Research suggests that interpersonal forgiveness is beneficial to individual functioning, but few longitudinal studies have explored the independent contributions of decisional and emotional ...forgiveness to reducing different forms of distress and improving multidimensional well-being. In this three-wave (T1: December 2020; T2: January 2021; T3: February 2021) prospective study of predominantly young Indonesian adults (
n
= 595), we examined the associations of decisional and emotional forgiveness with three indicators of distress and 10 components of well-being. Applying the outcome-wide analytic template for longitudinal designs, our primary analysis involved estimating two sets of linear regression models (one set for decisional forgiveness and one set for emotional forgiveness) in which the outcomes were regressed on each interpersonal forgiveness process (one outcome at a time). Adjusting for a range of covariates (including prior values of decisional forgiveness, emotional forgiveness, and all 13 outcomes) assessed at T1, decisional forgiveness assessed at T2 was associated with an increase in seven components of well-being (i.e., life satisfaction, physical health, sense of purpose, promote good, delayed gratification, content with relationships, satisfying relationships) approximately 1 month later at T3. In contrast, emotional forgiveness assessed at T2 was associated with an increase in a single component of well-being (i.e., satisfying relationships) assessed at T3. Neither decisional nor emotional forgiveness assessed at T2 showed evidence of associations with any of the subsequent indicators of distress assessed at T3. Our findings suggest that, at least within a principally collectivistic cultural context such as Indonesia, decisional forgiveness in the aftermath of a transgression may have greater short-term benefits for well-being compared to emotional forgiveness. Implications of the findings for research and interventions are discussed.
Aim This study aimed to identify and examine predictors of short‐term absences of staff nurses working in hospital settings reported in the research literature.
Background Front‐line staff nurse ...absenteeism contributes to discontinuity of patient care, decreased staff morale and is costly to healthcare.
Evaluation A systematic review of studies from 1986 to 2006, obtained through electronic searches of 10 online databases led to inclusion of 16 peer‐reviewed research articles. Seventy potential predictors of absenteeism were examined and analysed using content analysis.
Key issue Our findings showed that individual ‘nurses’ prior attendance records’, ‘work attitudes’ (job satisfaction, organizational commitment and work/job involvement) and ‘retention factors’ reduced nurse absenteeism, whereas ‘burnout’ and ‘job stress’ increased absenteeism. Remaining factors examined in the literature did not significantly predict nurse absenteeism.
Conclusions Reasons underlying absenteeism among staff nurses are still poorly understood. Lack of robust theory about nursing absenteeism may underlie the inconsistent results found in this review. Further theory development and research is required to explore the determinants of short‐term absenteeism of nurses in acute care hospitals.
Implications for nursing management Work environment factors that increase nurses’ job satisfaction, and reduce burnout and job stress need to be considered in managing staff nurse absenteeism.
In healthcare, a gap exists between what is known from research and what is practiced. Understanding this gap depends upon our ability to robustly measure research utilization.
The objectives of this ...systematic review were: to identify self-report measures of research utilization used in healthcare, and to assess the psychometric properties (acceptability, reliability, and validity) of these measures.
We conducted a systematic review of literature reporting use or development of self-report research utilization measures. Our search included: multiple databases, ancestry searches, and a hand search. Acceptability was assessed by examining time to complete the measure and missing data rates. Our approach to reliability and validity assessment followed that outlined in the Standards for Educational and Psychological Testing.
Of 42,770 titles screened, 97 original studies (108 articles) were included in this review. The 97 studies reported on the use or development of 60 unique self-report research utilization measures. Seven of the measures were assessed in more than one study. Study samples consisted of healthcare providers (92 studies) and healthcare decision makers (5 studies). No studies reported data on acceptability of the measures. Reliability was reported in 32 (33%) of the studies, representing 13 of the 60 measures. Internal consistency (Cronbach's Alpha) reliability was reported in 31 studies; values exceeded 0.70 in 29 studies. Test-retest reliability was reported in 3 studies with Pearson's r coefficients > 0.80. No validity information was reported for 12 of the 60 measures. The remaining 48 measures were classified into a three-level validity hierarchy according to the number of validity sources reported in 50% or more of the studies using the measure. Level one measures (n = 6) reported evidence from any three (out of four possible) Standards validity sources (which, in the case of single item measures, was all applicable validity sources). Level two measures (n = 16) had evidence from any two validity sources, and level three measures (n = 26) from only one validity source.
This review reveals significant underdevelopment in the measurement of research utilization. Substantial methodological advances with respect to construct clarity, use of research utilization and related theory, use of measurement theory, and psychometric assessment are required. Also needed are improved reporting practices and the adoption of a more contemporary view of validity (i.e., the Standards) in future research utilization measurement studies.
The End TB Strategy calls for global scale-up of preventive treatment for latent tuberculosis infection (LTBI), but little information is available about the associated human resource requirements. ...Our study aimed to quantify the healthcare worker (HCW) time needed to perform the tasks associated with each step along the LTBI cascade of care for household contacts of TB patients.
