Competency and Capability: Imperative for Nurse Practitioner Education

Objective The objective of this study was to conduct research to inform the development of standards for nurse practitioner education in Australia and New Zealand and to contribute to the international debate on nurse practitioner practice. Setting The research was conducted in all states of Australia where the nurse practitioner is authorised and in New Zealand Subjects The research was informed by multiple data sources including nurse practitioner program curriculae documents from all relevant universities in Australia and New Zealand, interviews with academic convenors of these programs and interviews with nurse practitioners. Primary argument Findings from this research include support for masters level of education as preparation for the nurse practitioner. These programs need to have a strong clinical learning component and in-depth education for the sciences of specialty practice. Additionally an important aspect of education for the nurse practitioner is the centrality of student directed and flexible learning models. This approach is well supported by the literature on capability. Conclusions There is agreement in the literature about the lack of consistent standards in nurse practitioner practice, education and nomenclature. The findings from this research contribute to the international debate in this area and bring research informed standards to nurse practitioner education in Australia and New Zealand

Nurse Practitioner Competency Standards: Findings from Collaborative Australian and New Zealand Research

Background: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and in New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role there is scant national or international research to inform development of nurse practitioner competency standards. Objectives: The aim of the study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. Design: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand Settings: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected. Participants: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interview and material data were collected from a range of sources and data were analysed within and across these data modalities. Results: Findings included identification of three generic standards for nurse practitioner practice namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with their own performance indicators. Conclusions: Generic Standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice

A Multiple Case Study Exploring Communities of Practice Led by Rural Secondary School Science Teachers to Overcome Community Isolation in a Research-Science, Dually-Enrolled, Program of Studies

This multiple case study focused on a research science dually-enrolled program of study and the unique challenges rural school educators face due to a lack of human and social capital. Some geographically-isolated rural secondary schools strategically use dual-enrollment programs to develop stronger social capital networks and communities of practice. Participants included five science research educators from rural, geographically-isolated secondary schools. Each case was examined individually, which allowed the researcher to explore the phenomenon within the context of the rural school research science teaching and learning environment. A cross-case analysis was conducted across all five cases using the inductive framework. The following research question guided this study: How do geographically-isolated rural secondary school Science Research in the High School (SRHS) educators utilize social capital and human action to establish, support, and facilitate communities of practice within their teaching and learning environment for student knowledge acquisition? This research study provided insight into the mutually beneficial roles communities and schools have in developing the social and human capital available to them in their community. By establishing partnerships through purposeful planning, community members, practitioners, and leaders can successfully work to address the student equity issues, often plaguing geographical-isolated rural schools. The results of this study reveal and communicate identified best educational practices used by SRHS educators in establishing communities of practice within their geographically isolated secondary schools. The identified need to prepare our students for a more global, technology, knowledge-driven society upon their graduation from secondary schools makes this study valuable and timely

Silver Dreams Fund Learning and Evaluation Contract: Final report June 2014

This is a summary of the Final Report which presents the findings of the evaluation of the Big Lottery Fund's Silver Dreams Fund conducted by Ecorys.The Silver Dreams Fund was a £10 million programme which sought to address the gaps in provision by challenging organisations to come up with an innovative idea for a project that would "pioneer ways to help vulnerable older people deal more effectively with life-changing events".Our approach involved both formative and summative elements and was based upon a robust and evidence-based outcome evaluation framework. In addition, we have also undertaken an evaluation of the new programme management processes employed by the Big Lottery Fund which has been reported separately.In summary, the evaluation involved:- development of an evaluation framework and common indicators to measure outcomes;- provision of a package of self-evaluation support to projects;- programme level work to provide independent primary qualitative research and to validate findings from self-evaluations;- a range of learning activities; and- analysis and reporting

