Two measures of systemic inflammation are positively associated with haemoglobin levels in adolescent girls living in rural India: a cross-sectional study.

OBJECTIVE: This study tested the hypothesis that systemic inflammation is inversely associated with haemoglobin levels in adolescent girls in India. METHODS: The study population consisted of adolescent girls aged between 10 and 19 years living in a remote rural region in Maharashtra State, India. Data were collected on anthropometric measures, and a venous blood sample was taken and tested for complete blood count and C-reactive protein (CRP). RESULTS: Of 679 individuals who were invited to the research site to participate, data were available from 401 participants giving a response rate of 59%. Median blood CRP was 1.26 mg/l (Range 0.00 to 26.33), and 167 (41.6%) participants had CRP level < 1.0 mg/l. The mean haemoglobin was 12.24 g/dl (standard deviation [SD] 1.51), and the mean total white blood cells (WBC) count was 9.02 × 103 /µl (SD 2.00). With each g/dl increase in blood haemoglobin, the risk of having an elevated CRP of ≥ 1 mg/l increased with an odds ratio of 1.16 (95% CI 1.01 to 1.33, P = 0.03). Total WBC count was also positively associated with blood haemoglobin, increasing by 0.24 × 103 /µl (95% CI 0.11 to 0.37, P < 0.001) per g/dl increase in haemoglobin. Both analyses were adjusted for age. CONCLUSIONS: In this population, blood haemoglobin levels were positively associated with two measures of systemic inflammation, contrary to the primary hypothesis being tested. Other unmeasured environmental exposures may modify haemoglobin levels in this population. Understanding this observation may help design better public health interventions to improve the well-being of adolescent girls in India.

OBJECTIF: Cette étude a testé l'hypothèse selon laquelle l'inflammation systémique est inversement associée aux taux d'hémoglobine chez les adolescentes en Inde. MÉTHODES: La population étudiée était composée d'adolescentes âgées de 10 à 19 ans vivant dans une région rurale éloignée de l'Etat du Maharashtra, en Inde. Les données ont été collectées sur des mesures anthropométriques et un échantillon de sang veineux a été prélevé et testé pour la formule globulaire complète et la protéine C-réactive (CRP). RÉSULTATS: Sur 679 personnes qui ont été invitées au site de recherche à participer, des données étaient disponibles pour 401 participantes, soit un taux de réponse de 59%. La CRP sanguine médiane était de 1,26 mg/L (intervalle de 0,00 à 26,33) et 167 participantes (41,6%) avaient un taux de CRP <1,0 mg/L. L'hémoglobine moyenne était de 12,24 g/dL (écart-type [ET] 1,51), et le nombre moyen total de globules blancs (GB) était de 9,02 x103 /µL (ET 2,00). Avec chaque augmentation par g/dL de l'hémoglobine sanguine, le risque d'avoir une CRP élevée ≥1 mg/L augmentait avec un rapport de cotes de 1,16 (IC95%: 1,01 à 1,33, p = 0,03). La numération totale des GB était également positivement associée à l'hémoglobine sanguine, augmentant de 0,24 x103 /µL (IC95%: 0,11 à 0,37, p <0,001) par g/dL d'augmentation de l'hémoglobine. Les deux analyses ont été ajustées en fonction de l'âge. CONCLUSIONS: Dans cette population, les taux d'hémoglobine sanguine étaient positivement associés à deux mesures de l'inflammation systémique, contrairement à l'hypothèse principale testée. D'autres expositions environnementales non mesurées peuvent modifier les taux d'hémoglobine dans cette population. Comprendre cette observation peut aider à concevoir de meilleures interventions de santé publique pour améliorer le bien-être des adolescentes en Inde.

Sun-safe behaviours, personal risk, level of concern, and knowledge about cutaneous melanoma in italy: time for social marketing?

