Biomedical subjects
Publications and source records attributed to Joanna Smith.
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Despite the publication over many years of guidance and policies related to children in hospital and children having surgery, concerns remain about the standards of care provided to children and families. A survey of 63 nurses working with children was carried out by members of the Royal College of Nursing Children's Surgical Nurses Forum to evaluate the extent of implementation of guidance related to: children's choices in relation to theatre garments, whether parents or the main carer can accompany the child into the anaesthetic room and be with their child in the recovery area, and which healthcare professionals are available to support the child and family during transfer to theatre and in the theatre environment. Forty four nurses responded (70 per cent). Results indicated that at least one parent was almost always given the opportunity to be present at induction and in recovery. Only 36 per cent said that children are always offered a choice of what to wear The presence of qualified children's nurses in theatres was reported to be limited. Policy principles and guidance documents can be used by nurses to influence new ways of working to ensure practices are appropriate for children undergoing surgery.
BACKGROUND: The purpose of this study was to evaluate the prognostic ability of polymorphisms of three genes involved in the metabolism of tobacco carcinogens (GSTT1, GSTM1, GSTP1) and one polymorphism of a DNA repair gene (XRCC1) for patients diagnosed with squamous cell carcinoma (SCC). METHODS: Cox proportional hazard models were used to estimate risk of death for a prospective cohort of 190 patients. RESULTS: Individuals with the GSTT1 functional genotype were twice as likely to die from any cause (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.13-4.97) and were three times as likely to die from SCC (HR, 3.4; 95% CI, 1.33-8.41) after adjustment for age, primary therapy, and stage of disease. The XRCC1 399 Gln genotype was predictive of disease recurrence. CONCLUSIONS: Our findings, from one of the first studies to examine this research question, suggest that genomic markers of carcinogen metabolism and DNA repair capability may serve as prognostic indicators of disease recurrence and death.
AIM: to test the validity, reliability and feasibility of using a modified version of Parkes' (1993) Bereavement Risk Index (BRI) and bereavement support protocol in an Australian home hospice care setting. In addition, the study aimed to explore what types of family members are most likely to experience a more difficult grief reaction. DESIGN: a prospective, descriptive study was used. One hundred and fifty bereaved family members participated. Bereaved family members were classified as high, medium or low risk and received a structured bereavement support protocol based on their level of risk as measured by the BRI. FINDINGS: results indicated that a shorter 4-item version of the BRI was more internally consistent than the longer version and demonstrated good predictive validity when correlated with outcome measures at 3 months following the patient's death. CONCLUSION: the modified 4-item BRI demonstrated acceptable reliability and validity and was brief and simple to use. Nurses were able to use the instrument with minimal training and were able to adhere to a matched bereavement support protocol.
The retention of nursing students is an ongoing problem, both within the United Kingdom (UK) and internationally. While there is a plethora of literature relating to student attrition, there is an absence of evidence in relation to the experiences of those students who are struggling to meet the demands of nursing programmes. Using an inductive sociological enquiry based approach, this study sought to examine the experiences of student nurses after referral on the first attempt of a summative assessment. Nursing students who had failed an assignment (n=20) were invited to participate. Data was collected using focus groups, with the emergent themes collapsed into a concise format using thematic content analysis. Four key themes were identified: desire to succeed; acceptance of personal failure; recognition of personal attributes required for success; and responsibility for personal success and failure. Students remained on the programme, despite struggling with financial and personal difficulties, because the desire to become a qualified nurse outweighed transient hardships. This paper will illustrate the benefits of understanding the students' experiences, in order to ensure the support students receive is appropriate to their needs. Understanding the support strategies as perceived by the students may prevent further wastage from nursing programmes.
BACKGROUND: If children are to be given the opportunity to develop to their full potential, fostering spiritual growth must be part of the process of caring for them. However, the meaningful application of spiritual care in everyday practice is fraught with difficulties. In addition to a lack of understanding of the term itself and of the expression of spirituality, in child health these difficulties are further compounded by the stage of a child's development. AIM: The aims of this paper are to explore spiritual awareness in children by providing examples of the expression of spiritual beliefs in relation to the developmental stage of the child, and to identify the implications of the findings for clinical practice. METHOD: A model of concept development, using the cyclical process of 'significance', 'use' and 'application' was applied, and formed the philosophical underpinnings for the paper. This framework is particularly relevant to child health, as there is little evidence to draw on, particularly in relation to a child's spiritual needs. FINDINGS: Five primary research papers which met the inclusion criteria were reviewed, and provided examples of spiritual beliefs and their manifestations in children. The examples highlighted the diversity and complexity of children's thinking. CONCLUSIONS AND RECOMMENDATIONS: Health care professionals working with children should receive education about the spiritual needs of children. Assessment tools should be developed to facilitate detailed assessment of children's spiritual needs. Professionals need to listen to and communicate with children at different stages of development if spiritual distress is to be identified. Families' health care beliefs should be respected and considered when planning care.
