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Ke Q, Timmins F, Furlong E, Stokes D. Unmet care needs of women who have undergone breast cancer surgery: A scoping review. J Adv Nurs 2024; 80:1732-1749. [PMID: 37950373 DOI: 10.1111/jan.15953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
AIM To summarize the evidence regarding the unmet care needs of women who have undergone breast cancer surgery and identify research gaps. DESIGN A scoping review. DATA SOURCES This review entailed a systematic search in EMBASE, Medline via PubMed, CINAHL Complete, APA PsycINFO, Cochrane Library, Web of Science and Scopus (up until 30 July 2023). REVIEW METHODS This review was guided by Arksey and O'Malley's Framework (2005) and the Preferred Reporting Items for Systematic Reviews and Meta-analysis-Scoping Review extension (PRISMA-ScR). RESULTS Twenty-five studies that included 4914 participants were retrieved. Fourteen studies employed quantitative designs, eight used qualitative methods, two were mixed-methods studies and one used a qualitative meta-synthesis. Women who have undergone breast cancer surgery experience a wide range of complex and multifaceted unmet care needs. The informational/educational and psychological/emotional domains were the most frequently reported among the identified domains. Meanwhile, the sexual and spiritual/religious beliefs domains remained relatively underexplored. Furthermore, none of the assessment tools used in these studies captured the entirety of the possible domains of unmet care needs. CONCLUSION Needs assessment should be integrated into the routine care of women who have undergone breast cancer surgery. Interventions should be developed to address the unmet informational/educational and psychological/emotional needs of women. Future studies should employ high-quality mixed-methods approaches to explore women's sexual and spiritual/religious concerns. IMPACT This review provides a comprehensive overview of the unmet care needs of women who have undergone the breast cancer surgery. These findings will contribute to the development of tailored interventions. This review also informs future studies to explore distinct domains of unmet care needs. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Qiaohong Ke
- School of Nursing, Midwifery and Health Systems, UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Fiona Timmins
- School of Nursing, Midwifery and Health Systems, UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Diarmuid Stokes
- College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
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Darley A, Furlong E, Maguire R, McCann L, Coughlan B. Relationship and Attachment to Digital Health Technology During Cancer Treatment. Semin Oncol Nurs 2024:151587. [PMID: 38342642 DOI: 10.1016/j.soncn.2024.151587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/06/2023] [Accepted: 01/15/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE The aim of this study is to explore the relationship that people with cancer and their family caregivers develop with symptom management technology during chemotherapy. DATA SOURCES A longitudinal and multi-perspective interpretative phenomenological approach was adopted. Data were collected using one-to-one in-depth interviews with people with colorectal cancer using supportive digital health symptom management technology (n=3) and their family caregivers (n=4) at two time points during chemotherapy treatment. Data were analyzed using interpretative phenomenological analysis and followed COREQ guidelines. CONCLUSION People with cancer and their family caregivers can develop emotional bonds with supportive symptom management technology during cancer treatment. Digital health technology can be experienced as a person guiding them during their cancer treatment. Participants felt vulnerable after the technology was returned to the research team. Participants recognized that it was not the technology that successfully facilitated them through their initial chemotherapy cycles; rather, the technology helped them learn to manage their symptoms and promoted their self-efficacy, as well as how to emotionally respond. IMPLICATIONS FOR NURSING PRACTICE The relationship and psychological bonds people with cancer and their family caregivers develop with technology during treatment may be critically important for oncology nurses to be aware of should digital health be prescribed within the outpatient model of cancer care. This study indicates that technology may not be needed for a full treatment experience, as digital health can promote confidence and self-efficacy regarding symptom management and prepare people with cancer to be independent after the digital health technology is returned to the research team. However, further research is needed regarding individual preferences for digital health provision.
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Affiliation(s)
- Andrew Darley
- Assistant Professor, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland.
| | - Eileen Furlong
- Associate Professor, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | - Roma Maguire
- Professor, Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Lisa McCann
- Senior Lecturer, Department of Computing and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Barbara Coughlan
- Associate Professor, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
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Ryder M, Mannion T, Furlong E, O'Donoghue E, Travers B, Connolly M, Lucey N. Exploring heart failure nurse practitioner outcome measures: a scoping review. Eur J Cardiovasc Nurs 2024:zvad108. [PMID: 38165269 DOI: 10.1093/eurjcn/zvad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
AIMS Clinical guidelines recommend people with heart failure are managed within a multidisciplinary team to receive optimal evidence-based management of the syndrome. There is increasing evidence that Nurse Practitioners (NP) in heart failure demonstrate positive patient outcomes. However, their roles as key stakeholders in a multidisciplinary heart failure team are not clearly defined. The aim of the review was to explore the literature related to NP-sensitive outcomes in heart failure. METHODS AND RESULTS A scoping review was conducted according to accepted guidelines using the Joanna Briggs Institute framework for conducting a scoping review, to identify the literature that related to NP-sensitive outcomes in heart failure management. Sixteen texts were selected for data extraction and analysis. The most common outcome measures reported were readmission rates, self-care measurement scales, functional status scores, quality of life measurements, and medication optimization outcomes. No two studies collected or reported on the same outcome measurements. CONCLUSION This review highlights that the reporting of heart failure (HF) NP outcome indicators was inconsistent and disparate across the literature. The outcome measures reported were not exclusive to NP interventions. Nurse Practitioner roles are not clearly defined, and resulting outcomes from care are difficult to characterize. Standardized NP-specific outcome measures would serve to highlight the effectiveness of the role in a multidisciplinary HF team.
