Position statement on the role of health care assistants who are involved in direct patient care activities within critical care areas

Intensive care has developed as a speciality since the 1950s, and during this time, there have been major technological advances in health care provision, leading to a rapid expansion of all areas of critical care. The ongoing problem in recruiting qualified nurses in general has affected, and continues to be a problem for, all aspects of critical care areas. During the past decade, nursing practice has evolved, as qualified nurses have expanded their own scope of practice to develop a more responsive approach to the complex care needs of the critically ill patient. The aim of this paper is to present the British Association of Critical Care Nurses (BACCN) position statement on the role of health care assistants involved in direct patient care activities, and to address some of the key work used to inform the development of the position statement.

Randomized controlled trial comparing couple satisfaction with appointment and telephone follow-up consultation after unsuccessful IVF/ICSI treatment

Couples undergoing in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) at Aberdeen Maternity Hospital come from a wide geographical area. Increasingly, telephone discussions after unsuccessful treatment have replaced appointments for those who do not live locally. The aim of this study was to compare patient satisfaction with telephone follow-up discussions versus clinic appointments. Couples were separated into those undergoing their first treatment cycle (100 couples) and those undergoing their second or subsequent treatment cycle (85 couples), and then randomized to either a telephone or appointment follow-up. Satisfaction was assessed by a postal questionnaire and analysis conducted on an 'intention to treat' basis. An overall response rate of 91% was achieved. Analysis indicated no statistically significant difference between telephone and appointment groups with regard to the degree of satisfaction. However, there was an association between the type of follow-up and the duration of discussion (P < 0.001): telephone follow-up discussions were significantly shorter than appointment follow-ups. There is the potential for significant savings in costs, both to the service and to patients, by providing telephone follow-up consultations. The savings may be achieved without compromising patient satisfaction as long as clinic appointments remain available as an option for those couples who prefer them.

Competing demands in the office visit: what influences mammography recommendations?

BACKGROUND

The multiple competing demands of the busy office visit have been shown to interfere with delivery of preventive services. In this study we used physician recommendations for screening mammography to examine the relative importance of physician, patient, and visit characteristics in determining on which patient visits this preventive service will be provided.

METHODS

Physicians in the Ambulatory Sentinel Practice Network (ASPN) completed a questionnaire describing their knowledge, attitudes, and beliefs about screening mammography. They also described the content of a series of nonacute care visits with women aged 40 to 75 years with regard to making a recommendation when the patient was due for screening mammography. The data were linked, and univariate and multivariate logistic regression methods were used to examine the relative importance of physician, patient, and visit characteristics on making a recommendation for mammography.

RESULTS

Ninety-three physicians reported making a recommendation for screening mammography on 53.1% of nonacute visits. When modeling physician, patient, and visit characteristics separately, 70% of the variability in the model is explained by physician characteristics only, 63% by patient characteristics only, and 73% by visit characteristics only. A combined model using all characteristics explained 85% of the variability.

CONCLUSIONS

Although characteristics of physicians and patients can predict frequency of recommendations for mammography, the specific characteristics of the visit are equally important. Efforts to improve delivery of preventive services in primary care that emphasize physician education and performance feedback are unlikely to increase rates of mammography recommendation. Effective strategies must consider the multiple competing demands faced by patients and physicians during each office visit and seek ways for assisting them in setting rational priorities for services.

High prevalence of celiac disease in patients with type 1 diabetes detected by antibodies to endomysium and tissue transglutaminase

OBJECTIVE

To establish the prevalence of celiac disease (CD) in children with type 1 diabetes in British Columbia.

PATIENTS AND METHODS

Two hundred thirty-three children with type 1 diabetes were prospectively screened for CD using blind testing with the current 'gold standard', immunoglobulin A endomysium antibody (EmA), and the novel immunoglobulin A tissue transglutaminase (tTG) antibody. Those children with positive results were offered small bowel biopsy; a gluten-free diet was recommended if CD was confirmed.

RESULTS

Nineteen children were positive for EmA and had an elevated tTG level. One patient from this group was already known to have CD, and the other 18 patients consented to biopsy. One biopsy was normal, three biopsies demonstrated elevated intraepithelial lymphocyte counts with normal morphology and 14 biopsies had morphological changes consistent with CD. Growth parameters were normal in all patients, and nine of 19 children who were positive for EmA were asymptomatic. Seven patients had mild elevation of tTG levels alone. Two children from this latter group had normal biopsies, and five declined biopsy.

