Precision of the Conceptual Research Utilization Scale.

BACKGROUND AND PURPOSE: Conceptual research utilization (CRU) is one indicator of an optimum practice environment that leads to improved patient and organizational outcomes. Yet, its measurement has not been adequately addressed. In this study, we investigated precision of scores obtained with a new CRU scale using item response theory (IRT) methods. METHODS: We analyzed the responses from 1,349 health care aides from 30 Canadian nursing homes using Samejima's (1969, 1996) graded response model (GRM). RESULTS: Findings suggest that the CRU scale is most precise at low to average trait levels with significantly less precision at higher trait levels. CONCLUSIONS: The scale showed acceptable precision at low to average trait levels. New items and/or different response options that capture higher trait levels are needed. Future development of the scale is discussed.

Embracing the population health framework in nursing research.

Individuals' health outcomes are influenced not only by their knowledge and behavior, but also by complex social, political and economic forces. Attention to these multi-level factors is necessary to accurately and comprehensively understand and intervene to improve human health. The population health framework is a valuable conceptual framework to guide nurse researchers in identifying and targeting the broad range of determinants of health. However, attention to the intermediate processes linking multi-level factors and use of appropriate multi-level theory and research methodology is critical to utilizing the framework effectively. Nurse researchers are well equipped to undertake such investigations but need to consider a number of political, societal, professional and organizational barriers to do so. By fully embracing the population health framework, nurse researchers have the opportunity to explore the multi-level influences on health and to develop, implement and evaluate interventions that target immediate needs, more distal factors and the intermediate processes that connect them.

Validation of the conceptual research utilization scale: an application of the standards for educational and psychological testing in healthcare.

BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Functional outcomes after neonatal open cardiac surgery: comparison of survivors of the Norwood staged procedure and the arterial switch operation.

BACKGROUND: Improvements in long-term survival of children undergoing the Norwood staged procedure and the arterial switch operation have resulted in the need to prepare these at-risk children for each stage of their developmental trajectory, including school readiness. This study describes and compares functional outcomes following the Norwood staged procedure and arterial switch operations. METHODS: This prospective inception cohort study comprised a sample of 73 children (71% boys) who had the Norwood staged procedure (n = 28) or the arterial switch operation (n = 45) at the age of 6 weeks or younger at the Stollery Children's Hospital, Edmonton, Alberta, between 2002 and 2005. We excluded children who had chromosomal abnormalities or cerebral palsy. When children were 18-24 months of age, parents completed the Adaptive Behavioral Assessment System II. Standard scores for the domains are mean 100, standard deviation (15); skill area scaled scores, 10 (3). Student's t-test with Bonferonni correction was used to compare groups. RESULTS: This population has greater than four times the number of children delayed on the General Adaptive Composite than the normative group. Functional outcomes were similar in the two groups other than those of home living (Norwood: 8.8 (2.8) compared with arterial switch: 11.2 (3.1), t = 3.389, p = 0.001) and self-care (Norwood: 5.9 (3.5) versus arterial switch: 8.1 (2.6), t = 3.140, p = 0.002). CONCLUSION: These survivors are at increased risk for delayed functional abilities. Self-care, necessary for independence and confidence as children reach school age, was particularly low in the Norwood group. Reasons for low self-care abilities require further study.

Addressing nonresponse bias in postal surveys.

Postal surveys are sometimes thought of as a simple option for collecting data in community-based studies; however, nurse researchers must exercise care in appropriately addressing the issue of nonresponse. In particular, both the reporters and the users of such research should look beyond survey response rates when considering nonresponse bias. This article describes the benefits of using postal surveys in public health nursing research, while noting the various potential sources of survey error. Particular attention is directed to the implications of low survey response rates, including decreased power, increased standard error, and nonresponse bias. The belief that increasing response rates will necessarily reduce nonresponse bias is discussed, with an emphasis on the need to identify the reasons for nonresponse and to be judicious in the use of strategies to reduce nonresponse bias. Common response-enhancement strategies are identified, while noting the potential for these strategies to increase nonresponse bias. Assessment of the presence and magnitude of nonresponse bias is discussed, and techniques for postsurvey data adjustment are noted. The need to consider nonresponse bias in designing all phases of the study is highlighted, and is exemplified with a case study.

Children's vomiting following posterior fossa surgery: A retrospective study.

