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PubMed2002

A comparison of predictors of the adolescent intention to smoke with adolescent current smoking using discriminant function analysis.

OBJECTIVES: This paper explores one possible operationalization of smoking intention to assist development of adolescent smoking intervention programmes. Such programmes usually focus on predictors of current smoking, ignoring predictors of intentions to smoke, or how intentions relate to actual future smoking. DESIGN AND METHODS: Respondents took part in two stages of a repeated measures national survey on Australian adolescent smoking behaviour (12-month interval between administrations). A total of N=1419 adolescents provided matched data, measuring personal smoking habits, intentions of smoking behaviour, stress (seven subscales), self-esteem and response to the General Health Questionnaire (GHQ-12). RESULTS: A comparison of discriminant function predictors showed similarity between the current smoking and intention to smoke, with only one predictor differing between the functions. Non-smokers were more behaviourally consistent with their stated non-smoking intention over 12 months (i.e. remain non-smokers) than smokers (i.e. intention seemed unrelated to actual behaviour). CONCLUSIONS: While the predictors give no general indication of whether the processes behind the intention to smoke differ from current smoking, the intention to smoke may be a better focus for intervention with smokers given the apparent inconsistency with stated intention. Intervention for non-smokers may be usefully focused on maintaining non-smoking rather than preventing smoking.

Journal Article↗

PubMed1981

Intention and uncertainty at later stages of childbearing: the United States 1965 and 1970.

While births may be dichotomous, fertility intentions are not inherently so. Intentions are predictions about the future and, as such, are couched in considerable uncertainty. Ignoring this uncertainty hides much of what could be learned from data on fertility intentions. This paper presents a model which allows analysis of the full range of intentions. This paper presents a model which allows analysis of the full range of intentions. After selecting a sample of women in the later stage of childbearing (e.g., those who intend fewer than two additional children) from the 1965 and 1970 National Fertility Studies, it is shown that: (1) substantial portions of women at this stage of the reproductive life cycle were indeed uncertain of their parity-specific intention; (2) this certainty, like more firm intentions, varies by age and parity as the model predicts; and (3) there were significant shifts in the level of certainty between 1965 and 1970. Specifically, while intentions for third, fourth, and fifth births declined, more women "didn't know" if they intended to have another child or not. Among those not intending another child, more seemed uncertain of this intention in 1970 than did comparable women in 1965. In contrast, those intending another child seemed more certain. These changes in intention and uncertainty indicate that the observed decline in intended parity was tentative. Post-1970 evidence suggests that this tentative decline has become an equivocal one.

Adolescent↗

PubMed2026

Global prevalence and associated factors of turnover intention among intensive care nurses: A systematic review and meta-analysis.

OBJECTIVES: To estimate the global prevalence of two distinct turnover intentions among intensive care unit (ICU) nurses-intention to leave the ICU and intention to leave the nursing profession-identify significant sources of heterogeneity, and synthesise associated psychosocial factors. METHODS: Ten databases were systematically searched from inception to September 28, 2025. Two reviewers independently conducted study selection, data extraction, and quality appraisal using Joanna Briggs Institute checklists. Random-effects meta-analyses were performed to estimate pooled prevalence and associated factors. Subgroup and meta-regression analyses explored potential sources of heterogeneity. Associated factors were pooled as odds ratios (ORs) and interpreted within an integrated Job Demands-Resources and Theory of Planned Behavior framework. RESULTS: Forty-six studies published between 2007 and 2025, involving 39,246 ICU nurses, were included. The pooled prevalence was 30.7% for intention to leave the ICU and 27.5% for intention to leave the nursing profession. Significant sources of heterogeneity included ICU type, geographic region, publication year, study design, measurement tool, and sampling method. Depression, burnout, high workload, and unsafe patient-to-nurse ratios were associated with increased turnover intention, whereas positive work environments, perceived organisational support, and nursing competence were protective factors. No significant publication bias was detected. CONCLUSIONS: Turnover intention affects approximately one-third of ICU nurses globally and varies across clinical and geographical contexts. Excessive workload, inadequate organisational support, and unfavourable work environments appear to be important contributors to turnover intention among ICU nurses. IMPLICATIONS FOR CLINICAL PRACTICE: Strategies to reduce turnover intention among ICU nurses should focus on reducing excessive workload, improving staffing conditions, strengthening organisational support, and fostering positive work environments. Promoting supportive and sustainable ICU work environments may help improve nurse retention and maintain the quality of critical care services.

