Search

The Annals of Family Medicine encourages readers to develop a learning community to improve health and health care through enhanced primary care. With the Annals Journal Club, we encourage diverse [...]

Background: Knowledge of the composition of a surgical team is the premise for studying efficiency inside the operating room. Methods: To investigate the team composition in general surgery procedures, we retrospectively reviewed procedures performed by an expert general surgeon in 2007-08 at 2 tertiary hospitals. For each patient, demographic characteristics, procedure type, team members and procedure length were extracted from intraoperative nursing records. We assessed procedure complexity using a calculated index. Multiple logistic regressions were performed to assess the association between procedure length and team size after adjusting for procedure complexity and patient condition. Results: For the 587 procedures reviewed, the mean procedure length was 88 (standard deviation [SD] 51) minutes. On average, 8 team members (range 4-14), including surgeons, anesthesiologists, nurses and other specialists, were involved in each procedure. Only 47 (8%) procedures were performed by 1 surgeon. Most were performed by 2 (295 [50%]) or 3 surgeons (214 [36%]). Half the team members were nurses (mean 4, range 1-7). Both the complexity of the operation and the team size affected the procedure length significantly. When procedure complexity and patient condition were constant, adding 1 team member predicted a 7-minute increase in procedure length. Conclusion: This study demonstrates that a frequent change of core team members has a negative impact on surgical performance. Management strategies need to improve to optimize team efficiency in the operating room. Contexte : Pour etudier l'efficience des equipes chirurgicales au bloc operatoire, il faut en connaitre la composition. Methodes : Pour analyser la composition d'une equipe de chirurgie generale, nous avons analyse retrospectivement les interventions effectuees par un chirurgien general d'experience en 2007-08 dans 2 hopitaux de soins tertiaires. Pour chaque cas, nous avons extrait les caracteristiques demographiques, le type d'intervention, les membres de l'equipe et la duree de l'intervention a partir des notes infirmieres peroperatoires. Nous avons evalue la complexite de l'intervention a l'aide d'un indice calcule. Nous avons utilise le modele de regression logistique multiple pour etablir le lien entre la duree de l'intervention et la taille de l'equipe apres ajustement pour tenir compte de la complexite de l'intervention et de l'etat des patients. Resultats : La duree moyenne des 587 interventions analysees a ete de 88 (ecart-type [ET] 51) minutes. En moyenne, les equipes de chaque intervention se composaient de 8 membres (etendue 4-14), incluant chirurgiens, anesthesistes, infirmieres et autres specialistes mis a contribution. Seulement 47 interventions (8 %) ont ete effectuees par un seul chirurgien. La plupart ont ete effectuees par 2 (295 [50 %]) ou 3 (214 [36 %]) chirurgiens. Les infirmieres formaient la moitie des equipes (moyenne, 4, etendue 1-7). La complexite de l'intervention et la taille de l'equipe ont significativement influe sur la duree de l'intervention. Lorsque la complexite des interventions et l'etat des patients demeuraient constants, l'ajout d'un membre a l'equipe permettait de predire une augmentation de la duree de l'intervention de l'ordre de 7 minutes. Conclusion : Cette etude demontre que les modifications frequentes des membres de l'equipe centrale exercent un impact negatif sur le rendement chirurgical. Il y aurait lieu d'ameliorer les strategies de gestion pour optimiser l'efficience des equipes des blocs operatoires., The introduction of minimally invasive surgery has substantially changed the pattern of surgical practice inside the operating room (OR). (1) Built on image-guided technology, outcomes of a minimally invasive operation [...]

Abstract Aims This article reflects the author's experience of qualitative interviews during his research project. It attempts to highlight how recording interviews can affect data collection and data quality. Background [...]

Abstract Emergency care services in the UK are receiving increasing numbers of patients presenting with a wide range of problems, from life-threatening conditions to minor injury or illness. All patients [...]

Summary The government has emphasised that, to deliver high quality, integrated care, staff must work across organisational boundaries using a team approach so that everyone works towards the same goals. [...]

Historically, DSNs have been involved in advising on, the prescribing of, administration of, and adjustment of diabetes medication, in varying capacities. In recent years, however, a formal training qualification has [...]

