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.     

The synergy professional practice model and its patient characteristics tool: a staff empowerment strategy

Nurse leaders can positively influence practice environments through a number of empowerment strategies, among them professional practice models. These models encompass the philosophy, structures and processes that support nurses' control over their practice and their voice within healthcare organizations. Nurse-driven professional practice models can serve as a framework for collaborative decision-making among nursing and other staff. This paper describes a provincewide pilot project in which eight nurse-led project teams in four healthcare sectors worked with the synergy professional practice model and its patient characteristics tool. The teams learned how the model and tool can be used to classify patients' acuity levels and make staffing assignments based on a "best fit" between patient needs and staff competencies. The patient characteristics tool scores patients' acuities on eight characteristics such as stability, vulnerability and resource availability. This tool can be used to make real-time patient assessments. Other potential applications for the model and tool are presented, such as care planning, team-building and determining appropriate staffing levels. Our pilot project evidence suggests that the synergy model and its patient characteristics tool may be an empowerment strategy that nursing leaders can use to enhance their practice environments.     

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.     

The lung and the brain: a dangerous cross-talk

Brain or lung injury or both are frequent causes of admission to intensive care units and are associated with high morbidity and mortality rates. Mechanical ventilation, which is commonly used in the management of these critically ill patients, can induce an inflammatory response, which may be involved in distal organ failure. Thus, there may be a complex crosstalk between the lungs and other organs, including the brain. Interestingly, survivors from acute lung injury/acute respiratory distress syndrome frequently have some cognitive deterioration at hospital discharge. Such neurologic dysfunction might be a secondary marker of injury and the neuroanatomical substrate for downstream impairment of other organs. Brainlung interactions have received little attention in the literature, but recent evidence suggests that both the lungs and brain can promote inflammation through common mediators. The present commentary discusses the main physiological issues related to brain-lung interactions.     

Early predictors of hospital admission in emergency department patients with chronic obstructive pulmonary disease

Background

Streamlining emergency department (ED) care of patients with chronic obstructive pulmonary disease (COPD) may be an important strategy in managing the increasing burden of this disease.

Study objectives

The aim of this study was to identify factors predictive of hospital admission in ED patients with COPD, specifically factors that can be used early in the ED episode of care.

Methods

Using retrospective regression analysis, case data from 321 randomly selected medical records from five Australian EDs were analysed. Patient characteristics, triage and ED system features, physiological status, and ED treatment during the first four hours of ED care were compared between discharged and admitted patients.

Results

Factors available on ED arrival associated with increased likelihood of admission were: age (OR = 1.04, p = 0.008) respiratory symptoms affecting activities of daily living (OR = 1.8, p = 0.043) and signs of respiratory dysfunction (OR = 2.5, p = 0.005). Factors available from the first four hours of ED care associated with increased likelihood of admission were: age (OR = 1.04, p = 0.021), oxygen use at four hours (OR = 3.5, p = 0.002) and IV antibiotic administration (OR = 2.6, p = 0.026). There were conflicting findings regarding the association between ambulance transport and admission.

Conclusion

There were significant differences in the characteristics of patients who were admitted or not admitted to hospital. Knowledge of these differences may be used to tailor care directed at anticipated outcome (home or hospital admission).