The Future of Neurocritical Care Research: Proceedings and Recommendations from the Fifth Neurocritical Care Research Network Conference.

The Fifth Neurocritical Care Research Network (NCRN) Conference held in Boca Raton, Florida, in September of 2018 was devoted to challenging the current status quo and examining the role of the Neurocritical Care Society (NCS) in driving the science and research of neurocritical care. The aim of this in-person meeting was to set the agenda for the NCS's Neurocritical Care Research Central, which is the overall research arm of the society. Prior to the meeting, all 103 participants received educational content (book and seminar) on the 'Blue Ocean Strategy®,' a concept from the business world which aims to identify undiscovered and uncontested market space, and to brainstorm innovative ideas and methods with which to address current challenges in neurocritical care research. Three five-member working groups met at least four times by teleconference prior to the in-person meeting to prepare answers to a set of questions using the Blue Ocean Strategy concept as a platform. At the Fifth NCRN Conference, these groups presented to a five-member jury and all attendees for open discussion. The jury then developed a set of recommendations for NCS to consider in order to move neurocritical care research forward. We have summarized the topics discussed at the conference and put forward recommendations for the future direction of the NCRN and neurocritical care research in general.

Effect of human albumin on TCD vasospasm, DCI, and cerebral infarction in subarachnoid hemorrhage: the ALISAH study.

BACKGROUND AND PURPOSE: The neuroprotective effects of human albumin have been studied in animal models of stroke and in humans with various intracranial disorders. We investigated the effect of 25 % human albumin (ALB) on mean cerebral blood flow velocities (MCBFV), delayed cerebral ischemia (DCI), and cerebral infarction. METHODS: We studied patients from the Albumin in Subarachnoid Hemorrhage (ALISAH) pilot clinical trial. We collected data on MCBFV as measured by transcranial Doppler ultrasound (TCD), incidence of DCI, and cerebral infarctions on head computed tomography (CT) scan at 90 days. RESULTS: TCD showed vasospasm in 75 % (n = 15), 55 % (n = 11), and 29 % (n = 2) of subjects in dosage tiers 1, 2, and 3, respectively. DCI was present in 20 % (n = 4), 15 % (n = 3), and 14 % (n = 1) of subjects in dosage tiers 1, 2, and 3, respectively. Cerebral infarctions were seen in 45 % (5 of 9), 27 % (3 of 18), and 25 % (1 of 4) of subjects who had follow-up head CT scans in dosage tiers 1, 2, and 3, respectively. CONCLUSIONS: Higher dosages of ALB were associated with a lower incidence of TCD vasospasm, DCI, and cerebral infarction at 90 days in a dose-dependent manner.

Research agenda for Hispanics in the United States: a nursing perspective.

Heterogeneity is perhaps the most salient characteristic that defines Hispanic populations of the United States. Hispanic populations include native-born, migrant, and immigrant peoples with distinctive national origins and regional settlement patterns. This multigenerational migratory and social adjustment process has produced important cultural variations within and among the respective Hispanic ethnic groups. Moreover, the demographic structure of Hispanic populations is also varied and complex. These historical, demographic, and sociocultural features shape the health and disease experience of Hispanics. As expected, respective Hispanic ethnic groups vary in health status and have differing needs for health services. This article provides demographic background, a historical perspective, a synthesis of Hispanic issues identified in major and authoritative government documents, summary on the state-of-the-science for nursing research with Hispanics, and recommendations for future nursing research directions.

Evaluation of the pain response by Mexican American and Anglo American women and their nurses.