INTRODUCTION: The incidence of cutaneous melanoma is increasing, although 80-95% of all deaths caused by melanoma can be avoided through protective behaviours. There is evidence that social marketing as an approach in public health can improve health-related behaviours and encourage sun-safe behaviours. METHODS: A multicentre survey was conducted to collect and compare data about cutaneous melanoma risk, knowledge, concern, and protective behaviours across Northern, Central, and Southern Italy, and explore how these data could potentially inform a social marketing intervention to improve sun-safe behaviours. Data were analysed using descriptive and inferential statistics. RESULTS: A total of 1,028 questionnaires were collected. Apart from 'Personal Risk' no statistically significant differences were found between the three regions. About 30% (n = 344) of the total sample had high levels of personal risk, and low levels of concern and protective behaviour, and over 70% (n = 711) gave priority to sun tanning. The worst scores were related to knowledge about melanoma (30% wrong answers, and over 40% 'don't know'). Protective behaviour was moderately correlated with age (p = 0.03). Personal risk was significantly higher in women (10.84 vs 10.05), and lower in individuals with a degree (9.46 vs 11.38; p < 0.001). CONCLUSIONS: Over 70% of our sample gave priority to sun tanning, which combined with low levels of concern and knowledge about melanoma, and high levels of personal risk, confirm that much still needs to be done in terms of melanoma prevention, but all these are aspects that could be effectively addressed through social marketing interventions.

Measuring the therapeutic properties of nursing home environments in the Italian context: findings from a validation and cross-sectional study design.

BACKGROUND: The social and the physical features of the nursing home (NH) environment can offer a therapeutic support capable of maximising residents' physical and cognitive functions. A total of 23 instruments evaluating the therapeutic properties of a NH has been documented to date; among them, the most recent and widely used is the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) composed of 13 domains and 84 items: higher scores in each domain indicate a higher presence of therapeutic principles. Validating the Italian version of TESS-NH tool and describing the therapeutic properties of Italian NH environments were the aims of this study. STUDY DESIGN: A validation and a cross-sectional study design, undertaken in 2017. METHODS: After having ensured the cross-cultural and the conceptual equivalence, together with the face and the content validation, 13 NHs accounting for 1,161 beds and articulated in 31 units have been evaluated with the TESS-NH tool via direct observation by trained researchers. Inter-rater reliability, test-retest, criterion validity, inter-dimension correlations and internal consistency were measured. Descriptive statistics was also calculated. RESULTS: The inter-rater reliability was Pearson (r) >0.917 for continuous variables and weighted kappa statistics (k) of > 0.779 for non-continuous variables; the test-retest reliability was r > 0.848 and k of > 0.778, respectively. The criterion validity was r > 0.500 between each dimension and the single TESS-NH global item; moreover, correlations among the domains varied from not significant to significantly strong, while the internal consistency resulted in all evaluable dimensions in Cronbach alpha > 0.600. In the involved NH units, the TESS-NH total score was on average 122.19 out of the possible score from 0 to 149 (confidence interval (CI) 95%, 115.89-128.49). 25% of the units (=7) reported a total score of ≤ 113, and another 25% reported scores ≥ 133, thus from poor to excellent therapeutic properties. CONCLUSION: The TESS-NH tool can be used in Italian facilities to support managers and researchers in evaluating the therapeutic properties of NH environments. Furthermore, the tool can support the evaluation of the effectiveness of interventional studies or quality improvement projects aimed at improving the NH's environment.

A meta-synthesis study of the key elements involved in childhood vaccine hesitancy.

OBJECTIVES: Immunization is one of the most successful and cost-effective interventions to improve health outcomes. However, internationally, the phenomenon of parental vaccine hesitancy is increasing and presents a growing challenge for health professionals. This article summarizes the evidence surrounding childhood vaccine hesitancy from the perspective of parents. STUDY DESIGN: We conducted a systematic review and meta-synthesis of qualitative studies. METHODS: We searched for qualitative research articles in electronic databases from inception to March 2018. In addition, a manual search of the retrieved articles and their references was conducted to identify other potential articles. We used the Critical Appraisal Skills Programme to examine study validity, adequacy and potential applicability of the results. No articles were excluded for reasons of quality. By performing a meta-synthesis, we identified descriptive themes and, subsequently, the conceptual elements of vaccine hesitancy. RESULTS: The review included 27 studies involving a total of 1557 parents who were hesitant about vaccinating their child. Five overarching categories were identified: (1) risk conceptualization; (2) mistrust towards vaccine-related institutions, pharmaceutical companies, researchers, health professionals and the information from media; (3) parental alternative health beliefs about childhood immunity, vaccine scheduling and the perceived toxicity of vaccinations; (4) philosophical views on parental responsibility; and (5) parents' information levels about vaccination. CONCLUSIONS: Healthcare providers need to approach this difficult situation considering that parents desire to do what they feel right for the child. Understanding the core elements of hesitancy will allow health professionals to adopt effective communication and behavioural strategies.

