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New Role (new + role)
Selected AbstractsA NEW ROLE FOR CONSUMERS' PREFERENCES IN THE PROVISION OF HEALTHCAREECONOMIC AFFAIRS, Issue 3 2006Harry Telser In the present allocation of resources in healthcare, preferences of consumers as the ultimate financiers of healthcare services are judged to be of little relevance. This state of affairs is being challenged because the past decade has seen great progress in the measurement of preferences, or more precisely, willingness-to-pay (WTP) as applied to healthcare services. This article reports evidence on WTP of the Swiss population with regard to three hypothetical modifications of the drug benefit to be covered by social health insurance: delaying access to the most recent therapeutic innovations (among them, drugs) by two years in exchange for a reduction of the monthly premium; substituting original preparations by generics, again in return for a lowered premium; and the exclusion of preparations for the treatment of minor complaints from the drug benefit. Using discrete-choice experiments, WTP and its determinants are estimated. Average WTP for avoiding such a delay (which acts across the board) is much higher than for eschewing the exclusive use of generics (which are claimed to be largely equivalent to the original) or the retention of ,unimportant' drugs in the list of benefits , a rating predicted by economic theory. In addition, a great deal of preference heterogeneity between the French-speaking minority and the German-speaking majority was found, pointing to considerable efficiency losses caused by uniformity of social health insurance. [source] Wage Setting, Social Pacts and the Euro: A New Role for the State , By A. HasselJCMS: JOURNAL OF COMMON MARKET STUDIES, Issue 3 2007ANDY MATHERS No abstract is available for this article. [source] The Perinatal Patient Safety Nurse: A New Role to Promote Safe Care for Mothers and BabiesJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2006Susan Brown Will Medical malpractice premiums and costs of obstetric claims, settlements, and jury awards are at an all-time high. This article describes one professional liability company's initiative to promote safer perinatal care and decrease costs of claims, including the development of the perinatal patient safety nurse role. The primary responsibility of the perinatal patient safety nurse is to promote safe care for mothers and babies by keeping patient safety as a focus of all unit operations and clinical practices. JOGNN, 35, 417-423; 2006. DOI: 10.1111/J.1552-6909.2006.00057.x [source] Negotiating a New Role in a Gendered Order: A Cultural LensNEGOTIATION AND CONFLICT MANAGEMENT RESEARCH, Issue 1 2009Karen Golden-Biddle Abstract This article examines how advocates for the nurse practitioner (NP) role negotiated its implementation in a large urban health system that differentiates nursing from medicine on the basis of gender. Using a cultural perspective, analyses show how advocates envisioned the NP role as liminal,neither traditional nursing nor medical,and as expanding the boundaries of nursing work through appropriation of some medical work. Four key negotiation strategies are profiled that advocates used to successfully implement and sustain this role in most settings. The conclusion examines whether and how this new role altered or maintained the gendered arrangements and more generally points to the significance of liminal phenomena in producing fundamental change. [source] Leading Business Improvement: a New Role for Statisticians and Quality ProfessionalsQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 3 2005Ronald D. Snee Abstract Following the successes of Motorola, Allied-Signal, General Electric and others, many companies are implementing the Six Sigma approach to business improvement. Millions of dollars are being saved in the process. Active leadership by management and others involved is integral to the method and critical to its success. This development provides a unique opportunity for statisticians and quality professionals to be leaders in their organizations. The leadership roles are discussed and it is shown how statisticians and quality professionals can assume leadership roles throughout the deployment process. As a result statisticians and quality professionals can expand their roles as internal trainers and consultants to include being leaders of business improvement. In the process their focus moves from facilitation of technical applications to the implementation of Six Sigma, skill deployment and delivery of bottom line business results. Copyright © 2005 John Wiley & Sons, Ltd. [source] New Roles for Evaluation at the Detroit Institute of ArtsCURATOR THE MUSEUM JOURNAL, Issue 1 2009Matt Sikora [source] Pathways out of Patronage Politics: New Roles for Communities, New Rules for Politics in the PhilippinesIDS BULLETIN, Issue 6 2009Jude Esguerra III This case study discusses adaptations of co-production and co-financing approaches pioneered by two non-governmental organisations (NGOs) in the province of Palawan in Metro Manila, part of the Baranggay-Bayan Governance Consortium, a loose network of NGOs across the Philippines. The Consortium associates itself with local government officials, social movements and political parties that are interested not only in making use of the existing so-called democratic spaces but also of the political empowerment of the poor. It does so by creating community capabilities for increased bargaining power vis-à-vis local elected officials, reversing the exclusionary logic of patronage politics in the country and supporting co-production and co-financing between local governments and communities willing to put efforts towards solving their own problems. [source] Increased Mental Health Needs and New Roles in School CommunitiesJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 3 2003Janis Hootman PhD TOPIC Mental health issues and partnership roles in school communities. PURPOSE To heighten the awareness