Relationships of apolipoprotein E genotypes with a cluster of seven in persons with type 2 diabetes.

OBJECTIVE.: The objective of the study was to determine if there would be statistically significant differences or trends among apolipoprotein E genotypes (2/2, 2/3, 2/4, 3/3, 3/4, and 4/4) for each member of the cluster of seven associated with type 2 diabetes (T2D). The cluster of seven includes abdominal obesity, hypertension, platelet hyperaggregability, hyperglycemia, dyslipidemia (decreased plasma levels of high-density lipoprotein cholesterol (HDL-C) and increased plasma levels of triglycerides)), increased low-density lipoprotein (LDL) oxidation, and increased inflammation. METHODS.: Forty-six patients with well-controlled T2D participated in the study. Abdominal obesity (assessed by waist circumference), hypertension (measured by manual sphygmomanometry), platelet hyperaggregability (measured by bleeding time), hyperglycemia (by enzymatic kit and spectrophotometry), decreased plasma levels of HDL-C and increased plasma levels of triglycerides (by enzymatic kit and spectrophotometry), increased LDL oxidation (measured by LDL conjugated dienes using spectrophotometry) and increased inflammation measured by C-reactive protein (CRP) (by EIA kit) were determined. RESULTS.: All genotypes, except 2/2 were found in the population studied. Abdominal obesity did not vary significantly across the five genotypes. However, glucose levels trended progressively higher going from 2/3 to 2/4 to 3/4 to 4/4. Systolic blood pressure was higher in 3/4 compared to 2/4 and trended higher in 3/4 compared to 3/3. Diastolic blood pressure trended higher in 3/3 vs 2/4 and significantly higher in 3/4 compared to 2/4. Triglycerides trended higher in 3/4 vs 3/3 while HDL-C came close to trending downward in 4/4 compared to 2/4. Bleeding time was unaffected by genotype. Plasma LDL conjugated dienes trended higher in 3/4 vs 2/4 and were significantly higher in 3/4 vs 3/3. CRP trended higher in 4/4 vs 2/3. CONCLUSION.: We can conclude that those with at least one 4 allele in the presence of another allele being 2, 3 or 4 is potentially (in the case of trends) deleterious or is deleterious in terms of hyperglycemia, hypertension (systolic and diastolic blood pressure), dyslipidemia, LDL conjugated dienes and CRP levels.

The impact of COVID-19 on nursing students' lives and online learning: A cross-sectional survey.

AIMS: To explore the impact of COVID-19 on students' lives and their online learning experience. DESIGN: A cross-sectional survey design was used in this study. METHODS: A total of 44 nursing students who were enrolled in an undergraduate programme at a Canadian University participated in the study. The students were asked to fill out a 35-item survey that was developed by the European Students' Union and that was circulated across Europe in April 2020. RESULTS: The COVID-19 pandemic and subsequent lockdown affected students mentally, and emotionally. Findings also revealed that whilst most students had the privilege to study from home, many students did not have a desk, or a quiet place to study in their home and some had problems with Internet connectivity. Online lectures were delivered according to students' preferences; however, students were dissatisfied with the way their practice was organized. CONCLUSION: The similarities between this study and the European study provide common grounds for academics around the world to connect, collaborate and work on the challenges in providing nurse education in emergencies such as national disasters or pandemics to ensure preparedness for such future events. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. IMPACT: The commonalities experienced in nursing education across the globe should act as an impetus for globalized nursing action. Educators need to prepare and reinvent a role for students in the clinical area in the event of future disasters/pandemics. Policy makers and administrators need to ensure when switching to online education no student is underprivileged or marginalized in the process.

Fatty acid correlations with HOMA-IR and HOMA-% ß are differentially dictated by their serum free and total pools and flaxseed oil supplementation.

Objective. The intent of the present study was to test two hypotheses. The primary hypothesis was that there would be differences between blood serum individual free fatty acids (SIFFA) and serum individual total fatty acids (SITFA) in terms of their different relationships (correlations) to each of homeostatic model assessment-individual insulin resistance (HOMA-IR) and homeostatic model assessment-individual insulin resistance-percentage ß-cell function (HOMA-% ß) remaining in human type 2 diabetic patients with pre-flaxseed oil (FXO) and pre-safflower oil (SFO) administration. The secondary hypothesis was that FXO (rich in alpha-linolenic acid, ALA) supplementation would alter these correlations differently in the SIFFA and STIFFA pools in comparison with the placebo SFO (poor in ALA). Methods. Patients were recruited via a newspaper advertisement and two physicians. All patients came to visit 1 and three months later to visit 2. At visit 2, the subjects were randomly assigned (double-blind) to flaxseed or safflower oil (placebo) treatment for three months until visit 3. Results. There were pre-intervention differences in the SIFFA and STIFA pool's relationships with each of HOMA-IR and HOMA-% ß. These relatioships remained either unchanged or became significant after intervention (treatment or placebo). There was a negative correlation found between HOMA-IR and serum free ALA (SFALA) mol % after FXO. Serum total ALA (STALA) mol % had no significant correlations with HOMA-IR and HOMA- % ß before and after flaxseed oil administration. Conclusions. The SIFFA and SITFA pools have different relationships with HOMA-IR and HOMA-% ß for each of pre- and post-intervention. It is concluded that the data support both the primary and the secondary hypotheses indicating that they are correct.

