Adherence, adaptation and acceptance of elderly chronic heart failure patients to receiving healthcare via telephone-monitoring

Background: Although the potential to reduce hospitalisation and mortality in chronic heart failure (CHF) is well reported, the feasibility of receiving healthcare by structured telephone support or telemonitoring is not. Aims: To determine; adherence, adaptation and acceptability to a national nurse-coordinated telephone-monitoring CHF management strategy. The Chronic Heart Failure Assistance by Telephone Study (CHAT). Methods: Triangulation of descriptive statistics, feedback surveys and qualitative analysis of clinical notes. Cohort comprised of standard care plus intervention (SC + I) participants who completed the first year of the study. Results: 30 GPs (70% rural) randomised to SC + I recruited 79 eligible participants, of whom 60 (76%) completed the full 12 month follow-up period. During this time 3619 calls were made into the CHAT system (mean 45.81 SD ± 79.26, range 0-369), Overall there was an adherence to the study protocol of 65.8% (95% CI 0.54-0.75; p = 0.001) however, of the 60 participants who completed the 12 month follow-up period the adherence was significantly higher at 92.3% (95% CI 0.82-0.97, p ≤ 0.001). Only 3% of this elderly group (mean age 74.7 ±9.3 years) were unable to learn or competently use the technology. Participants rated CHAT with a total acceptability rate of 76.45%. Conclusion: This study shows that elderly CHF patients can adapt quickly, find telephone-monitoring an acceptable part of their healthcare routine, and are able to maintain good adherence for a least 12 months. © 2007.

Things just got really serious : coping in crisis

You have chosen to enter a profession that can afford you a wonderfully rich career. It is a role that has many areas of speciality and many opportunities and challenges in communicating with a vast array of people including patients, families, peers, and management. Inherent in the role are all sorts of potential stressors such as not having the equipment you need at a time you think you crucially need it, working with people you find difficult, shift work, lack of staffing, overcrowding, and the list is sometimes seemingly endless. But there are also obvious advantages to your role such as meeting a large variety of people, helping people to recover, to feel comfortable in your care and supporting families, patients and colleagues. This brings me to the two primary points to this chapter. The first point of this chapter is to understand that sometimes the challenges you may face in the health arena overwhelm your initial understanding of your capacity to cope. That is to say, there will likely be times when you feel overwhelmed or even distraught in the face of a particular situation. The second point is that these same overwhelming experiences can provide a catalyst for you to grow as a human being; to develop beyond the person you perceived yourself to be beforehand. According to Aaron Antonovsky (1985), stress is inherent in the human condition, but further to that, in your role, there is a very high possibility of traumatic experiences as well.

Why do nurses migrate? – a review of recent literature

Aim  To identify the reasons why nurses continue migrating across international borders. Background  International nurse recruitment and migration have been increasing in the last decade and recent trends show an increase in the movement of nurses between developing and developed countries, resulting in a worldwide shortage of nurses. Methods  A manual and electronic database literature search was conducted from January 2004 to May 2010. Qualitative content analysis was completed for the final 17 articles that satisfied the inclusion criteria. Results  Motivators to nurse migration were linked to financial, professional, political, social and personal factors. Although economic factors were the most commonly reported, they were not the only reason for migration. This was especially evident among nurses migrating between developed countries. Conclusion  Nurses migrate for a wide variety of reasons as they respond to push and pull factors. Implications for nursing management  It is important for nurse managers in the source countries to advocate incentives to retain nurses. In the recipient countries the number of international nurses continues to increase implying the need for more innovative ways to mentor and orientate these nurses.

An exploration of the role of web and mobile social media in the implementation of e-Government in Malaysia

This paper reports on an exploratory study of the role of web and social media in e-governments, especially in the context of Malaysia, with some comparisons and contrasts from other countries where such governmental efforts have been underway for awhile. It describes the current e-government efforts in Malaysia, and proposes that applying a theoretical framework would help understand the context and streamline these ongoing efforts. Specifically, it lays out a theoretical and cultural framework based on Mary Douglas’ (1996) Grid-Group Theory, Mircea Georgescu’s (2005) Three Pillars of E-Government, and Gerald Grant’s and Derek Chau’s (2006) Generic Framework for E-Government. Although this study is in its early stages, it has relevance to everyone who is interested in e-government efforts across the world, and especially relevant to developing countries.

Imagination for re-engagement from the margins of education

For marginalised secondary school students, mainstream education may no longer appear to be an inviting place. While proposed solutions to problems of disengagement and marginalisation appear to concentrate on finding ways to coerce students back to mainstream education through, for example, ‘learning or earning’ legislation, this article suggests that more effective solutions may be found by engaging with the students in the margins that they occupy. Following discussion of key influences on student disengagement and a theory of imaginations, a ‘students-as-researchers’ (SaR) model of working with young people is discussed to demonstrate that, through the scaffolded application of active imagination, it is possible for such students to identify and create their own connections to the mainstream. The SaR model is illustrated through reference to groups of disaffected high school students who participated in an action research project to investigate apparent low aspiration for tertiary education among their peers at schools serving low-income communities in Queensland, Australia.

