Does successful treatment of constipation or faecal impaction resolve lower urinary tract symptoms? A structured review of the literature

Consensus guidelines advocate the treatment of constipation and faecal impaction in order to improve symptoms of urinary frequency, urgency and urinary incontinence and to promote bladder emptying in the absence of urinary tract obstruction. This structured review of the literature was undertaken to search for and appraise evidence to support or negate the hypothesis of this relationship. The search strategy was comprehensive and identified six relevant studies. Two of these had been conducted on an adult population and four studies involved children with constipation. These studies were appraised for methodological quality. It was found that sample sizes were small and evidence was inconsistent. Variable methods of reporting meant that data were not able to be pooled for meta-analysis.
Based on the limited and conflicting evidence, it is recommended that further research be undertaken to identify any correlation between bowel and bladder function.

Paediatric quality of life instruments: a review of the impact of the conceptual framework on outcomes

With an increasing number of paediatric quality of life (QOL) instruments being developed, it is becoming difficult for researchers and clinicians to select the most appropriate instrument. Reviews of QOL instruments tend to report only basic properties of the instruments such as domains and psychometric properties. This paper seeks to appraise critically the conceptual underpinnings of paediatric QOL instruments. A systematic review was conducted to identify QOL instruments for children aged 0 to 12 years, and to examine and compare their conceptual frameworks, definitions employed, and structure. Both generic and condition-specific measures were reviewed. Fourteen generic and 25 condition-specific QOL instruments were identified. Eleven types of definition of QOL and health-related QOL and three theories of QOL were identified. QOL was measured by a variety of domains including emotional, social and physical health, and well-being. Items commonly assessed difficulties, or intensity/frequency of feelings/symptoms, in contrast to positive aspects of life and happiness. The findings highlight the diversity that is apparent in the conceptualization of paediatric QOL and draw attention to the lack of empirical evidence for many of the fundamental assumptions. The impact of the conceptual underpinnings of the instruments on the resulting QOL scores is discussed.

Accompanying critically ill relatives in emergency departments

Background. Family members are a crucial part of the holistic approach to care in emergency departments. In particular, they are a group who are vulnerable, yet have been overlooked when considering care options.

Aim. The primary aim of this systematic review was to appraise research relevant to identifying and meeting the needs of family members who accompany a critically ill person into the Emergency Department (ED). The information was intended to inform future research into the care of these people.

Method. A quality assessment strategy was specifically developed to evaluate the various research designs used. The outcomes of the highest quality studies were used to develop evidence-based clinical practice guidelines to inform clinicians caring for family members who accompany a critically ill person into the ED.

Results. Recommendations for family care drawn from this review provide the foundation for more rigorous methodologies in future research into this topic. Key findings concern family needs for communication, proximity, support, comfort, assurance and to locate meaning in the event.

Conclusion. The review has revealed current knowledge about the care of family members who accompany a critically ill person into the ED that provides guidelines for practice. Despite significant limitations, the knowledge can lead to recommendation to guide and inform future intervention research.

Assessing indicant directionality of a media consumption construct using confirmatory tetrad analysis

When assessing the psychometric properties of measures and estimate relations among latent variables, many studies in the social sciences (including marketing) often fail to comprehensively appraise the directionality of indicants. Such failures can lead to model misspecification and inaccurate parameter estimates (Jarvis et al. 2003). In order to further assess the correct directionality of a ‘media consumption’ construct’s indicants, this paper employs confirmatory tetrad analysis (CTA). Previous studies advocate this construct being best viewed as formative. However, our CTA suggests it could be modelled using a reflective orientation. We then conclude the paper drawing recommendations for future studies advocating that when assessing item directionality researchers should implement pre and post hoc tests.

The effect of tai chi on psychosocial well-being : a systematic review of randomized controlled trials

Objective : This systematic review aimed to critically appraise published clinical trials designed to assess the effect of Tai Chi on psychosocial well-being.

