Combined positron emission tomography and contrast enhanced CT (PET/CeCT) is a feasible single investigation in the staging of oesophagogastric cancers: single-centre pilot study experience during the COVID-19 pandemic

INTRODUCTION

Staging of oesophagogastric (OG) cancers usually involves endoscopy (OGD), and separate visits for contrast enhanced computed tomography (CeCT) and positron emission tomography (PET/CT). At the height of the COVID-19 pandemic, some of our patients underwent single-visit combined staging with PET/CeCT. We compare this novel pathway with standard separate imaging in time to completion of staging, to start of treatment, and cost.

METHODS

We identified all patients discussed at our OG multidisciplinary team (MDT) meeting in 2020. Clinical records revealed dates of investigations and treatments. Data were tabulated in Excel, with statistical analysis in SPSS. All patients followed the same MDT process and image reviewing criteria. Costs were compared using prices supplied by finance departments.

RESULTS

A total of 211 new patients were discussed at our MDT in 2020. Of these, 48 patients had combined PET/CeCT staging, and 68 had separate scans. Median time (interquartile range) in days from OGD to final imaging was 9 (6-23) for the combined group versus 21 (16-28) for the separate group (p≤0.001). Median time (days) from OGD to treatment start was 37 (29-52) for combined versus 55 (40-71) for separate (p≤0.001). No combined scans were of insufficient diagnostic quality for the MDT. PET/CeCT had a potential cost saving of £113 per patient.

CONCLUSIONS

PET/CeCT allows accurate radiological staging of OG cancers with a single scan. Patients completed staging and started treatment faster, with a potential saving of £10,509 in one year. PET/CeCT has become standard staging at our trust, and we aim to incorporate radiotherapy planning images too.

Bullied: Exploring the concepts of territorialism and groupthink involvement in workplace bullying

AIMS

To educate nurse managers on territorialism and groupthink as being factors within workplace bullying among nurses within the clinical and academic settings that can psychologically and physically harm affected persons.

DESIGN

Territorialism and groupthink are explored as being factors within workplace bullying used by a bully or bullies to target others for personal gain and power. Workplace bullying has become habitual practice in nursing and nursing academia. Workplace bullying is identified not only as unethical behaviour but also as a dangerous practice that can lead to depression, anxiety, stress, and posttraumatic distress syndrome. Persons affected are subjected to emotional abuse that can lead to isolation, low self-esteem, and self-doubt.

METHODS

Methods by which persons in the workplace can identify bullying that involves territorialism and groupthink are examined. Nurse managers are identified as being instrumental in the identification of workplace bullying involving territorialism and groupthink, and in working with the affected person(s) and bully or bullies to seek mediation through a human resource representative. For nursing managers, it is imperative that workplace bullying is immediately addressed. Workplace bullying creates a hostile and intimidating working environment that affects the physical and mental health of affected persons.

RESULTS

Early identification and resolution of workplace bullying could alleviate the development of physiological and psychological health problems by affected persons. After workplace bullying has been reported, the affected persons should focus on the healing of mind, spirit, and body. New circumstances (e.g., a new place of employment or a promotion) may trigger feelings of anger, intimidation or fear; therefore, it' is important for persons who have experienced bullying in the workplace to understand the abusive environment itself was not directly associated with any wrongdoing by them.

NO PATIENT OR PUBLIC CONTRIBUTION

Workplace bullying is disruptive to the workplace and affects productivity, absenteeism from work and turnover intentions. Persons impacted by territorialism and groupthink within the context of workplace bullying can develop psychological and physiological health problems.

Multiple sclerosis health-related quality of life utility values from the UK MS register

Background

New interventions for multiple sclerosis (MS) commonly require a demonstration of cost-effectiveness using health-related quality of life (HRQoL) utility values. The EQ-5D is the utility measure approved for use in the UK NHS funding decision-making. There are also MS-specific utility measures - e.g., MS Impact Scale Eight Dimensions (MSIS-8D) and MSIS-8D-Patient (MSIS-8D-P).

Objectives

Provide EQ-5D, MSIS-8D and MSIS-8D-P utility values from a large UK MS cohort and investigate their association with demographic/clinical characteristics.

Methods

UK MS Register data from 14,385 respondents (2011 to 2019) were analysed descriptively and using multivariable linear regression, with self-report Expanded Disability Status Scale (EDSS) scores.

