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Background Chronic respiratory diseases are responsible for significant patient morbidity, mortality, and healthcare use. Community virtual ward (CVW) models of care have been successfully implemented to manage patients with complex medical conditions. Aims To explore the feasibility and clinical outcomes of a CVW model of care in patients with chronic respiratory disease. Methods Patients known to specialist respiratory services with Chronic Obstructive Pulmonary Disease (COPD) and/or asthma were admitted to the CVW for disease optimisation and exacerbation management. Individualised management plans were delivered in the patients’ home by hospital-based respiratory and community nursing teams, incorporating remote technology to monitor vital signs. Symptoms and health status at admission and discharge were compared. Results Twenty patients were admitted. One-quarter of patients had asthma, 50% COPD, and 25% combined asthma/COPD. Patients had severe disease, mean (SD) FEV1 50(20) % predicted, and an average 6.4(5.7) exacerbations of disease in the previous 12 months. Patients received personalised disease and self-management education. All acute exacerbations (n = 11) were successfully treated in the community. The average length of CVW admission was 10(4) days. By discharge, 60% of COPD and 66% of asthma patients recorded improvements in symptoms score exceeding the minimal clinically important difference. Fifty percent had clinically meaningful improvements in health status. Conclusion A CVW model facilitates the delivery of combined specialist and generalist care to patients with chronic respiratory disease in the community and improves symptoms and health status. The principles of the model are transferable to other conditions to improve overall health and reduce emergency hospital care.

Background Fentanyl and morphine are the 2 most commonly added opioids to bupivacaine for spinal anesthesia during cesarean delivery. Numerous clinical trials have assessed efficacy and safety of different doses of fentanyl added to intrathecal bupivacaine for spinal anesthesia, yet its benefit, harm, and optimal dose remain unclear. This study aimed to systematically review the evidence of the efficacy of fentanyl when added to intrathecal bupivacaine alone and when added to bupivacaine with morphine for spinal anesthesia during cesarean delivery. Methods Key electronic databases (PubMed, Embase, and Cochrane Library) were searched for randomized controlled trials in the cesarean delivery population. The primary outcome was the failure rate of spinal anesthesia, as assessed by the need for either conversion to general anesthesia or intraoperative analgesic supplementation. Two reviewers independently extracted the data using a standardized electronic form. Results are expressed as relative risks or mean differences with 95% CIs. Results Seventeen randomized controlled clinical trials (most judged as low or unclear risk of bias) with 1064 participants provided data for the meta-analysis. Fentanyl added to intrathecal bupivacaine alone reduced the need for intraoperative supplemental analgesia (relative risk, 0.18; 95% CI, 0.11-0.27; number needed to treat, 4) and the incidence of nausea/vomiting (relative risk, 0.41; 95% CI, 0.24-0.70; number needed to treat, 6.5), with longer time to first postoperative analgesia request (mean difference, 91 minutes; 95% CI, 69-113). No difference was observed regarding the need for conversion to general anesthesia (relative risk, 0.67; 95% CI, 0.12-3.57), the incidence of hypotension, the onset of sensory block, or the duration of motor block. However, the addition of intrathecal fentanyl was associated with higher incidence of intraoperative pruritus (relative risk, 5.89; 95% CI, 2.07-16.79; number needed to harm, 13.5). The inclusion of fentanyl to intrathecal bupivacaine-morphine compared to intrathecal bupivacaine-morphine alone conferred a similar benefit, with a significantly reduced need for intraoperative supplemental analgesia (relative risk, 0.16; 95% CI, 0.03-0.95; number needed to treat, 9). Analysis using a funnel plot indicated a possibility of publication bias in included studies. Conclusions Current evidence suggests a benefit of using fentanyl as both an additive to intrathecal bupivacaine alone and to intrathecal bupivacaine combined with morphine for cesarean delivery under spinal anesthesia. The possibility of publication bias, small sample size, and high risk of bias in some of the included studies warrant treating the results with caution.