Humans↗

PubMed2006

Category essence or essentially pragmatic? Creator's intention in naming and what's really what.

Daily experience is filled with objects that have been created by humans to serve specific purposes. For such objects, the very act of creation may be a key element of how people understand them. But exactly how does creator's intention matter? We evaluated its contribution to two forms of categorization: the name selected for an artifact, and intuitions about what an artifact "really" is. To contrast the possibility that intention serves as an essence (Bloom, P. (1996). Intention, history, and artifact concepts. Cognition, 60, 1-29; Bloom, P. (1998). Theories of artifact categorization. Cognition, 66, 87-93.) determining an artifact's name with the possibility that it matters through its relevance to discourse goals, participants in three experiments read scenarios about people interacting with an artifact and then judged the suitability of different names for it. The intention of the creator was of differing degrees of relevance to the communication, and the relevance of other aspects of the entity varied in a complementary fashion. We found that name selection was altered by the communicative goals of a situation, and name choice was most consistent with creator's intention when the situation made intention relevant to achieving those goals. In a fourth experiment, we used the same scenarios to test the possibility that intention serves as an essence determining intuitions about what an object "really" is. The impact of creator's intention was modulated by the discourse context. These findings suggest that creator's intention influences both name choice and intuitions about what something "really" is by virtue of its impact on how communicative goals are best realized.

Humans↗

PubMed2003

Predictors of community women's osteoporosis prevention intention--a pilot study.

The main purpose of this pilot study was to identify the predictors of community women's osteoporosis prevention intention. The osteoporosis assessment scales were self-developed and contained 5 scales: a demographics scale, a health status scale, an osteoporosis health belief scale (OHBS), a knowledge scale, and a prevention intention scale. The content validity of the five scales ranged from.90 to 1.00. Test-retest was used to examine the reliability of the demographic characteristics scale and the health status scale, which ranged from.9 to 1.0. Meanwhile, the reliability coefficients of the OHBS comprising perceived susceptibility, perceived seriousness, perceived benefit, and perceived barrier were .75, .90, .80, and .72. In this pilot study, the coefficient of KR-20 for osteoporosis knowledge was .88. The value of Cronbach 's Coefficient Alpha for prevention intention was .85. The results of this research were : (1) The averaged scores of the OHBS comprising perceived susceptibility, perceived seriousness, perceived benefit, and perceived barrier were 2.8 (SD = 0.5), 2.2 (SD = 0.7), 1.9 (SD = 0.4), and 2.9 (SD = 0.7). Meanwhile, the averaged score for women's knowledge on osteoporosis was 10.0 (SD = 2.8). The averaged score for women's intentions for the prevention of osteoporosis was 2.5 (SD = 0.6). (2) There were some significant correlations between OHBS and demographics, health status, knowledge, and prevention intention. (3) Knowledge was positively correlated with perceived barriers, prevention intention, age, self-rated score for health, breast feeding time, and amount of calcium intake. (4) Prevention intention was positively correlated with knowledge, number of children, age of fracture, and hormone replacement therapy. (5) The major factors influencing intention for community women were, in order, knowledge, educational level (high school graduate), number of children (n = 2), self-rated health score, experience of bone density examination (yes), hormone replacement therapy (yes), and kyphosis (yes). These seven items accounted for 45.8% of the variation in intention. The results of this pilot study can help community health professionals evaluate, implement and improve community women's health beliefs regarding prevention of osteoporosis.