Summary This article explores the effect on the quality of life experienced by patients and their families when low-grade, chemotherapy-induced neutropenia results in dose reductions and/or delays in treatment cycles. [...]

Summary This article explores the introduction of nurse-facilitated discharge in one children's day care unit. It highlights how a need for change to the discharge procedure was established and how [...]

There is little empirical evidence evaluating the effects of recent, widespread changes in nurse executive roles and nursing management structures on the costs of patient care. This retrospective cross-sectional study [...]

Summary There are a number of circumstances that may affect an individual's ability to maintain personal hygiene. Hospitalised patients, and in particular those who are bedridden, may become dependent on [...]

Summary Pretibial lacerations are a common injury, particularly in older adults. Patients may present to the emergency department for treatment, be treated in GP surgeries by community nurses or they [...]

Summary This article provides an overview of how an intravenous (IV) therapy service was developed in one primary care trust in England, the challenges that were faced and how they [...]

Summary This article describes a workshop held to address a perceived gap in nurses' knowledge about obtaining informed consent from participants in clinical trials. It summarises the legal requirements needed [...]

The role of nurse consultants was established in the UK in 2000 as part of the modernising strategy outlined in the NHS plan (DoH, 2000). The aim of the introduction of nurse consultants was to provide better outcomes for patients by improving services and quality of care, to strengthen leadership and to provide a new career opportunity to help retain experienced expert nurses. The authors' objective was to undertake an evaluation of the diabetes nurse consultant role from a national perspective using a 360-degree feedback evaluation tool that would provide the nurse consultants with an individual report on their effectiveness in their role. Key words - Diabetes nurse consultants - Role evaluation - 360-degree feedback, The role of a nurse consultant is structured around five core functions (see Box 1). A preliminary evaluation of the role of the nurse consultant undertaken in 2001 was generic, [...]

IN 2005, the NHS Performance Support Team (PST) was set up to work, and help improve the performances of, healthcare organisations that were considered to be failing to meet national [...]

The rising prevalence of obesity within the UK is cause for concern. Obesity, especially abdominal obesity, is often associated with a clustering of cardiovascular and metabolic risk factors, such as [...]

This qualitative study explores how recently qualified nurse prescribers describe, and rate, the safety of their prescribing. Internationally, the costs of drug errors are enormous and they can have serious implications for staff and patients. Nurses are now undertaking extended prescribing practice throughout the UK. Nurse prescribers work across different work settings and although safe prescribing is a priority in all of them, it is essential to ascertain the conditions that foster the highest levels of safety and how nurses can be supported in practice. Thirty-one nurses form the West Midlands area of England agreed to participate in an in-depth interview which sought to elicit their responses to various aspects of their prescribing work. They came from a variety of specialities and from hospital, community and general practice backgrounds. On completion of their training nurses were acutely aware of the responsibility that prescribing imposed on them. Although this awareness was thought to encourage caution and safety, it may also account for the fact that 26% of the nurses (n = 8) had not prescribed since qualifying. Nurses felt that the multidisciplinary team had a vital role to play in supporting their prescribing practice as did collaborative working. It is concluded that those working in specialty areas that are less well-defined in terms of scope of practice (e.g. older adult nursing and learning disability) would benefit in particular from ongoing mentoring relationships with experienced prescribers and the development of individual formularies. Keywords: UK; Non-doctor prescribing; Safety; Drug errors; Role change; Nurse prescribers

