Community care clinicians' experiences and perceptions of Waterlow pressure ulcer risk assessment

Background Pressure ulcer risk assessment tools play a pivotal role in meeting the challenge of the zero pressure ulcer agenda. Clinicians should use their clinical judgement in combination with a validated pressure ulcer assessment tool when detecting and managing patient pressure ulcer development risk. The assessment tool, therefore, should effectively, and reliably direct pressure relieving equipment resources. This is particularly important when considering the influence of the pressure ulcer assessment tool on patterns of care and allocation of resources. Aim To undertake a service evaluation and identify a quality improvement opportunity, surrounding pressure ulcer assessment, prevention, and care practices within one community health services NHS Trust. Method An online questionnaire was purposed-developed to capture the perceptions and experiences of the Trusts clinicians surrounding the assessment, prevention, and management of pressure ulcers using the Waterlow pressure ulcer risk assessment tool. Questionnaire content was developed in collaboration with a panel of Trust employed healthcare and research experts. Data analysis adhered to the principles of an inductively informed six-phase recursive Thematic Analysis. Results Two interrelated themes reflected the clinicians' perceptions and experiences: Confidence in Waterlow Supporting Clinical Decision-Making and Defensively Nursing. Some perceived Waterlow as useful, although flawed tool. Others perceived the use of Waterlow to have negatively influenced working practices by developing 'nursing by numbers' care practices and a propensity for over-prescription of pressure relieving resources. Conclusion The results provide important elucidation surrounding pressure ulcer care practices and provide evidence to support quality improvement innovation within the Trust

Effects on quality of life, anti-cancer responses, breast conserving surgery and survival with neoadjuvant docetaxel: a randomised study of sequential weekly versus three-weekly docetaxel following neoadjuvant doxorubicin and cyclophosphamide in women with primary breast cancer

<p>Abstract</p> <p>Background</p> <p>Weekly docetaxel has occasionally been used in the neoadjuvant to downstage breast cancer to reduce toxicity and possibly enhance quality of life. However, no studies have compared the standard three weekly regimen to the weekly regimen in terms of quality of life. The primary aim of our study was to compare the effects on QoL of weekly versus 3-weekly sequential neoadjuvant docetaxel. Secondary aims were to determine the clinical and pathological responses, incidence of Breast Conserving Surgery (BCS), Disease Free Survival (DFS) and Overall Survival (OS).</p> <p>Methods</p> <p>Eighty-nine patients receiving four cycles of doxorubicin and cyclophosphamide were randomised to receive twelve cycles of weekly docetaxel (33 mg/m²) or four cycles of 3-weekly docetaxel (100 mg/m²). The Functional Assessment of Cancer Therapy-Breast and psychosocial questionnaires were completed.</p> <p>Results</p> <p>At a median follow-up of 71.5 months, there was no difference in the Trial Outcome Index scores between treatment groups. During weekly docetaxel, patients experienced less constipation, nail problems, neuropathy, tiredness, distress, depressed mood, and unhappiness. There were no differences in overall clinical response (93% vs. 90%), pathological complete response (20% vs. 27%), and breast-conserving surgery (BCS) rates (49% vs. 42%). Disease-free survival and overall survival were similar between treatment groups.</p> <p>Conclusions</p> <p>Weekly docetaxel is well-tolerated and has less distressing side-effects, without compromising therapeutic responses, Breast Conserving Surgery (BCS) or survival outcomes in the neoadjuvant setting.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN09184069">ISRCTN09184069</a></p

A synthesis of Martian aqueous mineralogy after 1 Mars year of observations from the Mars Reconnaissance Orbiter

