Examining the hurdles in defining the practice of Nurse Navigators.

BACKGROUND: Nurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care. PURPOSE: A critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident. DISCUSSION: Nurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance. CONCLUSION: Nurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide.

The evaluation of nurse navigators in chronic and complex care.

AIM: With increasing age and chronicity in populations, the need to reduce the costs of care while enhancing quality and hospital avoidance, is important. Nurse-led co-ordination is one such model of care that supports this approach. The aim of this research was to assess the impact that newly appointed Navigators have on service provision; social and economic impact; nurses' professional quality of life and compassion fatigue; and analysis of the change that has occurred to models of care and service delivery. DESIGN: A concurrent mixed-method approach was selected to address the research aims. METHODS: The research project was funded in July 2018 and will conclude in December 2020. Several cohorts will be studied including; patients assigned to a navigator, patients not assigned to a navigator, family members of patients assigned a navigator; and a sample sized estimated at 140 navigators. DISCUSSION: This study provides a comprehensive international longitudinal and mixed method framework for evaluating the impact of nurse navigators on quality of care outcomes for patients with chronic conditions. IMPACT-WHAT PROBLEM WILL THE STUDY ADDRESS?: Even with specialty focused co-ordinated care, patients get lost in the system, increasing the incidence of non-compliance and exacerbation of condition. Navigators work with patients across service boundaries allowing for care that is patient responsive, and permitting variables in clinical, social and practical elements of care to be addressed in a timely manner. This novel nurse-led approach, supports hospital avoidance and patient self-management, while encouraging expansion and opportunity for the nursing and midwifery workforce.

Variation in the ovine hormone-sensitive lipase gene (HSL) and its association with growth and carcass traits in New Zealand Suffolk sheep.

The hormone-sensitive lipase (HSL) plays an important role in the regulation of lipolysis in adipose tissues, by catalysing a rate-limiting step in triglyceride hydrolysis. Variation within the human HSL gene (HSL) has been associated with an increased risk of obesity. In this study, variation within three regions (exon 3-4, exon 5-6 and exon 9) of ovine HSL was investigated in 538 Suffolk lambs bred from 13 independent sires using PCR-SSCP. Four sequence variants of intron 5 (designated A-D) and two variants of exon 9 (designated a and b) of ovine HSL were detected. No variation was found in exon 3-4 of the gene. The associations of the variation within ovine HSL with post-weaning growth and carcass traits including eye muscle depth (EMD), eye muscle width (EMW) and fat depth above the eye muscle (FDM) were assessed in 262 of the above 538 lambs using general linear mixed-effects models. In the single variant models, the presence of intron 5 A in a lamb's genotype was associated with reduced EMD (P = 0.036) and EMW (P = 0.018), whereas the presence of intron 5 C was associated with increased EMD (P < 0.001), EMW (P < 0.001) and FDM (P = 0.017). The association of C with increased EMD (P = 0.002) and EMW (P = 0.002) persisted in the multi-variant model. No association between HSL intron 5 variants and post-weaning growth, or between HSL exon 9 variants, post-weaning growth or carcass traits, were found.

Halplotypes of the ovine ADRB3 gene (ADRB3) and their association with post-weaning growth in New Zealand Suffolk sheep.

