A global review of the inferred meaning of woman centred care within midwifery professional standards.

BACKGROUND: As an integral and guiding approach, woman centred care is well-grounded as the cornerstone of midwifery training and practice. A previous global review established that the concept, even though acknowledged as pivotal, has limited attention within the professional standards documents that underpin the discipline [1]. Whilst not detracting from the overall importance of woman centred care, it is further suggested that a broader meaning is generally being implied. OBJECTIVE: Whether other related inferences and meanings of the actual term 'woman centred care' are also being utilised, has not yet been established. Therefore, this review of professional documents sought to investigate the occurrence of further depictions of the concept. METHODS: With an implied and inferred meaning of 'woman centred care' as the focus, a review and synthesis of narrative from a global sample of midwifery professional standards was conducted. The principles of meta-ethnography were utilised to develop a qualitative approach. Rather than the actual words 'woman centred care' further phrases implying or inferring the concept were sought. 'A priori' phrases were developed and narrative and examples were synthesised for each. FINDINGS: Standards and governance documents were located from within Australia, the United Kingdom and New Zealand and a further 139 nations. Overall, the seven phrases, each considered as an inference to woman centred care, were all substantiated. As a proportion of all documents, these were collated with the outcomes being a woman's right to choice (89%), being culturally sensitive (80.5%), a woman's voice and right to be heard (78%), the woman as an individual (68%), universal human rights (40%), being holistic (39%) and being self-determined (17.5%). CONCLUSION: The outcomes of this review demonstrate that woman centred care may be a multidimensional concept. There were occurrences of all seven phrases across a broad scope of global professional midwifery documents, and each can be shown through its meaning to contribute something to an understanding of woman centred care. The creation of a universal meaning is recommended.

Towards a conceptualisation of woman centred care - A global review of professional standards.

BACKGROUND: Woman centred care is purported to underpin Midwifery philosophy. However, the evidence and focus of this concept within midwifery professional standards has yet to be verified. Further to this, woman centred care is, at this time, mostly depicted as a way of assisting, supporting and interacting with a woman and her family. It is however, without a substantive universally accepted definition. OBJECTIVE: This study aimed to review midwifery standards documents. An organised and targeted methodology was conducted to identify the approaches to woman centred care that currently underpin midwifery governance. METHODS: A comprehensive and specific search for 'woman centred care' was conducted across a global collection of midwifery standards. A professional document was included if it represented either or all of the underpinnings of midwifery education, contained statements related to standards of practice, overall governance or any equivalence. Individual documents were initially searched for the words 'woman centred care', followed by 'women centred care', 'patient/person centred care' and 'client centred care'. FINDINGS: An extensive review of 142 documents was undertaken. These included: thirty independent nations, thirty represented by the European Midwives Association and a further twenty-one identified through the International Confederation of Midwives (ICM). The World Health Organisation (WHO), yielded midwifery information from a further sixty-one nations. The phrase 'woman centred care' was located within 3.5% of the documents reviewed. Overall, five examples were found that directly referred to the actual phrase 'woman centred care' and one to the use of 'person centred care'. Therefore, it was established, that at the time of this review, there was limited formal depiction of the concept of woman centred care.

Older gay men's engagement with physical activity: A scoping review.

Older gay men experience an elevated prevalence of adverse health conditions that may be compounded by age-related deterioration. Some of these conditions may be ameliorated by regular adherence to physical activity (PA). However, many gay men participate in less PA than their age-matched heterosexual counterparts. With a focus on gay men aged 60 and over, the aims of this review were to examine the evidence for older gay men's engagement with PA and the research approaches used to describe this group. A systematic search of six academic databases (Academic Search Premier, Cinahl, PubMed, Sport Discus, APA PsychInfo and APA PsychArticles) generated 23 papers from 1970 to 2020 that focused on older gay men's engagement with PA. Although surveys were well represented in the literature, further studies utilising qualitative methodological frameworks have the potential to inform targeted interventional programs aimed at reducing less health disparities. The value of PA in older adults lies principally in improved performance of activities of daily living, independent living, increased longevity, decreased cognitive decline and improved mental well-being.

Adding telehealth simulation into NP programs.

