Initial Exploratory Study Research Articles

Effectiveness of Homeopathic Medicines as Add-on to Institutional Management Protocol for Acute Encephalitis Syndrome in Children: An Open-Label Randomized Placebo-Controlled Trial.

Acute encephalitis syndrome (AES) is endemic to certain parts of India, with limited treatment options. In our initial exploratory comparative observational study of 151 patients with AES, there was significantly reduced mortality with adjunctive homeopathy compared to institutional management protocol (IMP). The present randomized placebo-controlled trial brings more statistical rigor to this research program. This study was conducted at a pediatric unit from 2013 to 2015. Children aged > 6 months and ≤ 18 years and receiving IMP were randomized to receive adjunctive homeopathy (n = 325) or placebo as control (n = 323). The primary effectiveness analysis was based on Glasgow Outcome Scale (GOS). Morbidity was assessed using the Liverpool Outcome Score for Assessing Children at Follow-up. Analysis was by intention to treat. A total of 612 children were analyzed (Homeopathy [H] = 304; Control [C] = 308). The primary outcome, GOS, differed significantly between H and C groups. There was 14.8% death/neuro-vegetative state in the H group compared to 29.8% in the C group. Relative risk was 0.49 (95% confidence interval [CI]: 0.36 to 0.68), with absolute risk reduction of 15.0% (95% CI: 8.6 to 21.6%). Number needed to treat to prevent one additional death/neuro-vegetative state was 6.6 (95% CI: 4.6 to 11.6). Proportional-odds analysis also revealed a greater effect in the H group: odds ratio, 0.40 (95% CI: 0.27 to 0.60). The most frequently used medicines were Belladonna (n = 116), Stramonium (n = 33), Arsenicum album (n = 25), Sulfur (n = 18), Opium (n = 17), and Nux vomica (n = 10). Adjunctive homeopathic medicines may improve clinical outcomes associated with AES. Further randomized and controlled studies, using double-blinded trial design, are recommended to discover if the current findings may be corroborated.

A Practitioner Reflection on Accessibility in Virtual Reality Environments

In this paper the author reflects on the accessibility issues and solutions that are specific to the intersection of virtual reality and gaming. This is a complex and nuanced usability domain for developers as it brings to the fore numerous issues for people with disabilities that are not prominently expressed in the design of most gaming experiences. Issues such as simulation sickness, binocularity of vision, physical context and the spatiality of an environment are all significant. There is limited developer awareness as to best practice in this new and innovative domain, and often no clear answer as to what the correct approach is likely to be. This paper represents a synthesis of the existing literature in an attempt to identify and map out the key areas for future research. There are many promising opportunities for collaborations between industry and academia. There are many interesting challenges in this field. It is hoped that this paper serves as an initial exploratory study on where investigation should be directed to ensure the greatest impact of future work in this area.

Family Group Conferencing for older adults: Social workers’ views

Summary Family Group Conferencing as deployed in child care might be useful in elderly care to strengthen older adults’ social networks and self-mastery. When Family Group Conferencing was implemented for older adults in the Netherlands, social workers were reluctant to refer. To discover reasons for this reluctance, we examined social workers’ views and attitudes concerning Family Group Conferencing for their clients. Findings In an initial exploratory study, we distributed a survey among social workers who worked with older adults and were informed about Family Group Conferencing, followed by three focus groups of social workers with and without Family Group Conferencing experience. We also held semi-structured individual interviews with social workers and an employee of the Dutch Family Group Conferencing foundation. The respondents were positive about Family Group Conferencing, but hesitant about referring their older clients. Reasons were: they were already working with their clients’ social networks; they feared losing control over the care process; and they wondered how they could motivate their clients. They also reported that their clients themselves were reluctant, because they seemed to fear that Family Group Conferencing would lose them self-mastery, and they did not want to burden their social networks. Applications Our findings indicate that implementing Family Group Conferencing in elderly care is a complicated and slow process, partly because social workers have little experience with Family Group Conferencing. To facilitate social workers it might be necessary to offer them more guidance, in a joint process with the Family Group Conferencing foundation. One might also experiment with alterations to the Family Group Conferencing model, for example, by focusing less on family networks and more on reciprocity.