The ß3-adrenergic receptor (ADRB3) regulates thermogenesis and lipolysis in brown and white adipose tissue. Previously, sixteen ovine ADRB3 haplotypes have been defined. In this study, the relationship between these ADRB3 haplotypes and variation in post-weaning growth was investigated in 797 New Zealand Suffolk lambs from 38 sire lines and eight studs, using PCR-SSCP and General Linear Mixed-effects Models. Seven haplotypes were found in these sheep and they comprised five previously reported intron sequences and four previously reported 3'UT sequences. The frequencies of the various diplotypes ranged from 0.1 to 17.6% and individual haplotypes from 0.8 to 32.5%. The presence of haplotype A-b was associated with a decreased weaning-weight (P=0.001). Sheep with the B-c/F-e diplotype had a higher mean weaning-weight than those with A-b/B-c or A-b/E-e (P<0.05). The presence of C-a was found to be associated with increased post-weaning growth (P=0.008), while the presence of B-c was associated with decreased post-weaning growth (P=0.005). Sheep with A-b/C-a had higher mean post-weaning growth than those with A-b/A-b, A-b/B-c, B-c/B-c, B-c/E-e or B-c/F-e (P<0.05). Sheep with B-c/B-c had lower mean post-weaning growth than those with A-b/C-a or B-c/C-a (P<0.05). Additive effects for the different forms of the B-c haplotypes on post-weaning growth were identified. The effects of the ovine ADRB3 haplotypes on weaning-weight and post-weaning growth confirm that they could be used as a candidate gene-marker for improving sheep growth.

Ovine forkhead box class O 3 (FOXO3) gene variation and its association with lifespan.

FOXO3 is a member of the FOXO (forkhead box class O) transcription factor family and has roles in cell cycle control, apoptosis, neural and hematopoietic cell differentiation and DNA repair among other functions. Several human studies provide evidence for an association between aging, longevity and variation in FOXO3. Recently variation has been identified in exon 2 of ovine FOXO3. This exon encodes the C-terminus of the DNA-binding domain and a transcription activation domain that is the key regulator of transcriptional activity in target genes. The association of genetic variation in exon 2 with lifespan was investigated in 1,732 New Zealand (NZ) sheep. Of the seven haplotypes detected, the presence of the D haplotype, which codes for an amino acid substitution (a conserved methionine residue is replaced by a valine) at residue 407, is associated with a decrease of 0.39 years in mean age (P = 0.034). Significant differences in mean age were also detected between genotypes containing D (AD: 4.7 ± 0.21; BD: 4.7 ± 0.25) and genotypes that did not contain D (AA: 5.1 ± 0.14; AB: 4.9 ± 0.18; BB: 5.3 ± 0.25). Other genotypes were rare in the sheep investigated and were not analyzed. This suggests that genetic variation in ovine FOXO3 influences the lifespan of sheep either directly or indirectly by impacting on factors that lead to reduced productivity and increased likelihood of culling.

Pet Owners' Attitudes and Opinions towards Cat and Dog Care Practices in Aotearoa New Zealand.

This research aimed to explore cat and dog owners' attitudes and opinions towards various pet care practices in Aotearoa New Zealand (NZ), and determine what factors were associated with them. An online survey composed of both closed and open-ended questions was administered from January to March 2019. A total of 2358 respondents answered the questions on pet care practices. Of these, 37.5 percent (n = 885) were both dog and cat owners, 28.0 percent (n = 652) were cat owners, and 26.0 percent (n = 609) were dog owners, while 9% (n = 212) of respondents did not own a cat or dog at the time of taking the survey. The study revealed that most respondents (>90%) acknowledge the importance of providing adequate housing, regular worming and flea treatments, microchipping, and vaccinations for their pets. Notably, demographic factors such as gender, ethnicity, age range, having children, having a rural upbringing, and place of residence influenced owners' attitudes, with those towards cat care practices varying more than those for dogs. The study highlights the need for responsible pet ownership interventions considering these demographic factors. The study identifies a knowledge gap among pet owners concerning the importance of regular veterinary visits and the impact of breeding for certain looks on animal welfare. The use of shock collar devices provoked varying opinions on their usage for training and behavior modification. The study suggests that enhancing pet owners' knowledge is pivotal for responsible pet ownership. Overall, the findings emphasize the need for tailored interventions that account for demographic variations for promoting responsible pet ownership and animal welfare. The findings underscore the importance of improving access to veterinary health care teams, especially in rural areas, and of providing culturally appropriate education resources for both pet owners and veterinary health care teams.

