Development of a validated patient satisfaction survey for HIV clinic attendees.

Patients are becoming more actively involved in decisions about their care and have greater influence to change and improve the quality of services by reporting their experiences. A recent systematic review failed to reveal a method of measuring HIV patient satisfaction that reflects their experience of contemporary treatment and care. The aim of this study was to design a specific HIV patient satisfaction questionnaire that can be used as a patient reported outcome measure. Key themes in the systematic review were identified and used as a topic guide for focus group discussion to confirm their relevance and importance. HIV patients were also interviewed about their motivation to complete a questionnaire. The data from the focus groups and interviews were used to develop an initial questionnaire and cognitive testing was used to provide face validity for the questionnaire design, layout and wording. A revised version was used in a pilot study of 80 respondents, which demonstrated that the questionnaire's completion rate and content validity were high.

Influence of comorbidity on the effect of adjuvant treatment and age in patients with early-stage breast cancer.

BACKGROUND: Prevalence of comorbidity at breast cancer diagnosis increases with age and is likely to influence the likelihood of receiving treatment according to guidelines. The aim of this study was to examine the effect of breast cancer treatment on mortality, taking age at diagnosis and comorbidity into account. METHODS: Four nationwide population registries in Denmark: the Danish Civil Registration System, the Danish Breast Cancer Cooperative Group, the Danish National Patient Register, and the Danish Register of Causes of Death provided information on 62 591 women diagnosed with early-stage breast cancer, 1990-2008, of whom data on treatment were available for 39 943. Comorbidity was measured using the Charlson Comorbidity Index. Adjuvant treatment were categorised as none, chemotherapy, endocrine therapy, and unknown. Multivariable Cox modelling assessed the effect of comorbidity on breast cancer-specific mortality and other cause mortality according to treatment, adjusting for age at diagnosis and other clinical prognostic factors. RESULTS: The impact of comorbidity on mortality was most pronounced in patients aged 50-79 years. Patients receiving chemotherapy with mild to moderate comorbidity had HR 0.99 (95% confidence interval (CI); 0.82-1.19) and 1.06 (95% CI; 0.77-1.46) for breast cancer-specific mortality, respectively, compared with patients without comorbidity. CONCLUSION: Comorbidity at breast cancer diagnosis is an independent adverse prognostic factor for death after breast cancer. We identified a subgroup of patients with mild to moderate comorbidity receiving chemotherapy who had similar breast cancer mortality as patients with no comorbidity.

Using patient experience to measure the quality of HIV care.

Measurement of health-care quality in the UK is no longer restricted to evaluating the effectiveness of treatments or the cost efficiency of services. There is a drive towards a patient-based agenda which enables them to make a clear contribution to the way services are shaped by expressing their values and sharing experiences. Positive engagement with HIV care has proven benefits to patients and the mandatory use of standardized reported outcome measures provides an opportunity to include HIV patients in the process of creating and refining an evaluation tool which places emphasis on aspects of care that are significant to them. Ultimately, this will provide services users with a stronger voice to guide appropriate service change and support the continuing improvement of HIV care.

Patient-derived outcome measures for HIV services in the developed world: a systematic review.

This review sought to establish the themes and approaches used in the measurement of patient satisfaction regarded by HIV service users as crucial to improving service quality. It also investigated how feedback has been measured previously and whether a gold standard instrument exists that is generalizable across HIV inpatient and clinic settings. Twelve databases and other sources yielded 1474 titles. Using a clinically-focused question and pre-defined inclusion and exclusion criteria, 32 articles were retrieved and reviewed for quality using a quality appraisal checklist. Two reviewers used a data extraction form to identify and verify key patient experiences. Thematic analysis revealed that clinic staffs' current knowledge of HIV was an essential factor in positive feedback. Treating patients with dignity and respecting their autonomy and confidentiality were also important. Developments in treatment, extended life expectancy and quality of life have altered patients' experience and level of satisfaction. Three instruments developed to assess patient satisfaction with HIV care were identified but there was no gold standard method of measuring it. There is a need to develop a specific, valid instrument that is easy to complete and analyse, and the data should be used to inform the redesign of services to promote a dynamic model of care.

