Bedside nursing handover: patients' opinions

Within the context of contemporary nursing practice, bedside handover has been advocated as a potentially more suitable mode for achieving patient-centred care. Given that patients can play an important role in the process, better understanding of patients' perspectives of bedside handover could be a critical determinate for successful implementation of the practice. Using a phenomenological approach, this study attempted to explore patients' perceptions of bedside nursing handover. Four key themes emerged from the patient interviews: 'a more effective and personalised approach', 'being empowered and contributing to error minimization', 'privacy, confidentiality and sensitive topics', and 'training need and avoidance of using technical jargon'. Patients welcome bedside handover as they can be empowered through participation in the process. Nevertheless, attention is needed to ensure that adequate training is provided to nurses and to minimize the use of technical jargon so that handover is delivered with a professional and consistent approach.

Attitudes of emergency department patients about handover at the bedside

AIMS AND OBJECTIVES

To explore patients' perspectives of bedside handover by nurses in the emergency department (ED).

BACKGROUND

International guidelines promote standardisation in clinical handover. Poor handover can lead to adverse incidents and expose patients to harm. Studies have shown that nurses and patients have favourable opinions about handover that is conducted at the bedside in hospital wards; however, there is a lack of evidence for patients' perspective of nursing handover in the ED environment.

DESIGN

Qualitative descriptive study.

METHODS

Semi-structured interviews with 30 ED patients occurred within one hour of bedside handover. Data were analysed using thematic content analysis.

RESULTS

Two main themes were identified in the data. First, patients perceive that participating in bedside handover enhances individual care. It provides the opportunity for patients to clarify discrepancies and to contribute further information during the handover process, and is valued by patients. Patients are reassured about the competence of nurses and continuum of care after hearing handover conversations. Second, maintaining privacy and confidentiality during bedside handover is important for patients. Preference was expressed for handover to be conducted in the ED cubicle area to protect privacy of patient information and for discretion to be used with sensitive or new information.

CONCLUSIONS

Bedside handover is an acceptable method of performing handover for patients in the ED who value the opportunity to contribute and clarify information, and are reassured that their information is communicated in a private location.

RELEVANCE TO CLINICAL PRACTICE

From the patients' perspective, nursing handover that is performed at the bedside enhances the quality and continuum of care and maintains privacy and confidentiality of information. Nurses should use discretion when dealing with sensitive or new patient information.

A regulatory circuit that involves HR23B and HDAC6 governs the biological response to HDAC inhibitors

Histone deacetylase (HDAC) is an emergent anticancer target, and HR23B is a biomarker for response to HDAC inhibitors. We show here that HR23B has impacts on two documented effects of HDAC inhibitors; HDAC inhibitors cause apoptosis in cells expressing high levels of HR23B, whereas in cells with low level expression, HDAC inhibitor treatment is frequently associated with autophagy. The mechanism responsible involves the interaction of HDAC6 with HR23B, which downregulates HR23B and thereby reduces the level of ubiquitinated substrates targeted to the proteasome, ultimately desensitising cells to apoptosis. Significantly, the ability of HDAC6 to downregulate HR23B occurs independently of its deacetylase activity. An analysis of the HDAC6 interactome identified HSP90 as a key effector of HDAC6 on HR23B levels. Our results define a regulatory mechanism that involves the interplay between HR23B and HDAC6 that influences the biological outcome of HDAC inhibitor treatment.

Lactogenic hormones stimulate expression of lipogenic genes but not glucose transporters in bovine mammary gland