Data Sources : Databases searched included MEDLINE, CINAHL, EMBASE, HEALT, PsycINFO, CISCOM, the Cochrane Central Register of Controlled Trials of the Cochrane Library, and dissertations and conference proceedings from inception to August 2008.

Review Methods : Methodological quality was assessed using a modified Jadad scale. A total of 15 studies met the inclusion criteria (i.e. English publications of randomized controlled trials with Tai Chi as an intervention and psychological well-being as an outcome measure), of which eight were high quality trials. The psychosocial outcomes measured included anxiety (eight studies), depression (eight studies), mood (four studies), stress (two studies), general mental health three studies), anger, positive and negative effect, self-esteem, life satisfaction, social interaction and self-rated health (one study each).

Results : Tai Chi intervention was found to have a significant effect in 13 studies, especially in the management of depression and anxiety. Although the results seemed to suggest Tai Chi is effective, they should be interpreted cautiously as the quality of the trials varied substantially. Furthermore, significant findings were shown in only six high quality studies. Moreover, significant between group differences after Tai Chi intervention was demonstrated in only one high quality study (the other three significant results were observed in non-high quality studies). Two high quality studies in fact found no significant Tai Chi effects.

Conclusion : It is still premature to make any conclusive remarks on the effect of Tai Chi on psychosocial well-being.

Processes for disciplining nurses for unprofessional conduct of a serious nature : a critique

Aims: This paper critiques the deliberative processes used by the discipline panels of an Australian statutory nurse regulating authority when appraising the alleged unprofessional conduct of nurses and determining appropriate remedies.

Background: Little is known about the nature and effectiveness of the deliberative processes used by nurse regulating authorities (NRAs) disciplinary panels established to appraise and make determinations in response to allegations of unprofessional conduct by nurses.

Methods: A qualitative exploratory descriptive/pragmatic research approach was used. Data were obtained from two case-orientated sampling units: (1) 84 Reasons for Determination made between 1994 and 2000 and (2) a purposeful sample of 12 former and current nurse regulating authority members, nurse regulating authority staff and a nurse regulating authority representative who had experience of disciplinary proceedings and/or who had served on a formal hearing panel. Data were analysed using content and thematic analysis strategies.

Results: Attitudinal considerations (e.g. whether a nurse understood the 'wrongness' of his or her conduct; accepted responsibility for his or her conduct; exhibited contrition/shame during the hearing; was candid in his or her demeanour) emerged as the singularly most significant factor influencing discipline panel determinations. Disciplinary action is taken appropriately against nurses who have committed acts of deliberate malfeasance. NRAs may not, however, be dealing appropriately with nurses when disciplining them for making honest mistakes/genuine practice errors.

Conclusion: Traditional processes used for appraising and disciplining nurses who have made honest mistakes in the course of their work need to be substantially modified as they are at odds with the models of human error management that are currently being advocated and adopted globally to improve patient safety and quality of care in health care domains.

