A theoretical model of nursing practice: Implications for a competence approach to nursing education.

This article puts forward a theoretical model of nursing practice, elaborating and illustrating how the model can be used by nursing practitioners, students, and educators. Experiences with using the model in a pilot study with a clinical supervisor and three nursing students is reported. Implications of the model for working with competence development is discussed, both in relation to issues raised by Weeks et al. (2017) specifically, and to competence-based approaches more generally. A key point is that a focus on competence alone may not provide students with adequate conceptual tools for interpreting and acting competently in practical situations. The proposed theoretical model is seen as providing such a tool.

Impact of tumour volume on prediction of progression-free survival in sinonasal cancer.

BACKGROUND: The present study aimed to analyse potential prognostic factors, with emphasis on tumour volume, in determining progression free survival (PFS) for malignancies of the nasal cavity and the paranasal sinuses. PATIENTS AND METHODS: Retrospective analysis of 106 patients with primary sinonasal malignancies treated and followed-up between March 2006 and October 2012. Possible predictive parameters for PFS were entered into univariate and multivariate Cox regression analysis. Kaplan-Meier curve analysis included age, sex, baseline tumour volume (based on MR imaging), histology type, TNM stage and prognostic groups according to the American Joint Committee on Cancer (AJCC) classification. Receiver operating characteristic (ROC) curve analysis concerning the predictive value of tumour volume for recurrence was also conducted. RESULTS: The main histological subgroup consisted of epithelial tumours (77%). The majority of the patients (68%) showed advanced tumour burden (AJCC stage III-IV). Lymph node involvement was present in 18 cases. The mean tumour volume was 26.6 ± 21.2 cm(3). The median PFS for all patients was 24.9 months (range: 2.5-84.5 months). The ROC curve analysis for the tumour volume showed 58.1% sensitivity and 75.4% specificity for predicting recurrence. Tumour volume, AJCC staging, T- and N- stage were significant predictors in the univariate analysis. Positive lymph node status and tumour volume remained significant and independent predictors in the multivariate analysis. CONCLUSIONS: Radiological tumour volume proofed to be a statistically reliable predictor of PFS. In the multivariate analysis, T-, N- and overall AJCC staging did not show significant prognostic value.