2,741 research outputs found
Constancy and difference in the dimensions and elements of nursing practice, 1901-1981 : a thesis presented in partial fulfilment of the requirements for the degree of M.A. (Soc. Sci.) at Massey University
Irregular pagination: pgs 124 & 285 missingThis study presents a selective literature review in which the three components of modern nursing (practice, education and research) are identified. Consideration is given to the dimensions and elements of two of the components - nursing education and nursing practice and the relationship between these two components is investigated using the examination system of nursing education as the connective link. From the literature review presented in the first three chapters, the Nursing Education Examination. Practice Model (N.E.E.P.) has been derived for this project which examines the constancy and differences in the six stated dimensions of nursing practice and their associated elements along a time continuum from 1901 to 1981. The model is used to collect and collate the data elicited from the analysis of the five yearly sample of State Final examination papers and the identification of historical trends in the New Zealand Nursing Journal, relating to the six dimensions of nursing practice and their associated elements. This two pronged approach allowed the author to crosscheck the findings from the two data sources. In addition, changes in the composition of nursing practice are studied in one specific area; the nursing care of patients with accidental trauma. The following propositions were derived from the literature review presented in the first section of this study; 1. That the six dimensions of nursing practice (care, cure, protection, teaching, co-ordination and patient advocacy) will remain constant over time and different practice setings; 2. that the elements of each dimension will vary with time and with practice setting. The findings elicited from the analysis of surgical examination papers revealed that the three dimensions of care, cure and co-ordination occur in all the time periods investigated in this study. The same three dimensions of nursing practice are evident in at least 81% of the time periods in which questions relating to accidental trauma in the examination papers are found. Therefore these three dimensions can be said to form the "heart" of nursing practice over the years. Although fluctuations occur in the importance placed upon the dimensions, from 1961 increasing emphasis is found in all the dimensions except the cure dimension where a declining trend is demonstrated. It was found that constancy in all six dimensions of nursing practice is apparent from this time. An examination of the elements of nursing practice shows that although the three dimensions of nursing practice remain constant over the years, findings relating to the elements making up three dimensions indicate both constancy and differences. The five elements of nursing practice which make up the "core" elements of nursing practice are; general nursing care; reference to specific patients; functional status; treatments; and nurse interactions. References to these elements appear in each of the 17 time periods in the general analysis. Their importance in relation to the nursing of patients with accidental trauma is also evident. At the other extreme are the elements of sleep, blood pressure, and T.P.R. which appear in less than 3 of the 17 time periods. Reference to patient preferences/ interests are never found in the data elicited from the examination papers. Examination of accidental trauma findings reveals similar trends to the general results. From 1961 particularly the journal articles substantiate the findings elicited from the examination analysis. A brief discussion of the implications of the constancy and difference in the dimensions of nursing practice and their associated elements for nursing is included
Indigenous vegetation types of Hamilton Ecological District
The following descriptions of indigenous vegetation types and lists of the most characteristic species have been compiled for the major landform units of the Hamilton Ecological District, which lies within the Waikato Ecological Region (McEwen 1987). The boundaries of the Hamilton Ecological District correspond approximately to those of the Hamilton basin, with the addition of parts of hills and foothills at the margins of the basin. The vegetation descriptions and species lists are based on knowledge of the flora of vegetation remnants in the ecological district, historical records (e.g., Gudex 1954), and extrapolation of data from other North Island sites with similar environmental profiles
The clinical effectiveness and cost-effectiveness of inhaler devices used in the routine management of chronic asthma in older children: a systematic review and economic evaluation
Background:
This review examines the clinical effectiveness and
cost-effectiveness of hand-held inhalers to deliver
medication for the routine management of chronic
asthma in children aged between 5 and 15 years.
Asthma is a common disease of the airways, with a
prevalence of treated asthma in 5ā15-year-olds of
around 12% and an actual prevalence in the community
as high as 23%. Treatment for the condition
is predominantly by inhalation of medication. There
are three main types of inhaler device, pressurised
metered dose, breath actuated, and dry powder, with
the option of the attachment of a spacer to the first
two devices under some prescribed circumstances.
Two recent reviews have examined the clinical and
cost-effectiveness evidence on inhaler devices, but
one was for children aged under 5 years and the
comparison in the second was made between pressurised
metered dose inhalers and other types only.
Objectives:
This review examines the clinical effectiveness and
cost-effectiveness of manual pressurised metered
dose inhalers, breath-actuated metered dose
inhalers, and breath-actuated dry powder inhalers,
with and without spacers as appropriate, to deliver
medication for the routine management of chronic
asthma in children aged between 5 and 15 years.
Methods:
Two previous HTA reviews have compared the
effectiveness of inhaler devices, one focusing on
asthma in children aged under 5 years and the
other on asthma and chronic obstructive airways
disease in all age groups. For the current review, a
literature search was carried out to identify all
evidence relating to the use of inhalers in older
children with chronic asthma. A search of in-vitro
studies undertaken for one of the previous reviews
was also updated.
The data sources used were: 15 electronic bibliographic
databases; the reference lists of one of the
previous HTA reports and other relevant articles;
health services research-related internet resources;
and all sponsor submissions.