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Affiliation(s)
- Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
| | - Tara Mannion
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
- St Claires Integrated Care Centre, Dublin 11, Ireland
| | - Eileen Furlong
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
| | - Ethel O'Donoghue
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Bronagh Travers
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
- Tallaght University Hospital, Dublin, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
- Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Niamh Lucey
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 C7X2, Ireland
- St Vincent's University Hospital, Dublin, Ireland
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Ryder M, Connolly M, Furlong E, Magennis B, Wells JSG, Timmins F. Where is Athena?-The dominant male voice on the future of nursing in published editorial debates. J Clin Nurs 2023; 32:7929-7931. [PMID: 37743620 DOI: 10.1111/jocn.16889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Mary Ryder
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Our Lady's Hospice & Care Services, Harold's Cross, Dublin, Ireland
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - John S G Wells
- School of Health Science, South East Technical University, Waterford, Ireland
| | - Fiona Timmins
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Darley A, Coughlan B, Maguire R, McCann L, Furlong E. A bridge from uncertainty to understanding: The meaning of symptom management digital health technology during cancer treatment. Digit Health 2023; 9:20552076231152163. [PMID: 36714543 PMCID: PMC9880573 DOI: 10.1177/20552076231152163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Objective Digital health technology is valued as a tool to provide person-centred care and improve health outcomes amongst people with cancer and their family caregivers. Although the evidence to date shows encouraging effectiveness, there is limited knowledge regarding the lived experience and personal meaning of using supportive technology during cancer treatment. The aim of this study was to explore the lived experiences of people with colorectal cancer receiving chemotherapy using digital health symptom management technology and their family caregivers. Methods A longitudinal and multi-perspective interpretative phenomenological analytical approach was adopted including three people with newly diagnosed colorectal cancer and four family caregivers. Findings Three superordinate themes and related subthemes were identified. The first theme (The 3 Cs of symptom management technology) centred on the continuity of care that participants felt while using the technology. The second theme (Digital health technology as a psychosocial support) offered insights into the psychological benefits using technology incurred as they navigated their cancer diagnosis including sense of control and psychological safety. The final theme (Impact of digital health technology on family caregivers) details the supportive effect the technology had on family caregivers' role, responsibilities and well-being during the cancer experience. Conclusion Digital health technology can act as a bridge from uncertainty to an understanding regarding a cancer diagnosis and its treatment. Digital health technology can support peoples' understanding of cancer and enhance self-management practices, while being a psychological support in navigating the uncertain and often worrying period of receiving cancer treatment.
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Affiliation(s)
- Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland,Andrew Darley, School of Medicine,
University College Dublin, Belfield, Dublin 4, Ireland.
| | - Barbara Coughlan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Roma Maguire
- Digital Health and Wellness Group, Department of Computing and
Information Sciences, University of Strathclyde, Glasgow, UK
| | - Lisa McCann
- Digital Health and Wellness Group, Department of Computing and
Information Sciences, University of Strathclyde, Glasgow, UK
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Ryder M, Smith R, Furlong E. Evaluation of a nurse practitioner clinical practicum module using a capability education framework: A case study design. J Clin Nurs 2023. [PMID: 36658779 DOI: 10.1111/jocn.16626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/04/2022] [Accepted: 12/31/2022] [Indexed: 01/21/2023]
Abstract
AIMS AND OBJECTIVES The aim of this research was to evaluate a nurse practitioner's clinical practicum module designed with a capability education framework. The objectives were to determine if the module prepared students adequately for their role and to determine if the Mini-CEX assessment tool was suitable for use with nurse practitioners. BACKGROUND Capability is a necessary part of expertise, where a capable person takes responsibility to develop their own education, knowledge and skills. The capability learning framework offers nurse practitioners flexible learning pathways between the student, the university and clinical practice. This capability learning framework focuses on the wider complexities of nurse practitioner practice as opposed to a point-in-time assessment. DESIGN A case study design was used. METHODS Mixed methods including, document review, focus group and field notes were used in the case study evaluation adhering to the standards for the reporting of organisational case studies. RESULTS A layered incremental approach to learning and assessments were applied. Students and assessors were satisfied with using the Mini-CEX assessment tool in the module. The Mini-CEX tool was familiar to clinical mentors, who compared students demonstrating competency in a similar manner to medicine. The feedback component of the tool provided deep and meaningful engagement for students. The module provided mentors with insight and understanding of the nurse practitioner role. Students identified the transitioning process from competent to capable practitioners. The module learning and assessments were mapped to regulatory nurse practitioner standards and requirements. CONCLUSIONS The module provided comprehensive preparation for students to develop their nurse practitioner role. The Mini-CEX assessment tool is a fitting assessment for nurse practitioner students, particularly when supplemented with a corresponding reflective exercise. The assessments and feedback provided the students with opportunities to focus on agreed learning outcomes in their specialist area of practice. RELEVANCE TO CLINICAL PRACTICE Nurse practitioners are required to practice autonomously and independently at a level of capability in clinical practice. The education preparation of nurse practitioner students must be directed appropriately.
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Affiliation(s)
- Mary Ryder
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Rita Smith
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Eileen Furlong
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Furlong E, Ryder M, Connolly M, Flanagan M, Flynn A, Gallagher P, Raftery M, Timmins F. Partnership working and planning for the future of nursing. J Adv Nurs 2022; 79:e45-e46. [DOI: 10.1111/jan.15514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Eileen Furlong
- UCD School of Nursing, Midwifery and Health Systems University College Dublin Dublin Ireland
| | - Mary Ryder
- UCD School of Nursing, Midwifery and Health Systems University College Dublin Dublin Ireland
| | - Michael Connolly
- UCD School of Nursing, Midwifery and Health Systems University College Dublin Dublin Ireland
- Our Lady's Hospice and Care Services Dublin Ireland
| | | | - Ann Flynn
- St Vincent's University Hospital Dublin Ireland
| | - Paul Gallagher
- Chief Director of Nursing & Midwifery, Ireland East Hospital Group Dublin Ireland
| | - Mary Raftery
- Mater Misericordiae University Hospital Dublin Ireland
| | - Fiona Timmins
- UCD School of Nursing, Midwifery and Health Systems University College Dublin Dublin Ireland
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O'Brien C, Furlong E, Coughlan B, Fox P, Darley A. Building research capacity and culture: Exploring nurses' experience of implementing a nurse-led clinical trial. J Nurs Manag 2022; 30:1002-1010. [PMID: 35246888 PMCID: PMC9314815 DOI: 10.1111/jonm.13576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
AIM To explore the experiences of a nursing team who implemented an international nurse-led clinical trial in practice and understand the facilitators to their involvement. BACKGROUND The role and responsibilities of the clinical nurse are advancing to encompass research activity to help inform evidence-based practice. However, several personal and organisational challenges can inhibit nurses' capacity to implement and undertake research within clinical practice. METHODS Three focus groups were conducted with members of a nursing team (N=18). Thematic analysis was employed, and themes were identified and agreed upon by the research team. FINDINGS Five themes were identified: 'Previous experience of and attitudes to participation in clinical research', 'Decision-making regarding participation in the clinical trial', 'Facilitators of participation in the clinical trial', 'Challenges of research in nursing practice' and 'Future orientation towards research'. CONCLUSION Through their experiences of implementing a nurse-led clinical trial within practice, nurses recognised a number of facilitators and challenges to their participation. The perceived relevance of the clinical trial to the nurses' practice, potential to improve patient care and appreciation of the nurse leader's expertise and understanding of their context were key motivators. Reciprocal trust with the nurse leader who was encouraging, motivating, supportive and accessible resulted in the engagement and commitment of the nursing team. IMPLICATIONS FOR NURSING MANAGEMENT This paper offers a perspective that can inform senior nursing management teams when implementing and conducting evidence-based research amongst nursing teams and in doing so meet the needs of developing research capacity amongst clinical nurses.
