A practical guide to laboratory investigations at diagnosis and follow up in Waldenström macroglobulinaemia: recommendations from the Medical and Scientific Advisory Group, Myeloma Australia, the Pathology Sub-committee of the Lymphoma and Related Diseases Registry and the Australasian Association of Clinical Biochemists Monoclonal Gammopathy Working Group.

Waldenström macroglobulinaemia (WM) is an indolent non-Hodgkin lymphoma which usually presents with symptoms related to infiltration of bone marrow or other tissues like lymph nodes, liver or spleen and has certain unusual clinical manifestations, e.g., renal and central nervous system (CNS) involvement. It also has an array of laboratory features including hypersecretion of IgM, cryoglobulinaemia, increased plasma viscosity and identification of mutated MYD88L265P in more than 90% of cases. In this review, we aim to provide a guide to the laboratory investigations recommended for WM at initial diagnosis and at follow-up. A discussion on the nuances of diagnosis and differential diagnoses is followed by bone marrow (BM) assessment, measurement of paraprotein and other ancillary investigations. Recommendations are provided on laboratory work-up at diagnosis, in the asymptomatic follow-up phase, and during and post-treatment. Finally, we briefly discuss the implications of laboratory diagnosis in regard to recruitment and monitoring on clinical trials.

Parish nursing: a unique resource for community and district nurses.

This paper examines the effect of parish nursing as a faith community initiative to support the work of district and community nurses and improve health outcomes. It discusses the reasons why faith communities might embark upon health initiatives, and describes the practice of parish nursing and its history and development in the UK. With reference to both quantitative and qualitative outcomes, the relevance of the practice in the UK health scene is assessed. The paper suggests that connecting with the third sector through parish nursing could enhance the work of community and district nurses; this would present additional sources of holistic care and health promotion and can be offered in an optional but complementary manner to the care provided through the NHS.

Health ministry through local faith communities: a European perspective.

Before the introduction of the NHS, faith communities were involved in health promotion and public health. Deaconesses often had nursing training as well as their theological study and visited homes where there were health needs. Over the last 10 years this role has re-emerged in the UK and now in 80 churches of various denominations parish nurses help to promote health generally, often engaging with hard-to-reach groups. With the help of the 2012 MacQueen Travel Award, Revd Dr Helen Wordsworth visited nurses in four different European countries to understand how other faith communities are involved in health promotion and spiritual care. This article describes the practice of parish nursing in the UK and reports on how similar ministry happens through churches in Finland, Ukraine, Georgia and Germany. The common presenting issues are: the ways in which the availability of the parish nurse is made known; its impact on ecumenical relationships; the potential for effective deployment of volunteers; and the need for resources to support these activities. The implications for the UK are that more promotion of the practice is needed, that it appears to fit with many denominational contexts, that it increases scope for co-ordinating and training volunteers, and that further resources should be made available to support the practice.

Delivering spiritual care. Interview by Lynne Pearce.

Spirituality is often confused with religion but the two are by no means interchangeable. For nurses it is about how they talk to patients.

Reclaim the spirit.

A system of parish nursing allows patients to receive spiritual care integrated with their other needs. There are now 29 churches in the U.K. with at least one parish nurse.