During the onset of lactation, there is a dramatic increase in the expression of glucose transporters (GLUT) and a group of enzymes involved in milk fat synthesis in the bovine mammary gland. The objective of this study was to investigate whether the lactogenic hormones mediate both of these increases. Bovine mammary explants were cultured for 48, 72, or 96 h with the following hormone treatments: no hormone (control), IGF-I, insulin (Ins), Ins + hydrocortisone + ovine prolactin (InsHPrl), or Ins + hydrocortisone + prolactin + 17β-estradiol (InsHPrlE). The relative expression of β-casein, α-lactalbumin, sterol regulatory element binding factor 1 (SREBF1), fatty acid synthase (FASN), acetyl-CoA carboxylase α (ACACA), stearyol-CoA desaturase (SCD), GLUT1, GLUT8, and GLUT12 were measured by real-time PCR. Exposure to the lactogenic hormone combinations InsHPrl and InsHPrlE for 96 h stimulated expression of β-casein and α-lactalbumin mRNA by several hundred-fold and also increased the expression of SREBF1, FASN, ACACA, and SCD genes in mammary explants (P < 0.01). However, those hormone combinations had no effect on GLUT1 or GLUT8 expression and inhibited GLUT12 expression by 50% after 72 h of treatment (P < 0.05). In separate experiments, the expression of GLUTs in the mouse mammary epithelial cell line HC11 or in bovine primary mammary epithelial cells was not increased by lactogenic hormone treatments. Moreover, treatment of dairy cows with bovine prolactin had no effect on GLUT expression in the mammary gland. In conclusion, lactogenic hormones clearly stimulate expression of milk protein and lipogenic genes, but they do not appear to mediate the marked up-regulation of GLUT expression in the mammary gland during the onset of lactation.

Medication administration by enrolled nurses: opinions of nurses in an Australian healthcare organization

OBJECTIVE

This study examined the opinions of nurses about the introduction of enrolled nurse medication administration and analyzed its impact on the medication error rate.

METHODS

Data were collected using a survey and examination of incident reports regarding nursing medication errors. Nurses (registered nurse, enrolled nurse with medication endorsement, enrolled nurse) responded to survey items regarding the introduction of enrolled nurse medication administration. Data analysis included descriptive statistics, Fischer's exact test, and chi-square analysis where appropriate.

RESULTS

The majority of nurses (75.2%) supported enrolled nurse medication administration. However, differences in opinion were observed between registered nurse (RN) and enrolled nurse with medication endorsement (ENME) regarding clear understanding of responsibility and accountability (RN: 47.2% vs. ENME: 77.8%; p =.033), and whether suitable education was provided (RN: 34.7% vs. ENME: 73.7%; p =.012). Moreover, less than one-third of RNs agreed that the assessment process for EN medication endorsement clearly identified the competence of the ENME to administer medications. Nonetheless, nursing medication errors did not increase in the 12-month period after the introduction of enrolled nurse medication administration (pre: 314, post: 302).

CONCLUSIONS

The findings of this study suggest areas that should be addressed in the future, including assessment of competence and focused education about accountability and responsibility.

The isolation and identification of cis-diamminedichloroplatinum (ii)-DNA adducts by anion-exchange HPLC and inductively coupled plasma mass-spectrometry

The adducts produced by the reaction of cis-diamminedichloroplatinum(II) with DNA have previously been isolated and characterised. These adducts may be measured at the cellular level by immunochemical detection but the accuracy of this assay is dependent on the number of adducts per nucleotide. We have developed a novel assay for cisplatin-DNA adducts, utilising an established method in which platinated DNA is digested to form a mixture of nucleotides and adducts; these are then separated by anion exchange HPLC. The number of cisplatin-DNA adducts is determined by measurement of the platinum content of the HPLC fractions by inductively coupled plasma mass spectrometry. The assay has been validated by cochromatography of purified drug-DNA adducts whose identity has been confirmed by NMR. We describe an application of the assay, namely the measurement of in vitro removal of cisplatin-DNA adducts from calf thymus DNA by cell free extracts derived from tumour cell lines. Adduct removal is dependent on both the amount of extract protein and the duration of the reaction. Almost 70% of adducts are removed from 5mug of DNA (drug:nucleotide ratio 0.08) by 80mug of extract. Other potential applications of the assay are discussed.

ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making

Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis at an earlier stage, the burden of disease and mortality is still high. Improvement of diagnostic and treatment options increased staging accuracy, functional outcome for early stages as well as survival. Although high quality surgery is still the mainstay of curative treatment, the management of CRC must be a multi-modal approach performed by an experienced multi-disciplinary expert team. Optimal choice of the individual treatment modality according to disease localization and extent, tumour biology and patient factors is able to maintain quality of life, enables long-term survival and even cure in selected patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer and the individual clinical situations. This ESMO guideline is recommended to be used as the basis for treatment and management decisions.