Results

The EQ-5D and MSIS-8D were both sensitive to differences in demographic/clinical characteristics. An inconsistency found in previous studies whereby mean EQ-5D values were higher for an EDSS score of 4 rather than 3 was not observed. Similar utility values were observed between MS types at each EDSS score. Regression showed EDSS score and age were associated with utility values from all three measures.

Conclusions

This study provides generic and MS-specific utility values for a large UK MS sample, with the potential for use in cost-effectiveness analyses of treatments for MS.

Transcriptomic response and immunological responses to chimpanzee adenovirus- and MVA viral-vectored vaccines for RSV in healthy adults

Cohorts of healthy younger adults (18-50yrs) and healthy older adults (60-75yrs) were immunized intramuscularly or intranasally with an adenovirus-vectored RSV vaccine (PanAd3-RSV) as a prime dose and boosted with PanAd3-RSV or a poxvirus-vectored vaccine (MVA-RSV) encoding the same insert. Whole blood gene expression was measured at baseline, 3- and 7-days post vaccination. Intramuscular prime vaccination with PanAd3-RSV induced differential expression of 643 genes (DEGs, FDR < 0.05). Intranasal prime vaccination with PanAd3-RSV did not induce any differentially expressed genes (DEGs) in blood samples at 3 days post vaccination. Intranasally primed participants showed greater numbers of DEGS on boosting than intramuscularly primed participants. The most highly enriched biological processes related to DEGs after both prime and boost vaccination were type-1 interferon related pathways, lymphocytic and humoral immune responses.

Use of implementation science to plan adoption of a tobacco-free policy on a historically black college/university (HBCU) campus

Objective: Implementation science tools were used to identify facilitators and barriers to adopting a tobacco-free policy on a historically Black college/university (HBCU). Participants: Study participants included 13 University staff, two students, and two public health educators/school alumni. Data were collected in 2015-2016. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to develop questions for focus groups and individual interviews. The CFIR was also used by two research team members to code transcripts independently, using an iterative deduction process to achieve ≥85% agreement on CFIR domains. Coded quotations were evaluated using the Qualitative Implementation Framework (QIF) to ascertain next adoption planning steps. Results: Qualitative data suggested that building capacity for tobacco control, linking policy to HBCU identity and priorities such as addressing marijuana use might facilitate adoption of a tobacco-free campus policy. Conclusions: Implementation science tools may be useful for planning adoption of comprehensive tobacco-free policies at HBCUs.

Applying the Nightingale Pledge in Reducing Health Disparities: A Hospital-Acquired Pressure Injury Case Study

ABSTRACT

Professional nurses, by virtue of their training, pledge to care for individuals who are sick or infirm. This commitment is confirmed via the Nightingale Pledge, which focuses on public health and equity and deems the nurse to be a missioner of health. Health disparities exist in direct conflict with the nursing responsibility of caritas, or love. Accordingly, it is imperative that nurse educators create learning environments that are conducive to comfortably discussing differences in physical assessments performed on diverse populations as part of their work to eliminate health disparities and in accordance with the Nightingale Pledge.

Development of a conceptual model for research on cyclical variation of patient reported outcome measurements (PROMs) in patients with chronic conditions: a scoping review

Background

Although circadian, seasonal, and other cycles have been observed for a number of chronic conditions, their impact on patient reported outcomes measurements (PROMs) has not been systematically explored, rendering our understanding of the effect of time of measurement on PROM scores very limited. The aim was to conduct a scoping review to determine what is known about how intra-individual cyclical variation might affect the way individuals with chronic conditions respond to patient-reported outcome measures.

Methods

A protocol of a systematic scoping review was registered on PROSPERO (CRD42017058365). We developed a search strategy based on previous relevant reviews and implemented it in: MEDLINE, Embase, PsycINFO, and CINAHL. No restrictions were placed on article types and backward and forward citation searches were conducted. Screening and data extraction were independently completed by up to four reviewers. An adapted version of CASP criteria was used to appraise the quality of included articles. Concepts that were important in understanding the impact of cyclical variation on PROM scores were elicited from the papers and iteratively refined through discussion amongst the authors.

Results

2420 references resulted from the searches, with 33 articles meeting the inclusion criteria. Most study designs included observational research (particularly ecological momentary assessment), 2 were RCTs and 2 were systematic reviews. Studies mainly focused on specific health conditions: mental health, respiratory and musculoskeletal. There was a lack of qualitative research and theoretical framework to explore these concepts more fully. Five overarching concepts emerged: variation in outcomes, variation of scores, psychological status, individual factors, and environmental/situational factors. A conceptual model was developed outlining the relationships between these concepts.

