Palliative care knowledge, attitudes and perceived self-competence of nurses working in Vietnam

AIM: To explore palliative care knowledge, attitudes and perceived self-competence of nurses working in oncology settings in Hanoi, Vietnam. METHOD: The study employed a cross-sectional descriptive survey design. The self-administered questionnaires consisted of three validated instruments: the Expertise and Insight Test for Palliative Care, the Attitude Toward Care of the Dying Scale B and the Palliative Care Nursing Self Competence Scale. The sample consisted of 251 nurses caring for cancer patients in three oncology hospitals in Vietnam. RESULTS: The responses identified low scores in nurses' palliative care knowledge related to pain and other symptom management and psychological and spiritual aspects. Nurses' responses reflected discomfort in communicating about death and establishing therapeutic relationship with oncology patients who require palliative care. Additionally, nurses reported low scores in perceived self-competence when providing pain management and addressing social and spiritual domains of palliative care. The findings also revealed that nurses who had higher palliative care knowledge scores demonstrated attitudes which were more positive and expressed greater perceived self-competence. CONCLUSION: Nurses working in oncology wards need more education to develop their knowledge and skills of palliative care, especially in the areas of pain management, psychological and spiritual care, and communication

The effectiveness of information-sharing interventions to reduce anxiety in families waiting for surgical patients undergoing an elective surgical procedure: A systematic review

Background Whilst waiting for patients undergoing surgery, a lack of information regarding the patient’s status and the outcome of surgery, can contribute to the anxiety experienced by family members. Effective strategies for providing information to families are therefore required. Objectives To synthesize the best available evidence in relation to the most effective information-sharing interventions to reduce anxiety for families waiting for patients undergoing an elective surgical procedure. Inclusion criteria Types of participants All studies of family members over 18 years of age waiting for patients undergoing an elective surgical procedure were included, including those waiting for both adult and pediatric patients.   Types of intervention All information-sharing interventions for families of patients undergoing an elective surgical procedure were eligible for inclusion in the review. Types of studies All randomized controlled trials (RCTs) quasi-experimental studies, case-controlled and descriptive studies, comparing one information-sharing intervention to another or to usual care were eligible for inclusion in the review. Types of outcomes Primary outcome: The level of anxiety amongst family members or close relatives whilst waiting for patients undergoing surgery, as measured by a validated instrument such as the S-Anxiety portion of the State-Trait Anxiety Inventory (STAI). Secondary outcomes: Family satisfaction and other measurements that may be considered indicators of stress and anxiety, such as mean arterial pressure (MAP) and heart rate. Search strategy A comprehensive search, restricted to English language only, was undertaken of the following databases from 1990 to May 2013: Medline, CINAHL, EMBASE, ProQuest, Web of Science, PsycINFO, Scopus, Dissertation and Theses PQDT (via ProQuest), Current Contents, CENTRAL, Google Scholar, OpenGrey, Clinical Trials, Science.gov, Current Controlled Trials and National Institute for Clinical Studies (NHMRC). Methodological quality Two independent reviewers critically appraised retrieved papers for methodological quality using the standardized critical appraisal instruments for randomized controlled trials and descriptive studies from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instruments (JBI-MAStARI). Data extraction Two independent reviewers extracted data from included papers using a customized data extraction form. Data synthesis Statistical pooling was not possible, mainly due to issues with data reporting in two of the studies, therefore the results are presented in narrative form. Results Three studies with a total of 357 participants were included in the review. In-person reporting to family members was found to be effective in comparison with usual care in which no reports were provided. Telephone reporting was also found to be effective at reducing anxiety, in comparison with usual care, although not as effective as in-person reporting. The use of paging devices to keep family members informed were found to increase, rather than decrease anxiety. Conclusions Due to the lack of high quality research in this area, the strength of the conclusions are limited. It appears that in-person and telephone reporting to family members decreases anxiety, however the use of paging devices increases anxiety.

Scheimpflug imaging of the post lens tear film during contact lens wear

A new imaging methodology is described to visualise the post lens tear film (PLTF) during contact lens wear. A rotating-Scheimpflug camera in combination with sodium fluorescein allows evaluation of the PLTF for different contact lens modalities, including mini-scleral, rigid gas permeable (RGP) and soft contact lenses. This imaging technique provides an extension of the instrument’s current functionality. The potential advantages and limitations of the technique are discussed.

