Managerial leadership for research use in nursing and allied health care professions : a narrative synthesis protocol

BACKGROUND: Nurses and allied health care professionals (physiotherapists, occupational therapists, speech and language pathologists, dietitians) form more than half of the clinical health care workforce and play a central role in health service delivery. There is a potential to improve the quality of health care if these professionals routinely use research evidence to guide their clinical practice. However, the use of research evidence remains unpredictable and inconsistent. Leadership is consistently described in implementation research as critical to enhancing research use by health care professionals. However, this important literature has not yet been synthesized and there is a lack of clarity on what constitutes effective leadership for research use, or what kinds of intervention effectively develop leadership for the purpose of enabling and enhancing research use in clinical practice. We propose to synthesize the evidence on leadership behaviours amongst front line and senior managers that are associated with research evidence by nurses and allied health care professionals, and then determine the effectiveness of interventions that promote these behaviours.Methods/design: Using an integrated knowledge translation approach that supports a partnership between researchers and knowledge users throughout the research process, we will follow principles of knowledge synthesis using a systematic method to synthesize different types of evidence involving: searching the literature, study selection, data extraction and quality assessment, and analysis. A narrative synthesis will be conducted to explore relationships within and across studies and meta-analysis will be performed if sufficient homogeneity exists across studies employing experimental randomized control trial designs. DISCUSSION: With the engagement of knowledge users in leadership and practice, we will synthesize the research from a broad range of disciplines to understand the key elements of leadership that supports and enables research use by health care practitioners, and how to develop leadership for the purpose of enhancing research use in clinical practice.

Local politico-administrative perspectives on quality improvement based on national registry data in Sweden : a qualitative study using the Consolidated Framework for Implementation Research.

Background. Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Methods. Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results. The politicians and administrators perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. Conclusions. The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

Ventilation research on Australian residential construction

This paper applies established and new testing methods to discover the ventilation performance of various residential building envelope constructions in Australia. Under the definition of 'ventilation performance' we imply the building envelope leakage (or infiltration) of the living space air change rates, the volumetric flow rates and the pathways of air flow between subfloor, living and roof spaces. All of the methods applied and discussed here are on-site, evidence-based performance of actual structures as tested by the Mobile Architecture and Built Environment Laboratory and Air Barrier Technologies. The testing processes primarily involve the Tracer Gas Decay Method (TGDM) and rhe fan pressurisation method (FPM a.k.a 'blower door'). All the measurements are performed with respect to the external wind speed and direction as well as the typical weather parameters. This paper discusses the differences and similarities of both testing methods as well as several other testing procedures that can inform the researcher on air leakage pathways. Findings of a simultaneous TGDM and FPM air leakage rate comparison are also encountered in this paper. One of the most informative testing methods, is the application of three different tracer gasses introduced into different spaces (subfloor, living and roof) to discover pathways of air flow within residential construction.

Frequency, intensity and duration of physical tasks performed by Australian rural firefighters during bushfire suppression

The current study combined, for the first time, video footage of individual firefighters wearing heart rate monitors and personal GPS units to quantify the frequency, duration and intensity of tasks performed by Australian rural fire crews when. suppressing bushfires. Across the four fireground 'shifts', the firefighters performed 34 distinct fireground tasks. Per shift, the task frequency ranged from once (raking fireline in teams, carrying a quick fill pump) to 103 times {lateral repositioning of a 38-mm charged firehose) .. The tasks lasted between 4 ± 2 s (bowling out 3-8-mm firehose) and 461 ± 387 s (raking fireline in teams). The task intensity~ as measured by average heart rate ranged between 97 ± 16 beats·min-1 (55.7 ± 8.7. %HRmax) and 157 ± 15 beats·min-1 (86.2 ± 10.8 %HRmax)· The tasks were performed a speeds that ranged from 0.12 ± 0.08 m·s-1 (manual hose retraction of 38-mm charged firehose) to 0.79 ± 0.40 m·s-1 (carrying a 38-mm coiled hose). Tasks found to be simultaneously frequent, long and intense (or two of these three) are likely to form the basis for job-specific testing of Australian rural firefighters suppressing bushfires.

Audit of the Douglas Hocking Research Institute bone bank : ten years of non-irradiated bone graft

Background:  An audit performed in the use of non-irradiated femoral head bone graft at the Geelong Hospital over a 10-year period. While it is thought the non-irradiated bone graft provides a better structural construct there is theoretical increased risk of infection transmission.

Methods:  We performed a retrospective review of prospectively collected data in the use of non-irradiated bone allograft used from the Geelong Hospital Douglas Hosking Research Institute bone bank over a 10-year period. The review was performed using data collected from the bone bank and correlating it with the patient’s medical record. All complications, including infections, related to the use of the allograft were recorded.

Results:  We found that over the 10 years to 2004 that 811 femoral heads were donated, with 555 being used over 362 procedures in 316 patients. We identified a total of nine deep infections, of which seven were in joint replacements. Overall this was a 2.5% deep infection rate, which was lowered to 1.4% if the previously infected joints that were operated on were excluded.