Conclusions

There is empirical evidence that supports cyclical variation in PROM scores across different chronic conditions, with potential very significant implications for administration and interpretation of PROMs. The proposed conceptual model can support further research in this area.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-021-00395-x.

Spiritual Health First Aid for Self-Care: Nursing During COVID-19

ABSTRACT

Nurses who provided care to patients with coronavirus (COVID-19) and supported patients in their transition from life to death in the absence of patients' families have been especially needful of spiritual self-care. A spiritual first aid kit can help nurses cope with these difficult times. Spiritual self-care is vital for all nurses to renew and preserve the psychological, spiritual, and physical self.

The hollow: A theory on workplace bullying in nursing practice

BACKGROUND

Incivility and bullying within the profession of nursing remains a problem within the workplace. As a result, healthcare workplaces can become unhealthy and difficult for nurses to function within. Work productivity is impacted and patients' healthcare is placed at risk when nurses are emotionally and physically affected by workplace incivility and bullying. Clinical nurse leaders (CNLs) applying theoretical reasoning and nursing competencies' in addressing bullying and incivility within the workplace, can provide an organized and effective organizational approach to addressing bullying and incivility in work environments.

METHODS

Theoretical reasoning and nursing competencies in addressing bullying and incivility within the workplace, will be examined as a means to identify nurses exhibiting signs and symptoms of bullying and incivility in work environments. The theory of The Hollow will identify the origins of affected nurses' behaviors and the physiological and psychological impact of bullying and incivility. The CNL role will be used as a facilitator of change at the microsystem level. And competencies for addressing behaviors associated with bullying and incivility will be addressed.

APPROACH

Innovation adapted from prior research and literature developed by the author, extrapolated from the literature on workplace bullying and incivility in nursing practice.

OUTCOMES

Bullying and incivility can be resolved in the workplace when competencies are set forth by nursing leaders to educate and empower nursing staff on expectations of healthy work environments.

CONCLUSION

Healthy workplaces are achievable when nurse leaders, such as CNLs, educate and empower nurses to have the expectation of healthy work environments not only for themselves, but for all nurses.

Narrative orphaned: When grief overwhelms

WHAT IS KNOWN ON THE SUBJECT?: The loss of a parent for an adult can be devastating and can impact other relationships. The adult, in absence of parental love and support, may question their own identity. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A narrative is used to explain the adults' experience of parental death and their new identity of being orphaned. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Increased awareness for adults grieving the loss of a parent(s), as to the normalcy of feeling orphaned Adults grieving the death of a parent(s) are provided resources and support in addressing their grieving process. ABSTRACT: Introduction When a parent dies during their child's adulthood, the life of the adult is altered as the familiarity of parental love and safety changes. The isolation and loneliness penetrates deeply as the orphaned adult must now navigate their world in absence of the most significant people in their lives, their parents. Aim To assist persons affected by parental death in understanding the normalcy of feeling orphaned while grieving. Method The use of a personal narrative to provide mental health support to others. Results The resumption of a routine that existed before parental death is possible, but takes time. Intermittent periods of grief can occur throughout one's life. Discussion When grief interrupts one's ability to function daily and the affected adult has relationships impacted by their parent's death, it is recommended that the adult seek mental health treatment. Implications for Practice Narratives can be used with persons affected by parental loss, to provide an example of normal versus complicated grieving and identify when mental health treatment is needed.

Nurses and Patients' Perspectives on Spiritual Health Assessment

Nurses conduct physical and psychosocial assessments during admissions to healthcare facilities. Patients rely upon nurses to provide support and education during their journey, from periods of health decline to states of optimal wellness. Therefore, nurses are an ideal population to assess spiritual health. The value and necessity of spiritual assessment were explored on an inpatient unit providing medical and palliative care to patients. Two spiritual assessment tools, comprised each of five items, were evaluated by nursing staff and patients. Spiritual Assessment Tool 1 used language that was unaffiliated with religion, nor a belief in God, and Spiritual Assessment Tool 2 used language affiliated with faith and belief in God.

Balance Right in Multiple Sclerosis (BRiMS): a feasibility randomised controlled trial of a falls prevention programme

Background

Balance, mobility impairments and falls are problematic for people with multiple sclerosis (MS). The “Balance Right in MS (BRiMS)” intervention, a 13-week home and group-based exercise and education programme, aims to improve balance and minimise falls. This study aimed to evaluate the feasibility of undertaking a multi-centre randomised controlled trial and to collect the necessary data to design a definitive trial.

