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At least 1,315 records · Page 73Linked to original sources

PubMed2003

Towards a decision support system for health promotion in nursing.

AIMS: This study was designed to investigate what type of models, techniques and data are necessary to support the development of a decision support system for health promotion practice in nursing. Specifically, the research explored how interview data can be interpreted in terms of Concept Networks and Bayesian Networks, both of which provide formal methods for describing the dependencies between factors or variables in the context of decision-making in health promotion. BACKGROUND: In nursing, the lack of generally accepted examples or guidelines by which to implement or evaluate health promotion practice is a challenge. Major gaps have been identified between health promotion rhetoric and practice and there is a need for health promotion to be presented in ways that make its attitudes and practices more easily understood. New tools, paradigms and techniques to encourage the practice of health promotion would appear to be beneficial. Concept Networks and Bayesian Networks are techniques that may assist the research team to understand and explicate health promotion more specifically and formally than has been the case, so that it may more readily be integrated into nursing practice. METHODS: As the ultimate goal of the study was to investigate ways to use the techniques described above, it was necessary to first generate data as text. Textual descriptions of health promotion in nursing were derived from in-depth qualitative interviews with nurses nominated by their peers as expert health promoting practitioners. FINDINGS: The nurses in this study gave only general and somewhat vague outlines of the concepts and ideas that guided their practice. These data were compared with descriptions from various sources that describe health promotion practices in nursing, then examples of a Conceptual Network and a representative Bayesian Network were derived from the data. CONCLUSIONS: The study highlighted the difficulty in describing health promotion practice, even among nurses recognized for their expertise in health promotion. Nevertheless, it indicated the data collection and analysis methods necessary to explicate the cognitive processes of health promotion and highlighted the benefits of using formal conceptualization techniques to improve health promotion practice.

Bayes Theorem↗

PubMed1997

Changing nursing practice through continuing education: a tool for evaluation.

In light of the current cost-orientated, rapidly changing health service, continuing education providers are challenged to achieve the greatest benefits for the service. Given this culture it is argued that it is essential for nurses to acquire the skills to continually learn, and that for managers there is seen to be a measurable change in a recommended practice or behaviour. To meet these challenges it is essential that continuing educators plan, implement and evaluate programmes in partnership with clinicians and managers. A literature review revealed that most evaluations did not address whether continuing education has resulted in a change in practice. This paper describes a study on the use of goal attainment scaling as an evaluation tool to measure changes in learner behaviour and as a means of promoting self-determination among the participants. It is proposed that goal attainment scaling can be used to measure changes in participant behaviour following an educational programme. In addition, this analysis of participant interviews indicates the tool's usefulness as a self-reporting instrument and this appears to foster the skills of self-assessment and appraisal of performance.

Clinical Competence↗

PubMed1998

Barriers to acceptance of medical error: the case for a teaching program (695).

There is need for a teaching programme aiming to impart a tolerance of error to undergraduate medical students. The implementation of such a programme may have to challenge the institutional norms that encourage authoritarianism, intolerance of uncertainty and denial of error. Acceptance of error is a prerequisite for its candid reporting, and reporting of errors is a prerequisite for their analysis with a view to their prevention. A curriculum on medical error may, therefore, not only help medical students cope with their future mistakes, but also reduce their frequency. Teaching intervention aiming to promote an acceptance of medical error as both inevitable and reducible may also encourage students' epistemological development by making them realize that their doubts and uncertainties are shared by their peers and instructors.

Curriculum↗

PubMed1999

The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences.

OBJECTIVES: To project the likely worldwide increase in the prevalence of erectile dysfunction (ED) over the next 25 years, and to identify and discuss some possible health-policy consequences using the recent developments in the UK as a case study. METHODS: Using the United Nations projected male population distributions by quinquennial age groups for 2025, the prevalence rates for ED were applied from the Massachusetts Male Aging Study (MMAS) to calculate the likely incidence of ED. The MMAS has the advantage of being the first study to provide population-based rates rather than rates based on clinical samples. All the projections were age-adjusted. RESULTS: It is estimated that in 1995 there were over 152 million men worldwide who experienced ED; the projections for 2025 show a prevalence of approximately 322 million with ED, an increase of nearly 170 million men. The largest projected increases were in the developing world, i.e. Africa, Asia and South America. DISCUSSION: The likely worldwide increase in the prevalence of ED (associated with rapidly ageing populations) combined with newly available and highly publicized medical treatments, will raise challenging policy issues in nearly all countries. Already under-funded national health systems will be confronted with unanticipated resource requests and challenges to existing government funding priorities. The projected trends represent a serious challenge for healthcare policy makers to develop and implement policies to prevent or alleviate ED.

Age Distribution↗

PubMed2005

Genital herpes in adolescents.