Financing the project : economic incentives promoting sustainable property development

This chapter is focussed on the various financial instruments and incentives that have been implemented in a range of countries to encourage sustainable developments in all property sectors. It is an area that has undergone substantial change globally since 2008. Sustainable property development has been impacted by the Global Financial Crisis, particularly with regards to the availability of private sector funding and the requirements of funders who now have a more cautious approach to risk. Sustainability, and sometimes a lack of it, is increasingly viewed as a risk in some markets; it is also seen as an area in which governments, through creation of markets and through the use of fiscal instruments can seek to speed up the pace at which the economics of sustainable development makes good business sense. However, it is not just governments that provide the incentive for sustainability- or the dis-incentive for non-sustainable behaviours.

Geo-economics and considerations on the tourism industry with emphasis on historical cities tourism and ecotourism in Iran

Considering its many potentials in the tourism industry, Iran has constantly been among the leading countries seeking development in this industry. Iran is a country with many attractions in different tourism sections including cultural, urban, and monument tourism, and ancient places as well as ecotourism, and water tourism etc. for tourists. However, Iran has never economically prospered regarding its potentials in this industry as compared to its rivals. Thus, the main objective of this work is to list the main necessities of harnessing economic power and required instruments to fulfill this goal. In addition, the tourism industry is discussed as an important strategy for reaching this power, and the Iranian wildlife is introduced as an intact environment. It is also discussed that what economic benefits are obtained through using this tourism industry. It must be noted that the main emphasis of this work is on urban, monument tourism, ancient places, and ecotourism as a case study in two Iranian provinces. Finally, the required analyses are performed considering the affinity between these two sections and two provinces. Results indicated that while Iran having the highest percent of growth compared to the two other countries active in this area, however this advantage has not significantly affected the GDP in Iran, and Iran has not been able to improve its geo-economic capacity in this area.

Biomechanical analyses of the performance of Paralympians: From foundation to elite level

Biomechanical analysis of sport performance provides an objective method of determining performance of a particular sporting technique. In particular, it aims to add to the understanding of the mechanisms influencing performance, characterization of athletes, and provide insights into injury predisposition. Whilst the performance in sport of able-bodied athletes is well recognised in the literature, less information and understanding is known on the complexity, constraints and demands placed on the body of an individual with a disability. This paper provides a dialogue that outlines scientific issues of performance analysis of multi-level athletes with a disability, including Paralympians. Four integrated themes are explored the first of which focuses on how biomechanics can contribute to the understanding of sport performance in athletes with a disability and how it may be used as an evidence-based tool. This latter point questions the potential for a possible cultural shift led by emergence of user-friendly instruments. The second theme briefly discusses the role of reliability of sport performance and addresses the debate of two-dimensional and three-dimensional analysis. The third theme address key biomechanical parameters and provides guidance to clinicians, and coaches on the approaches adopted using biomechanical/sport performance analysis for an athlete with a disability starting out, to the emerging and elite Paralympian. For completeness of this discourse, the final theme is based on the controversial issues on the role of assisted devices and the inclusion of Paralympians into able-bodied sport is also presented. All combined, this dialogue highlights the intricate relationship between biomechanics and training of individuals with a disability. Furthermore, it illustrates the complexity of modern training of athletes which can only lead to a better appreciation of the performances to be delivered in the London 2012 Paralympic Games

Oral liquid nutritional supplements for people with dementia in residential aged care facilities

AIM: This systematic review investigated the prescription, administration and effectiveness of oral liquid nutritional supplements (OLNS) for people with dementia in residential aged care facilities (RACF). METHODS: A comprehensive search of relevant databases, hand searching and cross-referencing found 15 relevant articles from a total of 2910 possible results. Articles which met the inclusion criteria were critically appraised by two independent reviewers using the relevant Joanna Briggs Institute (JBI) appraisal checklist. Data were extracted using the relevant JBI extraction instruments. No data synthesis was possible due to clinical and methodological heterogeneity. RESULTS: Included studies examined a range of strategies, issues and results related to OLNS for persons with dementia in RACFs; however there appear to be significant gaps in the current body of research, particularly in relation to examinations of effectiveness. CONCLUSIONS: This review was unable to produce a definitive finding regarding effectiveness. OLNS may improve the nutritional state of residents with dementia and help prevent weight loss, and there is some suggestion that it may slow the rate of cognitive decline. However, in order for OLNS to be effective, nursing and care staff need to ensure that sufficient attention is paid to the issues of prescription and administration.

