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Practical suggestions for community interventions using participatory action research.

Advanced practice nurses and nurse researchers with experience in clinical settings may encounter challenges in the initial development and implementation of community-based projects. Participatory action research methodology, a user-friendly framework for community-based research activities, provides a way for researchers and community members to work together to define a problem, take action, and evaluate their work. This article attempts to bridge the theory-implementation gap by describing background steps that researchers can use when conceptualizing and initiating a research project with community partners. Suggestions for initial steps and the planning and review cycles are presented, along with examples from the literature.

Community Health Nursing↗

Meeting the needs of minority ethnic patients.

BACKGROUND: Certain aspects of nursing care related to minority ethnic patients are being highlighted in the literature, but there is little exploration of nurses' experiences of caring for people from specific minority ethnic groups. AIM: This paper reports an investigation into the experiences of Registered Nurses caring for hospitalized Pakistani patients in the United Kingdom. METHOD: A qualitative study, with a sample of 30 Registered Nurses using semi-structured interviews. The sample was self-selecting from a large health care organization in the north of England, covering adult acute, critical and rehabilitation care settings. RESULTS: Interviewees had difficulty in explaining the meaning of culture and spirituality and their relationship to nursing practice. They also had limited understanding of the Pakistani community, and deficits were identified in meeting the challenges offered by this community. Inadequate implementation of 'holism', poor preparation to meet the needs of an ethnically diverse society and the presence of racism in practice settings emerged as explanations for the deficits participants identified between their expectations and the reality in care settings. CONCLUSION: Although 'holism' is a relevant concept for enhancing nursing practice, its meaning needs to be further debated in order to avoid a tokenistic approach to its implementation in the care of patients from minority ethnic communities.

Cultural Diversity↗

Integrative analysis of multiple gene expression profiles with quality-adjusted effect size models.

BACKGROUND: With the explosion of microarray studies, an enormous amount of data is being produced. Systematic integration of gene expression data from different sources increases statistical power of detecting differentially expressed genes and allows assessment of heterogeneity. The challenge, however, is in designing and implementing efficient analytic methodologies for combination of data generated by different research groups. RESULTS: We extended traditional effect size models to combine information from different microarray datasets by incorporating a quality measure for each gene in each study into the effect size estimation. We illustrated our method by integrating two datasets generated using different Affymetrix oligonucleotide types. Our results indicate that the proposed quality-adjusted weighting strategy for modelling inter-study variation of gene expression profiles not only increases consistency and decreases heterogeneous results between these two datasets, but also identifies many more differentially expressed genes than methods proposed previously. CONCLUSION: Data integration and synthesis is becoming increasingly important. We live in a high-throughput era where technologies constantly change leaving behind a trail of data with different forms, shapes and sizes. Statistical and computational methodologies are therefore critical for extracting the most out of these related but not identical sources of data.

Algorithms↗

Home visiting for intervention delivery to improve rural family asthma management.

The focus of this article is on the use of home visits in an asthma self-management intervention study with rural families who have a school-aged child with asthma. The study design involved randomization of the sample by elementary schools, then baseline (pretest) and postintervention data collection.(1) The purpose of this article is to describe challenges with, and pose solutions for, implementing home visits for asthma self-management in rural areas. Home visiting is a strategy for program delivery that takes advantage of the home context for tailoring services to address the family's individual needs. The advantages of intervening in the home include being able to (a) use actual home conditions for individualizing the asthma education to meet families' needs; (b) match home visitors with family in terms of ethnicity and language; (c) retain a high percentage of families over the year-long duration of the study; and (d) not add to family burden of managing asthma.

Asthma↗

Contested ground: how should qualitative evidence inform the conduct of a community intervention trial?

This paper presents issues which arose in the conduct of qualitative evaluation research within a cluster-randomized, community-level, preventive intervention trial. The research involved the collection of narratives of practice regarding the intervention by community development officers working in eight communities over a two-year period. The community development officers were largely responsible for implementing the intervention. We discuss the challenges associated with the collection of data as the intervention unfolded, in particular, the disputes over cues to revise and adjust the intervention (i.e. to use the early data formatively). We explore the ethical uncertainties that arise when multiple parties have different views on the legitimacy of types of knowledge and the appropriate role of research and theory in various trial stages. These issues are discussed drawing on the fields of ethnography, community psychology, epidemiology, qualitative methodology and notions of research reflexivity. We conclude by arguing that, in addition to the usual practice of having an outcome data-monitoring committee, community intervention trials also require a process data-monitoring committee as a forum for debate and decision-making. Without such a forum, the relevance, ethics and position of qualitative evaluation research within randomized controlled trials are destined to be a point of contention rather than a source of insight.

