Efficacy of beta blockers in the management of problem behaviours in people with intellectual disabilities: a systematic review.

Both medication and non-medication based strategies are used in the management of problem behaviours in individuals with intellectual disabilities. Beta-adrenoceptor blocking medications are one group of drugs used for this purpose. However, despite its regular use, the evidence for the efficacy of these drugs for in this context is lacking. A systematic review was conducted to establish the research evidence for the efficacy of beta blockers in problem behaviours in adults and children with intellectual disabilities. Although the research identified supported the efficacy of beta blockers for this indication the overall quality of studies identified was poor and no randomised controlled trials were identified. There is a need for more robust research into the use of beta blockers for people with intellectual disabilities who show problem behaviours.

Evaluating parents' perspectives of pediatric ethics consultation.

Ethics consultation is a familiar concept to clinicians, and there are site-specific guidelines detailing procedures for both obtaining and performing these consults. Evaluative data about clinician experiences with ethics consults are becoming more extensive but information about family experiences, especially parent perceptions, of the same is lacking. Without a better understanding of those family experiences, an evidence base for ethics consultations cannot be built. This manuscript describes the reasons for obtaining this necessary information, details prior research designed to obtain knowledge about family experiences with pediatric ethics consultations, and suggests mechanisms for acquiring it.

Making research real: embedding a longitudinal study in a taught research course for undergraduate nursing students.

Learning how and why scholarly research underpins and informs professional nursing practice is a continual challenge for undergraduate nursing students. They find the language and methods of research to be unfamiliar and unsettling. The work of educators thus becomes the process of breaking down barriers to students' understanding of research processes and application. Such work is increasingly important in the current era of evidence based practice, where students must be competent in sourcing, critiquing and applying research to meet real clinical questions. In response, as lecturers who taught the course, Research for Health Professionals, we have reinvented how research is taught to second year undergraduate students. This article outlines our creative approach to facilitate students learning research theory and methodology by conducting a "real-life" research study in a local retirement community.

Improving recording of capacity to consent and explanation of medication side effects in a psychiatric service for people with learning disability: audit findings.

This study aimed to examine the practice of psychiatrists in a large learning disability service in recording capacity to consent to treatment and side effect discussion, and the impact of measures aimed at improving this. Three audit cycles were completed between 2007 and 2009, each examining 26 case notes selected at random. Information was gathered on recording of capacity and documentation of explanation of potential side effects. Changes in practice following the introduction of a rubber stamp in 2008, as a visual prompt for clinicians, were examined. Rates of recording of capacity rose from 30% in 2007 to 51% in 2009 (P = 0.000006). Capacity was more likely to have been recorded if the stamp was present (odds ratio 13.5, p < 0.0001). Recording of side effect discussion was consistently higher than that of capacity and showed little change between cycles. We conclude that the use of a rubber stamp in case notes was associated with improvements in the recording of capacity assessments.

Great expectations: points of congruencies and discrepancies between incoming accelerated second-degree nursing students and faculty.

This study analyzes the expectations that incoming students and faculty bring to accelerated pre-licensure education programs for second-degree students. Although research supports the congruence of expectations between students and faculty as essential to learning, anecdotal evidence and single case reports suggest there may be important discrepancies in expectations of second-degree students and their faculty. Data are intended to support curriculum review, refinement, and innovation in these programs.

A road not taken: the proposal for a Harvard School of Nursing.

The modernist orientation of nurse leaders in the late nineteenth century directly impacted the future of nursing in the USA. Their orientation is explored in this article as a factor that may have contributed to the failure of the Harvard School of Nursing proposal - a road not taken in nursing education, a road that would have afforded nursing an early central role within the Harvardization of American post-secondary education. The backlash resulting from the attention that was given to Alfred Worcester and Annette Fiske's radical call for contextualization is explored. Modernist tropes of thought that enabled early nurse leaders to weld nursing education to hospitals through the actions of nursing superintendents are described. Outcomes resulting from this welding are delineated, including idolatry of the hospital as nursing's icon, subservience to physicians, a monastic on-duty mantra, the development of a standardized curriculum linked to hospitals, and the framing of state registration within a philosophy that disenfranchised nurses. A non-teleological, narrative analysis of this case is offered to enable nursing to heighten the tensions between the tropes of modernism and those of contextualism, and thus, to empower leaders in the re-invention of America's twenty-first century healthcare delivery system.

Parents' views of involvement in concurrent research with their neonates.

