUSION: Findings reinforce the published benefits of NLT. Additional studies examining adverse events and quality-of-life outcomes are needed to strengthen the evidence base. Several studies suggest a shift in resource use with NLT, highlighting the need for an economic evaluation to inform a cost-effective model of care.

Humans↗

The meaning of family routines in a homeless shelter.

OBJECTIVE: This exploratory investigation sought to understand what meaning parents, living in a homeless shelter, attribute to family routines and the nature of those routines. METHOD: In-depth interviews were conducted with 12 parents living in a homeless shelter. Thematic analysis was employed to develop descriptive codes and themes from transcribed data and field notes. RESULTS: Parents described family routines focused on three features: promoting intimacy, maintaining or developing a legacy, and connections with the community. These routines seemed to preserve family integrity while homeless and to provide hope for the family to continue into the future. CONCLUSIONS: Homeless parents, in this investigation, seemed to expend a substantial amount of energy to create or maintain family routines while living in a homeless shelter. Findings suggest that occupational therapy services may help support homeless parents as they exercise their role as the organizer of family routines.

Activities of Daily Living↗

Rehabilitation services for patients undergoing peritoneal dialysis in Hong Kong.

AIM: To examine whether rehabilitation services are provided to patients undergoing peritoneal dialysis in Hong Kong, and the impact of such services on patients' lives. METHOD: Semi-structured interviews were conducted with 30 participants. Transcripts were analysed using thematic content analysis. Categories and codes were identified from the first 21 interviews, but questioning continued throughout the process to saturate the categories. FINDINGS: Rehabilitation is not provided to patients undergoing peritoneal dialysis in Hong Kong. Most support services are initiated by patients themselves. CONCLUSION: To enable these patients to lead productive lives, efforts should be made to provide them with the required medical information to help them make choices. Nurses should provide appropriate training to peer counsellors and regular exercise should be encouraged to allow patients to maintain physical health and mobility. Support for retraining and employment is also important. Counselling on finding a purpose through other roles is beneficial for those who cannot return to work.

Activities of Daily Living↗

General practitioners and women with urinary incontinence.

BACKGROUND: Urinary incontinence is a common problem for adult women. It results in a large financial and psychosocial cost. Much urinary incontinence goes unreported. Women with urinary incontinence can be successfully assessed and treated in general practice but studies have shown that many GPs manage the condition inadequately. AIM: This study aims to examine GPs' awareness of urinary incontinence in women and their management of, and attitudes to, female urinary incontinence. METHOD: A qualitative study was conducted with 21 GPs responding to semi-structured interviews. Thematic analysis was carried out on these interviews, with recurrent views and experiences being identified and grouped. RESULTS: The interviews of 11 male and nine female GPs were suitable for analysis. GPs were aware of the prevalence and under-reporting of urinary incontinence in women. Many were unhappy with their own management of the condition and with the management options available to them. Male GPs in particular were reluctant to carry out gynaecological examinations, and few GPs expressed enthusiasm for teaching pelvic floor exercises or bladder drills. Medications were frequently used but generally considered ineffective or intolerable. The services of both public health nurses and practice nurses were under-used, largely because of lack of training in this area. Although incontinence nurses were employed in the area, many GPs did not know of their availability and, of those who did, few referred to them more than infrequently. CONCLUSION: This study demonstrates that many GPs avoid dealing with the problem of urinary incontinence in women and that they find it to be a difficult, chronic problem to treat. Specialist options seem not to be useful in general practice. The findings need to be explored in other GP settings.

Aged↗

Behind the Curtain of Care. Nurses' Experiences Providing Care to Consumers With Alcohol and Other Drug Issues: A Qualitative Scoping Review.

AIM: To scope and synthesise qualitative literature relating to nurses' experiences of providing care to consumers with alcohol and other drug issues and explore how meaning is constructed in practice. DESIGN: Scoping review. METHODS: A scoping review was conducted following Arksey and O'Malley's framework. Findings were analysed using thematic analysis. DATA SOURCES: Systematic searches were conducted between September and November 2025 across Medline, Emcare, CINAHL and Google Scholar, using controlled vocabulary and keywords relevant to nurses' experiences of providing care to consumers with alcohol and other drug issues. RESULTS: Twenty-four studies from 12 countries were included. Seven themes were identified: emotional aspects of care, education, training and skills in practice, the spectrum of stigma, ethical issues in professional practice, navigating pain management, limited support, and how meaning is constructed in practice. CONCLUSION: Nurses' experiences of providing care to consumers with alcohol and other drug issues are shaped by multiple intersecting factors influencing care delivery and professional practice. Further research is needed to examine how workplace culture, language and interpersonal interactions influence healthcare experiences, and inform education, service development and support needs. REPORTING METHOD: Reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

alcohol and other drugs↗

[Thematic and methodological analysis of investigation in primary care (1988-1992)].

