Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence: the ANRS 12249 TasP (Treatment as Prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa: study protocol for a cluster randomised controlled trial

Background: Antiretroviral therapy (ART) suppresses HIV viral load in all body compartments and so limits the risk of HIV transmission. It has been suggested that ART not only contributes to preventing transmission at individual but potentially also at population level. This trial aims to evaluate the effect of ART initiated immediately after identification/diagnosis of HIV-infected individuals, regardless of CD4 count, on HIV incidence in the surrounding population. The primary outcome of the overall trial will be HIV incidence over two years. Secondary outcomes will include i) socio-behavioural outcomes (acceptability of repeat HIV counselling and testing, treatment acceptance and linkage to care, sexual partnerships and quality of life); ii) clinical outcomes (mortality and morbidity, retention into care, adherence to ART, virologic failure and acquired HIV drug resistance), iii) cost-effectiveness of the intervention. The first phase will specifically focus on the trial's secondary outcomes.Methods/design: A cluster-randomised trial in 34 (2 × 17) clusters within a rural area of northern KwaZulu-Natal (South Africa), covering a total population of 34,000 inhabitants aged 16 years and above, of whom an estimated 27,200 would be HIV-uninfected at start of the trial. The first phase of the trial will include ten (2 × 5) clusters. Consecutive rounds of home-based HIV testing will be carried out. HIV-infected participants will be followed in dedicated trial clinics: in intervention clusters, they will be offered immediate ART initiation regardless of CD4 count and clinical stage; in control clusters they will be offered ART according to national treatment eligibility guidelines (CD4 <350 cells/μL, World Health Organisation stage 3 or 4 disease or multidrug-resistant/extensively drug-resistant tuberculosis). Following proof of acceptability and feasibility from the first phase, the trial will be rolled out to further clusters.Discussion: We aim to provide proof-of-principle evidence regarding the effectiveness of Treatment-as-Prevention in reducing HIV incidence at the population level. Data collected from the participants at home and in the clinics will inform understanding of socio-behavioural, economic and clinical impacts of the intervention as well as feasibility and generalizability. © 2013 Iwuji et al.; licensee BioMed Central Ltd

La pratique infirmière de promotion de la santé et de prévention en CSSS, mission CLSC : de la volonté à la réalité : Rapport synthèse ; vol. 11, no 2

La série "Rapport synthèse" met en relief les faits saillants des principales études, recherches, projets d'intervention ou promotion réalisés dans les différents domaines de la santé publique.Ce rapport synthèse présente les résultats d'une étude réalisée en étroite collaboration par des chercheurs de la Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal (DSP,de l'Université de Montréal et de quatre centres de santé et de services sociaux de Montréal(CSSS).Cette démarche participative s'inscrit dans une volonté d'ajuster la recherche aux réalités des CSSS, dans le but de formuler des recommandations et d'entreprendre des actions afin de favoriser une actualisation accrue de la pratique infirmière de promotion de la santé et de prévention dans une perspective populationnelle

Efficacy of African American Grandmothers Regarding the Education of Custodial Grandchildren

The roles of grandparents, from occasional helpers to custodial adults in their grandchildren\u27s lives, often raise levels of social discomfort among those involved,; especially when the children are still in elementary school. A disproportionate number of custodial grandparents are African American women. This phenomenological study explored the lived experiences of 8 custodial African American grandmothers in Delaware regarding the education of their school-aged grandchildren. The theoretical foundation was Carter and McGoldrick\u27s theory of families as interconnected systems, and Sands, Goldberg-Glen, Shin, and Robin\u27s theory that life event changes often lead to stress and coping strategies. Data were collected through in-depth interviews and analyzed using open and axial coding to reveal common themes. The grandmothers saw themselves as surrogate parents to their grandchildren and depended on support programs to help with their grandchildren\u27s education. A recommendation is for school districts to build relationships with these African American grandmothers to help facilitate the education of their grandchildren and provide effective and affordable services. Disseminating the findings to educational leaders could lead to the development of more programs to assist custodial African American grandmother families, thus promoting social change

Clinical Nursing Reasoning in Nursing Practice: A Cognitive Learning Model based on a Think Aloud Methodology