The effectiveness of combined alcohol and sexual risk taking reduction interventions on the sexual behaviour of teenagers and young adults: a systematic review.

OBJECTIVES: The objective of this study is to conduct a systematic review to summarise currently implemented interventions, investigating their effectiveness in reducing alcohol use and sexual risk taking behaviour in teenagers and young adults. STUDY DESIGN: This is a systematic review. METHODS: Studies published in English language with both alcohol and sexual risky behaviour reduction interventions were searched using five electronic database platforms. All review tasks such as study screening, selection, data extraction, quality rating and synthesis were performed in accordance with systematic review guidelines. RESULTS: The review included 18 studies. Fifteen studies were randomised control trials (RCTs), whereas three were interventional studies having pre-intervention and postintervention analysis. Overall study duration ranged from 6 months to 24 months. The retention rate decreased with an increase in study duration and ranged from 60% to 80% for majority of studies, whereas some studies particularly planned for a shorter period had a higher retention rate (≥90%). The study site showed a range of patterns (in schools/college = 5, at family level/home environment = 3, web based = 2, sexual health clinics = 2, mental health clinics = 1, community level = 1 and juvenile detention facility = 4). The study quality assessment showed that most studies were of medium to high quality. Evidence from this systematic review suggests that after interventions, young people are less likely to engage in risky sexual behaviour and choose harmful alcohol drinking. The major factors influencing individuals during adolescence and early adulthood include local cultural norms, acceptability of casual sex and binge drinking trends in the teenage and young communities. It was also observed that study setting and target population determine the type of intervention required and impacts on outcomes. CONCLUSIONS: This review suggests that interventions to reduce risky sexual behaviour and alcohol consumption work in teenagers and young adults. However, selection of appropriate intervention type/design, delivery methods and follow-up plans are key elements to ensure both uptake and success of such intervention projects.

Gender, power and leadership: the effect of a superior's gender on respiratory therapists' ability to challenge leadership during a life-threatening emergency.

BACKGROUND: Effective communication within teams is crucial, especially in crisis situations. Hierarchy gradients between team members can contribute to communication failures and are influenced by many factors. The effect of gender on team performance has not been well studied. The objective of this study was to examine the effect of the physician's gender on respiratory therapists' ability to effectively challenge clearly incorrect clinical decisions during a life-threatening crisis. METHODS: Respiratory therapists were recruited to take part in a high-fidelity simulation of can't-intubate can't-oxygenate scenarios. They were randomized into two groups, either assisting a male or a female anaesthetist in managing an airway crisis during which the anaesthetist made incorrect clinical decisions. Two independent raters scored the performances using the modified Advocacy-Inquiry Score (min 1, max 6). RESULTS: Twenty-nine subjects completed the study. The median best challenge score when the staff anaesthetist was female was 4 (3-5 IQR [2-6 range]) compared with 3 (3-3[0-3]) for challenges to a male anaesthetist (P=0.017). The median of the total challenges against a female staff member 11 (7.3-14.8 [2-18]) was significantly higher compared with 4 (3.5-7 [2-11.5]) for a male staff (P=0.006). CONCLUSIONS: The study showed a significant effect of superiors' gender on a respiratory therapist's ability to challenge leadership. A female staff anaesthetist was challenged more often and with greater assertiveness and effectiveness. This has implications for an educational intervention targeting the ability to challenge a wrong decision by a supervisor and emphasizing the effect of gender on the willingness to speak up.

Power and conflict: the effect of a superior's interpersonal behaviour on trainees' ability to challenge authority during a simulated airway emergency.

A key factor that may contribute to communication failures is status asymmetry between team members. We examined the effect of a consultant anaesthetist's interpersonal behaviour on trainees' ability to effectively challenge clearly incorrect clinical decisions. Thirty-four trainees were recruited to participate in a video-recorded scenario of an airway crisis. They were randomised to a group in which a confederate consultant anaesthetist's interpersonal behaviour was scripted to recreate either a strict/exclusive or an open/inclusive communication dynamic. The scenario allowed trainees four opportunities to challenge clearly wrong decisions. Performances were scored using the modified Advocacy-Inquiry Score. The highest median (IQR [range]) score was 3.0 (2.2-4.0 [1.0-5.0]) in the exclusive communication group, and 3.5 (3.0-4.5 [2.5-6.0]) in the inclusive communication group (p = 0.06). The study did not show a significant effect of consultant behaviour on trainees' ability to challenge their superior. It did demonstrate trainees' inability to challenge their seniors effectively, resulting in critical communication gaps.