Can different measures of intelligence be used interchangeably? A comparison of the Wechsler and Stanford-Binet scales

The Wechsler and Stanford Binet scales are among the most commonly used tests of intelligence. In clinical practice, they often seem to be used interchangeably. This paper reports the results of two studies that compared the most recent editions of two Wechsler scales (WPPSI-III and WISC-IV) with the Stanford-Binet Fifth Edition (SB5). The participants in the first study were 36 typically developing 4-year-old children who completed the WPPSI-III and SB5 in counter-balanced order. Although correlations of composite scores ranged from r = .59 to r = .82 and were similar to those reported for earlier versions of the two instruments, more than half the sample had a score discrepancy greater than 10 points across the two instruments. In the second study, the WISC-IV and SB5 were administered to 30 children aged 12-14 years. There was a significant difference between Full Scale IQs on the two measures, with scores being higher on the WISC-IV. Differences between the two verbal scales were also significant and favoured the WISC-IV. There were moderate correlations of Full Scale IQs (r = .58) and Nonverbal IQs (r = .54) but the relationship between the two Verbal scales was not significant. For some children, notable score differences led to different categorisations of their level of intellectual ability The findings suggest that the Wechsler and Stanford Binet scales cannot be presumed to be interchangeable. The discussion focuses on how psychologists might reconcile large differences in test scores and the need for caution when interpreting and comparing test results.

Inventory of pedagogy and practice: Confirmatory factor analysis of multiple facets of teaching

Student perceptions of teaching have often been used in tertiary education for evaluation purposes. However, there is a paucity of research on the validity, reliability, and applicability of instruments that cover a wide range of student perceptions of pedagogies and practices in high school settings for descriptive purposes. The study attempts to validate an inventory of pedagogy and practice (IPP) that provides researchers and practitioners with a psychometrically sound instrument that covers the most salient factors related to teaching. Using a sample of students (N = 1515) from 39 schools in Singapore, 14 factors about teaching in English lessons from the students’ perspective were tested with confirmatory factor analysis (classroom task goal, structure and clarity, curiosity and interest, positive class climate, feedback, questioning, quality homework, review of students’ work, conventional teaching, exam preparation, behaviour management, maximizing learning time, student-centred pedagogy, and subject domain teaching). Two external criterion factors were used to further test the IPP factor structure. The inventory will enable teachers to understand more about their teaching and researchers to examine how teaching may be related to learning outcomes.

Country review on the main building energy-efficiency policy instrument

Building energy-efficiency (BEE) is the key to drive the promotion of energy saving in building sector. A large variety of building energy-efficiency policy instrument exist. Some are mandatory, some are soft scheme, and some use economic incentives from country to country. This paper presents the current development of implementing BEE policy instruments by examining the practices of BEE in seven selected countries and regions. In the study, BEE policy instruments are classified into three groups, including mandatory administration control instruments, economic incentive instruments and voluntary scheme instruments. The study shows that different countries have adopted different instruments in their practices for achieving the target of energy-saving and gained various kinds of experiences. It is important to share these experiences gained.

Predicting emotional exhaustion among haemodialysis nurses

Background Understanding the organisational predictors of burnout (emotional exhaustion) in haemodialysis nurses is critical for staff retention and improving nurse and patient outcomes. Previous research has demonstrated high levels of emotional exhaustion among haemodialysis nurses; yet the relationships among nurses’ work environment, job satisfaction, stress and emotional exhaustion are poorly understood. Aim To test an explanatory model of the relationships among the nursing work environment, job satisfaction, job stress and emotional exhaustion for haemodialysis nurses, drawing on Kanter’s Structural Theory of Organisational Empowerment. Methods Using a cross-sectional design 417 haemodialysis nurses completed an online survey between October 2011 and April 2012 using validated instruments to measure the work environment, and levels of job satisfaction, job stress and emotional exhaustion. Results Overall, the explanatory model demonstrated adequate fit and we found partial support for the hypothesised relationships. Haemodialysis nurses’ work environment had a direct positive effect on job satisfaction, explaining 88% of the variance. Greater job satisfaction, in turn, predicted lower job stress, explaining 82% of the variance. Job satisfaction also had an indirect effect on emotional exhaustion by mitigating job stress. However, job satisfaction did not have a direct effect on emotional exhaustion. Conclusion The work environment of haemodialysis nurses is pivotal to the development of job satisfaction. Nurses’ job satisfaction also affects the levels of job stress and emotional exhaustion. Our findings suggest nurse managers can improve staff retention by creating empowering work environments that promote job satisfaction in haemodialysis nurses.

Why are haemodialysis nurses satisfied also experiencing burnout?