CONCLUSIONS

At least 14 new cases of CD were detected in addition to four known cases, yielding an overall biopsy-confirmed prevalence of CD of 7.7% (18 of 233). The present study confirms that CD is as prevalent in the pediatric type 1 diabetic population in British Columbia as it is in Europe. Serological screening of these children is important because many children have no symptoms or signs suggestive of CD. This study suggests that tTG serology may also be useful in monitoring response and compliance with a gluten-free diet.

Barriers and gateways: a study of nursing students' utilisation of learning support resources

Many first year nursing students require additional academic support from both their lecturers and learning resources. Anecdotal evidence at an Australian university suggested that 'at risk' students did not follow up lecturer referral. This study identified what learning resources were accessed and what factors influenced students' decisions to follow up or not to follow up lecturer referral. First-year nursing students (n =150) were surveyed towards the end of their second semester regarding their use of learning support services. Twelve students were randomly selected and interviewed regarding their use of learning support and their first year learning experience. Demographic data were analyzed using descriptive statistics. Qualitative data were subjected to content analysis. Results revealed learning support utilisation was related to age and publicity but unrelated to gender or culture. Older students entering through non-traditional entry modes displayed a tendency to self refer to learning support. Younger students (<25 years) often lacked effective learning strategies and were reluctant to access on-campus learning support. For all students positive on and off campus support led to positive outcomes. Faculty and learning support lecturers need to foster integration of learning support for all students and encourage peer-learning partnerships within the foundation subjects.

The role of transcranial magnetic stimulation (TMS) in studies of vision, attention and cognition

Transcranial magnetic stimulation (TMS) can be conceptualized as a virtual lesion technique, capable of disrupting organized cortical activity, transiently and reversibly. The technique combines good spatial and temporal resolution and, moreover, because it represents an interference technique, can be said to have excellent functional resolution. The following is a review and discussion of the contribution which TMS has made to the study of vision, attention, development and plasticity and speech and language.

Melanoma differentiation associated gene-7 (mda-7): a novel anti-tumor gene for cancer gene therapy

BACKGROUND

The mda-7 gene (melanoma differentiation associated gene-7) is a novel tumor suppressor gene. The anti-proliferative activity of MDA-7 has been previously reported. In this report, we analyze the anti-tumor efficacy of Ad-mda7 in a broad spectrum of cancer lines.

MATERIALS AND METHODS

Ad-mda7-transduced cancer or normal cell lines were assayed for cell proliferation (tritiated thymidine incorporation assay, Alamar blue assay, and trypan-blue exclusion assay), apoptosis (TUNEL, and Annexin V staining visualized by fluorescent microscopy or FACs analysis), and cell cycle regulation (Propidium Iodide staining and FACs analysis).

RESULTS

Ad-mda7 treatment of tumor cells resulted in growth inhibition and apoptosis in a temporal and dose-dependent manner. The anti-tumor effects were independent of the genomic status of p53, RB, p16, ras, bax, and caspase 3 in these cells. In addition, normal cell lines did not show inhibition of proliferation or apoptotic response to Ad-mda7. Moreover, Ad-mda7-transduced cancer cells secreted a soluble form of MDA-7 protein. Thus, Ad-mda7 may represent a novel gene-therapeutic agent for the treatment of a variety of cancers.

CONCLUSIONS

The potent and selective killing activity of Ad-mda7 in cancer cells but not in normal cells makes this vector a potential candidate for cancer gene therapy.

Left posterior BA37 is involved in object recognition: a TMS study

Functional imaging studies have proposed a role for left BA37 in phonological retrieval, semantic processing, face processing and object recognition. The present study targeted the posterior aspect of BA37 to see whether a deficit, specific to one of the above types of processing could be induced. Four conditions were investigated: word and nonword reading, colour naming and picture naming. Repetitive transcranial magnetic stimulation (rTMS) was delivered over posterior BA37 of the left and right hemispheres (lBA37 and rBA37, respectively) and over the vertex. Subjects were significantly slower to name pictures when TMS was given over lBA37 compared to vertex or rBA37. rTMS over lBA37 had no significant effect on word reading, nonword reading or colour naming. The picture naming deficit is suggested to result from a disruption to object recognition processes. This study corroborates the finding from a recent imaging study, that the most posterior part of left hemispheric BA37 has a necessary role in object recognition.