The effect of a structured adolescent health summer programme: a quasi-experimental intervention.

BACKGROUND: It is important to integrate adolescent health domains into pre-service nursing education in order to enhance undergraduate nursing students' competencies in promoting adolescent health. AIM: To determine the effectiveness of a structured adolescent health summer programme for Chinese undergraduate nursing students. METHODS: A quasi-experimental design was used to evaluate differences in the Chinese undergraduate nursing students' perceived competency in promoting adolescent health. A stand-alone adolescent health course was implemented as an intervention with pre- and post-tests of a 2-week intensive summer programme in 2010. The questionnaire included demographics, adolescent health competency checklist and programme evaluation. Descriptive statistics with the Wilcoxon signed-ranks test and the Mann-Whitney U-test were used for data analysis. RESULTS: Of the 113 nursing students, seniors perceived higher adolescent health competence mean scores than the juniors in the post-test phase. Majority of nursing students revealed the increasing awareness of the importance in promoting healthy lifestyle behaviours and psychosocial well-being after attending the summer programme. They agreed that nurses do have a role to play. LIMITATIONS: This 2-week summer programme may only have short-term impacts on students' perception. CONCLUSIONS: A stand-alone adolescent health summer programme can prepare nursing students to respond to the health issues of adolescents by enhancing their competence in health need assessment and service delivery. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurses serve in a leadership role for health policies and programmes. In nursing education, it is important for students to understand how to put in place policies to resolve adolescent health issues.

Resilience, self-esteem and self-compassion in adults with spina bifida.

STUDY DESIGN: Cross-sectional survey. OBJECTIVES: To examine factors that may enhance and promote resilience in adults with spina bifida. SETTING: Community-based disability organisations within Australia. METHODS: Ninety-seven adults with a diagnosis of spina bifida (SB) completed a survey comprising of demographic questions in addition to standardised self-report measures of physical functioning (Craig Handicap Assessment and Reporting Technique), resilience (Connor-Davidson Resilience Scale, 10 item), self-esteem (Rosenberg Self-esteem Scale), self-compassion (Self-compassion Scale) and psychological distress (Depression Anxiety Stress Scales, 21 item). RESULTS: The majority (66%) of respondents reported moderate to high resilience. Physical disability impacted on coping, with greater CD-RISC 10 scores reported by individuals who were functionally independent in addition to those who experienced less medical co-morbidities. Significant correlations between resilience and psychological traits (self-esteem r=0.36, P<0.01; self-compassion r=0.40, P<0.01) were also noted. However, the combined contribution of these variables only accounted for 23% of the total variance in resilience scores (R(2)=0.227, F(5,94)=5.23, P<0.01). CONCLUSION: These findings extend current understanding of the concept of resilience in adults with a congenital physical disability. The suggestion is that resilience involves a complex interplay between physical determinants of health and psychological characteristics, such as self-esteem and self-compassion. It follows that cognitive behavioural strategies with a focus on self-management may, in part, contribute to the process of resilience in this group. Further large-scale and longitudinal research will help to confirm these findings.

Does warm-up using mental practice improve crisis resource management performance? A simulation study.

BACKGROUND: Mental practice (MP) is defined as the 'symbolic rehearsal of a physical activity in the absence of any gross-muscular movements' and has been used in sport and music to enhance performance. In healthcare, MP has been demonstrated to improve technical skill performance of surgical residents. However, its effect on crisis resource management (CRM) skills has yet to be determined. We aimed to investigate the effect of warm-up with MP on CRM skill performance during a simulated crisis scenario. METHODS: Following ethics board approval, 40 anaesthesia residents were randomized. The intervention group performed 20 min of MP of a script based on CRM principles. The control group received a 20 min didactic teaching session on an unrelated topic. Each subject then managed a simulated cardiac arrest. Two CRM experts rated the video recordings of each performance using the previously validated Ottawa GRS. The time to start chest compressions, administer epinephrine, and give blood was recorded. RESULTS: There was no significant difference between the intervention and control groups: total Ottawa GRS score was 24.50 (18.63-28.88 [6.50-34.50]) (median (inter-quartile range [range]) vs 20.50 (13.00-29.13 [6.50-34.50]) (P=0.53); the time to start chest compressions 146.0 s (138.0-231.0 [115.0-323.0]) vs 162.5 s (138.0-231.0 [100.0-460.0]) (P=0.27), the time to epinephrine administration 163.0 s (151.0-187.0 [111.0-337.0]) vs 187.0 s (164.0-244.0 [115.0-310.0]) (P=0.09), and the time to blood administration 220.5 s (130.8-309.0 [92.0-485.0]) vs 252.5 (174.5-398.8 [65.0-527.0]) (P=0.48). CONCLUSION: Unlike technical skills, warm-up with MP does not seem to improve CRM skills in simulated crisis scenarios.

