Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma : a meta-analysis and systematic review of the literature

Objectives: To investigate the efficacy of progestin treatment to achieve pathological complete response (pCR) in patients with complex atypical endometrial hyperplasia (CAH) or early endometrial adenocarcinoma (EC). Methods: A systematic search identified 3245 potentially relevant citations. Studies containing less than ten eligible CAH or EC patients in either oral or intrauterine treatment arm were excluded. Only information from patients receiving six or more months of treatment and not receiving other treatments was included. Weighted proportions of patients achieving pCR were calculated using R software. Results: Twelve studies met the selection criteria. Eleven studies reported treatment of patients with oral (219 patients, 117 with CAH, 102 with grade 1 Stage I EC) and one reported treatment of patients with intrauterine progestin (11 patients with grade 1 Stage IEC). Overall, 74% (95% confidence interval [CI] 65-81%) of patients with CAH and 72% (95% CI 62-80%) of patients with grade 1 Stage I EC achieved a pCR to oral progestin. Disease progression while on oral treatment was reported for 6/219 (2.7%), and relapse after initial complete response for 32/159 (20.1%) patients. The weighted mean pCR rate of patients with grade 1 Stage I EC treated with intrauterine progestin from one prospective pilot study and an unpublished retrospective case series from the Queensland Centre of Gynaecologic Oncology (QCGC) was 68% (95% CI 45- 86%). Conclusions: There is a lack of high quality evidence for the efficacy of progestin in CAH or EC. The available evidence however suggests that treatment with oral or intrauterine progestin is similarly effective. The risk of progression during treatment is small but longer follow-up is required. Evidence from prospective controlled clinical trials is warranted to establish how the efficacy of progestin for the treatment of CAH and EC can be improved further.

Optimising preventive maintenance strategy for production Lines

Preventive Maintenance (PM) is often applied to improve the reliability of production lines. A Split System Approach (SSA) based methodology is presented to assist in making optimal PM decisions for serial production lines. The methodology treats a production line as a complex series system with multiple (imperfect) PM actions over multiple intervals. The conditional and overall reliability of the entire production line over these multiple PM intervals are hierarchically calculated using SSA, and provide a foundation for cost analysis. Both risk-related cost and maintenance-related cost are factored into the methodology as either deterministic or random variables. This SSA based methodology enables Asset Management (AM) decisions to be optimised considering a variety of factors including failure probability, failure cost, maintenance cost, PM performance, and the type of PM strategy. The application of this new methodology and an evaluation of the effects of these factors on PM decisions are demonstrated using an example. The results of this work show that the performance of a PM strategy can be measured by its Total Expected Cost Index (TECI). The optimal PM interval is dependent on TECI, PM performance and types of PM strategies. These factors are interrelated. Generally, it was found that a trade-off between reliability and the number of PM actions needs to be made so that one can minimise Total Expected Cost (TEC) for asset maintenance.

Application of the self-efficacy model in nursing practice [自我效能模式於護理臨床應用之剖析]

Self-efficacy has two cognitive components, efficacy expectations and outcome expectations, and their influence on behavior change is synergistic. Efficacy expectation is effected by four main sources of information provided by direct and indirect experiences. The four sources of information are performance accomplishments, vicarious experience, verbal persuasion and self-appraisal. How to measure and develop interventions is an important issue at present. This article clearly analyzes the relationship between variables of the self-efficacy model and explains the implementation of self-efficacy enhancing interventions and instruments in order to test the model. Through the process of the use of theory and feasibility in clinical practice, it is expected that professional medical care personnel should firstly familiarize themselves with the self-efficiency model and concept, and then flexibly promote it in professional fields clinical practice, chronic disease care and health promotion.

