Modification, Translation, and Psychometric Testing of the Arabic Version of the Belongingness Scale-Clinical Placement Experience.

BACKGROUND: This paper aimed to describe the modification, translation, and psychometric testing of the Arabic version of the Belongingness Scale-Clinical Placement Experience (BES-CPE). METHODS: This study included the following phases: modification of the original BES-CPE based on the qualitative findings from a previous study; translation and back-translation of the scale; evaluation of the content validity by experts from Saudi Arabia; evaluation of the internal consistency reliability; and other psychometric properties of the Arabic BES-CPE. RESULT: The results demonstrated acceptable psychometric properties. The Cronbach' s alpha ranged from 0.68 to 0.92. CONCLUSION: The Arabic BES-CPE is a promising tool that can be used to assess Saudi nursing students' sense of belonging. However, testing the tool with other undergraduate nursing students in a different context is recommended.

A Pilot Trial Using Telemedicine in Radiation Oncology: The Future of Health Care Is Virtual.

Background: Social determinants of health directly affect cancer survival. Driven by advances in technology and recent demands due to COVID-19, telemedicine has the ability to improve patient access to care, lower health care costs, and increase workflow efficiency. The role of telemedicine in radiation oncology is not established. Materials and Methods: We conducted an IRB-approved pilot trial using a telehealth platform for the first post-radiation visit in patients with any cancer diagnosis. The primary endpoint was feasibility of using telehealth defined by completion of five telehealth visits per month in a single department. Secondary endpoints included the ability to assess patients appropriately, patient and physician satisfaction. Physicians were surveyed again during the pandemic to determine whether viewpoints changed. Results: Between May 27, 2016 and August 1, 2018, 37 patients were enrolled in the Telehealth in Post-operative Radiation Therapy (TelePORT) trial, with 24 evaluable patients who completed their scheduled telehealth visit. On average, 1.4 patients were accrued per month. All patients were satisfied with their care, had enough time with their physician and 85.7% believed the telehealth communication was excellent. All physicians were able to accurately assess the patient's symptoms via telehealth, whereas 82.3% felt they could accurately assess treatment-related toxicity. Physicians assessing skin toxicity from breast radiation were those who did not feel they were able to assess toxicity. Discussion and Conclusions: Both health care providers and patients have identified telemedicine as a suitable platform for radiation oncology visits. Although there are limitations, telemedicine has significant potential for increasing access of cancer care delivery in radiation oncology.

Teaching evidence-based nursing practice: A systematic review and convergent qualitative synthesis.

BACKGROUND: The benefits that ensue evidence-based nursing practice (EBNP) in health care settings have been globally communicated to the nurses. However, the current clinical activities surrounding EBNP demand the involvement of nursing schools to accelerate this practice. OBJECTIVES: The purpose of this study was to synthesize, describe, and explore the evidence available to teach EBNP to undergraduate student nurses, so the students can continue to integrate EBNP in clinical settings upon becoming professional nurses. DESIGN: Systematic review with convergent qualitative synthesis. DATA SOURCES: Five electronic databases were searched; CINAHL, MEDLINE, EMBASE, ERIC, and Web of Science Core Collection. REVIEW METHODS: This study followed the guidelines for writing systematic reviews by the Joanna Briggs Institute. RESULTS: Two themes were generated; educational strategies, and EBNP knowledge and implementation. The latter theme had six sub-themes of timing, duration, content, delivery method, context, and prerequisites while the former theme had four sub-themes of knowledge acquisition, EBNP use and research utilization, collaborative teaching, and barriers and facilitators. CONCLUSION: Well-designed educational strategies have a positive impact on students' EBNP knowledge and skills. These strategies are well suited for promoting EBNP implementation in clinical settings when students qualify as nurses.

Seeking Divine Intervention to Manage the Advanced Stages of Breast Cancer in Southwestern Nigeria.