Adult↗

PubMed2004

A history of major depressive disorder influences intent to die in violent suicide attempters.

BACKGROUND: The inconsistency of the results obtained in biological studies of suicidal behavior may be due to the use of broad categories lacking validity. In previous genetic studies, in which we identified an association between a serotonin-related gene and violent suicide attempts, we suggested that a history of major depressive disorder (MDD) might influence this association. In this study, we aimed to clarify the relationships between the violence of suicide attempts, intent to die, and depression in a large sample of suicide attempters. METHOD: We investigated intent to die, according to history of violent suicide attempts and MDD, in 502 consecutively admitted suicide attempters. We characterized patients in terms of lifetime DSM-IV Axis I diagnoses, suicidal intent (Beck Suicide Intent Scale), and history of violent suicide attempts. RESULTS: Suicidal intent, for both the last suicide attempt before admission and the most lethal suicide attempt, was higher in those with history of MDD (p =.03 and p =.04, respectively) but was not affected by history of violent suicide attempt. In violent suicide attempters, suicidal intent was higher in patients with a history of MDD than in patients with no such history (p =.04 for last suicide attempt and p =.02 for most lethal attempt), whereas MDD had no effect on suicidal intent in nonviolent suicide attempters. CONCLUSION: Violent suicide attempters constitute a heterogeneous group in terms of suicidal intent. Our results suggest that biological and genetic studies should take into account the method used to attempt suicide, intent to die, and history of MDD.

Adult↗

PubMed2003

The surgical treatment of cancer: a comparison of resource utilization following procedures performed with a curative and palliative intent.

BACKGROUND: Costs associated with the provision of medical care continue to escalate. Therefore, providers must evaluate the cost-effectiveness and benefit to individual healthcare practices. The authors evaluated the immediate and short-term resource utilization needs of patients undergoing surgical intervention with curative or palliative intent. METHODS: Three hundred two patients undergoing surgery with therapeutic intent were observed from the time of admission for intervention until the time of death or until 6 months from the time of the surgical procedure. Surgeons preoperatively identified each case as either curative or palliative in intent. Demographic information, as well as the nature of all interactions with the cancer center, was recorded. RESULTS: Surgeons identified 58 (19%) procedures as palliative and 244 (81%) as curative in intent. Demographic characteristics between the two groups were similar, although recurrent or metastatic disease was more often present in palliative rather than curative patients (P = 0.0078) and palliative intent patients were more likely to have received previous therapy. During the 6-month period, 4690 encounters occurred with the cancer center. The mean number of encounters per patient in each group was similar, although curative intent patients were more likely to have visits with therapeutic intent including chemotherapy administration (P = 0.01), radiation (P = 0.003), or repeat surgical procedures (P = 0.006). In contrast, palliative patients were more likely to be admitted for management of symptoms (P = 0.0001) and had fewer hospital-free days than did curative patients (P = 0.0069). CONCLUSIONS: The average number of encounters for patients undergoing treatment of disease was not significantly different, suggesting that patients undergoing surgery with palliative intent do not require a greater amount of resources than curative intent patients. The nature of the interactions, however, was different, suggesting that resource needs are different and may need to be anticipated in the assessment of how better quality outcomes can be achieved in the palliative surgery setting.

Adolescent↗

PubMed1996

Adolescents and the contraceptive pill: the impact of beliefs on intentions and use.

