Since the late 1990s there has been an increasing focus on parenting ability, support and education which is reflected in policy, practice and research in the UK. This research analyses how nurses might intervene to provide this support, specifically in relation to crying baby and the role of nurses at NHS direct. It involves collection and analysis of data from NHS Direct call data in 2002, and solo focus group data in 2006. Within the wider tradition of grounded theory, the methodology includes use of discourse and thematic analytical approaches. The research analyses the means by which NHS Direct nurses make different use of the algorithms and organisational protocols to make decisions and give advice to parents with crying babies, how their clinical knowledge and experience influences these decisions, and how nurses explore parents’ ability to cope. This is seen within the organisational context of NHS Direct, a 24 hour government funded telephone service described as both a triage service and an advice/helpline service. Findings from the study indicate a degree of tension between the essentially humanistic nursing culture and the highly scripted, protocol driven rules based system that underpins NHS Direct. Despite this tension, nurses will sometimes combine their knowledge with that of the algorithm where the call is involved with eliminating emergencies. The same synthesis of knowledge is not apparent with the knowledge contained in the algorithm regarding non-medical, nonemergency, value-sensitive issues relating to parental coping with excessive infant crying. Findings suggest that NHS Direct nurses use the ‘crying baby’ algorithm differently and this variance is influenced by experience and familiarity with the algorithm. Adherence to the algorithm is perceived by nurses as safe in relation to the medical questions which exclude emergencies. The non-medical elements of the algorithm, which include prompting the nurse to ask about parent coping ability and the possibility of shaking their child, are treated differently and it is considered safe to not ask, or ask around the question and to not offer the advice prompted by the decision aid software. The algorithm prompt to assess parental coping ability is rarely successful in encouraging the nurse to do so overtly. From these findings, consideration might be given to enhancing nurses’ knowledge, skills and confidence, supported with appropriate supervision, to provide effective intervention in relation to value sensitive, non-medical issues such as parental coping ability and in handling the uncertainty such issues may yield. Allied to this would be establishing clarity and recognition of the inherently different, but not opposing functions of providing a triage service and an advice/ helpline service.

No description available.

Abstract available in the Journal of Investigative Medicine.

Purpose: The purpose of this study was to determine if patient characteristics or clinical variables could predict who benefits from individual auditory training. Method: A retrospective series of analyses were performed using a data set from a large, multisite, randomized controlled clinical trial that compared the treatment effects of at-home auditory training programs in bilateral hearing aid users. The treatment arms were (a) use of the 20-day computerized Listening and Communication Enhancement program, (b) use of the 10-day digital versatile disc Listening and Communication Enhancement program, (c) use of a placebo “books-on-tape” training, and (d) educational counseling (active control). Multiple linear regression models using data from 263 participants were conducted to determine if patient and clinical variables predicted short-term improvement on word-recognition-in-noise abilities, self-reported hearing handicap, and self-reported hearing problems. Results: Baseline performance significantly predicted performance on each variable, explaining 11%–17% of the variance in improvement. The treatment arm failed to emerge as a significant predictor with other clinical variables explaining less than 9% of the variance. Conclusion: These results suggest that hearing aid users who have poorer aided word-recognition-in-noise scores and greater residual activity limitations and participation restrictions will show the largest improvement in these areas.

Over the last two decades, an enormous amount of scientic effort has been devoted to studying the relationship between vitamin E and prostate cancer. This effort is well justied, since prostate cancer remains the most common cancer in American men after skin cancer and is the second leading cause of cancer deaths: over 220,000 men will develop prostate each year (U.S. Cancer Statistics Working Group 2011). Nevertheless, large-scale, well-designed clinical intervention studies have not shown that alpha-tocopherol prevents prostate cancer or cancer in general (Lippman et al. 2009; Ju et al. 2010; Wada 2012). Alpha-tocopherol is the primary form of vitamin E in the plasma of fasting subjects and the primary form of vitamin E in most vitamin supplements. Gamma-tocopherol is, however, the primary dietary form of vitamin E. Vitamin E is a term that refers to at least eight different compounds that fall into two general categories: tocopherols and tocotrienols. Tocotrienols are normally not present in human plasma at detectable levels, yet the evidence for their role in preventing prostate cancer is both extensive and compelling (Conte et al. 2004; Srivastava and Gupta 2006; McAnally et al. 2007; Barve et al. 2009; Campbell et al. 2011; Luk et al. 2011). Excellent reviews are available on the general anticancer effects of tocotrienols (Wada 2009, 2012; Ju et al. 2010). It is unlikely that an anticancer effect could be achieved by consuming a tocotrienol rich diet, and instead a supplement-possibly in the form of a soft gel-would be necessary. Despite the ever-increasing data supporting the antiprostate cancer role of tocotrienols, a well-designed chemoprevention trial has yet to be conducted. Given the negative results with alpha-tocopherol chemoprevention trials, a future prostate cancer chemoprevention trial with another isoform of vitamin E must be well justied and designed. Moreover, the cost effectiveness of any future tocotrienol chemoprevention trial must be given high priority.