Orthopaedic and trauma patients' perceptions of individualized care.

BACKGROUND: Individualized care is a universal concept in nursing. An international collaboration of nurses, led by, and funded in, Finland was developed, including Sweden, Greece, USA and the UK, in order to test an Individualized Care Scale (ICS) for cross-cultural comparison. This paper reports the results from the UK survey. AIM: The study aimed to employ an ICS to describe orthopaedic and trauma patients' perceptions of individualized care. METHODS: A total of 159 orthopaedic and trauma patients, aged 18 years or over, admitted for over 48 hours as emergencies or for elective surgery, participated from one hospital in Central England using a two-part ICS. The data were analysed using both descriptive and inferential statistics. RESULTS: Sixty-three per cent of the patients (n = 82) strongly agreed that it was very important to be treated as an individual or unique person, and 55% (n = 72) experienced this type of care. The lowest rated assessments concerned the support (3.23 +/- 1.15) and perceptions (3.69 +/- 0.98) of personal life situation, and the highest concerned the perceptions of decisional control over care (4.25 +/- 0.72). The longer the patients stayed, the more they perceived individuality in their own care. Those less educated perceived higher levels of support regarding individuality in their care. CONCLUSIONS: These results could assist changes to individualized care processes in orthopaedic and trauma wards. Future research should focus on the evaluation of taking into account of patient's personal life situation as a foundation for individualized clinical care.

Topical negative pressure for treating chronic wounds.

BACKGROUND: Chronic wounds mainly affect the elderly and those with multiple health problems. Despite the use of modern dressings, some of these wounds take a long time to heal, fail to heal, or recur, causing significant pain and discomfort to the person and cost to health services. Topical negative pressure is used to promote healing of surgical wounds by using suction to drain excess fluid from wounds. OBJECTIVES: To assess the effectiveness of topical negative pressure (TNP) in treating people with chronic wounds and to identify an optimum TNP regimen. SEARCH STRATEGY: The Cochrane Wounds Group Specialised Trials Register was searched until July 2000. Experts in the field and relevant companies were contacted to enquire about ongoing and recently completed relevant trials. In addition citations within obtained papers were scrutinised to identify additional studies. SELECTION CRITERIA: All randomised controlled trials which evaluated the effectiveness of TNP in treating chronic wounds were considered. DATA COLLECTION AND ANALYSIS: Eligibility for inclusion, data extraction and details of trial quality was conducted by two reviewers independently. A narrative synthesis of results was undertaken as only two small trials fulfilled the selection criteria and they used different outcome measures. MAIN RESULTS: Two small trials with a total of 34 participants evaluated the effectiveness of TNP on chronic wound healing. Trial 1 considered patients with any type of chronic wound; Trial 2 considered patients with diabetic foot ulcers only. The trials compared TNP (as open cell foam dressing with continuous suction) for the first 48 hours with saline gauze dressings. Trial 1 reported a statistically significant reduction in wound volume at 6 weeks in favour of TNP. Trial 2 (continuous suction, followed by intermittent suction after 48 hours) reported a reduction in the number of days to healing and a reduction in wound surface area at 2 weeks in favour of TNP, - although no statistical analysis was reported. REVIEWER'S CONCLUSIONS: The two small trials provide weak evidence suggesting that TNP may be superior to saline gauze dressings in healing chronic human wounds. However, due to the small sample sizes and methodological limitations of these trials, the findings must be interpreted with extreme caution. The effect of TNP on cost, quality of life, pain and comfort was not reported. It was not possible to determine which was the optimum TNP regimen.

Topical negative pressure for treating chronic wounds: a systematic review.

