Information and communication technologies to support patients with long-term conditions

This one part unit explores how nurses can harness technologies to provide efficient and effective care for patients with long-term conditions. It also examines the key issues nurses should consider when developing such a programme and looks at some examples of existing systems.

047. SPERM COMPETITION, INBREEDING AND THE EVOLUTION OF SUPERIOR EJACULATES

The production of viable sperm is essential for male reproductive success. However, because females in many species mate with several males during a single reproductive episode, leading to sperm competition, a male's reproductive success also depends critically on the ability of his sperm to compete efficiently with those from rival males for fertilizations. Therefore, males who regularly encounter sperm competition are expected to produce high quality ejaculates. Here, I will provide an overview of how sperm morphology and performance are influenced by sperm competition, both within and between species, using recent empirical examples. Having established the importance of producing high quality ejaculates in males experiencing sperm competition, I will then examine the reproductive consequences of producing sub-optimal sperm. Given the well known role that inbreeding plays in reducing genetic quality and reproductive success, I will focus in particular on how inbreeding acts to reduce sperm quality. Finally, I will examine the consequences of inbreeding for male reproductive success in species where sperm competition is rampant. Together, these results highlight the evolutionary importance of sperm competition and inbreeding in shaping ejaculate traits.

The Influence of Integration on the Expenditures and Costs of Mental Health and Substance Use Care: Results from the randomized PRISM-E Study

We compared the healthcare costs associated with an integrated care model to an enhanced referral model for the treatment of depression, anxiety, and at-risk drinking from the randomized Primary Care Research in Substance Abuse and Mental Health for the Elderly study. We examined total healthcare costs and cost components, separately for Veteran's Affairs and non-VA participants. No differences in total health expenditures were detected between study arms. No differences in behavioral health expenditures were detected for non-VA sites, but the VA integrated arm had slightly higher ($38; p<0.05) behavioral health costs. Differences in other types of services use were detected.

White matter brain lesions in midlife familial hypercholesterolemic patients at 3-Tesla magnetic resonance imaging

BACKGROUND

Patients with hypercholesterolemia of 60 years and older have an increased risk for white matter brain lesions and dementia.

PURPOSE

To investigate whether patients with familial hypercholesterolemia (FH) develop white matter lesions at 3-Tesla (T) MRI as early as in midlife.

MATERIAL AND METHODS

Non-diabetic, nonsmoking, and non-hypertensive heterozygous FH patients on treatment with maximally tolerated dose of a statin for more than 5 years (n = 14) and matched controls (n = 22) aged 25 to 60 years of age were studied. Imaging was performed at 3T with a fluid-attenuated T2-weighted MR pulse sequence and a T1-weighted spin-echo pulse sequence following 10 ml of i.v. gadopentetate dimeglumine. Images were evaluated by two independent readers. Fasting blood samples were taken. Student's t test was employed at P<0.05.

RESULTS

Three volunteers and one FH patient had white matter lesions (P<0.53). No other evidence of past ischemic stroke was observed. Mean total serum cholesterol and low-density lipoprotein (LDL) cholesterol were significantly higher in the FH group (6.0+/-1.1 vs. 5.1+/-0.9 mmol/l, P<0.02 and 4.1+/-0.9 vs. 3.1+/-0.8 mmol/l, P<0.004, respectively).

CONCLUSION

Heterozygous FH patients on statin treatment in the age range of 25 to 60 years are not at increased risk of white matter lesions at 3T MRI.

The impact of private-sector provision on equitable utilisation of coronary revascularisation in London

OBJECTIVE

To investigate the impact of including private-sector data on assessments of equity of coronary revascularisation provision using NHS data only.

DESIGN

Analyses of hospital episodes statistics and private-sector data by age, sex and primary care trust (PCT) of residence. For each PCT, the share of London's total population and revascularisations (all admissions, NHS-funded, and privately-funded admissions) were calculated. Gini coefficients were derived to provide an index of inequality across subpopulations, with parametric bootstrapping to estimate confidence intervals.

SETTING

London.

PARTICIPANTS

London residents undergoing coronary revascularisation April 2001-December 2003.

INTERVENTION

Coronary artery bypass graft or angioplasty.

MAIN OUTCOME MEASURES

Directly standardised revascularisation rates, Gini coefficients.