The Protective Behavioral Strategies for Marijuana Scale: Further examination using item response theory.

Given recent state legislation legalizing marijuana for recreational purposes and majority popular opinion favoring these laws, we developed the Protective Behavioral Strategies for Marijuana scale (PBSM) to identify strategies that may mitigate the harms related to marijuana use among those young people who choose to use the drug. In the current study, we expand on the initial exploratory study of the PBSM to further validate the measure with a large and geographically diverse sample (N = 2,117; 60% women, 30% non-White) of college students from 11 different universities across the United States. We sought to develop a psychometrically sound item bank for the PBSM and to create a short assessment form that minimizes respondent burden and time. Quantitative item analyses, including exploratory and confirmatory factor analyses with item response theory (IRT) and evaluation of differential item functioning (DIF), revealed an item bank of 36 items that was examined for unidimensionality and good content coverage, as well as a short form of 17 items that is free of bias in terms of gender (men vs. women), race (White vs. non-White), ethnicity (Hispanic vs. non-Hispanic), and recreational marijuana use legal status (state recreational marijuana was legal for 25.5% of participants). We also provide a scoring table for easy transformation from sum scores to IRT scale scores. The PBSM item bank and short form associated strongly and negatively with past month marijuana use and consequences. The measure may be useful to researchers and clinicians conducting intervention and prevention programs with young adults. (PsycINFO Database Record

A Prospective, Randomized, Multicenter Clinical Trial on the Safety and Efficacy of a Ready-to-Use Fibrin Sealant as an Adjunct to Hemostasis during Vascular Surgery

Anastomotic or "stitch hole" bleeding is common during vascular surgery with synthetic material such as Dacron or polytetrafluoroethylene. Hemostatic adjuncts such as fibrin sealant (FS) may reduce blood loss and operating time in such circumstances. We evaluated the safety and the hemostatic effectiveness of a ready-to-use human plasma-derived FS in vascular surgery. Patients with mild/moderate suture line bleeding during elective, open, vascular surgery using synthetic grafts or patches were studied. In an initial Exploratory Study, all patients were treated with FS Grifols, and in a subsequent Primary Study were randomized in a 2:1 ratio to FS Grifols or manual compression (MC). The primary efficacy end point was time to hemostasis (TTH), assessed at defined intervals from the start of treatment application, during a 10-min observational period. Safety end points (in Exploratory+Primary Studies) included adverse events (AEs), vital signs, physical assessments, common clinical laboratory tests (coagulation, complete blood count, serum clinical chemistry parameters, microscopic urinalysis), viral markers, and immunogenicity. In the Primary Study, the proportion of patients who achieved hemostasis at the 3-min time point was higher in the FS Grifols group (46.4%, n=51/110) than in the MC group (26.3%, n=15/57) (P<0.05). The benefit was maintained at successive time intervals: 69 FS Grifols patients (62.7%) and 18MC patients (31.6%) at 4min; 82 FS Grifols patients (74.5%) and 28MC patients (49.1%) at 5min. The differences between the groups persisted for TTH ≤ 7min and TTH ≤ 10min. Treatment failure was reported for 13 FS Grifols patients (11.8%) and 16MC patients (28.1%). TTH was shorter after FS Grifols application than after MC application. Differences were statistically significant in favor of FS Grifols for each TTH category and for the overall comparison (P<0.001) as well as for each TTH category (cumulative) and for treatment failure (P=0.016). Overall, AE experience and types of AEs reported were those expected in this patient population and were similar between the 2 treatment groups. The most frequently reported AEs were procedural pain (59.9% and 69.2% of patients in the FS Grifols [n=72+111] and MC [n=57] groups, respectively) and nausea (23.5% and 19.2% of patients, respectively). FS Grifols was efficacious and safe as an adjunct to anastomotic hemostasis in patients undergoing arterial surgery using prosthetic material with mild to moderate bleeding.