Challenging authority during a life-threatening crisis: the effect of operating theatre hierarchy.

BACKGROUND: Effective operating theatre (OT) communication is important for team function and patient safety. Status asymmetry between team members may contribute to communication breakdown and threaten patient safety. We investigated how hierarchy in the OT team influences an anaesthesia trainee's ability to challenge an unethical decision by a consultant anaesthetist in a simulated crisis scenario. METHODS: We prospectively randomized 49 postgraduate year (PGY) 2-5 anaesthesia trainees at two academic hospitals to participate in a videotaped simulated crisis scenario with a simulated OT team practicing either a hierarchical team structure (Group H) or a non-hierarchical team structure (Group NH). The scenario allowed trainees several opportunities to challenge their consultant anaesthetist when administering blood to a Jehovah's Witness. Three independent, blinded raters scored the performances using a modified advocacy-inquiry score (AIS). The primary outcome was the comparison of the best-response AIS between Groups H vs NH. Secondary outcomes included the comparison of best AIS by PGY and the percentage in each group that checked and administered blood. RESULTS: The AIS did not differ between the groups (P=0.832) but significantly improved from PGY2 to PGY5 (P=0.026). The rates of checking blood (92% vs 76%, P=0.082) and administering blood (62% vs 57%, P=0.721) were high in both groups but not significantly different between the groups. CONCLUSIONS: This study did not show a significant effect of OT team hierarchical structure on trainee's ability to challenge authority; however, the results are concerning. The challenges were suboptimal in quality and there was an alarming high rate of blood checking and administration in both groups. This may reflect lack of training in appropriately and effectively challenging authority within the formal curriculum with implications for patient safety.

School-linked sexual health services for young people (SSHYP): a survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities.