of healthcare providers about the multiple mental health conditions students bring into school communities and the impact of these conditions on students' ability to learn; to encourage partnering between healthcare providers and educators to support students in achieving academic and developmental success. SOURCES Literature review and authors' experiences with assessment of and intervention with school-age children presenting with impaired mental health. CONCLUSIONS Health and education systems must increase their partnerships on behalf of children for a healthy future. [source] New role for majors in Atta leafcutter antsECOLOGICAL ENTOMOLOGY, Issue 5 2007SOPHIE E. F. EVISON Abstract 1.,Atta (Hymenoptera: Formicidae) leafcutter ants display the most polymorphic worker caste system in ants, with different sizes specialising in different tasks. The largest workers (majors) have large, powerful mandibles and are mainly associated with colony defence. 2.,Majors were observed cutting fallen fruit and this phenomenon was investigated in the field by placing mango fruit near natural Atta laevigata and Atta sexdens colonies in São Paulo State, Brazil. 3.,Ants cutting the fruit were significantly heavier (mean = 49.1 mg, SD = 11.1 mg, n= 90) than the ants carrying the fruit back to the nest (mean = 20.9 mg, SD = 9.2 mg, n= 90). 4.,Fruit pieces cut by majors were small (mean = 15.9 mg), approximately half the weight of leaf pieces (mean = 28.5 mg) cut and carried by media foragers. It is hypothesised that it is more difficult to cut large pieces from three-dimensional objects, like fruit, compared to two-dimensional objects, like leaves, and that majors, with their longer mandibles, can cut fruit into larger pieces than medias. 5.,The study shows both a new role for Atta majors in foraging and a new example of task partitioning in the organisation of foraging. [source] Matrix metalloproteinases in tumor invasion: Role for cell migrationPATHOLOGY INTERNATIONAL, Issue 4 2002Kazuki Nabeshima Matrix metalloproteinases (MMP) play a role in a wide range of tumorigenesis, including early carcinogenesis events, tumor growth and tumor invasion and metastasis. Given that the ability of tumor cells to infiltrate and disseminate widely is what makes the tumors malignant, a role of MMP in cell migration during this invasive and metastatic process is important. There are two types of cancer cell migration: single cell locomotion and cohort migration (cell movement en mass keeping cell,cell contact, which is frequently seen in better differentiated carcinomas). Cell surface localization and activation of MMP is essential for cells to migrate, through rearrangement of extracellular matrix (ECM) to suit cell migration. Certain MMP, such as gelatinases and membrane -type 1 MMP, have special mechanisms to localize at leading edges in both types of cell migration. Moreover, in cohort migration, expression of these MMP is regulated via cell,cell contact within migrating cell sheets and confined to the foremost pathfinder cells of the migrating cell sheets. New roles of cell surface MMP, such as cleavage of cell surface receptors or cofactors involved in cell,ECM interactions during cell migration, are also discussed. [source] Eosinophils: ,new' roles for ,old' cellsALLERGY, Issue 3 2004A. Munitz Prominent blood and tissue eosinophilia is manifested in a number of inflammatory states, particularly in allergic diseases. Eosinophils are a source of numerous cytokines and growth factors, thus in principle they can display both pro-inflammatory and anti-inflammatory activities as well as immunoregulatory ones. In this review, we will discuss the cross-talk between eosinophils and other cell types that they come in contact with in the inflammatory milieu, such as mast cells, fibroblasts and endothelial cells. ,New' roles for eosinophils in cancer and novel activatory signals will also be described. [source] A CRITICAL LOOK AT PAP ADEQUECY: ARE OUR CRITERIA SATISFACTORY?CYTOPATHOLOGY, Issue 2006D.R. Bolick Liquid based Pap (LBP) specimen adequacy is a highly documented, yet poorly understood cornerstone of our GYN cytology practice. Each day, as cytology professionals, we make adequacy assessments and seldom wonder how the criteria we use were established. Are the criteria appropriate? Are they safe? What is the scientific data that support them? Were they clinically and statistically tested or refined to achieve optimal patient care? In this presentation, we will take a fresh look at what we know about Pap specimen adequacy and challenge some of the core assumptions of our daily practice. LBP tests have a consistent, well-defined surface area for screening, facilitating the quantitative estimates of slide cellularity. This provides an unprecedented opportunity to establish reproducible adequacy standards that can be subjected to scientific scrutiny and rigorous statistical analysis. Capitalizing on this opportunity, the TBS2001 took the landmark step to define specimen adequacy quantitatively, and set the threshold for a satisfactory LBP at greater than 5,000 well visualized squamous epithelial cells. To date, few published studies have attempted to evaluate the validity or receiver operator characteristics for this threshold, define an optimal threshold for clinical utility or assess risks of detection failure in ,satisfactory' but relatively hypocellular Pap specimens. Five years of cumulative adequacy and cellularity data of prospectively collected Pap samples from the author's laboratory will be presented, which will serve as a foundation for a discussion on ,Pap failure'. A relationship between cellularity and detection of HSIL will be presented. Risk levels for Pap failure will be presented for Pap samples of different cellularities. The effect of different cellularity criterion on unsatisfactory Pap rates and Pap failure rates will be demonstrated. Results from this data set raise serious questions as to the safety of current TBS2001 adequacy guidelines and suggest that the risk of Pap failure in