Features students really expect from learning analytics

More and more learning in higher education settings is being facilitated through online learning environments. Students' ability to self-regulate their learning is considered a key factor for success in higher education. Learning analytics offer a promising approach to better support and understand students' learning processes. The purpose of this study is to investigate students' expectations towards features of learning analytics systems and their willingness to use these features for learning. A total of 20 university students participated in an initial qualitative exploratory study. They were interviewed about their expectations of learning analytics features. The findings of the qualitative study were complemented by a quantitative study with 216 participating students. The findings show that students expect learning analytics features to support their planning and organization of learning processes, provide self-assessments, deliver adaptive recommendations, and produce personalized analyses of their learning activities.

Correlation of ABO blood groups with spontaneous recanalization in acute myocardial infarction

Objectives. Although previous studies have demonstrated the relationship between ABO blood groups and cardiovascular disease, the association of ABO blood type with spontaneous recanalization (SR) in patients with acute myocardial infarction (AMI) has not been previously investigated. Methods. We performed an initial exploratory study on the association of ABO blood groups with the presence of SR in 1209 patients with AMI. They were divided into two groups according to the thrombolysis in myocardial infarction (TIMI) grades: no-SR group (TIMI 0–1, n = 442) and SR group (TIMI 2–3, n = 767). To confirm our primary findings, data from a second AMI population (n = 200) was analyzed. Results. In the initial data, SR group had a significantly higher percentage of blood type O and a lower percentage of blood type A compared to the no-SR group. Multivariate logistic regression analysis showed that blood type O was positively associated with SR (odds ratio: 1.40, 95% confidence interval: 1.05–1.87, p = .02), and this finding was confirmed in our second population. Conclusion. The present study demonstrates that blood type O was independently and positively associated with an open culprit artery in patients with AMI, suggesting that the ABO blood type is not only associated with the susceptibility to coronary artery disease but also to spontaneous reperfusion in AMI patients.

Bridging the Gap between Brazilian Startups and Business Processes – Process Thinking’s Initial Exploratory Case Study

Startup is a new business segment that has been growing up in the last years. These companies have an innovative spirit and are usually searching for new solutions to real problems that can be transformed into scalable businesses. The majority of these companies are not aware of their processes and how the company need to be organized. For this kind of companies, we propose Process Thinking, an innovative approach that makes the business process management viable in the daily lives of startups. This paper presents the Process Thinking framework, which prescribes 10 main processes that a startup needs and a utility belt to help the startup to organize their processes. We illustrate this proposal through an exploratory case study with a real IT startup company that used a 5-step methodology in an immediate implementation of proposed processes and artifacts. The results indicate a positive impact in the short and medium term strategies and management of the startup. However, these results cannot be generalized to other startups and should be received with caution, since this is an initial exploratory study limited to a single company.

Employee Primacy and Corporate Slogans in Japanese and American Firms’ Communication in Times of Crisis

Given the frequency and severity of crises faced by organizations, the question of how managers can best lead their organizations through times of crisis is important. Communication plays a particularly critical role in such situations. We perform a multistage content analysis study using letters to shareholders appearing in publicly traded Japanese and U.S. firms during the economic downturn following Lehman Brothers bankruptcy in 2008. In our initial exploratory study, we identify employee primacy and the existence of corporate slogans as relevant constructs. We then develop hypotheses and test them in a larger sample confirmatory study. We find that firms concurrently exhibiting both employee primacy and corporate slogans in their communication outperformed their peers. To aid in interpreting our results, we also provided three examples of qualitative descriptions of such firms. Our Japanese and U.S. sample increases the generalizability of our results.

