Participation in an international education experience provides an opportunity for nursing students to gain knowledge of other cultures and develop cultural competence. Using Collaborative Online International Learning/Globally Networked Learning model, students from the United States and Denmark collaborated for 3 weeks focusing on development of collaborative relationships and learning about nurses’ roles and clinical judgment in other countries. Students felt the international experience was positive, developed relationships, and increased their knowledge of the nurses’ role and use of clinical judgment in other countries. Providing an international education experience is an option for faculty regardless of institution size, location, and level of student.
Six recommendations to facilitate rehabilitation research and supplement existing research practices were identified. Rehabilitation practice requires research addressing different long-term multi-faceted needs and perspectives of end users, including service users, professionals, politicians, and administrators. Research in rehabilitation should therefore integrate different research traditions and methods. Rehabilitation research with a broad focus is sparse, and most of the research takes its starting point in the biomedical research tradition. Through a nominal group process, we developed recommendations to emphasize important issues in rehabilitation research.
Objective: To investigate the discriminative properties of the Six-Spot Step Test in older adults with self-reported balance problems. Methods: Seventy-five older adults aged ≥65 years completed the Six-Spot Step Test and the Timed "Up and Go" test. A Mini-BESTest score of ≤19 was used as a cutoff for defining the risk of falling, and a receiver operating characteristics curve was generated to determine relevant cutoff scores. Results: An overall accuracy of 85% for the Six-Spot Step Test and 88% for the Timed "Up and Go" test were found. The probability of ruling out people at risk of falling increased with a test score shorter than 8.0 and 7.3 seconds on the Six-Spot Step Test and the Timed "Up and Go" test, respectively. Maximizing the total true positive and true negative test results generated a cutoff score of 8.8 seconds (accuracy 79%) and 8.3 seconds (accuracy 80%) for the Six-Spot Step Test and the Timed "Up and Go" test, respectively. Conclusions: The Six-Spot Step Test, which challenges the ability to adapt to more complex tasks during walking, discriminates accurately between older adults at risk of falling and those not at risk. Results as low as eight seconds qualify for fall-preventive interventions.
Insulin resistance in skeletal muscle in type 2 diabetes (T2D) is characterized by more pronounced metabolic and molecular defects than in obesity per se. There is increasing evidence that adipose tissue dysfunction contributes to obesity-induced insulin resistance in skeletal muscle. Here, we used an unbiased approach to examine if adipose tissue dysfunction is exaggerated in T2D and linked to diabetes-related mechanisms of insulin resistance in skeletal muscle. Transcriptional profiling and biological pathways analysis were performed in subcutaneous adipose tissue (SAT) and skeletal muscle biopsies from 17 patients with T2D and 19 glucose-tolerant, age and weight-matched obese controls. Findings were validated by qRT-PCR and western blotting of selected genes and proteins. Patients with T2D were more insulin resistant and had lower plasma adiponectin than obese controls. Transcriptional profiling showed downregulation of genes involved in mitochondrial oxidative phosphorylation and the tricarboxylic-acid cycle and increased expression of extracellular matrix (ECM) genes in SAT in T2D, whereas genes involved in proteasomal degradation were upregulated in the skeletal muscle in T2D. qRT-PCR confirmed most of these findings and showed lower expression of adiponectin in SAT and higher expression of myostatin in muscle in T2D. Interestingly, muscle expression of proteasomal genes correlated positively with SAT expression of ECM genes but inversely with the expression of ADIPOQ in SAT and plasma adiponectin. Protein content of proteasomal subunits and major ubiquitin ligases were unaltered in the skeletal muscle of patients with T2D. A transcriptional signature of exaggerated adipose tissue dysfunction in T2D, compared with obesity alone, is linked to low plasma adiponectin and increased transcriptional activation of proteasomal degradation in skeletal muscle.
Relationer mellem forskning og uddannelse på videregående uddannelser har været genstand for stigende forskningsmæssig opmærksomhed op gennem 00-erne. Den karakteriseres ofte som ”nexus-forskningen” og refererer til teorier og begreber med henblik på at kunne kategorisere forskellige forbindelsestyper (nexus) mellem forskning og uddannelse. Imidlertid synes underviseres didaktiske transformationsprocesser mellem de to felter at være relativt underbelyste. Empiriske studier fra et University College viser, at underviseres professionelle selvforståelse, deres dispositioner og positioneringer har stor indflydelse på den enkeltes måde at forbinde forskning med undervisning. Artiklens ambition er derfor at udvide det analytiske spekter i nexus-forskningen med et særligt blik på disse aspekters betydning for underviseres didaktiske transformationsprocesser. Med afsæt i aktuel teori fra nexus-forskningen samt uddannelsessociologiske og didaktiske teorier argumenteres for en udvidet analytisk ramme, der kan synliggøre og integrere flere dimensioner, der har betydning for didaktisk fortolkning og transformation fra forskning til undervisning. Nøgleord: Didaktisk transformation, nexus mellem forskning og uddannelse, rekontekstualisering, didaktisering.