BACKGROUND: Nausea and vomiting is a problem for children after neurosurgery and those requiring posterior fossa procedures appear to have a high incidence. This clinical observation has not been quantified nor have risk factors unique to this group of children been elucidated. METHODS: A six year retrospective chart audit at two Canadian children's hospitals was conducted. The incidence of nausea and vomiting was extracted. Hierarchical multivariable logistic regression was used to quantify risk and protective factors at 120 hours after surgery and early vs. late vomiting. RESULTS: The incidence of vomiting over a ten day postoperative period was 76.7%. Documented vomiting ranged from single events to greater than 20 over the same period. In the final multivariable model: adolescents (age 12 to <17) were less likely to vomit by 120 hours after surgery than other age groups; those who received desflurane, when compared to all other volatile anesthetics, were more likely to vomit, yet the use of ondansetron with desflurane decre kelihood. Children who had intraoperative ondansetron were more likely to vomit in the final multivariable model (perhaps because of its use, in the clinical judgment of the anesthesiologist, for children considered at risk). Children who started vomiting in the first 24 hours were more likely to be school age (groups 4 to <7 and 7 to <12) and receive desflurane. Nausea was not well documented and was therefore not analyzed. CONCLUSION: The incidence of vomiting in children after posterior fossa surgery is sufficient to consider all children requiring these procedures to be at high risk for POV. Nausea requires better assessment and documentation.

Effect of older maternal age on the risk of spontaneous preterm labor: a population-based study.

To determine if older maternal age (35 years and older) at first birth was an independent risk factor for spontaneous preterm labor, we conducted a retrospective population-based cohort study. Using provincial perinatal data, we developed separate risk models for low- and high-risk women using multivariate logistic regression. We found that older maternal age exerted a direct and independent effect on spontaneous preterm labor for both nulliparous women with no preexisting chronic illnesses or pregnancy complications (low-risk) and nulliparous women who did not have any preexisting chronic illnesses, but developed one or more pregnancy complications (high-risk).

Modifiable risk factors for term large for gestational age births.

To determine modifiable and nonmodifiable risk factors for term large for gestational age (T-LGA) births in Northern and Central Alberta and their public health importance, a retrospective cohort study (n = 115,198) of singleton live births (1996-2003) was conducted using maternal and newborn data from a provincial perinatal database. After adjusting for potential confounders, predictors of T-LGA births included prepregnancy weight 91 kg or greater, multiparity, and previous LGA birth. The strongest modifiable predictor was prepregnancy weight 91 kg or greater (OR = 2.52; CI 2.39, 2.65). The population-attributable risk percentage for prepregnancy weight 91 kg or greater was 10%.

Predictors of nurse absenteeism in hospitals: a systematic review.

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.

Inadequate prenatal care and its association with adverse pregnancy outcomes: a comparison of indices.

BACKGROUND: The objectives of this study were to determine rates of prenatal care utilization in Winnipeg, Manitoba, Canada from 1991 to 2000; to compare two indices of prenatal care utilization in identifying the proportion of the population receiving inadequate prenatal care; to determine the association between inadequate prenatal care and adverse pregnancy outcomes (preterm birth, low birth weight [LBW], and small-for-gestational age [SGA]), using each of the indices; and, to assess whether or not, and to what extent, gestational age modifies this association. METHODS: We conducted a population-based study of women having a hospital-based singleton live birth from 1991 to 2000 (N = 80,989). Data sources consisted of a linked mother-baby database and a physician claims file maintained by Manitoba Health. Rates of inadequate prenatal care were calculated using two indices, the R-GINDEX and the APNCU. Logistic regression analysis was used to determine the association between inadequate prenatal care and adverse pregnancy outcomes. Stratified analysis was then used to determine whether the association between inadequate prenatal care and LBW or SGA differed by gestational age. RESULTS: Rates of inadequate/no prenatal care ranged from 8.3% using APNCU to 8.9% using R-GINDEX. The association between inadequate prenatal care and preterm birth and LBW varied depending on the index used, with adjusted odds ratios (AOR) ranging from 1.0 to 1.3. In contrast, both indices revealed the same strength of association of inadequate prenatal care with SGA (AOR 1.4). Both indices demonstrated heterogeneity (non-uniformity) across gestational age strata, indicating the presence of effect modification by gestational age. CONCLUSION: Selection of a prenatal care utilization index requires careful consideration of its methodological underpinnings and limitations. The two indices compared in this study revealed different patterns of utilization of prenatal care, and should not be used interchangeably. Use of these indices to study the association between utilization of prenatal care and pregnancy outcomes affected by the duration of pregnancy should be approached cautiously.

Prognostic models and risk scores: can we accurately predict postoperative nausea and vomiting in children after craniotomy?

Postoperative nausea and vomiting (PONV) is a problem for many children after craniotomy. Prognostic models and risk scores help identify who is at risk for an adverse event such as PONV to help guide clinical care. The purpose of this article is to assess whether an existing prognostic model or risk score can predict PONV in children after craniotomy. The concepts of transportability, calibration, and discrimination are presented to identify what is required to have a valid tool for clinical use. Although previous work may inform clinical practice and guide future research, existing prognostic models and risk scores do not appear to be options for predicting PONV in children undergoing craniotomy. However, until risk factors are further delineated, followed by the development and validation of prognostic models and risk scores that include children after craniotomy, clinical judgment in the context of current research may serve as a guide for clinical care in this population.