Methods

This randomised controlled feasibility study recruited from four United Kingdom NHS clinical neurology services. Patients ≥ 18 years with secondary progressive MS (Expanded Disability Status Scale 4 to 7) reporting more than two falls in the preceding 6 months were recruited. Participants were block-randomised to either a manualised 13-week education and exercise programme (BRiMS) plus usual care, or usual care alone.

Feasibility assessment evaluated recruitment and retention rates, adherence to group assignment and data completeness. Proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls) and economic data were collected at baseline, 13 and 27 weeks, and participants completed daily paper falls diaries.

Results

Fifty-six participants (mean age 59.7 years, 66% female, median EDSS 6.0) were recruited in 5 months; 30 randomised to the intervention group. Ten (18%) participants withdrew, 7 from the intervention group. Two additional participants were lost to follow up at the final assessment point. Completion rates were > 98% for all outcomes apart from the falls diary (return rate 62%).

After adjusting for baseline score, mean intervention—usual care between-group differences for the potential primary outcomes at week 27 were MS Walking Scale-12v2: − 7.7 (95% confidence interval [CI] − 17.2 to 1.8) and MS Impact Scale-29v2: physical 0.6 (CI − 7.8 to 9), psychological − 0.4 (CI − 9.9 to 9). In total, 715 falls were reported, rate ratio (intervention:usual care) for falls 0.81 (0.41 to 2.26) and injurious falls 0.44 (0.41 to 2.23).

Conclusions

Procedures were practical, and retention, programme engagement and outcome completion rates satisfied a priori progression criteria. Challenges were experienced in completion and return of daily falls diaries. Refinement of methods for reporting falls is therefore required, but we consider a full trial to be feasible.

Trial registration

ISRCTN13587999

Date of registration: 29 September 2016

P323Triage-HF Plus: identification of heart failure and non-heart failure events in an ambulatory population using remote monitoring and the triage heart failure risk score Algorithm

Background/introduction

Previous studies examining the utility of cardiac implantable electronic devices (CIEDs) to remotely monitor heart failure patients for decompensation have not demonstrated an impact on hard end-points. However, a key limitation of these prior studies (REM-HF and MORE-CARE) has been the failure to stratify patients according to their risk of worsening heart failure (WHF) prior to randomization (usual care vs active monitoring). We examined a different approach, using a single manufacturer’s remote monitoring platform, whereby only patients with CIED-derived data indicating the highest risk of WHF are contacted for assessment. The validated ‘Triage Heart Failure Risk Score’ (Triage-HFRS) is a medical algorithm within Medtronic CIEDs that can risk-stratify patients as low-, medium- or high-risk of WHF in the next 30 days based on integrated monitoring of physiological parameters.

Purpose

 This study is the largest prospective evaluation of the Triage-HFRS, and examines the additional role of contacting those patients with a ‘High-Risk’ Triage-HFRS alert by telephone (Triage-HF Plus pathway).

Methods

 Prospective, real-world evaluation of the Triage-HF Plus pathway undertaken between June 2016 and September 2019. 326 high-risk Triage-HFRS transmissions were contacted for telephone triage assessment. Screening questions were designed to identify episodes of WHF and non-heart failure events. Interventions were at the discretion of the clinical practitioner and in line with guideline-directed practice. An additional 3-month consecutive sample of low and medium Triage-HFRS transmissions (control group) were also contacted for telephone triage assessment (n= 98).

Results

Successful telephone contact was made following 245 high-risk Triage-HFRS alerts. Following contact, 194 (79.1%) patients reported an acute medical issue: 137 (70.6%) reported symptoms consistent with worsening heart failure (WHF) requiring intervention; and 57 (29.4%) had an alternative acute medical problem. 51 (26.2%) had no apparent reason for the high score. The sensitivity and specificity of CIED-based remote monitoring to identify any HF and non-HF events requiring intervention was 99.5% (97.2-99.9%) and 65.5% (57.3-73.2%) respectively; positive predictive value was 79.2%. The negative predictive value of a non-high risk score to rule out an acute event was 98.9%. Overall accuracy of the pathway to identify an acute issue (HF or non-HF related) was 84.8%.