Conclusion:  The use of non-irradiated femoral head bone graft was safe in a regional setting.

Performing research as a method of analysis

This paper outlines a theatre-based research method undertaken as a means of analysing and representing data from a study into first-year teachers’ identity transformation. It reports on the processes employed, and the attempt by the researcher to bring together complimentary and innovative ways of interpreting interview data. Interview data from twelve teachers throughout their first year of teaching were scripted, rehearsed and performed to ‘expert’ audiences. The written script provided the basis for analysis of the teachers’ identity transformation as seen through their firsts – epiphanic and/or revelatory experiences that marked a moment of transition or transformation. The script served as an effective tool for data analysis, particularly when developing an understanding of the process of data reduction. Initially dissatisfied with the term ‘data reduction’, believing it to be counter-intuitive to ‘reduce’ the participants’ descriptions of their experiences, the process of scripting emphasised the importance of honing in on meaning, and reconciled such concerns by creating a snapshot of each participant’s first as representative of their experiences. Later, the performance revealed more nuanced understandings of the participants’ experiences as viewed through the eyes of the teacher-actors and audiences. The actors selected to represent the experiences of the first-year teachers in the performance were also teachers. The process of casting, and the teacher-actors’ experiences of rehearsing and performing the work ‘The First Time’ over the past two years will also be discussed. This paper concludes with some of the feedback from various audiences of both the performance and the written thesis from arts- and non-arts-based practitioners. Some feedback contends that the theatre-based method was less rigorous than other more ‘traditional’ methods. Such feedback prompts the consideration of weighing the benefits of employing theatre-based research against the risk of alienating some members of the audiences (both of the performance and the page). This paper includes live/digital excerpts of the theatre-based performance ‘The First Time’.

Performing beginning teachers’ ‘firsts’: exploring a theatre-based research method

Theatre-based research methods have been employed in a variety of ways to transcend more traditional research methods, and bring research findings to a broader and relevant audience. Performing research to an 'expert' audience is transformative in nature. The audience share a collective understanding of the material presented, where their understandings can be challenged or confirmed. The ethical responsibilities of the theatre-based researcher are therefore paramount in presenting the research in a manner that respects the research participants, and allows the audience to make informed judgements.This paper outlines my experience in devising and performing 'The First Time' - a performance about twelve beginning teachers' firsts. The performance was constructed from their interview data and performed by teachers - most of who are drama teachers – in order to sensitively represent the real stories of the research participants. The research was framed within a practice theory approach (Schatzki 2001) with a focus on the transformation of practices situated within a particular time and place. The method of performing the research to an 'expert' audience of performing arts practitioners, teachers, and teacher educators created an opportunity for both the transformation of teaching practice and the transformation of theatre.The research findings focus on the importance of creativity and flexibility in an approach to both research and teaching. The outcomes of my research have implications for theatre-based researchers, as well as teacher educators, in-service teachers, and beginning teachers. All these practitioners are continually negotiating the waters of their ever-changing professions.

Epidemiological aspects in leptospirosis. Research of anti-Leptospira spp antibodies, isolation and biomolecular research in bovines, rodents and workers in rural properties from Botucatu, SP, Brazil.

Leptospirosis is a worldwide infection, transmitted between man and animals that causes a decrease in the production of bovine flocks, and offer risks for public health, as an important zoonosis. The rodents are the main reservoirs of leptospires. It was studied 27 dairy farm properties located in or near from Botucatu-SP, Brazil. In these farms were collected blood and kidney samples from rodents, blood and urine samples from bovines and blood samples from the workers. The serology was performed with microscopic agglutination test (MAT). Samples of bovine urine and rodent kidneys were cultivated searching for leptospires isolation. The polymerase chain reaction (PCR) of the kidneys of the rodents was performed. In MAT, 46/ 140 (32.85%) bovine and 8/34 (23.53%) human sera samples were positive, respectively. In human samples, the serovar Brastilava (37.51%) presented the highest occurrence, while in bovines, the serovars Hardjo and Castellonis were most frequent, with 26.08% each one. All of the rodents were negatives in serology. No leptospire was isolated, and kidney samples were negative in PCR. In bovines, the dam water and the bad hygiene quality of milking process were considered important risks of infection in the affected properties (p<0.05), where other reproductive problems, except abortion, can be related. In other side, to human beings the drainage system was the most important risk factor in the studied properties. Thus, it was verified the necessity of an improvement in zoosanitary handling of the properties, mainly of water supply.