Early evidence for direct and indirect effects of the infant rotavirus vaccine program in Queensland

Objective: To assess the impact of introducing a publicly funded infant rotavirus vaccination program on disease notifications and on laboratory testing and results. Design and setting: Retrospective analysis of routinely collected data (rotavirus notifications [2006–2008] and laboratory rotavirus testing data from Queensland Health laboratories [2000–2008]) to monitor rotavirus trends before and after the introduction of a publicly funded infant rotavirus vaccination program in Queensland in July 2007. Main outcome measures: Age group-specific rotavirus notification trends; number of rotavirus tests performed and the proportion positive. Results: In the less than 2 years age group, rotavirus notifications declined by 53% (2007) and 65% (2008); the number of laboratory tests performed declined by 3% (2007) and 15% (2008); and the proportion of tests positive declined by 45% (2007) and 43% (2008) compared with data collected before introduction of the vaccination program. An indirect effect of infant vaccination was seen: notifications and the proportion of tests positive for rotavirus declined in older age groups as well. Conclusions: The publicly funded rotavirus vaccination program in Queensland is having an early impact, direct and indirect, on rotavirus disease as assessed using routinely collected data. Further observational studies are required to assess vaccine effectiveness. Parents and immunisation providers should ensure that all Australian children receive the recommended rotavirus vaccine doses in the required timeframe.

Validity and use of the UV index : Report from the UVI working group, Schloss Hohenkammer, Germany, 5-7 December 2011

The adequacy of the UV Index (UVI), a simple measure of ambient solar ultraviolet (UV) radiation, has been questioned on the basis of recent scientific data on the importance of vitamin D for human health, the mutagenic capacity of radiation in the UVA wavelength, and limitations in the behavioral impact of the UVI as a public awareness tool. A working group convened by ICNIRP and WHO met to assess whether modifications of the UVI were warranted and to discuss ways of improving its effectiveness as a guide to healthy sun-protective behavior. A UV Index greater than 3 was confirmed as indicating ambient UV levels at which harmful sun exposure and sunburns could occur and hence as the threshold for promoting preventive messages. There is currently insufficient evidence about the quantitative relationship of sun exposure, vitamin D, and human health to include vitamin D considerations in sun protection recommendations. The role of UVA in sunlight-induced dermal immunosuppression and DNA damage was acknowledged, but the contribution of UVA to skin carcinogenesis could not be quantified precisely. As ambient UVA and UVB levels mostly vary in parallel in real life situations, any minor modification of the UVI weighting function with respect to UVA-induced skin cancer would not be expected to have a significant impact on the UV Index. Though it has been shown that the UV Index can raise awareness of the risk of UV radiation to some extent, the UVI does not appear to change attitudes to sun protection or behavior in the way it is presently used. Changes in the UVI itself were not warranted based on these findings, but rather research testing health behavior models, including the roles of self-efficacy and self-affirmation in relation to intention to use sun protection among different susceptible groups, should be carried out to develop more successful strategies toward improving sun protection behavior. Health Phys. 103(3):301-306; 2012

YuMi deadly maths program : efficacy and collaboration

Historically, perceptions about mathematics and how it is taught and learned in schools have been mixed and as a consequence have an influence on self efficacy. There are those of us who see mathematics as logical and an enjoyable subject to learn, whilst others see mathematics as irrelevant, difficult and contributing to their school failure. Research has shown that over-represented in the latter are Aboriginal and Torres Strait Islander, low SES and ESL students. These students are the focus of YuMi Deadly Centre (YDC) professional learning and research work at the Queensland University of Technology in Brisbane.

Preliminary reliability and validity testing of a self-efficacy questionnaire for Chinese family caregivers

Objectives: To develop and test preliminary reliability and validity of a Self-Efficacy Questionnaire for Chinese Family Caregivers (SEQCFC). Methods: A cross-sectional survey of 196 family caregivers (CGs) of people with dementia (CGs) was conducted to determine the factor structure of a SEQCFC of people with dementia. Following factor analyses, preliminary testing was performed, including internal consistency, 4-week test retest reliability, and construct and convergent validity. Results: Factor analyses with direct oblimin rotation were performed. Eight items were removed and five subscales(selfefficacy for gathering information about treatment, symptoms and health care; obtaining support; responding to behaviour disturbances; managing household, personal and medical care; and managing distress associated with caregiving) were identified. The Cronbach’s alpha coefficients for the whole scale and for each subscale were all over 0.80. The 4-week testretest reliabilities for the whole scale and for each subscale ranged from 0.64 to 0.85. The convergent validity was acceptable. Conclusions: Evidence for the preliminary testing of the SEQCFC was encouraging. A future follow-up study using confirmatory factor analysis with a new sample from different recruitment centres in Shanghai will be conducted. Future psychometric property testings of the questionnaire will be required for CGs from other regions of mainland China.