Response of a plastic pipe buried in expansive clay

Failure of buried pipes due to reactive soil movement (e.g. shrinking/swelling) is a common problem for water and gas pipe networks in Australia and the world. Soil movement is closely related to seasonal climatic change, and particularly to the moisture content of soil. Although some research has been carried out to understand the effect of freezing and thawing of soils and temperature effects in colder climates, very limited research has been undertaken to examine the possible failure mechanisms of pipes buried in reactive soils. This study reports the responses of a 2 m long polyethylene pipe buried in reactive clay in a box under laboratory conditions. The soil and pipe movements were measured as the soil was wetted from the bottom of the box. It was observed that the pipe underwent substantial deformation as the soil swelled with increase of the moisture content. The results are explained with a simplified numerical analysis.

Collaborative academic/practitioner research in project management : theory and models

Purpose – The purpose of this paper is to provide of a review of the theory and models underlying project management (PM) research degrees that encourage reflective learning. Design/methodology/approach – Review of the literature and reflection on the practice of being actively involved in conducting and supervising academic research and disseminating academic output. The paper argues the case for the potential usefulness of reflective academic research to PM practitioners. It also highlights theoretical drivers of and barriers to reflective academic research by PM practitioners. Findings – A reflective learning approach to research can drive practical results though it requires a great deal of commitment and support by both academic and industry partners. Practical implications – This paper suggests how PM practitioners can engage in academic research that has practical outcomes and how to be more effective at disseminating these research outcomes. Originality/value – Advanced academic degrees, in particular those completed by PM practitioners, can validate a valuable source of innovative ideas and approaches that should be more quickly absorbed into the PM profession’s sources of knowledge. The value of this paper is to critically review and facilitate a reduced adaptation time for implementation of useful reflective academic research to industry.

Collaborative academic/practitioner research in project management : examples and applications

Purpose – The purpose of this paper is to present a cost-benefit interpretation of academic-practitioner research by describing and analysing several recent relevant examples of academic-practitioner research with a focus on doctoral theses carried out at universities and business schools in clusters of research centred in North America, Australia and Europe. Design/methodology/approach – Using case study examples, a value proposition framework for undertaking collaborative research for higher degree level study is developed and presented. Findings – Value proposition benefits from this level of collaborative research can be summarised as enhancing competencies at the individual and organisational level as well as providing participating universities with high-quality candidates/students and opportunities for industry engagement. The project management (PM) professional bodies can also extend PM knowledge but they need to be prepared to provide active support. Practical implications – A model for better defining the value proposition of collaborative research from a range of stakeholder perspectives is offered that can be adapted for researchers and industry research sponsors. Originality/value – Few papers offer a value proposition framework for explaining collaborative research benefits. This paper addresses that need.

The diagnostic accuracy of telegeriatrics for the diagnosis of dementia via video conferencing

Introduction The suitability of video conferencing (VC) technology for clinical purposes relevant to geriatric medicine is still being established. This project aimed to determine the validity of the diagnosis of dementia via VC. Methods This was a multisite, noninferiority, prospective cohort study. Patients, aged 50 years and older, referred by their primary care physician for cognitive assessment, were assessed at 4 memory disorder clinics. All patients were assessed independently by 2 specialist physicians. They were allocated one face-to-face (FTF) assessment (Reference standard – usual clinical practice) and an additional assessment (either usual FTF assessment or a VC assessment) on the same day. Each specialist physician had access to the patient chart and the results of a battery of standardized cognitive assessments administered FTF by the clinic nurse. Percentage agreement (P0) and the weighted kappa statistic with linear weight (Kw) were used to assess inter-rater reliability across the 2 study groups on the diagnosis of dementia (cognition normal, impaired, or demented). Results The 205 patients were allocated to group: Videoconference (n = 100) or Standard practice (n = 105); 106 were men. The average age was 76 (SD 9, 51–95) and the average Standardized Mini-Mental State Examination Score was 23.9 (SD 4.7, 9–30). Agreement for the Videoconference group (P0= 0.71; Kw = 0.52; P < .0001) and agreement for the Standard Practice group (P0= 0.70; Kw = 0.50; P < .0001) were both statistically significant (P < .05). The summary kappa statistic of 0.51 (P = .84) indicated that VC was not inferior to FTF assessment. Conclusions Previous studies have shown that preliminary standardized assessment tools can be reliably administered and scored via VC. This study focused on the geriatric assessment component of the interview (interpretation of standardized assessments, taking a history and formulating a diagnosis by medical specialist) and identified high levels of agreement for diagnosing dementia. A model of service incorporating either local or remote administered standardized assessments, and remote specialist assessment, is a reliable process for enabling the diagnosis of dementia for isolated older adults.

Unwrapping an Egyptian mummy

It is difficult to get school and university students interested in physics. Many students place physics in the ‘too hard basket’. In many cases this is because physics is perceived to contain a lot of mathematics, which many students also find hard. Another barrier to the study of physics is that there is no easily identifiable career as a physicist, as for example there is for a chemist, engineer, nurse, lawyer, doctor, dentist etc. Physics touches many aspects of life. All electronic equipment, phones, computers etc contain semiconductor chips that were developed by physicists. A result of this very diverse application of physics is that physicist end up working all over the place. For example, physicists end up in private and government research laboratories, as teachers in schools and as medical physicists in hospitals.

