Samantha Coster

Self-monitoring in Type 2 diabetes mellitus: a meta-analysis

SUMMARY

The validation of a quality of life scale to assess the impact of arm morbidity in breast cancer patients post-operatively

This paper documents the validation of a quality of life scale (QOL) designed to assess the impact of arm morbidity on patients following breast cancer surgery. A four item arm subscale was developed to supplement a multi-dimensional, validated breast cancer QOL tool, the functional assessment of cancer therapy (FACT-B.) The new questionnaire, the FACT-B+4, was validated on 279 women participating in a trial of sentinel node guided axillary therapy and 29 women attending a lymphoedema clinic. The subscale demonstrated good internal consistency (alpha co-efficient=0.62 to 0.88) and stability (test–retest reliability=0.97). Lymphoedema patients reported significantly greater arm problems than a matched sample of pre-operative trial participants. The lymphoedema group also scored lower than trial patients on the FACT-B+4 indicating a poorer quality of life (p<0.05). A subset of 66 trial patients who had completed three consecutive assessments was used to evaluate the sensitivity of the questionnaire to change over time. Scores on the FACT-B+4 were found to decline significantly between the pre-operative assessment and post-operative assessment at 1 month. Arm problems significantly increased during this period. FACT-B+4 score increased again from 1 month to 12 weeks post-surgery and symptoms reduced, as the extent of arm morbidity resolved. The FACT-B+4 appears to be psychometrically robust and sensitive to patient rehabilitation, making it suitable for use in longitudinal surgical trials. Given the dearth of existing scales available to measure arm morbidity, we hope this new tool will prove useful to researchers

Evaluation of a Nurse-Led Educational Telephone Intervention to Support Self-Management of Patients With Chronic Obstructive Pulmonary Disease: A Randomized Feasibility Study.

Abstract This randomized, two armed feasibility study in a UK General Practice Surgery investigated the feasibility of introducing a nurse-led educational telephone intervention for patients with chronic obstructive pulmonary disease (COPD) to reinforce their understanding and use of their self-management plan. Methods: 73 patients were randomly allocated to a control group which received standard care including a self-management plan or an intervention group which received in addition, two scheduled telephone calls over six weeks from a practice nurse. Calls were tailored to the needs of the patient, but provided education about the use of their plan to manage exacerbations, use of health services and emergency medication. The primary endpoint to be tested was the impact of symptoms assessed by the COPD Assessment Tool (CAT) at baseline and 12 weeks. Secondary endpoints were self-reported exacerbations, emergency visits and service satisfaction. Results: Follow-up CAT data was available for 69 of the 73 randomized patients. CAT scores in the intervention group decreased significantly showing improvement between time 1 and 2 (Time 1 = 15.56 vs 12.44 at Time 2, Mean difference: 3.12, CI 1.52 –4.72, p <0.05) with no significant change in the control group. A significant difference between the CAT scores of the intervention and control groups was found at time 2 adjusting for baseline CAT scores at time 1 (−2.38 (−4.40 to −0.36) p <0.05.) No significant change was found in exacerbations between the groups at time 2. Satisfaction ratings did not vary significantly between the intervention and control groups over time. Conclusion: A nurse-led telephone intervention is feasible in primary care and may help to improve patients’ health and well-being.

Adaptação transcultural e validação da Readiness for Interprofessional Learning Scale no Brasil

Objective Conduct a cross-cultural adaptation of the expanded version of the 29-items Readiness for Interprofessional Learning Scale (RIPLS) into Brazilian Portuguese. Method Five steps were adopted: three translations, synthesis, three back-translations, assessment by an expert committee, and pre-test. Validation comprised 327 students from 13 undergraduate health courses from a public university. Parallel analyses were conducted using the R software and factor analysis using Exploratory Structural Equation Modeling. Results 1 9 12 16 10 11 17 19 21 24 25 29 Conclusion Evidences were found relating to the validity of the RIPLS version in Brazilian Portuguese in its application in the national context.Objetivo Realizar la adaptacion transcultural y la validacion de la version de 29 items de la Readiness for Interprofessional Learning Scale(RIPLS) para el portugues hablado en Brasil. Metodo Adoptado cinco etapas: tres traducciones, sintesis, tres retro-traducciones, evaluacion de expertos y pretest. Validacion consistio de 327 alumnos de 13 cursos de formacion de grado en una universidad publica. Analisis paralelos con el software R y analisis factorial utilizando Modelo de Ecuaciones Estructurales fueron realizados. Resultados El analisis factorial resulto en una escala de 27 items y tres factores: Factor 1 - Trabajo en equipo y colaboracion con 14 items (1-9, 12-16), Factor 2 - Identidad Profesional ocho items (10, 11, 17, 19, 21-24) y Factor 3 - Atencion a la salud centrada en el paciente, cinco items (25- 29). El Alfa de Cronbach de los tres factores fueron, respectivamente: 0,90; 0,66; 0.75. Analisis de varianza mostro diferencias significativas en los promedios de los grupos profesionales. Conclusion Se identificaron evidencias de validacion de la version en portugues de RIPLS en su aplicacion en el contexto nacional.

An exploration of personal initiative theory in the role of consultant nurses

The aim in this paper is to investigate the contribution personal initiative theory makes in understanding the consultant nurse role. The role was introduced in the UK in 2000 to improve patient outcomes, clinical leadership and retention of experienced clinicians. A larger study used a multi-method approach to collect quantitative and qualitative data from focus groups, interviews and a questionnaire administered nationally at two time points. Findings from longitudinal telephone interviews with 30 consultant nurses are the focus of this paper. Three consultant nurses were selected as case studies to examine the potential of personal initiative theory when applied to new nursing roles. The activities of two of the three demonstrated a high level of personal initiative in the job. They persisted in overcoming problems faced in improving practice. The third scored lower: she emerged as a reactive conformist and less likely than the other two to pursue initiatives of her own. Personal initiative theory has potential as a framework for evaluating the consultant nurse role, although further research is needed to test it. The longitudinal analysis revealed a determination to stay in the job and overcome difficult challenges when consultants show initiative and are making progress in achieving change.