OBJECTIVES: To determine which beliefs about the contraceptive pill predict adolescent females' intentions to use the pill and their actual pill use, and to examine how intentions toward other birth control methods influence adolescents' intentions to use the pill and their eventual pill use. METHODS: Three hundred forty-five adolescents were interviewed about their beliefs regarding the consequences of using the pill and about their intentions to use the pill and other contraceptive methods. Follow-up interviews were conducted 1 year later, during which subjects reported their sexual activity and oral contraceptive use over the course of the year. RESULTS: Concerns about health and physical appearance differentiated subjects who intended to use the pill from those who did not, those who reported actually using the pill at all from those who did not, and those who did or did not use the pill consistently. The impact of beliefs differed between sexually active subjects and those who first had sex after the initial interview. Intentions to use withdrawal were negatively related to subjects' use of the pill (beta = -0.19, P < .05), although intentions to use condoms were unrelated to pill use. Intentions toward abortion were unrelated to either intentions to use the pill or eventual pill use. CONCLUSIONS: Female adolescents' beliefs about the contraceptive pill predicted their initial intentions to use the pill and their actual pill use over the course of a year. Adolescents may view withdrawal-although apparently not condoms-as an alternative to pill use. Abortion appears to be a backup to pill use rather than a substitute.

Abortion, Induced↗

PubMed2005

Relations between normative beliefs and initiation intentions toward cigarette, alcohol and marijuana.

PURPOSE: To examine the relations between normative beliefs and intentions to initiate cigarette, alcohol, and marijuana use among adolescents reporting no prior use. METHODS: An anonymous questionnaire was administered to 6,594 seventh- to twelfth-grade students in northeast Ohio. Separate analyses were conducted on sub-samples of respondents reporting no prior use of each substance. Within each of these 3 sub-samples, respondents were classified as holding high-risk intentions if they reported that they intended to begin using that particular substance within the next 6 months or were "not sure" of their intentions. Those reporting that they did not intend to start using a substance were classified as holding low-risk intentions. Multivariate logistic regression analyses examined the relations between normative beliefs and intention status (low- vs. high-risk), while accounting for socio-demographic characteristics. RESULTS: Across all 3 substances, normative beliefs were stronger predictors of intention status than socio-demographic variables. Higher levels of perceived acceptability and perceived prevalence were associated with holding high-risk intentions. Normative belief measures assessing close friend and sibling reference groups were much more important in explaining intention status than those assessing other reference groups (e.g., same age peers). CONCLUSIONS: Among adolescents with no prior use, normative beliefs concerning close friends and siblings may play an important role in the catalysis and support of intentions to initiate substance use. These findings challenge the utility of primary prevention strategies that provide normative feedback based on rates of substance use among distal reference groups.

Adolescent↗

PubMed2003

The effect of a psychiatric attachment on students' attitudes to and intention to pursue psychiatry as a career.

OBJECTIVES: This study examined determinants of students' attitudes to psychiatry and intentions to pursue psychiatry as a career, considering: (1) experiences during the clinical attachment; (2) type of curriculum (traditional or problem-based), and (3) student characteristics (age and gender). The relationships between attitudes, career intentions and academic performance were examined. METHOD: Fourth year medical students (n = 379) completed questionnaires at the beginning and end of an 8-week psychiatry attachment to assess their attitudes to psychiatry, career intentions and experiences during the attachment. Students completed two assessments consisting of a multiple choice paper and a clinical viva. Consecutive cohorts of students receiving a traditional curriculum (n = 188) and a problem-based curriculum (n = 191) were compared. RESULTS: Students' attitudes to psychiatry improved and intentions to pursue psychiatry as a career increased during the attachment. These changes were predicted by specific experiences during the attachment, such as receiving encouragement from consultants, seeing patients respond well to treatment and having direct involvement in patient care. There was no difference in change in attitudes or career intentions between the two cohorts. Students with more favourable attitudes or career intentions at the outset did not report more favourable experiences during the attachment. Attitudes and career intentions were unrelated to performance in psychiatry assessments. Improvement in attitudes was related to an increased intention to pursue psychiatry as a career. CONCLUSIONS: Change in attitudes and career intentions was dependent on the actions of the clinical teachers. Undergraduate teachers may have an important influence on the numbers of doctors who choose this specialty as a career.

Adult↗

PubMed2001

The influence of self-efficacy and past behaviour on the physical activity intentions of young people.

