Enrolled nurse medication administration

This paper describes an initiative undertaken at Sir Charles Gairdner Hospital in Perth, Western Australia to enhance the professional development of enrolled nurses to allow them to administer medications without the direct supervision of a registered nurse. This practice change proved to be a positive step for the hospital and for enrolled nurses. Benefits for patients were identified as greater continuity of care and increased timeliness of medication admiuistrqtion. The benefits for enrolled nurses were increased job satisfaction, improved morale and self esteem while the main benefit for registered nurses was decreased stres and workload.     

ACUPUNCTURE CHANNELS - MYTH OR REALITY GS Sekhon School of Surgery and Allied Sciences

Spurred by recent advances in the ancient science of acupuncture in China, world interest in the subject has renewed. While the benefits of acupuncture are evident, its. mode of action and the existence of channels and collaterals are major controversial subjects. Based on personal experience and that of some of their colleagues and patients, the authors believe that channels and collaterals exist. These channels not only play a role in the treatment of deep seated dis- eases and analgesia induction and probably a.lso moderate normal healthy perception. The ex- istence of channels and their collaterals has not been proved anatomically.     

Exploring what patients think when answering the Interpersonal Skills Questionnaire (ISQ): A ‘think aloud’ study

BackgroundThe Interpersonal Skills Questionnaire (ISQ) was developed to collect patient feedback on consultation skills of practitioners. However, it has not yet been evaluated with pharmacists.ObjectiveTo explore the thinking process of patients as they completed the ISQ following a consultation with a pharmacist.MethodsA qualitative think aloud (TA) methodology was used to explore patients' thinking while completing the ISQ following a consultation with a pharmacist. The study was conducted in secondary care with outpatients ≥18 years old. Interviews were carried out in rounds and were informally analysed (i.e., by writing notes while listening to recordings) to identify any associated major problem(s). Discussions were held between researchers to determine whether changes were needed based on patients' comments.ResultsEight patients in total (50% females) participated in this study (mean age: 48 years). Three rounds of TA were conducted. Most items of the ISQ were interpreted similarly by all participants with no major problems necessitating refining the ISQ.ConclusionsModification of the ISQ was unnecessary as interviews demonstrated no major problems with its use. The ISQ is thus a potentially suitable tool to collect patient feedback on pharmacists' consultations.     

Smoking cessation in England: Intentionality,anticipated ease of quitting and advice provision

Smoking prevalence in England continues to reduce but further reduction is increasingly difficult. Cessation policy has successfully targeted those who want to quit but further reduction will need to shift attention to more difficult ‘core smoker’ populations. Following the established ‘stages of change’ perspective, this paper considers the characteristics of people who do not intend to quit smoking, anticipate difficulties in quitting and have not received advice about quitting. We deploy multilevel models of data drawn from the Health Survey for England years 2002–2004, and the NHS Primary Care Trust Patient Surveys for 2004 and 2005. It was found that variations in intentionality and anticipated ease of quitting are associated with individual factors such as smoking intensity, parental smoking, age/length of time as a smoker and the nature of the advice-giving consultation. Household composition and household income are also implicated in the intention to quit and anticipated difficulties in quitting. Once individual and household factors are taken into account the only identifiable area-level variation is reduced intentionality towards quitting in rural areas. We conclude by arguing that further gains in smoking cessation must focus on understanding the characteristics of ‘hard-to-engage’ populations.     

Obligatory medical insurance in Russia: the participants' perspective.

The Russian Federation adopted a nation-wide system of obligatory medical insurance in 1993 in an effort to earmark a targeted source of funding for health care and to reverse a steep decline in health outcomes. The author conducted a survey in 1995-1996 of managers of two of the new institutional participants in Russia's health insurance scheme: Territorial Health Insurance Funds and private medical insurance companies. The survey results reveal deep dissatisfaction with the level of financing provided by the new system; continuing confusion and substantial regional variation in the implementation of the insurance legislation; fierce bureaucratic and institutional infighting between the major players, stemming primarily from controversy over delineation of responsibilities and ongoing battles for control over resources; promising hints of competition and other market-based incentives emerging from the current chaos; and broad agreement that further structural reform must accompany increased infusions of resources in order for significant systemic improvements to be realized.     