The efficacy of 5-HT3 receptor antagonists for the prevention of postoperative nausea and vomiting after craniotomy: a meta-analysis.

The purpose of this meta-analysis was to assess the efficacy of prophylactic administration of 5-HT3 receptor antagonists for postoperative nausea and vomiting in neurosurgical patients at 24 and 48+ hours. After a systematic search, 7 published randomized placebo controlled trials involving 448 craniotomy patients (222 treatment, 226 control) were included in the meta-analysis. Study drugs included ondansetron, granisetron, and tropisetron. The cumulative incidence of emesis was significantly reduced in the treatment group at 24 hours [relative risk (RR)=0.50, 95% confidence interval (CI): 0.38-0.66] and 48+ hours (RR=0.52, 95% CI: 0.36-0.75). There were no differences between the treatment and control groups in the cumulative incidence of nausea at 24 hours (RR=0.76, 95% CI: 0.54-1.06) and 48+ hours (RR=0.81, 95% CI: 0.62-1.06). The cumulative incidence of both nausea and vomiting continued to increase after 24 hours in both groups. Despite the ability of 5-HT3 receptor antagonists to reduce emetic episodes, future investigations should seek to address the control of postoperative nausea and to reduce further postoperative emesis in this population.

Social inequalities in use of prenatal care in Manitoba.

OBJECTIVE: Analysis of regional variations in use of prenatal care to identify individual-level and neighbourhood-level determinants of inadequate prenatal care among women giving birth in the province of Manitoba. METHODS: Data were obtained from Manitoba Health administrative databases and the 1996 Canadian Census. An index of prenatal care use was calculated for each singleton live birth from 1991 to 2000 (N = 149,291). Births were geocoded into 498 geographic districts, and a spatial analysis was conducted, consisting of data visualization, spatial clustering, and data modelling using Poisson regression. RESULTS: We found wide variation in rates of inadequate prenatal care across geographic areas, ranging from 1.1% to 21.5%. Higher rates of inadequate care were found in the inner-city of Winnipeg and in northern Manitoba. After adjusting for individual characteristics, the highest rates of inadequate prenatal care were among women living in neighbourhoods with the lowest average family income, the highest proportion of the population who were unemployed, the highest rates of recent immigrants, the highest percentage of the population reporting Aboriginal status, the highest percentage of single parent families, the highest percentage of the population with fewer than nine years of education, and the highest rates of women who smoked during pregnancy. CONCLUSION: Social inequalities exist in the use of prenatal care among Manitoba women, despite there being a universally funded health care system. Regional disparities in rates of inadequate prenatal care emphasize the need for further research to determine specific risk factors for inadequate prenatal care in socioeconomically disadvantaged neighbourhoods, followed by provision of effective targeted services.

Do maternal characteristics and past pregnancy experiences predict preterm delivery among women aged 20 to 34?

OBJECTIVE: To identify key demographic, lifestyle, and medical indicators for preterm births in women aged 20 to 34. METHODS: A population-based, case-control study consisting of 987 women aged 20 to 34, who delivered a liveborn singleton infant at <37 weeks' gestation in Alberta between May 1999 and August 2000. Controls delivered liveborn infant(s) at > or =37 weeks' gestation. Information was obtained from computer-assisted telephone interviews, and the provincial Physician Notice of Stillbirth/Birth database. Analysis included bivariate and logistic regression techniques. RESULTS: Logistic regression modelling indicated that significant risk factors for preterm delivery included poor past pregnancy outcome (odds ratio [OR] 6.4), poor emotional health (OR 1.8), more than 3 years or less than 1 year between pregnancies (OR 1.4 and 1.9, respectively), polyhydramnios and oligohydramnios (OR 4.1), bleeding at greater than 20 weeks' gestation (OR 10.4), malpresentation (OR 2.9), gestational hyper- tension (OR 2.2), and gestational hypertension with proteinuria (OR 4.4). Women who had fewer than 10 prenatal visits, regardless of attending prenatal classes, were at highest risk of preterm delivery (OR 6.7). CONCLUSIONS: In this population of women aged 20 to 34 years, few prenatal visits, poor emotional health prior to pregnancy, and conditions of the current pregnancy were strongly associated with preterm singleton birth.

Where and to what extent is prevention of low birth weight possible?