specimens with 5,000 to 20 000 squamous cells on the slide is significantly higher than those assumed by the current criteria. TBS2001 designated all LBP to have the same adequacy criterion. Up to this point, it has been assumed that ThinPrep, SurePath, or any other LBP would be sufficiently similar that they should have the same adequacy criteria. Data for squamous cellularity and other performance characteristics of ThinPrep and SurePath from the author's laboratory will be compared. Intriguing data involving the recently approved MonoPrep Pap Test will be reviewed. MonoPrep clinical trial data show the unexpected finding of a strong correlation between abundance of endocervical component and the detection of high-grade lesions, provoking an inquiry of a potential new role for a quantitative assessment of the transition zone component. The current science of LBP adequacy criteria is underdeveloped and does not appear to be founded on statistically valid methods. This condition calls us forward as a body of practitioners and scientists to rigorously explore, clarify and define the fundamental nature of cytology adequacy. As we forge this emerging science, we will improve diagnostic performance, guide the development of future technologies, and better serve the patients who give us their trust. Reference:, Birdsong GG: Pap smear adequacy: Is our understanding satisfactory? Diagn Cytopathol. 2001 Feb; 24(2): 79,81. [source] New role for majors in Atta leafcutter antsECOLOGICAL ENTOMOLOGY, Issue 5 2007SOPHIE E. F. EVISON Abstract 1.,Atta (Hymenoptera: Formicidae) leafcutter ants display the most polymorphic worker caste system in ants, with different sizes specialising in different tasks. The largest workers (majors) have large, powerful mandibles and are mainly associated with colony defence. 2.,Majors were observed cutting fallen fruit and this phenomenon was investigated in the field by placing mango fruit near natural Atta laevigata and Atta sexdens colonies in São Paulo State, Brazil. 3.,Ants cutting the fruit were significantly heavier (mean = 49.1 mg, SD = 11.1 mg, n= 90) than the ants carrying the fruit back to the nest (mean = 20.9 mg, SD = 9.2 mg, n= 90). 4.,Fruit pieces cut by majors were small (mean = 15.9 mg), approximately half the weight of leaf pieces (mean = 28.5 mg) cut and carried by media foragers. It is hypothesised that it is more difficult to cut large pieces from three-dimensional objects, like fruit, compared to two-dimensional objects, like leaves, and that majors, with their longer mandibles, can cut fruit into larger pieces than medias. 5.,The study shows both a new role for Atta majors in foraging and a new example of task partitioning in the organisation of foraging. [source] Mast cells: novel clinical perspectives from recent insightsEXPERIMENTAL DERMATOLOGY, Issue 5 2009Manfred Kneilling Abstract:, Mast cells are still generally viewed as mediators of type I allergic or pseudoallergic reactions. Research over the past 10 years revealed that our view was too small and that mast cells are of key importance in innate immunity and also types II, III and IV adaptive immune reactions. Understanding their role in modulating and amplifying of inflammatory responses provides important insights into the pathogenesis of skin diseases such as psoriasis, atopic dermatitis, bullous pemphigoid or the control of infections. This helps us to understand the course of these diseases, their trigger mechanisms, and, the new role of agents, which can modulate the function of mast cells. These insights will help to develop new therapeutic approaches. [source] Stimulation of keratinocyte differentiation , a new role for the vanilloid receptor subtype 1 (VR1/TRPV1)?EXPERIMENTAL DERMATOLOGY, Issue 2 2005Sonja Ständer Vanilloids and endogenous cannabinoids mediate their actions via the vanilloid receptor subtype 1 (VR1/TRPV1), a non-selective cation channel, which is widely distributed in the central and peripheral nervous system. Only recently, VR1 has been shown to be expressed in keratinocytes in vitro and in vivo. However, a precise description of VR1 localization in epithelial cells was missing. To determine this, we investigated VR1-immunoreactivity as well as mRNA and protein expression in a series of biopsies from normal, diseased, and capsaicin-treated human skin. VR1 was found in epidermal keratinocytes, the inner root sheet and the infundibulum of hair follicles, differentiated sebocytes, sweat gland ducts, and the secretory portion of eccrine sweat glands upon immunohistochemistry, RT-PCR and Western blot analysis. Interestingly, in diseased skin such as prurigo nodularis, psoriasis vulgaris, and atopic dermatitis, VR1 expression in keratinocytes correlated with the degree of epidermal differentiation. Enhanced VR1 immunoreactivity and protein content was found in prurigo nodularis in which epidermal keratinocytes are highly differentiated. Under effective capsaicin therapy of prurigo nodularis, the epidermis thinned and the distribution pattern of VR1 on epidermal keratinocytes normalized. In psoriasis vulgaris, a disease with disturbed epidermal differentiation, less intense immunostaining for VR1 was observed. This could be confirmed by western blot analysis showing less VR1 protein amount in comparison to prurigo nodularis although histologically both showed a thickened epidermis. In atopic dermatitis, which is characterized by a moderate epidermal hyperplasia only and regular differentiated keratinocytes, VR1 immunoreactivity was unchanged in comparison to normal skin. These findings suggest that VR1 may contribute to regular differentiation of keratinocytes. VR1 activation opens non-selective cation channels with high permeability to calcium, a ion that is crucially important for the synthesis of cornification proteins such as involucrin, fillagrin and loricrin. The role of VR1 in other epithelial cells of appendage structures remains to be determined. In summary, VR1 is widely distributed in the skin suggesting a central role for this receptor not