Critical reflections on professional education for the environment

Evidence exists to suggest that in Australia many environmental issues remain unresolved even though the community has apparently become more environmentally aware. Although universities have undertaken responsibility to educate future environmental professionals to address this concern, there are numerous tensions underpinning professional environmental education. This folio explores my perceptions of these tensions and their effect on my professional practice as an academic. I refer to this as the relationships among theories and practices experienced in my work. Four perspectives are taken in this research as I appraise professional environmental education. This Dissertation (Vol. 1) focuses on views informing my professional environmental education, inclusive of my own reflexivity. From interviews with students, academics, professionals and environmentalists, and other sources of information, I consider various tensions arising from what I regard as dehumanising social and political forces. The conventional elite and authoritative roles for universities and professionals dominate most participants' understanding of professional activities. Professional practices often endorse these conventions. Juxtaposed to this authoritative view of professional education, and prescribing a different interpretation for professional practice, is my theoretical position informed by criticality and a need to challenge the status quo. I suggest that Leopold's The Land Ethic is an exemplar of criticality and a suitable basis for examining professional environmental education. The Land Ethic is used as a foundation to my thesis because it encapsulates suitable arguments to examine ideologies supportive of my understanding of professional environmental education. My thesis investigates the nature of participants' (including my own) understanding of their land ethic or land ethics suggesting that interpretations of 'place' provide an emotional and ethical appreciation of the land. I suggest that 'place', as a culturally derived construct, is central to the concept of a land ethic or land ethics, and a characteristic of an environmental ethic or ethics. To incorporate these different perspectives into professional environmental education perhaps land could be viewed, not just as a 'client' as in Schön's (1983) reflective contract, but expanded so that professionals form ethical partnerships with the land, which implies a greater equity between roles and responsibilities. This perspective challenges elite interpretations of the roles for environmental professionals by asking them to be advocates for their land, and to work with the land. Searching for my own land ethic or land ethics has promoted a discourse that encompasses a language of possibility and opportunity. This language of possibility and opportunity stands in contrast to the constraining language of reproduction that has promoted stasis. My reflexivity, a holistic and ecological view that in this thesis is an expression of my searching for a land ethic or land ethics, has encouraged me to develop critical and ethical questions to challenge my professional environmental education practice. As such the process of theorising about my theory and practice has been personally transformative as it encourages my development as a 'critical person'. Elective 1 (Vol. 2 ) reviews public information promoting a selected range of Australian environmental courses. Analysis demonstrates environmental courses are mainly technocratic, promoting technical-scientific and vocational perspectives. This orientation, I consider, is aligned to an emerging corporate agenda as universities attempt to be more accountable to the government within a competitive market dominated by economic interests. Elective 2 (Vol. 2 ) considers the providers of professional environmental education where I explore a diversity of tensions undermining current academic life found in many Australian universities. I suggest that corporatisation and vocationalisation dominate university culture to such an extent that any examination of professional environmental education is prejudiced. Professional environmental education appears to be biased toward maintaining the status quo. My conclusion is that professional environmental education does not promote graduates as 'critical persons' (Barnett 1997), and this may affect graduates' understandings of the purpose and aspirations of environmental professionalism. I suggest that elite and technical understandings of professionalism may affect the professionals' ability to implement environmental policy. Australia has an admirable record of developing environmental policy. However, public concern about a lack of resolution for many environmental issues suggests that professionals may be struggling to successfully implement policy in any meaningful way. Such challenges for environmental professionals may be a result of a professional environmental education that does not engage graduates within ideas that professional practice may require community participation and collaboration as key themes. Elective 3 (Vol. 2) is a case study investigating the development of conservation policies by the Ballarat community. The case demonstrates how the dominant social paradigm informs community views about environmental issues emphasising a technical emphasis and hierarchical arrangements of power and authority between local government and the community. The community view appears to be that environmental action should be mainly individualistic and behaviourist, which I suggest may have resulted from a technical framework for environmental knowledge. The community view of environmental issues resonates with the dominant view promoted by professional environmental education in most universities. In conclusion, my thesis is a representation of my challenges to critically engage in possible relationships among theories, practices and circumstances in my workplace, with a view to addressing what I perceive as a 'gap' between my own theory and practice. The motivation for this critical examination is to question the purpose of my professional environmental education practice in relation to the challenges of my emergent environmental ideology. The difficulty of promoting my critical theorising in a traditional small science faculty, within a corporate university, with my scientific background, is acknowledged. Nevertheless, based on my own experiences, I recommend that academics involved in professional environmental education should be encouraged to explore relationships between their own theories and practices in their own professional settings. I suggest that the search for a land ethic or land ethics, and one's 'place' in the 'land', can be an effective platform for this process.

Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting

Background. Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization. However, the research–practice gap remains a persistent issue for the nursing profession.

Aims and objectives. The aim of this study was to gain an understanding of perceived influences on nurses' utilization of research, and explore what differences or commonalities exist between the findings of this research and those of studies that have been conducted in various countries during the past 10 years.