We conducted a time and motion (TAM) study between January 2018 and March 2019, in which consenting HCWs were observed throughout a typical workday. The precise time spent was recorded in pre-specified categories of work activities for each step along the cascade. A linear mixed model was fit to estimate the time at each step.
A total of 173 HCWs in Benin, Canada, Ghana, Indonesia, and Vietnam participated. The greatest amount of time was spent for the medical evaluation (median: 11 min; IQR: 6-16), while the least time was spent on reading a tuberculin skin test (TST) (median: 4 min; IQR: 2-9). The greatest variability was seen in the time spent for each medical evaluation, while TST placement and reading showed the least variability. The total time required to complete all steps along the LTBI cascade, from identification of household contacts (HHC) through to treatment initiation ranged from 1.8 h per index TB patient in Vietnam to 5.2 h in Ghana.
Our findings suggest that the time requirements are very modest to perform each step in the latent TB cascade of care, but to achieve full identification and management of all household contacts will require additional human resources in many settings.
Vertebral collapse is a common fracture associated with osteoporosis. Subsequent pain may be severe and often requires medications and bed rest. Several studies have suggested the use of calcitonin ...for the treatment of fracture pain. We sought to determine the analgesic efficacy of calcitonin for acute and chronic pain of osteoporotic vertebral compression fractures (OVCF). We searched for randomized, placebo, and controlled trials that evaluated the analgesic efficacy of calcitonin for pain attributable to OVCFs. We performed meta-analyses to calculate standardized mean differences (SMDs) using a fixed or random effects model. The combined results from 13 trials (
n
= 589) determined that calcitonin significantly reduced the severity of acute pain in recent OVCFs. Pain at rest was reduced by week 1 mean difference (MD) = −3.39, 95% confidence interval (CI) = −4.02 to −2.76), with continued improvement through 4 weeks. At week 4, the difference in pain scores with mobility was even greater (SMD = −5.99, 95% CI = −6.78 to −5.19). For patients with chronic pain, there was no statistical difference between groups while at rest; there was a small, statistically significant difference between groups while mobile at 6 months (SMD = 0.49, 95% CI = −0.85 to −0.13,
p
= 0.008). Side effects were mild, with enteric disturbances and flushing reported most frequently. Although calcitonin has proven efficacy in the management of acute back pain associated with a recent OVCF, there is no convincing evidence to support the use of calcitonin for chronic pain associated with older fractures of the same origin.
There is a lack of acceptable, reliable, and valid survey instruments to measure conceptual research utilization (CRU). In this study, we investigated the psychometric properties of a newly developed ...scale (the CRU Scale).
We used the Standards for Educational and Psychological Testing as a validation framework to assess four sources of validity evidence: content, response processes, internal structure, and relations to other variables. A panel of nine international research utilization experts performed a formal content validity assessment. To determine response process validity, we conducted a series of one-on-one scale administration sessions with 10 healthcare aides. Internal structure and relations to other variables validity was examined using CRU Scale response data from a sample of 707 healthcare aides working in 30 urban Canadian nursing homes. Principal components analysis and confirmatory factor analyses were conducted to determine internal structure. Relations to other variables were examined using: (1) bivariate correlations; (2) change in mean values of CRU with increasing levels of other kinds of research utilization; and (3) multivariate linear regression.
Content validity index scores for the five items ranged from 0.55 to 1.00. The principal components analysis predicted a 5-item 1-factor model. This was inconsistent with the findings from the confirmatory factor analysis, which showed best fit for a 4-item 1-factor model. Bivariate associations between CRU and other kinds of research utilization were statistically significant (p < 0.01) for the latent CRU scale score and all five CRU items. The CRU scale score was also shown to be significant predictor of overall research utilization in multivariate linear regression.
The CRU scale showed acceptable initial psychometric properties with respect to responses from healthcare aides in nursing homes. Based on our validity, reliability, and acceptability analyses, we recommend using a reduced (four-item) version of the CRU scale to yield sound assessments of CRU by healthcare aides. Refinement to the wording of one item is also needed. Planned future research will include: latent scale scoring, identification of variables that predict and are outcomes to conceptual research use, and longitudinal work to determine CRU Scale sensitivity to change.
Summary
Background
Small intestinal strangulating obstruction (SISO) is associated with endotoxaemia which leads to an increased risk of death. Nonsteroidal anti‐inflammatory drugs (NSAIDs) are used ...to treat signs of endotoxaemia by inhibiting cyclo‐oxygenases (COX). COX‐1 is expressed constitutively and promotes gut barrier function, whereas COX‐2 is inducible and contributes to the signs of endotoxaemia. In preclinical SISO trials, intestinal barrier recovery was more complete with reductions in endotoxin permeability in horses treated with COX‐2 selective NSAIDs as compared with horses treated with flunixin meglumine.
