Adapting TeachABI to the local needs of Australian educators - a critical step for successful implementation.

Background The present study is the foundational project of TeachABI-Australia , which aims to develop and implement an accessible, nation-wide digital resource for educators to address their unmet acquired brain injury (ABI)-related professional learning needs. The aim of the present study was to identify the adaptations required to improve the suitability and acceptability of the TeachABI professional development module within the Australian education system from the perspectives of Australian educators. Methods The research design employed an integrated knowledge translation approach and followed the ADAPT Guidance for undertaking adaptability research. A purposive sample of eight educators eligible to teach primary school in Australia provided feedback on the module through a quantitative post-module feedback questionnaire and a qualitative semi-structured interview. Results Participants rated the acceptability of the module as 'Completely Acceptable ' (Mdn = 5, IQR = 1), and reported 'only Minor' changes were required (Mdn = 2, IQR = 0.25) to improve the suitability to the Australian context. Qualitative analysis of transcripts revealed three broad categories: (1) the usefulness of TeachABI , (2) the local fit of TeachABI , and (3) pathways for implementing TeachABI in the local setting. Recommended adaptations to the module collated from participant feedback included changes to language, expansion of content, and inclusion of Australian resources, legislation, and videos. Conclusions TeachABI is acceptable to Australian educators but requires modifications to tailor the resource to align with the unique schooling systems, needs, and culture of the local setting. The systematic methodological approach to adaptation outlined in this study will serve as a guide for future international iterations of TeachABI .

Neuropathic pain treatment provides unexpected benefit.

A 57-year-old African American woman was being treated at our clinic for neurogenic urinary incontinence (UI). The UI, which occurred day and night, began 2 years earlier following a laminectomy of vertebrae C3 to C6 with spinal fusion of C3 to C7 for cervical spinal stenosis. The UI persisted despite physical therapy and trials of oxybutynin and imipramine. Since the surgery, the patient had also been experiencing chronic (debilitating) neuropathic pain in both legs, and the sensation of incomplete bladder emptying. She denied bowel incontinence or saddle anesthesia. Her prescription medications included hydrocodone-acetaminophen 7.5/325 mg every 6 hours as needed for pain and lisinopril 20 mg/d for essential hypertension. The patient's body mass index was 23.3.

Increasing the effectiveness of referral of ovarian masses from cancer unit to cancer center by using a higher referral value of the risk of malignancy index.

HYPOTHESIS: Higher risk of malignancy index (RMI) with multidisciplinary approach will reduce the number of referrals of ovarian masses, thus reducing the stress for patients and workload at the cancer center. METHODS: Prospective observational study in which all patients with pelvic masses and an RMI lower than 450 were treated at the local hospital after discussion at multidisciplinary input. Patients with an RMI higher than 450 were referred to tertiary cancer centers. Records of multidisciplinary meetings, operative details, and histologic examination results were evaluated. Data were analyzed to calculate the predictive values and the sensitivity of this approach. RESULTS: If the RMI cutoff of 450 alone is considered, 1 woman with invasive cancer would not have been referred. The sensitivity for invasive epithelial ovarian cancer was 96.2% or 25 of 26 patients (95% confidence interval [CI], 80.4-99.9) with a positive predictive value of 96.3% or 26 of 27 patients (95% CI, 81.0-99.9). The specificity was 98.7% or 77 of 78 patients (95% CI, 93.1-100.0). The negative predictive value was 98.7% or 76 of 77 patients (95% CI, 93.0-100.0). CONCLUSIONS: A higher RMI with multidisciplinary approach to refer patients with pelvic masses has the potential to reduce the numbers of benign cases, thus reducing stress for patients and reducing workload at centers.

Readability and patient education materials used for low-income populations.