BACKGROUND: The World Health Organization records indicate that breast cancer is the most common cancer in women both in developed and developing regions of the world. In developed countries, breast cancer is the second cause of cancer-related deaths, whereas in developing countries, breast cancer is the leading cause of cancer-related mortality in women. The empirical literature on Nigeria indicates that women present with advanced stages of the illness. OBJECTIVES: To explore the health-seeking behaviors of Southwestern Nigerian women with advanced breast cancer from the time they noticed a breast abnormality to their eventual presentation at the hospital for the management of the illness. METHODS: Thirty women with advanced stages of breast cancer in a large tertiary, referral, teaching, and university-affiliated Southwestern Nigeria Hospital were purposively selected for study participation. Participants completed a demographic information form and an in-depth face-to-face, one-on-one, semistructured interview guided by open-ended questions. Data analysis was inductive. RESULTS: Findings revealed that women sought divine interventions for the management of breast cancer. Prayer and spirituality were associated with high levels of optimism among the study participants. CONCLUSION: Nurses should provide information and counseling to women and the general public on the etiology and appropriate management of breast abnormalities and include the importance of a spiritual dimension of care. IMPLICATIONS FOR PRACTICE: Findings indicate the need to introduce a spiritual dimension to the care of women with advanced breast cancer. Findings also indicate the need for a comprehensive population-based breast health education.

Teaching evidence-based nursing practice to student nurses in developing countries: strategies for novice nurse educators.

Introduction Globally, Evidence based nursing practice (EBNP) is becoming an expected norm for nursing practice. The small-scale activities surrounding this practice in African countries indicate a need for better approaches to enhance EBNP. One of these approaches is strengthening nursing education through EBNP education. Objectives The purpose of this paper is to provide strategies to African novice nurse educators to teach EBNP, with the ultimate goal of promoting it in clinical settings when the student nurses enter professional practice. Methods This is a discussion paper based on the results of a systematic review. Results In this paper, the authors create an understanding of EBNP, describe the state of nursing education in Africa, and propose the EBNP content to be taught as well as how to teach it. Conclusions Emphasis is on educational strategies that create student engagement, promote critical thinking, unite clinical and classroom settings, and are cost-effective within the context of Africa.

Long-term Cross-reactivity Against Nonvaccine Human Papillomavirus Types 31 and 45 After 2- or 3-Dose Schedules of the AS04-Adjuvanted Human HPV-16/18 Vaccine.

This analysis focused on long-term cross-reactive immunogenicity against nonvaccine human papillomavirus (HPV) types 31 and 45 following 2 doses of AS04-adjuvanted HPV-16/18 vaccine in girls aged 9-14 years or following 3 doses in women aged 15-25 years, for up to 3 years (HPV-070 study) and up to 5 years (HPV-048 study) after the first vaccination. Both schedules elicited antibodies against HPV-31 and HPV-45 up to 5 years after first dose. The antibody concentration was similar in young girls as compared to women. Specific CD4+ T-cell and B-cell responses to HPV-31 and HPV-45 at month 36 were similar across groups. Clinical trials registration: NCT01381575 and NCT00541970.

Saudi female nursing students experiences of sense of belonging in the clinical settings: A qualitative study.

Many studies have reported that nursing students' sense of belonging during their clinical experiences is essential to their motivation to learn. This study was conducted to learn more about the meaning of sense of belonging, the consequences of sense of belonging, and the factors that affect Saudi female nursing students' sense of belonging in clinical settings. Using interpretive description methodology, the data were collected via semi-structured interviews with 16 students about their sense of belonging in clinical settings. It was conducted in three baccalaureate nursing programs in government institutions in Saudi Arabia. Each interview was audiotaped, transcribed verbatim in Arabic, and translated into English, and the data were analyzed using thematic analysis. The results indicated that participation in patient care, a welcoming environment, English language skills, the nationality of nursing staff, and acceptance by nursing staff, patients, and other health care professionals are some of the factors that affect Saudi female nursing students' sense of belonging in clinical settings. The findings may contribute to the creation and support of more effective clinical learning situations for nursing students in Saudi Arabia, improving the quality of their educational experiences and retaining them in the nursing profession.

Patients Undergoing Radiation Therapy Are at Risk of Financial Toxicity: A Patient-based Prospective Survey Study.