Previous studies have suggested an association between parental medical radiation exposure and increased incidence of certain childhood cancers. We investigated the relationship between medical radiation and risk of neuroblastoma in offspring using data from a North American case-control study. Cases were children diagnosed with neuroblastoma from 1 May 1992, to 30 April 1994, at Children's Cancer Group and Pediatric Oncology Group institutions throughout the United States and Canada. One matched control per case was selected using random-digit dialling. Telephone interviews were conducted with parents to collect data on any medical radiation examinations and treatments in the 2 years before conception or during pregnancy. We included 500 maternal and 339 paternal matched pairs. Overall, no association was found between maternal exposure to radiation and neuroblastoma risk (odds ratio [OR] = 1.0; 95% confidence interval [CI]: 0.7, 1.3). Analysis of maternal exposure by specific anatomical site showed no association for gonadal sites [OR = 1.0; 95% CI = 0.5, 2.0]. Little association was found with paternal radiation exposure [OR = 1.2; 95% CI = 0.8, 1.8]. No consistent exposure-response gradient was found based upon the number of maternal or paternal medical radiation examinations. The data presented here, coupled with the lower radiation doses currently used, indicate that any further study of this question will require larger studies with improved exposure assessment.
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BACKGROUND AND RATIONALE: The option of separate registration in children's nursing has been a feature of nursing in the United Kingdom since 1919, but this is currently under review. The recently superseded governing body of nursing, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, has suggested that generic nurse registration with later specialization would be a more appropriate structure. Polarized views tend to dominate the debate over whether or not children's nursing should remain a discrete branch of nursing rather than simply another postregistration speciality. A long series of reports is often referred to in the debate, but the recommendations of these are often misconstrued and misrepresented. AIMS: First, to provide a factual historical overview of the significant reports on the provision of child health care over the past 50 years, identifying the key principles of each, and to develop from this analysis reasoned conclusions regarding the priorities in skill mix for nursing children. Second, to propose an alternative framework for nursing skill mix that will ensure that children receive care appropriate to their needs, and that nurses are appropriately prepared for the level of service to be offered. CONCLUSION: The problems associated with expectations of universal provision of registered children's nurses for all children requiring nursing intervention have resulted from misunderstandings of the recommendations of key historical reports. In the light of evidence presented for the drive for abolition of specialist registration, and the main arguments of the polar stances of genericism or specialization, it is vital that alternative strategies are developed and debated. The proposed framework, based on pragmatism and key principles established from major reports, is discussed in an attempt to address the real issues; namely that all children are cared for by nurses who have adequate preparation commensurate with their needs, and that there is a strong career trajectory for all nurses working in the field of child heath.
PURPOSE: Markers of somatic mutation such as p16 and p53 remain controversial prognostic indicators for patients with squamous cell carcinoma of the head and neck (SCCHN). The relationship between p53 protein expression and radiation therapy is also unclear. EXPERIMENTAL DESIGN: We made a prospective cohort study (n = 171) of incident cases receiving standardized therapy for SCCHN. RESULTS: Patients whose tumors showed increased p53 protein expression had over twice the risk of all-cause mortality after 550 days [hazard ratio (HR), 2.7; 95% confidence interval (CI), 1.07-6.66] and three times the risk of dying from cancer-specific causes after 550 days (HR, 3.09; 95% CI, 1.15-8.30) after adjustment for age, therapy, and stage. Tumors demonstrating alteration of both p16 and p53 did not confer any additional diagnostic information over p53 alone. Patients whose tumors expressed increased levels of p53 protein and received radiation were almost three times more likely to die as compared with those who received radiation but whose tumors did not express increased p53 protein after adjustment for age and stage (HR, 2.6; 95% CI, 1.03-6.50). CONCLUSIONS: p53 protein expression was found to violate the proportional hazards assumption for our cohort, which may explain the controversial prognostic ability of this protein in the literature. p53 protein expression, but not p16 protein expression, was related to poor survival in general for men and women. In addition, an interaction between p53 expression and radiation therapy was demonstrated. Additional studies are needed to confirm and extend our results.
The safe administration of medicines is a key nursing activity. The most common type of medication error is administering the wrong dose (Armitage, 2006). To administer medicines correctly, nurses must apply appropriate knowledge specific to the patients receiving medication, and execute the skills required to administer medicines to a high degree of accuracy. This may include mathematical calculations. The potential for errors in child health settings is compounded by the complex calculations often required to ensure children receive the appropriate dose. Nurse educators face dilemmas in both pre- and post-registration settings relating to students' lack of ability to undertake drug calculations without a calculator. This means that students may not be able to follow the Nursing and Midwifery Council (NMC) Guidelines for the Administration of Medicines (NMC, 2004b). Medication dosage calculations continue to be problematic for qualified nurses. It is too early to assess whether changes in state education will improve pre-registration students' abilities to apply skills in basic mathematical principles to drug calculations. In the meantime, it is important that nurses who appear to have a weakness in applying mathematical principles to drug calculations seek, and are offered, the opportunity to develop these skills.