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Terms modified by Health Boards Selected AbstractsNurse-led flexible cystoscopy: the UK experience informs a New Zealand nurse specialist's trainingINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 2 2007Sue Osborne Abstract Flexible cystoscopy utilizes a fibre-optic scope with a light source to examine the internal surfaces of the bladder and urethra. The procedure is undertaken to investigate and diagnose the cause of lower urinary tract symptoms. It is also used extensively to detect the recurrence of bladder tumours in people diagnosed with transitional cell carcinoma of the bladder and kidney. In the UK, the advent of flexible cystoscopy clinics undertaken by appropriately trained and supervised nurses has been one way of improving provision of a flexible cystoscopy service. Information from published literature informed the decision to establish a nurse-led flexible cystoscopy clinic at one large District Health Board in New Zealand. This article reviews the current body of knowledge on nurse-led flexible cystoscopy, focusing on the education and training required to prepare nurses for independent cystoscopy practice. Literature findings are discussed, along with the observations of a urology nurse specialist undertaking flexible cystoscopy training in New Zealand and anecdotal evidence from visits with nurse cystoscopists in England during 2006. Carefully designed research studies published in literature have a key role to play in augmenting the body of evidence around this relatively new area of nursing practice, and as such should be strongly encouraged in both countries. It is recommended that nurse cystoscopy training and competencies are standardized and adopted internationally in order to increase the transferability of findings from research on the clinical outcomes of nurses performing nurse-led flexible cystoscopy. [source] Practitioner assessments of ,good enough' parenting: factorial surveyJOURNAL OF CLINICAL NURSING, Issue 8 2009Julie Taylor Aim., The aim of this study was to measure health visitors' professional judgements on ,good enough' parenting and identify what factors and combinations of these are important when making such judgements. Background., The relationship between parenting and child health is unclear. Whilst agreement exists that ,good enough' parenting requires boundary setting, consistency and putting the child's needs first, attempting to define ,good enough' parenting in precise terms is complex. When faced with a complex situation, practitioners rely on relatively few factors to form judgements. Design., Factorial survey methods were employed using vignette techniques. Methods., Vignettes were constructed using previous research on those variables, which may influence nurses' judgements, for example, accommodation and child dentition. The level of factors was randomly varied. Two thousand vignettes were administered to a sample of 200 health visitors in two Health Boards who then made a judgement about this scenario. Analysis., Data were analysed through multiple regression with dummy variables and one-way analysis of variance. Regression equations for both good enough mothering and good enough parenting are reported. Results., The models used are significant predictors of parenting and mothering. Significant predictors on health visitor judgements' were boundary setting in sleep behaviours, type of housing inhabited and health behaviours. Although parenting and mothering are often conflated, health visitors appear to separate these aspects when making judgements based on type of housing. Conclusions., Most professionals can articulate what makes a ,good' parent, equally they may have strong views regarding what constitutes ,poor' parenting. The difficulty is in determining when parenting is ,good enough' to provide a child with a nurturing environment. Relevance to clinical practice., This study suggests that practitioners move their thresholds of what is ,good enough' depending on a narrow range of factors. Awareness of the factors, which influence individuals' judgements is important in safeguarding children. [source] Cutaneous melanoma in New Zealand: 2000,2004ANZ JOURNAL OF SURGERY, Issue 5 2010Jennifer J. C. Liang Abstract Background:, In 2004, we published data on the trends in New Zealand (NZ) cutaneous melanoma (CM) for the period 1995,1999. The present report documents the trends in the next period from 2000 to 2004. Method:, Data were obtained from the New Zealand Cancer Registry by way of a computerized search of CM ICD-10 (172) codes from 2000 to 2004. Only one registration per person was made to avoid including patients with metastatic melanoma. The exclusion criteria were: incorrect or absent data; benign naevi; and melanoma in situ. Incidence rates were age standardised to the Segi world population. Results:, The total study population was 8262 patients. There was no increase found in the overall incidence rate over the time period, but men had a statistically higher overall incidence rate (P= 0.0002) and thicker CMs (P= 0.003) compared with women. This gender difference was particularly marked in those patients aged greater than 59 years. Breslow thickness increased from 0.7 to 0.8 mm. The incidence rates varied quite significantly among District Health Boards, with Taranaki having the highest rate (70.3/100 000/year) and Southland had the lowest rate (20.1/100 