The aim of the present study was to assess the influence of self-efficacy and past behaviour on young people's physical activity intentions using an augmented version of Ajzen's Theory of Planned Behaviour. We hypothesized that self-efficacy would exhibit discriminant validity with perceived behavioural control and explain unique variance in young people's intentions to participate in physical activity. We also expected that past physical activity behaviour would attenuate the influence of attitude, subjective norms, perceived behavioural control and self-efficacy on intention. The sample comprised 1,152 young people aged 13.5 +/- 0.6 years (mean +/- s) who completed inventories assessing their physical activity intentions, attitudes, subjective norms, perceived behavioural control, self-efficacy and past physical activity behaviour. A confirmatory factor analysis demonstrated that the constructs of the Theory of Planned Behaviour achieved discriminant validity. Furthermore, the measures of attitudes, subjective norms, perceived behavioural control and self-efficacy were significantly related to their respective belief-based measures, supporting the concurrent validity of the measures of the Theory of Planned Behaviour. A non-standard structural equation model demonstrated that attitude and self-efficacy were strong predictors of physical activity intention, but perceived behavioural control and subjective norms were not. Self-efficacy attenuated the influence of attitudes and perceived behavioural control on intention. Past behaviour predicted intention directly and indirectly through self-efficacy and attitude. The present findings demonstrate that young people with positive attitudes and high self-efficacy are more likely to form intentions to participate in physical activity. Furthermore, controlling for past physical activity behaviour revealed that the unique effects of self-efficacy and attitudes on young people's physical activity intentions were unaltered.

Adolescent↗

PubMed2000

Essential tremor and cerebellar dysfunction clinical and kinematic analysis of intention tremor.

The cerebellum is assumed to play a major role in the pathophysiology of essential tremor (ET). As intention tremor is considered one of the classical features of cerebellar disease, we have assessed a large group of patients with ET for the semiology of the tremor and have performed objective quantitative analysis of a grasping movement in patients with ET, cerebellar disease and a normal control group. We found 25% of the patients to have a moderate or severe kinetic tremor with clear-cut features of a classical intention tremor. Another 33% of the patients had a mild intentional component of their kinetic tremor. Patients with intention tremor (ET(IT)) did not differ from those with predominant postural tremor (ET(PT)) with respect to alcohol sensitivity of the tremor and the frequency of a family history. ET(IT) patients were older and more often showed head and trunk involvement. The onset of this intention tremor has been assessed retrospectively. It was found to begin at a randomly distributed time interval after the onset of the postural tremor, but older patients had a shorter time to development of intention tremor. Quantitative accelerometry of postural tremor showed similar tremor frequencies in both patient groups, but ET(IT) patients had a slightly larger tremor amplitude. Quantitative analysis of a grasping movement using an infrared-camera system was performed in two subgroups of the patients with ET(PT) and ET(IT) and control groups with cerebellar disease or normal subjects. The intention tremor could be quantified objectively as an increased amplitude of curvature during the deceleration and target phase of the movement. The amplitude measurements of intention tremor were clearly abnormal and of comparable magnitude for ET(PT) and cerebellar disease. Additionally, the patients with ET(IT) had a significantly slowed grasping movement during the deceleration and target period. Hypermetria was significantly increased for the patients with ET(IT) and cerebellar disease. We conclude that intention tremor is a feature of ET. ET(IT) patients have abnormalities of their upper limb function compatible with cerebellar disease. This suggests that patients with more advanced ET show abnormalities of cerebellar functions.

Adolescent↗

PubMed2004

What determines future smoking intentions of 12- to 13-year-old UK African-Caribbean, Indian, Pakistani and white young people?