Objectives: Neurological complications including pain are common after treatment for breast cancer. This prospective study investigated the symptoms, intensity and interference of chemotherapy-induced peripheral neuro-pathy. (CIPN) in the feet and hands compared to surgery- and radiation-induced neuropathy in the breast and upper arm. Methods: Consecutive patients referred to surgery for breast cancer were included in a prospective study and completed a questionnaire at baseline and a follow-up questionnaire and interview after one year. CIPN was assessed with the CIPN20 questionnaire and the Michigan Neuropathy Screening Instrument questionnaire (MNSIq). Pain intensity was rated on a numeric rating scale (NRS, 0-10). Results: In total 144 patients were included, of which 73 received chemotherapy. At one-year follow-up, symptoms of polyneuropathy were more common in patients treated with chemotherapy. Tingling or numbness in the feet in those treated/not treated with chemotherapy was reported by 44 (62%) and 15 (21%), respectively. Pain was present in 22 (30%) and 10 (14%), respectively. Pain in the area of surgery was reported by 66 (46%). Although less common, pain in the feet in those treated with chemotherapy was rated as more intense and with more daily life interference than pain in the surgical area (NRS 5.5 (SD 1.9) vs. 3.1 (SD 1.9). Conclusions: Neurological complications including pain following surgery and chemotherapy represent a burden to breast cancer survivors. In those who had received chemotherapy, pain in the feet was less common than pain in the surgical area, but pain in the feet was more intense and had a higher interference with daily life. Our study emphasizes the need for either baseline data or a control population for improved estimation of the presence and severity of CIPN and pain from questionnaires.
There is increasing pressure for all education institutions to undergo transformation, with education as needing to adapt in ways that meet the conceptual needs of our time. Reflecting this is the educators’ role in the classroom. The purpose of this scoping review is to provide a comprehensive overview of relevant research regarding the emergence of different kind of creative and innovative methods used by educators at all levels – and the links to including pedagogy. The scoping review is underpinned by the framework of Arksey & O`Malley (2005) that offers a new approach by including a consultation exercise in this sort of study that may enhance the results, making them more useful to policy makers, practitioners and service users. The results indicate that there is much indirect evidence emerging of improved academic performance and student and staff satisfaction with methodologies connected to or compared with what we call exposure methods. The literature points out, that exposure is coherent to aesthetic performance such as drama and applied aesthetics may lead to practical ethics. It is evident that methodologies connected to exposure have a significant impact on people involved – both educators and students.
Ethnic minority patients have been discussed and problematised in Western health literature. Drawing on an interpretation of central parts of the French philosopher Michel Foucault's authorship, we analysed a broad selection of materials to identify mechanisms through which the truth about ethnic minority patients is constructed. We identified a single, yet consistent discursive strategy that we termed ‘figure of inconvenience’ in which ethnic minority patients were classified and assigned a specific subjection illustrating them as ‘inconvenient’ to the nurse's practice. Concurrently, their relatives were afforded the position of substitutes. The discourse exemplifies how the behaviour or appearances of ethnic minority patients cannot be reconciled with the traits of ethnic Danish patients. Finally, we discussed implications that such a strategy may have for the provision of healthcare services for ethnic minority patients in Denmark.
Background: During the last decades, a recovery-based approach has called for a change in mental health care services. Several programmes have been presented, and the need to develop student and professional competences in education and clinical practice has been documented. Aim: The aim of this study was to explore how psychiatric care is understood seen from a student perspective (nursing students, masters nurses and a master in applied philosophy) with focus on their personal competences and the educational interventions empowering processes for users' personal and social recovery. Method: A qualitative design with a phenomenological-hermeneutic approach based on the French philosopher Paul Ricoeur's theory of interpretation. Data were collected through semi-structured interviews. Findings: All interviewees expressed that both theoretically and clinically students did not experience a recovery-oriented approach empowering users' personal and social recovery process. On the contrary, they experienced that both education and practice were dominated by a biomedical approach providing clinical recovery. However, several students were aware of their need of developing personal and relational competences to be able to support the users' personal and social recovery journey. The students expressed that there is a need for educational processes targeting personal competences in 'becoming a professional' supporting 'presentness and awareness' and thereby the development of relational abilities and the courage to engage. The results relate to two nursing schools and two universities. Conclusion: A biomedical approach dominates and makes it difficult to develop students' personal competences during education in practice and theory vital to the development of personal and social recovery-oriented practices. It is recommended that educators-in practice and in school-accentuate presentness, awareness and creativity as crucial relational capabilities and incorporate this in their teaching and supervision method, supporting the education and formation of the students' (and teachers' and supervisors') personal development processes.