Relations Between Self-Regulation Behavior and Vocal Symptoms

The study aimed to determine if people with vocal symptoms have different self-regulation aspects compared with vocally healthy people, and to evaluate the relationship between the number of vocal symptoms and self-regulation. This is a cross-sectional, prospective, multicentric study. Two hundred ninety-eight male and female adults who are nonprofessional voice users volunteered to participate in the study. The participants answered an online survey and two self-assessment instruments: the Voice Symptom Scale (VoiSS) and the Short Self-Regulation Questionnaire (SSRQ). Individuals were classified into two groups according to VoiSS cutoff value: a vocally healthy group (total score of 15 points or lower) and a vocal symptoms group (16 points and above). The subscales of the VoiSS (impairment, emotional, and physical) were compared with the subscales of the SSRQ (goal setting and impulse control). Subjects of the vocally healthy group scored differently from subjects with vocal symptoms both in goal setting and impulse control. The results from subjects with vocal symptoms are similar to individuals with addictive behaviors. A significant negative correlation was found between the SSRQ and the VoiSS scores, indicating a strong relationship between self-regulation and vocal symptoms. A relationship between impulsivity, lack of control, and difficulty in goal setting for specific behaviors was also noted. However, caution should be taken as this is an initial exploratory study using self-assessment questionnaires. Subjects with vocal symptoms have a lower level of self-regulation compared to those without vocal symptoms. As the number of vocal symptoms increased, the impulse control and goal setting scores decreased.

What sow the seeds of hardship for the poorest of the poor? Towards increasing the performance of informal sector in war affected regions of Sri Lanka

Less performance of informal sector among the poorest of the poor in the war affected regions in Sri Lanka has been caused by many reasons. Findings of an exploratory study and the factor analysis revealed four important factors namely training and skills, education, social and economic. As the extension of the exploratory study, to test this prediction empirically with a larger sample size, the present study applied a survey method using a questionnaire especially designed based on the initial exploratory study which was conducted inductively. A sample of 300 women headed households engaged in the informal sector participated in this study. The results indicates these four factors significantly predict the performance of informal sector. More specifically, while, economic factors contribute more to the performance of the informal sector, training contributes less. The study also discussed the implication of findings and area for future research. Based on the findings and conclusions, few recommendations are also made to enhance the performance of women headed households in the informal sector.

Integrated in the industrial design system

Although the majority of trends confirm the design aspects of the performance, functional and aesthetic design of the product. However, the attention was more focused on the nature of the plastic for those results, it is through the appearance of formal and guaranteed career such as designing Achieved adopt us the extent of the impact Relations Association between the elements and principles of design to achieve complementarity in the completed design of aesthetic and functional significance expressive and symbolic and in doing so has introduced a lot of new concepts for the arrangement and organization, coordination and functional classification of the unfinished design gave way to show diversity trends in the design of industrial products, according to the value of functionality and aesthetic addition to the specifications of the raw material, organization and composition of the design, which featured creations design in done through the introduction of changes in the systems of formal and functional in the construction design of the accomplishment associated with the function of the design and the accompanying technical evolution of the material is a necessity in the maturing design idea. Through an initial exploratory study researcher of industrial products performed locally in the city of Baghdad, the researcher found that there is a problem standing in front of the concept of complementarity in terms of construction and relations between the Association and the meaning of integration based on the basis of the dimensions of the aesthetic and functional design is finished

Explicating consumer segmentation and brand positioning in the Islamic financial services industry