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Affiliation(s)
| | - Eileen Furlong
- University College Dublin, School of Nursing Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Barbara Coughlan
- University College Dublin, School of Nursing Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Patricia Fox
- University College Dublin, School of Nursing Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Andrew Darley
- University College Dublin, School of Medicine, Health Sciences Centre, Belfield, Dublin 4, Ireland
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Abstract
Delirium is a term used to describe an array of symptoms that indicate a disruption in cerebral metabolism, a condition that is often under-recognised, leading to delayed interventions. The condition is a common cause of older adults presenting in hospital, with significant morbidity and mortality associated with increased length of stay. A case study is used to illustrate the use of a diagnostic algorithm for older adults presenting with delirium to an advanced nurse practitioner (ANP)-led service. The clinical decision pathway provides four differential diagnoses, using the case study to put the decision-making process in context. The article demonstrates the ability of the ANP to practise at a high level of expertise as an autonomous practitioner and shows how the pathway supports the nurse to reach an accurate diagnosis. It shows that prompt and accurate diagnosis of delirium in older adults is crucial to avoiding the complications and cognitive decline associated with the condition.
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Affiliation(s)
- Edel Carey
- Registered Advanced Nurse Practitioner, Older Adult Care, Cherry Orchard Hospital and Dublin South Kildare and West Wicklow Community Healthcare Area, Dublin, Ireland
| | - Eileen Furlong
- Associate Professor in Nursing, School of Nursing, Midwifery and Health Systems, University College Dublin. Ireland
| | - Rita Smith
- Associate Professor in Nursing, School of Nursing, Midwifery and Health Systems, University College Dublin. Ireland
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Darley A, Coughlan B, Furlong E. People with cancer and their family caregivers' personal experience of using supportive eHealth technology: A narrative review. Eur J Oncol Nurs 2021; 54:102030. [PMID: 34531122 DOI: 10.1016/j.ejon.2021.102030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/01/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To synthesise existing qualitative evidence regarding the experiences of people living with cancer and their family caregivers using eHealth technology in their home setting. METHOD A narrative review using a systematic approach was utilised. Five databases (PubMed, CINAHL, EMBASE, PsycINFO and the Cochrane Library) were searched using a tailored search strategy to identify primary research articles published between January 2005 and May 2021. Studies were quality appraised using the Critical Appraisal Skills Programme's Qualitative Studies Checklist and the Mixed Method Appraisal Tool, where relevant. Identified studies were appraised by three reviewers and data were extracted for analysis. Key themes were identified and agreed upon by the authors. RESULTS 28 empirical studies were included in the review. Five major themes emerged: (i) understanding of cancer and its care (ii) alignment and integration of eHealth technology into daily life (iii) connection and collaboration with healthcare professionals, family and peers (iii) reassurance and sense of safety (iv) and the psychosocial impact on the self during the cancer experience. CONCLUSIONS eHealth technology can have positive role in the lives of people with cancer and their family caregivers, beyond the intended health outcomes of the intervention. Individual preferences amongst people with cancer and their family caregivers using eHealth technology must be considered, especially regarding cancer information delivery, content and support methods. This review underlines a critical need for further in-depth evidence on the personal meaning and relationships people with cancer and their family caregivers develop with eHealth technology in an ambulatory care setting.
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Affiliation(s)
- Andrew Darley
- School of Medicine, University College, Dublin, Ireland.
| | - Barbara Coughlan
- School of Nursing, Midwifery and Health Systems, University College, Dublin, Ireland.
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College, Dublin, Ireland.
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Connolly M, Ryder M, Frazer K, Furlong E, Escribano TP, Larkin P, Carruthers E, McGuigan E. Evaluating the specialist palliative care clinical nurse specialist role in an acute hospital setting: a mixed methods sequential explanatory study. BMC Palliat Care 2021; 20:134. [PMID: 34479521 PMCID: PMC8418028 DOI: 10.1186/s12904-021-00834-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Special palliative care is provided in a range of settings including a patient’s home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting. Methods This study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4). Results Phase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support. Conclusions This study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff.