Problem As programmes to deliver antiretroviral therapy (ART) are implemented in resource-constrained settings, the problem becomes not how these programmes are going to be financed but who will be responsible for delivering and sustaining them. Approach Physician-led models of HIV treatment and care that have evolved in industrialized countries are not replicable in settings with a high prevalence of HIV infection and limited access to medical staff. Therefore, models of care need to make better use of available human resources. Local setting Using Botswana as an example, we discuss how nurses are underutilized in long-term clinical management of patients requiring ART. Relevant changes We argue that for ART-delivery programmes to be sustainable, nurses will need to provide a level of clinical care of patients receiving this therapy, including prescribing ART and managing common adverse effects. Lessons learned Practicalities involved in scaling up nurse-led models of ART delivery include overcoming political and professional barriers, identifying educational requirements, agreeing on the limitations of nursing practice, developing clear referral pathways between medical and nursing personnel, and developing mechanisms to monitor and supervise practice. Operational research is required to demonstrate that such models are safe, effective and sutainable. Problematique Avec la mise en oeuvre dans des pays a ressources limitees de programmes de delivrance de traitements antiretroviraux (ART), le probleme n'est plus de savoir comment ces programmes seront finances, mais de determiner qui se chargera de leur mise en oeuvre et de leur maintien. Demarche Les systemes de delivrance du traitement et de prestation des soins lies au VIH/sida geres par des medecins qui ont ete mis en place dans les pays industrialises ne peuvent etre reproduits dans les pays o le VIH/sida est fortement prevalent et l'acces au personnel medical tres restreint. Il faut donc que les systemes de soins exploitent mieux les ressources humaines disponibles. Contexte local A partir de l'exemple du Botswana, nous etudions la sous-utilisation du personnel infirmier dans la prise en charge a long terme des patients ayant besoin d'un traitement antiretroviral. Modifications pertinentes Pour que les programmes de delivrance de traitements ART soient durables, il faut, a notre avis, que le personnel infirmier assure des soins cliniques d'un certain niveau aupres des patients recevant ce type de traitement, et notamment la prescription des ART et la prise en charge des effets indesirables courants. Enseignements tires Parmi les considerations pratiques intervenant dans l'extension des systemes de delivrance des traitements ART geres par du personnel infirmier, figurent l'elimination des barrieres politiques et professionnelles, l'identification des besoins en matiere de formation, la concertation sur les limites a fixer aux pratiques infirmieres, l'elaboration de procedures claires pour l'orientation vers du personnel medical ou infirmier et la mise au point de mecanismes pour surveiller et superviser ces pratiques. Des etudes relevant de la recherche operationnelle sont necessaires pour demontrer la securite, l'efficacite et la durabilite de tels systemes. Problema A medida que se aplican los programas destinados a suministrar tratamiento antirretroviral (TAR) en entornos con recursos limitados, el problema no es tanto encontrar la manera de financiar esos programas como determinar quien se responsabilizara de su implementacion y mantenimiento. Metodos Los modelos de tratamiento y atencion de la infeccion por VIH dirigidos por el medico que han surgido en los pafses industrializados no son reproducibles en los entornos con alfa prevalencia de esa infeccion y acceso limitado a personal medico. Es preciso, por tanto, que los modelos de atencion aprovechen mejor los recursos humanos disponibles. Contexto local Tomando Botswana como ejemplo, analizamos la infrautilizacion que se hace del personal de enfermerfa en el manejo clinico a largo plazo de los pacientes que requieren TAR. Cambios destacables Argumentamos que, para que los programas de TAR sean sostenibles, las enfermeras tendron que asumir parte de la atencion clinica de los pacientes que reciban esa terapia, incluidos la prescripcion de TAR y el manejo de efectos adversos comunes. Ensefianzas extraidas Entre los aspectos practicos que plantea la expansion de los modelos de suministro de TAR dirigidos por personal de enfermeria cabe citar la necesidad de superar barreras politicas y profesionales, la identificacion de las necesidades educacionales, el establecimiento de vias de derivacion claras entre los medicos y el personal de enfermerfa, y la formulacion de mecanismos de vigilancia y supervision de las practicas. Es necesario emprender investigaciones operacionales para comprobar si esos modelos son seguros, eficaces y sostenibles., Introduction Expanding access to antiretroviral therapy (ART) to treat HIV in low-resource settings has demonstrated benefits in terms of health and survival (1-7) and, contrary to earlier claims, high levels [...]

Abstract Often individuals with cancer attend outpatient clinics for follow-up care. In the literature, there is minimal discussion of the role of the nurse or the nursing care delivered at [...]

Summary All patients with palliative care needs should receive an equitable service, and there is evidence to suggest that patients with life-limiting illnesses other than cancer would benefit from specialist [...]

Most healthcare professionals working in cancer care in the UK will acknowledge that there has been an unprecedented investment in their specialty by the present government in the past few [...]

Parents of children in pediatric intensive care units (PICUs) place great importance on receiving information about their children's condition, having their questions answered, and talking with the physicians in charge [...]