Audit: an exploration of some tensions and paradoxical expectations

There can be very few nurses, at the moment, whose daily activity is not in some way influenced by the notion of audit and related concepts Yet despite an impressive growth in the literature relating to audit, conceptual clarity on a number of key issues remains elusive This paper suggests that there are major tensions inherent in much of the current thinking about audit In outlining the arguments supporting our position, we term these tensions primary and secondary The potential effects of ignoring such tensions are illustrated by reference to the development of day hospital care for older people in the United Kingdom This is used to highlight a number of paradoxical expectations and deleterious consequences for day hospital services which have arisen from a failure adequately to address a number of fundamental questions The lessons to be drawn are then applied to audit in general, with particular reference to services for individuals with on-going health care needs     

Traumatic brain injury: a review

Traumatic brain injury (TBI) is defined as "a blow or jolt to the head ...which can disrupt the function of the brain" (CDC. Traumatic brain injury [TBI]: Topic Home. 2004 [http://www.cdc.gov]). TBI changes the lives of approximately 2 million persons each year in the United States. Rapid diagnosis and treatment are imperative to promote optimum outcomes. The critical care clinician who is able to identify and treat appropriately utilizing best practice guidelines may significantly reduce the morbidity and mortality of TBI. This article describes the classification, mechanism of injury, pathophysiology, and clinical therapeutic management strategies identified as best practice for TBI.     

Stress among nephrology nurses in Northern Ireland.

This qualitative study was designed to explore the perception of stress of nephrology nurses within a major nephrology center in Northern Ireland. The information was collated from a sample of 10 nurses through semi- structured taped interviews. The findings indicate that stress was derived from the following categories: job content, resource issues, professional concerns, professional working relationships, and extrinsic factors. The coping mechanisms adopted by these nurses are also discussed. The actual dialogue of the nurses is included to provide depth and substance to the categories and themes, and a discussion is presented of the relationship of these findings to theory. These findings have relevant implications for nursing practice, nursing education, and nursing administration.     

Exposure to drugs among pre-teenage schoolchildren

Aims To describe the nature and extent of exposure to drugs in a sample of pre‐teenage children and to examine some of the factors that might be associated with it. Participants and design A survey of 1202 10–12‐year‐old children based on a questionnaire administered in schools under examination‐type conditions. Findings A third of the children reported having been exposed to drugs in the sense of either having been in situations in which they were being used or of having been offered them. While the most common drug to which they were exposed was cannabis, considerable numbers had also been exposed to more dangerous drugs. The factors which were associated most closely with exposure were drug use by friends or family members, associating with peers who engaged in antisocial activities, the child's own involvement in problem behaviours and the regular consumption of alcohol. Boys and older children were also significantly more likely to be offered drugs. Conclusion A large proportion of young children are exposed to illicit drugs primarily through use of these drugs by family members and peers. There is a strong association with antisocial behaviour. Attempting to influence such exposure is challenging but may be one avenue for reducing drug use in adolescents.     

Distribution of IL-1β immunoreactive cells in pancreatic biopsies from living volunteers with new-onset type 1 diabetes: comparison with donors without diabetes and with longer duration of disease

Aims/hypothesis

Although IL-1β is considered a key mediator of beta cell destruction, its cellular expression in islets during early type 1 diabetes remains unclear. We compared its expression in rare pancreatic biopsies from new-onset living volunteers with its expression in cadaveric pancreas sections from non-diabetic autoantibody-positive and -negative individuals and those with long-standing disease.

Methods

Pancreatic biopsy sections from six new-onset living volunteers (group 1) and cadaveric sections from 13 non-diabetic autoantibody-negative donors (group 2), four non-diabetic autoantibody-positive donors (group 3) and nine donors with diabetes of longer duration (0.25–12 years of disease; group 4) were triple-immunostained for IL-1β, insulin and glucagon. Intra- and peri-islet IL-1β-positive cells in insulin-positive and -negative islets and in random exocrine fields were enumerated.

Results

The mean number of IL-1β-positive cells per islet from each donor in peri- and intra-islet regions was <1.25 and <0.5, respectively. In all study groups, the percentage of islets with IL-1β cells in peri- and/or intra-islet regions was highly variable and ranged from 4.48% to 17.59% in group 1, 1.42% to 44.26% in group 2, 7.93% to 17.53% in group 3 and 3.85% to 42.86% in group 4, except in a single case where the value was 75%. In 25/32 donors, a higher percentage of islets showed IL-1β-positive cells in peri-islet than in intra-islet regions. In sections from diabetic donors (groups 1 and 4), a higher mean number of IL-1β-positive cells occurred in insulin-positive islets than in insulin-negative islets. In group 2, 70–90% of islets in 3/13 sections had weak-to-moderate IL-1β staining in alpha cells but staining was virtually absent or substantially reduced in the remaining groups. The mean number of exocrine IL-1β-positive cells in group 1 was lower than in the other groups.