Herpes simplex virus (HSV) infections occur commonly among adolescents. Most HSV-2 infections are genital, but genital herpes can be caused by either HSV-1 or HSV-2. Weighted means were calculated based on published seroprevalence data on adolescents from the United States and found HSV-1 rates of 53.1 percent for adolescent males and 49.4 percent for adolescent females. The weighted means for HSV-2 was 15 percent for adolescent females and 12 percent for adolescent males. Most individuals who are infected with HSV-2 are unaware of their infection. Healthcare providers of adolescents should consider genital herpes even when an adolescent presents with nonspecific genital symptoms. In this article, we review current recommendations for diagnosis and management and review the psychological sequelae that can be associated with having genital herpes. Finally, we discuss biomedical interventions that are being developed to help reduce the epidemic of HSV and the challenges that these interventions face with regard to implementation.

Adolescent↗

PubMed2004

Evaluating mesenteric ischemia with multidetector-row CT angiography.

Multidetector-row computed tomographic (MDCT) angiography is an established non-invasive imaging modality to evaluate the mesenteric vasculature. It has an important role in diagnostic algorithms for assessment of suspected acute and chronic mesenteric ischemia. Clinical success for synchronizing a MDCT volumetric acquisition with a bolus of contrast medium and also for depicting vascular pathology with high accuracy relies on implementing several key principles. This can be more challenging with advanced generation MDCT scanners. This article reviews the technical principles fundamental to evaluating the mesenteric vasculature with MDCT angiography. An overview of clinical application is also presented.

Angiography↗

PubMed2005

Prevention of type 2 diabetes by diet and lifestyle modification.

Diabetes mellitus is an epidemic of our time. This disease affects nearly 150 million adults worldwide and nearly 11 million in the United States in 2000. Because of the prevalence of obesity and diabetes and associated vascular complications, preventing even a small proportion of cases would save thousands of lives and billions of dollars in healthcare costs and lost productivity. Researchers have made great strides in identifying many lifestyle and dietary factors associated with diabetes, but solidifying the scientific basis for prevention and control of this disease as well as implementation at a national level remains a difficult challenge. The literature on the influence of diet and lifestyle in the development of diabetes is reviewed here, with emphasis on epidemiologic data. We outline a systematic approach to primary and secondary prevention of this disease by evaluating and prioritizing risk factors for which intervention is effective and developing a framework for application of intervention strategies. Effective interventions must target not only the affected individuals but also families, workplaces, schools and communities. Prevention of this devastating disease calls for the identification of culture-sensitive measures that can be applied to the population in general and some high-risk minority groups in particular.

Alcohol Drinking↗

PubMed1995

Group intervention to improve coping with AIDS-related bereavement: model development and an illustrative clinical example.

Despite the widespread losses from AIDS, there have been no published evaluations of mental health interventions for people experiencing AIDS-related bereavement. We describe a cognitive behavioural coping model for support group interventions with people who experience an AIDS-related loss. The support group model consists of six primary components to address grief-related responses and the unique features of AIDS bereavement: social support and group cohesion; identification and expression of emotion; identification of AIDS loss specific coping challenges; recognition of current coping; goal setting; and, implementation of adaptive coping to reduce psychological distress. The model integrates theories of cognitive behavioural coping within a social support group context. Results of a pilot study with four men and four women showed that the intervention model cast into eight group sessions significantly reduced depression, intrusive experiences, grief reactions, demoralization, and overall psychological distress immediately following the intervention and at a 3-month follow-up assessment. The intervention appeared to facilitate the adjustment of these bereaved persons and warrants further study.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

The effectiveness of constraint induced movement therapy in two young children with hemiplegia.

Constraint induced movement therapy (CIMT) for hemiplegia involves constraining use of the unaffected limb while providing intensive shaping and practice of movements in the hemiplegic limb. The technique had been shown to be highly effective in improving upper limb function in adults following stroke, but there is only a limited literature on the use of this intervention in children. This paper provides a brief overview of the theory and background of this procedure, and reviews the literature on use of the technique in children. It then provides detailed case reports for two hemiplegic children, ages 19 and 38 months, each of whom underwent a trial of CIMT. Both children made significant gains in upper arm function that were reflected in a variety of domains, including aspects of everyday functional limb use. Gains persisted to variable degrees and some unexpected new gains were noted following cessation of CIMT. Practical challenges for the children, parents, and therapists in implementing this intensive but promising intervention are also discussed.

Child, Preschool↗

PubMed2025

Seed2LP: seed inference in metabolic networks for reverse ecology applications.