This study examined the relationship between ethnicity and pain. The study addressed three major research questions. The first question asked whether there was a significant difference in Mexican American women's and Anglo American women's response to cholecystectomy pain. Secondly, the nurses' attribution of pain to each of the two ethnic groups was compared. Finally, the patient's evaluation of the pain being experienced was compared to the nurse's evaluation of the pain the patient was experiencing. The sample consisted of 60 patient subjects and 60 nurse responses. Data were collected at two major teaching hospitals in southern California. Patient pain was measured using the McGill Pain Questionnaire, amount of analgesics and three physiological measures. The nurse's assessment of patient pain was measured using the Present Pain Intensity scale. MANOVA was used to analyse differences between the two ethnic groups on all measures of pain and no significant differences were found between the two ethnic groups on any of the measures of pain. However, nurses judged the two ethnic groups' pain response differently, assigning more pain to Anglo Americans. Finally, a dependent t-test was used to compare nurses' and patients' evaluation of pain. There were significant differences. Nurses evaluated the patients' pain as being less than patients did. Pearson product-moment correlations were used to examine the relationship between pain and sample characteristics of both patients and nurses. For the nurses, pain was significantly related to the patient's education, place of birth, language and religion.

The adequacy and scope of Roy's adaptation model to guide cross-cultural pain research.

The purpose of this study was to examine the adequacy (operational, empirical, and pragmatic) and scope of the Roy adaptation model and the gate control theory of pain to guide the cross-cultural study of pain. The sample consisted of 60 Mexican-American and Anglo-American women undergoing elective cholecystectomy. The conceptual-theoretical-empirical structure developed by Fawcett and Downs (1986) provided the framework for designing the study. Operational adequacy was determined by examining the reliability and validity of the empirical indicators used; it was judged adequate. Empirical adequacy was evaluated by comparing empirical data to hypothesized expectations. Only some of the conceptual-theoretical relational statements were supported. Pragmatic adequacy was assessed by determining whether innovative practice strategies might be derived from the data; several were recommended. Finally, the scope was determined by examining the variables identified by the model and several additional variables. Scope was judged adequate to the current stage of the model's development.

[Determining factors of rubella in the 10 to 14 year-old population in Mexico]. / Factores determinantes de la rubéola en población de 10 a 14 años de edad en México.

The clinical and epidemiological importance of rubella relates to its teratogenic effects. When this disease occurs in children, adolescents and adults, it is usually benign. On the other hand, these age groups are source of disease transmission to pregnant women. The serology studies on rubella carried in Mexico prior to 1974, detected seropositivity levels from 87.1 to 97.7 percent in children younger than 14 years of age. In contrast, the National Seroepidemiology Survey (NSS) (1988) reported a much lower seropositivity (69.3%) in children of the same age group, and a rate of 80 percent in women of reproductive age. This situation is a particular problem for Mexico where a high proportion of the pregnancies occur during adolescence. While previous research has commented on descriptive measures of seroprevalences in women, this study, which is based on a logistic regression model, has the purpose of identifying the factors associated with the immunological status of girls between 10 and 14 years of age. The variable which showed the most evident relation to the antibody levels for rubella was years of schooling. The odds ratios (OR) for seropositivity among those who finished secondary schooling was 2.05 times (CI 1.28-2.56) that of the illiterate group. Other statistically significant variables were related to residence, urban vs rural (OR = 1.69; CI 1.48-2.12) and age, 10 vs 14 years (OR = 1.93; CL 1.69-2.42). Based on the multivariate model, it was observed that the girls with a greater risk of seropositivity were those who live in urban areas, attend secondary school, and are 14 years of age, with an OR = 4.05 (G = 6,756.4 and 5,580 gl; p less than .001). The study concludes with the following considerations: the immunological levels of girls from 10 to 14 years of age are low, and the results of the NSS suggest that Mexican public health authorities should evaluate the policy of vaccination against rubeola in the population potentially at risk, and that the factors associated with the disease, in descending order, are: years of schooling, age, and place of residence. It is also necessary to carry out analytic studies which will identify the risks and the etiology of congenital malformations which are likely to have been associated with the occurrence of rubeola virus during pregnancy.

Moving beyond: a generative philosophy of science.