Some wounds take a long time to heal, fail to heal or recur, causing significant pain and discomfort to the patient and cost to the National Health Service. This review assesses the effectiveness of topical negative pressure (TNP) in treating chronic wounds. The Cochrane Wounds Group Specialised Trials Register was searched for randomised controlled trials (RCTs) that evaluated the effectiveness of TNP on chronic-wound healing. Eligibility for inclusion, data extraction and details of trial quality were conducted by two reviewers independently. A narrative synthesis of results was undertaken as only two small trials, with different outcome measures, fulfilled the selection criteria. Trial 1 considered any type of chronic wound, trial 2 considered diabetic foot ulcers. Both trials compared TNP with saline-gauze dressings. Trial 1 reported a statistically significant difference in the percentage change in wound volume after 6 weeks, in favour of TNP. Trial 2 reported a difference in the number of days to healing and a difference in the percentage change in wound surface area after 2 weeks, in favour of TNP. These two small trials provide weak evidence to suggest that TNP may be superior to saline-gauze dressings in terms of wound healing. However, due to the small sample sizes and the methodological limitations of the studies, these findings must be interpreted with extreme caution. The effects of TNP on cost, quality of life, pain and comfort were not reported. It was not possible to determine the optimum TNP regimen. Further high-quality RCTs that address these issues are required.

A clinical evaluation of an alternating-pressure mattress replacement system in hospital and residential care settings.

An observational study was carried out to compare wound healing on alternating-pressure mattress replacement systems (APMRS) and other surfaces in an elderly population in acute and residential care settings. Subjects were assessed for the reduction in their pressure ulcers at approximately two weeks and per day, and a visual analogue scale was used to record the patients' comfort. Seven and ten subjects were allocated to the Nimbus III APMRS (Huntleigh Healthcare Ltd) in the hospital and residential care settings respectively. There was no significant difference in the healing of the subjects' sores in the two areas either at two weeks or per day. Five people were allocated to control surfaces in the hospital setting (mainly APMRS; Pegasus Airwave, Pegasus Egerton) and ten in the residential care setting (mainly alternating-pressure overlays; AlphaXcell, Huntleigh Healthcare Ltd). There was no significant difference in the healing of subjects' sores in the two areas, either at two weeks or per day. The trial APMRS was found to be equally comfortable in either setting, and in both settings the control surfaces were not regarded as significantly different in terms of comfort. These findings, from a small sample, promote discussion about the use of pressure-relieving equipment in settings where there are older people who may be at particular risk from pressure damage and where nursing interventions are less intensive and routine.

A clinical evaluation of the Nimbus 3 alternating pressure mattress replacement system.

This study assessed the clinical effectiveness of the Nimbus 3 alternating pressure mattress replacement system (APMRS) on pressure ulcer healing and comfort in subjects > or = 65 years, with at least a Grade 2 ulcer and some mobility problems. Twelve patients in a hospital setting were randomly allocated to the Nimbus 3 or another APMRS, and 20 residents in a nursing home setting to the Nimbus 3 or an alternating pressure mattress overlay. Wound surface area (WSA) (cm2) was recorded twice weekly and comfort once weekly. In the hospital setting, there were no significant differences between groups in the reduction in WSA per day. In the nursing home setting, though subjects on Nimbus 3 had significantly more pressure ulcers at baseline, there were no significant differences between groups in the reduction in WSA per day. Nimbus 3 was statistically more comfortable than control surfaces. The study's sample size has not shown the products were different with regard to clinical effectiveness. However, it might serve as a pilot for a larger, multi-centre RCT aimed at establishing the efficacy of a pressure-relieving (PR) device on pressure ulcer healing.

Extent and effectiveness of the Scope of Professional Practice.