It would be useful to researchers and bioethicists to know more about parents' decision processes and emotional state during the time they are deciding whether to enroll their infant in a clinical trial. The aim of this research study was to discover whether parents who had been previously asked to enroll their neonates in clinical trials would have found concurrent research about their decision-making overly burdensome. Twenty-seven parents of critically ill neonates who had been approached for their child's research participation in a clinical trial were asked what they believed about the potential burden or value of being interviewed during the time of research decision-making about their infant's participation. For this qualitative descriptive study, interviews were audio-recorded, transcribed, and analyzed using content analysis techniques. Participants considered concurrent research acceptable for them but potentially problematic for others. Theories of risk preferences and social comparison might explain these findings.

The behavioral assessment scale: a measure of community living skills.

This study reports the development of a community living skills measure of long-term care AIDS residents. Community living skills impact numbers and types of care providers needed. The Behavioral Assessment Scale (BAS) used multiple sources of validity evidence to ensure community living skills construct representation. The BAS was piloted in four diverse long-term care facilities. Nurses rated residents using the BAS and the Nurse Perception Scale (NPS)-another community living skills measure. Researchers rated residents' community living skills through medical record notations (Interdisciplinary Notation Scale [INS]). Reliability coefficients over .6 (p < .001) were reported for the BAS in both the total sample and the individual samples. Evidence-based validity of the BAS was obtained via coefficients from the total sample (.422 [BAS and INS] and .526 [BAS and NPS], with p < .001 for both relationships), Cronbach's alpha (.851 for all community living skills tools), analysis of variance, and regression results. The BAS was substantiated for long-term care practice with AIDS residents.

Parents and professionals in the NICU: communication within the context of ethical decision making--an integrative review.

Communication between parents and professionals in the NICU is a necessary part of collaborative decision making in the provision of family-centered care. Decisions with ethical components, those regarding treatment plans or neonatal research enrollment, need to be made conjointly with parents and health care professionals. This article reviews the present state of knowledge of how parents' input can be facilitated in regard to decisions made about their children. Research studies involving decisions made with ethical components in the NICU since the advent of the Baby Doe regulations reveal parents' frustration with communication practices, their need for control of information, and the trust in their children's health care providers that is required to best facilitate their input into ethical decisions made about their children.

Exception from informed consent for pediatric resuscitation research: community consultation for a trial of brain cooling after in-hospital cardiac arrest.

OBJECTIVES: When prospective informed consent is not feasible, clinical research that presents more than minimal risk can proceed only after a community consultation and public disclosure process and the granting of exception from informed consent from the federal government. The applicability of exception from informed consent to pediatric resuscitation research has not been described. The objectives of this study were 1) to perform a community consultation and public disclosure process specific to a trial of induced hypothermia immediately after pediatric cardiac arrest and 2) to determine the applicability of exception from informed consent to randomized, controlled trials of emergency interventions after resuscitation from inpatient pediatric cardiac arrest. METHODS: Focus groups, information sheets with options for written responses, posted notices, e-mails, and telephone conversations with parents of critically ill children and hospital staff were conducted at a tertiary care children's hospital. Data were stored, organized, and retrieved using NVivo qualitative analysis software (QSR International). RESULTS: In focus groups (n = 8), parents (n = 23) and hospital staff (n = 33) concluded that prospective informed consent is not feasible for a trial of induced hypothermia after inpatient pediatric cardiac arrest. Focus group participants endorsed exception from informed consent for a trial of induced hypothermia but only if study information is easily available prospectively and if all parents have an explicit opportunity to decline participation in a verbal conversation before study enrollment. Separate from and without knowledge of the focus group results, 7 (100%) of 7 parents of past or current patients and 21 (50%) of 42 hospital staff who provided written opinions endorsed exception from informed consent for this study. Five (12%) of 42 hospital staff opposed, and 16 (38%) of 42 were neutral. In telephone conversations, 14 (70%) of 20 parents of children who were previously resuscitated from cardiac arrest endorsed exception from informed consent for this study, 3 (15%) of 20 opposed, and 3 (15%) of 20 were unsure. CONCLUSIONS: Community consultation for inpatient resuscitation research can be conducted in a children's hospital, with hospital staff and parents of patients as the relevant community. Exception from informed consent is necessary and appropriate for a randomized trial of induced hypothermia begun within 30 minutes after pediatric cardiac arrest. A process in which families are informed prospectively and have a pre-enrollment option to decline participation will likely be acceptable to families, health care providers, and the institution.