Muscle damage slows oxygen uptake kinetics during moderate-intensity exercise performed at high pedal rate

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of caffeine on time to exhaustion in exercise performed below and above the anaerobic threshold

Controversy still exists concerning the potential ergogenic benefit of caffeine (CAF) for exercise performance. The purpose of this study was to compare the effects of CAF ingestion on endurance performance during exercise on a bicycle ergometer at two different intensities, i.e., approximately 10% below and 10% above the anaerobic threshold (AT). Eight untrained males, non-regular consumers of CAF, participated in this study. AT, defined as the intensity (watts) corresponding to a lactate concentration of 4 mM, was determined during an incremental exercise test from rest to exhaustion on an electrically braked cycle ergometer. on the basis of these measurements, the subjects were asked to cycle until exhaustion at two different intensities, i.e., approximately 10% below and 10% above AT. Each intensity was performed twice in a double-blind randomized order by ingesting either CAF (5 mg/kg) or a placebo (PLA) 60 min prior to the test. Venous blood was analyzed for free fatty acid, glucose, and lactate, before, during, and immediately after exercise. Rating of perceived exertion and time to exhaustion were also measured during each trial. There were no differences in free fatty acids or lactate levels between CAF and PLA during and immediately after exercise for either intensity. Immediately after exercise glucose increased in the CAF trial at both intensities. Rating of perceived exertion was significantly lower (CAF = 14.1 ± 2.5 vs PLA = 16.6 ± 2.4) and time to exhaustion was significantly higher (CAF = 46.54 ± 8.05 min vs PLA = 32.42 ± 14.81 min) during exercise below AT with CAF. However, there was no effect of CAF treatment on rating of perceived exertion (CAF = 18.0 ± 2.7 vs PLA = 17.6 ± 2.3) and time to exhaustion (CAF = 18.45 ± 7.28 min vs PLA = 19.17 ± 4.37 min) during exercise above AT. We conclude that in untrained subjects caffeine can improve endurance performance during prolonged exercise performed below AT and that the decrease of perceived exertion can be involved in this process

Recent research developments in SnO2-based varistors

This paper discusses some advances in research conducted on SnO2-based electroceramics. The addition of different dopants, as well as several thermal treatments in oxidizing and inert atmospheres, were found to influence the microstructure and electrical properties of SnO2-based varistor ceramics. Measurements taken by impedance spectroscopy revealed variations in the height and width of the potential barrier resulting from the atmosphere in which thermal treatments were performed. High nonlinear coefficient values, which are characteristic of high-voltage and commercial ZnO varistors, were obtained for these SnO2-based systems. All the systems developed here have potentially promising varistor applications. (C) 2004 Elsevier B.V. All rights reserved.

The effect of water immersion on the shear bond strength between chairside reline and denture base acrylic resins: Basic science research

Purpose: The effect of water immersion on the shear bond strength (SBS) between 1 heat-polymerizing acrylic resin (Lucitone 550-L) and 4 autopolymerizing reline resins (Kooliner-K, New Truliner-N, Tokuso Rebase Fast-T, Ufi Gel Hard-U) was investigated. Specimens relined with resin L were also evaluated. Materials and Methods: One hundred sixty cylinders (20 × 20 mm) of L denture base resin were processed, and the reline resins were packed on the prepared bonding surfaces using a split-mold (3.5 × 5.0 mm). Shear tests (0.5 mm/min) were performed on the specimens (n = 8) after polymerization (control), and after immersion in water at 37°C for 7, 90, and 180 days. All fractured surfaces were examined by scanning electron microscopy (SEM) to calculate the percentage of cohesive fracture (PCF). Shear data were analyzed with 2-way ANOVA and Tukey's test; Kruskall-Wallis test was used to analyze PCF data (α = 0.05). Results: After 90 days water immersion, an increase in the mean SBS was observed for U (11.13 to 16.53 MPa; p < 0.001) and T (9.08 to 13.24 MPa, p = 0.035), whereas resin L showed a decrease (21.74 MPa to 14.96 MPa; p < 0.001). The SBS of resins K (8.44 MPa) and N (7.98 MPa) remained unaffected. The mean PCF was lower than 32.6% for K, N, and T, and higher than 65.6% for U and L. Conclusions: Long-term water immersion did not adversely affect the bond of materials K, N, T, and U and decreased the values of resin L. Materials L and U failed cohesively, and K, N, and T failed adhesively. © 2007 by The American College of Prosthodontists.

Telomere length and its relationship with chronic diseases - New perspectives for periodontal research

Objective: The ageing process is accompanied by a variety of cellular modifications, and telomere shortening is a common finding. Large epidemiological studies have reported an association between shorter telomere length in peripheral leukocytes and several inflammatory diseases of the elderly including diabetes, atherosclerosis and, recently, periodontitis. The primary aim of this study was to critically discuss available evidence regarding the potential mechanisms relating shorter telomeres to periodontitis. Design: A narrative literature review was performed to report evidence relating shorter telomeres to the ageing process and inflammation. Then, we searched MEDLINE (1950 to May 2012) and ISI WEB OF SCIENCE (1950 to May 2012) databases for the combination of the terms 'telomere' and 'periodontitis'. Results: Although these associations suggest a possible role of telomere attrition in the onset or evolution of chronic inflammatory diseases, only two studies addressed the relationship between telomere length and periodontitis. Conclusion: We suggest that the chronic inflammatory burden observed in people with chronic periodontitis could represent the driver of telomere shortening. However, further evidence is needed to confirm whether inflammation is the cause or the consequence of the shorter leukocyte telomere length observed in people with periodontitis. © 2012 Elsevier Ltd. All rights reserved.