The work undertaken by mechanically ventilated patients in intensive care : a qualitative meta-ethnography of survivors' experiences

Background: Mechanical ventilation is a routine intervention for the critically ill but patients' experiences of this intervention are largely hidden from clinicians. A comprehensive understanding of Intensive Care Units survivors' accounts is required to provide health professionals with evidence about the patients' experience to deliver patient-centred care. Objectives: To synthesise qualitative findings from international studies to understand Intensive Care Unit survivors' experiences of mechanical ventilation, clarify the components of patient-centred care from the patient perspective and understand what can be done by health professionals to improve care processes. Design: A meta-ethnography of qualitative evidence following ENTREQ recommendations for reporting systematic reviews. Data Sources: Eight databases (MEDLINE, AMED, CINAHL, PsychINFO, Scopus, WileyOnline, PubMed Central, TRIP) were systematically searched using a piloted strategy described in a published protocol. Searches were completed on 31.8.16 and no date restrictions were placed. Searches were updated on 25.4.17. Review Methods: Two researchers independently reviewed studies against pre-determined inclusion criteria to assess their eligibility. Studies were included if they reported on the adult patient experience of mechanical ventilation and used qualitative data collection and analysis methods. All included studies were quality appraised. Participant quotes and concepts, described within the categories and themes of published studies, were extracted by one reviewer and coded by two reviewers. A process of constant comparison, which is central to meta-ethnography, facilitated the re-interpretation of data by a team of researchers to generate the final qualitative synthesis. The Enhancing Transparency in Reporting the Synthesis of Qualitative (ENTREQ) statement was used to ensure that all synthesis stages were comprehensively reported. Results: Findings from 38 studies, with 608 participants, informed a patient-centred trajectory model; three overlapping stages; alienation, hidden work and recovery characterised the experiences of mechanical ventilation survivors. Health professionals could positively influence the patient experience by promoting ‘trust’ and being vigilant so that patients felt ‘safe’. Care provision that promoted ‘personalisation’ helped participants to retain their identity as unique human beings. Conclusions: For the first time the pooling of qualitative findings from international studies, using meta-ethnography, has provided a patient-centred model of mechanical ventilation survivors’ experiences of their care processes. Patients may actively engage or passively endure the treatment burden associated with mechanical ventilation. Keywords: Critical care; mechanical ventilation; patient experience; qualitative synthesis, care processes, meta-ethnograph

Upaya Peningkatan Hasil Belajar dengan Metode Constructive Controversy pada Materi Asam Basa

Tujuan dari penelitian ini adalah untuk mengetahui kegiatan guru, keaktifan siswa dan peningkatan hasil belajar siswa menggunakan metode Constructive Controversy pada materi asam basa bagi siswa kelas XI IPA 4 SMA Negeri 3 Gorontalo tahun pelajaran 2015/2016. Penelitian ini merupakan penelitian tindakan kelas yang dilaksanakan dua siklus dengan tiap siklus terdiri dari perencanaan, tindakan, pengamatan dan refleksi. Subjek penelitian adalah siswa kelas XI IPA 4 SMA Negeri 3 Gorontalo. Teknik pengumpulan data adalah dengan tes, dan observasi. Analisis data menggunakan teknik analisis deskriptif kualitatif. Hasil penelitian menunjukkan bahwa penggunaan metode Constructive Controversy dapat meningkatkan kegiatan guru (dari 70,52% pada siklus I menjadi 86,83% pada siklus II), keaktifan siswa meningkat (dari 69% pada siklus I menjadi 89% pada siklus II) dan hasil belajar (pencapaian persentase dimensi pengetahuan meningkat dari 45,16% pada siklus I menjadi 92,86% pada siklus II; persentase dimensi sikap siswa pada kegiatan diskusi meningkat dari 45,16% menjadi 100% pada siklus II dan untuk kegiatan praktikum sebesar 67,74% menjadi 100% pada siklus II; persentase dimensi keterampilan siswa pada kegiatan diskusi sebesar 41,94% menjadi 100% pada siklus II dan untuk kegiatan praktikum sebesar 64,52% menjadi 100% pada siklus II