OBJECTIVE: To describe Spanish scientific output in primary care with regard to subjects, design and statistical methods employed and also its appropriateness, importance and funding. DESIGN: Descriptive, longitudinal and retrospective study. SETTING: Spanish scientific output in primary care published in medical journals and listed in the Indice Medico Español during the five year period 1988-1992. MATERIAL: 446 original articles published in thirty-four journals. MEASUREMENTS AND MAIN RESULTS: The greatest percentage of articles came under the heading "policy and health" (23.6%), next was "health services" (14.8%). There was a predominance of observational designs (79.9%) and within this category, descriptive studies (67.1%). The most common statistical methods used were contingency tables (35,9%). The majority of articles (94.8%) do not indicate the source of their funding. The appropriateness was around 50% and the importance around 4%. CONCLUSIONS: According to our study, research into primary care centres on the evaluation and organization of the health services. The majority of the designs have little inferential power and simple statistical methods. There is hardly any funding available, and only a half of the articles comply with appropriateness criteria.

Longitudinal Studies↗

Access to the world after myocardial infarction: experiences of the recovery process.

Myocardial infarction (MI) is a traumatic health event and at the same time a transition of vital importance in human life. The purpose of this study was to elucidate recovery patterns after myocardial infarction with regard to the content of patients' experiences. The study used a descriptive design and a qualitative method. Interviews with 16 men and women were performed, and data were subjected to a thematic content analysis. The recovery process had a pattern of ability, restraints, and reorientation. Through self-help and help from others, the mutual sharing of burdens, and clarifying restraints to recovery, the recovery process progressed toward reorientation. New values and motivation for change, as well as a new balance within the self and relationships were found. The MI had been integrated into life and, through the recovery process, patients' attitudes were better focused, leading to an enhanced quality of life.

Activities of Daily Living↗

The experiences of the registered nurse caring for the person dying of cancer in a nursing home.

This paper reports on research that set out to identify and describe the experiences of the registered nurse caring for the resident dying of cancer in a nursing home. The research method used was a qualitative single case study involving five registered nurses in one nursing home. Thematic analysis of data from unstructured interviews and reflective journals was used to explicate the nurses' experiences. Four major themes were extracted from the data. These themes were the exclusivity of the relationships, difficulties in the management of pain, the expectations of the registered nurse and the impact of caring. The nurses' experiences were loving, fascinating, compelling and rich. The overarching experience of the nurses came from the relationship they formed with the residents. A crucial finding in this study was that these registered nurses valued the elderly resident and developed meaningful relationships with them. All aspects of the relationships were unique and profound. However, the emotional involvement with the resident, multiple death losses, confrontation of personal losses, limited workplace support such as counselling, potentially places these registered nurses at emotional risk from burnout and complicated bereavement. The implications of these findings for nursing practice, education and research are discussed.

Adaptation, Psychological↗

Mature women's experiences of preregistration nurse education.

BACKGROUND: The government of the United Kingdom is encouraging more flexible recruitment strategies to overcome the shortage of qualified nurses. Mature women returning to education, often after completing their families, are a major target, but there has been little evaluation of their experiences as higher education students of nursing. AIM: The aim of the study was to follow-up a previous quantitative study of mature women students' outcomes on preregistration diploma courses in order to gain a deeper understanding of their experiences, and consider ways in which their needs might be addressed. METHODS: Five focus groups were conducted in one higher education institution, and data were analysed using thematic analysis, assisted by the 'spike' feature of Word for Windows. FINDINGS: Three major themes were identified: 'Didn't know what to expect', 'Reality shock' and 'Learning the game'. Subthemes of 'Learning the game' were 'Academic study', 'Practice placements and shift work', 'Managing the effect of course workload on domestic roles', 'Personal growth and changing relationships', and 'Support systems and friendships'. CONCLUSIONS: The findings are discussed in relation to reports of women's experiences in higher education in general. We conclude that the situation and needs of mature women preregistration nursing students are such that fundamental curriculum redesign is needed so that they can participate in higher education in ways that allow integration of their family and student lives, and permit them to benefit from the higher education experience in the same ways as younger students. The study is limited by its local nature, but the findings mirror those of other work, giving reassurance of its wider applicability. Recommendations are made for changes in the philosophy and organization of future programmes to improve their appropriateness and acceptability to mature women nursing students.

