A novel deep learning conditional generative adversarial network for producing angiography images from retinal fundus photographs.

Fluorescein angiography (FA) is a procedure used to image the vascular structure of the retina and requires the insertion of an exogenous dye with potential adverse side effects. Currently, there is only one alternative non-invasive system based on Optical coherence tomography (OCT) technology, called OCT angiography (OCTA), capable of visualizing retina vasculature. However, due to its cost and limited view, OCTA technology is not widely used. Retinal fundus photography is a safe imaging technique used for capturing the overall structure of the retina. In order to visualize retinal vasculature without the need for FA and in a cost-effective, non-invasive, and accurate manner, we propose a deep learning conditional generative adversarial network (GAN) capable of producing FA images from fundus photographs. The proposed GAN produces anatomically accurate angiograms, with similar fidelity to FA images, and significantly outperforms two other state-of-the-art generative algorithms ([Formula: see text] and [Formula: see text]). Furthermore, evaluations by experts shows that our proposed model produces such high quality FA images that are indistinguishable from real angiograms. Our model as the first application of artificial intelligence and deep learning to medical image translation, by employing a theoretical framework capable of establishing a shared feature-space between two domains (i.e. funduscopy and fluorescein angiography) provides an unrivaled way for the translation of images from one domain to the other.

Effect of continuous positive airway pressure on maximal exercise capacity in patients with obstructive sleep apnea: a systematic review and meta-analysis.

STUDY OBJECTIVES: Exercise capacity is impaired in obstructive sleep apnea (OSA). There are conflicting reports on the effect of continuous positive airway pressure (CPAP) on maximal exercise capacity. The objective of this review was to determine if there is a change in exercise capacity and anaerobic threshold following CPAP treatment in OSA patients. METHODS: We conducted a systematic review and meta-analyses to summarize the changes in peak rate of oxygen uptake (V̇O2 peak) or maximum rate of oxygen uptake (V̇O2 max) and anaerobic threshold (AT) during cardiopulmonary exercise testing following CPAP intervention in patients with OSA. A systematic literature review was conducted to identify published literature on markers of V̇O2 peak, V̇O2 max, and AT pre- vs post-CPAP using a web-based literature search of PubMed/MEDLINE, Embase, CINAHL, and Cochrane review (CENTRAL) databases. Two independent reviewers screened the articles for data extraction and analysis. RESULTS: The total search of all the databases returned 470 relevant citations. Following application of eligibility criteria, 6 studies were included in the final meta-analysis for V̇O2 peak, 2 studies for V̇O2 max, and five studies for AT. The meta-analysis showed a mean net difference in V̇O2 peak between pre- and post-CPAP of 2.69 mL·kg-1·min-1, P = .02, favoring treatment with CPAP. There was no difference in V̇O2 max or AT with CPAP treatment (mean net difference 0.66 mL·kg-1·min-1 [P = .78] and -144.98 mL·min-1 [P = .20] respectively). CONCLUSIONS: There is a paucity of high-quality studies investigating the effect of CPAP on exercise capacity. Our meta-analysis shows that V̇O2 peak increases following CPAP treatment in patients with OSA, but we did not observe any change in V̇O2 max or AT. Our findings should be considered preliminary and we recommend further randomized controlled trials to confirm our findings and to clarify the peak and maximum rates of oxygen uptake adaptations with CPAP therapy.

Offline eLearning for undergraduates in health professions: A systematic review of the impact on knowledge, skills, attitudes and satisfaction.