The need for ‘representative task design’ in evaluating efficacy of skills tests in sport : a comment on Russell, Benton and Kingsley (2010)

Russell, Benton and Kingsley (2010) recently suggested a new association football test comprising three different tasks for the evaluation of players' passing, dribbling and shooting skills. Their stated intention was to enhance ‘ecological validity’ of current association football skills tests allowing generalisation of results from the new protocols to performance constraints that were ‘representative’ of experiences during competitive game situations. However, in this comment we raise some concerns with their use of the term ‘ecological validity’ to allude to aspects of ‘representative task design’. We propose that in their paper the authors confused understanding of environmental properties, performance achievement and generalisability of the test and its outcomes. Here, we argue that the tests designed by Russell and colleagues did not include critical sources of environmental information, such as the active role of opponents, which players typically use to organise their actions during performance. Static tasks which are not representative of the competitive performance environment may lead to different emerging patterns of movement organisation and performance outcomes, failing to effectively evaluate skills performance in sport.

What relationships exist between general self efficacy, locus of control and the nursing practice environment and caring efficacy and job satisfaction?

Research Question: What relationships exist between general self efficacy, locus of control and the nursing practice environment and caring efficacy and job satisfaction? Background: Important characteristics of current nursing practice include nurses having the ability to develop and continue therapeutic relationships with patients, nurses having autonomy and control over the practice environment and nurses having more involvement in decision making. In addition, employee satisfaction is enhanced when organisations offer access to authority. Despite this, nurses continue to complain of feeling powerless in their ability to make decisions. Sample: The study population and criteria for selection included Registered Nurses in Australia who were at the time members of an Australian professional and industrial organisation. Methods: A cross-sectional survey was undertaken. Data analysis was conducted using descriptive and bivariate statistics, and structural equation modeling. Results: The model fit the data well (χ² = 2.3594, χ²/df = 2.3594 and CFI = 0.9987). Twenty four percent of variation in caring efficacy (CE) can be accounted for by general self-efficacy (GSE); work locus of control (WLC) and practice environment (PE) and 62% of the variation in job satisfaction (JS) can be accounted for by GSE, WLC and PE. All pathways were found to be significant except PE to CE. GSE positively explained CE (β = 0.38). WLC was negatively related to CE i.e., as CE scores increased WLC scores decreased (β = -0.23). Further testing of the model found CE was positively related to GSE (βZ = 0.38, p < 0.001) and negatively related to WLC (βZ = - 0.23, p = 0.001). PE was not significantly associated with CE (βZ = - 0.01, p = 0.85). JS was explained by PE, which was positively related (βZ = 0.69, p = < 0.001); GSE which was negatively related (βZ - 0 .09, p < 0.001) and WLC, which was also negatively related (βZ = - 0.20, p < 0.001). Implications for Practice Nursing and organisational leaders should ensure the development of strategies for professional development and orientation programmes which may enhance nurses’ ability to develop caring relationships and express caring behaviours to their patients and as a result improve organisational and patient outcomes. Nursing shortages and turnover rates are associated with job satisfaction and the nursing practice environment. Improving the nursing environment can produce benefits to the health system such as better job satisfaction, improved workforce retention and better patient outcomes.

Examination of factors affecting caring efficacy, job satisfaction in Australian registered nurses