Cluster Analysis↗

Health disparities and toxicant exposure of Akwesasne Mohawk young adults: a partnership approach to research.

In this article we describe a research partnership between the Akwesasne Mohawk Nation and scientists at the University at Albany, State University of New York, initiated to address community and scientific concerns regarding environmental contamination and its health consequences (thyroid hormone function, social adjustment, and school functioning). The investigation focuses on cultural inputs into health disparities. It employs a risk-focusing model of biocultural interaction: behaviors expressing cultural identity and values allocate or focus risk, in this instance the risk of toxicant exposure, which alters health status through the effects of toxicants. As culturally based behaviors and activities fulfill a key role in the model, accurate assessment of subtle cultural and behavioral variables is required and best accomplished through integration of local expert knowledge from the community. As a partnership project, the investigation recognizes the cultural and socioeconomic impacts of research in small communities beyond the production of scientific knowledge. The components of sustainable partnerships are discussed, including strategies that helped promote equity between the partners such as hiring community members as key personnel, integrating local expertise into research design, and developing a local Community Outreach and Education Program. Although challenges arose during the design and implementation of the research project, a collaborative approach has benefited the community and facilitated research.

Adult↗

Peptide ligands in antibacterial drug discovery: use as inhibitors in target validation and target-based screening.

There is an urgent need to develop novel classes of antibiotics to counter the inexorable rise of resistant bacterial pathogens. Modern antibacterial drug discovery is focused on the identification and validation of novel protein targets that may have a suitable therapeutic index. In combination with assays for function, the advent of microbial genomics has been invaluable in identifying novel antibacterial drug targets. The major challenge in this field is the implementation of methods that validate protein targets leading to the discovery of new chemical entities. Ligand-directed drug discovery has the distinct advantage of having a concurrent analysis of both the importance of a target in the disease process and its amenability to functional modulation by small molecules. VITA is a process that enables a target-based paradigm by using peptide ligands for direct in vitro and in vivo validation of antibacterial targets and the implementation of high-throughput assays to identify novel inhibitory molecules. This process can establish sufficient levels of confidence indicating that the target is relevant to the disease process and inhibition of the target will lead to effective disease treatment.

Animals↗

Identification and recall of children with chronic medical conditions for influenza vaccination.

OBJECTIVES: Despite long-standing recommendations to provide annual influenza vaccination to children with chronic medical conditions, immunization rates are <10% in most primary care settings. Many obstacles impede implementation of these recommendations, including the challenge of identifying targeted children and the need to immunize yearly in a short time interval. The objective of this study was to assess the accuracy of billing data for identifying children who have high-risk conditions (HRCs) and need influenza vaccination and 2) to evaluate the efficacy of reminder/recall for children with HRCs. METHODS: The study was conducted in 4 private pediatric practices in metropolitan Denver, Colorado, that share a computerized billing system and also participate in an immunization registry. For all children aged 6 to 72 months, registry records were linked with the billing database. Patients with >or=1 encounters for an HRC in the previous 24 months were selected, with HRCs identified from International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Using medical records as the "gold standard," we reviewed 327 randomly selected records to determine the sensitivity, specificity, and accuracy of billing data for identifying HRCs. For children with an HRC, we then conducted a randomized, controlled trial of reminder/recall for influenza vaccination. The primary outcome of the recall trial was receipt of influenza vaccine. RESULTS: Billing data had a sensitivity of 72% (95% confidence interval [CI]: 48%-95%), specificity of 95% (95% CI: 90%-100%), and overall accuracy of 90% (95% CI: 84%-96%) in determining which children had an HRC. Of the 17,273 patients aged 6 to 72 months, 2007 had >or=1 HRCs (12% overall; range: 9%-14% per practice). Asthma/reactive airways disease accounted for 87% of all HRCs. Reminder/recall significantly increased influenza immunization in children with HRCs, with a vaccination rate of 42% in those recalled, compared with 25% in control subjects. Recalled subjects were more likely to have an office visit (68% vs 60%) and less likely to have a missed opportunity to immunize (28% vs 37%) compared with control subjects. CONCLUSIONS: Diagnosis-based billing data accurately identified children who had HRCs and needed annual influenza vaccination, and registry-driven reminder/recall significantly increased influenza immunization in targeted children.

