Effectiveness of nurse-led brief alcohol intervention: a cluster randomized controlled trial

AIM: This paper reports an evaluation of the effectiveness and cost-effectiveness of nurse-led screening and brief intervention in reducing excessive alcohol consumption among patients in primary health care. BACKGROUND: Excessive alcohol consumption is a major source of social, economic and health problems. However, such consumption is responsive to brief alcohol intervention. To date, brief intervention research in primary health care has focused on general practitioner-led interventions, and there is only circumstantial evidence of effectiveness in nurse-led interventions. However, nurses are increasingly taking a lead in health promotion work in primary care. METHODS: A pragmatic cluster-randomized controlled trial was carried out between August 2000 and June 2003 to evaluate the effects of a brief intervention compared with standard advice (control condition). A total of 40 general practice clusters (intervention = 21 and control = 19) recruited 127 patients (intervention = 67 and control = 60) to the trial. Excessive consumption was identified opportunistically via the Alcohol Use Disorders Identification Test. After baseline assessment, patients received either a 5-10 minutes brief intervention using the 'Drink-Less' protocol or standard advice (control condition). Follow-up occurred at 6 and 12 months postintervention. RESULTS: Analysis of variance weighted for cluster size revealed no statistically significant differences between intervention and control patients at follow up. A majority of patients in both conditions reduced their alcohol consumption between assessment and subsequent measurement. Economic analysis suggested that the brief intervention led to no statistically significant changes in subsequent health service resource use relative to standard treatment. CONCLUSION: The brief intervention evaluated in this trial had no effect over standard advice delivered by nurses in primary health care. However, there was a reduction in excessive drinking across both arms of the trial over time. Due to nurse drop-out, this trial was significantly underpowered. Future research should explore barriers to nurses' involvement in research trials, particularly with an alcohol focus. A larger trial is required to evaluate the effectiveness of nurse-led screening and brief alcohol intervention in primary care.     

Changes, challenges and choices for the primary health care workforce: looking to the future

AIMS: The main aim of this paper is to draw attention to problems facing the primary health care workforce in terms of demand for treatment of minor illness over the next two decades. These predictions have implications for the community nursing workforce in particular and the flexibility of primary health care teams in general. BACKGROUND: Care delivered in the primary care sector influences, and is influenced by, the characteristics of the health care workforce. These characteristics fall into two main groups: firstly, the shape of the present medical and nursing workforce and manpower trends; and secondly, the changes in doctors' and nurses' workloads. DESIGN: This paper draws on two studies, both commissioned by the Department of Health; the first study focusing on skill mix and delegation in primary health care teams and the second addressing the implications of skill mix for medical workforce scenarios in the changing policy environment. FINDINGS: From the first study, general practitioners across ten general practices were prepared to delegate at least one topic from over a third of 836 consultations and a further 17% of entire consultations. This potential delegation fell mainly to practice nurses and nurse practitioners. The second study used data extracted from the National Morbidity Surveys of 1981 and 1991 predicting that minor consultations are set to increase by 11 million from the 1990s to 2020--a minimal estimate. The authors argue that many of these extra predicted consultations will find their way onto practice nurses' and nurse practitioners' caseloads. CONCLUSIONS: Workforce issues and questions of professional roles and boundaries, in the context of the "greying" community nursing workforce, demand solutions if patient/client demand is to be met over the next two decades.     

A national audit of antibiotic prophylaxis in elective laparoscopic cholecystectomy

Introduction

Laparoscopic surgeons in Great Britain and Ireland were surveyed to assess their use of antibiotic prophylaxis in elective laparoscopic cholecystectomy. This followed a Cochrane review that found no evidence to support the use of antibiotic prophylaxis in routine cases.

Methods

Data were collected on routine use of antibiotics in elective laparoscopic cholecystectomy, and how that was influenced by factors such as bile spillage, patient co-morbidities and surgeons’ experience. An online questionnaire was sent to 450 laparoscopic surgeons in December 2011.