BACKGROUND: Report based on a service-mapping study and a systematic review concerning sexual health services for young people, either based in or closely linked to schools. OBJECTIVES: To identify current forms of school-based sexual health services (SBSHS) and school-linked sexual health services (SLSHS) in the UK, review and synthesise existing evidence from qualitative and quantitative studies concerning the effectiveness, acceptability and cost-effectiveness of these types of service and to identify potential areas for further research. DATA SOURCES: Electronic databases were searched from 1985 onwards. For published material: the Cochrane Library (1991-), MEDLINE, PREMEDLINE (2007-), CINAHL, EMBASE, AMED, ASSIA (1987-), IBSS, ERIC, PsycINFO, Science Citation Index (SCI) and Social Sciences Citation Index. For unpublished material and grey literature: the Social Care Institute of Excellence Research Register; the National Research Register (1997-), ReFeR; Index to Theses, and HMIC. REVIEW METHODS: A service-mapping questionnaire was circulated to school nurses in all parts of the UK, and semistructured telephone interviews with service coordinators in NHS and local authority (LA) roles were conducted. An evidence synthesis was performed based on a systematic review of the quantitative evidence about service effectiveness, qualitative evidence about user and professional views and a mixed-methods synthesis. A proof-of-concept model for assessing cost-effectiveness was drawn up. RESULTS: Three broad types of UK sexual health service provision were identified. Firstly, SBSHS staffed by school nurses, offering 'minimal' or 'basic' levels of service. Secondly, SBSHS and SLSHS staffed by a multiprofessional team, but not medical practitioners, offering 'basic' or 'intermediate' levels of service. Thirdly, SBSHS and SLSHS staffed by a multiprofessional team, including medical practitioners offering 'intermediate' or 'comprehensive' levels of service. The systematic review showed that SBSHS are not associated with higher rates of sexual activity among young people, nor with an earlier age of first intercourse. There was evidence to show positive effects in terms of reductions in births to teenage mothers, and in chlamydial infection rates among young men, although this evidence coming primarily from the USA. Therefore, the findings need to be tested in relation to UK-based services. Also evidence to suggest that broad-based, holistic service models, not restricted to sexual health, offer the strongest basis for protecting young people's privacy and confidentiality, countering perceived stigmatisation, offering the most comprehensive range of products and services, and maximising service uptake. Findings from the mapping study also indicate that broad-based services, which include medical practitioner input within a multiprofessional team, meet the stated preferences of staff and of young people most clearly. Partnership-based developments of this kind also conform to the broad policy principles embodied in the Every Child Matters framework in the UK and allied policy initiatives. However, neither these service models nor narrower ones have been rigorously evaluated in terms of their impact on the key outcomes of conception rates and sexually transmitted infection (STI) rates, in the UK or in other countries. Therefore, appropriate data were not found to support cost-effectiveness modelling. LIMITATIONS: Low response rate to the questionnaire. Scotland, Wales and Northern Ireland were under-represented. Also, the distinction made in the questionnaire between 'general health' and 'sexual health' services did not prove robust. CONCLUSIONS: There is no single, dominant service model in the UK. The systematic review demonstrated that the evidence base for these services remains limited and uneven, and draws largely on US studies. Qualitative research is needed to develop robust process and outcome indicators for the evaluation of SLSHS/SBSHS in the UK. These indicators could then be used both in local evaluations, and in large, longitudinal studies of service effectiveness and cost-effectiveness. Future research should examine the impact of the differing types of services currently evolving in the UK, encompassing school-based and school-linked models, as well as models with and without medical practitioner involvement.

Alternative approaches to 'enhanced observations' in acute inpatient mental health care: a review of the literature.

Formal 'enhanced observations' involving allocating one or two nurses to place an patient under continuous observation when acutely ill and at risk of self-harm are ineffective, contribute to impersonal care, are stressful to practitioners and reinforce the perception of a custodial environment. The aim of this literature review was to systematically bring together published studies and research that identified alternative approaches to 'enhanced observations' from those proposed in the Standing Nursing and Midwifery Advisory Committee guidelines on individuals receiving care on open acute inpatient settings. The literature search strategy resulted in the retrieval of five empirical studies, with further analysis revealing six potential interventions relating to the development of an alternative approach to observations. These are: (1) assessment; (2) nurse autonomy; (3) ward management initiatives (4) engagement and collaboration; (5) a team approach; and (6) intermittent observations. The review emphasized how enhanced observations and the development of alternative approaches are a complex activity requiring planning and consideration to facilitate appropriate implementation. The review also highlights a dearth in empirical evidence for alternatives, and a need to revise current practices because of the dissatisfaction from clients and practitioners involved in this intervention.

Effect of sleep deprivation on labour epidural catheter placement.

BACKGROUND: Epidural catheter insertion for labour analgesia is an invasive procedure with potential serious complications, often performed by a sleep-deprived clinician. The aim of this study was to examine the effects of sleep deprivation on physicians of variable levels of experience performing this procedural skill in the clinical setting. METHODS: After institutional review board approval, anaesthetists of three levels of experience were recruited: novice residents (<30 epidurals, n=9), experienced residents (>100 epidurals, n=8), and attending anaesthetists (>500 epidurals, n=12). All participants were measured twice, rested and sleep deprived in a random order while performing a labour epidural for analgesia. Our primary outcome measures were scores achieved on the Imperial College Surgical Assessment Device (ICSAD) (measuring path length, number of movements, and time), task-specific checklist (CL), and global rating scale (GRS). Sleep deprivation was documented by the ActiGraph and Epworth sleepiness scale. RESULTS: Subjects were adequately sleep deprived for their sleep deprivation observation. Data were analysed with a two-way mixed design analysis of variance. No significant difference in the effect of sleep deprivation on performance was detected between the groups on the ICSAD measures of movement (P=0.86), path length (P=0.79), and time (P=0.80), or for the CL (P=0.65), and GRS (P=0.86). CONCLUSIONS: The performance of this procedural skill in a clinical setting does not seem to be affected by sleep deprivation irrespective of the level of experience.

