Self-care after traumatic injury and the use of the therapeutic self care scale in trauma populations

Aims: To report a correlational study of the relationship between gender, age, severity of injury, length of hospital stay and self-care behaviour in patients with traumatic injuries. Background: This study may provide a foundation for targeted nursing intervention and education programmes to help patients better recover from their injury, which is a fundamental aspect of nursing. Design: A longitudinal cohort study. Method: This study of patients hospitalized for traumatic injury was conducted from May 2006–November 2007. The Therapeutic Self Care Scale along with demographic and clinical data, were completed at 3 and 6 months after hospital discharge. Using data from the 3-month survey, the validity and reliability of the scale was calculated. Multiple regression was used to identify predictors of self-care at 3 and 6 months. Finding: Participants (n = 125) completed the questionnaire at 3 months and 103 participants completed it at 6 months. Self-care was high on both occasions and high self-care at 3 months was related to high self-care at 6 months. Older participants reported higher self-care at 3 months compared with younger patients. Factor analysis of the scale revealed three clear components; taking medication, recognition and managing symptoms and managing changes in health conditions, which explained a total of 59·8% of the variance. The 10-item revised scale was reliable. Conclusion: The findings indicate that self-care remains fairly high and stable in the first 6 months after trauma. The revised Therapeutic Self Care Scale was valid and reliable in the trauma population

Regular treatment with formoterol and an inhaled corticosteroid versus regular treatment with salmeterol and an inhaled corticosteroid for chronic asthma: serious adverse events

Background An increase in serious adverse events with both regular formoterol and regular salmeterol in chronic asthma has been demonstrated in comparison with placebo in previous Cochrane reviews. This increase was significant in trials that did not randomise participants to an inhaled corticosteroid, but less certain in the smaller numbers of participants in trials that included an inhaled corticosteroid in the randomised treatment regimen. Objectives We set out to compare the risks of mortality and non-fatal serious adverse events in trials which have randomised patients with chronic asthma to regular formoterol versus regular salmeterol, when each are used with an inhaled corticosteroid as part of the randomised treatment.Search strategyTrials were identified using the Cochrane Airways Group Specialised Register of trials. Manufacturers' web sites of clinical trial registers were checked for unpublished trial data and Food and Drug Administration (FDA) submissions in relation to formoterol and salmeterol were also checked. The date of the most recent search was July 2009. Selection criteria Controlled clinical trials with a parallel design, recruiting patients of any age and severity of asthma were included if they randomised patients to treatment with regular formoterol versus regular salmeterol (each with a randomised inhaled corticosteroid), and were of at least 12 weeks duration. Data collection and analysis Two authors independently selected trials for inclusion in the review and extracted outcome data. Unpublished data on mortality and serious adverse events were sought from the sponsors and authors. Main results Eight studies met the eligibility criteria of the review recruiting 6,163 adults and adolescents. There were seven studies (involving 5,935 adults and adolescents) comparing formoterol and budesonide to salmeterol and fluticasone. All but one study administered the products as a combined inhaler, and most used formoterol 50 mcg and budesonide 400 mcg twice daily versus salmeterol 50 mcg and fluticasone 250 mcg twice daily. There were two deaths overall (one on each combination) and neither were thought to be related to asthma.There was no significant difference between treatment groups for non-fatal serious adverse events, either all-cause (Peto OR 1.14; 95% CI 0.82 to 1.59, I(2) = 26%) or asthma-related (Peto OR 0.69; 95% CI 0.37 to 1.26, I(2) = 33%). Over 23 weeks the rates for all-cause serious adverse events were 2.6% on formoterol and budesonide and 2.3% on salmeterol and fluticasone, and for asthma-related serious adverse events, 0.6% and 0.8% respectively.There was one study (228 adults) comparing formoterol and beclomethasone to salmeterol and fluticasone, but there were no deaths or hospital admissions.No studies were found in children. Authors' conclusions The seven identified studies in adults did not show any significant difference in safety between formoterol and budesonide in comparison with salmeterol and fluticasone. Asthma-related serious adverse events were rare, and there were no reported asthma-related deaths. There was a single small study comparing formoterol and beclomethasone to salmeterol and fluticasone in adults, but no serious adverse events occurred in this study. No studies were found in children.Overall there is insufficient evidence to decide whether regular formoterol and budesonide or beclomethasone have equivalent or different safety profiles from salmeterol and fluticasone

Combination fluticasone and salmeterol versus fixed dose combination budesonide and formoterol for chronic asthma in adults and children