only in nociception but also maturation and function of epithelial cells. [source] Completing the hypusine pathway in PlasmodiumFEBS JOURNAL, Issue 20 2009Deoxyhypusine hydroxylase is an E-Z type HEAT repeat protein In searching for new targets for antimalarials we investigated the biosynthesis of hypusine present in eukaryotic initiation factor-5A (eIF-5A) in Plasmodium. Here, we describe the cloning and expression of deoxyhypusine hydroxylase (DOHH), which completes the modification of eIF-5A through hydroxylation of deoxyhypusine. The dohh cDNA sequence revealed an ORF of 1236 bp encoding a protein of 412 amino acids with a calculated molecular mass of 46.45 kDa and an isoelectric point of 4.96. Interestingly, DOHH from Plasmodium has a FASTA SCORE of only 27 compared with its human ortholog and contains several matches similar to E-Z-type HEAT-like repeat proteins (IPR004155 (InterPro), PF03130 (Pfam), SM00567 (SMART) present in the phycocyanin lyase subunits of cyanobacteria. Purified DOHH protein displayed hydroxylase activity in a novel in vitro DOHH assay, but phycocyanin lyase activity was absent. dohh is present as a single-copy gene and is transcribed in the asexual blood stages of the parasite. A signal peptide at the N-terminus might direct the protein to a different cellular compartment. During evolution, Plasmodium falciparum acquired an apicoplast that lost its photosynthetic function. It is possible that plasmodial DOHH arose from an E/F-type phycobilin lyase that gained a new role in hydroxylation. Structured digital abstract ,,MINT-7255047: DHS (uniprotkb:P49366) enzymaticly reacts (MI:0414) with eIF-5A (uniprotkb:Q710D1) by enzymatic studies (MI:0415) ,,MINT-7255326: DOHH (uniprotkb:Q8I701) enzymaticly reacts (MI:0414) with eIF-5A (uniprotkb:Q710D1) by enzymatic studies (MI:0415) [source] A new role for MSY in single-species and ecosystem approaches to fisheries stock assessment and managementFISH AND FISHERIES, Issue 1 2001In 1977, Peter Larkin published his now-famous paper, ,An epitaph for the concept of maximum sustained yield'. Larkin criticized the concept of single-species maximum sustained yield (MSY) for many reasons, including the possibility that it may not guard against recruitment failure, and the impossibility of maximising sustainable yields for all species simultaneously. However, in recent years, there has been a fundamental change in the perception of the fishing mortality associated with MSY (FMSY) as a limit to be avoided rather than a target that can routinely be exceeded. The concept of FMSY as a limit is embodied in several United Nations Food and Agriculture Organization (FAO) agreements and guidelines, and has now been incorporated into the US Magnuson,Stevens Fishery Conservation and Management Act. As a result, the United States now requires the development of overfishing definitions based on biological reference points that treat the FMSY as a limit reference point and must also define a lower limit on biomass below which rebuilding plans with strict time horizons must be developed. This represents a major paradigm shift from the previously mandated (but often unachieved) objective to simply maintain fishing mortalities at levels below those associated with recruitment overfishing. In many cases, it requires substantial reductions in current fishing mortality levels. Therefore, the necessity of the new paradigm is continually questioned. This paper draws on examples from several fisheries, but specifically focuses on the recent US experience illustrating the practical difficulties of reducing fishing mortality to levels below those corresponding to MSY. However, several studies suggest that even more substantial reductions in fishing mortality may be necessary if ecosystem considerations, such as multispecies interactions, maintenance of biodiversity and genetic diversity, and reduction of bycatch and waste, are taken into account. The pros and cons of moving beyond single-species assessment and management are discussed. A US plan for improving stock assessments indicates that even a ,basic' objective such as ,adequate baseline monitoring of all managed species' may be extremely costly. Thus, the suggestion of Larkin (1983, 1997) that the costs of research and management should not exceed 10,20% of the landed value of the catch may preclude comprehensive ecosystem management. More importantly, neither single-species nor ecosystem-based fisheries management is likely to improve appreciably unless levels of fishing capacity are aligned with resource productivity, as is currently being promoted by FAO and several individual nations. [source] Characterization of a mouse model overexpressing beta-site APP-cleaving enzyme 2 reveals a new role for BACE2GENES, BRAIN AND BEHAVIOR, Issue 2 2010G. Azkona BACE2 is homologous to BACE1, a ,-secretase that is involved in the amyloidogenic pathway of amyloid precursor protein (APP), and maps to the Down syndrome critical region of chromosome 21. Alzheimer disease neuropathology is common in Down syndrome patients at relatively early ages, and it has thus been speculated that BACE2 co-overexpression with APP would promote the early neurodegenerative phenotype. However, the in vivo function of BACE2 has not yet been elucidated. The aim of the present work has been to analyse the impact of in vivo BACE2 overexpression using a transgenic mouse model. Our results suggest that BACE2 is not involved in the amyloidogenic pathway, cognitive dysfunction or cholinergic degeneration. However, TgBACE2 animals showed increased anxiety-like behaviour along with increased numbers of noradrenergic neurones in locus coeruleus, thus suggesting an unexpected role of BACE2 overexpression. [source] The presence of active Cdk5 associated with p35 in astrocytes and its important role in process elongation of scratched astrocyteGLIA, Issue 6 2007Yi He Abstract Cyclin-dependent kinase 5 (Cdk5) is a unique member of the Cdk family; its kinase activity requires association with its activator, p35 or p39. p35 is the