A combined program of education plus exercise versus general advice for ankle osteoarthritis: A feasibility randomised controlled trial.

BACKGROUND: Unlike hip and knee OA, there is little evidence to guide the management of ankle osteoarthritis (OA) and there are no clinical guidelines for ankle OA. Regardless of the body region, guidelines for treating OA typically include education, weight loss and exercise as the key components of management. Such an intervention has not been investigated in people with ankle OA. OBJECTIVES: To determine the feasibility of conducting a randomised controlled trial (RCT) that compares physiotherapist-delivered education plus exercise to physiotherapist-delivered general advice for people with ankle OA. Secondarily, to inform planning for future RCTs. DESIGN: A randomised parallel-group feasibility trial. METHOD: Study participants were recruited, assessed for eligibility, and randomised using 1:1 concealed allocation to receive either physiotherapist-delivered education plus exercise, or physiotherapist-delivered general advice. Primary feasibility outcomes were evaluated based on predetermined feasibility criteria. Secondary participant-reported and physical outcomes were collected to inform the design of future RCTs. RESULTS: Thirty participants (67% (n = 20) women, mean (standard deviation) age: 66.1 (11.5) years) were randomised. Data for key feasibility outcomes met a priori feasibility criteria: consent rate (97%), participant adherence with their allocated intervention arm (71%), fidelity of the intervention (94%) and rate of completion of outcome measures at 3 months (87%). CONCLUSIONS: This study demonstrates that it is feasible to run an adequately powered RCT comparing physiotherapist-delivered education plus exercise versus physiotherapist-delivered general advice for people with ankle OA. Study data will inform the planning of a full-scale RCT.

The neuropsychiatric and neuropsychological features of chronic fatigue syndrome: revisiting the enigma.

The aim of this article is to provide a comprehensive and updated review of the key neuropsychiatric and neuropsychological complaints associated with chronic fatigue syndrome (CFS). Neuropsychiatric and neuropsychological difficulties are common in CFS and are linked primarily to disorders of mood, affect and behaviour. The neuropsychiatric complaint most frequently encountered amongst CFS patients is depression and in particular major depressive disorder (MDD). Despite decades of research, the precise aetiological relationship between CFS and MDD remains poorly understood. This has resulted in the development of a number of interesting and polarised hypotheses regarding the aetiological nature of CFS. Recent scientific advances have however begun to unravel a number of interesting inflammatory and immunological explanations that suggest CFS and MDD are distinct yet interrelated conditions. The possibility that the overlap between CFS and MDD might be explained in terms of shared oxidative and nitrosative (IO&NS) pathways is an area of intense research interest and is reviewed in detail in this article. The overlap between CFS and MDD is further differentiated by variations in HPA axis activity between the two disorders. Important immunological differences between MDD and CFS are also reviewed with particular emphasis on antiviral RNase L pathways in CFS. In addition to the presence of neuropsychiatric complaints, CFS is also associated with neuropsychological symptoms such as impaired attention, memory and reaction time. The key neuropsychological problems reported by CFS patients are also included in the review in an effort to understand the significance of cognitive impairment in CFS.

Family health nursing: a response to the global health challenges.

The European Family Health Nursing Project is a revitalized World Health Organization initiative led by the University of the West of Scotland. Partner countries include Armenia, Austria, Germany, Italy, Poland, Portugal, Romania, Slovenia, and Spain. European Union Lifelong Learning funding was received in 2011 to facilitate a consistency of approach in the development of a definition of family health nursing, required core competencies and capabilities, and consequent education and training requirements. Global health challenges have informed the development of the project: increasingly aging populations, the increasing incidence in noncommunicable diseases that are currently the main cause of death, and the significant progress made in the way health systems have developed to meet the demands in relation to access and equality of health services. Governments and policy makers should develop a health workforce based on the principles of teamwork and interdisciplinarity while recognizing the core contribution of the "specialist generalist" role in the primary care setting.

Assessment and treatment of patients with anxiety.

This article aims to assist nurses in the identification, assessment and treatment of patients experiencing anxiety. The focus is on generalised anxiety disorder and its effect on the individual and society. Guidance from the National Institute for Health and Clinical Excellence is used to inform management strategies. Nurses have a pivotal role to play in the assessment and treatment of anxiety and need to work closely with patients to ensure they receive appropriate support and referral if necessary.

