Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial.

AIMS: To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. METHODS AND RESULTS: This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). CONCLUSION: An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791

Defining collaboration in Australian maternity care

Background: Within maternity services, collaboration between maternity care professionals appears problematic in spite of widespread support for collaborative practice amongst stakeholders. Objective: The objective of this paper was to examine and to clarify what the key elements of interprofessional collaboration are and how they relate to maternity care in Australia. Method: A review of the literature was performed to identify key characteristics of collaboration. All papers, theoretical and empirical, that discussed the concept of collaborative practice between professionals were considered. Findings: Currently there are inconsistencies around the concept of collaboration in terms of definitions, characteristics and language. A comprehensive definition was developed that incorporates elements of collaboration suitable for the various professions involved in the provision of maternity care in Australia. The recently developed national criteria for 'collaborative arrangements' in maternity care, however, does not contain the elements of our proposed definition and may discourage collaboration between primary maternity care providers. Conclusion: The proposed definition could be useful in further development of collaborative arrangements within maternity care and assist to further inform research on collaborative practice

The impact of pre-entry study skills training programmes on students' first year experience in health and social care programmes

The Faculty of Health and Social Care Sciences at Kingston University and St. George's, University of London has provided a pre-entry study skills course since July 2001. The course runs over one weekend and although short, is comprehensive. An evaluative research study, using case study methodology was undertaken to examine the impact of this pre-entry initiative on the first year student experience. Data were obtained through focus groups with students and semi-structured interviews with both students and staff. The findings show that the study skills weekend programmes prepare students realistically for their first year university experience. In addition, the evaluation helped to develop insight into the first year experience which have informed a number of academic initiatives

Providing writing and language support for students who have English as a second language – a pilot study

This paper reports on a pilot project which provided writing support for registered nurses undertaking Continuing Professional Development (CPD) and for preregistration nursing students. Both groups of students have English as a second language (ESL). The aims of the project were to extend the scope of the available writing support within the faculty for ESL students through the provision of one-to- one sessions and workshops. In addition, workshops were provided for lecturers to improve their understanding of the barriers faced by ESL students. Literature indicates that communication with tutors and the need for clear feedback are important factors for ESL students. Quantitative and qualitative data were collected from questionnaires completed by participants after teaching sessions and were analysed against pre-agreed success criteria. Findings indicate that students were very positive about the effectiveness of the sessions in helping them improve their academic writing. Additionally, three themes emerged from the student data: reasons for using the ELS support service; what they liked most about the ELS service and suggestions for improvements to the service. Data from staff show that the sessions have given staff a greater insight into the problems faced by ESL students

The importance of effective communication in interprofessional practice: perspectives of maternity clinicians

Midwives and doctors require effective information-sharing strategies to provide safe and evidence-based care for women and infants, but this can be difficult to achieve. This article describes maternity care professionals’ perceptions of communication in their current workplace in Australia. We invoke social identity theory (SIT) to explore how these perceptions affect interprofessional practice. A survey was conducted with 337 participants (281 midwives and 56 doctors). Using exploratory factor analysis we developed three scales that measured interprofessional workplace practice collaboration. Results indicated an intergroup environment in maternity care in which the professionals found exchange of ideas difficult, and where differences with respect to decision making and professional skills were apparent. Although scores on some measures of collaboration were high, the two professions differed on their ratings of the importance of team behaviors, information sharing, and interprofessional socialization as indicators of collaborative practice. These results highlight the complexities among maternity care providers with different professional identities, and demonstrate the impact of professional identity on interprofessional communication