Design. Nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. The instrument comprised a 29-item validated questionnaire, titled Barriers to Research Utilisation Scale (BARRIERS Scale), an eight-item scale of facilitators, provision for respondents to record additional barriers and/or facilitators and a series of demographic questions.

Method. The questionnaire was administered in 2001 to all nurses (n = 761) working at a major teaching hospital in Melbourne, Australia. A 45% response rate was achieved.

Results. Greatest barriers to research utilization reported included time constraints, lack of awareness of available research literature, insufficient authority to change practice, inadequate skills in critical appraisal and lack of support for implementation of research findings. Greatest facilitators to research utilization reported included availability of more time to review and implement research findings, availability of more relevant research and colleague support.

Conclusion. One of the most striking features of the findings of the present study is that perceptions of Australian nurses are remarkably consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade.

Relevance to clinical practice. If the use of research evidence in practice results in better outcomes for our patients, this behoves us, as a profession, to address issues surrounding support for implementation of research findings, authority to change practice, time constraints and ability to critically appraise research with conviction and a sense of urgency.

Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses

Objective
Health literacy refers to an individual's ability to seek, understand, and use health information. A range of indices exist that purport to measure health literacy across individuals and populations. This study aimed to review the development and content of existing indices and to critically appraise their properties.

Study Design and Setting
Using standardized search terms, published generic health literacy indices (1990–2008) were identified. Using a methodological framework, each was evaluated for purpose, validity (face, content, construct), reliability, responsiveness, feasibility, and generalizability.

Results
Nineteen instruments were evaluated. Three measurement approaches were identified: direct testing of individual abilities, self-report of abilities, and population-based proxy measures. Composition of underlying constructs and content varied widely across instruments, and none appeared to fully measure a person's ability to seek, understand, and use health information. The content was focused primarily on reading comprehension and numeracy; scoring categories were poorly defined and may not be mutually exclusive, and few indices had been assessed for reliability.

Conclusion
Health literacy is not consistently measured, making it difficult to interpret and compare health literacy at individual and population levels. Empirical evidence demonstrating validity and reliability of existing indices is required, and more comprehensive health literacy instruments need to be developed.

Enhancing creativity through design technology : opportunities for developing children's creative thinking

Creative problem solving is essential to technology education. In our research project we explored the suggestion that creativity may need to include a time of ‘non-thinking’ during which innovative responses to problem tasks are generated. The period of non-conscious cognitive process (NCCP) time is considered to be when the brain makes connections between independent ideas and when inappropriate responses can be forgotten, allowing more relevant responses to be made available for problem solving. Our research provided an opportunity for several primary school teachers to focus on enhancing creativity in technology education and to explore the notion of the NCCP time for creative problem solving. In this chapter we review the current literature on enhancing creativity and comment on how the teachers fostered creativity as they implemented a design, make and appraise technological task to produce recycling devices in their classrooms. Classes and children were observed and teachers interviewed about their perception of children’s creativity and the NCCP time. In this study, a time frame of only several days appears to be ideal for non-conscious cognitive processing to occur and more time may hinder creativity. These findings have implications for teachers of technology who assign the same day and time each week for technology learning.
During the non-task time, which included the NCCP time, children were able to discuss their ideas with family members. As children learn in social and cultural contexts, these discussions can be fruitful. The teachers indicated that peer discussions also played an important role after the generation of designs.

Investigating directionality for a media consumption construct : establishing the utility of confirmatory vanishing tetrad analysis