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Affiliation(s)
- Michael Connolly
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland.
| | - Mary Ryder
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Kate Frazer
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Eileen Furlong
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Teresa Plazo Escribano
- UCD School of Nursing, Midwifery &Health Systems, University College Dublin, Dublin, Ireland
| | - Philip Larkin
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eileen Carruthers
- Regional Specialist Palliative Care Services, Louth, Meath, Cavan, and Monaghan, Drogheda, Ireland
| | - Eileen McGuigan
- Regional Specialist Palliative Care Services, Louth, Meath, Cavan, and Monaghan, Drogheda, Ireland
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12
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Maguire R, McCann L, Kotronoulas G, Kearney N, Ream E, Armes J, Patiraki E, Furlong E, Fox P, Gaiger A, McCrone P, Berg G, Miaskowski C, Cardone A, Orr D, Flowerday A, Katsaragakis S, Darley A, Lubowitzki S, Harris J, Skene S, Miller M, Moore M, Lewis L, DeSouza N, Donnan PT. Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART). BMJ 2021; 374:n1647. [PMID: 34289996 PMCID: PMC8293749 DOI: 10.1136/bmj.n1647] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations. DESIGN Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial. SETTING Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK. PARTICIPANTS 829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin's disease, or non-Hodgkin's lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years. INTERVENTION Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy. MAIN OUTCOME MEASURES The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy-General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory-Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ). RESULTS For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference -0.15, 95% confidence interval -0.19 to -0.12; P<0.001; Cohen's D effect size=0.5). Analysis of MSAS sub-domains indicated significant reductions in favour of ASyMS for global distress index (-0.21, -0.27 to -0.16; P<0.001), psychological symptoms (-0.16, -0.23 to -0.10; P<0.001), and physical symptoms (-0.21, -0.26 to -0.17; P<0.001). FACT-G scores were higher in the intervention group across all cycles (mean difference 4.06, 95% confidence interval 2.65 to 5.46; P<0.001), whereas mean scores for STAI-R trait (-1.15, -1.90 to -0.41; P=0.003) and STAI-R state anxiety (-1.13, -2.06 to -0.20; P=0.02) were lower. CASE-Cancer scores were higher in the intervention group (mean difference 0.81, 0.19 to 1.43; P=0.01), and most SCNS-SF34 domains were lower, including sexuality needs (-1.56, -3.11 to -0.01; P<0.05), patient care and support needs (-1.74, -3.31 to -0.16; P=0.03), and physical and daily living needs (-2.8, -5.0 to -0.6; P=0.01). Other SCNS-SF34 domains and WLQ were not significantly different. Safety of ASyMS was satisfactory. Neutropenic events were higher in the intervention group. CONCLUSIONS Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A "medium" Cohen's effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients' symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic. TRIAL REGISTRATION Clinicaltrials.gov NCT02356081.
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Affiliation(s)
- Roma Maguire
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Lisa McCann
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | | | | | - Emma Ream
- University of Surrey, School of Health Sciences, Guildford, UK
| | - Jo Armes
- University of Surrey, School of Health Sciences, Guildford, UK
| | - Elisabeth Patiraki
- National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Patricia Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Alexander Gaiger
- Department of Internal Medicine 1, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Paul McCrone
- Department of Health Services and Population Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Geir Berg
- Department of Health Sciences, NTNU, Gjøvik, Norway
| | | | | | | | | | - Stylianos Katsaragakis
- National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Simone Lubowitzki
- Department of Internal Medicine 1, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Jenny Harris
- University of Surrey, School of Health Sciences, Guildford, UK
| | - Simon Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
| | - Morven Miller
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Margaret Moore
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - Liane Lewis
- Johnson and Johnson Medical, Norderstedt, Germany
| | - Nicosha DeSouza
- Population Health and Genomics, Medical School, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Population Health and Genomics, Medical School, University of Dundee, Dundee, UK
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Liu J, Viales RR, Khoueiry P, Reddington JP, Girardot C, Furlong E, Robinson-Rechavi M. The hourglass model of evolutionary conservation during embryogenesis extends to developmental enhancers with signatures of positive selection. Genome Res 2021; 31:1573-1581. [PMID: 34266978 PMCID: PMC8415374 DOI: 10.1101/gr.275212.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022]
Abstract
Inter-species comparisons of both morphology and gene expression within a phylum have revealed a period in the middle of embryogenesis with more similarity between species compared to earlier and later time-points. This "developmental hourglass" pattern has been observed in many phyla, yet the evolutionary constraints on gene expression, and underlying mechanisms of how this is regulated, remains elusive. Moreover, the role of positive selection on gene regulation in the more diverged earlier and later stages of embryogenesis remains unknown. Here, using DNase-seq to identify regulatory regions in two distant Drosophila species (D. melanogaster and D. virilis), we assessed the evolutionary conservation and adaptive evolution of enhancers throughout multiple stages of embryogenesis. This revealed a higher proportion of conserved enhancers at the phylotypic period, providing a regulatory basis for the hourglass expression pattern. Using an in silico mutagenesis approach, we detect signatures of positive selection on developmental enhancers at early and late stages of embryogenesis, with a depletion at the phylotypic period, suggesting positive selection as one evolutionary mechanism underlying the hourglass pattern of animal evolution.
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Sheridan A, Kemple M, Hyde A, Fox P, Furlong E, Coughlan B, Bell M, Naughton C, Carberry S, Drennan J. Non-use of cancer information services among people experiencing cancer in Ireland. Eur J Oncol Nurs 2020; 44:101700. [PMID: 32007695 DOI: 10.1016/j.ejon.2019.101700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to explore the reasons for non-use of a national cancer society's cancer information services among people experiencing cancer. METHOD This study used a qualitative design. Semi-structured interviews were conducted with a total of 17 participants who had not previously utilised the Cancer Society's information services. Data were analysed using Thematic Analysis. RESULTS The key themes to emerge from the date were 'living in the here and now' and 'awareness of the Cancer Society'. For most participants, not utilising cancer information services was a means of coping with the initial diagnosis and the impact of treatment. Those who progressed to being ready to seek information identified the multi-disciplinary team as the primary source of trusted information, with particular mention of cancer nurse specialists. For participants with children, their role as a parent was central in how they managed their diagnosis. The majority of participants lacked awareness of the range of services provided by the Cancer Society. CONCLUSIONS Reasons for non-use of cancer information services were identified as: readiness to seek information and a lack of knowledge of the Cancer Societies' services. Cancer information services need to continue make a concerted effort to enhance visibility and awareness of its services to optimise patient engagement.
