Planning for research impact.

BACKGROUND: Several drivers are currently leading to greater emphasis of the importance of ensuring research has impact. Nursing research aims to improve patient care, safety and well-being, so it might be assumed results with the potential to effect such changes would automatically have an impact on clinical practice. However, experience suggests this is not the case and careful attention is needed for there to be an impact. AIM: To present the example of a project commissioned to develop a health communication tool to support people with learning disabilities in accessing healthcare. DISCUSSION: The authors explore the importance of a planned approach to impact by referencing existing frameworks and providing examples of strategies used in the project. They also discuss the importance of framing the question using a range of approaches to actively engage stakeholders and of using diverse strategies to embed the development in practice. CONCLUSION: A planned approach is required to maximise impact from research. Planning and associated actions need to start at the very beginning of the research project and continue beyond the point of delivering the project report. IMPLICATIONS FOR PRACTICE: This paper relates to a specific context and patient group but the principles discussed are transferable to other clinical settings and patient groups.

Management and outcomes of ruptured, perforated or fistulized tumors of mesenchymal origin.

BACKGROUND: Patients with ruptured, perforated or fistulized (RPF) sarcomas commonly have issues such as sepsis and malnutrition and are usually unsuitable for oncologic resection in the emergency setting. We present our approach for managing a series of patients and the outcomes which were achieved with multidisciplinary care. METHODS: We reviewed records of patients referred to the section of sarcoma surgical oncology. Clinicopathologic factors, preoperative and operative interventions as well as short-term oncologic outcomes were assessed. RESULTS: Sixteen patients were identified between 1 January 1998 to 31 December 2018. Median age was 42.8 years. Histologies were; Gastrointestinal stromal tumors (7), desmoid (4), spindle cell tumor (2), dedifferentiated liposarcoma (2), and nonseminomatous germ cell tumor (1). Five patients had preoperative sepsis, 8 received antimicrobials, and 50% required hospitalization with a median stay of 21 days. Total parenteral nutrition was administered to 5 (31.3%) patients. Median tumor size and estimated blood loss were 13.1 cm and 350 mL respectively. No perioperative mortality occurred. Two patients have expired at a median follow-up of 16.1 months. CONCLUSION: Preoperative optimization, including the use of percutaneous drains, and antibiotics to control sepsis, where necessary, can lead to eventual oncologic resection with acceptable morbidity and no short-term mortality for patients with RPF sarcomas.

Implementation of independent nurse prescribing in UK mental health settings: focus on attention-deficit/hyperactivity disorder.

Legislative changes that came into effect in the UK in April 2012 gave nurse independent prescribers (NIPs) the power to prescribe schedule 2-5 controlled drugs. Therefore, suitably qualified UK nurses can now independently prescribe any drug for any medical condition within their clinical competence. The potential benefits of independent nurse prescribing include improved access to medications and more efficient use of skills within the National Health Service workforce. This review explores the published literature (to July 2013) to investigate whether the predicted benefits of NIPs in mental health settings can be supported by empirical evidence, with a specific focus on nurse-led management of patients with attention-deficit/hyperactivity disorder (ADHD). The most common pharmacological treatments for ADHD are controlled drugs. Therefore, the 2012 legislative changes allow nurse-led ADHD services to offer holistic packages of care for patients. Evidence suggests that independent prescribing by UK nurses is safe, clinically appropriate and associated with high levels of patient satisfaction. The quality of the nurse-patient relationship and nurses' ability to provide flexible follow-up services suggests that nurse-led ADHD services are well positioned to enhance the outcomes for patients and their parents/carers. However, the empirical evidence available to support the value of NIPs in mental health settings is limited. There is a need for additional high-quality data to verify scientifically the value of nurse-delivered ADHD care. This evidence will be invaluable in supporting the growth of nurse-led ADHD services and for those who support greater remuneration for the expanded role of NIPs.

Efficient incorporation of positively charged 2', 3'-dideoxynucleoside-5'-triphosphates by DNA polymerases and their application in 'direct-load' DNA sequencing.

A series of charge-modified, dye-labeled 2', 3'-dideoxynucleoside-5'-triphosphates have been synthesized and evaluated as reagents for dye-terminator DNA sequencing. Unlike the commonly used dye-labeled terminators, these terminators possess a net positive charge and migrate in the opposite direction to dye-labeled Sanger fragments during electrophoresis. Post-sequencing reaction purification is not required to remove unreacted nucleotide or associated breakdown products prior to electrophoresis. Thus, DNA sequencing reaction mixtures can be loaded directly onto a separating medium such as a sequencing gel. The charge-modified nucleotides have also been shown to be more efficiently incorporated by a number of DNA polymerases than regular dye-labeled dideoxynucleotide terminators or indeed normal dideoxynucleoside-5'-triphosphates.