Learning styles and academic outcome: the validity and utility of Vermunt's Inventory of Learning Styles in a British higher education setting.

BACKGROUND: Vermunt's (1994) Inventory of Learning Styles (ILS) integrates four components of learning: processing strategies, regulation strategies, mental models of learning and learning orientations. Using explanatory factor analysis, Vermunt (1998) identified four different learning styles, meaning-directed, reproduction-directed, application-directed and undirected, which displayed characteristic patterns of factor loadings across the four components of learning. AIMS: The aims of the current study were to test the generalisability of Vermunt's integrated model of learning with a sample of students from a British university and to establish whether different learning styles were associated with different academic outcomes. SAMPLE: A total of 273 students from a British university took part. METHODS: Confirmatory factor analysis was used to test Vermunt's four-factor model of learning styles and compare it with alternative models. Interrelationships between components of the ILS were examined in more detail using regression analyses. The relationship between learning style and academic outcome was also examined. RESULTS: Fit indices indicated that Vermunt's four-factor model of learning styles provided the best fit for the current sample. Path estimates associated with meaning-directed and reproduction-directed learning styles loaded across components as described by Vermunt but application-directed and undirected learning styles loaded mainly on conceptions and orientations components. Undirected learning style had a low negative association with academic performance, while the meaning-directed learning style had a low positive association with academic performance. CONCLUSIONS: Although the ILS did identify Vermunt's four learning styles, different learning environments influence the precise characteristics of each learning style.

Review of the integrity of a Self Administered Motivational Instrument.

BACKGROUND: Motivational interviewing (MI) was developed by Miller and Rollnick as an evidence-based counselling approach for use in supporting people with alcohol problems. Over the years the principles and spirit of MI have been reviewed and fine-tuned and the approach has been embraced by practitioners worldwide and across fields. Since 2001 a number of instruments have been designed to evaluate the fidelity of MI practice. For the purposes of this study, one such instrument is used to assess a self-administered motivational instrument, known as the SAMI, which takes the interviewer role. OBJECTIVES: The SAMI is evaluated against the MITI 3.1.1, which is designed to assess the extent to which MI interventions perform on five global dimensions. These are evocation, collaboration, autonomy/support, direction and empathy. DESIGN: The SAMI was assembled based on the principles and spirit of MI, problem solving and goal-setting. The targeted behaviour changes were student learning styles and approaches to study. SETTING: The SAMI was distributed, completed and submitted electronically via the university virtual learning environment. PARTICIPANTS: Thirty three mature students of a university which delivered online nursing programme were invited to complete the SAMI. Of these, 25 submitted completed transcripts. METHODS: Transcripts of a sample of six completed SAMIs were assessed by a group of teachers and researchers with experience in the use and evaluation of MI, using five-point Likert scales to assess the SAMI on the five dimensions. RESULTS: Overall, an average score exceeding 4.5 was attained across the five dimensions. Conventionally, such a score is recognised as competency in MI. However, on one dimension (empathy), the rating was three. CONCLUSIONS: This current research confirms that global principles have been observed in the online delivery of MI using the SAMI to probe approaches to study.

A review of the definitional criteria for chronic fatigue syndrome.

RATIONALE, AIMS AND OBJECTIVES: The research community has for more than three decades tried to unravel the diagnostic mystery that is Chronic Fatigue Syndrome (CFS). This has resulted in considerable amounts of time and money being invested in attempts aimed at establishing the aetiology and pathogenesis of CFS. All of this investment has produced evidence of an interesting variety of endocrine, immune, infectious, muscular and neurological abnormalities in CFS; however, the cause remains elusive. The absence of a known causative agent or diagnostic test for CFS has resulted in the development of a number of CFS case definitions. As such, the main objectives of this paper are to provide a critical review of the similarities and differences between the varying approaches to CFS case definition. The conflicts and controversies that have emerged as a result of the differing definitional criterion for CFS are highlighted and the potential impact on future research is identified. METHODS, RESULTS AND CONCLUSIONS: This paper presents a critical review of the most frequently used case definitions in CFS. There are currently five case definitions of CFS; however, the most prominent and widely used of these definitions is the 1994 Centre for Disease Control and Prevention Case Definitions. However, the pre-eminence of this definition over the others has never been substantiated and it has been widely criticized for its lack of specificity. Furthermore, none of the above case definitions have produced evidence to demonstrate their accuracy or precision at defining cases of CFS. A summary description of the symptom profile included in each of the case definitions is provided. The inconsistencies that have emerged in CFS research as a consequence of differing approaches to case definition are also highlighted and discussed.