Social and cultural origins of motivations to volunteer a comparison of university students in six countries

Although participation in volunteering and motivations to volunteer (MTV) have received substantial attention on the national level, particularly in the US, few studies have compared and explained these issues across cultural and political contexts. This study compares how two theoretical perspectives, social origins theory and signalling theory, explain variations in MTV across different countries. The study analyses responses from a sample of 5794 students from six countries representing distinct institutional contexts. The findings provide strong support for signalling theory but less so for social origins theory. The article concludes that volunteering is a personal decision and thus is influenced more at the individual level but is also impacted to some degree by macro-level societal forces

A core curriculum for the continuing professional development of nurses: Developed by the Education Committee on behalf of the Council on Cardiovascular Nursing and Allied Professions of the ESC

Background: The European Society of Cardiology and the Council on Cardiovascular Nursing and Allied Professions share a vision; to decrease the burden of cardiovascular disease in Europe. Nurses represent the largest sector of the health professional workforce and have a significant contribution to make, which has not yet been fully realised. Recent evidence highlights an association between the level of nurse education and inpatient mortality making this an important topic, particularly as the provision of nurse education in Europe is variable. Aim: To develop a core curriculum to inform the education of nurses following initial qualification for work in cardiovascular settings. Method: A syllabus was developed using published literature, policy documents and existing curricula with expert input from service users, specialist nurses, cardiologists, educationalists and academics. The syllabus formed the framework for the development of the core curriculum. Results: Eight key themes characterise the core curriculum which are presented together with an account of the development process. While the curriculum is not intended to cover all aspects of the highly complex role of the cardiovascular nurse, the themes do exemplify the science and art of nursing and are transferable across different levels of clinical practice and settings. The curriculum functions both as a ‘map’, which identifies key themes to include in nurse education, and as a ‘tool’ to inform educational provision that bridges’ the gap between initial nurse education and advanced specialist practice. Content can be adapted for use to fit the national context and reflects the specific needs, health priorities, legislative and regulatory standards that govern safe nursing practice across different countries. Conclusion: The core curriculum can be used as a learning framework to guide nurse education, in particular the continuing professional education of post-qualifying nurses working in cardiovascular settings. This represents a significant step towards streamlining cardiovascular nurse education in Europ

Environmental noise levels in hospital settings : a rapid review of measurement techniques and implementation in hospital settings

Background: Hospitals provide treatment to improve patient health and well-being but the characteristics of the care environment receive little attention. Excessive noise at night has a negative impact on in-patient health through disturbed sleep. To address this hospital staff must measure night-time environmental noise levels. Therefore, an understanding of environmental noise measurement techniques is required. In this review, we aim to 1) provide a technical overview of factors to consider when measuring environmental noise in hospital settings; 2) conduct a rapid review on the equipment and approaches used to objectively measured noise in hospitals and identify methodological limitations. Design: A rapid review of original research articles, from 3 databases, published since 2008. Studies were included if noise levels were objectively measured in a hospital setting where patients were receiving treatment. Results: 1429 articles were identified with 76 included in the review. There was significant variability in the approaches used to measure environmental noise in hospitals. Only 14.5% of studies contained sufficient information to support replication of the measurement process. Most studies measured noise levels using a sound level meter positioned closed to a patient’s bed area in an intensive care unit. Conclusion: Unwanted environmental noise in hospital setting impacts negatively on patient and staff health and well-being. However, this literature review found that the approaches used to objectively measure noise level in hospital settings have been inconsistent and poorly reported. Recommendations on best-practice methods to measure noise levels in hospital environments are provided

Immunoresponsive Gene 1 Augments Bactericidal Activity of Macrophage-Lineage Cells by Regulating β-Oxidation-Dependent Mitochondrial ROS Production

