Developing service provision for patients in primary care

This article outlines the government's changes to the way that primary and community health services will be commissioned and provided. It also discusses the opportunities that exist for nurses to lead and develop services for the benefit of patients in the implementation of changes.     

Why are fewer medical students in Florida choosing obstetrics and gynecology?

OBJECTIVES: To determine why there has been a decrease in the amount of applicants to Florida-based obstetrics and gynecology (OB/GYN) residency programs, and how this has been affected by the current medical liability climate. METHODS: Fourth year Florida medical students were surveyed about their concerns of a career in OB/GYN. The students were then grouped into three categories: students never interested in OB/GYN, students at one point interested in OB/GYN, and students pursuing a career in OB/GYN. The groups were analyzed for differences in their concerns about OB/GYN and the impact it had on their final career decisions. Finally, we addressed the question of whether or not medical liability played a significant role in their career choice. RESULTS: From September to November of 2005, 198 total students were surveyed. Of those surveyed, 10.8% were applying for OB/GYN, 47.7% had considered OB/GYN but chose another field, and 41.5% never considered OB/GYN as a specialty. The primary and secondary reasons for not choosing OB/GYN were the same in the two groups pursuing different specialties; "more interested in a different specialty" and "desire a specialty with more predictable work hours/lifestyle," respectively. Approximately 27% of those who considered OB/GYN but did not choose it ranked "fear of being sued" first or second, compared with 6.7% of those who never considered it (P < 0.01). Of the 21 students who will pursue careers in OB/GYN, 85.7% stated they are considering leaving Florida because of high malpractice/litigation. CONCLUSIONS: There is a subgroup of students in Florida who were initially interested in OB/GYN but may have been deterred by current medical liability issues. Florida is a state known as being in a professional liability crisis and this survey demonstrates evidence that this has adversely affected students' decisions to pursue OB/GYN.     

Spigelian hernia presenting as an appendicular mass

Incarcerated spigelian hernias are a rare cause of acute abdomen. The clinical diagnosis of incarcerated spigelian hernia can be a challenge in the absence of definite signs. Reported here is a case of a strangulated spigelian hernia that mimicked an appendicular mass and was discovered on CT scan of the abdomen and pelvis.     

Automated solutions for total RNA isolation from diverse sample types

In response to the increasing demands to generate larger amounts of quality data faster, specifically in the area of RNA isolation to support gene expression assays, the authors have adopted several automated solutions for isolating total RNA from a variety of sample types, (eg, blood, cells, and tissue). By using automated solutions, the authors were able to increase their throughput without compromising data integrity.     

Research priorities for parenting and child health: a Delphi study

AIM: This paper is a report of a study to identify research priorities of clinical staff working with families at a Western Australian centre for parenting. BACKGROUND: Australian centres for parenting focus on children's needs while working in partnership with parents, families and their communities. These agencies incorporate primary healthcare strategies in their unique approach with families. Clinicians' research priorities at these centres have not been explored in an Australian context. METHOD: In 2005, a Delphi study was conducted in which clinicians were asked to provide a list of five important issues relating to care provided to children, parents and their families. Research topics identified were then ranked for their importance to the family and clinicians. Finally, the top 10 research topics were ranked for priority. FINDINGS: In round 1, 148 research topics were identified. Thirty-six topics were removed, due to the availability of existing evidence. Content analysis was used to collapse statements into 26 research questions, which were further classified into seven categories: parenting issues; sleep and settling issues; postnatal depression; evaluation and impact of programmes; staffing issues; centre marketing services and others. Issues relating to sleep and settling and postnatal depression were rated as top research priorities. CONCLUSION: The priorities of clinicians working with families provide research direction for this Western Australian centre and potentially other centres in Australia and similar settings elsewhere in the world. The Delphi approach in determining clinicians' perceptions of relevant research areas may be useful to direct research in other contexts.     

