Pauline Raynor

Nurses, information use, and clinical decision making—the real world potential for evidence-based decisions in nursing

Nurses have probably always known that their decisions have important implications for patient outcomes. Increasingly, however, they are being cast in the role of active decision makers in healthcare by policy makers and other members of the healthcare team. In the UK, for example, the Chief Nursing Officer recently outlined 10 key tasks for nurses as part of the National Health Service’s modernisation agenda and the breaking down of artificial boundaries between medicine and nursing.1 As well, nurses are expected to access, appraise, and incorporate research evidence into their professional judgment and clinical decision making.2 This active engagement with research evidence is the focus of this paper. We will explore why it is necessary to consider the clinical decision making context when examining the ways in which nurses engage with research based information. We will also consider the relation between the accessibility and usefulness of information from different sources and the decisions to which such information is applied. Finally, we will argue that if we are to encourage nurses to actively engage with research evidence during clinical decision making, we need to better understand the relation between the decisions that nurses make and the knowledge that informs them. In this paper, we draw heavily on the findings of 2 major studies conducted at the University of York between 1997 and 2002.3–,9 2 case studies were conducted in 3 geographical areas with different hospital types, population characteristics, and levels of health service provision. We purposively sampled participants according to a sampling frame constructed around variables deemed to be theoretically significant for clinical decision making.7 Data collection comprised 200 indepth interviews with nurses and managers; 400 hours of non-participant observation of “decision making and information use in action”; 4000 practice based documents audited for characteristics such …

Cohort Profile: The Born in Bradford multi-ethnic family cohort study

Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford, UK, School of Health Studies, University of Bradford, Bradford, UK, Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK, Medical Research Council Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, UK, Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, Leeds Institute of Genetics, Health and Therapeutics, Faculty of Medicine and Health, University of Leeds, Leeds, UK and Department of Health Sciences, University of York, York, UK

Seroprevalence of Cytomegalovirus, Epstein Barr Virus and Varicella Zoster Virus among Pregnant Women in Bradford: A Cohort Study

Objective To estimate the seroprevalence of cytomegalovirus (CMV), Epstein Barr virus (EBV) and varicella zoster virus (VZV) among pregnant women in Bradford by ethnic group and country of birth. Methods A stratified random sample of 949 pregnant women enrolled in the Born in Bradford birth cohort was selected to ensure sufficient numbers of White UK born women, Asian UK born women and Asian women born in Asia. Serum samples taken at 24-28 weeks’ gestation were tested for CMV IgG, EBV IgG and VZV IgG. Each woman completed a questionnaire which included socio-demographic information. Results CMV seroprevalence was 49% among the White British women, 89% among South Asian UK born women and 98% among South Asian women born in South Asia. These differences remained after adjusting for socio-demographic factors. In contrast, VZV seroprevalence was 95% among women born in the UK but significantly lower at 90% among South Asian women born in Asia. EBV seroprevalence was 94% overall and did not vary by ethnic group/country of birth. Conclusions Although about half of White British women are at risk of primary CMV infection in pregnancy and the associated increased risk of congenital infection, most congenital CMV infections are likely to be in children born to South Asian women with non-primary infection during pregnancy. South Asian women born in South Asia are at risk of VZV infection during pregnancy which could produce congenital varicella syndrome or perinatal chickenpox. Differences in CMV and VZV seroprevalence by ethnic group and country of birth must be taken into account when universal immunisation against these viruses is contemplated.

The reliability of routine anthropometric data collected by health workers: a cross-sectional study.

BACKGROUND Reliable data on child growth is a prerequisite for monitoring and improving child health. Despite the extensive resources invested in recording anthropometry, there has been little research into the reliability of these data. If these measurements are unreliable growth may be misreported, and health problems may go undetected. OBJECTIVES To assess the reliability of routine infant growth data, following anthropometric training of health workers responsible for collecting these data, in Bradford, UK. To determine whether being observed by an external administrator influenced reliability. DESIGN A test-retest design was used. PARTICIPANTS All health workers (n=192) responsible for growth monitoring in Bradford were included in the study, of which 36.5% (n=70) had complete data. METHODS Following training in basic anthropometry all health workers were asked to complete a test-retest study, using infants aged 0-2 years. Health workers took two recordings of weight, length, head circumference, and abdominal circumferences on five infants. A peer health worker recorded a third set of measurements on each infant. Twenty-two individuals were selected to be observed by an external administrator during data collection. Technical error of measurements (TEMs) were produced to assess intra-observer and inter-observer reliability. Differences between groups were tested to determine whether external observation influences reliability. RESULTS None of the TEMs were excessively large, and coefficients of reliability ranged from 0.96 to 1.00. All intra-observer and inter-observer TEMs for the observed group were larger than those for the non-observed group. For example, the observed groups intra-observer TEMs for weight, length, abdominal circumference, and head circumference (46.18 g, 0.60 cm, 0.65 cm, 0.47 cm) were larger than the non-observed groups TEMS (9.14 g, 0.35 cm, 0.34 cm, 0.19 cm). TEMs for weight, abdominal circumference, and head circumference were significantly larger for the observed group, compared to the non-observed group (p<0.001). Inter-observer TEMs for length were also significantly larger for the observed group (p=0.031), whilst intra-observer TEMs for length were not significantly different between the two groups (p=0.137). CONCLUSIONS Following training in anthropometry health workers in Bradford can, in general, reliably measure child growth. TEMs were comparable to data from other research studies and all coefficients of reliability were indicative of good quality control. Reliability measurement provides a method of quality assurance for routine data monitoring. If commissioners of health services are to be informed by these data then some form of reliability assessment should be considered, and if employed external observation is recommended to improve validity.

Tap water use amongst pregnant women in a multi-ethnic cohort.

BackgroundStudies of disinfection by-products in drinking water and measures of adverse fetal growth have often been limited by exposure assessment lacking data on individual water use, and therefore failing to reflect individual variation in DBP exposure.MethodsPregnant women recruited to the Born in Bradford cohort study completed a questionnaire which covers water exposure. Information was collected on water consumption, showering, bathing and swimming. Water exposure data from a subset of 39 women of the cohort are described here.ResultsMean total tap water intake was 1.8 l/day, and women on average spent 146 minutes per week showering and bathing. Most tap water intake occurred at home (100% for unemployed, 71.8% for employed). Differences between age groups were observed for total tap water intake overall (p = 0.02) and at home (p = 0.01), and for bottled water intake (p = 0.05). There were differences between ethnic groups for tap water intake at home (p = 0.02) and total tap water intake at work (p = 0.02). Total tap water intake at work differed by income category (p = 0.001). Duration per shower was inversely correlated with age (Spearmans correlation -0.39, p = 0.02), and differed according to employment status (p = 0.04), ethnicity (p = 0.02) and income (p = 0.02).ConclusionThis study provides estimates of water exposure in pregnant women in a multi-ethnic population in the north of England and suggests differences related to age, employment, income and ethnicity. The findings are valuable to inform exposure assessment in studies assessing the relationship between DBPs and adverse birth outcomes.

How is research evidence used to support claims made in advertisements for wound care products

AIMS AND OBJECTIVE To investigate the amount, type and accuracy of citations use in support of product related claims from advertisements of wound care products. BACKGROUND Although articles submitted to most medical journals are subjected to peer review, such scrutiny is often not required for the content of advertisements. DESIGN A contents survey of advertisements from two wound care journals (Journal of Wound Care and Ostomy Wound Management) from 2002-2003 and the British Medical Journal, 2002-2003. METHODS Data collected from advertisements included identification of product related claims made and any corresponding citations. Where journal articles were cited to support claims, the articles were obtained. Where data on file were cited, this material was requested. In each case the accuracy of claims in relation to the content of the supporting citation was assessed. RESULTS The use of citations to support product related claims was infrequent in advertisements from wound care journals, where 35% of advertisements containing a product related claim also contained at least one citation, compared with 63% of advertisements from the British Medical Journal. Of citations that were supplied, journal articles were less common in the wound journals (40% vs. 73% in the British Medical Journal) and data on file more common (38% vs. 6% in the British Medical Journal). Where journal articles were obtained, 56% of claims in the wound care journals advertisements were not supported by the cited article, compared with 12% of claims in the British Medical Journal. CONCLUSION The wound journals advertised predominantly medical devices. The use and accuracy of referencing in advertisements from wound care journals was poor. RELEVANCE TO CLINICAL PRACTICE Nurses have increasing responsibilities for the prescribing of both drugs and devices, which must be accompanied by the ability to interpret marketing materials and research evidence critically. Nurse educators must ensure that nurse education generally and nurse prescriber training particularly, builds skills of information retrieval and critical appraisal.

Validation of trichloroacetic acid exposure via drinking water during pregnancy using a urinary TCAA biomarker

Disinfection by-product (DBP) exposure during pregnancy may be related to reduced fetal growth, but the evidence is inconclusive and improved DBP exposure assessment is required. The authors conducted a nested exposure study on a subset (n=39) of pregnant women in the Born in Bradford cohort to assess validity of TCAA exposure assessment based on tap water sampling and self-reported water-use; water-use questionnaire validity; and use of a one-time urinary TCAA biomarker. TCAA levels in urine and home tap water supply were quantified, and water use was measured via a questionnaire and 7-day diary, at 28 weeks gestation. Diary and urine measures were repeated later in pregnancy (n=14). TCAA level in home tap water supply was not correlated with urinary TCAA (0.18, P=0.29). Cold unfiltered tap water intake at home measured by questionnaire was correlated with urinary TCAA (0.44, P=0.007), but correlation was stronger still for cold unfiltered tap water intake reported over the 3 days prior to urine sampling (0.60, P<0.001). For unemployed women TCAA ingestion at home, derived from tap water sampling and self-reported water-use, correlated strongly with urinary TCAA (0.78, P<0.001), but for employed women the correlation was weak (0.31, P=0.20). Results suggest individual tap water intake is most influential in determining TCAA exposure variability in this cohort, and that TCAA ingestion at home is a valid proxy for TCAA exposure for unemployed women but less satisfactory for employed women.

P13 Association of prenatal and postnatal smoking and alcohol consumption on birth weight in the white British population in Bradford: preliminary findings from the born in Bradford study

Background Exposure to cigarette smoke and heavy alcohol consumption has been known to influence birth weight and risk of being small for gestational age. Despite this knowledge, very little exploration of the timing of cigarette smoking and alcohol exposure on growth has been undertaken. Aims To investigate the effect of dose and timing of pre-pregnancy and prenatal alcohol and cigarette exposure on birth weight. Methods The Born in Bradford cohort includes women of diverse ethnicities, with 46% of the population being of South Asian origin. However, smoking prevalence (5.9%) and alcohol consumption rates (0.4%) in pregnant women of South Asian origin were too low for meaningful analyses. Therefore, analyses were restricted to the white British women who had completed a questionnaire and had a live singleton full-term birth at the Bradford Royal Infirmary, between October 2007 and August 2009. Data were available on smoking and alcohol consumption at three different time points: in the 3 months prior to pregnancy, first 3 months of pregnancy and when the baseline questionnaire was administered (26–28 weeks gestation) by trained interviewers. This information was used to classify women into three mutually exclusive categories separately for both smoking and alcohol: smoker/drinker at all time points, decreasing or quitting at different time periods throughout and nonsmokers/drinkers at all time points. Mean differences in birth weight between these categories were investigated using multivariable linear regression. The model adjusted for maternal age, babys gender, parity, area deprivation, caffeine consumption, and mothers weight at her first antenatal clinic appointment. Results 1933 white British mothers and their children were eligible for inclusion. 39.7% were regular smokers in the 3 months prior to pregnancy and 33.6% during pregnancy, whilst 72% consumed alcohol in the 3 months prior to pregnancy and 40% during pregnancy. 29.3% of pregnant women both smoked and drank before pregnancy reducing to 15.1% during pregnancy. Adjusted analysis showed that birth weight was negatively associated with continual smoking, −231 g (95% CI −318.3 to −144.5), whilst quitting or decreasing smoking was associated with −68.5 g reduction (95% CI −119.7 to −17.4) compared to nonsmokers. No association with birth weight was observed for alcohol consumption (−0.16 g, 95% CI −69.9 to 69.6). Conclusions Timing of quit smoking interventions should concentrate on the pre-pregnancy period to ensure optimal benefits on birth weight. These results suggest that smoking cessation advice provided in the ante natal period may have limited benefit.

Review: home visiting programmes that include ⩾1 postnatal home visit are associated with improved quality of home environment and parenting

(2000) Arch Dis Child 82, 443. Kendrick D, Elkan R, Hewitt M . , et al. . Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis. . Jun; . : . –51 . [OpenUrl][1][Abstract/FREE Full Text][2] 
 QUESTION: Do home visiting programmes improve quality of home environment and parenting? Studies were identified by searching Medline (1966 to July 1996), CINAHL (1982 to July 1996), EMBASE/Excerpta Medica (1980 to October 1996), and the Cochrane Library . The journal Health Visitor was handsearched (1982–97), bibliographies of relevant reviews were checked, key individuals and organisations were contacted, and advertisements were placed in relevant journals to identify unpublished studies. Randomised controlled trials or quasi-experimental studies that had a control group were included if they evaluated a home visiting programme, the programme included ⩾1 postnatal home visit, the tasks undertaken in the home visit were within the practice of British health visitors (eg, social support and facilitation of mother-child interaction), and outcomes relevant to British home visiting were reported (eg, quality of home environment and parent-child interaction). Data were extracted on study purpose, design, sample size determination, description of participants, randomisation and stratification, use of a comparison group, management procedures, blinding, loss to follow up, … [1]: {openurl}?query=rft.jtitle%253DArchives%2Bof%2BDisease%2Bin%2BChildhood%26rft.stitle%253DArch.%2BDis.%2BChild.%26rft.issn%253D0003-9888%26rft.aulast%253DKendrick%26rft.auinit1%253DD.%26rft.volume%253D82%26rft.issue%253D6%26rft.spage%253D443%26rft.epage%253D451%26rft.atitle%253DDoes%2Bhome%2Bvisiting%2Bimprove%2Bparenting%2Band%2Bthe%2Bquality%2Bof%2Bthe%2Bhome%2Benvironment%253F%2BA%2Bsystematic%2Breview%2Band%2Bmeta%2Banalysis%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fadc.82.6.443%26rft_id%253Dinfo%253Apmid%252F10833174%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=archdischild&resid=82/6/443&atom=%2Febnurs%2F4%2F1%2F9.atom