strongest and best characterized activator. Previous studies showed that p35 is a neuron-specific protein that restricts Cdk5 activity in neurons. However, a high expression level of Cdk5 is found in astrocytes, which raises the possibility that astrocytic Cdk5 is functional. Here we show the presence of functional Cdk5 associated with p35 in astrocytes and demonstrate its important role in process elongation of scratched astrocytes. We found that p35 and glial fibrillary acidic protein (GFAP) were co-localized in primary cultured and acute isolated brain cells. Cdk5 could form an immunocomplex with p35 and its activity was shown in pure primary cultured astrocytes. p35 was upregulated in astrocytes injured by scratching, concomitantly with upregulation of Cdk5 kinase activity. Pretreatment of the scratched astrocytes with a Cdk5 inhibitor, roscovitine, could delay wound healing by inhibiting the reorganization of tubulin, GFAP, and the extension of hypertrophic processes. Moreover, overexpression of dominant negative Cdk5 could shorten the length of extending protrusion of reactive astrocytes. Thus, our findings demonstrated that functional Cdk5, associated with p35, was expressed in astrocytes and its activity could be upregulated in reactive astrocytes, a new role of Cdk5 that has never been reported in the nervous system. The present study may provide new insight for understanding the multifunctional protein complex Cdk5/p35 in the nervous system. © 2007 Wiley-Liss, Inc. [source] The advanced practice nurse,nephrologist care model: Effect on patient outcomes and hemodialysis unit team satisfactionHEMODIALYSIS INTERNATIONAL, Issue 3 2004Lori Harwood Abstract The tertiary care nurse practitioner/clinical nurse specialist (NP/CNS) is an advanced practice nurse with a relatively new role within the health-care system. It is stated that care provided by the NP/CNS is cost-effective and of high quality but little research exists to document these outcomes in an acute-care setting. The clinical coverage pattern by nephrologists and NP/CNS of a hemodialysis unit in a large academic center allowed such a study. Two NP/CNS plus a nephrologist followed two of three hemodialysis treatment shifts per day; only a nephrologist followed the third shift. The influence of this care pattern of patients was examined using a cross-sectional review of outcomes such as adequacy of delivered dialysis, anemia management, phosphate control, hospitalizations, etc. In addition, the level of satisfaction of the dialysis team and perceptions of care delivered with the care models was assessed. The care model staff-to-patient-number ratio was similar in both groups (1:27 for NP/CNS plus nephrologist; 1:29 for nephrologist alone). Patient demographics were similar in both groups but the NP/CNS,nephrologist group had patients with more comorbidities. No statistically significant (p < 0.05) differences existed between the groups in patient laboratory data, adherence to standards, medications, inter- and intradialytic blood pressure, achievement of target postdialysis weights, and hospitalizations or emergency room visits. Significantly more adjustments were made to target weights and medications and more investigations were ordered by the NP/CNS,nephrologist team. Team satisfaction and perceptions of care delivery were higher with the NP/CNS,nephrologist model. It is concluded that the NP/CNS,nephrologist care model may increase the efficiency of the care provided by nephrologists to chronic hemodialysis patients. The model may also be a solution to the problem of providing nephrologic care to an ever-growing hemodialysis population. [source] Osteoprotegerin (OPG),a potential new role in the regulation of endothelialcell phenotype and tumour angiogenesis?INTERNATIONAL JOURNAL OF CANCER, Issue 8 2006Simon S. Cross Abstract The progression of cancer depends on the establishment of a tumour blood supply, and therefore tumour angiogenesis has been identified as a major target for new anticancer agents. Recent reports have suggested that osteoprotegerin (OPG) is involved in the control of endothelial cell survival through the inhibition of the activity of tumour necrosis factor- (TNF) related apoptosis-inducing ligand (TRAIL). The role of OPG in human tumour development and angiogenesis is currently unknown. In the present study we demonstrate the ability of OPG to support endothelial cell survival, as well as the formation of cord-like structures in vitro using a matrigel tubule formation assay. Investigation of various human cancers demonstrated endothelial OPG expression in 59% of malignant tumours (n = 512), but in contrast, OPG was absent in endothelial cells associated with benign tumours and normal tissues (n = 178). In a series of 400 breast tumours, endothelial OPG expression was associated with high tumour grade and certain histological types. Our data show a clear separation in endothelial OPG expression between malignant tumours and nonmalignant tissues, supporting a potential biological role for this molecule in the development and/or maintenance of the tumour vasculature. This is the first study to report the proangiogenic effects of OPG in vitro, as well as correlating expression of OPG by tumour endothelial cells with clinicopathological data in human tumours. © 2005 Wiley-Liss, Inc. [source] Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2008Deborah Parker BA, MSocSci Executive summary Objectives, The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Inclusion criteria, Types of participants, Adult caregivers who provide support for people with dementia living in the community (non-institutional care). Types of interventions, Interventions designed to support caregivers in their role such as skills training, education to assist in caring for a person living with dementia and support groups/programs. Interventions of formal approaches to care designed to support caregivers in their role, care planning, case management and specially designated members of the healthcare team , for