Acute care nurses' perceptions of barriers to using research information in clinical decision-making

Aim. To examine the barriers that nurses feel prevent them from using research in the decisions they make. Background. A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self-reported utilization behaviour; poor response rates and small, nonrandom sampling strategies. Design. Cross-case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%). Results. Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, 'academic' and overly statistical; (2) Nurses who felt confident with research-based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research-based practice, rather than becoming directly involved themselves. Conclusions. Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy-makers and the research community

The accessibility of research-based knowledge for nurses in United Kingdom acute care settings

Background. The successful dissemination of the results of the National Health Service (NHS) research and development strategy and the development of evidence based approaches to health care rely on clinicians having access to the best available evidence; evidence fit for the purpose of reducing the uncertainties associated with clinical decisions. Aim. To reveal the accessibility of those sources of information actually used by nurses, as well as those which they say they use. Design. Mixed method case site, using interview, observational, Q sort and documentary audit data in medical, surgical and coronary care units (CCUs) in three acute hospitals. Results. Three perspectives on accessibility were identified: (a) the humanist-in which human sources of information were the most accessible; (b) local information for local needs-in which locally produced resources were seen as the most accessible and (c) moving towards technology-in which information technology begins to be seen as accessible. Nurses' experience in a clinical specialty is positively associated with a perception that human sources such clinical nurse specialists, link nurses, doctors and experienced clinical colleagues are more accessible than text based sources. Clinical specialization is associated with different approaches to accessing research knowledge. Coronary care unit nurses were more likely perceive local guidelines, protocols and on-line databases as more accessible than their counterparts in general medical and surgical wards. Only a third of text-based resources available to nurses oil the wards had any explicit research base. These, and the remainder were Out of date (mean age of textbooks 11 years), and authorship hard to ascertain. Conclusion. A strategy to increase the use of research evidence by nurses should harness the influence of clinical nurse specialists, link nurses and those engaged in practice development. These roles Could act as 'conduits' through which research-based messages for practice, and information for clinical decision making, could flow. This role should be explored and enhanced

Infected deep vein thrombophlebitis in people who inject drugs: missed opportunities and potential for alternative antimicrobial approaches.

Infected deep vein thrombophlebitis (i-DVT) in people who inject drugs (PWID) is a clinically challenging but poorly characterised disease. We undertook a retrospective observational study of 70 PWID presenting acutely with i-DVT to improve the clinical and microbiological characterisation of this disease. i-DVT was frequently associated with bacteraemia (59.1% patients with blood cultures obtained), groin abscesses (in 34.3%; of which 54.2% required surgical drainage), and septic pulmonary emboli (38.6%) requiring anticoagulation. Network analysis identified a cluster of patients presenting with respiratory symptoms but lacking typical DVT symptoms, more likely to have septic pulmonary emboli. A microbiologic diagnosis was frequently achieved (70%). Causative pathogens were predominantly gram-positive (S. aureus and streptococci, especially anginosus group), whereas gram-negative pathogens were identified very infrequently (in 6.1% of microbiological diagnoses). This suggests routine empiric therapy against gram-negative bacteria, though commonly administered, is not required. High rates of clinical cure (88.6%) were observed despite the complex nature of infections and independently of the highly variable intravenous and total antimicrobial durations received. There exists a rationale to devise pragmatic approaches to implement novel individualised treatment plans utilising oral antimicrobial therapy for i-DVT. Despite frequent healthcare interactions, opportunities to address HCV treatment and opioid substitution therapy were frequently missed during these acute admissions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s15010-021-01725-3

Comparing Athletes’ Perceptions of Leadership Behaviour Frequency and Effectiveness in Relation to Cohesion and Athlete Satisfaction

The frequency and the effectiveness of leadership behaviours have been used interchangeably by researchers using the Leadership Scale for Sports (LSS; Chelladurai & Saleh, 1980) and/or Differentiated Transformational Leadership Inventory (DTLI; Callow, Smith, Hardy, Arthur, & Hardy, 2009). The primary purpose of the present study was to determine if athletes perceive differences between the frequency and effectiveness of athlete leadership behaviours. The secondary purpose was to examine the relationships between the frequency and the effectiveness of athlete leadership behaviours, cohesion, and athlete satisfaction. The sample was 80 intercollegiate varsity athletes (34 females, 46 males) from the University of Windsor. The LSS and DTLI were administered containing response formats for both frequency and effectiveness. An overall single group repeated measures MANOVA revealed a significant multivariate effect for response format, Pillai’s trace = .139, F(1,11) = 9.38, p \u3c .01, η2 = .14, indicating that an athlete leaders’ leadership behaviours significantly differed based on the perceptions of frequency and effectiveness. The within-subject effect of response format indicated a significant difference, F(1,58) = 3.43, p \u3c .01, η2 = .14. Post hoc ANOVAs revealed that the frequency of athlete leadership behaviours were greater for fostering acceptance of group goals and promoting teamwork, F(1,144) = 4.03, p \u3c .05, η2 = .03; and high performance expectations, F(1,144) = 7.09, p = .01, η2 = .05, compared to the effectiveness of these two leadership behaviours. In addition, multiple regressions indicated that the effectiveness of athlete leadership behaviours significantly predicted both dimensions of task cohesion, along with the task and social dimensions of athlete satisfaction

