The Impact on Midwives of Undertaking Screening for Domestic Violence: Focus Group Findings

Objective: To investigate the impact mandatory screening for domestic violence has had upon registered midwives. Design: Three phase study – Phase one involved focus group interviews. Setting: Hospitals in South-East Queensland undertaking mandatory domestic violence screening. Participants: Registered midwives undertaking screening for domestic violence. Results: Several barriers were identified that directly impacted upon the midwives' potential to screen effectively. Barriers identified were classified as intrinsic (intrapersonal and perception) and extrinsic (interpersonal, environmental and organisational infrastructure). Principle, conclusions and implications for practice: Although midwives have strong beliefs about the value of domestic violence screening, there is a negative perception about it's efficacy and an assumption of failure due to the barriers identified by the registered midwives

NATPGE: understanding registered nurses’ attitudes towards post graduate education

Nursing education is a dynamic process designed to enable nurses to competently meet the healthcare needs of society. Health system restructuring has been associated with diminishing postgraduate specialist nursing numbers worldwide. Valid instruments that monitor and evaluate nurses’ attitudes to gauge educational barriers and facilitators are a central component in planning effective education, and have been unavailable. Overall both the CE and the RNs ranked the NATPGE, using the CVI, as a realistic training platform that would be useful for evaluating RNs’ attitudes towards postgraduate education. The comments received from the CE resulted in some minor changes to the wording of some items for better clarity and simplicity. No particular concerns were raised about any of the items by the CE. The CE was agreeable that the items were arranged in a positively and negatively worded sequence, which was intentional as to prevent response bias. The present research indicates very good content and face validity and whilst the test-retest reliability overall was moderate, several individual questions did have poor kappa values

Exploring registered nurses’ attitudes towards postgraduate education in Australia: an overview of literature

Background: Nursing education is designed to prepare competent nurses to meet the current and future health care needs of society. Changes to nursing education, especially at post graduate level, will therefore likely be influenced by the on-going developments in healthcare and socio-economic factors. Objective: The main purpose of this study is to develop and validate an instrument that explores the beliefs of Registered Nurses about Postgraduate education in the context of specialist nursing practice in Australia (specialty education). Methods: The Nurses Attitudes Towards Post Graduate Education (NATPGE) instrument was sent to an expert panel to undertake judgment-quantification (content validity testing). Content Validity Index (CVI) based on expert ratings of relevance was used as a method of quantifying content validity for the NATPGE instrument. A convenience sample of 25 Registered Nurses (RN) was selected from four major Queensland tertiary hospitals to assess the face validity of the instrument. A random sample of 100 RN from the Nurses and Midwives e-Cohort Study (NMeS) were invited to participate in a test-retest pilot as part of the process of assessing the reliability of the online NATPGE. To gauge the test-retest reliability, the instrument was administered at two different time points, 3 weeks apart, under similar conditions. Results: The content and face validity was assessed using descriptive statistics. For the test-retest reliability, the NATPGE instrument were analysed on an item by item basis to calculate the intra rater reliability using the weighted kappa (kw) statistic. The NATPGE instrument attained moderate test-retest reliability. 80% of the items on the instrument reached a fair to moderate agreement between the test and retest. Conclusions: There is a need for development of a robust psychometric instrument to explore Registered Nurses’ Attitudes Towards Post Graduate Education (NATPGE)

Facilitators and Barriers Affecting Implementation of Neonatal Palliative Care by Nurses in Mainland China

Neonatal nurses in mainland China encounter various challenges when it comes to delivering palliative care to neonates. The aim of this study was to determine the barriers and facilitators of neonatal nurses' attitudes to palliative care for neonates in mainland China. A simplified Chinese version of the Neonatal Palliative Care Attitude Scale was piloted, administered, and analyzed using survey methods. Nurses in neonatal intensive care units in mainland China regardless of experience in the field were invited to take part in. Over a five-month period in 2019, we surveyed neonatal nurses from 40 hospitals in five provinces of China. The response rate was 92.5% (N = 550). This study identified eight facilitators and four barriers to neonatal palliative care implementation. In terms of nurses' attitudes on providing palliative care, younger and older nurses were more positive, whereas middle-aged nurses were less so. Nurses' emotional wellbeing was rarely impacted by neonatal death. They considered neonatal palliative care, particularly pain management, to be just as important as curative treatment. Parents were invited to participate in decision-making by nurses. Nurses reported having access to professional counseling and talking about their concerns with other healthcare professionals. The following barriers to neonatal palliative care were identified in this study that were not observed in the original English version scale research in 2009: a lack of clinicians, time, clinical skills, systematic education, neonatal palliative care experience, and social acceptance. Future research is required to investigate each barrier in order to improve the implementation of neonatal palliative care in mainland China

Development of the Simplified Chinese version of neonatal palliative care attitude scale

Background The provision of palliative care for neonates who are not expected to survive has been slow in mainland China, and this model of care remains in its early stages. Evaluating nurses' attitudes toward neonatal palliative care (NPC) has the potential to provide valuable insight into barriers impeding NPC implementation. This study aimed to translate and adapt the traditional Chinese version of the Neonatal Palliative Care Attitude Scale (NiPCAS) into Simplified Chinese to assess its psychometric properties. Methods The NiPCAS is a valid and reliable instrument to measure nurses' attitudes for evidence-based practice. To date, the scale has not been used largely in mainland China. With translation and cultural adaptation, the traditional Chinese version of the NiPCAS was developed into a Simplified Chinese version. Its reliability was tested using internal consistency and test-retest reliability, and its validity was measured using the content validity index and exploratory factor analysis. Results A total of 595 neonatal nurses from mainland China were recruited. Twenty-six items in the scale were translated into Simplified Chinese. The scale demonstrated excellent reliability with a Cronbach's α coefficient of 0.87 and a test-retest reliability of 0.88. To support the Simplified Chinese version of NiPCAS, the scale content validity score was 0.98, and the exploratory factor analysis revealed five factors representing the conceptual dimensions of the scale. Conclusion This study demonstrated the psychometric properties of the Simplified Chinese version of NiPCAS, validated its use as a viable tool for measuring neonatal nurses' attitudes toward NPC, and identified facilitators and barriers to NPC adoption. Our findings suggested supported clinical application in the context of mainland China. A confirmatory factor-analysis approach with a different sample of neonatal nurses is required for further testing of the instrument in the future

