Ruth Elkan

Effectiveness of home based support for older people: systematic review and meta-analysis

Abstract Objective: To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people. Design: Systematic review and meta-analysis of 15 studies of home visiting. Participants: Older people living at home, including frail older people at risk of adverse outcomes. Outcome measures: Mortality, admission to hospital, admission to institutional care, functional status, health status. Results: Home visiting was associated with a significant reduction in mortality. The pooled odds ratio for eight studies that assessed mortality in members of the general elderly population was 0.76 (95% confidence interval 0.64 to 0.89). Five studies of home visiting to frail older people who were at risk of adverse outcomes also showed a significant reduction in mortality (0.72; 0.54 to 0.97). Home visiting was associated with a significant reduction in admissions to long term care in members of the general elderly population (0.65; 0.46 to 0.91). For three studies of home visiting to frail, “at risk” older people, the pooled odds ratio was 0.55 (0.35 to 0.88). Meta-analysis of six studies of home visiting to members of the general elderly population showed no significant reduction in admissions to hospital (odds ratio 0.95; 0.80 to 1.09). Three studies showed no significant effect on health (standardised effect size 0.06; −0.07 to 0.18). Four studies showed no effect on activities of daily living (0.05; −0.07 to 0.17). Conclusion: Home visits to older people can reduce mortality and admission to long term institutional care. What is already known on this topic The benefits of regular, preventive home visits to older people are the subject of controversy A recent systematic review found no clear evidence that preventive home visits were effective What this study adds This meta-analysis of 15 trials shows that home visiting can reduce mortality and admission to institutional care among older people

Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis

AIMS To evaluate the effectiveness of home visiting programmes on parenting and quality of the home environment. DESIGN Systematic review of the literature of randomised controlled trials and quasi-experimental studies evaluating home visiting programmes involving at least one postnatal visit. SUBJECTS Thirty four studies reported relevant outcomes; 26 used participants considered to be at risk of adverse maternal or child health outcomes; two used preterm or low birth weight infants; and two used infants with failure to thrive. Only eight used participants not considered to be at risk of adverse child health outcomes. RESULTS Seventeen studies reported Home Observation for Measurement of the Environment (HOME) scores, 27 reported other measures of parenting, and 10 reported both types of outcome. Twelve studies were entered into the meta analysis. This showed a significant effect of home visiting on HOME score. Similar results were found after restricting the analyses to randomised controlled trials and to higher quality studies. Twenty one of the 27 studies reporting other measures of parenting found significant treatment effects favouring the home visited group on a range of measures. CONCLUSIONS Home visiting programmes were associated with an improvement in the quality of the home environment. Few studies used UK health visitors, so caution must be exercised in extrapolating the results to current UK health visiting practice. Further work is needed to evaluate whether UK health visitors can achieve similar results. Comparisons with similar programmes delivered by paraprofessionals or community mothers are also needed.

Ethnicity and participation in cancer self-help groups.

Objectives: Investigations of the benefits of membership of a cancer self‐help group have suggested that it leads to improved sense of support, increased ability to deal with life‐events, and decreased anxiety, confusion, depression and helplessness. However, some evidence suggests that people from black and ethnic groups are less likely to join a cancer self‐help group. The main aims of the reported study were: to explore possible reasons why people from some ethnic groups have not participated in self‐help to the same extent as the rest of the community; and to identify ways in which participation of people from ethnic groups can be increased.

Nursing history and the politics of welfare

A quiet revolution has been sweeping through the writing of nursing history over the last decade, transforming it into a robust and reflective area of scholarship. Nursing History and the Politics of Welfare highlights the significant contribution that researching nursing history has to make in settling a new intellectual and political agenda for nurses. The seventeen international contributors to this book look at nursing from different perspectives, as it has developed under different regimes and ideologies and at different times, in America, Australia, Britain, Germany, India, The Phillipines and South Africa. They highlight the role of politics and gender in understanding nursing history and propose strategies for achieving greater recognition for nursing, and bringing it into line with other related health care professions.

Feedback of trial results to participants: a survey of clinicians' and patients' attitudes and experiences.

Purpose There is growing interest in the provision of trial results to trial participants. However, there are a number of gaps in the research base relating to the closure of clinical trials and feedback of results to participants. Methods The aim of this research was to explore the practice of feeding back trial results to trial participants and to identify best practice in this area. Postal questionnaires were sent to members of the UK National Cancer Research Institute Clinical Studies Groups (NCRI CSG) and to patients over the age of 18 years who completed trial treatment (located in one Cancer Network) during a 16-month period (April 07–July 08). Results 145 NCRI CSG member surveys and 81 patient questionnaires were returned. The vast majority of all respondents supported the idea of offering results to trial participants. However, NCRI members and trial participants differed in their opinions about the timing and method for the provision of results. Conclusion The results provide an insight into the views of these groups in relation to desire for results and practical aspects of results feedback which should inform further investigations into trial management and the practice of feedback of trial results.

A randomised controlled trial of nurse-managed trial conclusion following early phase cancer trial participation.

The effect of a nurse-managed intervention, for early phase cancer trial participants at trial conclusion, on psychosocial outcomes was evaluated at two cancer centres in the Midlands, England using a randomised controlled trial. It involved 117 patients who were participating in an early phase cancer clinical trial. It was a nurse-managed trial exit, which included a trial exit interview, trial feedback information leaflet and telephone follow-up compared with standard care at trial conclusion. Psychological distress at 1 week and 4–6 weeks post-trial conclusion, patients knowledge and understanding and patients satisfaction were assessed. The results showed there was no significant difference between the two groups regarding scores for anxiety and depression at time one and time two. There is some suggestion that the intervention reduced anxiety from trial conclusion to follow-up (P=0.27). Patients in both groups felt they had contributed to cancer research through trial participation. However, intervention patients were more likely to feel that they knew how the trial was going (P<0.001), knew how other people in the trial were doing (P=0.001), had all the feedback they needed about the trial they took part in (P<0.01) and knew how they would be followed up (P=0.02). Patient satisfaction with the intervention was high (median score=4.5 where 5 is greatest satisfaction). In conclusion, nurse-managed trial conclusion led to positive outcomes for patients who had recently completed a clinical trial.

Project 2000 and the replacement of the traditional student workforce

This paper reports on part of a 4-year study monitoring the implementation of Project 2000 in one health authority. Its focus is on the consequences for the nursing service of replacing traditional, pre-Project 2000 students with permanent staff. It is argued that the Department of Health, who have been responsible for funding the replacement programme, have underestimated the numbers of permanent staff required to replace the traditional student workforce, and that the Project 2000 replacement exercise has contributed to a deterioration in staffing levels and skill mix.