BACKGROUND: The world is short of 7.2 million health-care workers and this figure is growing. The shortage of teachers is even greater, which limits traditional education modes. eLearning may help overcome this training need. Offline eLearning is useful in remote and resource-limited settings with poor internet access. To inform investments in offline eLearning, we need to establish its effectiveness in terms of gaining knowledge and skills, students' satisfaction and attitudes towards eLearning. METHODS: We conducted a systematic review of offline eLearning for students enrolled in undergraduate, health-related university degrees. We included randomised controlled trials that compared offline eLearning to traditional learning or an alternative eLearning method. We searched the major bibliographic databases in August 2013 to identify articles that focused primarily on students' knowledge, skills, satisfaction and attitudes toward eLearning, and health economic information and adverse effects as secondary outcomes. We also searched reference lists of relevant studies. Two reviewers independently extracted data from the included studies. We synthesized the findings using a thematic summary approach. FINDINGS: Forty-nine studies, including 4955 students enrolled in undergraduate medical, dentistry, nursing, psychology, or physical therapy studies, met the inclusion criteria. Eleven of the 33 studies testing knowledge gains found significantly higher gains in the eLearning intervention groups compared to traditional learning, whereas 21 did not detect significant differences or found mixed results. One study did not test for differences. Eight studies detected significantly higher skill gains in the eLearning intervention groups, whilst the other 5 testing skill gains did not detect differences between groups. No study found offline eLearning as inferior. Generally no differences in attitudes or preference of eLearning over traditional learning were observed. No clear trends were found in the comparison of different modes of eLearning. Most of the studies were small and subject to several biases. CONCLUSIONS: Our results suggest that offline eLearning is equivalent and possibly superior to traditional learning regarding knowledge, skills, attitudes and satisfaction. Although a robust conclusion cannot be drawn due to variable quality of the evidence, these results justify further investment into offline eLearning to address the global health care workforce shortage.

Development and validation of an instrument to measure the burden experienced by community health volunteers.

AIMS AND OBJECTIVES: To develop and validate a scale to measure the burden experienced by community health volunteers. BACKGROUND: Research demonstrates the burden experienced by informal carers is substantial. There is no available information about the burden placed on community health volunteers, nor is there a scale developed for the purpose of measuring their burden. DESIGN: An instrument development and psychometric analysis study was undertaken. METHODS: Exploratory principal component factor analysis was applied to investigate the internal structure of the new scale. RESULTS: The initial item pool derived from literature review and experts resulted in 44 items linked to volunteer burden. The final scale includes 20 items with a content validity index of 0·86 and Cronbach's alpha for test (0·82) and retest (0·77). The reliability coefficient of the test-retest results was 0·63 [95%-confidence interval = (0·44, 0·77)]. Principal component analysis identified five underlying factors: Factor 1 items are related to personal and family matters; factor 2 items are related to administrative issues; factor 3 items concern the community support; factor 4 items are related to organisational matters; and factor 5 items concern issues of adequate health promotion delivery. CONCLUSION: The 20 item instrument designed to measure the burden on community health volunteers in Taiwan showed good internal consistency, content validity and construct validity. The findings infer that the scale may be an effective measure of the burden experienced by community health volunteers. Further testing of this scale within other countries that make use of community health volunteers is required to confirm the results. RELEVANCE TO CLINICAL PRACTICE: As volunteers play an important role in supporting the work of community health nurses, the new scale provides a means for nurses to assess volunteers' level of burden and develop interventions as required.

Motivations to nurse: an exploration of what motivates students in Pacific Island countries to enter nursing.

The aim of this study was to explore the motivations of student nurses enrolled in nursing courses across a variety of Pacific Island countries. The image of nursing, the desire to help others, family and friends in the profession, personal experience, security, travel opportunities and flexibility have all been identified as motivators for people to enter nursing. To date, what motivates students in Pacific Island countries to enrol in a nursing course has not been investigated. An exploratory qualitative approach using focus group interviews with 152 nursing students was undertaken. Data were analysed using thematic content analysis, revealing four themes: (i) helping others; (ii) 'making a difference for my people'; (iii) following in the footsteps of others; and (iv) financial and professional gain. In a time of health and nursing workforce shortages, developing a deeper understanding of what drives people can be used to improve recruitment strategies in the future.

Accidental insider: living the PhD study.

This paper explores the concept of 'insider' and 'outsider' and the challenges involved in conducting research when the researches finds themself living the phenomenon under study. Recent literature has been drawn on to explain the context of the 'insider' and 'outsider' in regard to the stance of the researcher. This is followed by an overview of the personal experiences of the author. The advantages and disadvantages of being an insider within the context of the phenomenon of study are discussed along with the challenges and implications for a researcher 'living their PhD research'.