Studies were selected according to strict inclusion
and exclusion criteria, and relevant information
concerning effectiveness and patient compliance
and preference was extracted directly on to an
extraction/evidence table. Quality assurance
was monitored.
Economic evaluation was undertaken by reviewing
existing cost-effective evidence. Further economic
modelling was carried out, and tables constructed
to determine device cost-minimisation and
incremental quality-adjusted life-year (QALY)
thresholds between devices.
Results:
Number and quality of studies, and
direction of evidence:
Fourteen randomised controlled studies were
identified relating to the clinical effectiveness of
inhaler devices for delivering Ī²2-agonists. A further
five were on devices delivering corticosteroids and
one concerned the delivery of cromoglicate.
Overall, there were no differences in clinical
efficacy between inhaler devices, but a pressurised
metered dose inhaler with a spacer would appear
to be more effective than one without. These
findings endorse those of a previous HTA review
but extend them to other inhaler devices.
Seven randomised controlled trials examined the
impact on clinical effectiveness of using a nonchlorofluorocarbon
(CFC) propellant in place of
a CFC propellant in metered dose inhalers, both
pressurised and breath activated, although only one
study considered the latter type. No differences were
found between inhalers containing either propellant.
A further 30 studies of varying quality, from 12 randomised
controlled trials to non-controlled studies,
were identified that concerned the impact of use
by, and preference for, inhaler type, and treatment
adherence in children. Differences between the
studies, and limitations in comparative data between
various inhaler device types, make it difficult to draw
any firm conclusions from this evidence.
Summary of benefits:
No obvious benefits for one inhaler device type
over another for use in children aged 5ā15 years
were identified.
Costs and cost per quality-adjusted
life-year:
Two approaches have been taken: cost-minimisation
and QALY threshold. In the QALY threshold
approach, additional QALYs that each device must
produce compared with a cheaper device to achieve
an acceptable cost per QALY were calculated. Using
the cheapest and most expensive devices for delivering
200 Ī¼g of beclometasone per day, assuming no
cost offset for any device, and a threshold of Ā£5000,
the largest QALY needed was 0.00807. With such
a small QALY increase, no intervention can be
categorically rejected as not cost-effective.
Conclusions:
Generalisability of findings:
On the available evidence there are no obvious
benefits for one inhaler device over another
when used by children aged 5ā15 years with
chronic asthma. However, the evidence, in the
majority of cases, was compiled on children
with mild to moderate asthma and restricted
to a limited number of drugs. Therefore the
findings may not be generalisable to those at
the more severe end of the spectrum of the
disease or to inhaler devices delivering some
of the drugs used in the management of asthma.
Need for further research:
Many of the previous studies are likely to
have been underpowered. Further clinical
trials with a robust methodology, sufficient
power and qualitative components are needed
to demonstrate any differences in clinical
resource use and patientsā asthma symptoms.
Further studies should also include the
behavioural aspects of patients towards their
medication and its delivery mechanisms.
It is acknowledged that sufficient power may
prove impractical owing to the large numbers
of patients required
On suffering: pathways to healing & health
About the Book
Currently in medicine, theories of pain regard pain and suffering as one and the same. It is assumed that if pain ceases, suffering stops. These theories are not substantiated in clinical practice, where some patients report little pain and extreme suffering and other individuals have a lot of pain and virtually no suffering. Based on the results of a scientific questionnaire, as well as evidence from and conversations with hundreds of patients, Beverley M. Clarke argues convincingly that suffering is often separate from pain, has universal measurable characteristics, and requires suffering-specific treatments that are sensitive to the patientās individual psychology and cultural background. According to Clarke, suffering occurs when individuals who have experienced a life change because of medical issues perceive a threat to their idea of self and personhood. This kind of suffering, based on a lost dream of self, affects every aspect of an individual\u27s life. Treating the patient as a whole personāan approach that Clarke strongly advocatesāis an issue overlooked in the majority of chronic care and traumatic injury treatments, focused as they are on pain reduction.
About the Author
Beverley M. Clarke is an associate professor, School of Rehabilitation Science, and a neurology associate, Division of Neurology, at McMaster University, Hamilton, Ontario, Canada.
About the Electronic Publication
This electronic publication of On Suffering was made possible with the permission of the author. The University Press of New England created EPUB and PDF files from a scanned copy of the book.
Rights Information
Creative Commons Attribution-NonCommercial License Ā© Trustees of Dartmouth Collegehttps://digitalcommons.dartmouth.edu/dartmouth_press/1005/thumbnail.jp
Identifying the transporters of different flavonoids in plants
We recently identified a new component of flavonoid transport pathways in Arabidopsis. The MATE protein FFT (Flower Flavonoid Transporter) is primarily found in guard cells and seedling roots, and mutation of the transporter results in floral and growth phenotypes. The nature of FFTās substrate requires further exploration but our data suggest that it is a kaempferol diglucoside. Here we discuss potential partner H+-ATPases and possible redundancy among the close homologues within the large Arabidopsis MATE family
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