Understanding how nurse practitioners estimate patients' risk for coronary heart disease: a judgment analysis

AIM: This paper is a report of a study to examine how nurse practitioners combine information when estimating patient risk of coronary heart disease. BACKGROUND: In the United States of America and other countries, nurse practitioners are increasingly working alongside physicians in primary healthcare settings. Given this role, nurse practitioners represent an important resource in early detection of numerous diseases. Understanding how nurse practitioners use patient characteristics (cues) to form estimates of patient risk for disease may improve general disease prevention efforts. METHOD: Social judgment theory and its lens model analysis are concerned with the correspondence between a person's judgments and the environment. This approach was applied to examine how 15 nurse practitioners weighted eight risk factors for coronary heart disease, how accurate practitioners were in assessing patient risk for coronary heart disease, and how much self-insight practitioners had into their own risk estimation processes. The data were collected in 2006. RESULTS: Nurse practitioners showed moderate to high accuracy and evinced a variety of cue-weighting strategies. Insight into their own judgment policies was modest. The lens model analysis revealed that most practitioners had lower values on knowledge of the ecology than they did on cognitive control. CONCLUSION: Educational efforts aimed at improving detection of patients at risk for diseases might do better to target increasing clinicians' understanding of cue-criteria relationships, than to stress themes of consistency in evaluating patients.     

Developing meaningful systematic review of CAD/CAM reconstructions and fiber-reinforced composites

Objective: Clinical literature was examined for evidence supporting use of CAD/CAM reconstructions and fiber‐reinforced materials. Materials and methods: Potential evidence was identified via databases [PubMed; EMBASE (R) Drugs & Pharmacology; Center for Reviews and Dissemination, University of York; Cochrane Library], hand search of non‐indexed literature, secondary reference searches, and personal contacts with clinical trial PI's. Search terms included: dental restorations; CAD/CAM; CEREC; LAVA; CERCON; Procera; inlay/onlay; dental prosthesis; fiber‐reinforced composite (FRC). Results: Two randomized‐controlled clinical trials were identified as examined in one Cochrane Collaboration review relevant to CAD/CAM inlays. One systematic review of 15 CAD/CAM inlay studies was examined. Six studies were identified of three commercial FRC endodontic posts and eight reported on FRC use for fixed denture prostheses. Fifteen ongoing prospective trials were identified studying CAD/CAM fabricated zirconia‐based prostheses. A total of 76 papers were referenced including those related to use of in vitro measures as evidence. Conclusions: Review of the Cochrane analysis raised concerns that typical RCT protocols may prove insufficient for stratification of confounding variables (patient, practitioner, material) when treatment outcomes are primarily prosthesis‐ or material‐based (not patient‐based, e.g., as in fracture). RCT designs are most straightforward when treatment outcomes are patient‐based (e.g., soft tissue changes). When treatment responses are material‐based, controls also become difficult to define and studies become tests of equivalency/superiority; where well‐stratified cohort designs are likely preferred. Large numbers of independent cohort studies support the use of CAD/CAM ceramic inlay/onlay restorations and crowns but many complications inhibit the application of high‐level systematic review. Except perhaps for fiber‐based endodontic posts, the clinical FRC literature appears insufficient for expert review. Single in vitro measures cannot currently serve as evidence for clinical practice, except in limited cases of simple function (e.g., impression material accuracy). Batteries of in vitro measures are often applied during materials development but cannot substitute for clinical study.     

The segway personal transporter as an alternative mobility device for people with disabilities: a pilot study

Sawatzky B, Denison I, Langrish S, Richardson S, Hiller K, Slobogean B. The Segway Personal Transporter as an alternative mobility device for people with disabilities: a pilot study.

Objectives

To determine the functional measures that best correlate with the skill levels of people with disabilities who operate a Segway Personal Transporter, and—using a qualitative analysis—to explore subjects’ experience with the Segway.

Design

A prospective study encompassing 3 training sessions with the Segway to correlate subjects’ functional ability (eg, cognition, balance, mobility, muscle strength) with their skill level on the device.

Setting

A provincial adult rehabilitation center.

Participants

Twenty-three subjects (age range, 19−65y) with a wide range of disabilities (eg, multiple sclerosis, spinal cord injury, amputation) who could walk at least 6m with or without assistance.

Interventions

Not applicable.

Main Outcome Measures

Segway Task Assessment, Berg Balance Scale, and Timed Up & Go test.

Results

No correlation was found because all participants successfully completed the final Segway Task Assessment, regardless of scores on functional assessments.

Conclusions

The Segway is a useful device for a broad range of populations with functional disabilities. Subjects found the Segway easy to use and were excited about its potential as an assistive device for use in their communities.