Child↗

Development of the PANVAC-VF vaccine for pancreatic cancer.

PANVAC-VF is a vaccine regimen composed of a priming dose of recombinant vaccinia virus and booster doses of recombinant fowlpox virus expressing carcinoembryonic antigen, mucin-1 and a triad of costimulatory molecules (TRICOM), which include B7.1, intercellular adhesion molecule-1 and leukocyte function-associated antigen-3. Vaccination is administered by subcutaneous injection followed by 4 days of local recombinant adjuvant granulocyte-macrophage colony-stimulating factor at the vaccination site. The vaccine has been developed for patients with advanced pancreatic cancer and has now entered a randomized Phase III clinical trial. This review will describe the background of recombinant poxvirus technology for tumor vaccine development, detail the key preclinical studies supporting the regimen, review the clinical trials supporting the current Phase III study, and highlight the key challenges and future obstacles to successful implementation of PANVAC-VF for pancreatic cancer.

Adjuvants, Immunologic↗

Neoliberalism, "globalization," unemployment, inequalities, and the welfare state.

This analysis of "neoliberalism" and its economic and social consequences is presented in six sections. Section I begins by describing the impact of neoliberal public policies on economic growth and inflation, on business profits and business investments, on productivity, on business credit, on unemployment and social inequalities, on social expenditures, and on poverty and family debt. The author shows that, except in the area of business profits and control of inflation, neoliberal policies have not proved superior to those they replaced. Section II deals with unemployment and social polarization in the developed capitalist countries. The author criticizes some of the theories put forward to explain these social problems, such as the introduction of new technologies and globalization of the economy, and suggests that a primary reason for these problems is the implementation of neoliberal policies. Section III challenges the widely held neoliberal perception that the U.S. economy is highly efficient and the E.U. economies are "sclerotic" due to their "excessive" welfare states and "rigid" labor markets. The author shows that the U.S. economy is not so dynamic, nor the E.U. economies so sclerotic. Some developed countries with greater social protection and more regulated labor markets are shown to be more successful than the United States in producing jobs and lowering unemployment. The reasons for the growing polarization in developed capitalist countries, rooted in political rather than economic causes, are discussed in section IV--especially the enormous power of the financial markets and their influence on international agencies and national governments, and the weakness of the labor movements, both nationally and internationally. Section V questions the major theses of globalization. The author shows that rather than globalization of commerce and investments, we are witnessing a regionalization of economic relations stimulated by political considerations. He also analyzes the globalization of capital finance, criticizing the thesis that capital markets are determining public policies. The economic determinism that underlies the globalization position is questioned, uncovering the importance of political explanations for understanding major social problems such as unemployment. Finally, section VI shows that neoliberal public policies on the deregulation of labor markets are creating enormous instability in the labor force, worsening the living conditions of the majority of the populations.

Developed Countries↗

Genome organization and three kinds of heritable changes: general description and stochastic factors (a review).

Due to the increased knowledge of genome architecture, topology, and the mechanisms of hereditary variability, the list of genetic components has grown. This review outlines the general features and principles of genome organization in diverse organisms. The genome codes, stores, and transfers information in both structurally and dynamically. The genome includes two subsystems of genetic elements: obligatory (genes and gene families) and various types of facultative elements which are predominant the content of the human genome. The features of three kinds of heritable changes: mutations, variations (changes in the number or topography of facultative elements), and epigenetic alterations are described. Facultative elements are the first to react to environmental challenges. Together with epigenetic changes, they implement the operational genomic memory. This review discusses both the role of stochastic factors and the transient features of DNA components.

Animals↗

Employing behavioral methods to improve the context of care within a public psychiatric hospital: enhancing psychosocial programming.

This article reviews efforts, grounded in principles of behavioral science, to improve the "goodness of fit" between the needs of psychiatrically impaired individuals and the array of day program classes offered in a public psychiatric hospital. The relevance of behavioral science and technology for planning and implementing such change in resource-challenged organizations is discussed.

Behavior Therapy↗

Mentoring for research skill development.

