TONI - One for all? Participatory development of a transtheoretic and transdiagnostic online intervention for blended care.

Background: Internet-based interventions offer a way to meet the high demand for psychological support. However, this setting also has disadvantages, such as the lack of personal contact and the limited ability to respond to crises. Blended care combines Internet-based interventions with face-to-face psychotherapy and merges the benefits of both settings. To ensure the uptake of blended care in routine care, Internet-based interventions need to be suitable for different therapeutic approaches and mental disorders. Objective: This paper describes the participatory development process of the Internet-based intervention "TONI" using a common therapeutic language and content on various transdiagnostic topics to be integrated into routine outpatient psychotherapy. Methods: To develop this intervention in a participatory manner, we followed the Integrate, Design, Assess, and Share (IDEAS) framework. In a multilevel development process, we used a combination of interviews, focus groups, and proofreading to optimally tailor online modules to routine outpatient psychotherapy. Building on well-established cognitive-behavioral online content, we included expert interviews with psychodynamic (n = 20) and systemic psychotherapists (n = 9) as well as focus groups with psychotherapists of different approaches (n = 10) and persons with lived experience of mental illness (PWLE; n = 10). Results: We describe the development process of TONI step-by-step, outlining the specific requirements that therapists from different therapeutic approaches as well as PWLE have and how we implemented them in our intervention. This includes the content and specific exercises in the online modules, aspects of data protection, language, design, and usability. Conclusion: Internet-based interventions that use a common therapeutic language and address therapeutic principles across different approaches have the potential to advance digitalization in psychotherapy. Involving psychotherapists and PWLE in intervention development may positively impact acceptance and usage in practice. This study shows how participatory intervention development involving both psychotherapists and PWLE can be carried out.

Meckel diverticulum: one pathology, different clinical presentations. A report of two cases.

Meckel diverticulum is the most prevalent congenital malformation of gastrointestinal tract and usually it remains asymptomaRomatic. Approximately in 25% of cases Meckel diverticulum comes to be symptomatic with various clinical presentations where lower gastrointestinal hemorrhage or intestinal obstruction represent the most frequent clinical outcome. In present paper two cases of complicated Meckel diverticulum in young patients are described; in both cases diagnosis was difficult and initially mistaken with other pathologies. Surgical resection was the treatment of choice.

Nurse practice centers in academia: an emerging subsystem.

Nurse practice centers have been instituted by numerous schools of nursing throughout the United States. This study was done in part to better identify their components as well as the forces constraining and stimulating their development. General systems theory was used as the theoretical base. Academically-based nursing centers were identified as a subsystem of both the health care system and the higher education system in America. As a subsystem of both of these systems, the nurse practice center operated by a school of professional nursing represents an entity that has the capacity to foster all components of professional nursing including scholarly practice, education and research. Forty such centers were found to be sites for a wide variety of care, research and learning involving faculty and students. Forces stimulating the development of such centers were faculty clinical practice, clinical learning experiences and service opportunities. Constraining forces were time management and role ambiguity. Faculty members' job satisfaction correlated significantly with the budget at the .007 level.

Nurse faculty practice: from theory to reality.

This article discusses the developmental stages involved in moving the concept of faculty practice from theory to reality. Bennis, Benne, and Chin's theories for planned change and Hage's theory for organizational change with a dominant coalition form the theoretical bases for this redical innovation. Smith's Time Line serves as the framework for tracing the development of the plan over its 6-year history. The political, logistic, and financial promoters and constraints at each stage of development are identified. Faculty reaction to the idea of faculty practice is presented, and the mechanisms used to bring about group consensus are described. The key elements for the successful transition of this plan are a small and resilient group of faculty planners and adaptation of existing organizational systems to accommodate nursing's interests. Finally, the practice plan is presented at its present stage of development with its future goals.

The undergraduate student as research assistant: promoting scientific inquiry.

As nurse scientists, we must find a way to excite our undergraduate students about research so that they will value it and include it as an integral part of their practice. The ambience surrounding scientific inquiry cannot be captured from readings and classroom activities alone, but must be modelled by enthusiastic faculty who are actively involved in research. Two exemplary cases involving the use of undergraduate students as integral members of faculty-directed research teams are described.

Promoting maternal infant health in rural communities. The Rural Health Outreach Program.

RHOP is a nurse-managed community-based program that uses a variety of approaches to reduce infant mortality and improve maternal child health. In a rural area, representative of much of the rural South, which has a persistent record of poor maternal-child outcomes, the program is using university and community resources to make a difference. The goal is to empower the community to help it help itself using all the available resources. The initial outcome data indicate that these positive changes are happening and can be the site for future activities by those in the community as well as the university. Future plans include involving more departments at the university in the program and expanding services to three additional counties. Graduate students and faculty are becoming interested in conducting research using RHOP activities as a base, and future grants are being considered to expand into new areas such as substance abuse and cancer prevention.

Nurse practice centers and faculty job satisfaction.

This descriptive, correlational study describes academically-based nurse practice centers and the associated job satisfaction of nurse faculty members. The theoretical framework selected for the research was general systems theory. The Boettcher Nursing Center Inventory (BNCI) was developed for the study to identify characteristics of these centers. The Brayfield Job Satisfaction Questionnaire (BJSQ) was used to determine levels of job satisfaction. Thirty-two centers in 25 states and 124 nursing faculty members participated in the study. Findings reveal that academically-based nursing centers are offering a wide range of nursing care to clients throughout the life span in a variety of settings. Forces stimulating continued nursing center development are opportunities for clinical practice, student learning, public service, professional development, research, income generation, and professional development. High levels of job satisfaction were indicated by BJSQ mean score of 70.83 (maximum score, 90). Significant correlations were found between job satisfaction and the budget (p less than or equal to .007): when the budget increased, the level of job satisfaction decreased.