BackgroundCombination therapies are frequently recommended as maintenance therapy for people with asthma, whose disease is not adequately controlled with inhaled steroids. Fluticasone/salmeterol (FP/SAL) and budesonide/formoterol (BUD/F) have been assessed against their respective monocomponents, but there is a need to compare these two therapies on a head-to-head basis.ObjectivesTo estimate the relative effects of fluticasone/salmeterol and budesonide/formoterol in terms of asthma control, safety and lung function.Search strategyWe searched the Cochrane Airways Group register of trials with prespecified terms. We performed additional hand searching of manufacturers' web sites and online trial registries. Searches are current to May 2008.Selection criteriaRandomised studies comparing fixed dose FP/SAL and BUD/ F were eligible, for a minimum of 12 weeks. Crossover studies were excluded. Our primary outcomes were: i) exacerbations requiring oral steroid bursts, ii) hospital admission and iii) serious adverse events.Data collection and analysisTwo authors independently assessed studies for inclusion in the review. We combined continuous data outcomes with a mean difference (MD), and dichotomous data outcomes with an odds ratio (OR).Main resultsFive studies met the review entry criteria (5537 participants). Primary outcomes: The odds of an exacerbation requiring oral steroids did not differ significantly between treatments (OR 0.89; 95% CI 0.73 to 1.09, three studies, 4515 participants). The odds of an exacerbation leading hospital admission were also not significantly different (OR 1.29; 95% CI 0.68 to 2.47, four studies, 4879 participants). The odds of serious adverse events did not differ significantly between treatments (OR 1.47; 95% CI 0.75, 2.86, three studies, 4054 participants). Secondary outcomes: Lung function outcomes, symptoms, rescue medication, exacerbations leading ED visit/hospital admission and adverse events were not significantly different between treatments.Authors' conclusionsThe evidence in this review indicates that differences in the requirement for oral steroids and hospital admission between BUD/F and FP/SAL do not reach statistical significance. However, the confidence intervals do not exclude clinically important differences between treatments in reducing exacerbations or causing adverse events. The width of the confidence intervals for the primary outcomes justify further trials in order to better determine the relative effects of these drug combinations. Although this review sought to assess the effects of these drugs in both adults and children, no trials were identified in the under-12s and research in this area is of a high priority

Patients prefer clinical handover at the bedside; Nurses do not: Evidence from a Discrete Choice Experiment

Background: Shift-to-shift bedside handover is advocated as a patient-centred approach, yet its enactment is challenging. Objectives: To describe and compare the preferences of both patients and nurses in the implementation of bedside handover in a Swedish University Hospital. Design: A discrete choice experiment (DCE) survey. Settings: University setting, four medical wards in two hospitals. Participants: Adult medical patients (n = 218) and registered nurses (n = 101) Methods: The survey was administered by an electronic tablet-assisted face-to-face survey. Respondents made repeated choices between two hypothetical bedside handover alternatives and a third alternative of ‘handover away from the bedside’. Handover alternatives were described according to six attributes: invitation to participate, number of nurses present at the handover, family member, carer or trusted friend (of the patient) allowed to be present, level of (patient) involvement, what information related to your (patient) care is discussed. Choice data were analyzed using a mixed logit model. Results: A total of 1308 (patients) and 909 (nurses) choice observations were included in the preference models. Patients showed a strong preference for handover at the bedside compared to nurses. Nurses generally preferred handover away from the bedside. Patients perceived their level of involvement in handover as highly important, being able to speak, hear what was said being the most important characteristic, closely followed by being invited to participate and asked questions as well as being heard. Nurses considered patients being invited to participate most important, followed by level of involvement. Different options for handing over sensitive information were not perceived of importance by patients or nurses. There was substantial variation at the individual level across both patients and nurses for where and how handover is delivered. Conclusions: In this study, patients strongly preferred handover at the bedside, while the nurses considered patients to be invited to participate to be the most important preference but generally preferred handover to take place away from the bedside, all else equal. When implementing bedside handover in a Swedish context this must be considered, although participation is a prerequisite for bedside handover. Differences between patients and nurses’ preferences could jeopardize future introduction of bedside handover in Swedish health care, and might explain why bedside handover is still not very common in hospital wards

Conflict and domestic turmoil: A review of intimate partner violence in conflict settings

