Who is in control? Clinicians' view on their role in self-management approaches: a qualitative metasynthesis

Objective To explore clinician perceptions of involvement in delivery of self-management approaches. Setting All healthcare settings. Design EBSCO, Scopus and AMED databases were searched, in July 2013, for peer-reviewed studies in English reporting original qualitative data concerning perceptions of clinicians regarding their involvement in or integration of a self-management approach. Of 1930 studies identified, 1889 did not meet the inclusion criteria. Full text of 41 studies were reviewed by two independent reviewers; 14 papers were included for metasynthesis. Findings and discussion sections were imported into Nvivo-10 and coded line-by-line. Codes were organised into descriptive themes and cross-checked against original sources to check interpretation, and refined iteratively until findings represented an agreed understanding. Studies were appraised for quality. Results Delivering self-management in practice appeared to be a complex process for many clinicians. The issue of ‘control’ arose in all studies, both in the qualitative data and authors’ interpretations. The first theme: Who is in control?—represented ways clinicians talked of exercising control over patients and the control they expected patients to have over their condition. The second theme: Changing clinician views—reflected what appeared to be an essential transformation of practice experienced by some clinicians in the process of integrating self-management approaches into the practice. A range of challenges associated with shifting towards a self-management approach were reflected in the third theme, Overcoming challenges to change. Tensions appeared to exist around forming partnerships with patients. Strategies found helpful in the process of change included: dedicating time to practice reciprocity in communication style, peer support and self-reflection. Conclusions A consistent finding across studies is that ‘control’ is a key feature of how self-management is viewed by clinicians. They described challenges associated with the paradigm shift required to share or let go of control. Future research should identify whether strategies described by clinicians are key to successful self-management

Real-time, label-free, intraoperative visualization of peripheral nerves and microvasculatures using multimodal optical imaging techniques

Accurate, real-time identification and display of critical anatomic structures, such as the nerve and vasculature structures, are critical for reducing complications and improving surgical outcomes. Human vision is frequently limited in clearly distinguishing and contrasting these structures. We present a novel imaging system, which enables noninvasive visualization of critical anatomic structures during surgical dissection. Peripheral nerves are visualized by a snapshot polarimetry that calculates the anisotropic optical properties. Vascular structures, both venous and arterial, are identified and monitored in real-time using a near-infrared laser-speckle-contrast imaging. We evaluate the system by performing in vivo animal studies with qualitative comparison by contrast-agent-aided fluorescence imaging

Pneumocephalus after posterior fossa exploration in the sitting position

Entrainment of air following exploration of posterior cranial fossa in the sitting position was studied in five patients. Intracranial pressure was monitored through a ventriculostomy catheter after closure of the dura. In three patients nitrous oxide was added to the breathing mixture only after the baseline intracranial pressure had stabilised following closure of the dura. A marked rise in intracranial pressure was observed immediately. A rapid decrease in intracranial pressure occurred when nitrous oxide administration was stopped. Two patients were given nitrous oxide from the beginning. No change in intracranial pressure was noted. Computerised tomogram on the first postoperative day revealed a significant amount of air in eight cases.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72920/1/j.1365-2044.1982.tb01711.x.pd

Mobility deficit – Rehabilitate, an opportunity for functionality

There are many pathological conditions that cause mobility deficits and that ultimately influence someone’s autonomy.Aims: to evaluate patients with mobility deficits functional status; to implement a Rehabilitation Nursing intervention plan; to monitor health gains through mobility deficits rehabilitation.Conclusion: Early intervention and the implementation of a nursing rehabilitation intervention plan results in health gains (direct or indirect), decreases the risk of developing Pressure Ulcers (PU) and the risk of developing a situation of immobility that affects patients’ autonomy and quality of life

Use of Guided Wave Inspections to Monitor the Integrity of Nuclear Power Station Boilers

This paper describes a ground-breaking application of guided wave testing for the nuclear power industry. Hartlepool and Heysham 1 power stations in the UK contain boilers of a unique ‘pod’ design in which the spiral boiler tubes are supported from above by a central vertical ‘spine’, which is a tubular component approximately 520mm in diameter and 21m long with complex changes in cross-section and attachments along its length. There are 32 boilers in the two stations. The gas which has passed through the reactor core flows down over the boiler tubes, heating the water inside. Only the top 2m of each spine is accessible above the top of the boiler pod. Plant Integrity Ltd was engaged by to inspect these ‘spine’ supports in 2003 using its Teletest guided wave system at statutory outages, which occur on a 3-year interval for each reactor. The Teletest tool was positioned in the only accessible place, just below the inlet header which protrudes approximately 2m from the top of the boiler. A procedure was developed to enable the full 21m length of the spine inside the boiler pod itself to be examined. During one of the regular Teletest inspections, at Heysham 1 power station in September 2013, a significant change in response was detected from the central part of one of the boiler spines. As a result, two of the eight boilers at Heysham 1 Reactor 1 were shut down pending further investigations. The indication was confirmed to be a structurally significant crack in the spine concerned. The crack detected was at the exact position and of the approximate extent reported by Teletest, which had detected the flaw from some 10m away. All four reactors at Hartlepool and Heysham 1 power stations were shut down in the latter part of 2014 while a new safety case for return to service of the remaining boilers was made. There is currently no viable alternative to guided wave inspection for monitoring the integrity of these boiler spines and a significant programme of work has been carried out to demonstrate the performance of Teletest for detection of flaws in these components under a variety of circumstances in order to support the safety case for operation. This has involved theoretical modelling, review of information contained in historical inspection data, practical tests on a full scale mock-up component, development of high temperature Teletest tooling to allow in- service tests and production of automated Teletest data collection equipment to allow real time in-service monitoring of the spines. TWI’s and Plant Integrity’s support enabled all four reactors to be returned to service before the end of 2014

The promoter from SlREO, a highly-expressed, root-specific Solanum lycopersicum gene, directs expression to cortex of mature roots

Root-specific promoters are valuable tools for targeting transgene expression, but many of those already described have limitations to their general applicability. We present the expression characteristics of SlREO, a novel gene isolated from tomato (Solanum lycopersicum L.). This gene was highly expressed in roots but had a very low level of expression in aerial plant organs. A 2.4-kb region representing the SlREO promoter sequence was cloned upstream of the uidA GUS reporter gene and shown to direct expression in the root cortex. In mature, glasshouse-grown plants this strict root specificity was maintained. Furthermore, promoter activity was unaffected by dehydration or wounding stress but was somewhat suppressed by exposure to NaCl, salicylic acid and jasmonic acid. The predicted protein sequence of SlREO contains a domain found in enzymes of the 2-oxoglutarate and Fe(II)-dependent dioxygenase superfamily. The novel SlREO promoter has properties ideal for applications requiring strong and specific gene expression in the bulk of tomato root tissue growing in soil, and is also likely to be useful in other Solanaceous crop

The cultural capitalists: notes on the ongoing reconfiguration of trafficking culture in Asia

Most analysis of the international flows of the illicit art market has described a global situation in which a postcolonial legacy of acquisition and collection exploits cultural heritage by pulling it westwards towards major international trade nodes in the USA and Europe. As the locus of consumptive global economic power shifts, however, these traditional flows are pulled in other directions: notably for the present commentary, towards and within Asia

Coleridge, Sara

An encylopaedia article on the life and writings of Sara Coleridge (1802-1852), for an online work of reference and scholarshi

Somatic Cell Count

This archival publication may not reflect current scientific knowledge or recommendations. Current information available from the University of Minnesota Extension: https://www.extension.umn.edu