Learning preferences of Enrolled Nursing students: Educational preparation and training for workplace readiness

In Australia there are two entry levels in nursing: the Registered Nurse (RN) and the Enrolled Nurse (EN). Nursing education research is predominately focused on higher education for Registered Nurses and postgraduate nursing students; as a result, the educational preferences of Enrolled Nursing students in the vocational education and training (VET) setting have not been identified. Enrolled Nursing students have some distinct educational needs as they transition through education into the workforce due to their diversity in learner characteristics and backgrounds. As the role of this group continues to expand in the workplace to meet the demands of the health workforce, attention to the educational preparation of this cohort of learners is relevant and timely. This requires identifying targeted educational strategies to support learner preferences for the planning and delivery of education to these students. A qualitative research study using focus groups was undertaken to identify specific learner preferences for teaching modalities among Enrolled Nursing students in a Diploma of Nursing program. A thematic analysis of the data identified the following five main themes: a variety of teaching and assessment methods; educator-directed or guided learning; practical application and simulated learning; face-to-face learning; and closer integration of theory to clinical practicum. The main focus of these learners was preparation for workplace settings. The findings have implications for education strategies in the diploma program, in terms of planning the program structure and its delivery; teaching and learning methods; educator development; development of practical and clinical skills; experiential learning; and the promotion of skills for independent and lifelong learning, the latter being essential preparation for professional nursing practice

Accommodation, Pattern Glare, and Coloured Overlays

We manipulated the accommodative response using positive and negative lenses to study any association between symptoms of pattern glare and accommodation. Two groups of eighteen young adults were selected from seventy-eight on the basis (i) that their rate of reading increased by 5% or more with an overlay compared to their rate without it, and (ii) that they reported more than 2 symptoms of pattern glare (group 1) or had no such increment in reading speed and reported fewer than 2 symptoms (group 2). Under double-masked conditions participants observed at 0.4 m a pattern of stripes while measurements of accommodation were made using an open field autorefractor with and without positive and negative trial lenses (0.75 D), and with and without a coloured overlay. Pattern glare was also assessed with and without the trial lenses. Without lenses, the mean accommodative response in group 1 was 1.55 D, a lag of 0.95 D ± 0.24 D relative to the demand. The lag decreased by 0.43 D ( p &lt; 0.0001) when the chosen overlay was used, an effect that was not shown in group 2 even when lag increased with negative trial lenses ( p = 0.13). In both groups, pattern glare scores were reduced by the trial lenses, but were unaffected by the sign of the lenses. This suggests that symptoms of pattern glare are not strongly associated with accommodative response. </jats:p

Perceived benefits and challenges of coordinated approaches to chronic disease prevention in state health departments

INTRODUCTION: Chronic disease prevention efforts have historically been funded categorically according to disease or risk factor. Federal agencies are now progressively starting to fund combined programs to address common risk. The purpose of this study was to inform transitions to coordinated chronic disease prevention by learning views on perceived benefits and challenges of a coordinated approach to funding. METHODS: A national survey on evidence-based public health was conducted from March through May 2013 among state health department employees working in chronic disease prevention (N = 865). Participants were asked to rank the top 3 benefits and top 3 challenges in coordinating chronic disease approaches from provided lists and could provide additional responses. Descriptive analyses, χ(2) tests, and analysis of variance were conducted. RESULTS: The most common perceived benefits of coordinated approaches to chronic disease prevention were improved health outcomes, common risk factors better addressed, and reduced duplication of program efforts. The most common perceived challenges were funding restrictions, such as disease-specific performance measures; competing priorities; lack of communication across programs; funding might be reduced; agency not structured for program coordination; and loss of disease-specific partner support. Rankings of benefits and challenges were similar across states and participant roles; the perceived challenges “lack of communication across programs” (P = .02) and “funding might be reduced” differed by program area (P < .001). CONCLUSION: Findings can be used by funding agencies and state health departments for planning, training, and technical assistance. The information on perceived challenges demonstrates the need to improve communication across programs, enhance organizational support for coordinated approaches, and create benefits for organizational partners

Exploring and understanding the scope and value of the Parkinson’s nurse in the UK (The USP Project): a realist economic evaluation protocol

Introduction There are multiple configurations of specialist nurses working in the field of Parkinson’s. Parkinson’s Nurse Specialists (PNSs) are recognised as playing a pivotal role; however, there is little published evidence to demonstrate their effectiveness. Further evidence is needed to establish which aspects of the PNSs provide the greatest benefit to people with Parkinson’s and their families, and the cost-effectiveness of different models of care. Methods and analysis Realist approaches explain how and why programmes work (or not) through striving to answer the question: what works, for whom and under what circumstances. This research uses a realist evaluation and aims to integrate an economic analysis within the realist framework. We refer to this as ‘realist economic evaluation’. It comprises four phases: (1) developing resource-sensitive initial programme theories (IPTs) using surveys to gain a better understanding of the role and impact (costs and benefits) of the PNSs; (2) testing the IPTs through qualitative interviews and quantitative data analysis; (3) evaluating the cost and resource use implications alongside the benefits associated with the role of the PNSs and (4) iteratively refining the IPTs throughout the project. The IPTs will draw on both quantitative and qualitative data. The result of the study will be a series of refined programme theories, which will explain how specialist nurses work in the field of Parkinson’s in the UK, what impact they have on people with Parkinson’s and their families and carers, and at what cost. Ethics and dissemination Northumbria University, the Health Research Authority and Health and Care Research Wales have approved this study. Key findings will be disseminated throughout the duration of the project online and through social media, and via annual and regional Parkinson’s meetings and the Parkinson’s UK Excellence Network. Academic dissemination will occur through publication and conference presentations

Americans\u27 Attitudes Toward Euthanasia and Physician-Assisted Suicide, 1936-2002

Public opinion polls conducted from 1936 to 2002 found that Americans support both euthanasia and physician-assisted suicide. Although public opinion regarding end-oflife decisions appears to have been influenced by the events of the times, Americans have consistently favored the freedom to end one\u27s life when the perceived quality of life has significantly diminished, either by one\u27s own hand or with the assistance of a physician. This paper indicates that existing policy regarding euthanasia and physician-assisted suicide conflicts with the American public\u27s attitudes regarding the matter, as well as examines implications for social workers who serve clients facing end-of-life decisions

Antibiotics and oral contraceptive failure - a case-crossover study

Background: Evidence on the association between antibiotic use and combined oral contraceptive (COC) failure is controversial. We examined the effect of concomitant antibiotic treatment on the risk of breakthrough pregnancy among COC users. Study Designs: We performed a case-crossover study of 1330 COC failure cases among 17,721 women from the Slone Epidemiology Center Birth Defects Study (1997-2008) and among 25,941 women from the National Birth Defects Prevention Study (NBDPS, 1997-2005). Self-matched odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by comparing antibiotic use between the 4 weeks before conception ("case period") and the 4-8 weeks before conception ("control period") using conditional logistic regression. A case time-control analysis was conducted using nonusers of COCs with unplanned pregnancies as controls. Results: For the combined data, the self-matched OR was 1.08 (95% CI: 0.63-1.84) and the case time-control OR was 1.12 (0.63-1.98) for antibiotics overall. The results did not appreciably differ when adjusted for characteristics that might vary between the case and control period. However, among COC failure cases from the NBDPS, allowing a 1-month gap between the case and control period resulted in a self-matched OR of 1.45 (0.85-2.50) and a case time-control OR of 1.55 (0.86-2.79) for antibiotics overall. Conclusions: We did not find an association between concomitant antibiotic use and the risk of breakthrough pregnancy among COC users. However, due to limited power and potential carryover effects, findings from this study cannot rule out an elevated risk of COC failure among antibiotic users. (C) 2011 Elsevier Inc. All rights reserved

Training needs and supports for evidence-based decision making among the public health workforce in the United States

BACKGROUND: Preparing the public health workforce to practice evidence-based decision making (EBDM) is necessary to effectively impact health outcomes. Few studies report on training needs in EBDM at the national level in the United States. We report competency gaps to practice EBDM based on four U.S. national surveys we conducted with the state and local public health workforce between 2008 and 2013. METHODS: We compared self-reported data from four U.S. national online surveys on EBDM conducted between 2008 and 2013. Participants rated the importance of each EBDM competency then rated how available the competency is to them when needed on a Likert scale. We calculated a gap score by subtracting availability scores from importance scores. We compared mean gaps across surveys and utilized independent samples t tests and Cohen’s d values to compare state level gaps. In addition, participants in the 2013 state health department survey selected and ranked three items that “would most encourage you to utilize EBDM in your work” and items that “would be most useful to you in applying EBDM in your work”. We calculated the percentage of participants who ranked each item among their top three. RESULTS: The largest competency gaps were consistent across all four surveys: economic evaluation, communicating research to policymakers, evaluation designs, and adapting interventions. Participants from the 2013 state level survey reported significantly larger mean importance and availability scores (p <0.001, d =1.00, and p <0.001, d = .78 respectively) and smaller mean gaps (p <0.01, d = .19) compared to the 2008 survey. Participants most often selected “leaders prioritizing EBDM” (67.9%) among top ways to encourage EBDM use. “EBDM training for specific areas” was most commonly ranked as important in applying EBDM (64.3%). CONCLUSION: Perceived importance and availability of EBDM competencies may be increasing as supports for EBDM continue to grow through trends in funding, training, and resources. However, more capacity building is needed overall, with specific attention to the largest competency gaps. More work with public health departments to both situate trainings to boost competency in these areas and continued improvements for organizational practices (leadership prioritization) are possible next steps to sustain EBDM efforts

Identification of Phthalates in Medications and Dietary Supplement Formulations in the United States and Canada

Background: In animal studies, some ortho-phthalates, including di(2-ethylhexyl) phthalate (DEHP) and di-n-butyl phthalate (DBP), have been shown to be reproductive and developmental toxicants. Human studies show widespread population exposure to background levels of phthalates. Limited evidence suggests that particularly high exposure levels may result from orally ingested medicinal products containing phthalates as excipients (inactive ingredients)

Using Molecular Initiating Events To Generate 2D Structure-Activity Relationships for Toxicity Screening

Molecular initiating events (MIEs) can be boiled down to chemical interactions. Chemicals that interact must have intrinsic properties that allow them to exhibit this behavior, be these properties stereochemical, electronic, or otherwise. In an attempt to discover some of these chemical characteristics, we have constructed structural alert-style structure-activity relationships (SARs) to computationally predict MIEs. This work utilizes chemical informatics approaches, searching the ChEMBL database for molecules that bind to a number of pharmacologically important human toxicology targets, including G-protein coupled receptors, enzymes, ion channels, nuclear receptors, and transporters. By screening these compounds to find common 2D fragments and combining this approach with a good understanding of the literature, bespoke 2D structural alerts have been written. These SARs form the beginning of a tool for screening novel chemicals to establish the kind of interactions that they may be able to make in humans. These SARs have been run through an internal validation to test their quality, and the results of this are also discussed. MIEs have proven to be difficult to find and characterize, but we believe we have taken a key first step with this work.Unileve