Immune response to the HPV-16/18 AS04-adjuvanted vaccine administered as a 2-dose or 3-dose schedule up to 4 years after vaccination: results from a randomized study.

This randomized, partially-blind study (ClinicalTrials.gov registration number NCT00541970) evaluated the immunogenicity and safety of 2-dose (2D) schedules of the HPV-16/18 AS04-adjuvanted vaccine. Results to month (M) 24 have been reported previously and we now report data to M48 focusing on the licensed vaccine formulation (20 µg each of HPV-16 and -18 antigens) administered at M0,6 compared with the standard 3-dose (3D) schedule (M0,1,6). Healthy females (age stratified: 9-14, 15-19, 20-25 years) were randomized to receive 2D at M0,6 (n = 240) or 3D at M0,1,6 (n = 239). In the according-to-protocol immunogenicity cohort, all initially seronegative subjects seroconverted for HPV-16 and -18 antibodies and remained seropositive up to M48. For both HPV-16 and -18, geometric mean antibody titer (GMT) ratios (3D schedule in women aged 15-25 years divided by 2D schedule in girls aged 9-14 years) at M36 and M48 were close to 1, as they were at M7 when non-inferiority was demonstrated. The kinetics of HPV-16, -18, -31, and -45 antibody responses were similar for both groups and HPV-16 and -18 GMTs were substantially higher than natural infection titers. The vaccine had a clinically acceptable safety profile in both groups. In summary, antibody responses to a 2D M0,6 schedule of the licensed vaccine formulation in girls aged 9-14 years appeared comparable to the standard 3D schedule in women aged 15-25 years up to 4 years after first vaccination. A 2D schedule could facilitate implementation of HPV vaccination programs and improve vaccine coverage and series completion rates.

Putting the 'patient' back into patient-centred care: an education perspective.

Patient-centred care is a value espoused by most healthcare systems and a concept taught in nursing education programs as a fundamental concept of patient care. In this study, we focused on the patient's experience of patient-centredness, interviewing eighteen patients and eight family members about their experiences as patients on an in-patient acute care medical unit in a large hospital in Canada. Approximately half of the patients expressed satisfaction with their experiences and their involvement in decisions about their healthcare. The remainder expressed concerns about their care that jeopardized their experiences of patient-centredness. These areas concerned issues of communication with and among healthcare professionals, relationships with these care providers, trust and respect in the professional relationships, and general satisfaction with care. Participants provided advice to professional students about ways to interact more effectively with their patients to establish caring, empathetic, patient-centred relationships as the basis for care. We address patient recommendations to support learner understanding of the patient experience both in classrooms and clinical experiences throughout educational programs as a means to enhance their patient-centredness.

Nursing preceptorship experiences in rural settings: "I would work here for free".

AIMS: The primary aim was to capture the experience of preceptorship in a rural setting, via photographic narrative. It is hoped that this narrative will highlight areas that require greater support; communicate the experience of rural preceptorship for students, educators and policymakers; and emphasize the benefits of this experience for these current and future stakeholders. METHODS: In a photovoice study, preceptors (n = 4) and students (n = 4) in rural, Western Canadian health care settings were given digital cameras and asked to provide images and commentary about the experience of preceptorship. Participants selected the photographs to be included as data, and participated in thematic data analysis, through facilitated group discussions during and following the preceptorships. FINDINGS: This article explores the category of teaching and learning, encompassing three themes: confidence, conscientiousness, and mutual growth. Preceptors emphasized the importance of students bringing sufficient knowledge to the rural preceptorship, pertaining not only to the nature of care but also to the predominant health care issues in the community. IMPLICATIONS: The implications were generated in part by the participants, who indicated a need for more student practica in rural settings; curricular changes to incorporate knowledge about rural health care and communities; post-graduation rural mentorship programs; and site/community-specific preparation.

Immunogenicity and safety of the HPV-16/18 AS04-adjuvanted vaccine administered as a 2-dose schedule compared with the licensed 3-dose schedule: results from a randomized study.

The immunogenicity of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine (Cervarix®, GlaxoSmithKline Biologicals) administered according to its licensed vaccination schedule (3-dose, 3D) and formulation (20 µg of each HPV antigen; 20/20F) has previously been demonstrated. This partially-blind, controlled, randomized trial (NCT00541970) evaluated 2-dose (2D) schedules using the licensed 20/20F or an alternative formulation containing 40 µg of each antigen (40/40F), compared with the licensed 3D schedule. Healthy females stratified by age (9-14, 15-19, 20-25 y) were randomized to receive 2 doses of 20/20F at Months (M) 0,6 (n=240), 40/40F at M0,6 (n=241) or 40/40F at M0,2 (n=240), or 3 doses of 20/20F at M0,1,6 (licensed schedule/formulation, n=239). One month after the last dose, the 3D schedule was not immunologically superior to 2D schedules except in the 40/40F M0,2 group for HPV-16 (lower limit of 95% CI geometric mean antibody titer (GMT) ratio [2D/3D] < 0.5). For both HPV-16 and HPV-18, the 2D schedules in girls 9-14 y were immunologically non-inferior to the 3D schedule in women 15-25 y (the age group in which efficacy has been demonstrated) (upper limit of 95% CI for GMT ratio [3D/2D] < 2) one month after the last dose. At Month 24, non-inferiority was maintained for the 2D M0,6 schedules in girls 9-14 y versus the 3D schedule in women 15-25 y. All formulations had acceptable reactogenicity and safety profiles. These results indicate that the HPV-16/18 vaccine on a 2D M0,6 schedule is immunogenic and generally well tolerated in girls 9-14 y and that the 2D schedule is likely adequate for younger females.