Observer error: are medical students good observers?

Observer error affects virtually all aspects of medicine. Our objective was to find a way to reduce it among clinical students. A minority need to be shown how to observe. A classroom exercise, repeated 6 times on separate days, using different simple objects, more than doubled the mean score on observation of visible properties of objects by a class of students in their first clinical year. Their corrected answer-slips were returned to the students at the next lecture 2 or 3 days later. Errors of omission and commission both decreased. Omission errors showed greater improvement but commission errors persisted in the class. The increment in observation seemed to be retained 5 months after tuition. Attempts were made to make a universal proforma suitable for any observation. It increased mean class score by 33% in 1994. Reducing observer error may have an educational strand. strand.

Clinical significance of initial troponin I in the grey zone in emergency department chest pain patients: a retrospective pilot study

AIM

'Normal' range for cardiac troponin I (TnI) has changed with more sensitive tests, but the validity of low-level elevations is contentious. We aimed to describe the characteristics and outcome of patients with an initial TnI level 1-5 times the upper limit of normal.

METHODS

Retrospective study of patients assessed for ACS with initial TnI level between 0.05-0.19 ng/ml. Data collected included demographics, clinical data, TnI levels and outcome. Primary outcome was the proportion of patients who had a serial TnI rise consistent with ACS.

RESULTS

72 patients were studied; median age 71, median TIMI score 3, 66.7% male. 35 patients (48.6%) had a TnI rise consistent with ACS.

CONCLUSION

Approximately half of patients with initial TnI between 0.05-0.19 ng/ml had a TnI rise consistent with ACS. An initial TnI in this range is not, of itself, indicative of ACS. Clinical decision-making should be guided by clinical features and serial TnI measurement.

Poor numeracy skills are associated with glycaemic control in Type 1 diabetes

AIMS

To assess the numeracy and literacy skills of individuals with Type 1 diabetes and determine if there is a relationship with achieved glycaemic control independent of their duration of diabetes, diabetes education, demographic and socio-economic factors.

METHODS

One hundred and twelve patients completed the study (mean current age 43.8 ± 12.5 years, 47% male, mean duration of diabetes 22.0 ± 13.2 years) out of 650 randomly selected patients from the Bournemouth Diabetes and Endocrine Centre's diabetes register. The Skills for Life Initial Assessments were used to measure numeracy and literacy. These indicate skills levels up to level 2, equivalent to the national General Certificate of Secondary Education grades A*-C. HbA(1c) was also measured. Pearson's correlation was used to measure the correlation of numeracy and literacy scores with HbA(1c.) To compare mean HbA(1c) between those with or without level 2 skills, t-tests were used, and multiple linear regression was used to investigate whether any differences were independent of duration of diabetes, diabetes education, demographic and socio-economic factors.

RESULTS

Literacy was not associated with achieved HbA(1c). In contrast, participants with numeracy skills at level 2 or above achieved an HbA(1c) lower than those with numeracy skills below level 2 (P = 0.027). Although higher socio-economic status was associated with lower mean HbA(1c) , the relationship between numeracy and HbA(1c) appeared to be independent of socio-economic factors.

CONCLUSIONS

Low numeracy skills were adversely associated with diabetes control. Assessment of numeracy skills may be relevant to the structure of diabetes education programmes.

TERC polymorphisms are associated both with susceptibility to colorectal cancer and with longer telomeres

BACKGROUND AND AIMS

Shorter telomeres have been associated with increased risk of malignancy, including colorectal cancer (CRC). Telomere length is heritable and may be an intermediate phenotype linked to genetic susceptibility to CRC.

METHODS

In a large sample, the study investigated whether candidate single nucleotide polymorphisms (SNP) in 'telomere biology' genes were associated with telomere length in leucocytes. SNP associated with an increased risk of CRC were searched for separately.