000). Overall, NZ had a CM incidence rate of 41.2/100 000/year). Conclusion:, The current study confirmed that NZ has the highest overall CM incidence rate in the world. Elderly men (>59 years old) have the highest risk of developing melanoma. The increase in melanoma thickness with its associated higher mortality risk is of grave concern. [source] Variables associated with attendance at, and the perceived helpfulness of, meetings for people with multiple sclerosisHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2003Tim J. Peters PhD Abstract People who have chronic disabling conditions are frequently advised by health or social care practitioners to attend meetings organised specifically for individuals who have the same or similar health problems. The purpose of the analyses described in the present paper was to ascertain the variables independently associated with attendance at meetings for people with multiple sclerosis (MS), and amongst those who did attend, variables related to the level of perceived helpfulness. A postal questionnaire was sent to a random sample of 471 people with MS in eight randomly selected health authorities/boards across England and Scotland with the general aim of eliciting their preferences for and views of health and social care. There were 318 respondents to this questionnaire (68%), 136 (43%) of whom had attended such a meeting. Logistic regression and proportional odds regression models were used to investigate the relationships with the two outcomes of attendance and helpfulness for 23 explanatory variables drawn from the questionnaire. The explanatory variables related to the following six broad areas: socio-demographic, illness-related, support, self-management, psycho-social factors and social function. Just under half of the respondents reported that they had attended a meeting. Half of these individuals found the last meeting that they had attended to be reasonably helpful, and one in five found it of no help. The individuals who were more likely to have attended were aged 45,64 years, had been in contact with a health professional in the past 12 months and felt that they had the ability and means to access MS-related information. The last meeting was considered more helpful by those who reported greater contentment with access to MS-related information and by those with mild depression. These findings should be useful to health professionals who may consider recommending meetings to people with MS, and also to those who are engaged in ensuring that meetings are both attractive and relevant to all potential attendees. [source] Developing an advanced nurse practitioner service in emergency care: attitudes of nurses and doctorsJOURNAL OF ADVANCED NURSING, Issue 3 2006Miriam Griffin MSc RGN PGCSNP Aim., This paper reports a study to determine the attitudes of nurses, doctors and general medical practitioners towards the development of an advanced nurse practitioner service within an emergency department. Background., The role of advanced nurse practitioner in emergency care has emerged in a number of countries, and has brought with it confusion about titles, role boundaries, clinical accountability and educational requirements. Initially, the role resulted from a need for healthcare professionals to provide a service to the increased numbers of patients presenting to hospital with less urgent problems. Since then, the service has evolved to one where nurse practitioners provide high-quality and cost-effective care to persons who seek help for non-urgent, urgent or emergent conditions in a variety of emergency care settings. However, little research could be identified on the attitudes of relevant nursing and medical staff towards the development of this role. Methods., A questionnaire survey was carried out, and a 29-item Likert rating scale was developed to measure attitudes. Along with some demographic variables, two open-ended questions were added to allow respondents to elaborate on what they perceived as benefits and difficulties associated with an advanced nurse practitioner service. All general practitioners, emergency nurses and emergency doctors in one health board in the Republic of Ireland were targeted, and 25 emergency nurses, 13 emergency doctors and 69 general practitioners were approached to take part. Data were collected in February 2004. Findings., An overall response rate of 74·8% was achieved. All respondents were positive towards the development of an advanced nurse practitioner service, with general practitioners being less positive. The principal differences appeared between general practitioners and hospital emergency care staff. Conclusion., There is a need for a multidisciplinary approach to the planning of advanced nurse practitioner services. To achieve multiprofessional acceptance, an accredited and standardized education programme is required, and this must address existing role boundaries. [source] More aspiration than achievement?HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2006Children's complaints, advocacy in health services in Wales Abstract The present paper reports on key results from a government-funded survey of all National Health Service trusts, local health boards and community health councils in Wales, which was conducted in 2004,2005 to identify the characteristics of complaints involving children, and the use of professional advocacy services in these complaints and their role in supporting children