Preventability of infant mortality in a rural community.

Preventability of infant mortality in a rural southern county was examined with a Delphi technique using case summaries of infant deaths during a selected four-year period. The first two rounds were aimed at developing a consensus of panelists' opinions about problems leading to the high infant mortality rate in the study area. From these opinions, an Infant Mortality Preventability Decision Tree and a Problem List was developed. Panelists used these in Rounds III and IV to evaluate the case summaries. There were significant differences in the preventability ratings between physicians and nurses, indicating the importance of assessing individuals' philosophies of preventability when working with an interdisciplinary team of health care providers.

Pain management knowledge of hospital-based nurses in a rural Appalachian area.

The American Pain Society cites the failure of health care providers to routinely assess pain and pain relief as the most common reason for unrelieved pain in US hospitals. Lack of knowledge on the part of nurses about pain and its treatment is one of the major barriers to achieving comfort for those in pain. Thus, the purpose of this descriptive study was to determine the pain management knowledge of hospital-based nurses in a rural Appalachian area. The nonpurposive sample consisted of 123 registered nurses. The questionnaire consisted of three sections: demographic items and two instruments designed to measure knowledge of opioid classification and pain management. The overall pain management knowledge score was 67.4%. The findings indicate a knowledge deficit specifically related to the behavioural indicators of pain, classification of opioid analgesics, properties of opioid analgesics and adjuvant medications, and incidence of addiction. This sample of rural nurses demonstrates similar pain management knowledge compared to the reported scores of urban nurses. These results may serve as the impetus to develop strategies to decrease the barriers to effective pain management. Further education about pain management is warranted.

Interaction of factors related to lactation duration.

Perceived social support and interpersonal dependency were studied as potential factors associated with lactation duration based upon previous breastfeeding experience. Inexperienced breastfeeding mothers perceived more social support than experienced breastfeeding mothers did. Perceived social support was not significantly correlated with lactation duration. An ancillary finding was that women providing a combination of breast milk and human milk substitutes had significantly lower social self-confidence than did mothers providing breast milk exclusively.

Use of electrical impedance scanning in the differentiation of sonographically suspicious and highly suspicious lymph nodes of the head-neck region.

Sonographic differentiation between inflammatory and malignant lymph nodes is difficult, due in part to almost unchanged morphology of small lymph node metastases; however, as cancer cells exhibit altered dielectric properties, measurement of local electrical field distortions may be useful as adjunct to ultrasound in detection of malignancy. In this study, we evaluated the ability of electrical impedance scanning (EIS) to differentiate cervically located sonographically suspicious or highly suspicious lymph nodes. Seventy patients with 106 sonographically suspicious lymph nodes (mean size 20 x 13 x 13 mm, mean depth 8 mm) were examined using TransScan TS2000 (Siemens, Erlangen, Germany; manufactured by TransScan Research and Development Co., Israel). Included in the study were cervical ( n=64), inframandibular/periparotideal ( n=32) and nuchal/supraclavicular ( n=10) nodes. The EIS results were compared with histopathological ( n=100) and serological ( n=6) findings. Sixty-two of 64 malignant lymph nodes were correctly detected using EIS; 19 of 42 inflammatory/benign lymph nodes were correctly identified as benign (true positive 96.9%, true negative 45.2%; accuracy 71.3%, negative predictive value 90.5%, positive predictive value 59.6%). The high tumour detection rate achieved in this study suggests that EIS may be of value as an adjunctive technique in differentiation of lymph nodes of the head-neck region. Software changes to reduce the high number of false-positive markers are, however, necessary to improve the value in the evaluation during a regular clinical routine.

The impact of technical conditions of X-ray imaging on reproducibility and precision of digital computer-assisted X-ray radiogrammetry (DXR).

OBJECTIVE: To evaluate the reproducibility of imaging and analysis for bone mineral density (BMD) determination using digital computer-assisted X-ray radiogrammetry (DXR; Pronosco X-posure, version V.2, Sectra Pronosco, Denmark); to verify potential factors that influence BMD extrapolation such as tube voltage, film-focus distance (FFD), film quality and brand (Kodak T-MAT-Plus, Konika SRH, Agfa Scopix), imaging technology (conventional, digital), imaging system (Kodak, Agfa) and exposure level (mAs); and to clarify whether DXR analysis based on printouts of digital images is comparable to analysis of conventional images. DESIGN AND PATIENTS: The hand of a cadaver was X-rayed using varied parameters: 4-8 mAs, 40-52 kV, 90-130 cm FFD. Radiographs under standardised conditions were performed 10 times using a conventional machine (Philips Super 80 CP) and the printouts of a digital system (Digital Diagnost Philips Optimus) for the analysis of reproducibility. One image was scanned and analysed 10 times additionally for imaging reproducibility. RESULTS: Reliability error of the system for the imaging process using conventional radiographs-rays was 0.49% (standard conditions: 6 mAs, 40 kV, 1 m FFD), using printouts of digital images was 2.89% (4 mAs, 42 kV, 1 m FFD) and regarding the analysis process was 0.22%. BMD calculation is not affected by alterations in FFD (precision error 1.21%), mAs (0.83%) or film quality/brand (0.38%), but differs significantly depending on tube voltage (2.70%). The system was not able to analyse conventional images with tube voltages of 49/52 kV. CONCLUSION: DXR technology is stable with most of the tested parameters. Normative data should exclusively be used for calculations using similar tube voltage or correction factors. All other parameters had no significant influence on the BMD calculation. Reproducibility is high. For technical reasons it is not recommended to use the printouts of digital images for BMD determination.