It is important to know when designing adolescent smoking interventions how ethnicity and gender influence intention. This paper reports an investigation into how ethnicity influences the smoking intentions of disadvantaged UK African-Caribbean (n = 275), Indian (n = 397), Pakistani (n = 687) and white (n = 1792) 12-13 year olds. The Attitudes-Social influences-Efficacy (ASE) model underpinned the study. It states that ASE determinants (advantages, disadvantages, social acceptance, social norms, modelling, perceived pressure and self-efficacy) directly influence behavioural intention. External factors (country, ethnicity and gender) indirectly influence intention by influencing ASE determinants. ASE determinant scores and future smoking intentions were measured. Linear regression analyses showed that smoking intention varied by ethnicity and gender. Differences in ASE scores largely explained these variations. Ethnicity and gender did not modify the predictive effects of equivalent ASE determinant scores on intention. Being a white boy had a small independent direct influence on intention, which was ascribed to affective beliefs underpinning fitness and sporting prowess. Otherwise, ethnicity had no independent direct effects on intention. Culturally appropriate interventions that aim to change cognitions underpinning ASE determinants and, thus, ASE scores would, consequently, be expected to be equally effective amongst disadvantaged UK African-Caribbean, Indian, Pakistani and white adolescents.

Adolescent↗

PubMedDate not supplied

The role of psychopathology and suicidal intention in predicting suicide risk: a longitudinal study.

OBJECTIVE: In this study, we describe psychological symptoms, any relationship with suicidal intention in a sample of subjects recently attempting suicide and the predictive value of this association in later completed suicide. METHODS: An assessment was made of 467 suicidological consultations carried out by the Suicidology Unit of the Department of Neurology and Psychiatry, University of Padua, on 421 patients admitted to hospital following attempted suicide in the 5-year period 1990-1994. Suicidal intention was appraised by the Intent Score Scale (ISS). Suicide mortality was assessed after a mean follow-up period of 3.5 years. RESULTS: Psychiatric evaluation was completely negative in only 8% of cases. The most commonly identified symptom was depressed mood (79% of cases, 22% severe depression), followed by anxiety (43% of cases, 32% severe anxiety). From the study, it emerged that psychopathology seemed to influence suicidal intent, where this was characterized by severe depression. Anxiety and other symptoms appeared to have a secondary role. Assessments of suicidal intent showed that intention heightened as the number of symptoms increased. The symptom 'anxiety' did not prove to have a significant bearing on assessment of the seriousness of suicidal intention, whereas severely depressed mood did. The total number of subsequent suicide victims was 5.5%. During consultation relating to the index parasuicide, these subjects did not manifest a discriminate psychopathological profile (the only distinguishing characteristic was anxiety, which was less frequently identified in suicide victims), but did present a more positive personal and family psychiatric history. CONCLUSIONS: In subjects who had recently attempted suicide, the psychopathological profile appeared to be related to suicidal intent, where this was characterized by severe depression. Anxiety and other symptoms seemed to have a secondary role. Nonetheless, both total scores and subscores should be taken into consideration when assessing suicidal intention through the ISS. The psychopathological profile and ISS score following attempted suicide do not appear to permit prediction, in the medium to long term, of subsequent completed suicide.

Adult↗

PubMed2006

Do self- reported intentions predict clinicians' behaviour: a systematic review.

BACKGROUND: Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice. Several interventions have been shown to be effective in changing health care professionals' behaviour, but heterogeneity within interventions, targeted behaviours, and study settings make generalisation difficult. Therefore, it is necessary to identify the 'active ingredients' in professional behaviour change strategies. Theories of human behaviour that feature an individual's "intention" to do something as the most immediate predictor of their behaviour have proved to be useful in non-clinical populations. As clinical practice is a form of human behaviour such theories may offer a basis for developing a scientific rationale for the choice of intervention to use in the implementation of new practice. The aim of this review was to explore the relationship between intention and behaviour in clinicians and how this compares to the intention-behaviour relationship in studies of non-clinicians. METHODS: We searched: PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Science/Social science citation index, Current contents (social & behavioural med/clinical med), ISI conference proceedings, and Index to Theses. The reference lists of all included papers were checked manually. Studies were eligible for inclusion if they had: examined a clinical behaviour within a clinical context, included measures of both intention and behaviour, measured behaviour after intention, and explored this relationship quantitatively. All titles and abstracts retrieved by electronic searching were screened independently by two reviewers, with disagreements resolved by discussion. DISCUSSION: Ten studies were found that examined the relationship between intention and clinical behaviours in 1623 health professionals. The proportion of variance in behaviour explained by intention was of a similar magnitude to that found in the literature relating to non-health professionals. This was more consistently the case for studies in which intention-behaviour correspondence was good and behaviour was self-reported. Though firm conclusions are limited by a smaller literature, our findings are consistent with that of the non-health professional literature. This review, viewed in the context of the larger populations of studies, provides encouragement for the contention that there is a predictable relationship between the intentions of a health professional and their subsequent behaviour. However, there remain significant methodological challenges.