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Affiliation(s)
- A Sheridan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland.
| | - M Kemple
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - A Hyde
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - P Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - E Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - B Coughlan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - M Bell
- Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland
| | - C Naughton
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - S Carberry
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - J Drennan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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15
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Fox P, Neill OO, Slevin T, Carberry S, Furlong E, Coughlan B, Clarke A, Corboy H. The perceptions of parents/guardians regarding their child/adolescent’s experience of reflexology or non specific foot massage. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz275.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Furlong E, Darley A, Fox P, Buick A, Kotronoulas G, Miller M, Flowerday A, Miaskowski C, Patiraki E, Katsaragakis S, Ream E, Armes J, Gaiger A, Berg G, McCrone P, Donnan P, McCann L, Maguire R. Adaptation and Implementation of a Mobile Phone-Based Remote Symptom Monitoring System for People With Cancer in Europe. JMIR Cancer 2019; 5:e10813. [PMID: 30869641 PMCID: PMC6437605 DOI: 10.2196/10813] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/30/2018] [Accepted: 12/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. OBJECTIVE This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone-based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. METHODS There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. RESULTS The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. CONCLUSIONS Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries.
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Affiliation(s)
- Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Andrew Darley
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Patricia Fox
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Alison Buick
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Grigorios Kotronoulas
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Morven Miller
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | | | - Christine Miaskowski
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | | | | | - Emma Ream
- School of Health Sciences, University of Surrey, Surrey, United Kingdom
| | - Jo Armes
- School of Health Sciences, University of Surrey, Surrey, United Kingdom
| | - Alexander Gaiger
- Division of Hematology and Hemaostaseology, Medical University of Vienna, Vienna, Austria
| | - Geir Berg
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway.,Innlandet Hospital Trust Division Lillehammer, Lillehammer, Norway
| | - Paul McCrone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, United Kingdom
| | - Lisa McCann
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Roma Maguire
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
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17
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McCann L, Ream E, Armes J, Harris J, Kotronoulas G, Miaskowski C, Furlong E, Fox P, Patiraki E, Miller M, Donnan P, McCrone P, Flowerday A, Apostolidis K, Gaiger A, Berg G, Katsaragakis SS, O'Brien C, Kearney N, Maguire R. Remote monitoring systems in the cancer setting: eSMART: Electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology for patients with cancer. Breast 2018. [DOI: 10.1016/j.breast.2018.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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18
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Ward ME, De Brún A, Beirne D, Conway C, Cunningham U, English A, Fitzsimons J, Furlong E, Kane Y, Kelly A, McDonnell S, McGinley S, Monaghan B, Myler A, Nolan E, O'Donovan R, O'Shea M, Shuhaiber A, McAuliffe E. Using Co-Design to Develop a Collective Leadership Intervention for Healthcare Teams to Improve Safety Culture. Int J Environ Res Public Health 2018; 15:ijerph15061182. [PMID: 29874883 PMCID: PMC6025638 DOI: 10.3390/ijerph15061182] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 11/16/2022]
Abstract
While co-design methods are becoming more popular in healthcare; there is a gap within the peer-reviewed literature on how to do co-design in practice. This paper addresses this gap by delineating the approach taken in the co-design of a collective leadership intervention to improve healthcare team performance and patient safety culture. Over the course of six workshops healthcare staff, patient representatives and advocates, and health systems researchers collaboratively co-designed the intervention. The inputs to the process, exercises and activities that took place during the workshops and the outputs of the workshops are described. The co-design method, while challenging at times, had many benefits including grounding the intervention in the real-world experiences of healthcare teams. Implications of the method for health systems research are discussed.
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Affiliation(s)
- Marie E Ward
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Deirdre Beirne
- Integrated Care Team Older Persons, Community Healthcare Organisation 6, Clonskeagh, Dublin 6, Ireland.
| | - Clare Conway
- Midlands Regional Hospital Mullingar, Longford Road, Mullingar, Co. Westmeath, Ireland.
| | - Una Cunningham
- Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | | | - John Fitzsimons
- Quality Improvement Division HSE & Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland.
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Yvonne Kane
- Midlands Regional Hospital Mullingar, Longford Road, Mullingar, Co. Westmeath, Ireland.
| | - Alan Kelly
- Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Sinéad McDonnell
- Integrated Care Team Older Persons, Community Healthcare Organisation 6, Clonskeagh, Dublin 6, Ireland.
| | - Sinead McGinley
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | | | - Ann Myler
- Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Emer Nolan
- Integrated Care Team Older Persons, Community Healthcare Organisation 6, Clonskeagh, Dublin 6, Ireland.
| | - Róisín O'Donovan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Marie O'Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Arwa Shuhaiber
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland.
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland.