Strategies to improve response rates to web surveys: A literature review.

BACKGROUND: The development of the web survey has led to significant strides in questionnaire survey methodology, including its potential to substantially increase sample sizes at minimal costs. Despite its advantages, web surveys typically achieve lower response rates from participants compared to more conventional survey methods. OBJECTIVE: The aim of this review was to evaluate strategies to increase the response rate to web surveys. METHODS: CINAHL (EBSCO), MEDLINE Complete, the Cochrane database of systematic reviews, the Cochrane central register of controlled trials and Psych Info were searched, from inception to the 24th of June, 2021. The Boolean search phrase (Ti: Web survey* OR online survey* OR internet survey*) AND (Ti: response rate* OR nonresponse* or participation rate*) was used. This was supplemented by a secondary search of the reference lists. To be eligible for inclusion in the review, papers had to evaluate one or more strategies to improve response rates to web surveys. Experimental and quasi experimental studies were included in the review. RESULTS: A total of 159 papers were identified. Following removal of duplicates, and further screening by two independent reviewers, 45 papers met the inclusion and exclusion criteria, and were included in the final review. The use of e-mail pre-notification, email invitation and two reminders were found to increase response rates to web surveys as do the use of a semi-automatic log-in, a simple design and a short survey which takes around 10 min to complete. Incentives, including entry into a prize draw with a cash prize considered to be of value to the participants also increase response rates. CONCLUSION: Research studies are needed to explore whether the different strategies used by researchers with the intent to improve response rates are acceptable to potential participants and to evaluate the potential synergistic effect of combinations of several strategies identified in this review. Tweetable abstract: Email prenotification, email invitation, 2 reminders, simple 10 min design and lottery incentives improve response rates to web surveys.

Power and resistance within the hospital's hierarchical system: the experiences of chronically ill patients.

AIMS AND OBJECTIVES: To explore experiences of chronically ill patients and registered nurses when they negotiate patient care in hospital settings. Specifically, we explored how social and institutional discourses shape power relations during the negotiation process. BACKGROUND: The hospital system is embedded in a hierarchical structure where the voice of the healthcare provider as expert is often given more importance than the patient. This system has been criticised as being oppressive to patients who are perceived to be lower in the hierarchy. In this study, we illustrate how the hospital's hierarchical system is not always oppressing but can also create moments of empowerment for patients. DESIGN: A feminist poststructuralist approach informed by the teaching of Foucault was used to explore power relations between nurses and patients when negotiating patient care in hospital settings. METHODS: Eight individuals who suffered from chronic illness shared their stories about how they negotiated their care with nurses in hospital settings. The interviews were tape-recorded. Discourse analysis was used to analyse the data. RESULTS AND CONCLUSIONS: Patients recounted various experiences when their voices were not heard because the current hospital system privileged the healthcare provider experts' advice over the patients' voice. The hierarchical structure of hospital supported these dynamics by privileging nurses as gatekeepers of service, by excluding the patients' input in the nursing notes and through a process of self-regulation. However, patients in this study were not passive recipients of care and used their agency creatively to resist these discourses. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be mindful of how the hospital's hierarchical system tends to place nurses in a position of power, and how their authoritative position may positively or adversely affect the negotiation of patient care.

The experiences of chronically ill patients and registered nurses when they negotiate patient care in hospital settings: a feminist poststructural approach: A qualitative study that explores negotiation of patient care between patients and chronically ill patients in hospital settings.

AIMS AND OBJECTIVES: The aim of this study was to understand the experiences of chronically ill patients and registered nurse in negotiating patient care in hospital. Specifically, we explored how social and institutional discourses shaped power relations and negotiation of patient care. BACKGROUND: Current literature indicates that although nurses embrace this notion, such partnerships are not easily implemented. Most existing studies focus on the role of the nurse as the leader of the partnership with little attention paid to how social and institutional values, beliefs and practices shape nurse/patient power relations; or how these relationships are negotiated between nurses and patients. DESIGN: The theoretical and methodological approaches used in this study are based on the precepts of Foucault and feminist poststructural theorists. METHODS: In depth interviews were conducted with eight chronically ill patients and 10 registered nurses. RESULTS: Both nurses and patients commented about the relationships that develop between nurses and chronically ill patients and how these relationships facilitate negotiation of patient care. Both parties described challenging moments and how institutional discourses may hinder positive negotiations of care. In this paper we highlight three themes that emerged: getting to know each other, they are not the sickest patients and finding time to listen. CONCLUSIONS: This study offers an innovative way of unpacking negotiation of care between chronically ill patients and registered nurses. It exposes how social and institutional discourses play a pivotal role in shaping negotiations between nurses and chronically ill patients. RELEVANCE TO CLINICAL PRACTICE: Negotiating care with chronically ill patients is not as asymmetric as portrayed in some of the literature and tends to be based on mutual agreements between nurses and patients. Nurses make it a point to listen to patients' needs and resist institutional discourses that preclude them from spending time with patients.