IntroductionOne of the main harms from breast cancer screening is the anxiety caused by false positive results. Various factors may be associated with false-positive anxiety. One modifiable factor may be the method of communication used to deliver results. The aim of this study is to measure the effect on anxiety of receiving benign biopsy results in-person or by telephone.Methods and analysisThis is a multi-centre cluster randomised crossover trial in the English National Health Service Breast Screening Programme (NHSBSP) involving repeated survey measures at four time points. Participants will be women of screening age who have a biopsy following a suspicious mammography result, who ultimately receive a benign or normal (B1) result. Centres will trial both telephone and in-person results on a month-by-month basis, being randomised to which communication method will be trialled first. Women will be blinded to the method of communication they will receive. The analysis will compare women who have received telephone results and women who have received in-person results. The primary outcome measure will be anxiety (measured by the Psychological Consequences Questionnaire) after receiving results, while controlling for baseline anxiety. Secondary outcome measures will include anxiety at 3 and 6 months post-results, understanding of results and patient preferences for how results are communicated. Qualitative telephone interviews will also be conducted to further explore women’s reasons for communication preferences. Qualitative and quantitative data will be integrated after initial separate analysis using the pillar integration process.Ethics and disseminationThis study has been approved by the Public Health England Breast Screening Programme Research Advisory Committee, (BSPRAC_0013, ODR1718_040) and the National Health Service Health Research Authority (HRA) West Midlands—Coventry & Warwickshire Research Ethics Committee (17/WM/0313). The findings from this study will be disseminated to key stakeholders within the NHSBSP and via academic publications.Trial registration numberISRCTN36997684Trial sponsorThis research is part of a PhD award and is funded by the Economic and Social Research Council Doctoral Training Centre at the University of Warwick and Public Health England. The sponsor for this research is Jane Prewett (sponsorship@warwick.ac.uk).

Presents a brief review of research literature to indicate problems in using research data and summarizes a study undertaken to determine if a correlation exists between the perceptions of a group of business world authorities and the perceptions of business educators with reference to the abilities being required of clerical personnel "now" and "in the future." (TA)

A co-ordinated approach was adopted to monitor practice standards among clinical nurse specialists (CNSs) in West Midlands breast screening assessment nursing teams. A regional working party was assembled and a patient satisfaction survey was produced. Results of the survey show that for women attending for breast screening assessment, interaction with a CNS is perceived to be highly beneficial. Contact points vary with local practice, but the majority of women had contact with a CNS at some point during the assessment process for support and information. The results of the survey are used as an integral part of the quality assurance process in relation to CNS provision in the West Midlands. Services should aim to ensure that sufficient CNSs are available for women attending breast screening assessment centres.