Hypothalamus-Pituitary-Adrenal Dysfunction in Cholestatic Liver Disease

The Hypothalamic-Pituitary-Adrenal (HPA) axis has an important role in maintaining the physiological homeostasis in relation to external and internal stimuli. The HPA axis dysfunctions were extensively studied in neuroendocrine disorders such as depression and chronic fatigue syndrome but less so in hepatic cholestasis, cirrhosis or other liver diseases. The HPA axis controls many functions of the liver through neuroendocrine forward signaling pathways as well as negative feedback mechanisms, in health and disease. This review describes cell and molecular mechanisms of liver and HPA axis physiology and pathology. Evidence is presented from clinical and experimental model studies, demonstrating that dysfunctions of HPA axis are correlated with liver cholestatic disorders. The functional interactions of HPA axis with the liver and immune system in cases of bacterial and viral infections are also discussed. Proinflammatory cytokines stimulate glucocorticoid (GC) release by adrenals but they also inhibit bile acid (BA) efflux from liver. Chronic hepatic inflammation leads to cholestasis and impaired GC metabolism in the liver, so that HPA axis becomes depressed. Recently discovered interactions of GC with self-oscillating transcription factors that generate circadian rhythms of gene expression in brain and liver, in the context of GC replacement therapies, are also outlined

The Angiopoietin-Tie2 axis contributes to placental vascular disruption and adverse birth outcomes in malaria in pregnancy

BACKGROUND Malaria during pregnancy is a major contributor to the global burden of adverse birth outcomes including fetal growth restriction, preterm birth, and fetal loss. Recent evidence supports a role for angiogenic dysregulation and perturbations to placental vascular development in the pathobiology of malaria in pregnancy. The Angiopoietin-Tie2 axis is critical for placental vascularization and remodeling. We hypothesized that disruption of this pathway would contribute to malaria-induced adverse birth outcomes. METHODS Using samples from a previously conducted prospective cohort study of pregnant women in Malawi, we measured circulating levels of angiopoietin-1 (Angpt-1) and Angpt-2 by Luminex (n=1392). We used a preclinical model of malaria in pregnancy (Plasmodium berghei ANKA [PbA] in pregnant BALB/c mice), genetic disruption of Angpt-1 (Angpt1 mice), and micro-CT analysis of placental vasculature to test the hypothesis that disruptions to the Angpt-Tie2 axis by malaria during pregnancy would result in aberrant placental vasculature and adverse birth outcomes. FINDINGS Decreased circulating levels of Angpt-1 and an increased ratio of Angpt-2/Angpt-1 across pregnancy were associated with malaria in pregnancy. In the preclinical model, PbA infection recapitulated disruptions to the Angiopoietin-Tie2 axis resulting in reduced fetal growth and viability. Malaria decreased placental Angpt-1 and Tie2 expression and acted synergistically with reduced Angpt-1 in heterozygous dams (Angpt1), to worsen birth outcomes by impeding vascular remodeling required for placental function. INTERPRETATION Collectively, these data support a mechanistic role for the Angpt-Tie2 axis in malaria in pregnancy, including a potential protective role for Angpt-1 in mitigating infection-associated adverse birth outcomes. FUNDING This work was supported by the Canadian Institutes of Health Research (CIHR), Canada Research Chair, and Toronto General Research Institute Postdoctoral Fellowship Award. The parent trial was supported by the European & Developing Countries Clinical Trials Partnership and the Malaria in Pregnancy Consortium, which was funded by the Bill & Melinda Gates Foundation. The funders had no role in design, analysis, or reporting of these studies

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

The Effects of a Multimodal Intervention Trial to Promote Lifestyle Factors Associated With the Prevention of Cardiovascular Disease in Menopausal and Postmenopausal Australian Women

The purpose of this study was to test the efficacy of a multi-modal intervention (Women’s Wellness Program) to improve women’s cardio-vascular risk factors. This twelve week randomized experiment with a control group targeted women 50-65 years living in the general population. Women in the intervention group were provided with a consultation with a Registered Nurse at which biophysical cardio-vascular risk measures were taken and health education was provided in both verbal and written form. Women were encouraged to review their smoking, nutrition and water intakes and to commence an exercise program which included aerobic fitness exercises. Women in the control group continued their normal activities. The sample consisted of 90 women aged 50-65 years. Pre- and post-intervention assessment utilized seven measures of cardio-vascular risk factors: waist to hip ratio, body mass index, blood pressure, heart rate, weight, exercise levels and smoking. Analysis of covariance indicated that the intervention was effective in improving women’s aerobic exercise activity and decreasing smoking. The data from all five biophysical outcome measures supported the efficacy of the intervention, with significant decreases seen in the women’s waist-hip ratios, body mass index, blood pressure and measured weight. Study implications suggest that this type of intervention may provide an effective, clinically manageable therapy for women who prefer a self-directed approach to preventing and decreasing cardio-vascular risk factors