Diagnostic Accuracy of Fine Needle Biopsy for Metastatic Melanoma and Its Implications for Patient Management

The use of fine needle biopsy (FNB) for the diagnosis of metastatic melanoma can lead to the early removal and treatment of metastases, reduce the frequency of unnecessary surgery, and facilitate the staging of patients enrolled in clinical trials of adjuvant therapies. In this study, the accuracy of FNB for the diagnosis of metastatic melanoma was investigated. A retrospective cohort study was performed with 2204 consecutive FNBs performed on 1416 patients known or suspected to have metastatic melanoma. Almost three-quarters (1582) of these FNBs were verified by either histopathologic diagnosis following surgical resection or clinical follow-up. FNB for metastatic melanoma was found to have an overall sensitivity of 92.1% and a specificity of 99.2%, with 69 false-negative and 5 false-positive findings identified. The sensitivity of the procedure was found to be influenced by six factors. The use of immunostains, reporting of the specimen by a cytopathologist who had reported >500 cases, lesions located in the skin and subcutis, and patients with ulcerated primary melanomas were factors associated with a significant improvement in the sensitivity of the test. However, FNBs performed in masses located in lymph nodes of the axilla and FNBs that required more than one needle pass to obtain a sample were far more likely to result in false-negative results. FNB is a rapid, accurate, and clinically useful technique for the assessment of disease status in patients with suspected metastatic melanoma

Delineating the practice profile of advanced practice nursing: A cross-sectional survey using the modified strong model of advanced practice

Aims: To test a model that delineates advanced practice nursing from the practice profile of other nursing roles and titles. Background: There is extensive literature on advanced practice reporting the importance of this level of nursing to contemporary health service and patient outcomes. Literature also reports confusion and ambiguity associated with advanced practice nursing. Several countries have regulation and delineation for the nurse practitioner, but there is less clarity in definition and service focus of other advanced practice nursing roles. Design: A statewide survey. Methods: Using the modified Strong Model of Advanced Practice Role Delineation tool, a survey was conducted in 2009 with a random sample of registered nurses/midwives from government facilities in Queensland, Australia. Analysis of variance compared total and subscale scores across groups according to grade. Linear, stepwise multiple regression analysis examined factors influencing advanced practice nursing activities across all domains. Results: There were important differences according to grade in mean scores for total activities in all domains of advanced practice nursing. Nurses working in advanced practice roles (excluding nurse practitioners) performed more activities across most advanced practice domains. Regression analysis indicated that working in clinical advanced practice nursing roles with higher levels of education were strong predictors of advanced practice activities overall. Conclusion: Essential and appropriate use of advanced practice nurses requires clarity in defining roles and practice levels. This research delineated nursing work according to grade and level of practice, further validating the tool for the Queensland context and providing operational information for assigning innovative nursing service. © 2012 Blackwell Publishing Ltd

Manager, clinician or both? Nurse managers' engagement in clinical care activities

© 2019 John Wiley & Sons Ltd Aim: To explore the extent of Australian nurse managers' engagement in clinical care activities. Background: Hybrid nurse manager roles lack clarity in the optimal balance between the clinical and other activities, resulting in stress and challenges in recruiting and retaining nurse managers. Methods: In a national survey using the Advanced Practice Role Delineation tool, Australian nurses self-assessed their level of engagement in activities across five domains of nursing practice. The subset sample analysed comprised 2,758 registered nurses, 390 clinical (front-line) nurse managers and 43 organisational (middle) nurse managers. Median domain scores were compared with non-parametric tests of difference. Results: Clinical nurse managers were in a hybrid role, reporting high levels of engagement across the domains. Lower scores observed for organisational nurse managers highlight the shift to strategy-focussed activities that occurs as nurses up the management hierarchy. Conclusions: By indicating their engagement in the clinical care domain, respondents demonstrated that clinically focused activities were not entirely lost from either front-line or middle-management roles. Implications for Nursing Management: Nurse managers equipped with clinical and management skills, and allowed time to remain engage in clinical care activities are critical for patient-centred and cost-effective care in today's complex health care environments

An interventional skin care protocol (InSPIRE) reduces pressure injuries in critically ill patients in intensive care

Introduction: Pressure injuries (PrI) are a common, preventable, adverse event. PrIs cause harm, pain and infections to patients, adversely effect recovery, and contribute to disease burden and ongoing healthcare costs.Objectives: It was hypothesised that, when compared with patients who receive standard skin care, patients who receive the InSPiRE protocol:1. will have a lower incidence of PrI; and2. develop PrIs later in their intensive care unit stay.Methods: The study used a prospective cohort design. The group of patients receiving the intervention (InSPiRE protocol) was compared with a similar control group who received standard care. The study was conducted over 12-months in the adult ICU of an Australian metropolitan tertiary hospital. Data collected included demographic and clinical variables, skin assessment, PrI presence and stage, and illness severity score. Following ethical approval, employed research nurses were trained in clinical assessment, data collection tools and recruitment processes.Results: Of 207 patients enrolled, 105 were in the intervention group and 102 in the control group. Most patients were men, mean age 55 years. The groups were similar on major demographic variables. PrI incidence was significantly different between the intervention group (18.1%, 19/105 patients) and control group (30.4%, 31/102 patients) (χ2 = 4.271, p = 0.039). The intervention significantly lowered the number of PrI events developing over time (Logrank [Mantel–Cox] = 11.842, p = 0.001).Conclusions: The InSPiRE protocol resulted in significant reductions in the cumulative incidence and time to occurrence of PrIs. The protocol was tailored to the ICU population and assisted registered nurses in delivering quality-focused patient care