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19
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Velikova G, Valderas JM, Potter C, Batchelder L, A’Court C, Baker M, Bostock J, Coulter A, Fitzpatrick R, Forder J, Fox D, Geneen L, Gibbons E, Jenkinson C, Jones K, Kelly L, Peters M, Mulhern B, Labeit A, Rowen D, Meadows K, Elliott J, Brazier J, Knowles E, Keetharuth A, Brazier J, Connell J, Carlton J, Buck LT, Ricketts T, Barkham M, Goswami P, Salek S, Ionova T, Oliva E, Fielding AK, Karakantza M, Al-Ismail S, Collins GP, McConnell S, Langton C, Jennings DM, Else R, Kell J, Ward H, Day S, Lumley E, Phillips P, Duncan R, Buckley-Woods H, Aber A, Jones G, Michaels J, Porter I, Gangannagaripalli J, Davey A, Ricci-Cabello I, Haywood K, Hansen ST, Valderas J, Roberts D, Gumber A, Podmore B, Hutchings A, van der Meulen J, Aggarwal A, Konan S, Price A, Jackson W, Bottomley N, Philiips M, Knightley-Day T, Beard D, Gibbons E, Fitzpatrick R, Greenhalgh J, Gooding K, Gibbons E, Valderas C, Wright J, Dalkin S, Meads D, Black N, Fawkes C, Froud R, Carnes D, Price A, Cook J, Dakin H, Smith J, Kang S, Beard D, Griffiths C, Guest E, Harcourt D, Murphy M, Hollinghurst S, Salisbury C, Carlton J, Elliott J, Rowen D, Gao A, Price A, Beard D, Lemanska A, Chen T, Dearnaley DP, Jena R, Sydes M, Faithfull S, Ades AE, Kounali D, Lu G, Rombach I, Gray A, Jenkinson C, Rivero-Arias O, Holch P, Holmes M, Rodgers Z, Dickinson S, Clayton B, Davidson S, Routledge J, Glennon J, Henry AM, Franks K, Velikova G, Maguire R, McCann L, Young T, Armes J, Harris J, Miaskowski C, Kotronoulas G, Miller M, Ream E, Patiraki E, Geiger A, Berg GV, Flowerday A, Donnan P, McCrone P, Apostolidis K, Fox P, Furlong E, Kearney N, Gibbons C, Fischer F, Gibbons C, Coste J, Martinez JV, Rose M, Leplege A, Shingler S, Aldhouse N, Al-Zubeidi T, Trigg A, Kitchen H, Davey A, Porter I, Green C, Valderas JM, Coast J, Smith S, Hendriks J, Black N, Shah K, Rivero-Arias O, Ramos-Goni JM, Kreimeier S, Herdman M, Devlin N, Finch AP, Brazier JE, Mukuria C, Zamora B, Parkin D, Feng Y, Bateman A, Herdman M, Devlin N, Patton T, Gutacker N, Shah K. Proceedings of Patient Reported Outcome Measure's (PROMs) Conference Oxford 2017: Advances in Patient Reported Outcomes Research : Oxford, UK. 8th June 2017. Health Qual Life Outcomes 2017; 15:185. [PMID: 29035171 PMCID: PMC5667589 DOI: 10.1186/s12955-017-0757-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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Maguire R, Fox PA, McCann L, Miaskowski C, Kotronoulas G, Miller M, Furlong E, Ream E, Armes J, Patiraki E, Gaiger A, Berg GV, Flowerday A, Donnan P, McCrone P, Apostolidis K, Harris J, Katsaragakis S, Buick AR, Kearney N. The eSMART study protocol: a randomised controlled trial to evaluate electronic symptom management using the advanced symptom management system (ASyMS) remote technology for patients with cancer. BMJ Open 2017; 7:e015016. [PMID: 28592577 PMCID: PMC5734219 DOI: 10.1136/bmjopen-2016-015016] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION While some evidence exists that real-time remote symptom monitoring devices can decrease morbidity and prevent unplanned admissions in oncology patients, overall, these studies have significant methodological weaknesses. The electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology (eSMART) study is designed to specifically address these weaknesses with an appropriately powered, repeated-measures, parallel-group stratified randomised controlled trial of oncology patients. METHODS AND ANALYSIS A total of 1108 patients scheduled to commence first-line chemotherapy (CTX) for breast, colorectal or haematological cancer will be recruited from multiple sites across five European countries.Patients will be randomised (1:1) to the ASyMS intervention (intervention group) or to standard care currently available at each site (control group). Patients in the control and intervention groups will complete a demographic and clinical questionnaire, as well as a set of valid and reliable electronic patient-reported outcome measures at enrolment, after each of their CTX cycles (up to a maximum of six cycles) and at 3, 6, 9 and 12 months after completion of their sixth cycle of CTX. Outcomes that will be assessed include symptom burden (primary outcome), quality of life, supportive care needs, anxiety, self-care self-efficacy, work limitations and cost effectiveness and, from a health professional perspective, changes in clinical practice (secondary outcomes). ETHICS AND DISSEMINATION Ethical approval will be obtained prior to the implementation of all major study amendments. Applications will be submitted to all of the ethics committees that granted initial approval.eSMART received approval from the relevant ethics committees at all of the clinical sites across the five participating countries. In collaboration with the European Cancer Patient Coalition (ECPC), the trial results will be disseminated through publications in scientific journals, presentations at international conferences, and postings on the eSMART website and other relevant clinician and consumer websites; establishment of an eSMART website (www.esmartproject.eu) with publicly accessible general information; creation of an eSMART Twitter Handle, and production of a toolkit for implementing/utilising the ASyMS technology in a variety of clinical practices and other transferable health care contexts. TRIAL REGISTRATION NUMBER NCT02356081.
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Affiliation(s)
- Roma Maguire
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
| | - Patricia A Fox
- UCD School of Nursing, Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin, Ireland
| | - Lisa McCann
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, California, USA
| | - Grigorios Kotronoulas
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
| | - Morven Miller
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
| | - Eileen Furlong
- UCD School of Nursing, Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin, Ireland
| | - Emma Ream
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
| | - Jo Armes
- Florence Nightingale Faculty of Nursing & Midwifery, King’s College London, James Clerk Maxwell Building, England, UK
| | - Elisabeth Patiraki
- National and Kapodistrian University of Athens, Papadiamantopoulou, Goudi, Athens, Greece
| | - Alexander Gaiger
- Medical University Vienna Comprehensive Cancer Center, Spitalgasse, Austria
| | - Geir V Berg
- Innlandet Hospital Trust Lillehammer and Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | | | - Peter Donnan
- Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, Scotland
| | - Paul McCrone
- King’s College London, David Goldberg Centre, Denmark Hill, London, UK
| | | | - Jenny Harris
- Florence Nightingale Faculty of Nursing & Midwifery, King’s College London, James Clerk Maxwell Building, England, UK
| | - Stylianos Katsaragakis
- National and Kapodistrian University of Athens, Papadiamantopoulou, Goudi, Athens, Greece
| | - Alison R Buick
- UCD School of Nursing, Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin, Ireland
| | - Nora Kearney
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Surrey, Guildford, UK
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21
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Fox P, Darley A, Furlong E, Miaskowski C, Patiraki E, Armes J, Ream E, Papadopoulou C, McCann L, Kearney N, Maguire R. The assessment and management of chemotherapy-related toxicities in patients with breast cancer, colorectal cancer, and Hodgkin's and non-Hodgkin's lymphomas: A scoping review. Eur J Oncol Nurs 2016; 26:63-82. [PMID: 28069154 DOI: 10.1016/j.ejon.2016.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/01/2016] [Accepted: 12/10/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of the eSMART (Electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology) study is to evaluate the use of mobile phone technology to manage chemotherapy-related toxicities (CRTs) in people with breast cancer (BC), colorectal cancer (CRC), Hodgkin's lymphoma (HL), and non-Hodgkin lymphoma (NHL)) across multiple European sites. One key objective was to review the published and grey literature on assessment and management of CRTs among patients receiving primary chemotherapy for BC, CRC, HL, and NHL to ensure that ASyMS remained evidence-based and reflected current and local practice. METHODS Three electronic databases were searched for English papers, with abstracts available from 01/01/2004-05/04/2014. For the grey literature, relevant clinical practice guidelines (CPGs)/evidence-based resources (EBRs) from the main international cancer organisations were reviewed as were symptom management (SM) protocols from the sites. RESULTS After full-text screening, 27 publications were included. The majority (n = 14) addressed fatigue and focused on BC patients. Relevant CPGs/EBRs were found for fatigue (n = 4), nausea/vomiting (n = 5), mucositis (n = 4), peripheral neuropathy (n = 3), diarrhoea (n = 2), constipation (n = 2), febrile neutropenia/infection (n = 7), palmar plantar erythrodysesthesia (PPE) (n = 1), and pain (n = 4). SM protocols were provided by >40% of the clinical sites. CONCLUSIONS A need exists for empirical research on SM for PPE, diarrhoea, and constipation. Research is needed on the efficacy of self-care strategies in patients with BC, CRC, HL, and NHL. In general, consistency exists across CPGs/EBRs and local guidelines on the assessment and management of common CRTs.