Purpose – When assessing the psychometric properties of measures and estimate relations among latent variables, many studies in the social sciences (including management and marketing) often fail to comprehensively appraise the directionality of indicants. Such failures can lead to model misspecification and inaccurate parameter estimates. The purpose of this paper is to apply a post hoc test called confirmatory vanishing tetrad analysis (CTA hereafter) to a single construct called mass media consumption information exposure, which antecedent studies conceptually posited to be a formative (causative) representation.
Design/methodology/approach – This paper analyses a consumer sample of 585 US respondents and applies the CTA test to a single construct by its inclusion in various matrices within a statistical analysis system-macro that takes into account nonnormal data characteristics. The matrices are derived from Mplus 5 through the estimation of a single-factor congeneric model. The CTA test calculates a test statistic similar to an asymptotic x2 distribution with degrees of freedom equal to the number of nonredundant tetrads tested.
Findings – The preliminary data analyses reveal that the data characteristics are nonnormal which is not uncommon in social research. The CTA results reveal that the reflective (emergent) item orientation cannot be fully ruled out as being the correct model representation. This is in contrast to prior theoretical conceptual work which would strongly support this construct being a formative representation.
Originality/value – Insofar as the authors are aware, there is no paper with a particular focus on how the CTA might not provide sound results with a demonstrated example. The paper makes a valuable contribution by discussing modelling philosophy and a procedure for directionality testing. The authors advocate the implementation of pre and post hoc tests as a key component of standard research practice.

Missing Data - implications for outcomes research and strategies to maximise data integrity

he workshop will firstly provide an overview of the problems associated with missing data within the context of clinical trials and how to minimise these. Missing data will be explored by modeling the impact on a number of datasets. This approach will be invaluable in highlighting how alternative methods for controlling for missing data impact differentially on the interpretation of study findings. Popular strategies involve options based on an assessment of the percentage of missing data. More innovative approaches to the management of missing data (e.g. based upon reliability analyses) will be explored and evaluated and the role of the most popular methods of data management explored in several study designs beyond those of the classic randomised controlled trial. Participants will have the opportunity to appraise and debate existing methods of missing data handling.

The role of health literacy and social networks in arthritis patients' health information-seeking behavior : a qualitative study

Background. Patients engage in health information-seeking behaviour to maintain their wellbeing and to manage chronic diseases such as arthritis. Health literacy allows patients to understand available treatments and to critically appraise information they obtain from a wide range of sources.

Aims. To explore how arthritis patients' health literacy affects engagement in arthritis-focused health information-seeking behaviour and the selection of sources of health information available through their informal social network.

Methods. An exploratory, qualitative study consisting of one-on-one semi-structured interviews. Twenty participants with arthritis were recruited from community organizations. The interviews were designed to elicit participants' understanding about their arthritis and arthritis medication and to determine how the participants' health literacy informed selection of where they found information about their arthritis and pain medication.

Results. Participants with low health literacy were less likely to be engaged with health information-seeking behaviour. Participants with intermediate health literacy were more likely to source arthritis-focused health information from newspapers, television, and within their informal social network. Those with high health literacy sourced information from the internet and specialist health sources and were providers of information within their informal social network.

Conclusion. Health professionals need to be aware that levels of engagement in health information-seeking behaviour and sources of arthritis-focused health information may be related to their patients' health literacy.

Instrumental vision

This chapter interrogates stereo-immersive ‘virtual reality’ (VR), the technology that enables a perceiver to experience what it is like to be immersed in a simulated environment. While the simulation is powered by the “geometry engine” (Cutting, 1997: 31) associated with high-end computer imaging technology, the visual experience itself is powered by ordinary human vision: the vision system’s innate capacity to see “in 3D”. To understand and critically appraise stereo-immersive VR, we should study not its purported ‘virtuality’, but its specific visuality, because the ‘reality’ of a so-called ‘virtual environment’ is afforded by the stereoacuity of binocular vision itself. By way of such a critique of the visuality of stereo-immersive VR, this chapter suggests that we think about the ‘practice’ of vision, and consider on what basis vision can have its own ‘materiality’. Pictorial perception is proposed as an exemplary visual mode in which the possibilities of perception might emerge. Against the ‘possibilities’ of vision associated with pictures, the visuality of stereo-immersive VR emerges as a harnessing, or ‘instrumentalisation’ of vision’s innate capabilities. James J. Gibson’s ‘ecological’ approach to vision studies is referenced to show the degree to which developers of VR have sought — and succeeded — to mimic the ‘realness’ of ordinary perceptual reality. This raises a question concerning whether the success of stereo-immersive VR is simultaneously the source of its own perceptual redundancy: for to bring into being the perceptual basis of ordinary ‘real’ reality, is to return the perceiver to what is already familiar and known.