RESULTS

NHS-funded age-standardised revascularisation rates varied from 95.2 to 193.9 per 100,000 and privately funded procedures from 7.6 to 57.6. Although the age distribution did not vary by funding, the proportion of revascularisations among women that were privately funded (11.0%) was lower than among men (17.0%). Privately funded rates were highest in PCTs with the lowest death rates (p = 0.053). NHS-funded admission rates were not related to deprivation nor age-standardised deaths rates from coronary heart disease. Privately funded admission rates were lower in more deprived PCTs. NHS provision was significantly more egalitarian (Gini coefficient 0.12) than the private sector (0.35). Including all procedures was significantly less equal (0.13) than NHS-funded care alone.

CONCLUSION

Private provision exacerbates geographical inequalities. Those responsible for commissioning care for defined populations must have access to consistent data on provision of treatment wherever it takes place.

The development of role adequacy for professional nurses in Jordan

AIM

This paper reviews the development of role adequacy in Jordan through an examination of nurse education, specialization and continuing education programmes in order to identify the developmental needs for the Jordanian professional nurse's initial and continued competence.

BACKGROUND

The concept of role adequacy in nursing relates directly to the skills and competencies of individuals who undertake the nursing role. Various types and levels of nursing education have been established with several reforms over time in attempt to meet the Jordanian nursing workforce's need for key competencies. A nursing council was established in 2002 but it has yet to guide professional development.

CONCLUSION

The nursing profession in Jordan has made great advances towards developing role adequacy over the last half century. Currently, there is a relatively good national system of educational preparation of nurses with the Bachelor of Science in Nursing degree providing the only point of entry to the profession. However, this draws heavily on North American curricula and textbooks and therefore may not be culturally and economically sensitive to the population's needs. The state of continuing education and specialist training in Jordan indicates there is an urgent need to set national minimum standards for continuing professional development requirements if nurses' role adequacy and continued competence are to be maintained. National cooperation between educational institutions, healthcare providers and the nursing regulatory body is needed if the goal of a competent nursing workforce is to be realized.

Empowering the initiation of a prevention strategy to combat malaria in Papua New Guinea

CONTEXT

Approximately 3 million people die each year from malaria, making it a significant public health issue worldwide. Malaria is endemic in Papua New Guinea (PNG) and is the second most prevalent cause of death. In addition to associated mortality there is a high degree of morbidity. In remote PNG the village population has low access to even rudimentary health care; however, the use of bed nets impregnated with insecticides has been established as a simple and effective strategy for malaria control.

ISSUE

This project sought to explore if and how an empowerment approach to community development could affect changes in malaria prevalence among remote members of the Kewapi language group in PNG. The 'Batri Village Bed Net Initiative' began in 2004 as a development of the Erima Empowerment Research Health Promotion Project. Members of the Kewapi language group living in urban Port Moresby raised concerns that their extended families in the remote village of Batri could not acquire bed nets to prevent malaria. The project empowered members of the Kewapi language group to take responsibility for the acquisition, distribution and effective use of 400 WHO approved bed nets in the Batri village, demonstrating good governance and project acquittal. This empowerment approach to community development involved dialogue with a range of stakeholders including village Elders and the British High Commission in PNG. The project has led to a significant decrease in the incidence malaria-related mortality and morbidity in the village.

LESSONS LEARNED

Participatory planning was a key aspect of the success of this initiative. Using an empowerment approach, opportunities exist to extend the development of language-group networks in the cause of effective health promotion and disease prevention in remote PNG.

Promotion of physical activity by Canadian Registered Dietitians in daily practice

BACKGROUND

Dietitians are in an opportunistic position to promote healthy eating and active living. The purpose of this study was to determine counselling strategies of dietitians 1 year after attending a workshop designed to strengthen dietitians' self-efficacy for promoting physical activity (PA) as an adjunct to regular nutrition practice.

METHODS

A convenience sample of Registered Dietitians (RDs) in Alberta, Canada (n=103) responded to an invitation via an electronic newsletter to complete a web-based survey that asked about counselling practices related to PA.

RESULTS

Thirty-seven workshop attendees (n=37) were compared with a group of dietitians (n=66) who completed the survey but who did not attend the workshop. Nearly all (91%) respondents reported promoting PA in daily practice. Those who attended the workshop were more likely to refer clients to PA professionals (chi2=12.68, P<0.05) than those who were not workshop attendees.

CONCLUSIONS

Despite a relatively modest response rate, there were clear suggestions that RDs in Alberta, Canada promote PA in daily practice and attending a workshop designed to facilitate the use of specific tools and strategies for promoting PA in daily practice resulted in increased referral of their clients to exercise specialists.