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Affiliation(s)
- Patricia Fox
- UCD School of Nursing, Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin 4, Ireland.
| | - Andrew Darley
- UCD School of Nursing, Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Eileen Furlong
- UCD School of Nursing, Midwifery and Health Systems, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, CA 94143-0610, United States
| | | | - Jo Armes
- Florence Nightingale SchNM, James Clerk Maxwell Building, Waterloo, United Kingdom
| | - Emma Ream
- University of Surrey, School of Health Sciences, Faculty of Health and Medical Sciences, Guildford, Surrey, GU2 7XH, United Kingdom
| | - Constantina Papadopoulou
- University of Surrey School of Health Sciences, Faculty of Health & Medical Sciences, Standard Buildings, Office 2.4, 2nd Floor, 94 Hope Street Glasgow, G2 6PH, United Kingdom
| | - Lisa McCann
- University of Surrey School of Health Sciences, Faculty of Health & Medical Sciences, Standard Buildings, Office 2.4, 2nd Floor, 94 Hope Street Glasgow, G2 6PH, United Kingdom
| | - Nora Kearney
- University of Surrey, Faculty of Health and Medical Sciences, Duke of Kent Building, Guildford, Surrey, GU2 7XH, United Kingdom
| | - Roma Maguire
- University of Surrey School of Health Sciences, Faculty of Health & Medical Sciences, Standard Buildings, Office 2.4, 2nd Floor, 94 Hope Street Glasgow, G2 6PH, United Kingdom
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Miaskowski C, Cooper BA, Aouizerat B, Melisko M, Chen LM, Dunn L, Hu X, Kober KM, Mastick J, Levine JD, Hammer M, Wright F, Harris J, Armes J, Furlong E, Fox P, Ream E, Maguire R, Kearney N. The symptom phenotype of oncology outpatients remains relatively stable from prior to through 1 week following chemotherapy. Eur J Cancer Care (Engl) 2016; 26. [PMID: 26777053 DOI: 10.1111/ecc.12437] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 01/23/2023]
Abstract
Some oncology outpatients experience a higher number of and more severe symptoms during chemotherapy (CTX). However, little is known about whether this high risk phenotype persists over time. Latent transition analysis (LTA) was used to examine the probability that patients remained in the same symptom class when assessed prior to the administration of and following their next dose of CTX. For the patients whose class membership remained consistent, differences in demographic and clinical characteristics, and quality of life (QOL) were evaluated. The Memorial Symptom Assessment Scale (MSAS) was used to evaluate symptom burden. LTA was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of the MSAS symptoms. Of the 906 patients evaluated, 83.9% were classified in the same symptom occurrence class at both assessments. Of these 760 patients, 25.0% were classified as Low-Low, 44.1% as Moderate-Moderate and 30.9% as High-High. Compared to the Low-Low class, the other two classes were younger, more likely to be women and to report child care responsibilities, and had a lower functional status and a higher comorbidity scores. The two higher classes reported lower QOL scores. The use of LTA could assist clinicians to identify higher risk patients and initiate more aggressive interventions.
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Affiliation(s)
- C Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA
| | - B A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - B Aouizerat
- College of Dentistry, New York University, New York, NY, USA
| | - M Melisko
- School of Medicine, University of California, San Francisco, CA, USA
| | - L-M Chen
- School of Medicine, University of California, San Francisco, CA, USA
| | - L Dunn
- School of Medicine, University of California, San Francisco, CA, USA
| | - X Hu
- School of Nursing, University of California, San Francisco, CA, USA
| | - K M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - J Mastick
- School of Nursing, University of California, San Francisco, CA, USA
| | - J D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - M Hammer
- New York University College of Nursing, New York, NY, USA
| | - F Wright
- School of Nursing, Yale University, New Haven, CT, USA
| | - J Harris
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - J Armes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - E Furlong
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | - P Fox
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | - E Ream
- School of Health Sciences, University of Surrey, Guilford, UK
| | - R Maguire
- School of Health Sciences, University of Surrey, Guilford, UK
| | - N Kearney
- School of Health Sciences, University of Surrey, Guilford, UK
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Furlong E. Commentary on Liu J, Mok E and Wong T (2006) Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China. Journal of Clinical Nursing 15, 188?196. J Clin Nurs 2007; 16:1761-2. [PMID: 17727595 DOI: 10.1111/j.1365-2702.2006.01605.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eileen Furlong
- School of Nursing, Midwifery and Health Systems, UCD Dublin, Ireland.