NP educators are challenged to ensure their students have opportunities to learn how to apply skills within a telehealth context. This article presents an integration of telehealth into clinical learning, depicting the connectedness possible when a healthcare professional and patient are challenged by geographic distance.

Intermittent and graded exercise effects on NK cell degranulation markers LAMP-1/LAMP-2 and CD8+CD38+ in chronic fatigue syndrome/myalgic encephalomyelitis.

There is substantial evidence of immune system dysfunction in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) but little is understood of exercise training effects on lymphocyte function in this illness. This study investigated whether graded and intermittent exercise improved CD8+ lymphocyte activation and natural killer cell degranulation markers compared to no exercise. Twenty-four chronic fatigue syndrome (CFS) patients (50.2 ± 10 year) were randomized to graded exercise (GE), intermittent exercise (IE) or usual care (UC) groups; a control group (CTL) of 18 matched sedentary non-CFS/ME participants were included for immunological variable comparisons. Main outcome measures were pre- and postintervention expression of CD3+CD8+CD38+ and CD3-CD16+56+CD107a+ (LAMP-1) CD107b+ (LAMP-2) and aerobic exercise capacity. The postintervention percentage of NK cells expressing LAMP-1 and -2 was significantly higher in IE compared to UC, and higher in GE compared to UC and CTL LAMP-1 and LAMP-2 expression (absolute numbers and percent positive) increased significantly pre-to-postintervention for both GE and IE Preintervention, the absolute number of CD8+CD38+ cells was significantly lower in CTL compared to UC and IE There were no significant pre- to postintervention changes in CD8+CD38+ expression for any group. Aerobic exercise capacity was significantly improved by GE and IE Twelve weeks of GE and IE increased the expression of NK cell activation and degranulation markers, suggesting enhanced immunosurveillance. Low-intensity exercise may also reduce CD8+CD38+ expression, a marker of inflammation. Both GE and IE improved exercise capacity without worsening CFS/ME symptoms, and more robust trials of these exercise modalities are warranted.

Identifying common values among seven health professions: An interprofessional analysis.

This article reviews the competency frameworks of seven Australian health professions to explore relationships among health professions of similar status as reflected in their competency frameworks and to identify common themes and values across the professions. Frameworks were compared using a constructivist grounded theory approach to identify key themes, against which individual competencies for each profession were mapped and compared. The themes were examined for underlying values and a higher order theoretical framework was developed. In contrast to classical theories of professionalism that foreground differentiation of professions, our study suggests that the professions embrace a common structure and understanding, based on shared underpinning values. We propose a model of two core values that encompass all identified themes: the rights of the client and the capacity of a particular profession to serve the healthcare needs of clients. Interprofessional practice represents the intersection of the rights of the client to receive the best available healthcare and the recognition of the individual contribution of each profession. Recognising that all health professions adhere to a common value base, and exploring professional similarities and differences from that value base, challenges a paradigm that distinguishes professions solely on scope of practice.

An interprofessional health assessment program in rural amateur sport.

Effective interprofessional learning (IPL) in multisectoral collaborations such as those linking health services within communities can provide an authentic experience for students and also appears to be the most effective way to achieve health changes in targeted population groups. The aim of this study was to facilitate the IPL of students at a rural university in a multisectoral health assessment programme and to promote health in players of rural amateur sport. Two rural rugby league teams took part in three pre-season health assessments conducted by general medical practitioners, practice nurses, and nursing, osteopathy, and exercise science students. The Readiness for Interprofessional Learning Scale questionnaire and a series of focus groups were used to evaluate participants' experiences of the programme. Results indicated that students saw the benefits for patients and 93% valued the opportunity to improve interprofessional communication, problem-solving and team skills. Some students felt they needed to learn more about their own professional role before learning about others, and instances of stereotyping were identified. The programme also enabled early detection of potential health risks and referral for medical care, management of musculoskeletal conditions, and health promotion. These health assessments would be readily transferred to other multisectoral sporting settings.

Graded versus Intermittent Exercise Effects on Lymphocytes in Chronic Fatigue Syndrome.