Purpose– The purpose of this paper is to discuss how the current research on the Islamic financial services industry attempts to classify its consumers and provide a fresh and critical insight into the retail Islamic banking market segmentation to harness and enhance understanding, as well as provide a guideline for a better segmentation to bank marketers.Design/methodology/approach– This study is conceptual in nature. Based on Qur’anic verses and previous literature, the authors aim to propose an applicable model of market segmentation for the retail Islamic banking market in Malaysia. Consumer segmentation in the conventional financial service industry is analysed, and prior studies on the selection criteria of Islamic banks are evaluated.Findings– In moving forward, taking cue from the classification of people in classical doctrinal and historical literature and the initial exploratory study conducted from the managerial perspective, the authors propose five cluster groups of consumers for the retail Islamic banking market in Malaysia, namely, religious conviction, religious and economic rationality, economic rationality, ethical observant and economic rationality and ethical observant. A discussion linking consumer segmentation to the branding in the retail Islamic banking market is discussed.Research limitations/implications– The five cluster groups of consumers for the retail Islamic banking market in Malaysia proposed in this study pave the way for embarking on promising and relevant future research, which is needed to substantiate and enrich the academic understanding and managerial practice of linking market segmentation and brand positioning for Islamic banking market in Malaysia. Future research should focus on verifying the five proposed segments by conducting empirical studies on a larger scale among the retail banking consumers in Malaysia and globally.Practical implications– The study provides an initial bases or dimensions of consumers of the retail Islamic banking market in Malaysia. The proposed consumers segments are useful in guiding the management of Islamic bank in Malaysia in making decisions relating to the promotion strategy as well as product and brand positioning strategy.Originality/value– For both academia and the Islamic banking industry, this study provides useful knowledge in strategically using market segmentation to position Islamic banking products and services in Malaysia and the global market.

STEM Education and Sexual Minority Youth: Examining Math and Science Coursetaking Patterns among High School Students

Sexual minority students such as those identifying as lesbian, gay, or bisexual, as well as those identifying with emerging self-labels (e.g., queer) face a host of risk factors in high school that can potentially compromise educational excellence, particularly in rigorous academic disciplines. The current study advances the area of diversity within science, technology, engineering, and mathematics (STEM) education by empirically exploring the question: Is there a gap in STEM education participation based on sexual minority status? After reviewing the relevant research, we employed hierarchical linear modeling to explore advanced math and science coursetaking patterns among a nationally representative sample of students from the National Longitudinal Study of Adolescent Health. Results of this initial exploratory study suggest that advanced math and science course-taking does not vary significantly based on sexual minority status once a host of individual and school factors are included. The null findings advance the discussion of equity and excellence in STEM education as it relates to vulnerable populations. The article ends with a discussion of limitations and directions for future research.

Serum Magnesium and Mortality in Hemodialysis Patients in the United States: A Cohort Study

Low serum magnesium levels in patients with kidney disease have been linked to increased mortality. This study investigated whether similar associations existed in maintenance hemodialysis (HD) patients. Cohort study. All Fresenius Medical Care North America in-center HD patients with available serum magnesium measurements were studied. The initial exploratory study in 21,534 HD patients evaluated associations among serum magnesium level, dialysate magnesium concentration, and mortality from April 2007 through June 2008. The follow-up study in 27,544 HD patients evaluated associations between serum magnesium levels and mortality over 1 year (January through December 2008). The primary predictor was serum magnesium level, with adjustment for case-mix (age, sex, race, diabetes, and dialysis vintage and additionally for follow-up study: body surface area and vascular access) and laboratory variables (albumin, hemoglobin, phosphorus, equilibrated Kt/V, potassium, calcium, and intact parathyroid hormone values). Primary outcome variable was 1-year mortality risk, evaluated using Cox proportional hazards models. Among 21,534 HD patients in the exploratory study, there were 3,682 deaths. Higher dialysate magnesium level was associated with higher serum magnesium level (R=0.22; P<0.001). Patients with the lowest serum magnesium levels (<1.30 mEq/L) were at highest risk for death (HR, 1.63; 95% CI, 1.30-1.96; reference serum magnesium, 1.60-<1.90 mEq/L). Among 27,544 HD patients in the follow-up study, there were 4,531 deaths. In Cox proportional hazards models, there was a linear decline in death risk from the lowest to the highest serum magnesium category, with the best survival at serum magnesium levels≥ 2.50 mEq/L (HR, 0.68; 95% CI, 0.56-0.82). However, risk estimates were attenuated with case-mix and lab adjustment. This pattern was consistent within diabetes subgroups and for cardiovascular or noncardiovascular causes of death. Observational study with cross-sectional serum magnesium measurements and no information for oral magnesium intake. Elevated serum magnesium levels > 2.10 mEq/L were associated with better survival than low serum magnesium levels< 1.30 mEq/L in HD patients. Prospective studies may determine whether manipulation of low serum magnesium levels affects survival.