PURPOSE: Little is known about the financial burden experienced by patients receiving radiation therapy. Furthermore, currently, no financial toxicity screening tools have been validated for use in radiation oncology. METHODS AND MATERIALS: Physician surveys were used to gauge provider understanding of treatment costs and their willingness to adopt the use of financial toxicity screening tools. Post-treatment patient surveys were used to investigate the covariates of treatment-induced financial risk. RESULTS: Of the 210 radiation oncologists who completed our survey, 53% reported being "very concerned" with treatment-related costs negatively affecting their patients, and 80% believed that a financial toxicity screening tool would be useful in practice. An analysis of patient surveys using logistic regression found age and cancer site to be the most important variables associated with financial toxicity. Thirty-four patients (22%) experienced financial toxicity related to treatment. The financial toxicities experienced were loss of job (28%), loss of income (24%), difficulty paying their rent or mortgage (20%), difficulty paying for transportation (15%), and difficulty paying for meals (13%). CONCLUSIONS: Financial toxicity is an important measure for patients and providers and is experienced by approximately one quarter of patients. Further studies to improve models to predict financial toxicity and how financial toxicity is related to patient outcomes and quality of life are warranted.

Forward view: advancing health library and knowledge services in England.

This article is the fourth in a series on New Directions. The National Health Service is under pressure, challenged to meet the needs of an ageing population, whilst striving to improve standards and ensure decision making is underpinned by evidence. Health Education England is steering a new course for NHS library and knowledge services in England to ensure access to knowledge and evidence for all decision makers. Knowledge for Healthcare calls for service transformation, role redesign, greater coordination and collaboration. To meet user expectations, health libraries must achieve sustainable, affordable access to digital content. Traditional tasks will progressively become mechanised. Alongside supporting learners, NHS librarians and knowledge specialists will take a greater role as knowledge brokers, delivering business critical services. They will support the NHS workforce to signpost patients and the public to high-quality information. There is a need for greater efficiency and effectiveness through greater co-operation and service mergers. Evaluation of service quality will focus more on outcomes, less on counting. These changes require an agile workforce, fit for the future. There is a bright future in which librarians' expertise is used to mobilise evidence, manage and share knowledge, support patients, carers and families, optimise technology and social media and provide a keystone for improved patient care and safety.

Sustained immunogenicity of the HPV-16/18 AS04-adjuvanted vaccine administered as a two-dose schedule in adolescent girls: Five-year clinical data and modeling predictions from a randomized study.

In this randomized, partially-blind study ( clinicaltrials.gov ; NCT00541970), the licensed formulation of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine (20 µg each of HPV-16/18 antigens) was found highly immunogenic up to 4 y after first vaccination, whether administered as a 2-dose (2D) schedule in girls 9-14 y or 3-dose (3D) schedule in women 15-25 y. This end-of-study analysis extends immunogenicity and safety data until Month (M) 60, and presents antibody persistence predictions estimated by piecewise and modified power law models. Healthy females (age stratified: 9-14, 15-19, 20-25 y) were randomized to receive 2D at M0,6 (N = 240 ) or 3D at M0,1,6 (N = 239). Here, results are reported for girls 9-14 y (2D) and women 15-25 y (3D). Seropositivity rates, geometric mean titers (by enzyme-linked immunosorbent assay) and geometric mean titer ratios (GMRs; 3D/2D; post-hoc exploratory analysis) were calculated. All subjects seronegative pre-vaccination in the according-to-protocol immunogenicity cohort were seropositive for anti-HPV-16 and -18 at M60. Antibody responses elicited by the 2D and 3D schedules were comparable at M60, with GMRs close to 1 (anti-HPV-16: 1.13 [95% confidence interval: 0.82-1.54]; anti-HPV-18: 1.06 [0.74-1.51]). Statistical modeling predicted that in 95% of subjects, antibodies induced by 2D and 3D schedules could persist above natural infection levels for ≥ 21 y post-vaccination. The vaccine had a clinically acceptable safety profile in both groups. In conclusion, a 2D M0,6 schedule of the HPV-16/18 AS04-adjuvanted vaccine was immunogenic for up to 5 y in 9-14 y-old girls. Statistical modeling predicted that 2D-induced antibodies could persist for longer than 20 y.

Studying abroad: Exploring factors influencing nursing students' decisions to apply for clinical placements in international settings.