Cognitive aid for neonatal resuscitation: a prospective single-blinded randomized controlled trial.

BACKGROUND: Retention of skills and knowledge after neonatal resuscitation courses (NRP) is known to be problematic. The use of cognitive aids is mandatory in industries such as aviation, to avoid dependence on memory when decision-making in critical situations. We aimed to prospectively investigate the effect of a cognitive aid on the performance of simulated neonatal resuscitation. METHODS: Thirty-two anaesthesia residents were recruited. The intervention group had a poster detailing the NRP algorithm and the control group did not. Video recordings of each of the performances were analysed using a previously validated checklist by a peer, an expert anaesthetist, and an expert neonatologist. RESULTS: The median (IQR) checklist score in the control group [18.2 (15.0-20.5)] was not significantly different from that in the intervention group [20.3 (18.3-21.3)] (P=0.08). When evaluated by the neonatologist, none of the subjects correctly performed all life-saving interventions necessary to pass the checklist. A minority of the intervention group used the cognitive aid frequently. CONCLUSIONS: Retention of skills after NRP training is poor. The infrequent use of the cognitive aid may be the reason that it did not improve performance. Further research is required to investigate whether cognitive aids can be useful if their use is incorporated into the NRP training.

Prophylaxis to combat HIV infection after sexual exposure.

This article explores the use of drugs to treat patients who have recently been exposed to HIV. Known as postsexual exposure prophylaxis, this emerging practice has been accused of creating a number of problems for HIV prevention. However, there is a case that PSEP can make a significant contribution to HIV prevention strategies.

Burnout and AIDS care-related factors in HIV community clinical nurse specialists in the North of England.

Burnout in Acquired Immune Deficiency Syndrome (AIDS) care nursing is well described in the literature from a hospital based perspective. No studies into the effects of AIDS care and burnout have been carried out within the community setting. A two-stage, mixed method study was carried out. In Stage one 30 Clinical Nurse Specialists in human immunodeficiency virus (HIV)/AIDS from the North of England completed the Maslach Burnout Inventory (MBI) and the AIDS Impact Scale. For Stage two five practitioners were selected randomly for semi-structured interview. Burnout morbidity was significant. Sixty-six per cent of informants scored as moderate or high burnout cases on the emotional Exhaustion and Personal Accomplishment subscales of the MBI. Only three per cent scored as cases on the depersonalization subscale. Links between the close involvement of practitioners with clients, death of clients, isolation, stigma and discrimination and the availability of support and supervision were identified as significant factors in AIDS care within this population that contributed to stress and burnout. Paradoxically, informants found the close relationships with clients, the autonomy of isolation and the exclusive nature of AIDS care positive aspects of their practice. The role of support and supervision in facilitating the continuance of a close empathic and therapeutic relationship and the prevention of an over-involved, isolated and stressful relationship is proposed as a way forward.

Confidentiality and the acquired immune deficiency syndrome (AIDS): an analysis of the legal and professional issues.

Confidentiality is one of the most significant concepts in health care and nursing practice, particularly in the arena of HIV infection and AIDS. The implications for individuals of deliberate or accidental disclosure of their HIV status can and does have far reaching effects. This paper will explore the concept of confidentiality by discussing the legal and professional issue of confidentiality and AIDS. The nature of the law and guidance by professional bodies allow exceptions to the respect of confidentiality in certain situations. AIDS and the need for confidentiality often is in conflict when public health considerations are deemed to be involved. The law is poorly developed in this area and often professional guidance is less than clear.

Is non-judgemental care possible in the context of nurses' attitudes to patients' sexuality?

Developments in nursing practice in the United Kingdom are increasingly focusing on holistic models and approaches to care. The recognition of the importance of sexuality and sexual orientation of patients is a significant aspect of holistic care. This paper explores and discusses the literature in the arena of nurses' attitudes to patients' sexuality. From this discussion the concept emerges that nursing needs to recognize the effect that attitudes towards patients' sexuality has on nursing care, and develop strategies that allow this to be reflected on. The use of reflection facilitated by clinical supervision will be presented as a potential way forward.

Nurses and AIDS care.

The VIIIth International Conference on AIDS held in Amsterdam, July 1992, covered many issues pertinent to nurses; however, the lack of nursing participation was evident. This article examines the issues of concern to nurses in AIDS care that were highlighted at the meeting.