example dementia nurse specialist or volunteers trained in caring for someone with dementia. Types of studies, This review considered any meta-analyses, systematic reviews, randomised control trials, quasi-experimental studies, cohort studies, case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Search strategy, The search sought to identify published studies from 2000 to 2005 through the use of electronic databases. Only studies in English were considered for inclusion. The initial search was conducted of the databases, CINAHL, MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. A second more extensive search was then conducted using the appropriate Medical Subject Headings (MeSH) and keywords for other available databases. Finally, hand searching of reference lists of articles retrieved and of core dementia, geriatric and psycho geriatric journals was undertaken. Assessment of quality, Methodological quality of each of the articles was assessed by two independent reviewers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Reviews and Dissemination. Data collection and analysis, Standardised mean differences or weighted mean differences and their 95% confidence intervals were calculated for each included study reported in the meta-analysis. Results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software from the Cochrane Collaboration. Heterogeneity between combined studies was tested using standard chi-square test. Where statistical pooling was not appropriate or possible, the findings are summarised in narrative form. Results, A comprehensive search of relevant databases, hand searching and cross referencing found 685 articles that were assessed for relevance to the review. Eighty-five papers appeared to meet the inclusion criteria based on title and abstract, and the full paper was retrieved. Of the 85 full papers reviewed, 40 were accepted for inclusion, three were systematic reviews, three were meta-analysis, and the remaining 34 were randomised controlled trials. For the randomised controlled trials that were able to be included in a meta-analysis, standardised mean differences or weighted mean differences and their 95% confidence intervals were calculated for each. Results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi-square test. Where statistical pooling was not appropriate or possible, the findings are summarised in narrative form. The results are discussed in two main sections. Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression, health, subjective well-being, self-efficacy and burden. Secondly, results are reported by main outcome category. For each of these sections, meta-analysis was conducted where it was possible; otherwise, a narrative summary describes the findings. Effectiveness of intervention type, Four categories of intervention were included in the review , psycho-educational, support, multi-component and other. Psycho-educational Thirteen studies used psycho-educational interventions, and all but one showed positive results across a range of outcomes. Eight studies were entered in a meta-analysis. No significant impact of psycho-educational interventions was found for the outcome categories of subjective well-being, self-efficacy or health. However, small but significant results were found for the categories of depression and burden. Support Seven studies discussed support only interventions and two of these showed significant results. These two studies were suitable for meta-analysis and demonstrated a small but significant improvement on caregiver burden. Multi-component Twelve of the studies report multi-component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self-efficacy, depression, subjective well-being and burden. Unfortunately because of the heterogeneity of study designs and outcome measures, no meta-analysis was possible. Other interventions Other interventions included the use of exercise or nutrition which resulted in improvements in psychological distress and health benefits. Case management and a computer aided support intervention provided mixed results. One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour. Effectiveness of interventions using specific outcome categories, In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies. In particular the impact of interventions on caregiver depression was available for meta-analysis from eight studies. This indicated that multi-component and psycho-educational interventions showed a small but significant positive effect on caregiver depression. Five studies using the outcome category of caregiver burden were entered into a meta-analysis and findings indicated that there were no significant effects of any of interventions. No meta-analysis was possible for the outcome categories of health, self-efficacy or subjective well-being. Implications for practice, From this review there is evidence to support the use of well-designed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community. Factors that appear to positively contribute to effective interventions are those which: ,,Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved ,,Encourage active participation in educational interventions for caregivers ,,Offer individualised programs rather than group sessions ,,Provide information on an ongoing basis, with specific information about services and coaching regarding their new role ,,Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which: ,,Simply refer caregivers to support groups ,,Only provide self help materials ,,Only offer peer support [source] Identifying measures for evaluating new models of nursing care: A survey of NSW nurse practitionersINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 6 2007Sandy Middleton RN BAppSc(Nursing) MN PhD Health-care reforms in Australia and worldwide have seen the creation of the position of nurse practitioner (NP). To date, no protocol has been developed in Australia to guide the evaluation of this new role. All NSW authorized NPs were invited to participate in a self-administered