BACKGROUND: For over 15 years the College of Nursing at the University of Saskatchewan has facilitated study abroad clinical placements in a number of countries to enhance student learning. Nursing students often find their study abroad experience to be a defining moment in their educational program, and in their personal and professional growth. OBJECTIVES: The main objective of this research was to explore factors influencing nursing students' decisions to study abroad. DESIGN: A descriptive longitudinal design study was conducted using an online survey. SETTINGS: The Study Abroad Survey was distributed to all undergraduate and graduate nursing students, in all years of all programs, at all sites of the College of Nursing, University of Saskatchewan in Saskatchewan, Canada. PARTICIPANTS: A total of 1058 nursing students registered in the 2013-2014 academic year were surveyed. METHODS: The data were collected using an online survey administered by Campus Labs™ (2014). RESULTS: Students indicated that their interest in study abroad international experiences was high (84%), with many perceived benefits, but barriers to participation were also high for these students. Financial barriers topped the list (71%), followed by family responsibilities (30%) and job obligations (23%). CONCLUSION: The research highlights the factors behind student decision making related to international placements, and provides the basis for improvements to the College of Nursing's International Study Abroad Program (ISAP). Previous travel and international service learning, resulting in increased perceived value of a study abroad experience may prove to be the more significant factor influencing decision making, rather than financial barrier.

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.

Communities of practice in nursing academia: a growing need to practice what we teach.

Although the community of practice (CoP) concept has been heavily utilized in business literature since its inception in the 1990s, it has not been significantly featured in nursing research. With student-centered approaches increasingly infusing nursing classrooms, including opportunities for collaborative learning and the development of student learning communities, it may be time to ask: Do we practice what we teach? Nursing academia faces challenges related to recruitment and retention, scholarly productivity and engagement of new faculty, and increasing demands for collaborative research. Challenges, some would argue, that could be addressed through CoPs; a sentiment reflected in the recent expansion of nursing CoP literature. What is the current state of the application of this concept in nursing academia and what barriers present in the promotion and development of CoPs in the academy? This article addresses these questions and provides guidance for those in search of community.

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.

A student evaluation workshop with rural nursing preceptors.

Increasingly, clinicians and faculty members are motivated to provide students quality preceptorship placements in rural areas, particularly in light of the potential for recruitment of new graduates to underserved areas. Invariably, student performance evaluation is an onerous task for many preceptors and one in which they often feel ill-prepared. Rural preceptors may face additional challenges given the lesser availability of educational resources and professional development. In this article, the authors detail the development, pilot testing, and evaluation of a workshop on student evaluation that was created in collaboration with rural nurse preceptors.

Production and validation of a good manufacturing practice grade human fibroblast line for supporting human embryonic stem cell derivation and culture.

INTRODUCTION: The development of reproducible methods for deriving human embryonic stem cell (hESC) lines in compliance with good manufacturing practice (GMP) is essential for the development of hESC-based therapies. Although significant progress has been made toward the development of chemically defined conditions for the maintenance and differentiation of hESCs, efficient derivation of new hESCs requires the use of fibroblast feeder cells. However, GMP-grade feeder cell lines validated for hESC derivation are not readily available. METHODS: We derived a fibroblast cell line (NclFed1A) from human foreskin in compliance with GMP standards. Consent was obtained to use the cells for the production of hESCs and to generate induced pluripotent stem cells (iPSCs). We compared the line with a variety of other cell lines for its ability to support derivation and self-renewal of hESCs. RESULTS: NclFed1A supports efficient rates (33%) of hESC colony formation after explantation of the inner cell mass (ICM) of human blastocysts. This compared favorably with two mouse embryonic fibroblast (MEF) cell lines. NclFed1A also compared favorably with commercially available foreskin fibroblasts and MEFs in promoting proliferation and pluripotency of a number of existing and widely used hESCs. The ability of NclFed1A to maintain self-renewal remained undiminished for up to 28 population doublings from the master cell bank. CONCLUSIONS: The human fibroblast line Ncl1Fed1A, produced in compliance with GMP standards and qualified for derivation and maintenance of hESCs, is a useful resource for the advancement of progress toward hESC-based therapies in regenerative medicine.