The Epoch of Disk Formation: z is Approximately l to Today

We present data on galaxy kinematics, morphologies, and star-formation rates over 0.1 less than z less than 1.2 for approximately 500 blue galaxies. These data show how systems like our own Milky-Way have come into being. At redshifts around 1, about half the age of the Universe ago, Milky-Way mass galaxies were different beasts than today. They had a significant amount of disturbed motions, disturbed morphologies, shallower potential wells, higher specific star-formation rates, and likely higher gas fractions. Since redshift approximately 1, galaxies have decreased in disturbed motions, increased in rotation velocity and potential well depth, become more well-ordered morphologically, and decreased in specific star-formation rate. We find interrelationships between these measurements. Galaxy kinematics are correlated with morphology and specific star-formation rate such that galaxies with the fastest rotation velocities and the least amounts of disturbed motions have the most well-ordered morphologies and the lowest specific star-formation rates. The converse is true. Moreover, we find that the rate at which galaxies become more well-ordered kinematically (i.e., increased rotation velocity, decreased disturbed motions) and morphologically is directly proportional to their stellar mass

Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care:a pragmatic cluster randomised controlled trial

Objective Patients with multiple chronic health conditions are often managed in a disjointed fashion in primary care, with annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of the 3D intervention, which was developed to improve the system of care. Design Economic evaluation conducted alongside a pragmatic cluster-randomised trial. Setting General practices in three centres in England and Scotland. Participants 797 adults with three or more chronic conditions were randomised to the 3D intervention, while 749 participants were randomised to receive usual care. Intervention The 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments. Primary and secondary outcome measures The primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the National Health Service (NHS) and personal social services (PSS). Costs were related to changes in a range of secondary outcomes (QALYs accrued by both participants and carers, and deaths) in a cost-consequences analysis from the perspectives of the NHS/PSS, patients/carers and productivity losses. Results Very small increases were found in both QALYs (adjusted mean difference 0.007 (-0.009 to 0.023)) and costs (adjusted mean difference 126 pound (-739 pound to 991)) pound in the intervention arm compared with usual care after 15 months. The incremental cost-effectiveness ratio was 18 pound 499, with a 50.8% chance of being cost-effective at a willingness-to-pay threshold of 20 pound 000 per QALY (55.8% at 30 pound 000 per QALY). Conclusions The small differences in costs and outcomes were consistent with chance, and the uncertainty was substantial; therefore, the evidence for the cost-effectiveness of the 3D approach from the NHS/PSS perspective should be considered equivocal

Promoting HIV Testing for Gay and Bisexual Men: An evaluation of the 2011-2012 campaign in Toronto and Ottawa

This paper reports on a social marketing campaign directed toward high-risk men who have sex with men (MSM) in Toronto and Ottawa to: encourage testing for HIV and syphilis; improve knowledge about HIV transmission, seroconversion symptoms, and the HIV window period; and heighten awareness of syphilis transmission and its relationship to facilitating HIV transmission. Evaluation data were collected from a large-scale online pre-and post-campaign survey of sexually active MSM and from laboratory testing data. Men who turned up to be tested also filled out an exit survey. The campaign websites attracted some 15,000 unique visitors, 54% of whom had an IP address in Toronto or Ottawa. Laboratory data showed a 20% increase in HIV testing in Toronto over the campaign compared to the previous year. The overall rate of HIV-positive tests remained relatively constant. Knowledge levels about seroconversion symptoms, STI and HIV transmission, and the HIV window period were significantly better among post-campaign survey respondents aware of the campaign compared to post-campaign respondents who were not aware, and compared to pre-campaign respondents

The prevalence of urinary distress in male and female adults with diabetes mellitus attending a Northern Australian endocrine centre

Internationally, diabetes is one of the major contributors to health care costs. As the population ages, it is expected that the personal and economic burden of diabetes on individuals, families, health systems and countries will continue to increase. It is important that the aetiology and comorbidities of diabetes are investigated. There is a known, strong association between diabetes and incontinence but exploration of specific subgroups at risk is needed. This study explored prevalence and associated characteristics of incontinence and storage lower urinary tract symptoms in people with diabetes mellitus. A convenience sample comprised 273 adults of both sexes who attended a regional diabetes service. A self-administered, paper-based survey method was used and included the Modified Urinary Distress Inventory Short Form (UDI-6). The level of urinary distress was high. Over two-thirds of both men and women reported symptoms of incontinence, irritation or both. Significantly, more respondents with type 2 diabetes than type 1 diabetes reported symptoms. The study identified a high prevalence of urinary incontinence in adults with diabetes, with a high level of distress in males identified that had not previously been reported in Australia. These findings have significant public health importance and all adults attending diabetes services, both male and female, should receive opportunistic screening for voiding dysfunction and continence issues