Journal Article↗

PubMedDate not supplied

Job turnover intentions among Certified Pharmacy Technicians.

OBJECTIVE: To describe the job withdrawal intentions of a nationwide sample of Certified Pharmacy Technicians (CPhTs). DESIGN: Cross-sectional descriptive design. SETTING: A random sample of 3,200 CPhTs whose names and contact information were acquired from the Pharmacy Technician Certification Board. INTERVENTIONS: Mailed survey. MAIN OUTCOME MEASURES: Responses to questions eliciting job withdrawal intentions, reasons for remaining/staying with the employer, and various quality of worklife attitudes. Employment intentions were regressed over quality of worklife and practice environment variables in a forward-conditional logistic regression procedure. RESULTS: Nearly 4 in 5 respondents indicated intentions to remain with the current employer during the next 12 months. Relationships with coworkers, good benefits, and work schedule were frequently cited as reasons to stay. Poor salary, lack of advancement opportunity, and insufficient staffing were cited frequently as factors among those indicating intentions to leave. Mean hourly wages differed among respondents with intention to leave due to salary, those not citing salary as a reason to remain or leave, and those citing salary as a reason for staying. Intention to remain was associated with higher pay, perceived employer support, number of years with the current employer, and lower career turnover intentions, with organizational commitment acting as a powerful mediator for all of the variables. CONCLUSION: Differences in CPhTs' future employment intentions were described more comprehensively by perceptions of the employing organization than by perceptions of managers/supervisors and coworkers or personal/work environment variables. Implications for pharmacy organizations are discussed.

Certification↗

PubMed2001

A rapid and systematic review of the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention.