High dose flaxseed oil supplementation may affect fasting blood serum glucose management in human type 2 diabetics.

Type 2 diabetes is characterized partially by elevated fasting blood serum glucose and insulin concentrations and the percentage of hemoglobin as HbA1c. It was hypothesized that each of blood glucose and its co-factors insulin and HbA1c and would show a more favorable profile as the result of flaxseed oil supplementation. Patients were recruited at random from a population pool responding to a recruitment advertisement in the local newspaper and 2 area physicians. Completing the trial were 10 flaxseed oil males, 8 flaxseed oil females, 8 safflower (placebo) oil males and 6 safflower oil females. Patients visited on two pre-treatment occasions each three months apart (visits 1 and 2). At visit 2 subjects were randomly assigned in double blind fashion and in equal gender numbers to take flaxseed oil or safflower oil for three further months until visit 3. Oil consumption in both groups was approximately 10 g/d. ALA intake in the intervention group was approximately 5.5 g/d. Power was 0.80 to see a difference of 1 mmol of glucose /L using 12 subjects per group with a p < 0.05. Flaxseed oil had no impact on fasting blood serum glucose, insulin or HbA1c levels. It is concluded that high doses of flaxseed oil have no effect on glycemic control in type 2 diabetics.

Effectiveness of continuing education programmes in nursing: literature review.

AIM: The aim of this paper is to review the literature on what facilitates or inhibits continuing education in nursing and to identify ways to make continuing education more effective. BACKGROUND: [corrected] Healthcare professionals have always been encouraged to update their knowledge and maintain clinical competence. The rapid changes currently taking place within healthcare systems have increased the pressure from direct care providers, professional bodies and the general public for nurses to engage in continuing education programmes. Despite a growing body of empirical research on this topic, the effectiveness and impact of continuing education remains underexplored. METHOD: A literature search was conducted in January 2005 using CINAHL, Medline, the Cochrane databases and the Internet. Keywords used were: 'continuing education', 'professional development', 'viability of continuing education/professional development programmes', 'evaluation of continuing education/professional development programmes' and 'effectiveness of continuing education/professional development programmes'. No date restrictions were imposed. RESULTS: Factors that facilitate the implementation of continuing education in nursing arise from individual, professional and organizational perspectives. While the philosophy behind continuing education is to encourage nurses to become lifelong learners, the learning method chosen for such programmes is often didactic in nature, as opposed to encouraging nurses to take initiative and direct their own learning. Continuing education is intended to ensure healthcare practitioners' knowledge is current, but it is difficult to determine if those who attend these courses are implementing what they have learnt. CONCLUSION: To make continuing education programmes more effective, nurses need to have a more participatory role in their learning. A concerted effort should be made to make continuing education attainable and realistic.

The Nurse Educator's clinical role.

AIM: This paper reports a two-phase descriptive study exploring the clinical role of the nurse educator in Malta. BACKGROUND: Previous studies indicate a number of similarities and differences in the clinical role of nurse educators by country of practice. These include importance assigned to the role, factors inhibiting/facilitating the role, means to eliminate barriers to the role, and perceptions of the ideal role. DESIGN AND METHODS: Data were collected using both quantitative and qualitative strategies. The quantitative phase involved asking all educators to fill in a time log of their academic and clinical activities for a 2-week period. In the qualitative phase, the first author interviewed five educators, five nurses and five students about their perceptions of factors which impact the nurse educator's clinical role, as well as what the ideal clinical role of the nurse educator should be. FINDINGS: Maltese nurse educators allot minimal time to their clinical role. Main reasons cited included workload, perceived lack of control over the clinical area, and diminished clinical competence. Nurse educators who frequented the clinical settings (who were either university or joint university and health service employees) where the study took place perceived that employment inequities among the various categories of nurse educators played an important role in the amount of time dedicated by each group to their clinical roles, and the importance individuals in these groups assigned to that role. The majority of interviewees saw the current role of nurse educators in Malta as preparing students for successful completion of the didactic sections of their programme, rather than preparing them with all the knowledge and clinical skills necessary to be competent practitioners. Participants considered that, when in clinical areas, nurse educators did focus on their students, as they should. However, they also thought that they often did not take the opportunity to forge links with professional staff. CONCLUSION: The clinical role of the Maltese nurse educator needs to be more multifaceted in approach.