Objectives
We hypothesised that treatment of post‐surgical SISO horses with firocoxib (COX‐2 selective) would reduce the signs of endotoxaemia to a greater extent than flunixin meglumine (nonselective COX inhibitor) while continuing to provide similar levels of pain control.
Study design
Blinded randomised clinical trial.
Methods
In addition to clinical monitoring, preoperative and 12‐, 24‐ and 48‐h post‐operative plasma samples were assessed for prostaglandin E2 (PGE2), thromboxane B2 (TXB2), TNF⍺ and soluble CD14 (sCD14).
Results
In 56 recruited SISO horses, either flunixin meglumine (1.1 mg/kg, i.v., q12h) or firocoxib (0.3 mg/kg, i.v. loading dose; 0.1 mg/kg, i.v., q24h) was given in the post‐operative period in three university hospitals from 2015 to 2017.
COX‐2 selectivity was confirmed by a relative lack of inhibition of the COX‐1 prostanoid TXB2 by firocoxib and significant inhibition by flunixin meglumine (P = 0.014). Both drugs inhibited the COX‐2 prostanoid PGE2. There were no significant differences in pain scores between groups (P = 0.2). However, there was a 3.23‐fold increased risk (P = 0.04) of increased plasma sCD14 in horses treated with flunixin meglumine, a validated biomarker of equine endotoxaemia.
Main limitations
Horses were all treated with flunixin meglumine prior to referral. In addition, many horses were treated with lidocaine, which has been shown to mitigate the deleterious effects of flunixin meglumine.
Conclusions
In SISO cases, firocoxib reduced a biomarker of endotoxaemia as compared with flunixin meglumine while continuing to provide similar levels of pain control.
Therapeutic drug monitoring (TDM) may improve tuberculosis (TB) treatment outcomes, but there is little evidence to guide TDM in clinical practice.
We performed a systematic review and meta-analysis ...to summarise existing literature on TDM in first-line drugs.
We identified 41 studies that reported 2 h post-dose drug concentrations (C2h) for first-line drugs and 12 studies that reported clinical outcomes. We pooled data by study quality, design, region, dosing modality and patient characteristics. The pooled proportion of subjects with low isoniazid C2h was 0.43 (95%CI 0.32-0.55), 0.67 (95%CI 0.60-0.74) had low rifampicin C2h, 0.27 (95%CI 0.17-0.38) had low ethambutol C2h, and 0.12 (95%CI 0.07-0.19) had low pyrazinamide C2h. Patients with diabetes had a non-significant increase in the proportion of subjects with low C2h levels across all four drugs. Only three of 12 studies that examined clinical outcomes demonstrated an association between low C2h and unsuccessful treatment outcomes.
Across a wide variety of studies, a high proportion of patients undergoing first-line anti-tuberculosis treatment had 2 h drug concentrations below the accepted normal threshold. These findings point to a discrepancy between accepted 2 h TDM thresholds and TB drug dosing recommendations.
We evaluate the utility of an inexpensive, portable recovery bag designed to facilitate recovery of fish from capture stress by combining physiological assays, biotelemetry, and social science ...surveys. Adult migrating Pacific salmon (Oncorhynchus spp.) were used as a model, since some of their populations are threatened. While catch-and-release is common, there is a need to ensure that it is sustainable. A social science survey revealed that anglers generally have positive attitudes towards recovery bag use, particularly if research identifies that such techniques could be effective. Physiological assays on pink salmon (Oncorhynchus gorbuscha) revealed benefits of both high- and low-velocity recovery, but high velocity was most effective with reduced plasma cortisol concentrations and similar plasma sodium and chloride concentrations as those found in controls at all recovery durations. A biotelemetry study on sockeye salmon (Oncorhynchus nerka) captured by anglers and stressed by air exposure then placed in recovery bags had 20% higher, but not signiicantly different, survival than no-recovery salmon. The integration of natural science and social science provides an important step forward in developing methods for promoting recovery of fish from capture.
Tuberculosis (TB) in-patient treatment unit in Vancouver, Canada.
To examine the results of therapeutic drug monitoring (TDM) in anti-tuberculosis treatment.
We performed a retrospective analysis of ...TDM data from 2000 to 2010. All in-patients treated for TB with TDM performed during their treatment course were included.
TDM was performed on 52 patients in 76 treatment episodes from 2000 to 2010. Overall, 103/213 (48.4%) drug levels measured were low, and 5/213 (2.3%) were high. At least one drug level was low in 47/52 (90.3%) patients. Initial serum levels were low in respectively 76.6% and 68.4% of isoniazid (INH) and rifampicin (RMP) levels. In contrast, only 2.9% of initial pyrazinamide levels were low. Five patients with a susceptible strain on initial presentation later developed drug-resistant disease, with all five patients demonstrating at least one low drug level and two demonstrating multiple low levels. Dose adjustments were made in response to 26 INH and RMP levels, with variable serum responses.
In this population with high rates of treatment failure and acquired resistance, we demonstrate that most patients had low drug levels. Prospective studies are required to examine the relationship between drug levels and clinical outcomes.
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