Burden experienced by community health volunteers in Taiwan: a survey.

BACKGROUND: Volunteers in Taiwan complement the delivery of health services by paid health professionals. However, in doing so, community health volunteers experience burdens associated with their activities. The reasons for these burdens and degree to which they are experienced are explored in this paper. Our study adds to international research regarding the burden experienced by volunteers. This project is the first to assess how community health volunteers in Taiwan experience burden. METHODS: The 20 item Burden on Community Health Volunteer (BCHV) instrument, specifically designed for this project, was administered to 435 volunteers attached to Community Health Promotion Development Centres in northern Taiwan. RESULTS: The overall burden experienced by volunteers is relatively low. However, a multivariate adjusted regression analysis revealed significant differences in volunteer burden depending on the number of people each volunteer served on average per week, as well as the volunteer's marital status and their perceptions about personal health. Volunteers who served many people and who perceived their own health as poor experienced a higher level of burden. Those who were a widow or a widower felt less burdened than others. CONCLUSIONS: The results of the study identify areas where burden is high and where strategies can be developed to reduce the level of burden experienced by community health volunteers in Taiwan. Community health volunteers in Taiwan complement the role of nurses and other health care providers so their retention is important to ongoing service delivery.

Burden experienced by community health volunteers in Taiwan: a qualitative study.

In Taiwan, volunteers of each Community Health Promotion Development Centres help to diffuse healthy lifestyle education and complement the paid workforce, especially community nurses. An interpretive, descriptive qualitative design, using focus groups, was conducted to explore the burden experienced by community health volunteers in Taiwan. The data were analyzed inductively, and emergent themes were explored. The majority of participants were female between 50 and 59 years old with an average of 4.5 years experience as a volunteer. Thematic analysis resulted in four themes: preparation and scope of practice, lack of support for the role, work overload and expectations of the role. Volunteers in Taiwan do not always have the necessary skills to care for their clientele because of an inadequate programme of orientation, lack of continuing education and support for the role, role overload and expectations placed upon them by the clients and others.

Indigenous Australians' participation in pre-registration tertiary nursing courses: a mixed methods study.

Indigenous nurses have the potential to improve access to health services for Indigenous people by ensuring that services are culturally safe and respectful of Indigenous peoples' needs. Therefore, developing a well-educated Indigenous nursing workforce is one way to improve the poor health outcomes of Indigenous Australians. A mixed methods study was undertaken to determine the current rates of enrollment, progression and completion of Indigenous nursing students in Australia and to explore student and staff perceptions of barriers to completion and strategies for success. The results indicate that the national average completion rates are 36.3% for Indigenous nursing students and 64.6% for non-Indigenous nursing students - an average difference of 28.3%. Indigenous nursing students and academics identified barriers to completion, which were similar to those identified in previous research. Success strategies, however, revealed the importance of individual student characteristics; academics' knowledge, awareness, and understanding; relationships, connections, and partnerships; institutional structures, systems, and processes; and, family and community knowledge, awareness, and understanding. This paper offers an overview of the integration and interpretation process that makes up the final phase of a mixed methods study.

Resilience in families with a member with chronic pain: a mixed methods study.