MOTIVATION: A challenging problem in microbiology is to determine nutritional requirements of microorganisms and culture them, especially for the microbial dark matter detected solely with culture-independent methods. The latter foster an increasing amount of genomic sequences that can be explored with reverse ecology approaches to raise hypotheses on the corresponding populations. Building upon genome-scale metabolic networks (GSMNs) obtained from genome annotations, metabolic models predict contextualized phenotypes using nutrient information. RESULTS: We developed the tool Seed2LP, addressing the inverse problem of predicting source nutrients, or seeds, from a GSMN and a metabolic objective. The originality of Seed2LP is its hybrid model, combining a scalable and discrete Boolean approximation of metabolic activity, with the numerically accurate flux balance analysis (FBA). Seed inference is highly customizable, with multiple search and solving modes, exploring the search space of external and internal metabolites combinations. Application to a benchmark of 107 curated GSMNs highlights the usefulness of a logic modelling method over a graph-based approach to predict seeds, and the relevance of hybrid solving to satisfy FBA constraints. Focusing on the dependency between metabolism and environment, Seed2LP is a computational support contributing to address the multifactorial challenge of culturing possibly uncultured microorganisms. AVAILABILITY AND IMPLEMENTATION: Seed2LP is available on https://github.com/bioasp/seed2lp.

Metabolic Networks and Pathways↗

PubMed2025

Whole-genome phenotype prediction with machine learning: open problems in bacterial genomics.

MOTIVATION: How can we identify causal genetic mechanisms governing bacterial traits? Initial efforts entrusting machine learning models to handle the task of predicting phenotype from genotype yield high accuracy scores. However, attempts to extract meaningful interpretations from the predictive models are found to be corrupted by falsely identified 'causal' features. Relying solely on pattern recognition and correlations is unreliable, significantly so in bacterial genomics settings where high-dimensionality and spurious associations are the norm. Though it is not yet clear whether we can overcome this hurdle, significant efforts are being made towards discovering potential high-risk bacterial genetic variants. In view of this, we set up open problems surrounding phenotype prediction from bacterial whole-genome datasets and extending those approaches to learning causal effects, and discuss challenges that impact the reliability of a machine's decision-making when faced with datasets of this nature. RESULTS: We identify major sources of non-injectivity in the formulation of the genotype-to-phenotype mapping function-linkage-disequilibrium, limited sampling, information loss in representations, unmeasured confounders and observational noise-and analyse their implications for machine learning applications. Using a collection of 4,140 Staphylococcus aureus isolates, we illustrate challenges surrounding the defined open problems. AVAILABILITY AND IMPLEMENTATION: Raw sequencing data are available from the European Nucleotide Archive (ENA) under project accessions ERP001012, PRJEB3174, PRJEB2655, PRJEB2756, and PRJEB2944. Assemblies and annotations were generated with the Sanger bacterial pipeline (https://github.com/sanger-pathogens/vr-codebase) and unitigs extracted using DBGWAS (https://gitlab.com/leoisl/dbgwas).

Machine Learning↗

PubMed2001

Translating evidence into practice. The case of influenza vaccination.

A problem common to all health care systems remains the translation of robust evidence into effective practice. Influenza vaccination has been reported to be an effective public health care intervention, but guidelines on coverage and subsequent uptake rates for vaccination across European countries vary substantially. One challenge therefore is to evaluate how effective different implementation mechanisms may be in improving overall vaccination rates for target populations across Europe.

Delivery of Health Care↗

PubMed1992

Ten steps for managing organizational change.

Managing interdepartmental relations in healthcare organizations is a major challenge for nursing administrators. The authors describe the implementation process of an organization-wide change effort involving individuals from departments throughout the medical center. These strategies can serve as a model to guide effective planning in other institutions embarking on change projects, resulting in smoother and more effective implementation of interdepartmental change.

Communication↗

PubMedDate not supplied

Teaching strategies for critical thinking.

Critical thinking is a phase that is being heard frequently in nursing education. Nurse educators are encouraged to teach students to think critically because of the higher-order thinking skills that are required in our complex health care delivery system. The challenge to educators is the selection, development, and implementation of appropriate teaching strategies. This article describes a variety of strategies for teaching critical thinking within the context of nursing.

Computer-Assisted Instruction↗

PubMed1999

Closed-unit staffing speaks volumes.

Providing the right staff mix for a highly fluctuating patient census challenges most nurse managers. Read how one hospital implemented a closed-unit staffing model to better serve its patients and control staffing costs.

Bed Occupancy↗

PubMedDate not supplied

Translating pressure ulcer guidelines into practice: it's harder than it sounds.