Results

Data were received from 111 surgeons (87 consultants) representing over 7,000 cases per year. In routine cases without bile spillage, 64% of respondents gave no antibiotics and 36% gave a single dose. In cases with bile spillage, 11% gave no antibiotics. However, 80% gave one dose and 7% gave three doses. Co-amoxiclav was used by 75% of surgeons. Surgeons are more likely to give antibiotics when patients have risk factors for infective endocarditis.

Conclusions

This study suggests over 20,000 doses of antibiotics and over £100,000 could be saved annually if surgeons modified their practice to follow current guidelines.     

Microbial keratitis in Sydney,Australia: risk factors,patient outcomes,and seasonal variation

Graefe's Archive for Clinical and Experimental Ophthalmology - To provide recent data on patient demographics, clinical profile and outcomes of patients with microbial keratitis over a 5-year...     

应用全颌曲面断层片判断牙周炎骨密度和预测下颌角骨折风险的研究

目的：应用一种新的全颌曲面断层分析方法来判断牙周炎组和正常组之间的相对骨密度（RBD）的差异,并预测下颌角骨折的风险.方法：回顾性研究60例牙周炎患者和60例正常组病例,应用全颌曲面断层片比较其相对骨密度（RBD）.同时,调查所有患者的下颌角骨折病史并做记录.结果：牙周炎组和正常组之间的三个RDB指数的差异有明显统计学意义.正常组有3例下颌角骨折患者,牙周炎组有8例下颌角骨折病例.两组下颌角骨折患者RBD指数均相对较低.结论：牙周炎组和正常组的RBD指数之间具有明显统计学意义,RBD指数可以作为普通全颌曲面断层片的一种新的分析方法.可用做牙周炎的筛选工作,并在一定程度上可以预测发生下颌角骨折的风险.     

医药工业洁净室悬浮粒子的测量不确定度评定

目的：评定洁净室悬浮粒子的测量不确定度。方法对悬浮粒子的测量不确定度来源分析,建立数学模型,逐项评定悬浮粒子的不确定度的分量,合成标准不确定度,最后得出测量结果的扩展不确定度。结果粒径≥0.5μm的悬浮粒子数为（10490±2472）粒/m3,k=2;粒径≥5μm的悬浮粒子数为（923±296）粒/m3, k=2。结论悬浮粒子的测量不确定度主要来源是仪器的计量性能及试验重复性引起的不确定度,测量时应注意采样点的均匀性及代表性,多点采样,以减少不确定度,提高结果的可靠性。     

体脂量是绝经后女性股骨近端骨强度的决定因素

正Lower body weight or body mass index(BMI)has been known to be higher risk of developing osteoporosis and low-energy fractures via mechanical loading and other factors in both men and women[1].Recently,there have been new insights into the relationships between body composition and bone health.However,most of the previous studies regarding the relative effect of body composition on bone mass yielded inconsistent     

人文关怀护理干预对门诊护理服务满意度的影响

目的了解通过人文关怀护理干预后就诊者对门诊护士满意度影响。方法护理服务质量满意度调查表共设置17条,每条项目有"满意"、"基本满意"、"不满意"3项选择或"是"与"否"2项选择。"满意"、"基本满意"、"是"项列入优良项目数,"不满意"、"否"项列入不良项目数。对人文关怀护理干预及常规护理的就诊者各50例采用门诊现场问卷调查和集中填表相结合的方式进行满意度调查。结果分别收到人文关怀护理干预组及常规护理组就诊者对门诊护理服务综合评价不良项目179条和21条,两者比较有统计学意义(P<0.05)。结论对门诊就诊者进行人文关怀护理干预可提高门诊护理服务质量及就诊者的满意度。     

开设护士门诊促进我国护理专业发展

通过综述国内、外护士门诊的发展状况,进一步分析在我国设立护士门诊的必要性,以及对我国护理专业发展的意义,旨在弥补我国护士门诊专家的不足。建议护士门诊专家在具有护理专业知识的同时,还应掌握全面的预防保健和临床理论知识、丰富的临床实践经验、有效沟通以及紧急应急能力,必要时进行高效的团队合作,以促进我国护理专业的发展。