Philosophies of science are perhaps the most covert yet significant forces influencing the direction of change within disciplines. Although the era of logical positivism has waned for many disciplines, newer philosophies may not be satisfactory, especially for the applied disciplines. This article describes an alternative philosophy of science with special significance for nursing. This philosophy was influenced by several of the major existing philosophies, but especially by the paradigmatic view espoused by Thomas Kuhn. The generative philosophy of science was named because of its focus on generating growth among the applied disciplines. Members of these disciplines study questions with social significance and human application. This article defines major concepts, describes relationships among concepts and discusses implications for the development of nursing science and the nursing discipline.

Beliefs about AIDS, health, and illness among low-income Latina women.

The purposes of this study were to describe (a) the health beliefs of Latina women about acquired immunodeficiency syndrome (AIDS); and (b) the relationship of these beliefs to the subjects' traditional beliefs about illness and its treatment. The sample consisted of 59 low-income Latina women attending nutrition programs in Los Angeles. A qualitative approach was used to gather the data in semi-structured focus group interviews. Content analysis was used to classify data according to causes of AIDS and prevention and treatment of AIDS. Causes of AIDS included all of the current biomedical and public health explanations of transmission, current popular beliefs and misconceptions about transmission, and long-standing traditional beliefs about the causes of illness. Prevention and treatment of AIDS reflected these same three perspectives. The women's beliefs consisted of accurate, inaccurate, and incomplete information about AIDS. Implications were drawn from the findings for AIDS education and prevention programs which are congruent with the participants' cultural beliefs, values, attitudes, and expectations.

Review of literature on culture and pain of adults with focus on Mexican-Americans.

The purposes of this paper are to review the literature on culture and pain in adults, and specifically on Mexican-American beliefs about pain, and nurses' responses to patients' pain. Nurses and other health caregivers in the United States often characterize various ethnocultural groups according to their reaction to pain and their ability to tolerate pain. Cross-cultural studies have demonstrated that White Americans of Northern European origin react to pain stoically and as calmly as possible, choosing to withdraw if pain becomes intense. This response to pain has become the cultural model or norm in the United States. It is the behavior expected and valued by health caregivers. Mexican-Americans are often described as complainers who want immediate relief for their pain. Yet studies of Mexican-American culture and cross-cultural studies of the pain experience and responses of Mexican-Americans do not support this characterization. Nurses and patients assess pain differently regardless of cultural background. Both nurses and physicians tend to underestimate and undertreat the pain of their patients when compared to patients' assessment of pain. However, the ethnicity and culture of the patient influence the extent of difference between the patient's and nurse's assessment. The culture of the nurse also influences the inference of patients' physical pain and psychological distress. Based on the studies reviewed, implications are drawn for transcultural nursing practice and recommendations are made for future nursing research.

Seroepidemiology of the hepatitis B and delta in the southeast of Chiapas, Mexico.

An area of high endemicity for hepatitis B and delta antigen was identified in the southern border of Mexico (Chiapas). The study included individuals from mexican communities and guatemalan refugee camps. 91.1% of the subjects were positive to anti-HBcAg antibodies. The frequency of asymptomatic carriers of HBsAg went from 4.2% in mexican communities to 17.3% in guatemalan refugee camps, the percentage was higher in households with six or more persons per room (14.0 per 100 individuals). The prevalence of e antigen in subjects positive to HBsAg was higher among guatemalan refugees (35.3%) than among mexicans (7.7%). A refugee camp, Benemerito de las Americas, showed 65.6% positives to anti-HBcAg antibodies and 39.0% asymptomatic HBsAg carriers, 41.7% of these were positive to HBeAg. Antidelta antibodies were present in 50 of 119 subjects positive to HBsAg. The mechanism of transmission was mainly horizontal since most of the infected children in each household corresponded to the oldest offspring. Our data were similar to those observed in the amazonian region of Brazil, Southeast Asia and tropical Africa.