Nurses and teachers : partnerships for green health promotion

Background: The term ‘green health promotion’ is given to health promotion underpinned by the principles of ecological health and sustainability. Green health promotion is supported philosophically by global health promotion documents such as the Ottawa Charter for Health Promotion (1986) and the ecological public health movement. Green health promotion in schools aims to practice the principles of ecological health and sustainability. Methods: An extended literature review revealed a paucity of literature about green health promotion in schools across disciplines. Literature about nurses and health promotion in schools is generally found in nursing publications. Literature about ecological sustainability in schools is mostly found in teaching publications. Results: This paper explores the nexus between nursing and health promotion, and teachers and ecological sustainability. Collaborative partnerships between health and education do not capitalise on programs such as Health Promoting Schools and the School Based Youth Health Nurse Program in Queensland, Australia. The authors consider how collaborative partnerships between health and education in schools can work towards green health promotion. Conclusion: Nursing’s approach to health promotion and education’s approach to ecological sustainability need to be aligned to enhance green health promotion in schools and promote a new generation of ‘tree huggers and hippies’.

A tan in a test tube -in vitro models for investigating ultraviolet radiation-induced damage in skin

Presently, global rates of skin cancers induced by ultraviolet radiation (UVR) exposure are on the rise. In view of this, current knowledge gaps in the biology of photocarcinogenesis and skin cancer progression urgently need to be addressed. One factor that has limited skin cancer research has been the need for a reproducible and physiologically-relevant model able to represent the complexity of human skin. This review outlines the main currently-used in vitro models of UVR-induced skin damage. This includes the use of conventional two-dimensional cell culture techniques and the major animal models that have been employed in photobiology and photocarcinogenesis research. Additionally, the progression towards the use of cultured skin explants and tissue-engineered skin constructs, and their utility as models of native skin's responses to UVR are described. The inherent advantages and disadvantages of these in vitro systems are also discussed.

A Fair Go Beyond the School Gate? Systemic factors affecting participation and attainment in tertiary education by Queensland students from LSES backgrounds

The purpose of this project was to conduct an empirical study that would result in findings that inform systemic policy development aimed at improving tertiary participation and attainment by students from low socioeconomic status (LSES) backgrounds in Queensland. The project focuses on systemic policy, initiatives and programs that encourage tertiary education participation and attainment by individuals from LSES backgrounds, rather than on institution-specific initiatives or programs. While the broad remit was to consider tertiary education participation, the study particularly highlights issues pertaining to LSES student participation and attainment in the higher education sector, given the notable under representation of this demographic subgroup in Australian universities. This study supports the strategic priority of addressing professional skills shortages and innovations aiming to improve human and social capital in the state of Queensland. The ultimate goal is to contribute to the enhancement of Queensland’s education and training system by maximising participation and attainment by people from LSES backgrounds in higher education, thereby improving their quality of life and future life choices and opportunities. The study addressed the following five research questions: 1. What are the major factors that promote or inhibit participation and attainment in tertiary education by LSES students in Queensland? 2. To what extent do systemic policies or practices(systemic factors) of Queensland’s tertiary education system promote or inhibit participation and attainment by LSES students? That is, what features of Queensland’s tertiary education system have a significant effect on participation and attainment by LSES students? 3. What system policies or practices are found to boost participation and attainment by LSES students in other jurisdictions? 4. What evidence is there to suggest that policies or practices that have boosted participation and attainment by LSES students in other jurisdictions would be successful if implemented in Queensland? 5. What are the implications of the research findings for Queensland’s tertiary education system to improve participation and attainment by LSES students? The project adopted a mixed methods approach to data collection. A comprehensive review of the literature was conducted to identify relevant state, national and international literature. Both qualitative and quantitative methodologies were used to collect data from a range of key stakeholders.

Assisting ICU training management with virtual worlds

Conventional training methods for nurses involve many physical factors that place limits on potential class sizes. Alternate training methods with lower physical requirements may support larger class sizes, but given the tactile quality of nurse training, are most appropriately applied to supplement the conventional methods. However, where the importance of physical factors are periphery, such alternate training methods can provide an important way to increase upper class-size limits and therefore the rate of trained nurses entering the important role of critical care. A major issue in ICU training is that the trainee can be released into a real-life intensive care scenario with sub optimal preparation and therefore a level of anxiety for the student concerned, and some risk for the management level nurses, as patient safety is paramount. This lack of preparation places a strain on the allocation of human and non-human resources to teaching, as students require greater levels of supervision. Such issues are a concern to ICU management, as they relate to nursing skill development and patient health outcomes, as nursing training is potentially dangerous for patients who are placed in the care of inexperienced staff. As a solution to this problem, we present a prototype ICU handover training environment that has been developed in a socially interactive virtual world. Nurses in training can connect remotely via the Internet to this environment and engage in collaborative ICU handover training classes.