Subjective effects of prisoners using buprenorphine for detoxification.

PURPOSE: Buprenorphine (Subutex) was piloted in two Scottish prisons between 2004 and 2006 and consequently used within other penal establishments in Scotland. This 2007 qualitative study aimed to explore the use of Subutex and its associated effects on 14 participants on detoxification programmes. DESIGN/METHODOLOGY/APPROACH: All participants were male, aged from 21 to 44 years with prison sentences ranging from a few months to life imprisonment. Buprenorphine was unavailable to female prisoners at the time of this study. Participants were recruited from seven Scottish prisons. All 14 participants were on detoxification programmes, each was prescribed Subutex, and each was selected from a larger investigation that included both those undergoing detoxification and maintenance (n=21). All participants had previously also used methadone on previous detoxification programmes. FINDINGS: It can be concluded that the majority of detoxification participants within this study indicated that Subutex was a more effective treatment than methadone as it helped reduce craving, eased the process of withdrawal and improved sleeping patterns. In addition, the majority of participants noted higher levels of motivation and the ability to set goals towards obtaining an improved quality of life. ORIGINALITY/VALUE: This study provides an alternative perspective to the use of Subutex within prison settings, when compared with results from previous quantitative studies reported. The study also highlights inconsistencies drawn from studies in this area, which may be an artefact of study design. It is recommended that further qualitative studies be conducted to explore further this alternative perspective. Finally, the issue of methodological approach taken should be addressed within the context of a related, but independent, research forum.

Understanding and assessing the impact of end-stage renal disease on quality of life: a systematic review of the content validity of self-administered instruments used to assess health-related quality of life in end-stage renal disease.

Advances in healthcare, combined with an increasing number of adults with end-stage renal disease (ESRD), mean that there is a growing number of people now surviving on renal replacement therapy. The issue of health-related quality of life (HR-QOL) is becoming increasingly important in this area. For this reason, the content validity of various instruments used to measure HR-QOL in an ESRD population were explored. Systematic searches of MEDLINE (1950-2009) were conducted using terms related to ESRD combined with terms associated with measuring HR-QOL. A total of 378 abstracts were identified, detailing the repeated use of six generic measures and four disease-specific measures. The generic HR-QOL measures discussed include the Medical Outcomes 36-Item Short Form Survey (SF-36), the EuroQOL 5 Dimension (EQ-5D), and the WHO QOL assessment (WHOQOL-BREF). The most frequently used disease-specific measure discussed is the Kidney Disease QOL instrument (KDQOL) and its derivative versions (KDQOL-SF, KDQOL-36). The appropriateness of using the SF-36 in this population is challenged and recommendations include using the WHOQOL-BREF in cases when a generic instrument is required and the KDQOL-SF when a more disease-specific measurement is called for.

Absolute calibration method for laser megajoule neutron yield measurement by activation diagnostics.

The laser megajoule (LMJ) and the National Ignition Facility (NIF) plan to demonstrate thermonuclear ignition using inertial confinement fusion (ICF). The neutron yield is one of the most important parameters to characterize ICF experiment performance. For decades, the activation diagnostic was chosen as a reference at ICF facilities and is now planned to be the first nuclear diagnostic on LMJ, measuring both 2.45 MeV and 14.1 MeV neutron yields. Challenges for the activation diagnostic development are absolute calibration, accuracy, range requirement, and harsh environment. At this time, copper and zirconium material are identified for 14.1 MeV neutron yield measurement and indium material for 2.45 MeV neutrons. A series of calibrations were performed at Commissariat à l'Energie Atomique (CEA) on a Van de Graff facility to determine activation diagnostics efficiencies and to compare them with results from calculations. The CEA copper activation diagnostic was tested on the OMEGA facility during DT implosion. Experiments showed that CEA and Laboratory for Laser Energetics (LLE) diagnostics agree to better than 1% on the neutron yield measurement, with an independent calibration for each system. Also, experimental sensitivities are in good agreement with simulations and allow us to scale activation diagnostics for the LMJ measurement range.