Realizing autonomy in responsive relationships

The goal of this article is to augment the ethical discussion among nurses with the findings from empirical research on autonomy of older adults with type 2 diabetes mellitus. There are many factors influencing autonomy. These include: health conditions, treatment, knowledge, experience and skills, personal approach as well as familial patterns, type of relationship, life history and social context. Fifteen older adults with type 2 diabetes mellitus were interviewed in a nurse-led diabetes clinic. These participants perceive three processes which support autonomy in responsive relationships: preserving patterns of concern and interaction, nurturing collaborative responsibilities and being closely engaged in trustful and helpful family relations. People with diabetes realize autonomy in various responsive relationships in their unique life context. Next, we performed a literature review of care ethics and caring in nursing with regard to relational autonomy. We classified the literature in five strands of care: attitude-oriented, dialogue-oriented, activity-oriented, relationship-oriented and life-oriented. According to our respondents, autonomy in responsive relationships is fostered when patient, nurses, professionals of the health team and family members carry out care activities supported by a relational attitude of care. They can best realize autonomy in relationships with others when several essential aspects of care and caring are present in their lives. Therefore, we advocate a comprehensive approach to care and caring

Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada

<p>Abstract</p> <p>Background</p> <p>Aboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies.</p> <p>Methods</p> <p>In Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the Canadian First Nations Diabetes Clinical Management and Epidemiologic (CIRCLE) study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated). Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities.</p> <p>Results</p> <p>the key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs) and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs.</p> <p>Conclusions</p> <p>Addressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services. Research incorporating patient perspectives is needed to complete this picture and inform quality improvement initiatives.</p

Corroborating indicates nurses’ ethical values in a geriatric ward

The aim of the study was to identify nurses’ ethical values, which become apparent through their behaviour in the interactions with older patients in caring encounters at a geriatric clinic

Knowledge-to-action processes in SHRTN collaborative communities of practice: A study protocol

<p>Abstract</p> <p>Background</p> <p>The Seniors Health Research Transfer Network (SHRTN) Collaborative is a network of networks that work together to improve the health and health care of Ontario seniors. The collaborative facilitates knowledge exchange through a library service, knowledge brokers (KBs), local implementation teams, collaborative technology, and, most importantly, Communities of Practice (CoPs) whose members work together to identify innovations, translate evidence, and help implement changes.</p> <p>This project aims to increase our understanding of knowledge-to-action (KTA) processes mobilized through SHRTN CoPs that are working to improve the health of Ontario seniors. For this research, KTA refers to the movement of research and experience-based knowledge between social contexts, and the use of that knowledge to improve practice. We will examine the KTA processes themselves, as well as the role of human agents within those processes. The conceptual framework we have adopted to inform our research is the Promoting Action on Research Implementation in Health Services (PARIHS) framework.</p> <p>Methods/design</p> <p>This study will use a multiple case study design (minimum of nine cases over three years) to investigate how SHRTN CoPs work and pursue knowledge exchange in different situations. Each case will yield a unique narrative, framed around the three PARIHS dimensions: evidence, context, and facilitation. Together, the cases will shed light on how SHRTN CoPs approach their knowledge exchange initiatives, and how they respond to challenges and achieve their objectives. Data will be collected using interviews, document analysis, and ethnographic observation.</p> <p>Discussion</p> <p>This research will generate new knowledge about the defining characteristics of CoPs operating in the health system, on leadership roles in CoPs, and on the nature of interaction processes, relationships, and knowledge exchange mechanisms. Our work will yield a better understanding of the factors that contribute to the success or failure of KTA initiatives, and create a better understanding of how local caregiving contexts interact with specific initiatives. Our participatory design will allow stakeholders to influence the practical usefulness of our findings and contribute to improved health services delivery for seniors.</p

Applying compression simulation to behavioral study and efficiency analysis of DC mannitol powders

Le travail réalisé concerne l’étude de la fonctionnalité et des performances des poudres de mannitol en compression directe en s’appuyant sur la simulation de compression sur presse rotative comme outil d’investigations. Dans le contexte réglementaire actuel, il est important pour les industriels, fournisseurs d’excipients pharmaceutiques, d’approfondir leurs connaissances des matériaux afin de répondre aux critères de qualité des médicaments et aux exigences de l’industrie pharmaceutique. Le mannitol est un excipient très largement utilisé en formulation pharmaceutique et notamment pour la conception de comprimés. L’objectif essentiel de cette Etude vise à mieux connaître et maîtriser la qualité de cette matière première afin de pouvoir améliorer, voire optimiser ses performances en compression directe. A l’aide d’une série de tests de caractérisation physiques, physico-chimiques, mécaniques et de compression sur les poudres de mannitol, nous avons pu identifier, dans un premier temps, un certain nombre de critères qui nous ont permis d’émettre des hypothèses et d’établir des axes de travail afin d’analyser le comportement de ces poudres en compression. Les résultats obtenus ont également permis de mettre en avant, à l’aide de l’étude de la compressibilité et des modèles mathématiques associés, un mécanisme de déformation prédominant sur les poudres de mannitol de compression directe. De nombreux prototypes ont fait l’objet d’une investigation approfondie dans une seconde partie, permettant de valider ces hypothèses et d’identifier les paramètres et mécanismes responsables des performances en compression des poudres de mannitol.Globalement, les travaux de recherche conduits dans cette thèse ont permis d’améliorer les connaissances sur les performances en compression des poudres de mannitol de la société Roquette Frères dans des conditions réelles d’utilisation, semblables aux presses rotatives industrielles, et en fournissant des résultats expérimentaux validés et modélisés.This work focuses on the study of the functionality and performance of directly compressed mannitol powder using a rotary tablet press simulator as an investigation tool. For regulatory authority, it is essential for industrial - pharmaceutical raw material suppliers, to deepen their knowledge about materials to satisfy the drug quality standards and Pharmaceutical industry requirements. Mannitol is a widely used raw material in pharmaceutical formulations for the design of tablets. The main objective of this study is to have a better control and knowledge about this raw material quality, in order to improve and optimize the performance of mannitol in direct compression.Using a series of physical, physico-chemical, mechanical and compression studies on mannitol powders, we identified some criteria that allowed us to emit hypotheses and build a line of work to analyze the powders behavior under compression. The results also allowed us - using compressibility and associated mathematical models - to study the predominant deformation mechanism of directly compressed mannitol powders. Various mannitol prototypes were studied in a second part, permitting to validate these hypotheses and identify parameters and mechanisms affecting tableting performance.Overall, the research work achieved in this thesis have improved the knowledge about compression performance of mannitol powders from Roquette Frères SA company in tablet production used conditions, similar to industrial rotary tablet press, and providing validated and modeled experimental results

TACHYCARDIE VENTRICULAIRE DU SUJET JEUNE SUR UN COEUR APPAREMMENT SAIN ET SA REPONSE AU VERAPAMIL

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF