Graeme D Smith

The frequency and cause of anxiety and depression amongst patients with malignant brain tumours between surgery and radiotherapy

IntroductionBetween surgery and radiotherapy patients with a malignant glioma may encounter a number of psychosocial issues that could invoke an anxious or depressive response. This study explored the frequency, severity and cause of anxiety and depression in patients with presumed malignant brain tumours in the period between their surgery and radiotherapy.MethodsA prospective study of 51 patients used mixed methods to measure anxiety and depression at three time points; post surgery, three weeks post surgery and pre radiotherapy. Analysis was undertaken using statistical and content analysis of the Hospital Anxiety and Depression (HAD) scores and unstructured interviews respectively.ResultsAnalysis of HAD scores indicated a heightened level of anxiety in patients pre radiotherapy. This anxiety is more prevalent in younger patients and is not related to the patients change in functional state. Five patients had a significant depression at one or more time points between surgery and radiotherapy. Four of the five patients who reported scores consistent with depression had past histories of depression. Content analysis of unstructured interviews indicated that the HAD scores underestimated the presence of anxiety and depression amongst this group of patients.ConclusionAnxiety was more common in younger patients. Anxiety was slightly more frequent pre-radiotherapy. A past medical history of depression is a predictor of significant depression in the post-operative period. The HAD scale although useful is not an adequate measurement tool for detecting anxiety and depression amongst all patients and health care professionals should adopt other means to monitor for these signs and symptoms.

Exploring nursing staff's attitudes and use of music for older people with dementia in long-term care facilities.

AIMS This study aimed to explore nursing staffs attitudes and use of music for older people with dementia in long-term care facilities. BACKGROUND Music has shown positive outcomes in managing behavioural symptoms of older people with dementia. Older people living in long-term care facilities often do not have access to trained music therapists. Nursing staff provide the majority of direct care for institutionalised older people with dementia, therefore, will be the most appropriate personnel to learn and implement music therapy for those with dementia. To date, no studies have explored nursing staffs attitudes and use of music for those with dementia. DESIGN A cross-sectional research design was used. METHODS A convenience sample of 285 nursing staff caring for those with dementia in long-term care facilities in Taiwan were recruited. Participants received a self-administered questionnaire consisted of items exploring nursing staffs attitude and use of music for those with dementia. A total of 214 participants completed the questionnaires, giving a response rate of 75·1%. RESULTS Most nursing staff held positive attitudes towards use of music for older people with dementia (mean=84·89, range 23-115), but only 30·6% (n=66) had used music for those with dementia in practice. The majority perceived that they had limited knowledge and skills about use of music (72·9%). Over half of the participants reported that they lacked resources and time to implement music therapy in practice. CONCLUSIONS Nursing staff need more formal training to use music for those with dementia. Nursing staff can be the suitable personnel to learn easily and implement music therapy as a part of routine activity programmes for those with dementia. RELEVANCE TO CLINICAL PRACTICE Appropriately trained nursing staff in long-term care facilities who use music therapy may help improve the mental health of older people with dementia.

Editorial: The practice and research of complementary and alternative medicine in nursing

Complementary and alternative medicine (CAM) has become increasingly popular in the UK over the past 20 years (Thomas et al. 2001). Up to one in five people in the UK has tried at least one form of CAM, with one in 10 GPs actively involved in providing it and the national health service (NHS) is slowly incorporating more types of CAM and more integrated services are being developed (Thomas et al. 2003). Many nurses practise CAM therapies and most nurses are aware of the fact that such therapies are used by many of their patients for a wide range of conditions. This special edition of JCN is devoted entirely to the subject of CAM. There are several papers in this issue which aim, directly or indirectly, to demonstrate the complexities, problems and challenges of CAM in clinical nursing practice. One of the initial difficulties in compiling this special issue was in relation to what is CAM? It relates to a diverse array of interventions and diagnostic techniques not viewed as part of conventional medicine. The definition of what precisely constitutes CAM appears to differ considerably between countries. The National Centre for Complementary and Alternative Medicine (NCCAM) (2007) defined CAM as ‘a group of diverse medical and health care systems, practices and products which are not presently considered to be part of conventional medicine’. The World Health Organization defined CAM as ‘a comprehensive term used to refer to both traditional medical systems such as Traditional Chinese medicine, Indian ayurveda and Arabic unami medicine and to various forms of indigenous medicine’ (WHO 2004). One reason for confusion may relate to the lack of clarity over what constitutes CAM. The House of Lords Select Committee on Science and Technology (2000) classified CAM in the UK into three groups. The first of these groups includes the principal CAM disciplines, described as the ‘big five’. Grouping of CAM therapies on the basis of evidence and level of professional organisation may have several potential applications within the UK; however, its purpose internationally appears limited. The House of Lords Scientific Committee also made recommendations to the Nursing and Midwifery Council (NMC) and Royal College of Nursing (RCN) to collaborate in making CAM the part of preregistration nursing education and to provide more specific guidance on integrating CAM into clinical nursing care. However, the NMC regulates nurses and midwives, but not complementary therapy practitioners and it is out of their scope to provide specific advice on issues such as training in CAM (NMC 2004). The RCN published a useful framework ‘Complementary therapies in nursing, midwifery and health visiting practice’ which ensures nurses are following their professional code of conduct when integrating CAM into their everyday clinical practice (RCN 2003). Presently, if nurses wish to look for scientific evidence to support the use of a particular CAM therapy they will usually be disappointed to find that very limited evidence base exists. This is partly because, compared with conventional medicine, there has not yet been enough rigorous research to prove the effectiveness of specific treatments, but it is also because there are some difficulties in applying the methods of conventional medical research to CAM treatments. Several reasons have been postulated to explain this dearth of high-quality CAM research including: lack of research training across CAM professions; lack of research funding available for CAM projects; a poor research infrastructure within the CAM sector; and finally many CAM practitioners believing that conventional research methods are not suitable tools to investigate CAM (House of Lords Select Committee on Science and Technology 2000). Another problem may relate to the reluctance of nurses to apply rigorous research methods to their CAM practice to establish a reliable scientific evidence base. Many nurse CAM therapists are reluctant to conduct research or do not have the appropriate research skills which are required to conduct research on their practice. Others argue that they believe the CAM therapy they provide is safe and effective and does not require scientific scrutiny. Perhaps this, more than any other reason, explains why CAM therapies are viewed as unscientific, unsafe and viewed negatively in certain quarters (O’Mathuna & Larimore 2001). Additionally, many of the published CAM studies that do exist are flawed in nature from a methodological perspective; they suffer from poor design and inappropriate analysis (O’Mathuna 1998). There is also the possibility that even if individual CAM studies do show positive results, meta-analysis may reveal regression to the mean, which is highlighted by Watson (2008) in his editorial critique of homeopathy. It is important that research into all forms of CAM is subject to the same high standards of quality, rigour and ethics as observed in conventional medical research. Because an individual reports symptomatic improvement after

The structure of stress : confirmatory factor analysis of a Chinese version of the stressors in Nursing Students Scale (SINS)

BACKGROUND Stress is a feature of the life of nursing students and this had been well studied. However, there are very few instruments to measure stress in nursing students specifically. One such instrument, the Stressors in Nursing Students Scale has been developed in Scotland and applied in studies in Hong Kong and Australia and proved useful alongside other measures of individual differences and psychological distress. OBJECTIVES To translate the Stressors in Nursing Students Scale into Chinese, test it with Chinese nursing students and explore the psychometric structure of stress in this population. DESIGN Cross-sectional survey using a self-administered questionnaire. SETTING A large teaching hospital in Southwest Mainland China. PARTICIPANTS Nursing students (n=1090) participated (1000 in the classroom and 90 on clinical placement); 862 from the classroom and 79 from clinical placements returned questionnaires (n=914) representing a return rate of 86.3%. METHODS Principal component analysis and confirmatory factor analysis using structural equation modelling. RESULTS A four-factor structure was obtained from principal component analysis. This was confirmed (fit indices>0.9 and RMSEA<0.06) using structural equation modelling. The stress-related factors were: Clinical (0.83), Finance (0.81), Confidence (0.82), and Education (0.70). CONCLUSIONS The original structure of the SINS in English was confirmed in this large sample of Chinese nursing students. This will allow cross-cultural studies of stress in nursing students.

A Tai Chi exercise programme improved exercise behaviour and reduced blood pressure in outpatients with hypertension

This two-group pretest and posttest quasi-experimental study aimed to evaluate the effects of a Tai Chi exercise programme on exercise behaviour and blood pressure (BP) in outpatients with hypertension. The experimental group (n = 27) received the Yang-style Tai Chi exercise programme three times a week for 8 weeks. The control group (n = 31) received routine care with no Tai Chi exercise. Exercise behaviour and exercise time using Routine Health Care Behaviour scale and BP were assessed at baseline and 8 weeks. The experimental group had a significant improvement on exercise behaviour (t = 2.11, P < 0.001) and exercise time (t = 1.44, P = 0.003), and a significant reduction in systolic BP (t = 2.57, P <  0.001) and diastolic BPs (t = 2.86, P < 0.001) compared with those of the control group. Tai Chi is an inexpensive and viable exercise and can improve exercise behaviour and BP control in outpatients with hypertension. Tai Chi exercise might offer outpatients with hypertension additional options, such as an adjunct to formal cardiac rehabilitation or as an exercise alternative in their management of hypertension. Nursing staff can easily learn and incorporate this exercise in patient education or care planning in the care of patients with hypertension in outpatient settings.This two-group pretest and posttest quasi-experimental study aimed to evaluate the effects of a Tai Chi exercise programme on exercise behaviour and blood pressure (BP) in outpatients with hypertension. The experimental group (n = 27) received the Yang-style Tai Chi exercise programme three times a week for 8 weeks. The control group (n = 31) received routine care with no Tai Chi exercise. Exercise behaviour and exercise time using Routine Health Care Behaviour scale and BP were assessed at baseline and 8 weeks. The experimental group had a significant improvement on exercise behaviour (t = 2.11, P < 0.001) and exercise time (t = 1.44, P = 0.003), and a significant reduction in systolic BP (t = 2.57, P < 0.001) and diastolic BPs (t = 2.86, P < 0.001) compared with those of the control group. Tai Chi is an inexpensive and viable exercise and can improve exercise behaviour and BP control in outpatients with hypertension. Tai Chi exercise might offer outpatients with hypertension additional options, such as an adjunct to formal cardiac rehabilitation or as an exercise alternative in their management of hypertension. Nursing staff can easily learn and incorporate this exercise in patient education or care planning in the care of patients with hypertension in outpatient settings.

The use of data-mining to identify indicators of health-related quality of life in patients with irritable bowel syndrome

AIM To examine the health-related quality of life in a cohort of individuals with irritable bowel syndrome and to explore the use of several data-mining methods to identify which socio-demographic and irritable bowel syndrome symptoms are most highly associated with impaired health-related quality of life. BACKGROUND Health-related quality of life can be adversely affected by irritable bowel syndrome. Little is presently known about the predictive factors that may influence the quality of life in these patients. DESIGN Cross-sectional survey design involving the general population of the UK. Methods.  Individuals with symptoms of irritable bowel syndrome were recruited to a longitudinal cohort survey via a UK-wide newspaper advert. Health-related quality of life was measured using a battery of validated questionnaires. Several data-mining models to determine which factors are associated with impaired health-related quality of life are considered in this study and include logistic regression, a classification tree and artificial neural networks. RESULTS As well as irritable bowel syndrome symptom severity, results indicate that psychological morbidity and socio-demographic factors such as marital status and employment status also have a major influence on health-related quality of life in irritable bowel syndrome. CONCLUSION Health-related quality of life is impaired in community-based individuals in the UK with irritable bowel syndrome. Although not always as easily interpreted as logistic regression, data-mining techniques indicate subsets of factors that are highly associated with impaired quality of life. These models tend to include subsets of irritable bowel syndrome symptoms and psychosocial factors. RELEVANCE TO CLINICAL PRACTICE Identification of the role of psychological and socio-demographic factors on health-related quality of life may provide more insight into the nature of irritable bowel syndrome. Greater understanding of these factors will facilitate more flexible and efficient nursing assessment and management of this patient group.