questionnaire. Generic process and outcome measures of NP services were taken from a review of the literature. NPs were asked to determine how ,essential' each of these measures would be to describe their clinical practice. Of the 36 eligible authorized NPs in NSW, 30 returned completed questionnaires (83% response rate). The following measures were rated ,essential' by all (100%) NPs: presenting issue as stated by patient; current medications; patient satisfaction with education, quality of care received, and provider knowledge and skill. Our results provide a unique set of indicators with which to evaluate process and outcome measures of NP services. Standard outcome measures will enable NPs to evaluate their service efficiently and to benchmark against other NPs. [source] Doctors' assistants' views of case management to improve chronic heart failure care in general practice: a qualitative studyJOURNAL OF ADVANCED NURSING, Issue 4 2009Rebecca Olbort Abstract Title.,Doctors' assistants' views of case management to improve chronic heart failure care in general practice: a qualitative study. Aim., This paper is a report of a study to explore the views, concerns and experiences of doctors' assistants of case management for patients with chronic heart failure, while experiencing the new role of being a case manager within the Heidelberg Integrated Case Management trial. Background., Case management is being investigated as part of a randomised controlled trial aiming to improve care for patients with chronic systolic heart failure. In a complex, multifaceted intervention, trained doctors' assistants (equivalent to a nursing role) adopted new tasks using standardised case management involving telephone monitoring, home visits and diagnostic screening. Method., In April 2007, 3 months after implementation of the intervention programme, 27 doctors' assistants participated in four focus group interviews discussing their views on, and experiences of, case management. Thematic analysis of the data was undertaken. Findings., Participants believed that the most positive factors in case management were about interaction with patients, including opportunities for identifying disease and psychosocial problems. However, barriers included lack of time allocated to perform case management in addition to their normal role and poor cooperation within the practice team. According to the doctors' assistants, the routine implementation of case management was acceptable, feasible and effective in improving the management of patients with chronic systolic heart failure. Conclusion., Case management enhanced the role of doctors' assistants, leading to increased awareness of the perspective of patients with chronic disease. In the wider international primary care practice nursing context, the orchestrated delegation of tasks using specific case management may be a promising strategy for improving the quality of care of chronically ill patients and enabling patient self-management. [source] Primary mental health workers in child and adolescent mental health servicesJOURNAL OF ADVANCED NURSING, Issue 1 2004Wendy Macdonald BSc PhD Background., The interface between primary care and specialist services is increasingly seen as crucial in the effective management of child and adolescent mental health (CAMH) problems. In the United Kingdom, a new role of primary mental health worker (PMHW), has been established in order to achieve effective collaboration across the interface through the provision of clinical care in primary care settings and by improving the skills and confidence of primary care staff. However, little is known about the development of this innovative role in service contexts. Issues raised during the early stages of implementation may have important implications for the preparation and development of professionals who undertake the role. Aims., The aim of this paper is to report on a study that examined key issues in implementation of the PMHW role in six health authorities in England. Methods., Case study evaluation was conducted, using thematic analysis of 75 qualitative interviews with key stakeholders from different professions (e.g. PMHWs, general practitioners, health visitors, psychiatrists and service managers) and representing different sectors (primary care, specialist services and community child health services). Findings., The study identified three models of organization (outreach, primary care-based and teams). Each was associated with different advantages and disadvantages in its effects on referral rates to specialist services and the development of effective working relationships with primary care providers. Problems associated with accommodation and effective integration of PMHWs with specialist services, and tensions caused by the two different roles that PMHWs could undertake (direct clinical care vs. consultation-liaison) were common across all sites. Conclusions., The PMHW role is an important development that may go some way towards realizing the potential of primary care services in CAMH. The implementation of new roles and models of working in primary care is complex, but may be facilitated by effective planning with primary care providers, clear goals for staff, and a long-term perspective on service development. [source] A new role for OPG: Putting RANKL in its placeJOURNAL OF BONE AND MINERAL RESEARCH, Issue 9 2010Michael C Ostrowski No abstract is available for this article. [source] Perinatal nursing education for single-room maternity care: an evaluation of a competency-based modelJOURNAL OF CLINICAL NURSING, Issue 1 2005Patricia A Janssen PhD Aims and objectives., To evaluate the success of a competency-based nursing orientation programme for a single-room maternity care unit by measuring improvement in self-reported competency after six months. Background., Single-room maternity care has challenged obstetrical nurses to provide comprehensive nursing care during all phases of the in-hospital birth experience. In this model, nurses provide intrapartum, postpartum