Surgical ward rounds in England: a trainee-led multi-centre study of current practice

BACKGROUND: Recent guidance advocates daily consultant-led ward rounds, conducted in the morning with the presence of senior nursing staff and minimising patients on outlying wards. These recommendations aim to improve patient management through timely investigations, treatment and discharge. This study sought to evaluate the current surgical ward round practices in England. METHODS: Information regarding timing and staffing levels of surgical ward rounds was collected prospectively over a one-week period. The location of each patient was also documented. Two surgical trainee research collaboratives coordinated data collection from 19 hospitals and 13 surgical subspecialties. RESULTS: Data from 471 ward rounds involving 5622 patient encounters was obtained. 367 (77.9%) ward rounds commenced before 9am. Of 422 weekday rounds, 190 (45%) were consultant-led compared with 33 of the 49 (67%) weekend rounds. 2474 (44%) patients were seen with a nurse present. 1518 patients (27%) were classified as outliers, with 361 ward rounds (67%) reporting at least one outlying patient. CONCLUSION: Recommendations for daily consultant-led multi disciplinary ward rounds are poorly implemented in surgical practice, and patients continue to be managed on outlying wards. Although strategies may be employed to improve nursing attendance on ward rounds, substantial changes to workforce planning would be required to deliver daily consultant-led care. An increasing political focus on patient outcomes at weekends may prompt changes in these areas

Power and rights in the community: paralegals as leaders in women's legal empowerment in Tanzania

What can an analysis of power in local communities contribute to debates on women’s legal empowerment and the role of paralegals in Africa? Drawing upon theories of power and rights, and research on legal empowerment in African plural legal systems, this article explores the challenges for paralegals in facilitating women’s access to justice in Tanzania, which gave statutory recognition to paralegals in the Legal Aid Act 2017. Land conflicts represent the single-biggest source of local legal disputes in Tanzania and are often embedded in gendered land tenure relations. This article argues that paralegals can be effective actors in women’s legal empowerment where they are able to work as leaders, negotiating power relations and resisting the forms of violence that women encounter as obstacles to justice. Paralegals’ authority will be realised when their role is situated within community leadership structures, confirming their authority while preserving their independence

Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

OBJECTIVES: To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS: Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS: A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION: This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening

Evaluating nurse-led inpatient units

This article highlights findings from three studies into nurse-led inpatient units. The results are not the same in each case, particularly with regard to length of stay, and the authors discuss the possible reasons for this. Further work is needed to develop NLIUs and identify cost savings

Diel variation of chlorophyll-a fluorescence, phytoplankton pigments and productivity in the Sub-Antarctic and Polar Front Zones south of Tasmania, Australia

Marine primary production is a fundamental measure of the ocean's capacity to convert carbon dioxide to particulate organic carbon for the marine foodweb, and as such is an essential variable used in ecosystem and biogeochemical models to assess trophic dynamics and carbon cycling. The Sub-Antarctic Zone (SAZ) is a major sink for atmospheric carbon and exhibits large gradients in ocean conditions on both temporal and spatial scales. In this dynamic system, an understanding of small-scale temporal changes is critical for modelling primary production at larger scales. Thus, we investigated diel effects on maximum quantum yield of PSII (FV/FM), photosynthetic pigment pools and primary productivity in the western (Diel 1) and eastern SAZ region (Diel 3) south of Tasmania, Australia, and compared this to a station at the polar front (Diel 2). Phytoplankton in the eastern SAZ had the greatest diel response, with cells showing decreased FV/FM and increased biosynthesis and transformation of xanthophyll and other photoprotective pigments during the day, but only in the surface waters (0 and 10m). Diel responses diminished by 30m. Cells in the western SAZ had similar responses across the depths sampled, increasing their FV/FM during the night and increasing their xanthophyll pigment content during the day. Phytoplankton at the polar front (Diel 2) showed intermediate diel-related variations in photophysiology, with xanthophyll conversion and increases in photoprotective pigments during the day but constant FV/FM. These diel changes at all sampling stations had little impact on carbon fixation rates, although cells sampled from the deep chlorophyll maximum at the polar front had significantly lower maximum carbon fixation and minimum saturating irradiance (Ek) compared to the other depths and stations. Considering the oceanographic context, cells at Diel 1 and 2 received less light and were more deeply mixed than cells at Diel 3, causing a dampening of the diel response. These results highlight that phytoplankton in the SAZ is regulated by the physical processes of mixing and light provision, but short-term diel effects on maximum quantum yield of PSII and photoprotective pigments may not propagate to changes in carbon fixation, particularly when cells are nutrient replete. If however, the more stratified eastern SAZ (which had the greatest diel responses) is indicative of how the SAZ region might respond to climate change, then diel effects may become more prominent in the future. © 2011