The Breathe Easier through Weight Loss Lifestyle (BE WELL) Intervention: A randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Obesity and asthma have reached epidemic proportions in the US. Their concurrent rise over the last 30 years suggests that they may be connected. Numerous observational studies support a temporally-correct, dose-response relationship between body mass index (BMI) and incident asthma. Weight loss, either induced by surgery or caloric restriction, has been reported to improve asthma symptoms and lung function. Due to methodological shortcomings of previous studies, however, well-controlled trials are needed to investigate the efficacy of weight loss strategies to improve asthma control in obese individuals.</p> <p>Methods/Design</p> <p>BE WELL is a 2-arm parallel randomized clinical trial (RCT) of the efficacy of an evidence-based, comprehensive, behavioral weight loss intervention, focusing on diet, physical activity, and behavioral therapy, as adjunct therapy to usual care in the management of asthma in obese adults. Trial participants (n = 324) are patients aged 18 to 70 years who have suboptimally controlled, persistent asthma, BMI between 30.0 and 44.9 kg/m², and who do not have serious comorbidities (e.g., diabetes, heart disease, stroke). The 12-month weight loss intervention to be studied is based on the principles of the highly successful Diabetes Prevention Program lifestyle intervention. Intervention participants will attend 13 weekly group sessions over a four-month period, followed by two monthly individual sessions, and will then receive individualized counseling primarily by phone, at least bi-monthly, for the remainder of the intervention. Follow-up assessment will occur at six and 12 months. The primary outcome variable is the overall score on the Juniper Asthma Control Questionnaire measured at 12 months. Secondary outcomes include lung function, asthma-specific and general quality of life, asthma medication use, asthma-related and total health care utilization. Potential mediators (e.g., weight loss and change in physical activity level and nutrient intake) and moderators (e.g., socio-demographic characteristics and comorbidities) of the intervention effects also will be examined.</p> <p>Discussion</p> <p>This RCT holds considerable potential for illuminating the nature of the obesity-asthma relationship and advancing current guidelines for treating obese adults with asthma, which may lead to reduced morbidity and mortality related to the comorbidity of the two disorders.</p> <p>Trial registration</p> <p>NCT00901095</p

The REFLECT Statement: Reporting Guidelines for Randomized Controlled Trials in Livestock and Food Safety: Explanation and Elaboration

Concerns about the completeness and accuracy of reporting of randomized clinical trials (RCTs) and the impact of poor reporting on decision-making have been documented in the medical field over the past several decades. Experience from RCTs in human medicine would suggest that failure to report critical trial features can be associated with biased estimated effect measures, and there is evidence to suggest similar biases occur in RCTs conducted in livestock populations. In response to these concerns, standardized guidelines for reporting RCTs were developed and implemented in human medicine. The Consolidated Standards of Reporting Trials (CONSORT) statement was first published in 1996 with a revised edition published in 2001. The CONSORT statement consists of a 22-item checklist for reporting a RCT and a flow diagram to follow the number of participants at each stage of a trial. An explanation and elaboration document not only defines and discusses the importance of each of the items, but also provides examples of how this information could be supplied in a publication. Differences between human and livestock populations necessitate modifications to the CONSORT statement to maximize its usefulness for RCTs involving livestock. These have been addressed in an extension of the CONSORT statement titled the REFLECT statement: Methods and processes of creating reporting guidelines for randomized control trials for livestock and food safety. The modifications made for livestock trials specifically addressed the common use of group housing and group allocation to intervention in livestock studies, the use of a deliberate challenge model in some trials, and common use of non-clinical outcomes, such as contamination with a foodborne pathogen. In addition, the REFLECT statement for RCTs in livestock populations proposed specific terms or further clarified terms as they pertained to livestock studies