Simultaneous PET-MRI Studies of the Concordance of Atrophy and Hypometabolism in Syndromic Variants of Alzheimer's Disease and Frontotemporal Dementia: An Extended Case Series.

Simultaneous PET-MRI is used to compare patterns of cerebral hypometabolism and atrophy in six different dementia syndromes. The primary objective was to conduct an initial exploratory study regarding the concordance of atrophy and hypometabolism in syndromic variants of Alzheimer's disease (AD) and frontotemporal dementia (FTD). The secondary objective was to determine the effect of image analysis methods on determination of atrophy and hypometabolism. PET and MRI data were acquired simultaneously on 24 subjects with six variants of AD and FTD (n = 4 per group). Atrophy was rated visually and also quantified with measures of cortical thickness. Hypometabolism was rated visually and also quantified using atlas- and SPM-based approaches. Concordance was measured using weighted Cohen's kappa. Atrophy-hypometabolism concordance differed markedly between patient groups; kappa scores ranged from 0.13 (nonfluent/agrammatic variant of primary progressive aphasia, nfvPPA) to 0.49 (posterior cortical variant of AD, PCA). Heterogeneity was also observed within groups; the confidence intervals of kappa scores ranging from 0-0.25 for PCA to 0.29-0.61 for nfvPPA. More widespread MRI and PET changes were identified using quantitative methods than on visual rating. The marked differences in concordance identified in this initial study may reflect differences in the molecular pathologies underlying AD and FTD syndromic variants but also operational differences in the methods used to diagnose these syndromes. The superior ability of quantitative methodologies to detect changes on PET and MRI, if confirmed on larger cohorts, may favor their usage over qualitative visual inspection in future clinical diagnostic practice.

Are There “Honorable Merchants” in International Marketing Channels?

The starting points of this initial exploratory study are two research questions: (1) could marketing relationships in international marketing channels be predicted by international marketing managers’ behavior reflected by “honorable merchants’” key concepts (ethics and trust) and experiential learning key concepts such as capability and competence?; and (2) can we measure the progress of this research theme in the international marketing literature and understand the nature of this phenomenon? We examine how scholarly research on international marketing managers’ behavior and their marketing relationships evolved from 2003 to 2013 and envisage the shape of this research theme the next years, to uncover current trends and possible research gaps on the ethics agenda in the international marketing education area. We identified the most salient concepts from 2,083 words for 22 key concepts counted in the abstracts of the 327 journal articles of the international marketing literature, in order to innovatively uncover the trends and concepts, explaining the marketing relationships in the international marketing context. We assessed sets of concepts that best reflect the marketing relationships in international marketing channels and indicated prospects for increasing the focus on specific topics, by conducting a series of multiple linear regression analyses and trend analyses. The research results show that the progress of the research theme can be measured. Innovatively, key competences and capabilities of international marketing managers relating to the key concepts of the “honorable merchant” construct are realized as a strong logical basis for the explanation of effective marketing relationships in international marketing channels. © 2015 Wiley Periodicals, Inc.

Combining robust state estimation with nonlinear model predictive control to regulate the acute inflammatory response to pathogen.