PURPOSE: There is increasing evidence of immune system dysfunction in chronic fatigue syndrome (CFS), but little is known of the regular exercise effects on immune cell parameters. This pilot study investigated the effects of graded and intermittent exercise on CD4 lymphocyte subset counts and activation compared with usual care. METHODS: Twenty-four CFS patients (50.2 ± 10 yr) were randomized to graded exercise (GE), intermittent exercise (IE), or usual care (UC) groups; 18 sedentary non-CFS participants (50.6 ± 10 yr) were controls (CTL) for blood and immunological comparisons. Outcome measures were pre- and postintervention flow cytometric analyses of circulating lymphocyte subset cell counts; expression of CD3, CD4, CD25, and CD134; full blood counts; and V˙O2peak. RESULTS: Preintervention, CD3 cell counts, and expression of CD4, CD25, CD134, and CD4CD25CD134 were significantly lower in GE, IE, and UC compared with CTL (P < 0.05). Total lymphocyte concentration was significantly lower in GE and IE groups compared with CTL. There were significant postintervention increases in i) expression of CD4 and CD4CD25CD134 for GE and IE, but CD25 and CD134 for IE only; ii) circulating counts of CD3 and CD4 for GE, and CD3, CD4, CD8, CD3CD4CD8, CD3CD16CD56, CD19, and CD45 for IE; iii) neutrophil concentration for GE; and iv) V˙O2peak and elapsed test time for IE and GE, V˙Epeak for IE. CONCLUSIONS: Twelve weeks of GE and IE training significantly improved CD4 lymphocyte activation and aerobic capacity without exacerbating CFS symptoms. IE may be a more effective exercise modality with regard to enhanced CD4 activation in CFS patients.

Understanding clinical reasoning in osteopathy: a qualitative research approach.

BACKGROUND: Clinical reasoning has been described as a process that draws heavily on the knowledge, skills and attributes that are particular to each health profession. However, the clinical reasoning processes of practitioners of different disciplines demonstrate many similarities, including hypothesis generation and reflective practice. The aim of this study was to understand clinical reasoning in osteopathy from the perspective of osteopathic clinical educators and the extent to which it was similar or different from clinical reasoning in other health professions. METHODS: This study was informed by constructivist grounded theory. Participants were clinical educators in osteopathic teaching institutions in Australia, New Zealand and the UK. Focus groups and written critical reflections provided a rich data set. Data were analysed using constant comparison to develop inductive categories. RESULTS: According to participants, clinical reasoning in osteopathy is different from clinical reasoning in other health professions. Osteopaths use a two-phase approach: an initial biomedical screen for serious pathology, followed by use of osteopathic reasoning models that are based on the relationship between structure and function in the human body. Clinical reasoning in osteopathy was also described as occurring in a number of contexts (e.g. patient, practitioner and community) and drawing on a range of metaskills (e.g. hypothesis generation and reflexivity) that have been described in other health professions. CONCLUSIONS: The use of diagnostic reasoning models that are based on the relationship between structure and function in the human body differentiated clinical reasoning in osteopathy. These models were not used to name a medical condition but rather to guide the selection of treatment approaches. If confirmed by further research that clinical reasoning in osteopathy is distinct from clinical reasoning in other health professions, then osteopaths may have a unique perspective to bring to multidisciplinary decision-making and potentially enhance the quality of patient care. Where commonalities exist in the clinical reasoning processes of osteopathy and other health professions, shared learning opportunities may be available, including the exchange of scaffolded clinical reasoning exercises and assessment practices among health disciplines.

A Systematic Review of the Experience of Using Second Life in the Education of Undergraduate Nurses.

BACKGROUND: The virtual world of Second Life(®) is an emerging technology that is being considered as a simulation methodology for the education of professionals. Particularly for nursing, the adoption of simulation, although a response to technological advancement, is occurring during changes in population health care needs, the resultant impact on the workforce, and also the changing profile of students. METHOD: This systematic review aimed to establish the current applications of Second Life in the education of undergraduate nursing students. Databases searched were CINAHL(®), Medline(®), Education Research Complete(™), ERIC(™), Computers and Applied Sciences Complete(™), and Library, Information Sciences and Technology(™). RESULTS: Fourteen studies met the inclusion and exclusion criteria. Evidence identified included the themes of transferability from theory to practice, focus on learner centeredness, and evaluative processes. CONCLUSION: This review demonstrates that positive learning outcomes are achievable in Second Life. Evaluative research is in an early stage, and further investigation is warranted.

