Camille Cronin

The relationship of bone density and fracture to incident and progressive radiographic osteoarthritis of the knee: The Chingford study

OBJECTIVE Investigators performing cross-sectional studies have reported small increases in bone mineral density (BMD) in subjects with osteoarthritis (OA). This study was undertaken to examine the association of bone mass with incident and progressive disease and to determine whether prior fractures influence the development of OA. METHODS Eight hundred thirty women had repeat knee radiographs 48 months from baseline. All radiographs were graded on the presence or absence of osteophytes and joint space narrowing (JSN). Incident knee OA was defined as new disease in the 715 women without knee OA at baseline. Progression was a change of at least one grade in the 115 women with baseline knee OA. All women underwent bone densitometry of the lumbar spine and hip. Rates of subsequent incident OA were compared between fracture groups. RESULTS The 95 women with incident knee osteophytes had significantly higher baseline spine BMD (1.01 gm/cm2 versus 0.95 gm/cm2, or 6.3%; P = 0.002) and significantly higher hip BMD (0.79 gm/cm2 versus 0.76 gm/cm2, or 3.9%; P = 0.02) than those without incident disease. For the 33 women whose osteophytes progressed, no difference was seen compared with nonprogressors in spine BMD, but hip BMD was modestly reduced (-2.5%). The 81 women who had incident JSN had nonsignificantly higher baseline spine BMD (3.0%), while no difference was seen for the 30 women whose JSN had progressed. For hip BMD, a nonsignificant increase was seen in those with incident JSN (1.3%), and a nonsignificant reduction was seen in those whose JSN progressed (-2.7%). One hundred forty-five women sustained peripheral fractures, mainly in the distal forearm (27.6%) and vertebrae (28.3%). Women with a peripheral fracture had a reduced risk of subsequently developing incident knee OA (odds ratio [OR] 0.30, 95% confidence interval [95% CI] 0.11-0.84). Although numbers were smaller, nonsignificant reductions in rates of incident OA were seen for those with distal forearm (OR 0.40, 95% CI 0.11-1.49) and vertebral (OR 0.20, 95% CI 0.07-1.61) fractures. CONCLUSION These results confirm that for women who develop incident knee OA, defined by osteophytes, BMD is higher and of a magnitude similar to that shown in cross-sectional studies. Low BMD at the hip appears weakly related to progression. Women with previous fractures have less chance of developing OA, independent of BMD status. Although the mechanism for this action is unclear, these results suggest a possible common role of bone turnover and repair in the early manifestations of OA.

How do nurses deal with their emotions on a burn unit? A hermeneutic inquiry

Burn unit nurses work in an emotionally exhausting environment and are frequently exposed to emotional trauma. Emotion is a difficult concept to define. This study used a hermeneutic-phenomenological approach to establish the experiences of nurses working on a burn unit to find out how they deal with their emotions. The findings suggest that nurses have little or no time to deal with their emotional experiences. This study has shown that current support services might be ineffective. Nurses realize that they have emotions. They also recognize the need to address these emotions. Recommendations for nursing practice are made as a result of these findings.

Workplace learning – a healthcare perspective

Purpose – The purpose of this paper is to explore the complex relationship between the learner and the learning environment. As a method case study research was employed to examine the students experience of the learning environment. Work experience is considered to be an essential course requirement for vocational programmes throughout the world. This paper exclusively describes the learning environment and presents a number of significant processes that the learner experiences, each one having an impact on the learning experience. This paper will be of interest to policy makers, academics and educators who face the challenge of trying to understand how students learn in the workplace. Design/methodology/approach – Case study research was used to systematically investigate the learning environments and examine five students’ experience of learning in healthcare settings which included nurseries, nursing homes and hospitals while studying on a two-year health studies Further Education (FE) programme. Thr...

Making a difference through research

JILL MABEN OBE is professor of nursing research at King’s College London (KCL). Until recently she was director of the National Nursing Research Unit (NNRU) at the Florence Nightingale Faculty of Nursing and Midwifery at KCL. In June the unit moved to the Healthcare Organisation Workforce and Quality research group. Professor Maben, who is primarily a qualitative researcher, is recognised for conducting case studies and in-depth, observational research. She examines workforce, the work environment and the impact on patient care. She recently completed a national research study on single rooms in hospitals. She was named as one of Health Service Journal’s ‘Top 100 leaders’ in 2013 and was on HSJ’s first list of ‘Most inspirational women in healthcare’.