Perceived Susceptibility to Addiction among Adolescent Smokers

Previous research demonstrates that adolescent smokers are aware of smoking’s health consequences yet perceive they are less susceptible to harm than other smokers, thereby exhibiting an optimistic bias. The present study extends such research to consider whether optimistic bias is present in relation to the addictive consequences of smoking. To explore this, 416 adolescents responded to a questionnaire about the consequences of smoking. As predicted, there was a significant association between regular, experimental, and non-smokers’ perceptions about their personal susceptibility to addiction. Regular smokers showed the greatest bias about their ability to quit smoking. Implications for prevention campaigns are discussed.     

Identification of patients with atrial fibrillation in UK community pharmacy: an evaluation of a new service

Background Many patients with atrial fibrillation (AF) are asymptomatic and diagnosed via opportunistic screening. Community pharmacy has been advocated as a potential resource for opportunistic screening and lifestyle interventions. Objective The objective of this evaluation is to describe the outcomes from an AF service, in terms of referrals and interventions provided to patients identified as not at risk. Methods Eligibility was assessed from pharmacy records and the completion of a short questionnaire. Once consented, patients were screened for AF and their blood pressure was measured. Results Of 594 patients screened, nine were identified as at risk of having AF and were referred to their GP. The service also identified 109 patients with undiagnosed hypertension, 176 patients with a Body Mass Index >30, 131 with an Audit-C score >5 and 59 smokers. Pharmacists provided 413 interventions in 326 patients aimed at weight reduction (239), alcohol consumption (123) and smoking cessation (51). Conclusion This evaluation characterises the interventions provided to, not only those identified with the target condition—in this case AF—but also those without it. The true outcome of these additional interventions, along with appropriate follow-up, should be the focus of future studies.     

Vitamin D supplementation and bone mineral density in early postmenopausal women

BACKGROUND: Increased vitamin D intake may preserve or increase bone mineral density (BMD) in older persons. OBJECTIVE: A 2-y double-blind study was undertaken to determine whether weekly administration of 10 000 units of vitamin D(2) maintained or increased BMD in younger postmenopausal women more efficiently than did calcium supplements alone. DESIGN: One hundred eighty-seven women who were >or= 1 y postmenopausal were randomly assigned to take either 1000 mg Ca/d after the evening meal or 1000 mg Ca/d plus 10 000 U vitamin D(2)/wk in a double-blind, placebo-controlled format. The BMD of the proximal forearm, lumbar spine, femoral neck, Ward's triangle, and femoral trochanter was measured at 6-mo intervals by osteodensitometry. RESULTS: During the 2-y period, there was no significant difference in the change in BMD at any site between the subjects taking calcium supplements and those taking calcium plus vitamin D(2). Both groups significantly (P < 0.005) gained BMD in Ward's triangle and the femoral trochanter but significantly (P < 0.005) lost bone in the proximal radius. There was no significant change in the lumbar spine or femoral neck BMD. CONCLUSION: In younger postmenopausal women ( age: 56 y) whose average baseline serum 25-hydroxyvitamin D concentration was well within the normal range, the addition of 10 000 U vitamin D(2)/wk to calcium supplementation at 1000 mg/d did not confer benefits on BMD beyond those achieved with calcium supplementation alone.     

盎格鲁-凯尔特人群和中国人群2型糖尿病促发因素的对比研究

目的探讨盎格鲁-凯尔特人和中国人代谢综合征(IR)患病率和2型糖尿病促发因素。方法采用横断面研究,收集1992—2004年澳大利亚阿尔弗雷德王子医院和北京306医院门诊筛查糖尿病病程小于2a的病例资料,1016名盎格鲁-凯尔特人和1514名中国人,按发病时年龄分层后分析其IR(WHO标准)及其构成因素。结果在盎格鲁-凯尔特早发糖尿病病人中,IR患病率较高,且体质指数(BMI)与发病年龄呈显著负相关(r=-0.300;P<0.01),BMI每增加1kg/m2,发病年龄减小0.5岁。低发病年龄组可见IR患病率增加、甘油三酯(TG)升高以及高密度脂蛋白(HDL)降低;中国人发病年龄与BMI、IR、TG或HDL无关联。结论在凯尔特人中IR是2型糖尿病的重要促发因素,而在中国人中并非如此。提示中国人群中提早发生的beta细胞缺乏是糖尿病发病的更重要的促发因素。2型糖尿病具有异质性,因此,糖尿病的预防需要更多人种特异性的治疗策略。