From the perspective of new nurses: what do effective mentors look like in practice?

New nurses entering practice experience a challenging transition, one that can be moderated by the presence of mentors in the practice setting. Seeking mentors who enter into informal mentoring relationships with new nurses can be difficult for those new nurses who don't know what to look for in a mentor. In this Grounded Theory study, the author explored nurses' perspectives on what makes a mentor effective, and how they engaged in mentoring relationships with their informal mentors. Two key factors in the development of these mentoring relationships was 1) the relational connection that existed between new nurses and one of their more experienced colleagues in the practice setting, and 2) the perception of new nurses of the quality of the experienced nurses' practices. New nurses entered practice expecting to learn from their more experienced colleagues but recognized that they wanted to emulate the practice of experienced nurses who practiced nursing in the way new nurses idealized. In this article, the author describes the characteristics of effective mentors, from the perspectives of nurses who had mentors, and described their processes of engaging with their mentors.

Knowledge of the professional role of others: a key interprofessional competency.

In this paper, the authors present the results of a study which delineated six key competencies of interprofessional collaborative practice for patient-centred care: communication; strength in one's professional role; knowledge of professional role of others; leadership; team function; and negotiation for conflict resolution. While all of these competencies are important and require special attention, this paper examines and discusses the competency knowledge of professional role of others and its associated behavioural indicators, especially as these relate to the interprofessional education of nursing students. The identification of these competencies and their behavioural indicators serve two purposes. It forms the basis for the preparation of students, preceptors, and faculty for interprofessional practice, and it develops a tool for assessing student performance in such practice. Consequently, we believe that the utilization of this key competency and its behavioural indicators will contribute to the development of programs that include specific knowledge and skills related to interprofessional nursing education. This will enable educators to support and evaluate students in interprofessional educational experiences more efficiently and effectively. Ultimately, as nursing students practice and become fully functioning practitioners, client care will be optimized.

Challenges for new nurses in evidence-based practice.

AIM: The purpose of this article was to examine issues that new nurses encounter as they enter nursing practice, particularly in an evidence-based practice environment. BACKGROUND: These issues are not new. In part, these issues arise from our failure to acknowledge the developmental issues that new nurses experience on entry to practice and the lack of role models in evidence-based practice and holistic care. EVALUATION: This article synthesizes research reported over the last decade to delineate the issues of transition to practice and strategies that have proven effective in addressing them. KEY ISSUES: The key issues relate to the need to support new nurses in evidence-based and holistic practice, the strategies needed to do so, and the nurse manager's role in this process. CONCLUSIONS: We must invest resources in assisting new nurses into practice, which may have benefits in terms of both recruitment and retention of new nurses in practice.

Ethically involving students in faculty research.

Students in nursing education programs have a right to privacy as they engage in their learning. At the same time, their faculty may be engaged in nursing education research in order to facilitate student learning. These two goals may conflict when faculty engage students as participants in nursing education research while at the same time facilitating their learning. Faculty as researchers with their students may encounter a conflict of interest in collecting data for their research while providing learning experiences for the same students. As a basic principle, students must be engaged as participants in an ethical manner that respects their rights for privacy. In this article, we explore the issues of faculty as researchers of their students and suggest strategies for addressing these issues.

Ethically involving students in faculty research.

Students in nursing education programs have a right to privacy as they engage in their learning. At the same time, their faculty may be engaged in nursing education research in order to facilitate student learning. These two goals may conflict when faculty engage students as participants in nursing education research while at the same time facilitating their learning. Faculty as researchers with their students may encounter a conflict of interest in collecting data for their research while providing learning experiences for the same students. As a basic principle, students must be engaged as participants in an ethical manner that respects their rights for privacy. In this article, we explore the issues of faculty as researchers of their students and suggest strategies for addressing these issues.

From practice to midrange theory and back again: Beck's theory of postpartum depression.

This article presents a brief overview of theory as background for a more detailed discussion of midrange theory-its origins, the critical role for midrange theory in the development of nursing practice knowledge, and the criteria for evaluating midrange theory. We then chronicle Cheryl Tatano Beck's program of research on postpartum depression (PPD) and advance the thesis that her theory of PPD, titled Teetering on the Edge, is an exemplar of a substantive midrange nursing theory. We demonstrate Beck's progression from identification of a clinical problem to exploratory-descriptive research, to concept analysis and midrange theory development, and finally to the application and testing of the theory in the clinical setting. Through ongoing refinement and testing of her theory, Beck has increased its generalizability across various practice settings and continually identifies new issues for investigation. Beck's program of research on PPD exemplifies using nursing outcomes to build and test nursing practice knowledge.