Challenges in healthcare delivery in an economic downturn,in the Republic of Ireland

carney m . (2010) Journal of Nursing Management 18 , 509–514
Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland Aim The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Background Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Evaluation Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study’s aim. Key issues Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. Conclusions In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. Implications for nursing management As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.     

Intestinal microbiota in allergic and nonallergic 1‐year‐old very low birth weight infants after neonatal glutamine supplementation

Aim: Previously, glutamine‐enriched enteral nutrition in very low birth weight infants (VLBW) decreased the incidence of atopic dermatitis at age 1 year. The aim of this study was to determine whether this effect is related to changes in intestinal bacterial species that are associated with allergy, such as bifidobacteria, clostridium histolyticum, clostridium lituseburense (Chis/lit group) and Escherichia coli at age 1 year. Methods: Eighty‐nine infants were eligible for this follow‐up study, conducted at a Tertiary care hospital. Bifidobacteria, Chis/lit group and E. coli were measured by fluorescent in situ hybridization in faecal samples collected at age 1 year. Information on allergic and infectious diseases was previously determined by questionnaire. Results: Seventy‐two of 89 (81%) infants were participated. Prevalence of all studied species was not different between glutamine‐supplemented and control groups. Allergic infants were less frequently colonized with bifidobacteria than nonallergic infants (p = 0.04). Between neonatal period and 1 year, prevalence of bifidobacteria was increased (p < 0.001), of Chis/lit group was unchanged (p = 0.84), and of E. coli was decreased (p < 0.001). Conclusion: The beneficial effect of glutamine‐enriched enteral nutrition on the incidence of atopic dermatitis in the first year of life in VLBW infants is not related to changes in bifidobacteria, Chis/lit group or E. coli. Allergic VLBW infants are less frequently colonized with bifidobacteria compared to nonallergic VLBW infants.     

Perineal Injury in Nulliparous Women Giving Birth at a Community Hospital: Reduced Risk in Births Attended by Certified Nurse‐Midwives

Introduction : Our objective was to determine if there is a difference in rates of perineal injury sustained by nulliparous women attended by obstetricians compared with certified nurse‐midwives (CNMs) at a US community hospital. Methods : We analyzed retrospective data for 2819 women who spontaneously gave birth to singleton, vertex, term, live infants between 2000 and 2005. The independent variable was attendant type (obstetrician or CNM). The main outcome variables were intact perineum, episiotomy, and spontaneous perineal lacerations. Multivariate logistic regression was used to adjust for six potential confounders: macrosomia, maternal age, epidural anesthesia, oxytocin administration, medical insurance status, and ethnicity. Results : The odds ratios (ORs) for obstetrician‐attended births versus CNM‐attended births were significant for a spontaneous minor perineal laceration versus intact perineum (OR = 1.82; 95% confidence interval [CI], 1.33–2.48), spontaneous major laceration versus intact perineum (OR = 2.29; 95% CI, 1.13–4.66), and episiotomy use versus no perineal injury, with or without extension (OR = 2.94; 95% CI, 2.01–4.29). Discussion : We found that the prevalence and severity of perineal injury, both spontaneous and from episiotomy use, were significantly lower in CNM‐attended births. J Midwifery Womens Health 2010;55:243–249 c̊ 2010 by the American College of Nurse‐Midwives.     

Is a nurse‐led telephone intervention a viable alternative to nurse‐led home care and standard care for patients receiving oral capecitabine? Results from a large prospective audit in patients with colorectal cancer

Home care nursing has been shown to be a valuable service for patients receiving oral chemotherapy; however, associated costs can be high and telephone‐based services may be more cost‐effective options. This prospective audit explored the usefulness of a nurse‐led telephone intervention for supporting cancer patients treated with Capecitabine, comparing historical findings from a randomised trial evaluating a home‐based intervention over standard care with a modified nurse‐led telephone follow‐up intervention. Self‐reported toxicity and service use were assessed in 298 patients who received nurse‐led telephone follow‐up, compared with historical data from 164 patients (81 receiving standard care and 83 home care intervention). Findings suggested that nurse‐led telephone follow‐up can potentially lead to reduced toxicity (chest pain, vomiting, oral mucositis, nausea, insomnia) when compared with standard care, and that it has a similar impact on the management of some symptoms when compared with home care (i.e. vomiting, oral mucositis), although it was not as effective as the home care intervention for other toxicities (diarrhoea and insomnia). These encouraging findings need to be explored further using a randomised trial design before we reach any conclusions. Further research should also include a health economics study to assess the cost‐effectiveness of the telephone‐based services for patients receiving oral chemotherapy.     

Students' perceptions of the follow-through experience in 3 year bachelor of midwifery programmes in Australia

Background

providing opportunities for students to participate in midwifery continuity of care experiences is a challenge in many midwifery education programmes. The ‘follow-through experience’ was a deliberate strategy introduced into midwifery education programmes in Australia to ensure that students experienced midwifery continuity of care. The follow through experience provides an opportunity for midwifery students to follow a pre-determined number of women through pregnancy, labour and birth and into the early parenting period.

Aim

the aim of this study was to explore the follow-through experience in the 3 year Bachelor of Midwifery (direct entry) in Australia to better understand its impact on midwifery students and to identify the learning that is associated with this experience.

Methods

a qualitative methodology was used. Data were collected from former and current Bachelor of Midwifery students through a survey and telephone interviews. Students from all 3-year pre-registration Bachelor of Midwifery programmes in Australia were invited to participate. A thematic analysis was undertaken. Constructivist learning theories were used to identify whether learning occurred in the context of the follow-through experience.

Findings

students do learn from their engagement in midwifery continuity of care experiences. Learning was characterised by the primacy of the relationship with the women. Students also identified the challenges they faced which included recruitment of women and finding the time to fully engage with the follow-through experience. Difficulties were identified around the different requirements of the follow-through experience, the lack of support at times for students and the incongruence with the existing maternity system. These issues impacted on students' ability to engage in and maximise their learning.

Conclusions

the follow-through experience is an innovative midwifery education strategy that facilitates learning for midwifery students. Challenges need to be addressed at a systematic level and new strategies developed to support the learning opportunities presented by the follow-through experience.     

Interactions between genetic admixture,ethnic identity,APOE genotype and dementia prevalence in an admixed Cuban sample; a cross-sectional population survey and nested case-control study

Background  

The prevalence and incidence of dementia are low in Nigeria, but high among African-Americans. In these populations there is a high frequency of the risk-conferring APOE-e4 allele, but the risk ratio is less than in Europeans. In an admixed population of older Cubans we explored the effects of ethnic identity and genetic admixture on APOE genotype, its association with dementia, and dementia prevalence.