Do educational interventions aimed at nurses to support the implementation of evidence-based practice improve patient outcomes? A systematic review

Background: Numerous articles have sought to identify the impact of educational interventions for improving evidence-based practice (EBP) amongst nurses, most of these focus on skills and knowledge acquired. No systematic review has explored whether this educational input translates into improved patient outcomes. Objectives: To review the evidence on (1) The change in patient outcomes following educational interventions to support practising nurses in implementing EBP. (2) The instruments or methods used to determine whether EBP education improves patient outcomes. Methods: A systematic review following PRISMA guidance was conducted. Literature was comprehensive searched including 6 databases, journal handsearching, citation tracking, and grey literature websites. Studies were included if they reported an EBP educational intervention aimed at practising nurses and contained objective or self-reported measures of patient related outcomes. The quality of the included studies was assessed using a modified Health Care Practice R&D Unit (HCPRDU) tool. Because of the poor homogeneity of the included studies, the data were analysed by narrative synthesis. Results: Of the 4,284 articles identified, 18 were included: 12 pre–post studies, three qualitative studies, and three mixed-methods study designs. The level of quality was modest in the studies. The results of the EBP educational interventions on patient outcomes were assessed using three methods: individual projects to implement an evidence-based approach, qualitative approaches, and a questionnaire survey. The majority of the articles concluded there was a positive change in patient outcomes following an educational intervention to improve EBP; a wide range of context specific outcomes were described. Conclusion: Educational interventions for clinical nurses to support the implementation of EBP show promise in improving patient outcomes. However, the direct impact of EBP interventions on clinical outcomes is difficult to measure. Further testing and development is needed to improve the quality of studies and evaluation instruments in order to confirm the current findings

Counselling in primary care : a systematic review of the evidence

Primary objective: To undertake a systematic review which aimed to locate, appraise and synthesise evidence to obtain a reliable overview of the clinical effectiveness, cost-effectiveness and user perspectives regarding counselling in primary care. Main results: Evidence from 26 studies was presented as a narrative synthesis and demonstrated that counselling is effective in the short term, is as effective as CBT with typical heterogeneous primary care populations and more effective than routine primary care for the treatment of non-specific generic psychological problems, anxiety and depression. Counselling may reduce levels of referrals to psychiatric services, but does not appear to reduce medication, the number of GP consultations or overall costs. Patients are highly satisfied with the counselling they have received in primary care and prefer counselling to medication for depression. Conclusions and implications for future research: This review demonstrates the value of counselling as a valid choice for primary care patients and as a broadly effective therapeutic intervention for a wide range of generic psychological conditions presenting in the primary care setting. More rigorous clinical and cost-effectiveness trials are needed together with surveys of more typical users of primary care services

Materials for phantoms for terahertz pulsed imaging

Phantoms are commonly used in medical imaging for quality assurance, calibration, research and teaching. They may include test patterns or simulations of organs, but in either case a tissue substitute medium is an important component of the phantom. The aim of this work was to identify materials suitable for use as tissue substitutes for the relatively new medical imaging modality terahertz pulsed imaging. Samples of different concentrations of the candidate materials TX151 and napthol green dye were prepared, and measurements made of the frequency-dependent absorption coefficient (0.5 to 1.5 THz) and refractive index (0.5 to 1.0 THz). These results were compared qualitatively with measurements made in a similar way on samples of excised human tissue (skin, adipose tissue and striated muscle). Both materials would be suitable for phantoms where the dominant mechanism to be simulated is absorption (similar to ∼100 cm(-1) at 1 THz) and where simulation of the strength of reflections from boundaries is not important; for example, test patterns for spatial resolution measurements. Only TX151 had a frequency-dependent refractive index close to that of tissue, and could therefore be used to simulate the layered structure of skin, the complexity of microvasculature or to investigate frequency-dependent interference effects that have been noted in terahertz images

The UK register of HIV seroconverters: Methods and analytical issues

A Register of HIV-infected persons who have had a negative antibody test within 3 years of their first antibody positive test (seroconverters) is being set up in the UK to monitor the distribution of times from HIV seroconversion to AIDS (the incubation period) and to death. It will also provide a national resource for use by those designing studies in this group of individuals. Clinicians caring for HIV-positive persons in Genito-Urinary Medicine, Infectious Disease and other departments throughout the UK were asked to participate by providing information on eligible subjects. Most laboratories undertaking HIV antibody testing were also contacted and asked to provide the name of the attending clinician for all seroconverters identified through the HIV laboratory reporting systems of the PHLS Communicable Disease Surveillance Centre (CDSC) and the Scottish Centre for Infection and Environmental Health (SCIEH) and for any other seroconverters known to them but not identified by CDSC or SCIEH. Data items sought for the Register include: sex, ethnic group, probable route of HIV transmission, annual CD4 counts, details of therapy and prophylaxis prescribed, AIDS-defining events and vital status. Follow up information is collected annually. Wherever possible, all seroconverters known to a clinic have been identified, whether currently alive or dead, either from clinic records or laboratory reporting or both. The objective is to establish and update a complete register of seroconverters on a long-term basis to provide reliable estimates of the incubation period on which future projections of AIDS cases in the UK can be made