Background. The current context of increasingly complex nursing care requires a high level of clinical reasoning in nursing practice. Still, teaching clinical reasoning in nursing remains a challenge for educators in the field. Although several studies have been conducted to try to understand clinical reasoning in nursing, neither its developmental stages nor the corresponding critical milestones have been uncovered. Therefore, nursing educators cannot rely on a cognitive learning model (a description of how people learn and develop a specific competency) to facilitate the learning of this crucial competency. Objectives. This study was conducted to develop a cognitive learning model of clinical reasoning in nursing, from the beginning of education to the development of expertise, highlighting the critical milestones corresponding to each stage. Design. A descriptive design based on the think aloud method was used. Settings and participants. The study was held in one university and two associated hospitals. Individual interviews were conducted with 45 undergraduate nursing students and 21 registered nurses (RN). Participants were asked to think aloud, using five clinical scenarios that were validated in a previous study. Analysis. Interviews were transcribed verbatim and subsequently analyzed using the protocol analysis method recommended for think aloud studies. Results. Five developmental stages and their related critical milestones were identified and used in the elaboration of a cognitive learning model for clinical reasoning in nursing: (1) internalization of the idea that nursing is a scientific profession; (2) learning to read and use scientific literature in care planning and nursing interventions; (3) learning to move from data collection to hypothesis generation to nursing interventions; (4) integrating wards’ routines and protocols; (5a) towards professional expertise or (5b) towards task-oriented practice. Conclusion. Recommendations for teaching and learning clinical reasoning in nursing during initial and continuing education in nursing are suggested. _________________ Contexte. Le contexte actuel de soins infirmiers de plus en plus complexes exige un niveau élevé de raisonnement clinique. L’enseignement et l’apprentissage du raisonnement clinique représentent un défi pour la formation infirmière. L’utilisation d’une approche par compétences (APC) de deuxième génération pour la formation en sciences infirmières (initiale et continue) demande un modèle cognitif d’apprentissage (MCA) conçu avec rigueur pour chacune des compétences. Le raisonnement clinique en sciences infirmières constitue une compétence essentielle de la pratique infirmière; il est donc urgent d’élaborer un MCA pour cette compétence. Même si plusieurs études ont été menées pour comprendre le raisonnement clinique infirmier, aucune n’a porté sur ses étapes de développement ni sur les apprentissages critiques de ces étapes. Objectifs. Une étude a été menée pour élaborer un MCA du raisonnement clinique infirmier, du début de l’apprentissage à l’expertise, tout en faisant ressortir les apprentissages critiques qui correspondent à chaque étape de développement. Conception. Un devis descriptif fondé sur la méthode de réflexion à voix haute a été utilisé. Méthodologie. L’étude a été réalisée dans une université et deux centres hospitaliers affiliés. Des étudiantes (n=41) et des infirmières soignantes (n=25) ont été invitées à réfléchir à voix haute pendant des entrevues individuelles, sur 5 vignettes cliniques validées dans une étude antérieure. Résultats. La méthode d’analyse de protocole a été utilisée afin de définir les apprentissages critiques et les étapes de développement correspondantes. D’abord, les étudiantes doivent s’approprier l’idée que les sciences infirmières sont une profession scientifique et apprendre à lire des écrits scientifiques. Ensuite, les étudiantes et les infirmières doivent procéder à un processus itératif entre la collecte de données et l’élaboration d’hypothèses, au lieu de se reposer sur les routines et les protocoles des services. Conclusion. Des recommandations ont été formulées pour l’enseignement et l’apprentissage du raisonnement clinique infirmier pendant la formation initiale et continue des infirmières

Impacts of a tele-education program in dual diagnosis on nursing competency development: A mixed-methods study

This presentation aim is to discuss about an ongoing thesis project in Canada, a mixed-methods study. The general objective is to measure and understand the extent which a specific dual diagnosis tele-educative program will have an impact on primary care nurses\u27 competency development over a period of 12 months

Bronze Age and Early Saxon activity at Dagenham Heathway, London Borough of Barking and Dagenham

Excavations by Pre-Construct Archaeology Ltd in advance of development of a former school playing field at Dagenham Heathway, in the London Borough of Barking and Dagenham, revealed prehistoric archaeology, dominated by two phases of Late Bronze Age activity. This comprised a series of ditched fields with possible stock management elements, which was superseded by an enclosed settlement containing three roundhouses. The site was not reoccupied again until the Early Saxon period, when a different type of agrarian settlement was established. During either the Middle or Late Saxon period the site was abandoned and another series of field ditches was laid out

A note on comonotonicity and positivity of the control components of decoupled quadratic FBSDE

In this small note we are concerned with the solution of Forward-Backward Stochastic Differential Equations (FBSDE) with drivers that grow quadratically in the control component (quadratic growth FBSDE or qgFBSDE). The main theorem is a comparison result that allows comparing componentwise the signs of the control processes of two different qgFBSDE. As a byproduct one obtains conditions that allow establishing the positivity of the control process.Comment: accepted for publicatio