AIMS AND OBJECTIVE: To measure and explore between 2007-2010 measure and explore the nature of family resilience in the context of families with a member with chronic pain. BACKGROUND: Chronic pain impacts on the entire family. The literature suggests that it is possible to strengthen resilience in individuals with chronic conditions, but little is known about the impact of chronic pain on family resilience. DESIGN: A explanatory sequential mixed method study was undertaken. METHODS: In the initial quantitative phase, assessment measures were administered using the Connor-Davidson Resilience Scale, Family Impact of Pain Scale, Medical Outcomes Study Short Form 36 and Medical Outcomes Study Social Support Survey. Data were collected and analysed from 31 family cases (n = 67 participants). In the second, qualitative phase, follow-up semi-structured interviews were undertaken with 10 families to help explain the quantitative results. RESULTS: The impact of pain on the family was high overall, but the perceived impact was greater for the person with pain. Resilience scores were above average for both the person with pain and other family members. However, the person with pain scored lower on the resilience scale than other members of the family. The families scored high for social support overall, while the person with pain perceived they had greater support than their family members. CONCLUSIONS: Identifying the strengths or resilient properties inherent in families and using those strengths in the planning and implementation of care, especially of chronic conditions such as chronic pain, is pivotal to quality health outcomes. RELEVANCE TO CLINICAL PRACTICE: It is important that nurses and healthcare professionals include family members when planning and delivering care for persons with chronic pain. Identification of strengths within families can help tailor nursing interventions to meet family needs.

Through a critical lens: indigenist research and the dadirri method.

Indigenous scholars have addressed the problematic nature of research by adopting methodologies that fit well with their communities and that relate effectively and culturally with how knowledge is shared to give indigenous people a voice. In this article we discuss Dadirri, an indigenous research method and way of life, as a vital research framework, connecting it to other relevant political and critical methodologies such as Freire's transformative education process and Habermas' theory of communicative action. In doing so, we illustrate how this methodology provides a significant framework for indigenous researchers undertaking liberatory studies that promote change.

Chronic pain and the family: the experience of the partners of people living with chronic pain.

AIMS AND OBJECTIVES: The purpose of this study was to explore the impact of chronic pain on the partner and family of a person with chronic pain. BACKGROUND: Chronic pain impacts not only on the individual but also their partner and/or other family members. Families of people with chronic pain have reported feeling powerless, alienated, emotionally distressed, and isolated. These impacts have affected their relationship with the person with chronic pain. DESIGN: An interpretive qualitative design using in-depth interviews and thematic analysis was undertaken. METHODS: Purposive sampling and in-depth interviewing were undertaken to develop a rich description of the experience. RESULTS: Findings indicate the impact of chronic pain on the family is extensive, resulting in physical, social, and emotional changes. Four themes were revealed: (1) Family loss, (2) Life changes, (3) Emotional impact of pain, and (4) Future plans. CONCLUSION: This study reinforces and expands current knowledge regarding the impact of chronic pain on partners and families. Understanding this phenomenon opens opportunities for nurses and other health workers to develop and implement strategies to better support partners/families in the future. RELEVANCE TO CLINICAL PRACTICE: Nurses can help reduce the negative impact of pain by including families in assessment, education, referral and treatment processes, and by offering support and education to partners/families.

Circadian profiles of focal epileptic seizures: a need for reappraisal.

Circadian rhythm of seizure is underestimated in the study of focal epilepsies. A review of the current literature revealed a clear correlation between cortical epileptogenic focus and the circadian phase of seizure peak occurrence in adult patients. A single diurnal peak at 19:00 was found in seizures originating from the occipital lobe, between 5:00 and 7:00 in frontal lobe seizures, and between 16:00 and 17:00 h in temporal lobe seizures. Two diurnal peaks, between 5:00 and 7:00, and at 23:00 are reported in seizures from the parietal lobe, and between 7:00 to 8:00 and 16:00 to 17:00 in mesial temporal onset seizures. This circadian character of seizure occurrence in focal epilepsies may not be unique to partial seizures since recent clinical and experimental data indicate that generalized seizures also demonstrate circadian effects. The clinical evidence on generalized seizures and epilepsies is not recent, but a formal integration of circadian rhythmicity in our understanding and clinical management of epilepsies may be warranted.

Environmental enrichment improves behavioral outcome in the AY-9944 model of childhood atypical absence epilepsy.