Conclusion

The Triage-HF Plus clinical pathway is a potentially useful remote monitoring tool for patients with heart failure. The pathway has high diagnostic accuracy to identify patients with WHF and a wide range of non-HF issues which are just as relevant in a population who often have multiple complex co-morbidities and are known for their high health care utilisation.

Short pulse intense pulsed light versus pulsed dye laser for the treatment of facial redness

Treating diffuse facial redness with an intense pulsed light (IPL) source usually requires multiple sessions and may not achieve complete clearance. The 595 nm pulsed dye laser (PDL) enjoys a good reputation for reducing facial redness with non-purpuric settings. The objective of this study was to compare facial redness reduction using these two devices. After establishing the lowest light dose able to achieve transient purpura for the same pulse width of 1,5 ms with each technology, right and left sides of the face were randomly assigned for each type of treatment. There were two treatment sessions 4 weeks apart and the final evaluation was performed 8 weeks after thesecond treatment. Four blinded experienced dermatologists analyzed pre and post-treatment photographs, which demonstrated an average of 60% improvement on the segment treated with the IPL as opposed to 45% on the other segment. Pain level was described as mild and the procedure was well tolerated for both types of treatment. In this study we showed that short-pulsed intense pulsed light and PDL are similar in decreasing facial redness when non-purpuric low fluence settings are used. The IPL was faster and did not have consumables.

Teaching accelerated nursing students' self-care: A pilot project

Aim

A benchmark of 4 has been determined for the reduction of self-reported stress by nursing students' status post 5 weeks of holistic educational activities and interventions provided by a nurse educator.

Design

Provision 5 in the American Nurses Association Code of Ethics for Nurses with Interpretive Statements emphasizes the duty of the nurse to not only promote the health and safety of others, but to self as well (ANA, 2015, Code of ethics with interpretive statements, http://Nursebooks.org). A self-care for nurses' pilot project was trialled with 25 accelerated nursing students over the course of 5 weeks. Holistic education programmes were facilitated by a nurse educator uninvolved in providing clinical or classroom education to the students.

Methods

The Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines are used in this pilot project as a framework to explore standardization of education of nursing students about self-care in nursing programmes and to promote positive health behaviours and student nurses' insight into how nurses' self-care can have an impact on patient outcomes. The self-care pilot project introduced the importance of self-care for the pre-licensure nursing student by teaching healthy eating, physical exercise, the value of sleep, use of positive affirmations and aromatherapy to a cohort of accelerated nursing students over the course of 5 weeks. The Star Model of Knowledge Transformation was the theoretical framework for the pilot study. Two questionnaires were used by the principal investigator to obtain participant data, the Project Participant Questionnaire and the Final-Year Group Questionnaire.

Results

On completion of the self-care for nurses' pilot, the nursing students reported a reduction in stress and an increased ability to cope with stress after exposure to different holistic stress reduction strategies. An average benchmark of 4.36 was achieved indicating that the nursing students' self-care had improved status post the interactive teaching intervention.Self-care taught to pre-licensure nursing students by nurse educators can enhance their self-awareness of the importance of stress reduction and care of themselves while enduring the academic rigour and simultaneous clinical practicum experiences in nursing programmes.Applying self-care behaviours to reduction of stress for nursing students may be of benefit to of students as they transition from the pre-licensure to graduate nurse roles. Hence, teaching health behaviours that are self-protective and contribute to maintaining safe clinical environments for nurses and the patients in their care.

Should nursing be considered a STEM profession?

BACKGROUND

The National Science and Technology Council developed a 5-year plan in 2013 to ensure that science, technology, engineering, and mathematics (STEM) experienced sustained growth within the United States (US). Nursing is comprised of multiple sciences that include chemistry, physics, biology, microbiology, anatomy and physiology, pharmacology, and the social and behavioral sciences of sociology, developmental lifespan psychology, and psychology. Science, technology, engineering, and math constitute the traditional STEM acronym. Nursing programs graduate nurses with both the rigorous academic coursework and diverse clinical skills necessary to provide patient care. These skills employed by nurses in the clinical setting can serve as the basis for the inclusion of the nursing profession as a STEM-designated profession by the federal government and educational institutions within the US.

PROBLEM

Currently, the US government does not acknowledge the profession of nursing as a STEM-designated profession. Acknowledgment of nursing as a STEM profession could potentially make more funding available for nursing education within the US and address nursing shortages both in clinical and academic settings. As well as position professional nurses for careers not only within the health sector but that of business and industry because of nurses' STEM knowledge. Hence, enhancing the growth of STEM within the US and creating global market economic competitiveness with new innovation development.