The inflammatory response aims to restore homeostasis by means of removing a biological stress, such as an invading bacterial pathogen. In cases of acute systemic inflammation, the possibility of collateral tissue damage arises, which leads to a necessary down-regulation of the response. A reduced ordinary differential equations (ODE) model of acute inflammation was presented and investigated in [10]. That system contains multiple positive and negative feedback loops and is a highly coupled and nonlinear ODE. The implementation of nonlinear model predictive control (NMPC) as a methodology for determining proper therapeutic intervention for in silico patients displaying complex inflammatory states was initially explored in [5]. Since direct measurements of the bacterial population and the magnitude of tissue damage/dysfunction are not readily available or biologically feasible, the need for robust state estimation was evident. In this present work, we present results on the nonlinear reachability of the underlying model, and then focus our attention on improving the predictability of the underlying model by coupling the NMPC with a particle filter. The results, though comparable to the initial exploratory study, show that robust state estimation of this highly nonlinear model can provide an alternative to prior updating strategies used when only partial access to the unmeasurable states of the system are available.

Education and simulation training of pediatric intensive care unit nurses to care for open heart surgery patients.

Providing appropriate education for nurses working in the pediatric intensive care unit (PICU) to develop and update the skill sets and knowledge required to care for infants and children with congenital heart disease (CHD) is a challenge. We provide care to children with a variety of congenital heart defects that require medical care and surgical corrections. In the extreme circumstance, we provide extracorporeal membrane oxygenation to those children who require extracardiac support postoperatively. Our program deals with a mean of about 150 cases annually that require surgical correction, in addition to the medically managed patients with CHD. The hospital-based simulation center opened in 2010. It provides high-fidelity simulation to enhance current medical and nursing education. Patient scenarios are created on the basis of real patient cases, maintaining the realistic details of the disease and injury processes essential to provide the pertinent learning points of each case. Shortly after the simulation center opened, the PICU educator inquired about the process to provide PICU nurses an opportunity to learn about pediatric open heart surgery patients at the simulation center. The inherent challenge within our PICU is that we have 32 nurses with various skills sets and experiences who must be able to provide care for all patients within our unit, including children with CHD. At that time, 7 PICU nurses were ready to learn how to provide nursing care to children who have undergone open heart surgery. This state of readiness is detailed later. A classroom format was used to present the material, which addressed identification of defects, along with medical and nursing management. This classroom training was followed by a 4-hour simulation session, wherein these nurses participated in 2 patient scenarios. Clinical objectives (Table 1) were reviewed and reinforced to define what needed to be learned and to ensure that learning occurred. Following this simulation training, each nurse was assigned to admit a pediatric open heart patient with an experienced nurse present to reinforce the prior learning.

Characteristics of post-menopausal women with genitourinary syndrome of menopause: Implications for vulvovaginal atrophy diagnosis and treatment selection

BackgroundVulvovaginal atrophy (VVA), also known as genitourinary syndrome of menopause, exerts a negative impact on the sexuality, health and quality of life of post-menopausal women. A better understanding of post-menopausal women's profiles as defined by their attitude and behaviours in relation to their VVA symptoms may improve public health policies and will allow appropriate targeting of public health campaigns. These improvements may help women of middle and advanced age recover and maintain their quality of life.In this study, we analysed the attitudes of post-menopausal women, aged 45–74 years, with VVA symptoms from five European countries, with the aim of identifying profile markers to improve healthcare strategies. MethodsTwo consecutive cross-sectional studies were conducted in five European countries (the UK, France, Spain, Germany and Italy). An initial exploratory study (n=69) was based on interviews and then an analytical study (n=749) was based on online surveys to validate women's profiles by means of a multi-level approach. ResultsWe identified eight profiles: self-treater, pragmatic, vivacious, reserved, silent sufferer, expressive, stoic and sad. The percentage distribution varied among the countries. The ‘pragmatic’, ‘vivacious’ and ‘expressive’ women were the most proactive, talkative and open with their healthcare professional, whereas women with the ‘reserved’ and ‘stoic’ profiles showed less interest in searching for information about their VVA symptoms, either from their healthcare professional or from other sources. ConclusionsThe attitudes and behaviours of post-menopausal women in relation to their VVA allow for the clear definition of a series of profiles with varying representation across countries. This study reveals the importance of identifying post-menopausal women's profiles to develop interventions to help them overcome barriers to the diagnosis, management and treatment of VVA.