An exploratory randomised controlled trial comparing telephone and hospital follow-up after treatment for colorectal cancer

Aim:  Following treatment for colorectal cancer it is common practice for patients to attend hospital clinics at regular intervals for routine monitoring, although debate persists on the benefits of this approach. Nurse-led telephone follow-up is effective in meeting information and psycho-social needs in other patient groups. We explored the potential benefits of nurse-led telephone follow-up for colorectal cancer patients. Method:  Sixty-five patients were randomised to either telephone or hospital follow-up in an exploratory randomised trial. Results:  The telephone intervention was deliverable in clinical practice and acceptable to patients and health professionals. Seventy-five percent of eligible patients agreed to randomization. High levels of satisfaction were evident in both study groups. Appointments in the hospital group were shorter (median 14.0 minutes) than appointments in the telephone group (median 28.9 minutes). Patients in the telephone arm were more likely to raise concerns during consultations. Conclusion:  Historical approaches to follow-up unsupported by evidence of effectiveness and efficiency are not sustainable. Telephone follow-up by specialist nurses may be a feasible option. A main trial comparing hospital and telephone follow-up is justified although consideration needs to be given to trial design and practical issues related to the availability of specialist nurses at study locations

Patient experiences of nurse-led telephone follow-up after treatment for colorectal cancer.

Purpose Colorectal cancer is the third most prevalent cancer worldwide, although mortality rates across most of Europe have decreased in recent years. Historically, patients are asked to return to hospital outpatient clinics following treatment to monitor for disease progression. However, new approaches are being called for that focus on meeting the information and support needs of patients. Telephone follow-up (TFU) by specialist nurses is an alternative approach; this study aimed to explore patient views of TFU. Methods Qualitative interviews were conducted with 26 colorectal cancer patients who had received TFU. One interview was also conducted with the specialist nurse who had used a structured intervention to provide TFU. Data were analysed using content analysis. Results All patients found TFU to be a positive experience and all stated a preference for continuing with TFU. Three main themes emerged from the patient interviews; 1) accessible and convenient care, 2) personalised care, and 3) relationship with the specialist nurse. The themes from the specialist nurse interview were 1) knowing the patient, 2) the benefits of TFU and 3) the challenges of TFU. Conclusions TFU was well received by patients; it was perceived as highly convenient and had distinct advantages over hospital follow-up. Continuity of care was an important factor in building a trusting relationship between patient and nurse. Training in the use of the intervention is recommended and it may be useful for specialist nurses to initially meet eligible patients face to face to establish rapport before implementing TFU

From Observers to Participants: Joining the Scientific Community

In this essay, we have integrated the voices of our mentors and students to explore 45 years of undergraduate research experiences and their role in shaping our scientific community. In considering our collective experiences, we see undergraduate involvement in research as a rich source of community development, one that has both touched our lives and influenced our teaching

Eicosanoid Production following One Bout of Exercise in Middle-Aged African American Pre- and Stage 1 Hypertensives

Endothelial dysfunction and a sedentary lifestyle may be involved in the development of hypertension which is proliferative among middle-aged African Americans (AA). Signaling molecules derived from the oxidation of 20-carbon fatty acid molecules known as eicosanoids influence vascular tone. The relationship between aerobic fitness and eicosanoid formation following exercise in middle-aged African American hypertensives is unknown. Purpose. To determine the relationship between aerobic capacity and eicosanoid formation after a bout of moderate-intensity exercise in middle-aged AA hypertensives. Methods. Ten sedentary hypertensive AA underwent 50 min of aerobic exercise at 65% VO2max. Urine was collected for 24 hr on two occasions, prior to testing and immediately following the bout of exercise. Urinary metabolites of prostacyclin (6-keto PGF1α) and thromboxane (11-dTXB2) were measured during the day and night periods by high-performance liquid chromatography (HPLC). Results. 6-keto PGF1α levels significantly increased (P = .04) following the bout of exercise compared to the control day. There was a significant relationship (r = .49, P < .05) between 6-keto PGF1α levels and VO2max during the exercise day. Conclusion. Based on this preliminary study, there appears to be a relationship between aerobic capacity and exercise-induced 6-keto PGF1α production in middle-aged hypertensive AAs. AAs with lower VO2max had lower 6-keto PGF1α formation

Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial

Objective To compare traditional hospital follow-up with telephone follow-up by specialist nurses after treatment for breast cancer. Design A two centre randomised equivalence trial in which women remained in the study for a mean of 24 months. Setting Outpatient clinics in two NHS hospital trusts in the north west of England Participants 374 women treated for breast cancer who were at low to moderate risk of recurrence. Interventions Participants were randomised to traditional hospital follow-up (consultation, clinical examination, and mammography as per hospital policy) or telephone follow-up by specialist nurses (consultation with structured intervention and mammography according to hospital policy). Main outcome measures Psychological morbidity (state-trait anxiety inventory, general health questionnaire (GHQ-12)), participants’ needs for information, participants’ satisfaction, clinical investigations ordered, and time to detection of recurrent disease. Results The 95% confidence interval for difference in mean state-trait scores adjusted for treatment received (−3.33 to 2.07) was within the predefined equivalence region (−3.5 to 3.5). The women in the telephone group were no more anxious as a result of foregoing clinic examinations and face-to-face consultations and reported higher levels of satisfaction than those attending hospital clinics (intention to treat P<0.001). The numbers of clinical investigations ordered did not differ between groups. Recurrences were few (4.5%), with no differences between groups for time to detection (median 60.5 (range 37-131) days in hospital group v 39.0 (10-152) days in telephone group; P=0.228). Conclusions Telephone follow-up was well received by participants, with no physical or psychological disadvantage. It is suitable for women at low to moderate risk of recurrence and those with long travelling distances or mobility problems and decreases the burden on busy hospital clinics

Challenging gender pay gaps::organizational and regulatory strategies

Milner S, Pochic S, Scheele A, Williamson S. Challenging gender pay gaps. Organizational and regulatory strategies. Gender, Work &amp; Organization. 2019;26(5):593-598

Cancer through black eyes - The views of UK based black men towards cancer: A constructivist grounded theory study

Purpose: Little is known about black African (BA) and black African-Caribbean (BAC) men's views towards cancer; yet culture and acculturation can contribute to the way in which people understand, explain and develop their attitudes towards cancer. Hence, cancer prevention and early detection strategies may not be sensitive to United Kingdom (UK)-based black men's views, affecting their awareness of risk factors and early detection services. This study explored the views of UK-based BA and BAC men towards cancer. Method: In collaboration with black community organisations based in four major cities in the UK, 25 participants were recruited using convenience and theoretical sampling methods. Data were collected using 33 semi-structured interviews, and analysed using grounded theory analytic procedures. Results: One core category (cancer through black eyes) and seven sub-categories emerged; ‘cultural views’, ‘religious beliefs’, ‘avoiding Babylon’, ‘alienation’, ‘suspicious mind’, ‘advertisements and information influence very little’, and ‘gap in service provision (bridging the gap)’. Participants' views towards cancer were linked to socially constructed perspectives, linked with cultural and religious beliefs, and shaped by what being a black male means in society. Risk factors such as smoking and obesity had different meanings and symbolisation through black eyes. There were macro- and micro-level similarities and differences between BA and BAC men. Conclusions: Cancer services and related public-health campaigns aimed at black men need to understand cancer through black eyes. Public health campaigns based solely on the clinical meaning of cancer are incongruent with black men's understandings of cancer, and therefore ineffective at reducing health inequality

Indexing Adequacy and Interdisciplinary Journals: The Case of Women\u27s Studies

This paper examines access to women\u27s studies journals through standard indexes and abstracts. Reliability of coverage is important for women\u27s studies scholars and possibly other young interdisciplines. Articles from eighty-six journals were searched in online and print indexes. Access to each journal was evaluated as adequate or inadequate based on fixed criteria. Over 60 percent of the journals were inadequately indexed. These titles should be added to appropriate indexes; a list of specific recommendations is appended (see Appendix A). Parallel research in similar fields may allow librarians to draw generalizations about access to interdisciplinary materials

The Patient Needs Assessment in Cancer Care: Identifying Barriers and Facilitators to Implementation in the UK and Canada

Purpose Personalised information and support can be provided to cancer survivors using a structured approach. Needs assessment tools such as the Holistic Needs Assessment (HNA) in the United Kingdom and the Comprehensive Problem and Symptom Screening (COMPASS) questionnaire in Canada are recommended for use in practice; however, they are not widely embedded into practice. The study aimed to determine the extent to which nurses working in cancer care in the UK and Manitoba value NA and identify any barriers and facilitators they experience. Method Oncology nurses involved in the care of cancer patients in the UK (n=110) and Manitoba (n=221) were emailed a link to an online survey by lead cancer nurses in the participating institutions. A snowball technique was used to increase participation across the UK resulting in 306 oncology nurses completing the survey in the UK and 116 in Canada. Results Participants expressed concerns that these assessments were becoming bureaucratic “tick-box exercises” which did not meet patients’ needs. Barriers to completion were time, staff shortages, lack of confidence, privacy and resources. Facilitators were privacy for confidential discussions, training, confidence in knowledge and skills, and referral to resources. Conclusion Many busy oncology nurses completed this survey demonstrating the importance they attach to HNAs and COMPASS. The challenges faced with implementing these assessments into everyday practice require training, time, support services and an appropriate environment. It is vital that the HNA and COMPASS are conducted at optimum times for patients to fully utilise time and resources