APPROACH

In the practice of nursing, nurses apply the sciences, math, and innovative technology in the assessments, diagnoses, and planning of patients' care. Nurses implement scientifically-based interventions to treat illness and sustain human life and to ultimately evaluate the outcomes of the care provided to patients.

OUTCOMES

Methodologies of evaluation of outcomes of patient care status post nursing interventions (ie, administration of intravenous antibiotics to treat pneumonia) are based upon rationales that have been derived from evidenced-based practice and nursing research; both originating from applied STEM knowledge.

CONCLUSION

The formal designation by the US federal government, for nursing to be recognized as a STEM profession, can increase funding to the nursing profession and enhance the diversity of employment opportunities for nurses in industry and business. Thereby potentially decreasing nursing shortages and bringing national and worldwide recognition to nursing in both academia, industry, business, and clinical settings, as a profession contributing to the science of improvement of the health of all people through STEM knowledge.

Using the Fatigue Severity Scale to inform healthcare decision-making in multiple sclerosis: mapping to three quality-adjusted life-year measures (EQ-5D-3L, SF-6D, MSIS-8D)

Background

Fatigue has a major influence on the quality of life of people with multiple sclerosis. The Fatigue Severity Scale is a frequently used patient-reported measure of fatigue impact, but does not generate the health state utility values required to inform cost-effectiveness analysis, limiting its applicability within decision-making contexts. The objective of this study was to use statistical mapping methods to convert Fatigue Severity Scale scores to health state utility values from three preference-based measures: the EQ-5D-3L, SF-6D and Multiple Sclerosis Impact Scale-8D.

Methods

The relationships between the measures were estimated through regression analysis using cohort data from 1056 people with multiple sclerosis in South West England. Estimation errors were assessed and predictive performance of the best models as tested in a separate sample (n = 352).

Results

For the EQ-5D and the Multiple Sclerosis Impact Scale-8D, the best performing models used a censored least absolute deviation specification, with Fatigue Severity Scale total score, age and gender as predictors. For the SF-6D, the best performing model used an ordinary least squares specification, with Fatigue Severity Scale total score as the only predictor.

Conclusions

Here we present algorithms to convert Fatigue Severity Scales scores to health state utility values based on three preference-based measures. These values may be used to estimate quality-adjusted life-years for use in cost-effectiveness analyses and to consider the health-related quality of life of people with multiple sclerosis, thereby informing health policy decisions.

Electronic supplementary material

The online version of this article (10.1186/s12955-019-1205-y) contains supplementary material, which is available to authorized users.

Using instrumentation in psychiatric nursing to assess documentation of the nursing process for emergent non-psychiatric patient events

Ongoing education of experienced psychiatric nurses is imperative given the historically complex health presentations of psychiatric patients. Psychiatric patients tend to have medical co-morbidities and often do not have the financial resources for preventative health care. The hospitalization for acute psychiatric stabilization, is an opportunity for psychiatric nurses to teach and advocate for patients' physiological and psychological health. Documentation of patients' changes in condition and overall clinical presentation, is necessary to ensure patients' health care needs are met.

Contemporary issues: The pre-licensure nursing student and medication errors

In Modern health care, the creation of cultures of safety for patients is of the upmost importance. Impacting the institutional stabilization of health care facilities safety initiatives, is the preparation of pre-licensure nursing students to safely administer medications to patients. Therefore, preparation of the pre-licensure nursing student must be evidence-based practice focused and incorporate innovative ways to reduce the potential for medication errors.

Using Case Study Methodology to Explore the Role of Discrimination in Workplace Incivility

Exclusionary behaviors can be detrimental to the health and well-being of faculty in the workplace. When colleagues are judged by their peers because of the color of their skin, the language they speak, their gender, or who they choose to love (lesbian, gay, bisexual, transgender, asexual, or questioning), affected faculty are left emotionally and physically vulnerable. Institutions of higher learning must set standards of zero tolerance for faculty-to-faculty incivility. With standards taken from each faculty discipline, codes of conduct can be implemented not only at a departmental level, but also throughout the educational system.

Recommendation to test limonene hydroperoxides 0·3% and linalool hydroperoxides 1·0% in the British baseline patch test series

BACKGROUND

There is a significant rate of sensitization worldwide to the oxidized fragrance terpenes limonene and linalool. Patch testing to oxidized terpenes is not routinely carried out; the ideal patch test concentration is unknown.