Inflammatory bowel disease: developing a short disease specific scale to measure health related quality of life

AIM To report on the preliminary development of a short scale, the Edinburgh inflammatory bowel disease questionnaire (EIBDQ) to measure disease specific aspects of inflammatory bowel disease (IBD) in terms of both physical impact and health related quality of life (HRQoL) consequences. METHODS A survey of individuals with Crohns disease (n=50), ulcerative colitis (n=50) and psoriatic arthritis (n=28) was carried out using the EIBDQ. The data were subject to factor analysis in order to investigate underlying dimension of the EIBDQ which were then analysed for internal consistency. Data for disease specific aspects of the EIBDQ were compared between IBD patients and psoriatic arthritis patients using contingency tables and the underlying dimension of the EIBDQ were correlated with measures of quality of life and psychological morbidity and a disease specific measure. RESULTS There are three underlying dimensions to the EIBDQ: a disease specific factor, a bowel specific factor and an information factor. The disease specific factor and the bowel specific factor are internally consistent and correlate with other measures of disease activity, quality of life and psychological morbidity. The EIBDQ is able to discriminate between IBD and another inflammatory disease: psoriatic arthritis. CONCLUSION The EIBDQ is a reliable and valid instrument for measuring disease specific aspects of IBD but further development is required.

Editorial: The need for complementary and alternative medicine familiarisation in undergraduate nurse education

Complementary and alternative medicine (CAM) encompasses a wide range of therapeutic procedures and philosophies that are not traditionally viewed to be part of conventional medicine. This is the second special edition of JCN to focus specifically on CAM and in this issue there are several papers from around the world which examine, either directly or indirectly, the complexities and issues which surround the use of CAM in clinical practice. As with the first CAM special issue (Smith 2008) one of the main difficulties encountered whilst compiling this issue relates to the lack of clarity as to what actually constitutes CAM. Techniques can be as diverse as gut directed hypnotherapy in irritable bowel syndrome to acupuncture in pain relief to spiritual healing in oncology and manipulation in low back pain. CAM also appears to differ between countries. For example, Traditional Chinese Medicine (TCM) is classified as CAM by the House of Lords Scientific Committee in the UK. However, TCM approaches are viewed very differently in South East Asia (House of Lords Select Committee on Science and Technology 2000). The National Centre for Complementary and Alternative Medicine (NCCAM) classification has been used to determine the appropriateness of papers for this issue. This classification is supported with the following broad definition of CAM as a group of diverse medical and health care systems, practices and products which are not presently considered to be part of conventional medicine (NCCAM 2004). Regardless of the diversity of CAM approaches and difficulty to define, its popularity has increased in recent years worldwide (Chua & Furnham 2008). It is estimated that more than half of the world’s population have accessed some form of CAM therapy, often in conjunction with traditional medical approaches (Tiralongo & Wallis 2008). Concomitantly, there is an increasing evidence base outlining the potential benefits and adverse effects of CAM therapies (Izzo & Ernst 2001). As a consequence of this increasing popularity, CAM appears on the curricula of many medical schools. Elective courses on CAM are included in many North American medical schools; however, there is evidence that approaches to education are variable and arguably superficial and, in some instances, the CAM knowledge of medical educators is inadequate (Verhoef et al. 2004). In the UK, the Department of Health (2001) recommended that every medical school in the UK ensures that their undergraduate students are exposed to a degree of CAM familiarisation to help them deal with patients who use or have an interest in trying a CAM approach. Owen et al. (2001) highlighted several learning opportunities for medical students at the University of Southampton, where they have established a module for CAM for their third year undergraduate students. This module received very favourable feedback from students and it offered them the following learning opportunities: • To facilitate and encourage students to reflect of general issues surrounding the growth and practise of CAM • To introduce the students to the philosophy, historical development and underlying concepts of CAM • To study specific CAM therapies in more depth • To consider the evidence base of CAM therapies and to reflect on the relevance of specific CAM techniques in relation to clinical presentations. Owen et al. (2001) believe that doctors should have a role as ‘gatekeepers’, advising patients about CAM, arguing that if they are not appropriately educated in CAM then there is the risk that patient care, in relation to CAM, will continue to be patchy and largely out with the conventional care framework. A similar argument could be made for CAM familiarisation with nursing education. Nurse educators with expertise in CAM are continually being challenged to educate undergraduate and post-registration nursing students about efficacy, safety and assumptions of CAM approaches. Presently, it would appear the level of CAM input varies between institutions and often relates to individual staff interests. CAM education in nursing programmes tends to relate to elective courses or the occasional lecture within core curriculum. Further familiarisation and training in CAM may offer an opportunity for nurses to have greater understanding of their patients, to integrate different approaches into patient care. Interest in the use of CAM in clinical nursing practice has increased in recent years (Hon et al. 2006). As health professionals on the clinical frontline, nurses are often required to provide information and guidance to their patients about safe and effective CAM (Smith 2008). Nurses play a significant role assessing their patients’ current use of CAM and answering questions about CAM practice (Halcon et al. 2003). Despite increasing interest and positive attitudes towards CAM, nursing