Cross-cultural adaptation of the Readiness for Interprofessional Learning Scale in Brazil.

Objective Conduct a cross-cultural adaptation of the expanded version of the 29-items Readiness for Interprofessional Learning Scale (RIPLS) into Brazilian Portuguese. Method Five steps were adopted: three translations, synthesis, three back-translations, assessment by an expert committee, and pre-test. Validation comprised 327 students from 13 undergraduate health courses from a public university. Parallel analyses were conducted using the R software and factor analysis using Exploratory Structural Equation Modeling. Results 1 9 12 16 10 11 17 19 21 24 25 29 Conclusion Evidences were found relating to the validity of the RIPLS version in Brazilian Portuguese in its application in the national context.Objetivo Realizar la adaptacion transcultural y la validacion de la version de 29 items de la Readiness for Interprofessional Learning Scale(RIPLS) para el portugues hablado en Brasil. Metodo Adoptado cinco etapas: tres traducciones, sintesis, tres retro-traducciones, evaluacion de expertos y pretest. Validacion consistio de 327 alumnos de 13 cursos de formacion de grado en una universidad publica. Analisis paralelos con el software R y analisis factorial utilizando Modelo de Ecuaciones Estructurales fueron realizados. Resultados El analisis factorial resulto en una escala de 27 items y tres factores: Factor 1 - Trabajo en equipo y colaboracion con 14 items (1-9, 12-16), Factor 2 - Identidad Profesional ocho items (10, 11, 17, 19, 21-24) y Factor 3 - Atencion a la salud centrada en el paciente, cinco items (25- 29). El Alfa de Cronbach de los tres factores fueron, respectivamente: 0,90; 0,66; 0.75. Analisis de varianza mostro diferencias significativas en los promedios de los grupos profesionales. Conclusion Se identificaron evidencias de validacion de la version en portugues de RIPLS en su aplicacion en el contexto nacional.

Comparing the monitoring of patients transferred from a critical care unit to hospital wards at after-hours with day transfers: an exploratory, prospective cohort study.

AIMS To investigate possible factors related to patient monitoring to explain the higher mortality rates associated with after-hours transfers compared with daytime transfers from critical care units to the wards. BACKGROUND International research suggests that patients transferred from critical care units after-hours have a higher mortality rate than transfers during daytime, although the reasons remain unknown. DESIGN A prospective exploratory study. METHODS Twenty-nine patients transferred from a UK critical care unit to a ward within the same hospital after-hours for 10 weeks beginning April 2009 were compared with 29 transfers during daytime hours matched on potentially confounding characteristics. UK Critical Care Unit transfer guidelines have remained unchanged since data collection. Outcomes were as follows: (i) frequency of nursing observations; (ii) time periods from transfer to first medical review; (iii) time period from transfer to first clinical observations; (iv) frequency of transfer to an inappropriate ward; (v) delayed transfers from Critical Care Unit to ward. RESULTS Using Wilcoxons Rank test (two tail) to compare paired data from the matched groups, observations were recorded significantly less frequently within the first 12 hours for after-hours transfers. Time from transfer to first clinical observations was significantly longer for after-hour transfer patients. The delay from when the patient was ready for ward care and actual transfer was also longer for the after-hours transfer group. CONCLUSIONS Surveillance differences, including time to the first set of observations and frequency of observations in the first 12 hours, are potential factors that may explain the differential mortality associated with after-hours transfers.

Adaptación transcultural y validación de la Readiness for Interprofessional Learning Scale en Brasil

Objective Conduct a cross-cultural adaptation of the expanded version of the 29-items Readiness for Interprofessional Learning Scale (RIPLS) into Brazilian Portuguese. Method Five steps were adopted: three translations, synthesis, three back-translations, assessment by an expert committee, and pre-test. Validation comprised 327 students from 13 undergraduate health courses from a public university. Parallel analyses were conducted using the R software and factor analysis using Exploratory Structural Equation Modeling. Results 1 9 12 16 10 11 17 19 21 24 25 29 Conclusion Evidences were found relating to the validity of the RIPLS version in Brazilian Portuguese in its application in the national context.Objetivo Realizar la adaptacion transcultural y la validacion de la version de 29 items de la Readiness for Interprofessional Learning Scale(RIPLS) para el portugues hablado en Brasil. Metodo Adoptado cinco etapas: tres traducciones, sintesis, tres retro-traducciones, evaluacion de expertos y pretest. Validacion consistio de 327 alumnos de 13 cursos de formacion de grado en una universidad publica. Analisis paralelos con el software R y analisis factorial utilizando Modelo de Ecuaciones Estructurales fueron realizados. Resultados El analisis factorial resulto en una escala de 27 items y tres factores: Factor 1 - Trabajo en equipo y colaboracion con 14 items (1-9, 12-16), Factor 2 - Identidad Profesional ocho items (10, 11, 17, 19, 21-24) y Factor 3 - Atencion a la salud centrada en el paciente, cinco items (25- 29). El Alfa de Cronbach de los tres factores fueron, respectivamente: 0,90; 0,66; 0.75. Analisis de varianza mostro diferencias significativas en los promedios de los grupos profesionales. Conclusion Se identificaron evidencias de validacion de la version en portugues de RIPLS en su aplicacion en el contexto nacional.