TMS produces two dissociable types of speech disruption

We aimed to use repetitive transcranial magnetic stimulation (rTMS) to disrupt speech with the specific objective of dissociating speech disruption according to whether or not it was associated with activation of the mentalis muscle. Repetitive transcranial magnetic stimulation (rTMS) was applied over two sites of the right and left hemisphere while subjects counted aloud and recited the days of the week, months of the year, and nursery rhymes. Analysis of EMG data and videotaped recordings showed that rTMS applied over a posterior site, lateral to the motor hand area of both the right and the left hemisphere resulted in speech disruption that was accompanied by activation of the mentalis muscle, while rTMS applied over an anterior site on the left but not the right hemisphere resulted in speech disruption that was dissociated from activation of the mentalis muscle. The findings provide a basis for the use of subthreshold stimulation over the extrarolandic speech disruption site in order to probe the functional properties of this area and to test psychological theories of linguistic function.

Neuropsychology: music of the hemispheres

Music may be the food of love but it is also good fodder for cognitive scientists. Here we highlight a recent study of a neuropsychological patient who has lost her ability to read music, but not text, in the absence of any other musical deficit.

Does the family APGAR effectively measure family functioning?

BACKGROUND

The Family APGAR has been widely used to study the relationship of family function and health problems in family practice offices.

METHODS

Data were collected from 401 pediatricians and family physicians from the Pediatric Research in Office Settings network and the Ambulatory Sentinel Practice Network. The physicians enrolled 22,059 consecutive office visits by children aged 4 to 15 years. Parents completed a survey that included the Family APGAR and the Pediatric Symptom Checklist. Clinicians completed a survey that described child psychosocial problems, treatments initiated or continued, and specialty care referrals.

RESULTS

Family dysfunction on the index visit often differed from dysfunction at follow-up (kappa=0.24). Only 31% of the families with positive Family APGAR scores at baseline were positive at follow-up, and only 43% of those with positive scores at follow-up had a positive score at the initial visit. There were many disagreements between the Family APGAR and the clinician. The Family APGAR was negative for 73% of clinician-identified dysfunctional families, and clinicians did not identify dysfunction for 83% of Family APGAR-identified dysfunctions (kappa=0.06).

CONCLUSIONS

Our data do not support the use of the Family APGAR as a measure of family dysfunction in the primary care setting. Future research should clarify what it does measure.

Increased prevalence of celiac disease in girls with Turner syndrome detected using antibodies to endomysium and tissue transglutaminase

OBJECTIVE

To establish the prevalence of celiac disease (CD) in girls with Turner syndrome (TS) in British Columbia.

METHODS

Forty-five girls with TS were prospectively screened for CD using blinded testing with the current 'gold standard' - immunoglobulin A (IgA) endomysium antibody (EmA) and the novel IgA tissue transglutaminase antibody (tTG). Those with positive results were offered small bowel biopsies, and a gluten-free diet was recommended if CD was confirmed.

RESULTS

One asymptomatic prepubertal East Indian girl was positive for EmA, had an elevated tTG concentration of 560 U/mL and histological evidence of CD. Seven girls were negative for EmA but had elevated tTG concentrations (175 to 250 U/mL); five were white, one was Asian and one was East Indian. Small bowel biopsies were performed on three girls, and the histologies were normal. The remaining four patients declined biopsy.

CONCLUSIONS

One girl with TS was identified with CD from 45 screened, giving an overall biopsy-confirmed prevalence of 2.2%. This study confirms previous observations placing girls with TS at higher risk for CD and suggests a similar high prevalence in British Columbia.

Emergency department staff responses to a protocol of care for abused women

While there is increasing recognition by health care providers of the need to identify and intervene in cases of partner abuse, there has been little evaluation of the interventions that have been implemented. This article documents emergency department staff responses to a five-step protocol of care on partner abuse implemented in a public hospital. It draws on in-depth interviews with a range of emergency department staff members, undertaken as part of the project's process evaluation. Findings suggest protocol training provided staff members with an opportunity to gain a greater awareness and understanding of partner abuse. Protocol use improved and consolidated existing practices; however, staff members were concerned about screening all women for abuse and highlighted areas in which further support and resources are required. Taking these factors into account may assist the appropriate and effective introduction of such protocols in other health care settings.