CPD in the remote environment: a role for practice-based small group learning?

BACKGROUND: Continuous professional development (CPD) is recognised as essential and mandated by the Royal College of General Practitioners and other medical professional colleges. However, it can be difficult to maintain when deployed and remote from normal training and support structures. There is no literature directly discussing how military doctors in the deployed and remote environment maintain CPD and if practice-based small group learning (PBSGL) could be an appropriate tool to facilitate this in future. AIM: To describe the CPD experience of medical officers (MOs) working for the Defence Medical Services (DMS) and assess if offering PBSGL would be welcomed and likely beneficial. DESIGN AND SETTING: This is a quantitative survey of doctors working in primary care within the DMS. METHOD: A questionnaire was designed to elicit opinions, current practice and previous experience of CPD within the deployed and firm base environments. It also aimed to elicit prior experience of and appetite for PBSGL as a solution. This was then distributed via email to MOs working for the DMS. RESULTS: 130 responses (25%) were received. 122 (96%) had heard of PBSGL, 56% had participated in PBSGL in the firm base. 60% agreed or strongly agreed PBSGL was an effective way to maintain CPD. 73% reported eLearning as a mode of maintaining CPD while deployed or working in a remote environment. CONCLUSION: This study demonstrated that many general practitioners deployed to remote locations feel that CPD provision could be improved and that PBSGL is a potential solution.

Adverse events in nursing: A retrospective study of reports of patient and relative experiences.

BACKGROUND: Patient safety is an important global issue. While it is well known that patients can suffer from adverse events in nursing care, there is a lack of knowledge as to how they experience them. AIM: To examine adverse events in nursing care as they are experienced by patients and relatives. METHODS: This was a retrospective study taking both a qualitative and a quantitative approach. It was based on data regarding 242 adverse events in nursing care, as reported by patients and relatives to Sweden's Medical Responsibility Board, content analysis was used to analyse the reports. RESULTS: Patients' and relatives' experiences were analysed into four categories of adverse events, as concerning participation, clinical judgement, nursing intervention and the essentials of care. LIMITATIONS: The reports were classified by the Medical Responsibility Board, without a standardized system. The adverse events reported were few in number and were reported by patients and relatives only. CONCLUSION: Lack of participation has negative consequences and contributes to adverse events. Adverse events occur through missed care as well as through carer errors. IMPLICATIONS ON NURSING AND HEALTH PRACTICE: Nurses need to improve their skills that support patient participation. Patient participation needs to be incorporated into nurses' duties. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Resources for patients to participate in their own care needs to be a priority underpinning policy-making in health systems. Nursing education systems need to teach students about the value and benefits of involving patients in their care.

Economic evaluation of nursing practices: a review of literature.

BACKGROUND: The importance of cost-effectiveness of nursing practices and its influence on prioritizations has been discussed in literature. It is, however, unclear to what extent health economic analysis has been used in the area of nursing. AIM: The aim of this paper was to investigate how studies of nursing practices apply economic evaluations. METHODS: A literature review was conducted that included studies through August 2007. The search was performed using Medline, CINAHL, PsycINFO, Econlit, DARE, HTA, NHS EED, Cochrane reviews and clinical trials with a search term connected to nursing and health economics. Protocols were used in the screening procedure and the result is reported in a descriptive form. RESULTS: The search identified 115 studies published between 1984 and August 2007. Studies were found in the following nursing practices: provision of support and treatment (n = 17); assessing suffering/well-being (n = 1); preventing or treating ill health (n = 53); and organization of individual care (n = 44). In 22% of all studies, the authors explicitly presented the health economic method used. In 25% of all studies, the perspective of the economic analysis was explicitly stated and a large variability in cost was considered in the analysis. In 82 studies, the authors reported cost-effective intervention. CONCLUSIONS: Although economic evaluation of nursing practice has increased, it is still a rather small area. According to the items elucidated in this study, further methodological improvement is needed to evaluate the economics of nursing.

Risk factors and prevention among patients with hospital-acquired and pre-existing pressure ulcers in an acute care hospital.

AIMS AND OBJECTIVES: This study aimed to describe and identify risk factors associated with hospital-acquired pressure ulcers among adults in an acute care hospital compared with patients with pre-existing pressure ulcers present on admission. A further aim was to identify the preventive measures performed with both groups respectively. BACKGROUND: Pressure ulcers occur most often in older and immobile persons with severe acute illness and neurological deficits. However, few studies have addressed risk factors that are associated with hospital-acquired pressure ulcers compared with patients with pre-existing pressure ulcers. DESIGN: A point prevalence study with a cross-sectional survey design was conducted at a Swedish university hospital. METHOD: Data on 535 patients were recorded using a modified version of the protocol developed and tested by the European Pressure Ulcer Advisory Panel, including the Braden scale for risk assessment. RESULTS: The prevalence of pressure ulcers was 27% (95% confidence interval, 23-31%). Higher age and a total Braden score below 17 were significantly associated with the presence of pressure ulcers. Among individual risk factors higher age, limited activity level and friction and shear while seated or lying down were associated with hospital-acquired pressure ulcers, whereas only higher age and friction and shear were associated with the presence of pressure ulcers in the overall sample. There was an overall sparse use of preventive measures to relieve pressure. CONCLUSION: The findings of the present study revealed that pressure ulcers and the insufficient use of preventive measure to relieve pressure is still a problem in acute care settings. A continued focus must be placed on staff training in identifying patients at risk for pressure ulcers development. RELEVANCE TO CLINICAL PRACTICE: Increasing the ability to identify patients who are at risk for pressure ulcer development can assist in preventing unnecessary complications and suffering as well as reduce costs.