Adult↗

Forensic psychiatric nursing: a literature review and thematic analysis of role tensions.

This literature review was undertaken to explore the emergent issues relating to the difficulties encountered in forensic psychiatric nursing. The rationale for the study revolved around the paucity of research undertaken to identify the constituent parts of this professional practice. The aims included both a thematic analysis of the literature and the construction of a theoretical framework to guide further research. The method was a snowballing collection of literature and a computerized database search. The results were the identification of a series of major issues, which were broadly categorized as negative and positive views, security vs. therapy, management of violence, therapeutic efficacy, training and cultural formation. From this the six binary oppositions, or domains of practice, emerged as a theoretical framework to develop further research. These were medical vs. lay knowledge, transference vs. counter-transference, win vs. lose, success vs. failure, use vs. abuse, and confidence vs. fear. Further research is currently underway.

Clinical Competence↗

Obstacles to shared care for patients with dementia: a qualitative study.

BACKGROUND: All Primary Care Trusts in England were meant to have shared care protocols for antidementia medication use in place by 1 April 2004. Shared care of medical treatment in dementia depends upon early diagnosis, but under-recognition of and under-response to dementia appear widespread in general practice. AIM: To investigate the perceptions of specialists and generalists about the potential for shared care of people with dementia. DESIGN OF STUDY: Qualitative study with semistructured interviews. SETTING: Three inner-city and two rural areas. METHODS: Semistructured interviews were arranged at the participants' convenience and were tape-recorded and transcribed. Thematic analysis of the anonymized transcripts was undertaken and a case and cross-case analysis was performed. RESULTS: Thirty-nine GPs and 30 specialists were interviewed. Broad themes were reduced to following four key categories which appear to be layered over each other: therapeutic nihilism; risk reduction or avoidance; concerns about competency; and resources for shared care. CONCLUSION: Roles for primary and secondary care professionals are inappropriately distributed and require clearer definition. Resistance to shared care mostly comes from within general practice and reflects concerns about staffing, time constraints, lack of experience and confidence in making and disclosing a diagnosis. Developers of shared care protocols must dissect layered obstacles, addressing the issues of therapeutic nihilism, risk management and clinical competence.

Adult↗

Caring for older patients at an emergency department -- emergency nurses' reasoning.

AIM: The aim of the study was to use the experiences of emergency nurses to illuminate what constitutes good nursing care for patients 75 years or older transferred to emergency departments. BACKGROUND: Emergency departments have a medical technical character and the number of visits there increases dramatically as people age. Older patients require increased healthcare services in terms of nursing care, interventions and hospitalizations due to an increased complexity of their problems. For these reasons it is important to study what good nursing care of the older patients consists of at an emergency department from the emergency nurses' point of view. METHOD: Ten emergency nurses from a university hospital emergency department in Sweden were interviewed. A thematic content analysis was performed. RESULTS: The study showed that it was necessary to be knowledgeable, to be understanding of the older patients' situation and to take responsibility for them in order to be able to provide good nursing care. The emergency nurses shifted focus from describing the central aspect of good nursing care to describing what hinders the provision of it. Their experience was that prioritizing medical procedures, everyday tasks and routines threatens good nursing care of older patients in emergency departments. The emergency nurses held that the older patient is often sent to an emergency department where the level of care is not appropriate to their needs. CONCLUSIONS: The result can be seen as a challenge for the organization and the nurses in the future; to prioritize differently, thereby maintaining a balance between good nursing and medical/technical tasks when treating older patients. RELEVANCE TO CLINICAL PRACTICE: The present day healthcare system is not organized to appropriately meet the needs of the older patients. Nurses themselves hold they can better serve the older patient. By sharing their experiences, both can be accomplished.

Aged↗