in relation to health service matters more generally. Findings from the survey are presented which reveal the marginal take-up of professional advocacy services in health complaints, and the slender resource in professional advocacy for children commissioned by a small number of health bodies. Advocacy support for users of health services typically focuses upon adult-related issues. The needs of children, particularly those who may have special requirements because of disability, being looked after, or having language or cultural needs are not well met according to the present survey. This raises the question of whether recent policy and guidance on advocacy (particularly for children and vulnerable groups) is seen by health bodies as warranting decisive action and dedicated investment, or whether rhetoric and modest change is the more likely outcome in the face of other pressing demands on health budgets. [source] What are the concerns of prospective responsible officers about their role in medical revalidation?JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2010Annabel Shepherd MRCGP Abstract Introduction, The Health and Social Care Act 2008 sets out the requirement for the introduction of responsible officers for the NHS. The paper states that these individuals will be responsible for ensuring that doctors who are revalidated meet the required standards. It is not known how well prepared prospective responsible officers are for their new role. Methods, Semi-structured interviews were conducted with 12 medical directors from Scottish health boards who agreed to participate. Results, Prospective responsible officers remain uncertain about their role in medical revalidation. Specific concerns were raised: (1) What will responsible officers be responsible for? (2) How can appraisal be quality assured? (3) How will the information requirements for revalidation be met? and (4) How can organizations meet the requirement for revalidation? Conclusion, We found important issues regarding the arrangements for revalidation which have not previously been described which may impact on the effectiveness of prospective responsible officers. [source] Measuring the quality of clinical audit projectsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2000Andrew D. Millard MSc Abstract The aim of the study was to develop and pilot a scale measuring the quality of audit projects through audit project reports. Statements about clinical audit projects were selected from existing instruments assessing the quality of clinical audit projects to form a Likert scale. Audit facilitators based in Scottish health boards and trusts piloted the scale. The participants were known to have over 2 years of experience of supporting clinical audit. The response at first test was 11 of 14 and at the second test 27 of 46. Audit facilitators tested the draft scale by expressing their strength of agreement or disagreement with each statement for three reports. Validity and reliability were assessed by test , re-test, item , total, and total , global indicator correlation. Of the 20 statements, 15 had satisfactory correlation with scale totals. Scale totals had good correlation with global indicators. Test , re-test correlation was modest. The wide range of responses means further research is needed to measure the consistency of audit facilitators' interpretations, perhaps comparing a trained group with an untrained group. There may be a need for a separate scale for reaudits. Educational impact is distinct from project impact generally. It may be more meaningful to treat the selection of projects and aims, methodology and impact separately as subscales and take a project profiling approach rather than attempting to produce a global quality index. [source] Latest news and product developmentsPRESCRIBER, Issue 7 2008Article first published online: 28 APR 200 Referrals from Boots The majority of people requesting Boots' erectile dysfunction or weight management programmes are referred to their GP(Pharm J 2008;280:297). The programmes are run under patient group directions and exclude people with elevated blood pressure, blood glucose or cholesterol. Over 80 per cent of customers screened for the erectile dysfunction programme in Manchester and two-thirds of those screened for the national obesity programme were referred. Vildagliptin: new DPP-4 inhibitor for diabetes Novartis has introduced the DPP-4 inhibitor vildagliptin for the treatment of type 2 diabetes. Two formulations are available: Galvus (vildagliptin 50mg) is licensed for use with metformin, a sulphonylurea or a thiazolidinedione when these agents do not achieve glycaemic control alone, and Eucreas (vildagliptin 50mg plus metformin 850 or 1000mg) is licensed for patients requiring combined therapy with vildagliptin and metformin. Inhibition of DPP-4 blocks the breakdown of the incretin hormones GIP and GLP-1, reducing fasting plasma glucose and postprandial hyperglycaemia. Vildagliptin is the second DPP-4 inhibitor to be introduced; the first was sitagliptin (Januvia), which has similar licensed indications. The third available drug acting on the incretin system is the incretinmimetic exenatide (Byetta); administered by injection, this is licensed for use with metformin and/or a sulphonylurea and is the only agent in this class to be approved for triple therapy. No comparative trials of these agents have been published. A month's treatment with twice-daily