Priorities for the professional development of registered nurses in nursing homes: a Delphi study

Objective: to establish a consensus on the care and professional development needs of registered nurses (RNs) employed by UK care homes. Design: two-stage, online modified Delphi study. Setting and participants: a panel (n = 352) of individuals with experience, expertise or interest in care home nursing: (i) care home nurses and managers; (ii) community healthcare professionals (including general practitioners, geriatricians, specialist and district nurses); and (iii) nurse educators in higher education. Results: RNs employed by nursing homes require particular skills, knowledge, competence and experience to provide high-quality care for older residents. The most important responsibilities for the nursing home nurse were: promoting dignity, personhood and wellbeing, ensuring resident safety and enhancing quality of life. Continuing professional development priorities included personal care, dementia care and managing long-term conditions. The main barrier to professional development was staff shortages. Nursing degree programmes were perceived as inadequately preparing nurses for a nursing home role. Nursing homes could improve by providing supportive learning opportunities for students and fostering challenging and rewarding careers for newly RNs. Conclusion: if nurses employed by nursing homes are not fit for purpose, the consequences for the wider health and social-care system are significant. Nursing homes, the NHS, educational and local authorities need to work together to provide challenging and rewarding career paths for RNs and evaluate them. Without well-trained, motivated staff, a high-quality care sector will remain merely an aspiration

The hepatic transcriptome in human liver disease

The transcriptome is the mRNA transcript pool in a cell, organ or tissue with the liver transcriptome being amongst the most complex of any organ. Functional genomics methodologies are now being widely utilized to study transcriptomes including the hepatic transcriptome. This review outlines commonly used methods of transcriptome analysis, especially gene array analysis, focusing on publications utilizing these methods to understand human liver disease. Additionally, we have outlined the relationship between transcript and protein expressions as well as summarizing what is known about the variability of the transcriptome in non-diseased liver tissue. The approaches covered include gene array analysis, serial analysis of gene expression, subtractive hybridization and differential display. The discussion focuses on primate whole organ studies and in-vitro cell culture systems utilized. It is now clear that there are a vast number research opportunities for transcriptome analysis of human liver disease as we attempt to better understand both non-diseased and disease hepatic mRNA expression. We conclude that hepatic transcriptome analysis has already made significant contributions to the understanding of human liver pathobiology

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives

Objectives: Adults with knee instability related to neuromuscular disorders or central nervous conditions often experience mobility problems and rely on orthoses to improve function and mobility. Patient views of device effectiveness and acceptability are underexplored. Our study aimed to elicit device users’ perspectives regarding fitting, acceptability, effectiveness and use of orthoses, and identify important treatment outcomes. / Design: Qualitative descriptive study using in-depth semistructured interviews. Interview transcriptions were coded and thematically analysed, using ‘Framework’. / Setting and participants: A purposive sample of 24 adult users of orthotic devices. Nineteen patients were recruited across three National Health Service sites, and five people through charities/patient support groups in England. Half of the participants had been diagnosed with poliomyelitis, and the remainder with multiple sclerosis, Charcot-Marie-Tooth disease, spinal injury or spina bifida, and stroke. The median age of participants was 64.5 years (range 36–80 years). / Results: Patients’ medical condition impacted significantly on daily life. Participants relied on orthotic devices to enable engagement in daily activities. Patient goals for mobility were linked to individual circumstances. Desired treatment outcomes included reduction in pain, trips and falls, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses and associated with reported use. Obtaining suitable footwear alongside orthotic devices was a significant concern. Time pressures during device fitting were viewed negatively. / Conclusions: Orthotic devices for knee instability play a crucial role in promoting, maintaining and enhancing physical and psychological health and well-being, enabling patients to work, engage in family life and enjoy social activities. Future research should consider how best to measure the impact of orthotic devices on patient quality of life and daily functioning outside the clinic setting, as well as device use and any adverse effects. / Trial registration number: This qualitative study was retrospectively registered as Current Controlled Trials ISRCTN65240228

The thermally-coupled imager: A scalable readout architecture for superconducting nanowire single photon detectors

Although superconducting nanowire single-photon detectors (SNSPDs) are a promising technology for quantum optics, metrology, and astronomy, they currently lack a readout architecture that is scalable to the megapixel regime and beyond. In this work, we have designed and demonstrated such an architecture for SNSPDs, called the thermally-coupled imager (TCI). The TCI uses a combination of time-of-flight delay lines and thermal coupling to create a scalable architecture that can scale to large array sizes, allows neighboring detectors to operate independently, and requires only four microwave readout lines to operate no matter the size of the array. We give an overview of how the architecture functions, and demonstrate a proof-of-concept $32\times32$ imaging array. The array was able to image a free-space focused spot at 373 nm, count at 9.6 Mcps, and resolve photon location with greater than 99.83\% distinguishability