RESULTS

Carriers of the common allele at SNP rs10936599, near the telomerase RNA component (TERC) locus, had significantly longer telomeres. It was independently found that the same rs10936599 allele was associated with increased risk of both CRC and colorectal adenomas. Neither telomere length nor CRC risk was associated with variation near telomerase reverse transcriptase or other telomere biology genes. In silico analysis showed that SNP rs2293607 was strongly correlated with rs10936599, mapped within TERC transcripts, had a predicted effect on messenger RNA folding and lay at a reported transcription factor binding site. TERC mRNA were expressed, differing only at the alleles of rs2293607, in CRC cell line HCT116. The long-telomere/CRC-risk allele was associated with higher levels of TERC mRNA and the formation of longer telomeres.

CONCLUSIONS

Common genetic variation at TERC is associated with both longer telomeres and an increased risk of CRC, a potential mechanism being reduced levels of cell senescence or death. This finding is somewhat paradoxical, given retrospective studies reporting that CRC cases have shorter telomeres than controls. One possibility is that that association actually results from poorer survival in patients with longer telomeres.

Research-intensive cancer care in the NHS in the UK

In the late 1990 s, in response to poor national cancer survival figures, government monies were invested to enhance recruitment to clinical cancer research. Commencing with England in 2001 and then rolling out across all four countries, a network of clinical cancer research infrastructure was created, the new staff being linked to existing clinical care structures including multi-disciplinary teams. In parallel, a UK-wide co-ordination of cancer research funders driven by the 'virtual' National Cancer Research Institute, combined to create a 'whole-system approach' linking research funders, researchers and NHS clinicians all working to the same ends. Over the next 10 years, recruitment to clinical trials and other well-designed studies, increased 4-fold, reaching 17% of the incident cancer population, the highest national rate world-wide. The additional resources led to more studies opened, and more patients recruited across the country, for all types of cancers and irrespective of additional clinical research staff in some hospitals. In 2006, a co-ordinated decision was made to increasingly focus on randomized trials, leading to increased recruitment, without any fall-off in accrual to non-randomized and observational studies. The National Cancer Research Network has supported large successful trials which are changing clinical practice in many cancers.

HbA1c 3 months after diagnosis predicts premature mortality in patients with new onset type 2 diabetes

AIMS

To determine 5-year mortality rates, following the diagnosis of Type 2 diabetes, in a large local cohort of individuals with new onset of Type 2 diabetes seen within a few weeks of diagnosis in a single, community-based education programme.

METHODS

We reviewed referrals for people with Type 2 diabetes to our service over 5 years from 1999 to 2003 and determined, via regression analysis, which factors contributed significantly to mortality rates up to the end of 2007.

RESULTS

A total of 3781 new referrals were reviewed with an approximate doubling of referral rates over 5 years (546 in 1999-997 in 2003). Although the number of people developing the condition has increased, mortality rates over the 5 years from diagnosis has fallen from 11% in 1999-9% in 2003 (P < 0.005) Age at diagnosis was the strongest predictor of mortality (P < 0.001) but HbA(1c) at 3 months after diagnosis (P < 0.001), systolic (P < 0.001) and diastolic (P = 0.05) blood pressure, smoking status (P < 0.001) and gender (P = 0.04) were also significant predictors.

CONCLUSIONS

Our retrospective analysis adds weight to evidence suggesting that referral rates for people with Type 2 diabetes are increasing rapidly and that mortality rates are reducing but that the reasons for this are multifactorial. In addition to blood pressure, smoking and gender, the HbA(1c) achieved 3 months after the initial diagnosis also appears to predict subsequent mortality. It may be appropriate to consider early and intensive intervention for individuals with new onset type 2 diabetes.

The diagnosis and management of gastric cancer: expert discussion and recommendations from the 12th ESMO/World Congress on Gastrointestinal Cancer, Barcelona, 2010

Well-recognized experts in the field of gastric cancer discussed during the 12th European Society Medical Oncology (ESMO)/World Congress Gastrointestinal Cancer (WCGIC) in Barcelona many important and controversial topics on the diagnosis and management of patients with gastric cancer. This article summarizes the recommendations and expert opinion on gastric cancer. It discusses and reflects on the regional differences in the incidence and care of gastric cancer, the definition of gastro-esophageal junction and its implication for treatment strategies and presents the latest recommendations in the staging and treatment of primary and metastatic gastric cancer. Recognition is given to the need for larger and well-designed clinical trials to answer many open questions.