Martian aqueous mineral deposits have been examined and characterized using data acquired during Mars Reconnaissance Orbiter's (MRO) primary science phase, including Compact Reconnaissance Imaging Spectrometer for Mars hyperspectral images covering the 0.4–3.9 μm wavelength range, coordinated with higher–spatial resolution HiRISE and Context Imager images. MRO's new high-resolution measurements, combined with earlier data from Thermal Emission Spectrometer; Thermal Emission Imaging System; and Observatoire pour la Minéralogie, L'Eau, les Glaces et l'Activitié on Mars Express, indicate that aqueous minerals are both diverse and widespread on the Martian surface. The aqueous minerals occur in 9–10 classes of deposits characterized by distinct mineral assemblages, morphologies, and geologic settings. Phyllosilicates occur in several settings: in compositionally layered blankets hundreds of meters thick, superposed on eroded Noachian terrains; in lower layers of intracrater depositional fans; in layers with potential chlorides in sediments on intercrater plains; and as thousands of deep exposures in craters and escarpments. Carbonate-bearing rocks form a thin unit surrounding the Isidis basin. Hydrated silica occurs with hydrated sulfates in thin stratified deposits surrounding Valles Marineris. Hydrated sulfates also occur together with crystalline ferric minerals in thick, layered deposits in Terra Meridiani and in Valles Marineris and together with kaolinite in deposits that partially infill some highland craters. In this paper we describe each of the classes of deposits, review hypotheses for their origins, identify new questions posed by existing measurements, and consider their implications for ancient habitable environments. On the basis of current data, two to five classes of Noachian-aged deposits containing phyllosilicates and carbonates may have formed in aqueous environments with pH and water activities suitable for life

The CTSA Consortium's Catalog of Assets for Translational and Clinical Health Research (CATCHR)

The 61 CTSA Consortium sites are home to valuable programs and infrastructure supporting translational science and all are charged with ensuring that such investments translate quickly to improved clinical care. Catalog of Assets for Translational and Clinical Health Research (CATCHR) is the Consortium's effort to collect and make available information on programs and resources to maximize efficiency and facilitate collaborations. By capturing information on a broad range of assets supporting the entire clinical and translational research spectrum, CATCHR aims to provide the necessary infrastructure and processes to establish and maintain an open‐access, searchable database of consortium resources to support multisite clinical and translational research studies. Data are collected using rigorous, defined methods, with the resulting information made visible through an integrated, searchable Web‐based tool. Additional easy‐to‐use Web tools assist resource owners in validating and updating resource information over time. In this paper, we discuss the design and scope of the project, data collection methods, current results, and future plans for development and sustainability. With increasing pressure on research programs to avoid redundancy, CATCHR aims to make available information on programs and core facilities to maximize efficient use of resources.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106893/1/cts12144.pd

Beliefs About Medication and Uptake of Preventive Therapy in Women at Increased Risk of Breast Cancer: Results From a Multicenter Prospective Study

Introduction Uptake of preventive therapies for breast cancer is low. We examined whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs, and whether belief group membership was prospectively associated with uptake of preventive therapy. Patients and Methods Women (n = 732) attending an appointment to discuss breast cancer risk were approached; 408 (55.7%) completed the Beliefs About Medicines and the Perceived Sensitivity to Medicines questionnaires. Uptake of tamoxifen at 3 months was reported in 258 (63.2%). The optimal number of belief groups were identified using latent profile analysis. Results Uptake of tamoxifen was 14.7% (38/258). One in 5 women (19.4%; 78/402) reported a strong need for tamoxifen. The model fit statistics supported a 2-group model. Both groups held weak beliefs about their need for tamoxifen for current and future health. Group 2 (38%; 154/406 of the sample) reported stronger concerns about tamoxifen and medicines in general, and stronger perceived sensitivity to the negative effects of medicines compared with group 1 (62%; 252/406). Women with low necessity and lower concerns (group 1) were more likely to initiate tamoxifen (18.3%; 33/180) than those with low necessity and higher concerns (group 2) (6.4%; 5/78). After adjusting for demographic and clinical factors, the odds ratio was 3.37 (95% confidence interval, 1.08-10.51; P = .036). Conclusion Uptake of breast cancer preventive therapy was low. A subgroup of women reported low need for preventive therapy and strong medication concerns. These women were less likely to initiate tamoxifen. Medication beliefs are targets for supporting informed decision-making

The CTSA Consortium's Catalog of Assets for Translational and Clinical Health Research (CATCHR): The Ctsa Consortium's Catchr