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Abstract
AIMS AND OBJECTIVES This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. BACKGROUND The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. CONCLUSION The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. RELEVANCE TO CLINICAL PRACTICE In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.
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Affiliation(s)
- Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
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Furlong E, Fox P, Lavin M, Collins R. Oncology nursing students' views of a modified OSCE. Eur J Oncol Nurs 2005; 9:351-9. [PMID: 16027036 DOI: 10.1016/j.ejon.2005.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 02/28/2005] [Accepted: 03/03/2005] [Indexed: 11/26/2022]
Abstract
This paper discusses oncology nursing students' views of an objective structured clinical examination (OSCE). The OSCE has been used as a form of assessment in medical education since the 1970s. It has subsequently been used by nursing faculties as one of a number of approaches to assessment of clinical skills. As a form of assessment it has been lauded as being more objective than traditional clinical examinations. The information in this study was collected through annual evaluations since 1998, when the OSCE was first employed to assess the students on a post-graduate oncology nursing programme. The sample comprised 185 students, and the principle areas addressed were students' perceptions regarding their degree of preparation for the examination, the overall efficacy and relevance of the OSCE in testing clinical skills and their views on stress and anxiety associated with this form of assessment. The results indicate that while students acknowledge the OSCE was stressful, they felt they were well prepared and appreciated the efficacy and relevance of this assessment method.
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Affiliation(s)
- Eileen Furlong
- School of Nursing and Midwifery, University College Dublin, Health Sciences Complex, Belfield, Dublin 4, Ireland.
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Madonna AJ, Basile F, Furlong E, Voorhees KJ. Detection of bacteria from biological mixtures using immunomagnetic separation combined with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Rapid Commun Mass Spectrom 2001; 15:1068-1074. [PMID: 11404843 DOI: 10.1002/rcm.344] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A rapid method for identifying specific bacteria from complex biological mixtures using immunomagnetic separation coupled to matrix-assisted laser desorption/ionization time-of-flight mass spectrometry has been developed. The technique employs commercially available magnetic beads coated with polycolonal antibodies raised against specific bacteria and whole cell analysis by MALDI-MS. A suspension of a bacterial mixture is mixed with the immunomagnetic beads specific for the target microorganism. After a short incubation period (20 mins) the bacteria captured by the beads are washed, resuspended in deionized H(2)O and directly applied onto a MALDI probe. Liquid suspensions containing bacterial mixtures can be screened within 1 h total analysis time. Positive tests result in the production of a fingerprint mass spectrum primarily consisting of protein biomarkers characteristic of the targeted microorganism. Using this procedure, Salmonella choleraesuis was isolated and detected from standard bacterial mixtures and spiked samples of river water, human urine, and chicken blood.
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Affiliation(s)
- A J Madonna
- Department of Chemistry and Geochemistry, Colorado School of Mines, Golden, CO 80401, USA
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Abstract
The purpose of this study was to provide a qualitative description of women's experiences of divorcing and building a new life. Interviews with 10 divorced women were conducted, transcribed, and analyzed using the constant comparative method. Four phases were identified in the process of divorcing and building a new life: the emotional divorce, making the decision, pulling apart, and moving beyond. Feelings and coping strategies reported by the participants are described.
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Affiliation(s)
- B Radford
- Creighton University School of Nursing, Omaha, NE 68178, USA
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Furlong E. A middle-east oncology experience. Implementation of an oncology nursing programme. Eur J Cancer Care (Engl) 1994; 3:98-9. [PMID: 7711984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Barniville G, Hartigan PJ, Lydon A, Rawas O, Andrews JF, Donne B, Kelly M, Brady C, McNamara B, Taylor D, Ishtiaq A, Glacken P, O’brien M, Moraes D, Tyrrell J, McCormack PME, Feely J, Stinson J, Hemeryck L, Feely J, Chan R, Hemeryck L, Clancy L, Feely J, Sharma SC, Barry-Kinsella C, Cortell E, Harrison RF, O’connor JJ, Trout SJ, Kruk ZL, Sharma SC, Barry-Kinsella C, Foran K, Han B, Kelly JP, O’donnell JM, Hollywood MA, McHale NG, Kearns JB, Hardiman O, Harris AM, Harris CS, O’halloran KD, Bradford A, McKeogh D, Nolan P, O’regan RG, McDermott M, Maddineni VR, Mirakhur RK, Cooper AR, Clarke RSJ, O’brien W, Tarpey J, Cooney C, Blunnie WP, Moriarty DC, Niveditha Y, O’donovan DJ, Manning B, Furlong E, Martin F, Brazil DP, Smyth EM, Keenan AK, Nunan N, Faustman D, Li X, Sklar RM, Brown RH, O’gorman S, Bannigan J, Moynihan JB, Staunton HP, Breathnach CS, Lynch L, Bowen M, Malone L, Cunningham AJ, Armstrong NC, Allen JM, Strain JJ, McDermott BM, Strain JJ, Bailey CJ, Flatt PR, Megaw DP, Murphy FJ, Reen DJ, D’arcy G, Cooke T, Sheahan R, Foley D, Reilly M, Jauch W, Gibney M, Crean P, Gearty G, Walsh M, McGinley J, Hurley J, Phelan D, Neligan M, Luckwill RG, O’connor JJ, Rowan MJ, Anwyll R, Wall M, Houghton JA, Heatley M, Whiteside C, Maxwell P, Toner P, Walsh DM, Lowe AS, Baxter GD, Allen JM, Bell AJ, Lee TC, McNamara BP, Prendergast PJ, Taylor D, Campion DP, Leek BF. Royal academy of medicine in Ireland section of biomedical sciences. Ir J Med Sci 1992. [DOI: 10.1007/bf02983772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Furlong E. Training course for staff working with Asians. Nurs Times 1977; 73:428-9. [PMID: 854430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Furlong E. "Nurse, what is the matter with me? Nurs Mirror Midwives J 1970; 130:27. [PMID: 5198975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Furlong E. Study visit to Frankfurt. Nurs Mirror Midwives J 1968; 127:31-3. [PMID: 5188772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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