Law birth weight (LBW), due to shortened gestation and/or inadequate fetal growth. is the major determinant of infant mortality and morbidity. Despite improvements in infant mortality, them has been no reduction in LBW rates. The authors examined the relationship between 33 maternal characteristics and the increased risks of preterm (PT) delivery or small-for-gestational-age (SGA) births in 76,444 Alberta women 1994-1997. PT was associated with preexisting medical conditions, obstetrical history, and pregnancy complications. Modifiable factors such as advanced maternal age contributed only 11% to the overall PT risk. SGA births were associated with several modifiable factors, including low prepregnancy weight, maternal age, smoking, drinking, and drug dependency. These contributed to 29% and 31% of PTand term SGA births. Smoking remains an important target for intervention, having contributed to 8% of PT births and about 24% of SGA births. SGA appears to be more amenable to prevention than PT delivery.

The relationship between self-reported emotional health, demographics, and perceived satisfaction with prenatal care.

Aims to describe pregnant women with poor emotional health and the relationship between self-reported emotional health and prenatal care satisfaction. To this end, 1,265 women who delivered a live-born singleton infant were interviewed and information abstracted from prenatal records. Concludes that patient assessment of satisfaction with prenatal care may be related to both self-reported emotional health and delivery of medical care. Identifying and addressing emotional health of prenatal patients may improve compliance with medical recommendations, ultimately improving health outcomes.

Trends in health and healthcare utilization in Manitoba.

Trends in health status and healthcare utilization were examined for regions of Manitoba from 1985 to 2000. While the provincial premature mortality rate decreased, the difference between the northern and southern regions increased. Hospital admissions remained stable despite major bed closures and an aging population; a decrease in hospital days per capita was observed in all regions. Physician contact rates also remained constant despite a 40% increase in the number of seniors.

Dementia diagnosis and osteoporosis treatment propensity: a population-based nested case-control study.

AIM: Increasing age and a diagnosis of dementia both dramatically increase the risk of serious osteoporosis-related sequela. We sought to examine the factors associated with osteoporosis treatment, in relation to dementia diagnosis, in older adults with osteoporosis. METHODS: This was a population-based, retrospective, nested, case-control study utilizing administrative healthcare data from British Columbia, Canada. Community-based individuals aged ≥65 years with an osteoporosis diagnosis and continuous enrolment in the provinces' drug plan between 1991 and 2007 were eligible for inclusion. A multivariate logistic regression model was assembled to examine the relationship between dementia diagnosis, age, sex, other comorbidity, residence and osteoporosis medication dispensation. RESULTS: Almost half of the total osteoporosis cohort (n = 39 452) were dispensed an osteoporosis medication during the study period. Individuals with no dementia diagnosis were dispensed a medication significantly more often than those with a diagnosis of dementia (P < 0.001). Those patients with dementia (n = 13 315), who had been dispensed an osteoporosis drug, were more often younger, female, had not sustained a previous fracture, had ≥ 4 comorbid conditions and lived in the most central health region (P < 0.001). A diagnosis of dementia was found to be a significant negative predictor of osteoporosis drug dispensation (adjusted OR 0.55; 95% CI 0.44-0.69). Increasing comorbidity was significantly associated with receiving treatment (adjusted OR 3.30; 95% CI 2.88-3.78). CONCLUSION: Despite the wide availability of osteoporosis medications, our findings suggest that many older adults with a diagnosis of dementia, but not necessarily fewer comorbid conditions, were not receiving treatment.

A systematic review of the psychometric properties of self-report research utilization measures used in healthcare.

BACKGROUND: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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 efficacy of 5-HT3 receptor antagonists for the prevention of postoperative vomiting following craniotomy: two studies in children and young adults.

The purpose of this meta-analysis was to estimate the efficacy of prophylactic administration of 5-HT3 receptor antagonists for postoperative vomiting (POV) in pediatric craniotomy patients at 24 hours. By updating a previously published systematic literature search, we found a recently published pediatric study to combine with the one already identified. The two published randomized placebo-controlled trials were combined for a total of 135 participants aged 2 to 20 (79 treatment and 56 controls). The only study drug was ondansetron. The combined relative risk (RR) of vomiting was not statistically significant in the treatment group compared to the control group (RR = 0.77; 95% CI: 0.50-1.19). There was also no evidence of efficacy for ondansetron in reducing the use of rescue antiemetics in the treatment group compared to the control group (RR = .71; 95% CI: 0.34-1.49). While combining these randomized placebo-controlled trials did not show efficacy for ondansetron in preventing POV in craniotomy patients aged 2 to 20, a clinically significant effect cannot be excluded, as even the combined sample size remained small. Thus, there is no current evidence for or against this class of drugs for preventing POV in children after craniotomy, and clinical decision-making must be based on studies in other populations and clinical experience. Ongoing assessment of nausea and vomiting and ongoing evaluation of the effectiveness of treatments in individual children and young adults remains an essential part of perianesthesia and postoperative neuroscience nursing.