Extra patient movement during mammographic imaging : an experimental study

Objectives: To determine if movement external to the patient occurring during mammography may be a source of image blur. Methods: Four mammography machines with seven flexible and nine fixed paddles were evaluated. In the first stage, movement at the paddle was measured mechanically using two calibrated linear potentiometers. A deformable breast phantom was used to mimic a female breast. For each paddle, the movement in millimeters and change in compression force in Newton was recorded at 0.5 and 1 second intervals respectively for 40 seconds with the phantom in an initially compressed state under a load of 80N. In the second stage, clinical audit on 28 females was conducted on one mammography machine with the 18x24cm and 24x29cm flexible paddles. Results: Movement at the paddle followed an exponential decay with a settling period of approximately 40 seconds. The compression force readings for both fixed and flexible paddles decreased exponentially with time while fixed paddles have a larger drop in compression force than flexible paddles. There is a linear relationship between movement at the paddle and change in compression force. Conclusions: Movement measured at the paddle during an exposure can be represented by a second order system. The amount of extra-patient movement during the actual exposure can be estimated using the linear relationship between movement at the paddle and the change in compression force. Advances in knowledge: This research provides a possible explanation to mammography image blurring caused by extra patient movement and proposes a theoretical model to analyze the movement

Limited effect of highly active antiretroviral therapy among HIV-positive injecting drug users on the population level

There is evidence that HIV-positive injecting drug users benefit less than other risk groups from highly active antiretroviral therapy that has been available since 1996. In this multicentre European study the impact of the availability of highly active antiretroviral therapy on the progression rates to AIDS and death among injecting drug users with a documented date of HIV seroconversion is studied. After highly active antiretroviral therapy became available the risk of AIDS and death for injecting drug users decreased by 28% and 36%, which is less than has been reported for other risk group

Lower healthcare costs associated with the use of a single-pill ARV regimen in the UK, 2004-2008

Aim: Investigate the cost and effects of a single-pill versus two- or three pill first-line antiretroviral combinations in reducing viral load, increasing CD4 counts, and first-line failure rate associated with respective regimens at 6 and 12 months. Methods: Patients on first-line TDF+3TC+EFV, TDF+FTC+EFV, TruvadaH+EFV or AtriplaH between 1996–2008 were identified and viral load and CD4 counts measured at baseline, six and twelve months respectively. Factors that independently predicted treatment failure at six and twelve months were derived using multivariate Cox’s proportional hazard regression analyses. Use and cost of hospital services were calculated at six and twelve months respectively. Results: All regimens reduced viral load to below the limit of detection and CD4 counts increased to similar levels at six and twelve months for all treatment regimens. No statistically significant differences were observed for rate of treatment failure at six and twelve months. People on AtriplaH generated lower healthcare costs for non-AIDS patients at £5,340 (£5,254 to £5,426) per patient-semester and £9,821 (£9,719 to £9,924) per patient-year that was £1,344 (95%CI £1,222 to £1,465) less per patient-semester and £1,954 (95%CI £1,801 to £2,107) less per patient-year compared with TruvadaH+EFV; healthcare costs for AIDS patients were similar across all regimens. Conclusion: The single pill regimen is as effective as the two- and three-pill regimens of the same drugs, but if started as first-line induction therapy there would be a 20% savings on healthcare costs at six and 17% of costs at twelve months compared with TruvadaH+EFV, that generated the next lowest costs

How much image noise can be added in cardiac x-ray imaging without loss in perceived image quality?

YesCardiologists use x-ray image sequences of the moving heart acquired in real-time to diagnose and treat cardiac patients. The amount of radiation used is proportional to image quality; however, exposure to radiation is damaging to patients and personnel. The amount by which radiation dose can be reduced without compromising patient care was determined. For five patient image sequences, increments of computer-generated quantum noise (white + colored) were added to the images, frame by frame using pixel-to-pixel addition, to simulate corresponding increments of dose reduction. The noise adding software was calibrated for settings used in cardiac procedures, and validated using standard objective and subjective image quality measurements. The degraded images were viewed next to corresponding original (not degraded) images in a two-alternativeforced- choice staircase psychophysics experiment. Seven cardiologists and five radiographers selected their preferred image based on visualization of the coronary arteries. The point of subjective equality, i.e., level of degradation where the observer could not perceive a difference between the original and degraded images, was calculated; for all patients the median was 33% 15% dose reduction. This demonstrates that a 33% 15% increase in image noise is feasible without being perceived, indicating potential for 33% 15% dose reduction without compromising patient care.Funded in part by Philips Healthcare, the Netherlands. Part of this work has been performed in the project PANORAMA, co-funded by grants from Belgium, Italy, France, the Netherlands, and the United Kingdom, and the ENIAC Joint Undertaking

The molecular epidemiology of human immunodeficiency virus type 1 in six cities in Britain and Ireland

The authors sequenced the p17 coding regions of the gag gene from 211 patients infected either through injecting drug use (IDU) or by sexual intercourse between men from six cities in Scotland, N. England, N. Ireland, and the Republic of Ireland. All sequences were of subtype 5. Phylogenetic analysis revealed substantial heterogeneity in the sequences from homosexual men. In contrast, sequence from over 80% of IDUs formed a relatively tight cluster, distinct both from those of published isolates and of the gay men. There was no large-scale clustering of sequences by city in either risk group, although a number of close associations between pairs of individuals were observed. From the known date of the HIV-1 epidemic among IDUs in Edinburgh, the rate of sequence divergence at synonymous sites is estimated to be about 0.8%. On this basis it has been estimated that the date of divergence of the sequences among homosexual men to be about 1975, which may correspond to the origin of the B subtype epidemic