__________________________________________________________________________________________Full-text access to a view-only version (SpringerNature SharedIt link): https://rdcu.be/cPKfS_____________________________________________________________ The Six Spot Step Test has shown good psychometric properties in terms of validity and reliability in people with multiple sclerosis. Yet, the responsiveness and minimal important change are unknown. The objective was to investigate the responsiveness of the Six Spot Step Test against the perceived change of walking limitations and establish estimates for the minimal important change in people with multiple sclerosis. The Six Spot Step Test was performed before and after four weeks of specialised multidisciplinary inpatient rehabilitation by 142 adults with mild to severe multiple sclerosis. Responsiveness was determined based on anchor- and distribution-based methods, using the Multiple Sclerosis Walking Scale-12 as external criterion. In a supplementary analysis, the Six-Minute Walking Test was used as an external criterion. The correlation between the baseline (r = 0.56, p < 0.01) and discharge (r = 0.55, p < 0.01) Multiple Sclerosis Walking Scale-12 and Six Spot Step Test scores were acceptable. Furthermore, the change scores were weakly associated (r = 0.1, p = 0.27). This trend was similar for the Six-Minute Walking Test when used as anchor. The smallest detectable change was estimated to 1.7 seconds. An improvement in the Six Spot Step Test exceeding 2.1 (95% CI − 0.9 to 5.0) sec and 4.9 (95% CI 1.2–8.6) sec may be considered clinically important on a group level based on the Multiple Sclerosis Walking Scale-12 and the Six-Minute Walking Test, respectively. In a sample of mild to severely disabled people with multiple sclerosis, the Six Spot Step Test showed fair responsiveness against a subjective and objective criterion, indicating a minimal important change between ≥ 2.1 and ≥ 4.9 seconds, respectively. However, a weak association between the change in the Six Spot Step Test and the subjective and objective external criterion calls for cautious interpretation. Hence, the results should be further verified against a valid external criterion.
Background and objectives To evaluate the feasibility and acceptability of exercise and patient education for patients with hip dysplasia not receiving surgery. Design Feasibility study. Methods The participants received exercise instruction and patient education over six months. Feasibility covered recruitment, retention, and mechanisms of change (MC). MC were measured with Hip and Groin Outcome Score (HAGOS), muscle strength tests, Y-balance test, and hop for distance test (HDT) over six months. Acceptability covered adherence, expectations, perceptions, benefits, and harms. Results Thirty of 32 were recruited (median age: 30 years); six were lost to follow-up. Twenty-four participants improved by a mean of 11 (95%CI: 5–17) HAGOS pain points, improvements in all subscales were 1–11 points. Mean hip abduction strength improved 0.2 (95%CI: 0.04–0.4) Nm/kg, similar to flexion and extension. Median Y-balance test improvements: anterior: 70 (IQR: 64–74) to 75 (IQR: 72–80) centimetres; posteromedial: 104 (IQR: 94–112) to 119 (IQR: 112–122) centimetres and posterolateral: 98 (IQR: 89–109) to 116 (IQR: 108–121) centimetres (p < .001). Median improvement in HDT was: 37 (IQR: 30–44) to 52 (IQR: 45–58) centimetres (p < .001). Participants adhered to 84% of scheduled sessions (1581:1872), expectations were met, and perceptions were characterized by high self-efficacy for exercise. Benefits were reported with no serious harm. Conclusion Patients with hip dysplasia are willing to be recruited for exercise and patient education, with acceptable retention. MC were observed through improvements in pain, strength and function with high acceptance of the exercise and patient education intervention. Thus, it seems feasible to conduct a full-scale randomised controlled trial.
Delirium is common in hospitalized older adults. The condition is frequently not recognized, or managed appropriately, and has a poor prognosis. This review finds that a proactive multicomponent interdisciplinary non-farmacological approach can reduce incidence. Delirium is managed by identification of the condition, accurate diagnosis and treatment of the causes, and all other correctable contributing factors, using nonpharmacologic approaches. In some cases, and if required for patient safety, low doses of high-potency antipsychotic agents can be used, in lowest possible dose and for the shortest possible time.