Symptoms of muscle dysmorphia, body dysmorphic disorder, and eating disorders in a nonclinical population of adult male weightlifters in Australia.

The current study aimed to (a) determine the rates of symptoms of muscle dysmorphia (MD), body dysmorphic disorder (BDD), and eating disorder; (b) determine the relationships among symptoms of MD, BDD, and eating disorders; and (c) provide a comprehensive comparison of symptoms of MD, BDD, and eating disorders in a nonclinical population of adult male weightlifters in Australia. The participants (N = 648, mean age = 29.5 years, SD = 10.1) participated in an online survey, consisting of Muscle Appearance Satisfaction Scale, the Body Dysmorphic Disorder Questionnaire, and the Eating Attitude Test-26. Results indicated that 110 participants (17%) were at risk of having MD, 69 participants (10.6%) were at risk of having BDD, and 219 participants (33.8%) were at risk of having an eating disorder. Furthermore, 36 participants (5.6%) were found at risk of having both MD and BDD, and 60 participants (9.3%) were at risk of having both MD and an eating disorder. Significant correlations and associations were found between symptoms of MD and BDD, and symptoms of MD and eating disorders. Support was provided for the comorbidity of, and symptomatic similarities between, symptoms of MD and BDD, and symptoms of MD and eating disorders. This may reflect a shared pathogenesis between symptoms of MD, BDD, and eating disorders. Strength and conditioning professionals, exercise scientists, athletic trainers, and personal trainers should be aware that adult males who are working out with weights (i.e., free weights or machines) may be at increased risk of having MD, BDD, and eating disorders.

Developing a viva exam to assess clinical reasoning in pre-registration osteopathy students.

BACKGROUND: Clinical reasoning (CR) is a core capability for health practitioners. Assessing CR requires a suite of tools to encompass a wide scope of contexts and cognitive abilities. The aim of this project was to develop an oral examination and grading rubric for the assessment of CR in osteopathy, trial it with senior students in three accredited university programs in Australia and New Zealand, and to evaluate its content and face validity. METHODS: Experienced osteopathic academics developed 20 cases and a grading rubric. Thirty senior students were recruited, 10 from each university. Twelve fourth year and 18 fifth year students participated. Three members of the research team were trained and examined students at an institution different from their own. Two cases were presented to each student participant in a series of vignettes. The rubric was constructed to follow a set of examiner questions that related to each attribute of CR. Data were analysed to explore differences in examiner marking, as well as relationships between cases, institutions, and different year levels. A non-examining member of the research team acted as an observer at each location. RESULTS: No statistical difference was found between the total and single question scores, nor for the total scores between examiners. Significant differences were found between 4th and 5th students on total score and a number of single questions. The rubric was found to be internally consistent. CONCLUSIONS: A viva examination of clinical reasoning, trialled with senior osteopathy students, showed face and content validity. Results suggested that the viva exam may also differentiate between 4th and 5th year students' capabilities in CR. Further work is required to establish the reliability of assessment, to further refine the rubric, and to train examiners before it is implemented as a high-stakes assessment in accredited osteopathy programs.

Focus group interviews with older Australians to explore their awareness of the national age-adjusted dietary recommendations and their suggestions for assisting them to meet these dietary targets.

Promoting a healthy, nutritious diet is central to the goal of assisting individuals to age well. This study used focus groups to explore older people's awareness of the current age-adjusted nutrient recommendations and age-adjusted core food groups, and to capture their views about these dietary guidelines. Thematic analysis was applied to aggregate data into categories of frequently occurring responses. Data were collected from five focus groups: a total of 29 participants, aged 60-98 years of age. Analysis of responses revealed that participants were generally unaware of government-endorsed dietary guidelines or nutrient recommendations for older people. Their suggestions for assisting older people to meet these age-adjusted dietary targets included: targeted media campaigns to raise awareness about older people's nutrient requirements; the need for practical meal plans that do meet their dietary needs; and the removal of barriers to supermarket food choices, such as problems with opening jars and excessive packaging.