Context: Acute medicine nursing is an emerging discipline within unscheduled care. To September 2016 73,175 patients registered in Ireland’s acute medicine units, of which 26,830 (36.7%) were admitted to acute medical short stay or specialist wards, or discharged on the same day (n=46,345 / 63.3%). Nursing staff in these units (560) come from a variety of clinical general and specialist backgrounds with few possessing specialist acute medicine nursing qualifications to support patients on unscheduled care pathways inclusive of ambulatory care. Aim: To provide clinical education programmes to maximise the development Acute Medicine nurses’ skills and competence’ (H.S.E. 2016, p. 18) to meet identified patient needs. A particular focus being on improving patient access, assessment, care, and management across the patient pathway. Method: Nationally there are 32 acute hospitals which have either an AMAU or an MAU. To identify gaps in knowledge, skills and competencies: An education needs assessment to determine baseline knowledge, skills and competencies of nurses in these units a national survey was undertaken. All 32 hospitals were surveyed. A similar assessment was conducted amongst ED nurses The survey instrument was designed based on a Developmental Framework for Nursing Skills and Competencies in AMAUs, MAUs and MSSUs which was co-designed with the Acute Medicine Nurse Interest Group (AMNIG) and which identified the skills and competencies required of acute medicine nurses at core, specialist, enhanced/advanced levels. Outcome/Results: A 100% response rate was achieved. Hospitals were asked to provide information on numbers of nurses trained in a skill; those currently using the skill; and nurses requiring training in the skill. Demographics were captured in Section 1. Responses to, clinical skills and competencies needs (Section 2), were analysed using six broad categories. Results will be presented. Results were mapped to patient presentations and age profiles using NQAiS Medicine. Findings from the ED nurse survey were cross referenced to enable common core unscheduled care skills and competencies education needs to be identified. A Foundation Programme in Unscheduled Care, Acute Medicine Nursing was designed. On-line clinical skills programmes and currently provided in service programmes were excluded from the programme. 5 key skills and competency areas were validated by the Acute Medicine Programme Nurse Interest Group as required for inclusion. Provision of ongoing Level 8 education foundation programmes’ of 12 weeks duration with Nursing and Midwifery Board accreditation planned to commence 2017. Conclusion: A foundation programme will enable nurses to access educational and professional practice pathways in acute medicine at specialist and advanced practice levels. Having skilled and competent nurses educated to a national standard of skills and competencies in unscheduled acute medicine care inclusive of ambulatory and short stay acute medicine care will improve the patient outcomes,experience create capacity within the system generating greater access and effective efficient use of resource. Provides opportunities for interdisciplinary and cross clinical programme nurse education to generate a commonality of practice within the themes of rapid access, timely assessment , intervention, diagnosis, treatment plan and discharge.

After recognizing the problem areas in business education and the need for reexamination of goals and directions which would emphasize career education, the authors present a model to stimulate thinking about a core curriculum approach for business education that is in conformance with career education goals. (HD)

We summarize the first reported case of acquired lymphocytic choriomeningitis virus (LCMV) infection in Michigan to be investigated by public health authorities and provide evidence of the focal nature of LCMV infection in domestic rodents. Results of serologic and virologic testing in rodents contrasted, and negative serologic test results should be confirmed by tissue testing.

The authors describe the development of a double antibody radioimmunoassay specific for human secretory IgA (sIgA), and they report the results of measurements of serum sIgA concentrations in patients with chronic, nonalcoholic liver disease or carcinoma. Above-normal sIgA concentrations (greater than 25 micrograms/mL) were found in 22 of 38 sera from patients with chronic active liver disease and in 37 of 40 sera from patients with primary biliary cirrhosis. Markedly increased concentrations (greater than 118 micrograms/mL) were specific for primary biliary cirrhosis. Above-normal sIgA concentrations were found frequently in patients with colorectal (29/86, 34%), pancreatic (38/70, 54%), gastric (11/30, 37%), or mammary (6/46, 13%) carcinoma. An above-normal concentration of sIgA was more specific for hepatic metastases than an above-normal alkaline phosphatase activity in each type of carcinoma. The authors conclude that measurement of sIgA in serum is a useful diagnostic test in patients with chronic liver disease suspected of having primary biliary cirrhosis or in patients with carcinoma suspected of having hepatic metastases.

“… literature is available and does… provide guidelines to follow in bringing about meaningful change.”

A computerized infertility data registry form has been developed in order to facilitate the storage of a large amount of reproductive data to allow subsequent analyses pertinent to the management of the infertile couple. This abstract form of the patients' medical records has been readily applied to computer analysis using the SPSS reporting system. The abstract can be utilized both for the facilitation of patient management and as a means for obtaining a standardized, objective, retrospective review of clinical data. Through the evaluation and standardization of the therapeutic techniques frequently utilized by physicians, the treatment of infertile couples should be improved. Such an approach is essential for anyone involved in today's health care system.

(1977). An Alternative Shorthand System. The Journal of Business Education: Vol. 52, No. 5, pp. 209-210.