OBJECTIVES

To determine the best test concentrations for limonene and linalool hydroperoxides, added to the British baseline patch test series, to optimize detection of true allergy and to minimize irritant reactions.

METHODS

During 2013-2014, 4563 consecutive patients in 12 U.K. centres were tested to hydroperoxides of limonene in petrolatum (pet.) 0·3%, 0·2% and 0·1%, and hydroperoxides of linalool 1·0%, 0·5% and 0·25% pet. Irritant reactions were recorded separately from doubtful reactions. Concomitant reactions to other fragrance markers and clinical relevance were documented.

RESULTS

Limonene hydroperoxide 0·3% gave positive reactions in 241 (5·3%) patients, irritant reactions in 93 (2·0%) and doubtful reactions in 110 (2·4%). Linalool hydroperoxide 1·0% gave positive reactions in 352 (7·7%), irritant reactions in 178 (3·9%) and doubtful reactions in 132 (2·9%). A total of 119 patients with crescendo reactions to 0·3% limonene would have been missed if only tested with 0·1% and 131 patients with crescendo reactions to 1·0% linalool would have been missed if only tested with 0·25%. In almost two-thirds of patients with positive patch tests to limonene and linalool the reaction was clinically relevant. The majority of patients did not react to any fragrance marker in the baseline series.

CONCLUSIONS

We recommend that limonene hydroperoxides be tested at 0·3% and linalool hydroperoxides at 1·0% in the British baseline patch test series.

Balance Right in Multiple Sclerosis (BRiMS): a guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with secondary progressive multiple sclerosis: a protocol for a feasibility randomised controlled trial

BACKGROUND

Impaired mobility is a cardinal feature of multiple sclerosis (MS) and is rated by people with MS as their highest priority. By the secondary progressive phase, balance, mobility and physical activity levels are significantly compromised; an estimated 70% of people with secondary progressive MS fall regularly. Our ongoing research has systematically developed 'Balance Right in MS' (BRiMS), an innovative, manualised 13-week guided self-management programme tailored to the needs of people with MS, designed to improve safe mobility and minimise falls. Our eventual aim is to assess the clinical and cost effectiveness of BRiMS in people with secondary progressive MS by undertaking an appropriately statistically powered, multi-centre, assessor-blinded definitive, randomised controlled trial. This feasibility study will assess the acceptability of the intervention and test the achievability of running such a definitive trial.

METHODS/DESIGN

This is a pragmatic multi-centre feasibility randomised controlled trial with blinded outcome assessment. Sixty ambulant people with secondary progressive MS who self-report two or more falls in the previous 6 months will be randomly allocated (1:1) to either the BRiMS programme plus usual care or to usual care alone. All participants will be assessed at baseline and followed up at 15 weeks and 27 weeks post-randomisation. The outcomes of this feasibility trial include:Feasibility outcomes, including trial recruitment, retention and completionAssessment of the proposed outcome measures for the anticipated definitive trial (including measures of walking, quality of life, falls, balance and activity level)Measures of adherence to the BRiMS programmeData to inform the economic evaluation in a future trialProcess evaluation (assessment of treatment fidelity and qualitative evaluation of participant and treating therapist experience).

DISCUSSION

The BRiMS intervention aims to address a key concern for MS service users and providers. However, there are several uncertainties which need to be addressed prior to progressing to a full-scale trial, including acceptability of the BRiMS intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties and will enable a protocol to be finalised for use in the definitive trial.

TRIAL REGISTRATION

ISRCTN13587999.

Abstract C55: Assessing the organizational context for implementing tobacco use prevention programs at a Historically Black College/University (HBCU)

Background: African Americans have substantially higher mortality rates associated with tobacco-related cancers. Tobacco product use begins more commonly among African Americans at age 18-25 than at a younger age. HBCU campuses provide potential opportunities for implementing evidence-based tobacco product use prevention programs to reduce cancer risks among African Americans. The Consolidated Framework for Implementation Research (CFIR) provides a structure for assessing the organizational context for implementation.

Methods: Multiple assessment procedures were piloted as part of planning to implement tobacco product use prevention interventions on an HBCU campus. They included semi-structured staff interviews with key informants (n=7) and students (n=3); a staff focus group (n=7); and four versions of staff and student surveys (n=195). An environmental scan assessment tool using geographic information system (GIS) software was used to map tobacco waste (primarily cigarette butts) at nine sites on campus.