Background: Obstructive sleep apnea syndrome (OSAS) may promote hyperglycemia and insulin resistance. Objective: We studied the link between sleep apnea and microvascular diabetic complications in veterans with type 2 diabetes mellitus (DM-2). Design: A retrospective electronic chart of all veterans referred for sleep studies over a 1-year period was reviewed. Ninety-eight patients with a glycosylated hemoglobin <6.5% were included in the study. The degree of glycemia (HbA1c) and presence of macro-and microvascular complications were compared with OSAS variables. Method: Statistical analysis examined bivariate associations between OSAS variables and metabolic syndrome parameters. Results: The apnea hypopnea index was significantly related to diabetic microvascular complications, particularly retinopathy. Oxygen desaturation was significantly and inversely related to microalbuminuria, microvascular complications, retinopathy, and HbA1c . Conclusions: Sleep apnea is associated with microvascular complications even in well-controlled DM-2 veterans. Clinical implications: Screening for OSAS should be considered in patients with DM-2.

No description available.

A research report submitted in partial fulfillment of the requirements for the degree Master in Audiology, Department of Speech Pathology and Audiology Faculty of Humanities University of the Witwatersrand September 2018 / Newborn hearing screening (NHS) has been successfully implemented in developed countries such as the United States of America and the United Kingdom. This is however not the case in developing countries such as South Africa. The challenges impact on the implementation of such programmes include lack of suitably trained personnel, financial resources for staff and equipment, institutional support and political will. The lack of NHS programmes in South Africa has resulted in the late detection of hearing loss in infants and children and subsequently delayed intervention. In order to address the lack of NHS, a rural clinic-based NHS programme was implemented in July 2014 at three primary health care (PHC) clinics in the Limpopo Province. The main aim of the study was to describe the parental/caregiver perspectives regarding the effectiveness of this rural clinic-based NHS programme. The effectiveness of the programme was also evaluated in terms of meeting national (HPCSA, 2007) and international (JCIH, 2007) benchmarks. A retrospective review of 2 302 audiological records of babies who underwent NHS between July 2014 to June 2015 was conducted. Concurrently, 18 parents of infants who underwent hearing screening as part of the programme were purposefully selected and semistructured interviews were conducted to explore the parental perspectives regarding the programme. The results of the retrospective record review revealed that the mean age of the infants screened during the review period was 112 days (2 – 341; ± 40.26). The overall coverage rate was 87% and the referral rate, 7%. The overall follow-up return rate was 32% and only 15% the infants who failed both the initial and rescreening underwent comprehensive diagnostic assessment to confirm their hearing status. The overall prevalence rate for significant sensorineural hearing loss was 0.4/1000 and 7.8/1000 for middle ear effusion. The parents/caregivers confirmed the perceived effectiveness of the NHS programme. All the participants were satisfied with the programme and confirmed the credibility of the screening programme and screeners. Parents indicated that they were empowered with knowledge regarding the importance of early detection of hearing loss in infants and young children. Accessibility was both a facilitator and a barrier with travel distance and cost the most often cited obstacles to attending follow-up appointments. The findings indicate it is feasible to implement clinic-based NHS programmes that effectively meet the needs of parents/caregivers of infants residing in rural areas of South Africa. Although not all the benchmarks were met within the first year of implementation, the high coverage- and low referral rates are the first steps in improving the outcomes of the screening programme. The study highlight the importance of regular monitoring and evaluation of the NHS programmes to keep track of key outcomes and impacts related to the different components of the programme / MT 2019

Background: Diet therapies may be recommended for pediatric functional gastrointestinal disorders (FGIDs). However, little is known about the frequency with which diet therapy is recommended in FGIDs. Our aims were to determine and contrast the frequency and types of diet recommendations provided to children with FGIDs by pediatric gastroenterologists (PGIs) versus primary care pediatricians (PCPs). Methods: A retrospective chart review was performed using data from a large, metropolitan children's academic healthcare system to identify subjects meeting Rome IV criteria for functional abdominal pain, functional dyspepsia, irritable-bowel syndrome (IBS), and/or abdominal migraine over a period of 23 months. Results: Of 1929 patient charts reviewed, 268 were included for further analyses. Of these, 186 patients (69%) were seen by a PGI and 82 (31%) by a PCP. The most common diagnosis was IBS (49% for PGIs and 71% for PCPs). Diet recommendations were provided to 115 (43%) patients (PGI group: 86 [75%] vs PCP group: 29 [25%]; P <.1). The most frequent recommendations were high fiber (PGI: 15%; PCP: 14%) and low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) diet (PGI: 12%; PCP: 4%). Of those provided with diet recommendations, only 20% (n = 23) received an educational consult by a dietitian. Provision of diet recommendations was not affected by years in practice. Conclusion: Despite increasing awareness of the role of diet in the treatment of childhood FGIDs, a minority of patients receive diet recommendations in tertiary care or primary care settings. When diet recommendations were given, there was great variability in the guidance provided.

Abstract available in the Journal of Investigative Medicine.