Background Pharmacological interventions still form the mainstay of the management of pain, anxiety, sleep problems and discomfort. In Europe, an estimated 100 million people use complementary non-pharmacological interventions (NPIs) for these conditions. In their pre-registration education, nurses do not generally learn about the various types of NPIs and how patients and health care professionals can include NPIs complementary to their standard care. Some nursing schools in Europe offer elective courses on NPIs, often relying on individual initiatives. Little is publicly available about the content of these programmes and how they relate to the current nursing curriculum for EU countries. Objectives This pilot study aims to explore and map the field of nursing education with regard to complementary NPIs for nurses in Europe. Design A web-based open-access questionnaire administered through the online survey tool LimeSurvey® was designed by the authors. Participants The questionnaire was sent to a purposive sample of 49 experts on nurse education and complementary NPIs from 16 European countries. All levels of education were eligible for inclusion. Methods The questionnaire consisted of 35 items regarding course content, teaching material, teaching methods and methods of assessment. In addition, respondents were invited to perform a strengths, weaknesses, opportunities and threats (SWOT) analysis in relation to their education programme. Qualitative data was analyzed using a directive content analysis approach. Results Between January and May 2020, thirty-one completed questionnaires from ten different countries were returned (response rate 63.3%). Massage, meditation, mindfulness and relaxation are the most taught interventions. Anxiety, stress, chronic pain, depression and sleep problems are the most common symptoms addressed. Conclusions Currently, a consistent and European approach to education for nurses on complementary NPIs and integrative nursing is lacking. Although taught at regular nursing educational institutes, the courses discussed here are not yet embedded in mainstream education for nurses.
Introduction Critical illness and admission to an intensive care unit (ICU) can affect patients for months or years following discharge as many suffer from cognitive impairment. Long-term cognitive impairment affects patients’ quality of life and ability to adapt to everyday life. Exploring their experiences on how and which cognitive impairments are affecting their everyday lives facilitates planning of relevant research on interventions that may serve to alleviate the burden of post-ICU cognitive impairment. The objective of this scoping review is to map the existing research on patients’ experiences of cognitive impairment following critical illness. Methods and analysis The methodology will follow the Joanna Briggs Institute guidelines for scoping reviews. The databases MEDLINE, CINAHL, PsycINFO and Embase will be searched to identify studies appropriate for inclusion. Any peer-reviewed original studies meeting the inclusion criteria and include statements from adult patients about how they experience cognitive impairment following critical illness and ICU admission will be considered. Studies published in English and Scandinavian languages will be included, with no further geographical or cultural limitations. The included studies will be screened by two independent researchers using a standardised data extraction tool and the Mixed Methods Appraisal Tool will be used for critical appraisal. The results will be presented in a tabular form, and data will be supported by narrative descriptions or a narrative summary. Ethics and dissemination Since the scoping review methodology aims at synthetising existing research on patients’ experiences of cognitive impairment following critical illness, the scoping review does not require ethical approval. The results will be disseminated though a peer-reviewed publication in a scientific journal.
The Exercise Adherence Rating Scale (EARS) is a self-administrated questionnaire designed to measure adherence to prescribed home-based exercises in a British population. In a Danish context, no reliable and valid questionnaires are available to measure exercise adherence. This study aimed to translate and cross-culturally adapt the EARS into Danish following international guidelines and to provide insights about construct validity in a Danish population with longstanding hip pain. The EARS was translated and cross-culturally adapted into Danish using a forward-backward method. The understanding and interpretability of the EARS were evaluated with semi-structured interviews in 24 patients with longstanding hip pain due to hip dysplasia (22 females; median age 30 (IQR 24-37)). These patients were prescribed with home-based exercises. Using Spearman’s correlation, construct validity was evaluated by assessing if the Danish version of EARS was correlated with completed exercise sessions and self-reported pain and sport/recreation function. The EARS was translated and cross-culturally adapted into Danish following minor adjustments. The EARS was statistically significantly correlated to completed exercise sessions (p=0.005), self-reported pain (p=0.005) and sport/recreation function (p<0.03). In patients with longstanding hip pain, the Danish EARS seems suitable to measure adherence to prescribed exercises, however, further evaluation of measurement properties may be needed.
In this review, we present the 1-min sit-to-stand test, a short, easy and validated functional test usable for general practitioners, among others, to assess functional capacity for people with chronic obstructive pulmonary disease (COPD). Possibly, this can motivate people with COPD to be more physically active. From the first interaction, healthcare professionals should provide information about the positive effects of physical activities and continuously assess functional capacity with a functional test in people with COPD to promote an active lifestyle
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