SummaryEvidence suggests the bactericidal activity of mitochondria-derived reactive oxygen species (mROS) directly contributes to killing phagocytozed bacteria. Infection-responsive components that regulate this process remain incompletely understood. We describe a role for the mitochondria-localizing enzyme encoded by Immunoresponsive gene 1 (IRG1) during the utilization of fatty acids as a fuel for oxidative phosphorylation (OXPHOS) and associated mROS production. In a zebrafish infection model, infection-responsive expression of zebrafish irg1 is specific to macrophage-lineage cells and is regulated cooperatively by glucocorticoid and JAK/STAT signaling pathways. Irg1-depleted macrophage-lineage cells are impaired in their ability to utilize fatty acids as an energy substrate for OXPHOS-derived mROS production resulting in defective bactericidal activity. Additionally, the requirement for fatty acid β-oxidation during infection-responsive mROS production and bactericidal activity toward intracellular bacteria is conserved in murine macrophages. These results reveal IRG1 as a key component of the immunometabolism axis, connecting infection, cellular metabolism, and macrophage effector function

Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoples’ experiences

Background Coronary heart disease is an incurable condition. The only approach known to slow its progression is healthy lifestyle change and concordance with cardio-protective medicines. Few people fully succeed in these daily activities so potential health improvements are not fully realised. Little is known about peoples’ experiences of managing lifestyle change. The aim of this study was to synthesise qualitative research to explain how participants make lifestyle change after a cardiac event and explore this within the wider illness experience. Methods A qualitative synthesis was conducted drawing upon the principles of meta-ethnography. Qualitative studies were identified through a systematic search of 7 databases using explicit criteria. Key concepts were identified and translated across studies. Findings were discussed and diagrammed during a series of audiotaped meetings. Results The final synthesis is grounded in findings from 27 studies, with over 500 participants (56% male) across 8 countries. All participants experienced a change in their self-identity from what was ‘familiar’ to ‘unfamiliar’. The transition process involved ‘finding new limits and a life worth living’ , ‘finding support for self’ and ‘finding a new normal’. Analyses of these concepts led to the generation of a third order construct, namely an ongoing process of ‘reassessing past, present and future lives’ as participants considered their changed identity. Participants experienced a strong urge to get back to ‘normal’. Support from family and friends could enable or constrain life change and lifestyle changes. Lifestyle change was but one small part of a wider ‘life’ change that occurred. Conclusions The final synthesis presents an interpretation, not evident in the primary studies, of a person-centred model to explain how lifestyle change is situated within ‘wider’ life changes. The magnitude of individual responses to a changed health status varied. Participants experienced distress as their notion of self identity shifted and emotions that reflected the various stages of the grief process were evident in participants’ accounts. The process of self-managing lifestyle took place through experiential learning; the level of engagement with lifestyle change reflected an individual’s unique view of the balance needed to manage ‘realistic change’ whilst leading to a life that was perceived as ‘worth living’. Findings highlight the importance of providing person centred care that aligns with both psychological and physical dimensions of recovery which are inextricably linked

The multifaith campus: Transforming colleges and universities for spiritual engagement

Dafina Lazarus Stewart, Michael M. Kocet, and Sharon Lobdell explore what college and university campuses would look like if transformed to promote and sustain religious and secular pluralism and interfaith cooperation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/83741/1/20049_ftp.pd

Incommensurable worldviews? Is public use of complementary and alternative medicines incompatible with support for science and conventional medicine?

Proponents of controversial Complementary and Alternative Medicines, such as homeopathy, argue that these treatments can be used with great effect in addition to, and sometimes instead of, ?conventional? medicine. In doing so, they accept the idea that the scientific approach to the evaluation of treatment does not undermine use of and support for some of the more controversial CAM treatments. For those adhering to the scientific canon, however, such efficacy claims lack the requisite evidential basis from randomised controlled trials. It is not clear, however, whether such opposition characterises the views of the general public. In this paper we use data from the 2009 Wellcome Monitor survey to investigate public use of and beliefs about the efficacy of a prominent and controversial CAM within the United Kingdom, homeopathy. We proceed by using Latent Class Analysis to assess whether it is possible to identify a sub-group of the population who are at ease in combining support for science and conventional medicine with use of CAM treatments, and belief in the efficacy of homeopathy. Our results suggest that over 40% of the British public maintain positive evaluations of both homeopathy and conventional medicine simultaneously. Explanatory analyses reveal that simultaneous support for a controversial CAM treatment and conventional medicine is, in part, explained by a lack of scientific knowledge as well as concerns about the regulation of medical research