Background Haemodialysis nurses work in a technological environment caring for patients over a prolonged period of time leading to the development of unique nurse-patient relationships. In order to improve retention of nurses in this specialised area of nursing it is important to know the factors that affect job satisfaction, stress and burnout and understand how these experiences are conceptualised by haemodialysis nurses. Aim To explore the factors contributing to satisfaction with the work environment, job satisfaction, job stress and burnout in haemodialysis nurses in Australia and New Zealand. Method A quantitative dominant sequential explanatory mixed method design was used. Quantitative data was collected using an on-line questionnaire containing demographic questions and pre-existing instruments examining job satisfaction, stress, burnout and satisfaction with the work environment. The qualitative phase involved semi-structured interviews. Results 417 nurses completed the questionnaire. Overall, nurses were satisfied with their work environment and the job that they performed but there were stressors in the haemodialysis setting that led to high levels of burnout. Key themes emerged from the qualitative data related to the physical environment, intensity of nurse-patient relationships, workloads, and coping with death and dying. The qualitative findings also provide possible explanations for the high level of burnout identified in the quantitative findings. Conclusion Explanation of areas where specific nurse and patient outcomes were affected will support the development of appropriate interventions to sustain a work environment conducive to job satisfaction that also alleviates stress and burnout in these nurses.

Multiple perspectives on quality of life for residents with dementia in long term care facilities: Protocol for a comprehensive Australian study

Background Dementia is a chronic illness without cure or effective treatment, which results in declining mental and physical function and assistance from others to manage activities of daily living. Many people with dementia live in long term care facilities, yet research into their quality of life (QoL) was rare until the last decade. Previous studies failed to incorporate important variables related to the facility and care provision or to look closely at the daily lives of residents. This paper presents a protocol for a comprehensive, multi-perspective assessment of QoL of residents with dementia living in long term care in Australia. A secondary aim is investigating the effectiveness of self-report instruments for measuring QoL. Methods The study utilizes a descriptive, mixed methods design to examine how facility, care staff, and resident factors impact QoL. Over 500 residents with dementia from a stratified, random sample of 53 facilities are being recruited. A sub-sample of 12 residents is also taking part in qualitative interviews and observations. Conclusions This national study will provide a broad understanding of factors underlying QoL for residents with dementia in long term care. The present study uses a similar methodology to the US-based Collaborative Studies of Long Term Care (CS-LTC) Dementia Care Study, applying it to the Australian setting.

MATLAB/Simulink simulation and C2000 code generation model for a grid-interactive 3-phase 4-wire inverter

This work is a MATLAB/Simulink model of a controller for a three-phase, four-wire, grid-interactive inverter. The model provides capacity for simulating the performance of power electroinic hardware, as well as code generation for an embedded controller. The implemented hardware topology is a three-leg bridge with a neutral connection to the centre-tap of the DC bus. An LQR-based current controller and MAF-based phase detector are implemented. The model is configured for code generation for a Texas Instruments TMS320F28335 Digital Signal Processor (DSP).

Seasonal variations of outdoor air pollution and factors driving them in the school environment in rural Bhutan

A quantitative understanding of outdoor air quality in school environments is crucial given that air pollution levels inside classrooms are significantly influenced by outdoor pollution sources. To date, only a handful of studies have been conducted on this important topic in developing countries. The aim of this study was to quantify pollutant levels in the outdoor environment of a school in Bhutan and assess the factors driving them. Measurements were conducted for 16 weeks, spanning the wet and dry seasons, in a rural school in Bhutan. PM10, PM2.5, particle number (PN) and CO were measured daily using real-time instruments, while weekly samples for volatile organic compounds (VOCs), carbonyls and NO2 were collected using a passive sampling method. Overall mean PM10 and PM2.5 concentrations (µg/m3) were 27 and 13 for the wet, and 36 and 29 for the dry season, respectively. Only wet season data were available for PN concentrations, with a mean of 2.56 × 103 particles/cm3. Mean CO concentrations were below the detection limit of the instrumentation for the entire measurement period. Only low levels of eight VOCs were detected in both the wet and dry seasons, which presented different seasonal patterns in terms of the concentration of different compounds. The notable carbonyls were formaldehyde and hexaldehyde, with mean concentrations (µg/m3) of 2.37 and 2.41 for the wet, and 6.22 and 0.34 for the dry season, respectively. Mean NO2 cocentration for the dry season was 1.7 µg/m3, while it was below the detection limit of the instrumentation for the wet season. The pollutant concentrations were associated with a number of factors, such as cleaning and combustion activities in and around the school. A comparison with other school studies showed comparable results with a few of the studies, but in general, we found lower pollutant concentrations in the present study.