Geographical variation in radiological services: a nationwide survey

Background  

Geographical variation in health care services challenges the basic principle of fair allocation of health care resources. This study aimed to investigate geographical variation in the use of X-ray, CT, MRI and Ultrasound examinations in Norway, the contribution from public and private institutions, and the impact of accessibility and socioeconomic factors on variation in examination rates.     

The effect of staff training on the use of restraint in dementia: a single-blind randomised controlled trial

BACKGROUND: Use of restraint amongst institutionalised elderly with dementia and problem behaviour not only remains widespread, but also appears to be accepted as inevitable. OBJECTIVE: The aim of this study was to reduce problem behaviour and the use of restraint in demented patients using a staff training program as intervention. METHODS: The study was a randomised single-blind controlled trial and took place in Stavanger, Norway. Four nursing homes were randomised to a control or an intervention group after stratification for size. The intervention consisted of a full day seminar, followed by a one-hour session of guidance per month over six months. The content of the educational program focused on the decision making process in the use of restraint and alternatives to restraint consistent with professional practice and quality care. The primary outcome measures were number of restraints per patient in the nursing homes in one week and agitation as measured with the Brief Agitation Rating Scale (BARS). These were rated before and immediately after the intervention was completed. The assessments were performed blind to design and randomisation group. RESULTS: Clinical and demographic variables did not differ between the intervention and control groups at baseline. After the intervention period, the number of restraints had declined by 54% in the treatment group, and increased by 18% in the control group. The difference between the two groups was statistically significant ( p = 0.013). There was a trend towards higher BARS score in the intervention compared to the control group at follow up ( p = 0.052). CONCLUSION: Although the level of agitated behaviour remained unchanged or increased slightly, the educational program led to a significant reduction of the use of restraint in institutionalised elderly with dementia. These results suggest that educational programs can improve the quality of care of people with dementia.     

Patient experiences of uncertainty - a synthesis to guide nursing practice and research

hansen b.s., rørtveit k., leiknes i., morken i., testad i., joa i. & severinsson e. (2012) Journal of Nursing Management 20, 266–277
Patient experiences of uncertainty – a synthesis to guide nursing practice and research Aim The aim of this study was to provide a synthesis of patients’ experiences of uncertainty in illness and the interventions outlined, based on qualitative research. Background There is a need to explore various patient experiences from a nursing perspective in order to achieve evidence-based practice and improve the quality of care. Uncertainty in illness is a dynamic experience – a stressor with a major impact on patients’ illnesses. Methods A literature search performed on PubMed and Cinahl yielded 15 qualitative studies that met the inclusion criteria and which were analysed and interpreted. Results Experienced uncertainty was one of two main areas comprising three themes: explaining, feeling and facing uncertainty. The second main area was suggested intervention strategies consisting of three themes: organizing the patient trajectory throughout the health-care system, supporting patients through relationships and providing knowledge through clear and accurate communication. Conclusion Providing insight, confidence and supporting the patients’ feeling of control are of importance for health-care professionals. Implications for nursing management Structured organization of the trajectory system should be followed up, while outcome measures (patient satisfaction), education and training programmes for patients and families after discharge to improve coping strategies and reduce uncertainty should be developed. Nurse leaders should work towards the establishment of clinical academic nursing positions to integrate knowledge, skills, experiences and research into everyday routines.     

Evidence supporting nutritional interventions for persons in early stage Alzheimer’s disease (AD)

The purpose of this paper is to grade research evidence supporting nutritional interventions for persons with early stage dementias and to report the recommendations of a consensus panel. Thirty four studies were reviewed in the areas of dietary restriction, antioxidants, and Mediterranean diet with strong support from epidemiological studies found in all three areas. The body of evidence to support nutritional interventions in the prevention and treatment of AD is growing and has potential as a treatment modality following translational studies. Article taken from Dementia Day Camp (DDC) Dementia Research Group Early Stage Consensus Report, Primary author Sandy Burgener, Ph.D, University of Illinois.     

The Effect of a Multicomponent Intervention on Quality of Life in Residents of Nursing Homes: A Randomized Controlled Trial (COSMOS)

Objectives

To investigate if the multicomponent intervention of the COSMOS trial, combining communication, systematic pain management, medication review, and activities, improved quality of life (QoL) in nursing home patients with complex needs.

Effect of everolimus vs calcineurin inhibitors on quality of life in heart transplant recipients during a 3‐year follow‐up: Results of a randomized controlled trial (SCHEDULE)

The Sc andinavian he art transplant everolimus d e novo st u dy with ear l y calcineurin inhibitors avoidanc e (SCHEDULE) trial was a 12 month, randomized, open‐label, parallel‐group trial that compared everolimus (EVR; n=56) to conventional CsA (n=59) immunosuppression. Previously, we reported that EVR outperformed CsA in improving renal function and coronary artery vasculopathy, despite a higher rejection rate with EVR. This study aimed to compare the effects of these treatments on quality of life (QoL). Within five post‐operative days, patients (mean age 50±13 years, 27% women) were randomized to EVR or a standard CsA dosage (CsA group). This study assessed quality of life (QoL), based on the Short Form‐36, EuroQol‐5D, and Beck Depression Inventory (BDI). Assessments were performed pre‐HTx and 12 and 36 months post‐HTx. At 12 and 36 months, the groups showed similar improvements in Short Form‐36 measures (at pre‐HTx, 12 and 36 months the values were as follows: Physical component summary: EVR: 31.5±110.9, 49.1±9.7, and 47.9±10.6; P<.01; CsA: 32.5±8.2, 48.4±8.5, and 46.5±11.5; P<.01; mental component summary: EVR: 46.0±12.0, 51.7±11.9, and 52.1±13.0; P<.01; CsA: 38.2±12.5, 53.4±7.1, and 54.3±13.0; P<.01); similar decrease in mean BDI (EVR: 10.9±10.2, 5.4±4.7, and 8.1±9.0; P<.01; CsA: 11.8±7.1, 6.3±5.4, and 6.2±6.5; P<.01); and similar Euro Qol‐improvements. Thus, in this small‐sized study, EVR‐based and conventional CsA immunosuppressive strategies produced similar QoL improvements.