Role assessment of GIS analysis and its reliability while ranking urban sustainability using scenarios specific to regional climate, community and culture

Urban Sustainability expresses the level of conservation of a city while living a town or consuming its urban resources, but the measurement of urban sustainability depends on what are considered important indicators of conservation besides the permitted levels of consumption in accordance with adopted criteria. This criterion should have common factors that are shared for all the members tested or cities to be evaluated as in this particular case for Abu Dhabi, but also have specific factors that are related to the geographic place, community and culture, that is the measures of urban sustainability specific to a middle east climate, community and culture where GIS Vector and Raster analysis have a role or add a value in urban sustainability measurements or grading are considered herein. Scenarios were tested using various GIS data types to replicate urban history (ten years period), current status and expected future of Abu Dhabi City setting factors to climate, community needs and culture. The useful Vector or Raster GIS data sets that are related to every scenario where selected and analysed in the sense of how and how much it can benefit the urban sustainability ranking in quantity and quality tests, this besides assessing the suitable data nature, type and format, the important topology rules to be considered, the useful attributes to be added, the relationships which should be maintained between data types of a geo- database, and specify its usage in a specific scenario test, then setting weights to each and every data type representing some elements of a phenomenon related to urban suitability factor. The results of assessing the role of GIS analysis provided data collection specifications such as the measures of accuracy reliable to a certain type of GIS functional analysis used in an urban sustainability ranking scenario tests. This paper reflects the prior results of the research that is conducted to test the multidiscipline evaluation of urban sustainability using different indicator metrics, that implement vector GIS Analysis and Raster GIS analysis as basic tools to assist the evaluation and increase of its reliability besides assessing and decomposing it, after which a hypothetical implementation of the chosen evaluation model represented by various scenarios was implemented on the planned urban sustainability factors for a certain period of time to appraise the expected future grade of urban sustainability and come out with advises associated with scenarios for assuring gap filling and relative high urban future sustainability. The results this paper is reflecting are concentrating on the elements of vector and raster GIS analysis that assists the proper urban sustainability grading within the chosen model, the reliability of spatial data collected; analysis selected and resulted spatial information. Starting from selecting some important indicators to comprise the model which include regional culture, climate and community needs an example of what was used is Energy Demand & Consumption (Cooling systems). Thus, this factor is related to the climate and it‟s regional specific as the temperature varies around 30-45 degrees centigrade in city areas, GIS 3D Polygons of building data used to analyse the volume of buildings, attributes „building heights‟, estimate the number of floors from the equation, following energy demand was calculated and consumption for the unit volume, and compared it in scenario with possible sustainable energy supply or using different environmental friendly cooling systems this is followed by calculating the cooling system effects on an area unit selected to be 1 sq. km, combined with the level of greenery area, and open space, as represented by parks polygons, trees polygons, empty areas, pedestrian polygons and road surface area polygons. (initial measures showed that cooling system consumption can be reduced by around 15 -20 % with a well-planned building distributions, proper spaces and with using environmental friendly products and building material, temperature levels were also combined in the scenario extracted from satellite images as interpreted from thermal bands 3 times during the period of assessment. Other examples of the assessment of GIS analysis to urban sustainability took place included Waste Productivity, some effects of greenhouse gases measured by the intensity of road polygons and closeness to dwelling areas, industry areas as defined from land use land cover thematic maps produced from classified satellite images then vectors were created to take part in defining their role within the scenarios. City Noise and light intensity assessment was also investigated, as the region experiences rapid development and noise is magnified due to construction activities, closeness of the airports, and highways. The assessment investigated the measures taken by urban planners to reduce degradation or properly manage it. Finally as a conclusion tables were presented to reflect the scenario results in combination with GIS data types, analysis types, and the level of GIS data reliability to measure the sustainability level of a city related to cultural and regional demands.