Stakeholder views on the impact of nurse prescribing on dermatology services

Aim. To explore stakeholder views on the impact of nurse prescribing on dermatology services. Background. Nurse led care enhances the services that dermatology patients receive. Research indicates that care delivered by nurse prescribers can improve efficiency and access to medicines. There is no evidence exploring the impact of nurse prescribing on the configuration of dermatology services. Design. Case study. Method. A collective case study of 10 practice settings across England where nurses prescribed medicines for dermatology patients. A thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were qualified nurse prescribers, administrative staff, doctors and non-nurse prescribers. Findings. Nurse prescribing was reported to support and facilitate the modernisation of dermatology services. It enabled nurses to make effective use of their knowledge and skills, overcome delays in treatment and provide faster access to medicines. However several organisational issues restricted the success of the initiative. Conclusion. Nurse prescribing is successfully being used to support and deliver a range of services to dermatology patients. Stakeholders reported that both patients and staff had benefited by the adoption of this role by nurses. However issues over support and access to CPD and capacity of the workforce were identified as potential barriers which could affect the contribution of nurse prescribing to dermatology patients. Relevance to clinical practice. Nurse prescribing contributes to the services provided to dermatology patients; Nurse supplementary prescribing contributes to the ability of dermatology nurse specialists to work in teams and prescribe complex medicines; Provision of adequate support and strategic planning are essential if the impact of nurse prescribing is to be fully realised; © 2009 Blackwell Publishing Ltd

Estudo Comparativo de Sistemas de Bebedouros na Qualidade Microbiológica da Água Consumida por Frangos de Corte Comparative Study of Systems of Drinkers in the Microbiological Quality of the Water Consumed by Broiler Chickens

Dois sistemas de bebedouros utilizados na criação avícola, pendular e chupeta (nipple), foram estudados objetivando avaliar a qualidade microbiológica da água fornecida às aves, em relação à presença de coliformes totais e fecais, aeróbios mesófilos, bolores e leveduras. Realizaram-se coletas de água no primeiro, 14, 28 e 42 dias de idade, sendo os dias de amostragem divididos em três períodos, de acordo com o horário de limpeza dos bebedouros pendulares: primeira, antes da limpeza; segunda, logo após a limpeza e terceira, ao meio dia. Os bebedouros avaliados apresentaram índices de contaminação em relação ao NMP de coliformes fecais acima dos limites estabelecidos pela Portaria do MS-Brasil. As contagens para UFC de bolores e leveduras obtidas para bebedouros pendulares apresentaram índices de contaminação maiores do que os chupeta. Em uma segunda etapa do estudo, foi avaliado o efeito da cloração constante sobre a qualidade microbiológica da água, usando os mesmos parâmetros anteriores. Foram instaladas bombas dosadoras de cloro em cada galpão reguladas para manter concentração de 2mg/L de cloro residual livre. A cloração contínua da água melhorou a qualidade microbiológica em relação ao NMP de coliformes totais e fecais nos bebedouros avaliados. Quanto aos aeróbios mesófilos, os bebedouros apresentaram-se fora dos padrões estabelecidos pela Portaria MS-Brasil, sendo o chupeta o que apresentou melhor desempenho. O bebedouro chupeta apresentou índices de contaminação da água inferiores aos apresentados pelos pendulares. Mesmo assim, foram considerados fora dos padrões para água potável.<br>Two drinker systems used by commercial broiler growers, the bell drinker type and the nipple drinker, were studied aiming to evaluate the microbiological quality of the water supplied to the birds in relation to occurrence of total and fecal coliforms, mesophilic aerobic, moulds and yeast. The water samplings were taken on the 1st, 14th, 28th and 42th days of age. The days of sampling, in accordance with the cleaning schedule for the bell type drinkers, were divided into three periods: before the cleaning, right after cleaning and at noon. The evaluated drinkers presented patterns of contamination in relation to the most probable number (mpn/100ml) of fecal coliforms above that of the limit number established by the Ministry of Health, Brazil. The counts for mould and yeast (cfu/mL) obtained from bell type drinkers showed a higher pattern of contamination when compared to the nipple drinker. In a second stage of the study, the effect of constant flow chlorination was evaluated on the microbiological quality of the water, using the same standard parameters as previous described. Dosage measurement pumps of chlorine were installed in each poultry house and managed to keep a concentration of 2mg/l of free residual chlorine. Continuous flow water chlorination improved the microbiological quality in relation to the MPN of total and faecal coliforms in the evaluated drinkers. In relation to the mesophilic aerobic, the evaluated drinkers showed to be out of the standards established by the MH-Bresil, while the nipple type was the drinker that presented the best performance. The nipple drinker showed lower patterns of water contamination in relation to that presented in the bell type drinkers. Even thought, the water contamination were out of the established standard for drinking water

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A review of the impact and effectiveness of nurse-led care in dermatology

AIMS AND OBJECTIVES: To identify systematically, summarize and critically appraise the current evidence regarding the impact and effectiveness of nurse-led care in dermatology. BACKGROUND: A diverse range of nurse-led models of care exist in dermatology. Primary studies have been conducted evaluating these models, but review and synthesis of the findings from these studies have not been undertaken. METHOD: Systematic searches of CINAHL, MEDLINE, British Nursing Index (BNI) and the RCN Library Catalogue from 1990 until March 2005. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles and by contact with experts in the field. RESULTS: Fourteen relevant publications were identified and included findings from both primary and secondary care. The evidence indicates that nurses are treating a number of dermatological conditions, primarily using treatment protocols, across a broad range of clinical settings. However, some nurses working in primary care, lack confidence to treat some of these conditions and the educational needs of these nurses are frequently unmet. A reduction in the severity of the condition and more effective use of topical therapies are benefits of nurse interventions on service delivery. Faster access to treatment, a reduction in referrals to the general practitioner or dermatologist and an increase in knowledge of their condition are benefits reported by patients. CONCLUSIONS: Findings of the review are generally positive. However, there are methodological weaknesses and under researched issues, e.g. cost effectiveness of nurse-led care and the prescription of medicines by nurses for patients with dermatological conditions that point to the need for further rigorous evaluation. RELEVANCE TO CLINICAL PRACTICE: Nurse-led care is an integral element of the dermatology service offered to patients. This review highlights the impact of this care and the issues that require consideration by those responsible for the development of nurse-led models of care in dermatology

Effect of the litter material on drinking water quality in broiler production

Considering the importance of drinking water and its effect on broiler performance, drinking water quality was studied using six different litter materials. The presence of coliform bacteria and Escherichia coli was investigated. The following litter materials were used in the trial: wood shavings, rice husks, chopped Napier grass (Pennisetum pupureum), 50% sugarcane bagasse (Saccharum L.) + 50% wood shavings, 50% sugarcane bagasse (Saccharum L.) + 50% rice husks, and plain sugarcane bagasse (Saccharum L.). A number of 1620 Ross® one-day-old chicks were reared in 54 pens measuring 4.5 m² each, equipped with a bell drinker and a tube feeder. Water samples were collected in sterile tubes on days 28 and 42 of the rearing period, and submitted to the laboratory for analyses. Microbiological data were organized by classes expressed in a logarithm scale, where the lowest contamination corresponds to class 1 and the highest contamination to class 4. Results showed that total coliform contamination was higher on day 28 than in the end of the rearing period, and that E. coli presence was detected during both analyzed periods. The litter materials that presented lower degree of water contamination, predominantly class 1, were sugarcane bagasse and 50% of sugarcane bagasse and 50% of rice husks