UNLABELLED: More than 90 million Americans have low levels of health literacy that may contribute to poor health outcomes. Assessment of the readability of patient education materials (PEMs) is a vital component of health education. PURPOSE: The aim of this study was to describe the readability of PEMs used in community healthcare settings serving low-income populations to provide further insight into the complex area of health literacy. DESIGN: A descriptive, correlational, and nonexperimental design was used for this study. SETTING: The setting for this study was 5 free and low-cost community clinics in a Midwestern urban area. SAMPLE: Thirty-five unique PEMs produced by professional sources (government agencies, drug companies, and state/national organizations) or by providers comprised the final sample. METHODS: Readability was measured using Simple Measure of Gobbledygook (SMOG), Flesch-Kincaid, and Flesch Reading Ease. Significance was determined through t tests and Spearman rho correlations. FINDINGS: Variability in grade levels was noted using all measures. Mean Flesch-Kincaid grade level was 7.01, and that for SMOG was 9.89. Mean level for Flesch Reading Ease was 63.40, an estimated eighth and ninth grade level. The SMOG consistently measured 2 to 4 grades levels higher than did Flesh-Kincaid. Professionally developed PEMs had significantly higher reading levels using both SMOG and Flesch-Kincaid and were more difficult to read using Flesch Reading Ease when compared with those prepared by individual providers. CONCLUSIONS: Patient education materials were written at a level too high for the average adult. All PEMs should be analyzed carefully to ensure that they are at the recommended fifth grade level. Further understanding of available measures of readability is critical in the creation and/or assessment of PEMs that will strengthen services from safety net providers and support positive health outcomes. IMPLICATIONS: Nurses must expand their knowledge of all aspects of literacy and readability and take a proactive role in assessment and development of PEMs. Further research is needed to determine the best readability measures.

Health-promoting behaviors of sheltered homeless women.

To expand the body of knowledge and provide further insight into the complex area of homelessness and health, health practices of sheltered homeless women were investigated using a cross-sectional, descriptive, and non-experimental design using Pender's Health Promotion Model as the theoretical framework. The sample (n=137) was well educated, mostly unemployed, primarily single, and homeless due to relationship problems/conflict per self-report. Homeless women were noted to practice health-promoting behaviors in all areas but scored the lowest on physical activity and nutrition. Significant findings reflected women's personal strengths and resources in the areas of spiritual growth and interpersonal relations.

The future of telemedicine.

Despite a decade of tremendous advances in telemedicine, it still has potential far beyond current reality. New technologies are making the use of telemedicine ever more compelling and cost and payment barriers are being tackled so fewer barriers will impede the broad adoption of a now-proven cost-saving delivery of a variety of health care services. Adoption of telemedicine will accelerate with the aging of the Baby Boomer generation and globalization forces will broaden adoption and drive cost down.

Unwanted pregnancies involving young women and men in a New Zealand birth cohort.

AIMS: To examine the circumstances of wanted and unwanted pregnancies before age 25 years for both women and men, and compare the circumstances of the most undesired pregnancies with all others. METHODS: Cross-sectional study within a birth cohort using a computer-presented questionnaire. RESULTS: Of the 477 women, 173 (36%) had been pregnant before age 25 years, and experienced 289 pregnancies of which 173 (60%) were unwanted. Of the 489 men, 142 (29%) reported 225 pregnancies before age 25, of which 165 (73%) were unwanted. By age 25 about a quarter of the study members (27% of women and 24% of men), had been involved in at least one unwanted pregnancy. Wantedness increased with age and length of relationship with the other parent; both factors remained significant in multivariate analysis for men, but not age for women. For women unwanted pregnancies were more likely to be due to non-use of contraception than failure. For both women and men the commonest single reason for not using contraception was not thinking about it, followed by alcohol use. CONCLUSIONS: An environment has emerged for men and women in their twenties in New Zealand where most are sexually active but do not want a pregnancy to occur. To delay pregnancy for a prolonged period requires dedication and commitment to effective contraception. While more attention needs to be paid to promotion of effective use of contraception, more understanding is called for over the difficulties of avoiding pregnancy with long-term reversible contraception. A further approach to the problem of unwanted pregnancies which should be investigated is to encourage committed sexual relationships.