The protocol for a randomised controlled trial comparing intermittent and graded exercise to usual care for chronic fatigue syndrome patients.

BACKGROUND: Chronic Fatigue Syndrome is a debilitating disorder with an unknown aetiology but suspected multifactorial origins. Common "triggers" include severe viral infections and emotional stress. Recent studies have also found evidence of immune dysfunction and elevated inflammatory cytokines in CFS patients, but there has been considerable variation in the outcome measures and magnitude of these studies. Currently, there is no cure for CFS but treatments include rest, specialist medical care, cognitive behavioural therapy, and graded (self-paced) exercise. To date, several studies have examined the efficacy of graded exercise with or without Cognitive Behavioural Therapy, with some success for patients. However, improvements in functional capacity have not necessarily correlated with improvements in immune function, fatigue or other symptoms. This 12-week pilot trial compares graded and intermittent exercise to normal care, measuring physiological outcomes, fatigue levels, immune function and wellness. METHODS/DESIGN: 90 patients aged between 16 to 60 years, who meet the diagnostic criteria for CFS and have been diagnosed by their medical practitioner, will be randomly recruited into groups consisting of Intermittent exercise, Graded exercise and usual care (Control). The outcomes will be measured pre-study (Week 0) and post-study (Week 13). Primary outcomes are VO2peak, anaerobic threshold, peak power, levels of fatigue, immune cell (CD3+CD4+, CD3+CD8+, CD19+, CD 16+CD56+) concentrations and activation. Secondary outcomes include onset of secondary CFS symptoms (e.g. fever, swollen lymph nodes), wellness, mood and sleep patterns. Primary analysis will be based on intention to treat using logistic regression models to compare treatments. Quantitative data will be analysed using repeated measures ANOVA with a linear model, and Cohen's effect size. Qualitative data such as participants' responses (e.g. changes in mood and other reactions) following the exercise modalities will be read and sections demarcated. A code will be applied to each segment. A prevalence of codes will be considered thematically. DISCUSSION: The results of the trial will provide information about the efficacy of intermittent and graded exercise compared to usual care (rest and lifestyle recommendations), contributing to the evidence for best-practice CFS management. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ACTRN12612001241820.

The effect of short-term use of testosterone enanthate on muscular strength and power in healthy young men.

Use of testosterone enanthate has been shown to significantly increase strength within 6-12 weeks of administration (2, 9), however, it is unclear if the ergogenic benefits are evident in less than 6 weeks. Testosterone enanthate is classified as a prohibited substance by the World Anti-Doping Agency (WADA) and its use may be detected by way of the urinary testosterone/epitestosterone (T/E) ratio (16). The two objectives of this study were to establish (a) if injection of 3.5 mg.kg(-1) testosterone enanthate once per week could increase muscular strength and cycle sprint performance in 3-6 weeks; and (b) if the WADA-imposed urinary T/E ratio of 4:1 could identify all subjects being administered 3.5 mg.kg(-1) testosterone enanthate. Sixteen healthy young men were match-paired and were assigned randomly in a double-blind manner to either a testosterone enanthate or a placebo group. All subjects performed a structured heavy resistance training program while receiving either testosterone enanthate (3.5 mg.kg(-1)) or saline injections once weekly for 6 weeks. One repetition maximum (1RM) strength measures and 10-second cycle sprint performance were monitored at the pre (week 0), mid (week 3), and post (week 6) time points. Body mass and the urinary T/E ratio were measured at the pre (week 0) and post (week 6) time points. When compared with baseline (pre), 1RM bench press strength and total work during the cycle sprint increased significantly at week 3 (p < 0.01) and week 6 (p < 0.01) in the testosterone enanthate group, but not in the placebo group. Body mass at week 6 was significantly greater than at baseline in the testosterone enanthate group (p < 0.01), but not in the placebo group. Despite the clear ergogenic effects of testosterone enanthate in as little as 3 weeks, 4 of the 9 subjects in the testosterone enanthate group ( approximately 44%) did not test positive to testosterone under current WADA urinary T/E ratio criteria.