Research Question: What relationships exist between general self efficacy, locus of control and the nursing practice environment and caring efficacy and job satisfaction? Background: Important characteristics of current nursing practice include nurses having the ability to develop and continue therapeutic relationships with patients, nurses having autonomy and control over the practice environment and nurses having more involvement in decision making. In addition, employee satisfaction is enhanced when organisations offer access to authority. Despite this, nurses continue to complain of feeling powerless in their ability to make decisions. Sample: The study population and criteria for selection included Registered Nurses in Australia who were at the time members of an Australian professional and industrial organisation. Methods: A cross-sectional survey was undertaken. Data analysis was conducted using descriptive and bivariate statistics, and structural equation modelling. Results: The model fit the data well (χ² = 2.3594, χ²/df = 2.3594 and CFI = 0.9987). Twenty four percent of variation in caring efficacy (CE) can be accounted for by general self-efficacy (GSE); work locus of control (WLC) and practice environment (PE) and 62% of the variation in job satisfaction (JS) can be accounted for by GSE, WLC and PE. All pathways were found to be significant except PE to CE. GSE positively explained CE (β = 0.38). WLC was negatively related to CE i.e., as CE scores increased WLC scores decreased (β = -0.23). Further testing of the model found CE was positively related to GSE (βZ = 0.38, p < 0.001) and negatively related to WLC (βZ = - 0.23, p = 0.001). PE was not significantly associated with CE (βZ = - 0.01, p = 0.85). JS was explained by PE, which was positively related (βZ = 0.69, p = < 0.001); GSE which was negatively related (βZ - 0 .09, p < 0.001) and WLC, which was also negatively related (βZ = - 0.20, p < 0.001). Implications for Practice Nursing and organisational leaders should ensure the development of strategies for professional development and orientation programmes which may enhance nurses’ ability to develop caring relationships and express caring behaviours to their patients and as a result improve organisational and patient outcomes. Nursing shortages and turnover rates are associated with job satisfaction and the nursing practice environment. Improving the nursing environment can produce benefits to the health system such as better job satisfaction, improved workforce retention and better patient outcomes.

Caring efficacy and job satisfaction in Australian registered nurses

Purpose: The purpose of the study was to examine relationships between socio-demographic variables, job satisfaction and nurses’ caring experiences in a registered nurse population, as measured by the caring efficacy scale (CES) which was developed from Bandura’s social cognitive theory and Watson’s transpersonal caring theory. Methods: A cross-sectional survey was undertaken of nurses representing a variety of nursing specialties. A stratified random sample of registered nurses, who were members of a professional nursing organisation, was invited to participate in this study. Descriptive analyses, correlation analyses, one- way ANOVA tests, simple linear regression and multivariable analyses were conducted to examine if any relationships existed between these variables. Results: There were a total of 639 respondents to the national survey. The respondents (100%) showed positive perceived CES scores and 80.8% showed positive job satisfaction scores. Correlation analysis found age, years experience as a registered nurse and years in current job, all positively correlated with each other, (r >0.40: p < 0.001). CES scores were found to be positively correlated with age, years of experience as a registered nurse (r>0.1: p < 0.001) and job satisfaction (r>0.1: p < 0.001). An ANOVA found significant positive relationships between CES scores and age (p=0.05). Conclusion: Results from this study have identified that relationships between age, years of experience, job satisfaction and the perceived caring experiences of nurses’ exist. Organisational leaders may develop strategies for professional development and orientation programmes that enhance the caring experiences of nurses to provide quality patient care. The development of programmes that provide role modelling, emotional support or use verbal persuasion are needed where encouragement is required for nurses to master new skills. This may also improve job satisfaction and retention of nurses in the workplace in the current economically focussed healthcare system.

Coping Self-Efficacy and Psychological Distress in Flood Victims

Book Description: Life is a mix of good and bad happenings and sometimes terrible things happen to people. Trauma is evident across our lifespan; it is part of our lives. Trauma may not exert the same demands on the individual when they get on with their lives or experience other positive aspects of what life has to offer; however, it does not change its form from trauma to growth – it stays there etched into our psyche as trauma. In simple terms, growth occurs alongside the traumatic etchings. This is a book that will provide some answers to psychologists, counselors, social workers and mental health workers about what happens to people who are traumatized and how they ‘get on with their lives’; it also gives some excellent examples of how therapies can assist them in moving forward in life’s journey.

Education for sustainability : a case study of pre-service primary teachers' knowledge and efficacy

This study investigated the relationships between knowledge and efficacy for teaching sustainability in a sample of 266 pre-service primary teachers at a large, metropolitan university in Australia. A survey gathered information about the participant’s attitudes and self-efficacy for education for sustainability, along with their perceived and actual knowledge of environmental sustainability issues. The participants typically believed they were confident in their abilities to engage with education for sustainability with self-efficacy increasing with increased levels of perceived knowledge. However no relationship was found between perceived knowledge and actual knowledge which suggests that the participants either do not feel constrained by their lack of knowledge, or are perhaps unaware of their actual knowledge of sustainability issues. This lack of relationship may have implications for the development of pedagogical content knowledge with pre-service teachers potentially developing shallow, tokenistic approaches to Education for Sustainability.