and newborn care in one room. To date, an evaluation of nursing education for single-room maternity care has not been published. Design., A prospective cohort design comparing self-reported competencies prior to starting work in the single-room maternity care and six months after. Methods., Nurses completed a competency-based education programme in which they could select from a menu of learning methods and content areas according to their individual needs. Learning methods included classroom lectures, self-paced learning packages, and preceptorships in the clinical area. Competencies were measured by a standardized perinatal self-efficacy tool and a tool developed by the authors for this study, the Single-Room Maternity Care Competency Tool. A paired analysis was undertaken to take into account the paired (before and after) nature of the design. Results., Scores on the perinatal self-efficacy scale and the single-room maternity care competency tool were improved. These differences were statistically significant. Conclusions., Improvements in perinatal and single-room maternity care-specific competencies suggest that our education programme was successful in preparing nurses for their new role in the single-room maternity care setting. This conclusion is supported by reported increases in nursing and patient satisfaction in the single-room maternity care compared with the traditional labour/delivery and postpartum settings. Relevance to clinical practice., An education programme tailored to the learning needs of experienced clinical nurses contributes to improvements in nursing competencies and patient care. [source] Nurses' experiences of research utilization within the framework of an educational programmeJOURNAL OF CLINICAL NURSING, Issue 5 2001Kerstin Nilsson Kajermo RN ,,This paper explores nurses' reflections on their experiences of disseminating and implementing research findings in clinical practice within the framework of an educational programme. ,,Ten registered nurses, all in clinical practice, participated in a research-orientated educational programme with the aim of facilitating the dissemination and implementation of research findings in clinical practice. Thus, the programme contained different activities designed to disseminate and implement research findings in the participants' wards. ,,Focus groups were used to collect data and a qualitative content analysis was performed. The main themes that were developed were: organizational and leadership issues; acquiring a new role; responses and reactions by others; and orientation to research. ,,Organizational and leadership issues, nurses' interest in research, nurses' reading habits, and support and feedback from their head nurses and other managers and from their nursing colleagues and physicians were seen as important. ,,This study confirms that research utilization and the change to research-based nursing practice are complex issues which require both organizational and educational efforts. [source] Cross-sectional studies in prescribing researchJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2001J. Jesson BSc PhD A cross-sectional study aims to describe the overall picture of a phenomenon, a situational problem, an attitude or an issue, by asking a cross-section of a given population at one specified moment in time. This paper describes the key features of the cross-sectional survey method. It begins by highlighting the main principles of the method, then discusses stages in the research process, drawing on two surveys of primary care pharmacists to illustrate some salient points about planning, sampling frames, definition and conceptual issues, research instrument design and response rates. Four constraints in prescribing studies were noted. First the newness of the subject meant a low basis of existing knowledge to design a questionnaire. Second, there was no public existing database for the sampling frame, so a pragmatic sampling exercise was used. Third, the definition of a Primary Care Pharmacist (PCP) [in full] and respondents recognition of that name and identification with the new role limited the response. Fourth, a growing problem for all surveys, but particularly with pharmacists and general practitioners (GP) [in full] is the growing danger of survey fatigue, which has a negative impact on response levels. [source] Prescribing non-psychopharmacological agents: A new potential role for psychologists in primary care settings and specialty clinicsJOURNAL OF CLINICAL PSYCHOLOGY, Issue 10 2006Jay E. Earles At least 10 years have passed since the Department of Defense Psychopharmacology Demonstration Project graduated its first class of psychologists. All graduates of that program were credentialed to prescribe and the program received promising external reviews and audits. The profession has since moved well beyond the initial question, "Can and should psychologists prescribe?" posed over two decades ago. A number of professional schools and training institutions have implemented postdoctoral psychopharmacology training programs and over 20 states are actively pursuing legislative agendas. Given recent initiatives to provide health psychology services within the primary care arena, the authors introduce a new role in the scope of psychology's prescribing activities. They propose that psychopharmacological agents are not the only medications psychologists should be trained to prescribe and psychopharmacology training should include course work and supervision related to treatment within a primary care patient setting in addition to a traditional psychiatric one. The authors provide the rationale for primary care clinical health psychology training as the appropriate mechanism for psychopharmacology education and practice. Public health needs and epidemiological data provide the rationale for health psychologists additionally prescribing non-psychopharmacological agents. © 2006 Wiley Periodicals, Inc. J Clin Psychol 62: 1213,1220, 2006. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||