OBJECTIVE: To determine the cost-effectiveness of a guideline-based pressure ulcer prevention protocol over time. DESIGN: Retrospective and prospective quasi-experimental longitudinal design. Costs are presented from the long-term-care facility perspective. Data collection occurred for 3 periods: the first 6 months of 1994 (prior to protocol implementation), the first 6 months of 1995 (immediately following implementation) and the first 6 months of 1997 (2 years following implementation). SETTING: 77-bed long-term-care facility PATIENTS/PARTICIPANTS: Subjects were ulcer-free facility residents at the start of each data collection period. There were 69 subjects in the 1994 sample, 63 in the 1995 sample, and 71 in the 1997 sample. INTERVENTIONS: A guideline-based pressure ulcer prevention protocol was implemented during the last 3 months of 1994. The protocol consisted of specific policies for pressure ulcer prevention and treatment, intensive staff education on pressure ulcer care, and monitoring with regular performance feedback to staff. MEASUREMENTS AND MAIN RESULTS: Time to ulcer development varied among the 3 groups (log rank = 8.81, P = .01), with longer time to ulcer development in 1995 compared with 1994; no difference was seen between 1997 and 1994. The time for ulcers to heal decreased over the 3 years (log rank = 9.49, P <.01), with ulcer healing time being shorter in 1995 and 1997 compared with 1994. Total costs were unchanged during the 3 years (F = 0.2, P =.81). Costs of treatment declined significantly from 1994 to 1995 and 1997 (F = 5.5, P <.01) and costs of prevention increased significantly from 1994 to 1995 and 1997(F = 15, P <.01). From 1994 to 1997, the cost for 1 day of ulcer-free life was $3.50. CONCLUSIONS: Implementation of a pressure ulcer prevention protocol showed mixed results. Initial reductions in pressure ulcer incidence were lost over time. Clinical results of ulcer treatment, however, improved and treatment costs fell during the 3 years. Implementation of preventive programs poses a major leadership challenge.

Aged↗

PubMed2006

Inductively heated shape memory polymer for the magnetic actuation of medical devices.

Presently, there is interest in making medical devices such as expandable stents and intravascular microactuators from shape memory polymer (SMP). One of the key challenges in realizing SMP medical devices is the implementation of a safe and effective method of thermally actuating various device geometries in vivo. A novel scheme of actuation by Curie-thermoregulated inductive heating is presented. Prototype medical devices made from SMP loaded with nickel zinc ferrite ferromagnetic particles were actuated in air by applying an alternating magnetic field to induce heating. Dynamic mechanical thermal analysis was performed on both the particle-loaded and neat SMP materials to assess the impact of the ferrite particles on the mechanical properties of the samples. Calorimetry was used to quantify the rate of heat generation as a function of particle size and volumetric loading of ferrite particles in the SMP. These tests demonstrated the feasibility of SMP actuation by inductive heating. Rapid and uniform heating was achieved in complex device geometries and particle loading up to 10% volume content did not interfere with the shape recovery of the SMP.

Biocompatible Materials↗

PubMed2001

A case study comparing static and spatially explicit ecological exposure analysis methods.

Exposure to chemical contaminants must be estimated when performing ecological risk assessments. A previous article proposed a habitat area and quality conditioned population exposure estimator, E[HQ]P, and described an individual-based, random walk, Monte Carlo model (SE3M) to facilitate calculation of E[HQ]P. In this article, E[HQ]P was compared with exposure estimates from a baseline risk assessment that evaluated mink and great blue heron exposure to fluoride at a federal Superfund site. Calculation of E[HQ]P took into consideration a receptor's forage area, movement behavior, population size, and the areal extent and quality of suitable habitat. The baseline assessment used four methods that did (total and unit Tier 2) and did not (total and unit Tier 1) consider habitat area or quality; where "total" included all exposure units on site and "unit" only a given exposure unit. Total Tier 1 estimates were consistently higher than E[HQ]P (e.g., 169.1 mg/kg x d versus 21.6 mg/kg x d). Risk managers using total Tier 1 results for decision making would be unlikely to underestimate exposure; however, implementability of correspondingly lower remedial objectives could be challenging. Unit Tier 1 estimates were higher (e.g., 96.5 mg/kg x d versus 61.6 mg/kg x d) or lower (e.g., 3.5 mg/kg x d versus 51.1 mg/kg x d) than E[HQ]P depending on variations in landscape features. Total Tier 2 and E[HQ]P estimates were similar (e.g., 20.7 mg/kg x d versus 21.6 mg/kg x d) when an ecologically questionable average exposure was assumed. Unit Tier 2 estimates were consistently well below E[HQ]P (e.g., 17.8 mg/kg x d versus 61.6 mg/kg x d) when an average exposure was not assumed. Risk managers using unit Tier 1 or 2 results could be basing their decisions on potentially large underestimates of exposure. By forgoing average exposure assumptions, and explicitly addressing landscape heterogeneity, SE3M appears capable of yielding exposure estimates that are not as potentially misleading to risk managers as those produced with traditional averaging methods.

Aluminum↗