A phase II study of fixed dose rate gemcitabine in patients with relapsed müllerian tumors.

Gemcitabine (2',2'-difluorodeoxycytidine) is a novel purine analog with clinical activity against ovarian cancer. Accumulation of gemcitabine triphosphate (dFdCTP) increases in a linear fashion with prolonged infusions of gemcitabine, and there is a strong relationship between intracellular accumulation of dFdCTP and DNA damage. Women with ovarian, fallopian tube, or primary peritoneal carcinoma and documented recurrent disease were eligible for the study. Patients could not have received more than four prior lines of chemotherapy and had to have measurable or evaluable disease. Gemcitabine 800 mg/m2 administered by intravenous infusion at 10 mg/m2/min (fixed dose rate [FDR]) on days 1 and 8 of a 21-day schedule. Twenty-eight patients with a median age 60 (range, 40-77) years were treated. Although 43% were Eastern Cooperative Oncology Group 0, 50% had liver metastases. Eighty-eight cycles of therapy were delivered (median 2 [range, 1-6]). Five of the first ten patients treated at 800 mg/m2 could not receive day 8 FDR-gemcitabine because of neutropenia, and the starting dose was reduced to 700 mg/m2. Even at this dose there was cumulative hematologic toxicity resulting in dose reductions. Vomiting, mucositis, diarrhea, allergy, rash, fever, and alopecia were mild. In 28 patients, there was only one partial response (4%, 95% CI 0-18%) and median time to progression was 1.7 (interquartile range, 1.2-3.9) months. FDR-gemcitabine 700 mg/m2 administered by intravenous infusion at an FDR of 10 mg/m2/min had minimal activity against heavily pretreated recurrent tumors of müllerian origin. The optimal dose and schedule of gemcitabine is yet to be defined in this population.

Dealing with the disturbed soldier in primary care.

Medical Officers are often called to review violent or disturbed soldiers in barracks or in their homes. Management of the acutely disturbed soldier differs from the acutely disturbed civilian in that, whilst drug therapy will be largely similar, application of the Mental Health Acts (1) varies depending on the soldier's situation and, in some cases, the Acts do not apply at all. In addition, the rules on the arrest and detention of soldiers have changed considerably since the introduction of Human Rights legislation (2).

Evaluation of nursing documentation. A comparative study using the instruments NoGA and Cat-ch-ing after an educational intervention.

In this article we describe the results of a comparative study focusing on the evaluation of nursing documentation before and after an educational intervention. An additional aim is to report the results of a comparison between quality measurements of nursing documentation using the examination instruments NoGA and Cat-ch-ing and, against this background, to recommend an instrument for future examinations. The educational intervention was directed towards nurses at Helsingborg hospital/health care district. The intervention, which comprised supervision, group sessions, lectures and field trips, covered a period of two years and was built on a learning model. In all, the data material examined included 515 nursing records collected from 52 units. The study reports on a comparison of the examination results from four different clinics for the years 1994 and 1997. The results show a statistically significant difference between the four clinics before the intervention, a difference that disappeared after the intervention. Furthermore, the results show a statistically significant improvement in documentation after the intervention. For future examinations, it is recommended that the examination instrument Cat-ch-ing should be used and that methods for examination of the content of the documentation must be developed.

Perioperative nursing education and experience: a Swedish perspective.

1. Nursing science is a relatively new field of research in Sweden. Nursing research in Sweden is at an early stage of development and is scattered over different institutions, schools, and other centers. A systematic registration of research work is carried out only in certain areas. 2. Perioperative nursing care in Sweden is in a developmental stage. Some units have tried to introduce the perioperative nursing care model, but only the neurosurgical operation unit at Akademiska sjukhuset (Academic Hospital) in Uppsala, Sweden, has succeeded. 3. The perioperative nursing care model can be described briefly as follows: the operation nurse visits the patient at the ward and they have a structured conversation, the operation nurse is present when the operation is discussed and planned by the surgeon and anesthesiologist, and the operation nurse is responsible for the patient's care plan at the operation unit, visits the patient after the operation, and evaluates the experience in a structured conversation.

Inhibition of sound-induced convulsions by metoprine in the audiogenic seizure susceptible rat.

Metoprine which increases brain histamine by blocking its methylation, was recently demonstrated to inhibit electrically induced tonic convulsions in rats. Its effect was now tested on audiogenic convulsions in genetically audiogenic seizure sensitive rats. Metoprine (20 mg/kg, i.p.) reduced the severity of seizures significantly 4 and 28 h after drug administration. Also the duration of convulsions was significantly decreased. These results agree with an involvement of histaminergic neurons in convulsive phenomena perhaps as a part of an anticonvulsive inhibitory transmitter system.