Atypical absence seizures are drug resistant in the majority of children with Lennox-Gastaut syndrome and herald a poor neurodevelopmental outcome. Here we studied the effects of environmental enrichment, enriched housing conditions designed to stimulate sensory and motor systems in the brain, on behavioral outcome in mice treated with the cholesterol biosynthesis inhibitor AY-9944 (AY), a clinically relevant model of atypical absence epilepsy. Beginning at postnatal day (P) 2, C3H mice were treated with AY (7.5 mg/kg) every 6 days until P20 and then weaned into enriched or standard cages. After 30 days (∼P50), AY mice from the enriched housing condition exhibited less behavioral hyperactivity and anxiety, improved olfactory recognition, and spatial learning, but no significant reduction in the number of ictal discharges in comparison with their non-enriched cohorts. The beneficial effects of environmental enrichment in AY model were in some behavioral tests gender-specific in favor of males suggesting that other, possibly hormonally mediated mechanisms, may interact with the therapeutic effects of enrichment. Taken together, these data provide a starting point to derive clinical occupational therapies for improving behavioral outcome in cases of intractable childhood seizures.

The meaning of resilience to persons living with chronic pain: an interpretive qualitative inquiry.

AIM: The purpose of this study was to explore the meaning of resilience, or adaptation in the face of adversity, to people living with chronic pain. BACKGROUND: Little research on the usefulness of resilience, strength-based approach to health care has been undertaken to date in the area of pain yet this approach has recently been proposed as a new model for chronic pain management. However, the meaning of resilience to people with chronic pain remains unknown. DESIGN: An interpretive qualitative design using in-depth interviews and phenomenological type analysis was undertaken. METHODS: Purposive sampling and in-depth interviewing were undertaken to develop a rich description of the experience. RESULTS: The findings from this study revealed that while living with chronic pain is generally a negative experience, the participants also told positive stories around the following themes: (i) Recognising individual strength; (ii) Looking for the positives in life; (iii) Accepting the pain; and (iv) Learning to accept help. CONCLUSION: Chronic pain influences all aspects of life. Resilient individuals with chronic pain recognise the value of remaining positive, accepting help and learning to live with the pain. RELEVANCE TO CLINICAL PRACTICE: It is important for health professionals to recognise the role of supporting positive attributes in people living with chronic pain as a way of enhancing resilience.

Reclaiming caring in nursing leadership: a deconstruction of leadership using a Habermasian lens.

Nursing leaders function in an environment of increasing demands coupled with decreasing resources. This paper explores the landscape of nursing leadership from a critical theory perspective, particularly Habermas's theory of communicative action. We not only deconstruct contemporary nursing leadership, discussing the potential negative consequences for those who fulfil roles of both 'nurse' and 'leader', but also offer possibilities for a more positive future.

The impact of nursing leadership on patient safety in a developing country.

AIM: This article is a report of a study to identify the ways nursing leaders and managers in a developing country have an impact on patient safety. BACKGROUND: The attempt to address the problem of patient safety in health care is a global issue. Literature addressing the significant impact that nursing leadership has on patient safety is extensive and focuses almost exclusively on the developed world. DESIGN: A critical ethnography was conducted with senior registered nursing leaders and managers throughout the Fiji Islands, specifically those in the Head Office of the Fiji Ministry of Health and the most senior nurse in a hospital or community health service. METHOD: Semi-structured interviews were conducted with senior nursing leaders and managers in Fiji. Thematic analysis of the interviews was undertaken from a critical theory perspective, with reference to the macro socio-political system of the Fiji Ministry of Health. RESULTS: Four interrelated issues regarding the nursing leaders and managers' impact on patient safety emerged from the study. Empowerment of nursing leaders and managers, an increased focus on the patient, the necessity to explore conditions for front-line nurses and the direct relationship between improved nursing conditions and increased patient safety mirrored literature from developed countries. CONCLUSION: The findings have significant implications for developing countries and it is crucial that support for patient safety in developing countries become a focus for the international nursing community. RELEVANCE TO CLINICAL PRACTICE: Nursing leaders and managers' increased focus on their own place in the hierarchy of the health care system and on nursing conditions as these affect patient safety could decrease adverse patient outcomes. The findings could assist the global nursing community to better support developing countries in pursuing a patient safety agenda.