This paper describes a survey commissioned by the NHS Executive (West Midlands office) Nursing Directorate in conjunction with the Research and Development Directorate. The study aimed to explore the extent of initiatives associated with the UKCC's Scope of Professional Practice in 58 trusts in the West Midlands. The data were produced through semi-structured interviews with professional heads of nursing, professional development staff and educators, together with postal questionnaires to a sample of 100 clinical managers in all branches of nursing and midwifery. The results indicate that the activities associated with the Scope of Professional Practice are not easily defined. There is support for the UKCC document, although there are reservations about the forces behind it, and insufficient resources are an obstacle to role and practice developments. To gain the most benefit from this initiative, it is argued, nursing and midwifery practitioners must plan the development of their roles carefully.

A review of pressure damage prevention strategies.

The prevention of pressure damage is a fundamental aspect of nursing care. Despite this and the amount of literature available, the prevalence and incidence of pressure sores do not appear to be diminishing. This review focuses on elements of care that are within the power of nurses to attain and suggests strategies for promoting quality care by simple, economic and effective means.

Hypoxic ventilatory responses in Tibetan residents of 4400 m compared with 3658 m.

Lifelong Tibetan residents of 3658 m ventilate as much and have hypoxic and hypercapnic ventilatory responsiveness as least as great as acclimatized newcomers, and likely greater than lifelong North or South American high-altitude residents. To determine whether Tibetans residing at altitudes > 3658 m maintained similar levels of ventilation, hypoxic and hypercapnic ventilatory responses, we transported 20 lifelong residents of > or = 4400 m to 3658 m for comparison with 27 similarly-aged male Tibetan residents of 3658 m. At 3658 m, the 4400 m compared with the 3658 m Tibetans had similar levels of minute ventilation and arterial O2 saturation, higher respiratory quotients but lower hypoxic ventilatory responses. We conclude that Tibetan residents of > or = 4400 m ventilate as much as Tibetan residents of 3658 m despite an altitude-associated blunting of their hypoxic ventilatory responses. Thus, factors other than hypoxic ventilatory chemosensitivity are likely to be important contributors to resting ventilation among Tibetan high altitude residents.

The student nurse selection experience: a qualitative study.

A qualitative study was undertaken to explore the experiences of student nurses recruited to three British colleges of nursing. A series of focus groups was initiated to discuss the career decisions surrounding their entry into nursing and their experiences of the selection interview. Similar groups were conducted with those who are involved in the selection of candidates for nursing to determine what influenced their decisions to accept or reject people. Analysis of the data suggests that nursing is attracting people from careers that are unstable or unsatisfactory. Selection procedures are outdated and inconsistent and interviewees quickly learn to provide appropriate responses. There is confusion surrounding the skills and qualities required of potential nurses, and more effective recruitment strategies might attract potential undergraduates without losing those with vocational aspirations. A more systematic approach to selection, using a range of objective, measurable criteria, may remove the intuitive selection of nurses, increasing the efficiency of the selection process.

Problem solving using soft systems methodology.

This article outlines a method of problem solving which considers holistic solutions to complex problems. Soft systems methodology allows people involved in the problem situation to have control over the decision-making process.

Selecting potential nurses: a review of the methods.

The following paper presents an overview of the literature in relation to personnel selection and its particular application to the selection of candidates for nurse education. In industry and indeed general management circles within the National Health Service, dynamic methods are being used to select middle and higher management personnel. Yet the largest group of National Health Service employees to be selected, nurses, whose training costs represent no small amount in annual budgets, appear to be accepted on highly inconsistent and subjective grounds. Material derived from personnel management and occupational psychology demonstrates the importance of systematic staff selection and the resulting discussion questions why nursing retains such methods for selecting student nurses.

Computer-assisted interactive video instruction in nursing (CAIVIN).

Computer-assisted interactive video instruction in nursing (CAIVIN) uses a team approach in designing and producing interactive software. The team's goal is to produce videodiscs in a variety of settings within nursing specialties. The current focus is decision making in medical-surgical nursing using the nursing process as the problem-solving model. Interactive video is used to make a smooth, safe transition from theory to practice through the use of simulations.