This evidence review examines existing research linking conflict and intimate partner violence (IPV), identifies macro and micro-level mechanisms driving this relationship, and reviews interventions aimed at mitigating IPV in conflict settings. Findings indicate a strong association between conflict exposure and increased IPV, with significant impacts on mental health and social norms. While interventions focused on empowerment and changing gender norms show promise, gaps remain in understanding long-term effects and intervention efficacy across diverse contexts. Policy implications emphasize the need for integrated approaches addressing economic empowerment, mental health, and societal attitudes towards violence to effectively reduce IPV in conflict-affected areas

Small Hands Should Play, Not Work: A Theoretical Analysis of Interventions in Child Labor

Twelve hours a day, 7 days a week, there are 150 million children below the age of 15 working to make the clothes we wear, the carpets on our floors and the phones in our pockets. Most of these children do not have a choice: the alternative is worse. In this thesis, I use economic models to study how interventions (such as increased educational opportunities, firmer legislation, international conventions and product labeling) affect the incidence of child labor. I find that most interventions are likely to reduce the incidence of child labor either at a national level, a local level or in a specific industry. Some interventions (such as bans) are more likely to reduce the welfare of children than others (such as increased educational opportunities). It appears that if households do not chose by themselves to withdraw children from the labor market and are not given any form of compensation for lost income, the welfare of households (and thus the children as well) is reduced. Having this in mind, I take a closer look at one intervention in the carpet sector in Nepal: the Nepal GoodWeave Foundation. This organization labels carpets that are exported to countries such as Germany and the U.S. I find that GoodWeave is successful in reducing child labor in the factories that carry their label. At the same time, the organization helps to maintain the welfare of the children through education programs, in addition to preventing child labor by offering the children of carpet workers access to kindergartens and schools. Unfortunately, the scope of the program is too small to eliminate child labor throughout the carpet sector in Nepal

Participatory Customization of Platforms in the Public Sector

Denne studien undersøker prosessen for implementering av en generisk platform i offentlig sektor. Målet med studien er å få en bedre forståelse av rollen til testing i platformiseringsprosesser og hvordan det bidrar til deltakelse. En case-studie ble gjennomført på Helseplattformen, en generisk plattform som skal innføre felles journalløsning for primærog spesialisthelsetjenesten i Midt-Norge. Som en del av det nasjonale målbildet "Én innbygger - én journal", er Helseplattformen et pilotprosjekt for resten av landet. Helseplattformen leveres av amerikanske Epic Systems Corporation, og på deres "foundation system" skal det bygges et stort antall applikasjoner og integrasjoner for å tilpasse plattformen det norske helsesystemet. Det er forsket mye på verdien av å involvere brukere i systemutviklingsprosjekter, men deltakelse i stor-skala prosjekter er et langt mindre utforsket område. Ettersom slike prosjekter ofte skaper utfordringer knyttet til deltakelse, vil en økt forståelse av deltakelsesprosessen i Helseplattformen være nyttig for fremtidige utviklingsprosjekter, både i privat og offentlig sektor. Funnene viser at testing er en aktivitet for deltakelse som kanskje har blitt viktigere etterhvert som flere har adoptert platformmodellen. Kunnskapen som behøves for å tilpasse en plattform er distribuert, og distansen mellom kjernen og periferien kan øke på grunn av språk, terminologi, og kontekst for helsetjenester. Funnene indikerer også at leverandørens predefinerte og formelle roller og kommunikasjonsstrukturer påvirker implementasjonsprosessen.This study examine the process of implementing a generic platform in the public sector. The aim is to better understand the role of testing in platformization processes and how it contributes to participation. A case study was conducted on Helseplattformen as a generic platform that is currently being implemented in Central Norway. The aim of Helseplattformen is to introduce a common electronic health record (EHR) for primary and secondary health care. As part of the national objective "Én innbygger - én journal", Helseplattformen will serve as a pilot project for the rest of the country. Epic Systems Corporation is the vendor of Helseplattformen that will provide the generic core as a foundation for building a large number of applications and integrations. A number of studies have emphasized the value of involving future users in system development processes. However, user participation in large-scale projects is a far less explored area. Such projects often creates challenges related to participation which is why a deeper understanding of the participation process in Helseplattformen would be useful for a number of future development projects, in both the private and public sector. The findings from this research show that testing is an activity for participation that perhaps has become increasingly important as platform models are being adopted. The knowledge needed to customize a platform is distributed and the distance between the core and periphery might increase due to language, terminology, and the context of health care services. The findings also indicate that the vendor’s predefined and formal roles and communication structures might challenge the implementation process