A systematic review of medical diagnosis of Ogilvie's syndrome in childbearing

OBJECTIVE to review all published papers examining medical diagnosis of Ogilvies syndrome and pregnancy with a view to assessing the implications of the diagnosis and the condition itself for childbearing women, midwives and medical practitioners. DESIGN systematic review. SEARCH STRATEGY MEDLINE, CINAHL, EMBASE, Web of Science and Cochrane databases were searched from 1950 to 2006 inclusive. Papers were read by two independent researchers and selected if they informed the link between Ogilvies syndrome and childbearing or were concerned with other aspects of maternal mortality. FINDINGS 23 papers fulfilled the selection criteria and were of a suitable standard. Inconsistencies in relation to the diagnosis of Ogilvies syndrome were noted, and an increase in maternal deaths from this condition was reported up to 2002. KEY CONCLUSIONS this paper highlights the strengths and weaknesses of medical diagnosis, as exemplified by Ogilvies syndrome. The scientific basis of diagnoses such as Ogilvies syndrome may deserve attention. This diagnosis has been shown to be unstable, both in temporal and aetiological terms. The midwifery and nursing reaction to the abrupt appearance of this condition is, at best, unfortunate. The attribution of blame to midwifery practices is deserving of a more robust response. IMPLICATIONS FOR PRACTICE there may be clinical implications of the diagnosis of Ogilvies syndrome for other aspects of maternity (including any nursing) care. A particularly significant area is the widely recognised increase in the caesarean rate with which Ogilvies syndrome has been closely linked.

The use of data-mining to identify indicators of health related quality of life in patients with irritable bowel syndrome

Health-related quality of life can be adversely affected by irritable bowel syndrome (IBS). The aims of this study were to examine the health-related quality of life in a cohort of individuals with IBS and to determine which socio-demographic and IBS symptoms are independently associated with reduced health-related quality of life. Several data-mining models to determine which factors are associated with impaired health-related quality of life are considered in this study and include logistic regression, a classification tree and artificial neural networks. As well as severity of IBS symptoms, results indicate that psychological morbidity and socio-demographic factors such as marital status and employment status also have a major role to play.