BACKGROUND: Most surgically sutured wounds heal without any complication. However, in some cases wound healing can be delayed due to the presence of infection or wound breakdown. This can result in the wounds becoming cavity wounds and thus necessitate healing by secondary intention. Other surgical wounds that are not sutured but left to heal by secondary intention include abscess cavities such as perianal abscesses or breast abscesses. Surgical wounds healing by secondary intention are thought to heal more slowly than wounds healing by primary intention, especially if infection is present or healing is compromised by factors such as decreased blood supply, poor nutritional status or a general suppression of the immune response. Such wounds may contain dead tissue and have a moderate or high level of exudate. Debridement involves the removal of devitalised, necrotic tissue or fibrin from a wound. There are many different methods that can be used to debride a wound, which are broadly classified as surgical/sharp, biosurgical, mechanical, chemical, enzymatic and autolytic. Although it is generally agreed that the management of surgical wounds which contain devitalised tissue and are healing by secondary intention requires debridement, it is not always clear as to what is the best method or agent to use. There is currently a large selection of products with debriding properties available on the market, which vary considerably in cost. It is important that the choice of both debriding method and product is based on the best scientific evidence available, taking into account both cost and effectiveness data. OBJECTIVES: The review had two main objectives: (1) To determine the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention. (2) To evaluate the clinical effectiveness and cost-effectiveness of treating patients with surgical wounds healing by secondary intention at specialised wound care clinics as compared to conventional care. The review incorporated all debriding methods and any agent that is considered to have a debriding property. METHODS The following databases were searched using strategies designed specifically for each database: MEDLINE, EMBASE, CINAHL, HMIC (Health Management Information Consortium), CCTR via the Cochrane Library, the National Research Register (NRR), the NHS Economic Evaluation Database (NHS EED), and the Health Economic Evaluations Database (HEED). Additional references were identified through reviewing manufacturer and sponsor submissions made to NICE, the bibliographies of retrieved articles, and conferences proceedings on the Internet. Only randomised controlled trials (RCTs) or non-randomised controlled trials with concurrent controls and full economic evaluations were considered for inclusion. Only studies that evaluated some sort of debriding method or a specialised wound care clinic (a nurse with specialist training in wound care; care being provided by a multidisciplinary team; a fast-track referral system to other professions (e.g. dermatologist); or access to the latest health technology) were included in the review. Studies had to include participants with surgical wounds healing by secondary intention (e.g. cavity wounds, the consequences of wound dehiscence and abscesses) and report an objective measure of wound healing. Data were extracted by one reviewer and checked by a second. Quality assessment was conducted independently by two reviewers. Disagreements were resolved by consensus and, when necessary, by recourse to a third reviewer. The primary outcomes of interest were wound healing and cost. Results of data extraction and quality assessment were presented in structured tables and also as a narrative summary. In addition, where feasible, the results of individual studies were presented as forest plots. Studies were grouped according to the type of wound, debriding method and outcome measure used. RESULTS - CLINICAL EFFECTIVENESS: Seventeen trials met the inclusion criteria, all of which used the autolytic method of debridement. No studies were found that investigated sharp/surgical, biosurgical, mechanical, chemical or enzymatic debridement in the treatment of surgical wounds healing by secondary intention. No studies were found which investigated specialised wound care clinics that included the provision of care within a clinical setting (based in either primary or secondary care). The type of surgical wounds investigated by studies included in the review were those that had broken down postoperatively, perineal wounds resulting from proctolectomy or rectal excision, and those left open after pilonidal sinus excision or abscess incision, or wounds following a laparotomy. Four additional studies investigated treatment of postoperative wounds from toenail avulsions. (ABSTRACT TRUNCATED)

Clinical Trials as Topic↗

PubMed2005

Reasons for intentional weight loss, unintentional weight loss, and mortality in older men.

BACKGROUND: We have examined the relationship between intentional and unintentional weight loss and the reasons underlying intention to lose weight and all-cause mortality and mortality due to cardiovascular disease (CVD) and non-CVD causes in older men. METHODS: Prospective study of 4869 men aged 56 to 75 years drawn from general practices in 24 British towns, who in 1996 completed questionnaires about intentional and unintentional weight loss over the preceding 4 years and were followed up for a subsequent 7 years. RESULTS: Unintentional but not intentional weight loss was associated with a significant increase in risk of all-cause mortality compared with men who reported no weight change, even after adjustment for lifestyle characteristics and preexisting disease (adjusted relative risk [RR], 1.71; 95% confidence interval [CI], 1.33-2.19; and RR, 1.00; 95% CI, 0.91-1.10, respectively). Men who lost weight intentionally as a result of personal choice showed significant benefit in all-cause mortality (RR, 0.59; 95% CI, 0.34-1.00; P = .05), which was largely owing to a significant reduction in mortality from non-CVD causes (RR, 0.36; 95% CI, 0.15-0.87). The benefit in these men was most apparent in markedly overweight men (BMI [calculated as weight in kilograms divided by the square of height in meters] > or = 28) and in younger men (age < 65 years). Men who lost weight intentionally owing to ill health or physician's advice showed an increased risk of all-cause mortality (RR, 1.37; 95% CI, 0.96-1.94). No harm or benefit was seen for CVD mortality, irrespective of reasons for intentional weight loss. CONCLUSION: Intentional weight loss carried out for personal reasons is associated with a significant reduction in all-cause mortality in markedly overweight men, and the data suggest that the earlier the intervention, the greater the chance of benefit.

Age Factors↗