vildagliptin 50mg or either strength of vildagliptin plus metformin costs £31.76. Sitagliptin 100mg once daily costs £33.26. Sinusitis symptoms don't guide treatment The severity and duration of symptoms do not help to identify which patients with sinusitis will be helped by antibiotics, a new meta-analysis suggests (Lancet 2008;371: 908-14). The analysis of patient-level data from nine trials involving a total of 2547 adults showed that the number needed to treat (NNT) to cure one patient with rhinosinusitis was 15. Cure took longer to achieve in older patients and in those reporting symptoms for longer or with more severe symptoms. The authors comment that treatment is not justified given the risk of resistance and adverse effects and cost of antibiotics. Draft guidance from the National Institute for Health and Clinical Excellence (NICE) on the management of respiratory infections states that no antibiotic therapy or a delayed antibiotic prescribing strategy should be negotiated for patients with acute sinusitis. Taking cod liver oil leads to fewer NSAIDs Cod liver oil could help some patients with rheumatoid arthritis to reduce their NSAID consumption, according to a study from Dundee (Rheumatology online: 24 March 2008; doi: 10.1093/rheumatology/ ken024). A total of 97 patients were randomised to nine months' treatment with cod liver oil 10g per day or placebo. After 12 weeks, patients attempted to reduce or stop their use of NSAIDs. Significantly more of those taking cod liver oil achieved at least a 30 per cent reduction in NSAID use compared with placebo (39 vs 10 per cent). There were no differences in adverse effects or disease activity. Welsh prescriptions up The reduction in the prescription charge in Wales in 2004 was followed by an increase in prescribing of nonsedating antihistamines in wealthier areas, a study suggests (Health Policy online: 5 March 2008; doi:10.1016/j. healthpol.2008.01.006). In the two years preceding the cut, prescriptions for nonsedating antihistamines increased by about 7 per cent; in the two years after the cut, the increase was nearly 14 per cent. By contrast, there was no change in the rate of increase in the south-east of England (4,5 per cent in both periods). The increased growth in prescribing was statistically significant in the five least deprived but not in the five most deprived health boards in Wales. Aspirin linked with reduced asthma risk Low-dose aspirin is associated with a reduced risk of developing asthma, a new analysis of the Women's Health Study has shown (Thorax online: 13 March 2008; doi:10.1136/ thx.2007.091447). The analysis included 37 270 women with no asthma at baseline who were randomised to take placebo or aspirin 100mg every other day. After 10 years, 872 cases of asthma occurred in women taking aspirin and 963 with placebo, a 10 per cent reduction in risk. However, risk was not reduced in obese women. The mechanism by which aspirin may affect the risk of asthma is unknown. The latest evidence is consistent with findings published by the same investigators after analysis of two other large observational studies, the Physicians' Health Study and the Nurses Health Study. Anastrozole bone loss Long-term follow-up of the ATAC (Anastrozole, Tamoxifen, Alone or in Combination) trial has confirmed that adjuvant therapy with anastrozole (Arimidex) is associated with greater loss of bone mineral density (BMD) than tamoxifen in postmenopausal women with invasive primary breast cancer (J Clin Oncol 2008;26: 1051,7). After five years, median BMD was reduced by 6 and 7 per cent in the lumbar spine and hip with anastrozole compared with approximately 3 and 1 per cent respectively for tamoxifen, though no patients developed osteoporosis. Copyright © 2008 Wiley Interface Ltd [source] Specialist health services for people with intellectual disability in ScotlandJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 8 2002E. Smiley Abstract Background People with intellectual disability (ID) are known to have a high prevalence of health needs, and to require access to specialist health services in addition to primary care and generic secondary care health services. However, there is no national database of each locality's specialist health service provision. Such a record would highlight variation in provision and enable benchmarking. Method A 15-item questionnaire was developed which included questions on ID health services and staffing levels. This was sent to the chief executive of each of the 15 identified National Health Service primary care trusts/health boards which provide ID services in Scotland. The same questionnaire was also sent to the lead clinician/clinical director of each service. The results were converted to per 100 000 population per trust and presented in cumulative frequency tables to allow benchmarking. Results A response rate of 100% was achieved. The results show a wide range in the type of services provided by each locality in Scotland. Only three services (21%) have completed the process of resettlement. There was a wide-ranging variability in the number of beds/day places and professionals employed per 100 000 population per trust. Conclusions There is widespread diversity in the service provision between different parts of Scotland. Geographical distances and responsibilities for service provision to remote and rural communities did not appear to account for these differences. [source] | ||||||||||||||||||||||