The 61 CTSA Consortium sites are home to valuable programs and infrastructure supporting translational science and all are charged with ensuring that such investments translate quickly to improved clinical care. CATCHR (Catalog of Assets for Translational and Clinical Health Research) is the Consortium’s effort to collect and make available information on programs and resources to maximize efficiency and facilitate collaborations. By capturing information on a broad range of assets supporting the entire clinical and translational research spectrum, CATCHR aims to provide the necessary infrastructure and processes to establish and maintain an open-access, searchable database of consortium resources to support multi-site clinical and translational research studies. Data is collected using rigorous, defined methods, with the resulting information made visible through an integrated, searchable web-based tool. Additional easy to use web tools assist resource owners in validating and updating resource information over time. In this article, we discuss the design and scope of the project, data collection methods, current results, and future plans for development and sustainability. With increasing pressure on research programs to avoid redundancy, CATCHR aims to make available information on programs and core facilities to maximize efficient use of resources

“It was Pretty Scary”: The Theme of Fear in Young Adult Women's Descriptions of a History of Adolescent Dating Abuse

The mental health impact of abusive adolescent dating relationships has not been well described, but fear related to abuse has been reported. We elaborate the theme of fear in women's descriptions of a history of adolescent dating abuse. A sample of community-based women, ages 19-34, who experienced an abusive dating relationship during adolescence (ages 11-20) was used. Data were analyzed via thematic analysis. Fear was a consistent and resonant theme. Three types of fear were identified: fear for self, fear for other relationships, and fearful expectation. These results offer important insights into the impact of abusive adolescent relationships on women's mental health

Evaluating & Innovating the Pressure Ulcer Risk Assessment

Background Current clinical, assessment, prevention and management strategies using Waterlow were closely examined and innovation was implemented. Methods Staged, service evaluation. Stage-One, clinician’s perceptions and practice surrounding pressure ulcer (PU) assessment, prevention and management using Waterlow explored via purpose-designed questionnaire survey. Stage-Two, the Trust, became early adopters of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T)[1]. Stage-Three, a focus group obtained five Clinical Nurse Specialists (CNS) perceptions surrounding PURPOSE-T. Results Stage-One survey thematic analysis[2] identified two interrelated themes Confidence in Tool Supporting Clinical Decision Making and Defensively Nursing. Some considered Waterlow a useful, but flawed tool. Others considered Waterlow risk over estimation propensity and associated protocols resulted in a constrained dictation and organisational pressure to prescribe PU relief equipment. This seemingly had influenced a working culture where clinical judgement is (for some) overruled by Waterlow score outcome and ‘nursing by numbers’ care. Many directly requested Waterlow replacement. In Stage-Two PURPOSE-T was successfully integrated into SystmOne and clinical routine. Stage-Three Thematic analysis[2] identified two themes surrounding PURPOSE-T, A More Meaningful Assessment and Usability in Practice. Patient screening was considered important for improving patient care and enhancing decision-making. Comprehensiveness of PURPOSE-T assessment was instrumental in developing clinical decision-making confidence. PURPOSE-T was considered easy to use; the use of risk factor colour associations was limited by SystmOne functionality. Discussion Stage-One captured diverse clinical perspectives. Working practices identified in Stage-One reflect serious and expensive limitations. PURPOSE-T was considered to support a more meaningful assessment approach, that could potentially improve resource allocation and deliver Trust cost savings. Clinical Significance The findings provide robust evidence that PURPOSE-T is a suitable replacement for Waterlow across the Trust

Annexins in human breast cancer: possible predictors of pathological response to neoadjuvant chemotherapy

Neoadjuvant chemotherapy is used in women who have large or locally advanced breast cancers. However, up to 70% of women who receive neoadjuvant chemotherapy fail to achieve a complete pathological response in their primary tumour (a surrogate marker of long-term survival). Five proteins, previously identified to be linked with chemoresistance in our in vitro experiments, were identified histochemically in pre-treatment core needle biopsies from 40 women with large or locally advanced breast cancers. Immunohistochemical staining with the five proteins showed no single protein to be a predictor of response to chemotherapy. However, pre-treatment breast cancer specimens that were annexin-A2 positive but annexin-A1 negative correlated with a poor pathological response (p = 0.04, Fisher’s exact test). The mechanisms by which annexins confer chemoresistance have not been identified, but may be due to inhibition of apoptosis. Annexin-A1 has been shown to enhance apoptosis, whilst annexin-A2, by contrast, inhibits apoptosi

Improving prescribing safety in general practices in the East Midlands through the Scaling Up PINCER intervention

An oral presentation on "Improving prescribing safety in general practices in the East Midlands through the Scaling Up PINCER intervention