The nursing shortage is significantly affecting the nursing academic environment. A self-perpetuating cycle of insufficient numbers of faculty with inadequate preparation for academia could lead to a profound decline in the nursing profession. Institutions often implement mentoring plans for new tenure track faculty, and the challenge is even greater in environments that are not research intensive. This article describes the implementation of the research arm of an institutional mentoring plan for new tenure track faculty. The plan was designed to facilitate new faculty's attainment of tenure, while expediting the development of a satisfying career in academia. Doctoral education does not necessarily provide graduates with all the tools required to be successful researchers. However, specific guidance may be provided in the developing of a research program; creating networks and selecting consultants; preparing presentations and publications; and developing grantsmanship skills, particularly for institutions without established research centers.

Career Mobility↗

Teaching with the Nightingale Tracker technology in community-based nursing education: a pilot study.

Changes in health care delivery are becoming increasingly focused on technology. Nursing students are often expected to travel long distances to suitable community sites for clinical experiences, which challenges nurse educators to design and implement instructional strategies to provide students with optimal clinical practice opportunities, while maintaining preceptor-student supervision and vital communication links. This article reports a pilot evaluation of the Nightingale Tracker system, which included both a server and an innovative, hand-held device designed to accommodate multiple forms of data input and allow timely communication between clinical faculty and students in community-based clinical settings. A sample of 5 nursing students reported that the Nightingale Tracker enhanced learning, particularly in performing and documenting physical assessments, data input and transmissions, and autonomous clinical practice.

Adult↗

Single subject research strategies in occupational therapy: part 2.

This second of a 2-part paper on single subject research is devoted to practical implementation issues. Using clinical examples, the challenge of transferring single subject research strategies to occupational therapy intervention approaches is explored. The therapeutic approaches of behavioral, motoric, and processing are employed to discuss the use of single subject methodology in occupational therapy. Initial research activities for those interested in documenting treatment results are described. Finally, directions for the future use of single subject research are discussed.

Behavior Therapy↗

Violence in the workplace.

The challenge for health authorities is to implement effective preventive strategies and a zero-tolerance policy.

Australia↗

Creating a hospital-community infrastructure: challenges and benefits.

With rising public expectations and demands for increased accountability, hospitals will be even more challenged by their local communities to implement strategies such as those developed at SMH to enable community participation that assists the hospital in serving its local population into the future. In response to unique health needs of its local community, SMH created an Inner City Health (ICH) Program in the early 1990s to provide comprehensive inpatient, ambulatory, and community outreach services. To build on its philosophy to reduce barriers to health for disadvantaged populations, the ICH Research Program, the only one of its kind in Canada, was also established. This paper will describe and explore the formalised infrastructure between SMH and the community; its evolution, as well as SMH's involvement with its community in context of the hospital's relationships with its Board of Directors, the Toronto teaching hospital system, media and advocacy groups. The role of ICH research in influencing evidence-based clinical practice, innovations in health science education and government policy will also be discussed as part of the SMH's hospital-community infrastructure.

Canada↗

Evaluation and treatment of balance in the elderly: A review of the efficacy of the Berg Balance Test and Tai Chi Quan.

The purpose of this review of outcome studies was to determine whether the Berg Balance Test (BBT) can be considered a reliable predictor of a risk for falls in the elderly, and to review the efficacy of Tai Chi Quan in the physical therapy intervention of balance disorders in older adults as reported in the literature. The authors examined studies of the BBT, which showed that the two groups of people, fallers and non-fallers, have considerable differences among them. Fallers tended to be more variable in their characteristics as indicated by larger standard deviations. Based on these results, the authors suggest that patients who score high on the BBT should not be referred for further intervention, whereas patients who score 40 or less have a high probability of falls and require appropriate referrals. The BBT, which is relatively safe and simple, uses a quantitative scale, scoring is reproducible, and the strong internal consistency allows for easy interpretation of scores. The BBT has been shown to have moderately good sensitivity, and high specificity, and therefore is a good predictor of older adults who may have fall risks and may need assistive devices. A big challenge, then, is to plan and implement an effective treatment technique to improve balance control. One recently identified intervention is Tai Chi Quan. Tai Chi is an ancient form of exercise for fitness and the martial arts which has been practiced in China for centuries. The second part of this report examines the efficacy of Tai Chi Quan as a treatment modality. A review of studies on Tai Chi Quan indicates that it has a positive effect on improving balance in the elderly, although it has no effect on improving postural stability. The effects of Tai Chi on the treatment of balance still require extensive research. Although the articles reviewed indicate that Tai Chi does have a positive effect on balance, the methodology used in these studies needs to be improved.

Journal Article↗