Conclusions/interpretation

At onset of type 1 diabetes, the low number of islet-associated IL-1β-positive cells may be insufficient to elicit beta cell destruction. The variable expression in alpha cells in groups 2–4 suggests their cellular heterogeneity and probable physiological role. The significance of a higher but variable number of exocrine IL-1β-positive cells seen in non-diabetic individuals and those with long-term type 1 diabetes remains unclear.

     

Use of data linkage to improve communicable disease surveillance and control in Australia: existing practices,barriers and enablers

Objectives: To review the use of data linkage by Australian state and territory communicable disease control units, and to identify barriers to and enablers of data linkage to inform communicable disease surveillance and control activities. Methods: Semi‐structured telephone interviews were carried out with one key informant from communicable disease control units in all eight Australian states and territories between October 2017 and January 2018. Results: Key informants from all Australian states and territories participated in the interview. A variety of existing practices were identified, with few jurisdictions making systematic use of available data linkage infrastructure. Key barriers identified from the review included: a lack of perceived need; system factors; and resources. Existing regulatory tools enable data linkage to enhance communicable disease surveillance and control. Conclusions: We identified considerable variation in the use of data linkage to inform communicable disease surveillance and control activities between jurisdictions. We suggest that routinely collected, disparate data are systematically integrated into existing surveillance and response policy cycle to improve communicable disease prevention and control efforts. Implications for public health: Existing gaps in communicable disease surveillance data may affect prevention and control efforts. Data linkage is recognised as a valuable method to close surveillance gaps and should be used to enhance the value of publicly held health data.     

Increasing incidence and mortality related to liver cancer in Australia: time to turn the tide

Objective : Assess national and jurisdictional incidence and mortality trends for primary liver cancer in Australia. Methods : Analysis of Australian Cancer Incidence and Mortality data published in 2017 by the AIHW. Age‐standardised rates (ASR) for 1982 to 2014/2015. Piecewise linear regression was used to assess temporal trends. For the purposes of comparison, data were also extracted for all cancers with greater burdens of disease (lung, colorectal, breast, prostate, pancreatic, and brain cancers and melanoma of the skin). Results : Since 1982, the average annual percentage change (AAPC) for ASR incidence of liver cancer was 4.858% (95%CI 4.558–5.563). This marked a 306% increase from 1.822/100,000 persons (95%CI 1.586–2.058) in 1982 to 7.396/100,000 persons (95%CI 7.069–7.723) in 2014. AAPC for ASR mortality was 3.013% (95%CI 2.448–3.521): an increase of 184% from 2.323/100,000 persons (95%CI 2.052–2.594) in 1982 to 6.593/100,000 (95%CI 6.290–6.896) in 2015. ASR incidence and mortality were highest in the NT (12.607/100,000 persons), VIC (8.229/100,000) and NSW (7.798/100,000). In comparison to the other selected cancers, higher AAPC for both incidence and mortality of liver cancer were observed. Conclusion : Incidence and mortality associated with liver cancer have increased substantially in the past three decades, in contrast to the improved outcomes observed for many other cancers. Jurisdictional incidence rates reflect higher prevalence of hepatitis B and C. Implications for public health : In the context of Australian cancer prevention and care programs, liver cancer is an outlier. Strategies to mitigate risk factors and improve surveillance of liver health for at‐risk groups are urgently required.     

The Hopkins Rehabilitation Engagement Rating Scale – Reablement Version (HRERS‐RV): Development and psychometric properties

Patient or user engagement with health and social care interventions is receiving increased attention and interest within practice settings and research. An English evaluation of three reablement services wished to include a measure of user‐engagement so as to explore its association with outcomes. As no measure of reablement engagement existed, an existing measure designed for use with physical rehabilitation patients (the Hopkins Rehabilitation Engagement Rating Scale) was adapted and its psychometric properties were tested. The adapted version was completed by reablement staff at the time an individual (n = 129) was discharged from one of the three reablement services. Outcomes data (Barthel Index, Nottingham Extended Activities of Daily Living Scale, General Health Questionnaire‐12) collected by the evaluation study at baseline (that is, at entry into reablement), discharge and 6 months postdischarge was used for some psychometric testing. Internal consistency and construct, predictive and discriminant validity were investigated. The adapted scale measured a single construct and had good internal consistency. Tests of predictive and discriminant validity were positive. Findings from a separate, small‐scale (n = 31) test–retest study offer an early indication that this is acceptable. There was, however, evidence of a ceiling effect and we consider ways this may be ameliorated. The Hopkins Rehabilitation Engagement Rating Scale – Reablement Version offers a means by which user engagement in reablement can be measured using a staff‐completed instrument. The association between engagement and reablement outcomes, revealed when testing for predictive validity, supports the argument for greater attention and investment in research on user engagement in reablement. More broadly, researching engagement within the context of an intervention often delivered by multiple practitioners offers the opportunity to further understand this concept which, in the past, has particularly focused on interventions delivered by a single practitioner. In addition, future work should include developing a companion measure completed by service users.