A thematic approach was used to assess qualitative data. Interviews and focus group discussions were recorded and transcribed, and the first author used CFIR domains as a priori codes for the first step of analysis. Next, the coded transcripts were reviewed by the second and third authors, and differences of opinion regarding coding were resolved in discussions among all three authors. Numerical data collected from surveys was summarized with frequency distributions and descriptive analysis.

Some qualitative results include:

Inner Setting: The fact that this University is an HBCU was salient for nearly every informant, as a key reason they are here, and as a point of pride. Some feel strongly that tobacco use on campus is a significant problem in that it contributes to exposure to second-hand smoke and reflects poorly on an HBCU. Some individuals assume there is no tobacco use problem because current policy prohibits tobacco use on campus. Environmental scans demonstrated a high level of tobacco use in some areas.

Outer Setting: Some students want to inform other students about the existing policy, and are receptive to using a compassionate approach rather than shaming students who smoke. Smokers would like areas of the campus to be designated for tobacco use so they can smoke and get to class on time. Tobacco advertising and marketing is highly visible to some students.

Intervention: There is generally little awareness of the availability of evidence-based tobacco use prevention programs or other interventions.

Project staff: Several campus staff are interested in being trained to be providers of cessation services.

Implementation Process: There is strong interest on the part of key staff to undertake a systematic approach to assessing facilitators and barriers to tobacco use, identifying evidence-based tobacco use prevention interventions that could be used at this University, and developing a science-based implementation plan for those interventions.

Quantitative results: 75% of survey respondents were between 18-25 years of age.

Level of knowledge about tobacco was fairly high, although nearly 30% responded incorrectly about nicotine as a toxic substance that is made by tobacco plants; 42% said the stress of quitting is more harmful than smoking; and only 50% responded correctly to an item about lung cancer mortality disparity among African American men.

Conclusion: The selected methods provided information about many facilitators and barriers to tobacco use prevention program implementation on an HBCU campus. Next steps include refining and expanding the data procedures to reach more faculty and students, and using the results to select interventions and develop an implementation plan.

Note: This abstract was not presented at the conference.

Citation Format: Rebecca Selove, Cheryl Green, Charles Brown, Nahall Yousef-Zadeh, David Padgett. Assessing the organizational context for implementing tobacco use prevention programs at a Historically Black College/University (HBCU). [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C55.

Rehabilitation Enablement in Chronic Heart Failure-a facilitated self-care rehabilitation intervention in patients with heart failure with preserved ejection fraction (REACH-HFpEF) and their caregivers: rationale and protocol for a single-centre pilot randomised controlled trial

INTRODUCTION

The Rehabilitation EnAblement in CHronic Heart Failure in patients with Heart Failure (HF) with preserved ejection fraction (REACH-HFpEF) pilot trial is part of a research programme designed to develop and evaluate a facilitated, home-based, self-help rehabilitation intervention to improve self-care and quality of life (QoL) in heart failure patients and their caregivers. We will assess the feasibility of a definitive trial of the REACH-HF intervention in patients with HFpEF and their caregivers. The impact of the REACH-HF intervention on echocardiographic outcomes and bloodborne biomarkers will also be assessed.

METHODS AND ANALYSIS

A single-centre parallel two-group randomised controlled trial (RCT) with 1:1 individual allocation to the REACH-HF intervention plus usual care (intervention) or usual care alone (control) in 50 HFpEF patients and their caregivers. The REACH-HF intervention comprises a REACH-HF manual with supplementary tools, delivered by trained facilitators over 12 weeks. A mixed methods approach will be used to assess estimation of recruitment and retention rates; fidelity of REACH-HF manual delivery; identification of barriers to participation and adherence to the intervention and study protocol; feasibility of data collection and outcome burden. We will assess the variance in study outcomes to inform a definitive study sample size and assess methods for the collection of resource use and intervention delivery cost data to develop the cost-effectiveness analyses framework for any future trial. Patient outcomes collected at baseline, 4 and 6 months include QoL, psychological well-being, exercise capacity, physical activity and HF-related hospitalisation. Caregiver outcomes will also be assessed, and a substudy will evaluate impact of the REACH-HF manual on resting global cardiovascular function and bloodborne biomarkers in HFpEF patients.

ETHICS AND DISSEMINATION

The study is approved by the East of Scotland Research Ethics Service (Ref: 15/ES/0036). Findings will be disseminated via journals and presentations to clinicians, commissioners and service users.

TRIAL REGISTRATION NUMBER

ISRCTN78539530; Pre-results .