Pet Ownership in Aotearoa New Zealand: A National Survey of Cat and Dog Owner Practices.

This study used an online survey distributed between January and March 2019 to adults residing in Aotearoa New Zealand (NZ) to investigate cat and dog owner practices. Of the 2385 respondents, 885 (37%) owned both cat/s and dog/s, while 652 (28%) and 609 (26%) owned cat/s only or dog/s only, respectively. Nine percent of respondents (n = 212) did not own a cat or dog when the survey was administered. Gaps were identified in the practices of NZ pet owners with regard to regular grooming, immunizations, and deworming treatments. It was also found that many pets, especially cats, were allowed to wander freely both inside and outside the house. Collectively, these gaps in practice raise parasitology and infection concerns which may impact negatively on animal welfare and may increase the prevalence of zoonotic diseases. This study also revealed the need to improve desexing practices, particularly in dogs. Respondents in the survey expressed the wish to have pets regardless of the financial strain they may impose, indicating that future research should focus on reducing the financial burden of pet ownership along with promoting positive pet ownership practices. Our findings suggest the need for better education resources about pet ownership which are easily accessible and target diverse populations. The findings of this study will aid in developing appropriate educational resources to promote animal welfare and increase pet-related knowledge among the NZ populace.

Potential Owner-Related Risk Factors That May Contribute to Obesity in Companion Dogs in Aotearoa New Zealand.

Approximately a third of all Aotearoa New Zealand (NZ) households include a dog, with 28% of these dogs being overweight or obese, conditions that are associated with many serious health issues. Therefore, healthy weight interventions that focus on the owner's role are of great importance to companion animal welfare in NZ. Accordingly, the present study explores the feeding practices associated with NZ dogs and identifies potential owner-related risk factors contributing to these animals being overweight or obese. The current study used data collected from a survey conducted online in 2019 between January and March of NZ residents over 18. Along with demographic questions, the respondents were asked questions regarding their dog's body condition and diet questions related to the body. Nearly a quarter (26%, n = 609) of the survey participants (n = 2358) owned at least one dog. The current study reported that increasing age range, household income and the number of children increased the likelihood of having a dog while increasing qualification level and living in a town/city decreased the likelihood. The majority of the respondents fed their dog(s) treats (59%) and 85% fed them specialised food bought from a pet shop, veterinary clinic and/or different online sources. Just over a third of the participant (39%) reported that they fed their dog(s) biscuits from the supermarket, 36% fed their dog(s) raw meat, and 34% of respondents fee their dog(s) table scraps/human food. These results suggest that many dog owners feed their dog(s) various food types, making it a challenging task to determine the exact amount required from each type in order not to exceed caloric intake. Disagreement regarding the correct body condition were reported among twenty per cent of the respondents. This finding indicates a knowledge gap among the NZ dog-owning population that may negatively affect their dogs' welfare and wellbeing. Future research into pro-equity approaches to address these issues is needed so that dogs in NZ can live not only a good life but also their best life.

Locking down the Impact of New Zealand's COVID-19 Alert Level Changes on Pets.

The influence of the COVID-19 pandemic on human-pet interactions within New Zealand, particularly during lockdown, was investigated via two national surveys. In Survey 1, pet owners (n = 686) responded during the final week of the five-week Alert Level 4 lockdown (highest level of restrictions-April 2020), and survey 2 involved 498 respondents during July 2020 whilst at Alert Level 1 (lowest level of restrictions). During the lockdown, 54.7% of owners felt that their pets' wellbeing was better than usual, while only 7.4% felt that it was worse. Most respondents (84.0%) could list at least one benefit of lockdown for their pets, and they noted pets were engaged with more play (61.7%) and exercise (49.7%) than pre-lockdown. Many respondents (40.3%) expressed that they were concerned about their pet's wellbeing after lockdown, with pets missing company/attention and separation anxiety being major themes. In Survey 2, 27.9% of respondents reported that they continued to engage in increased rates of play with their pets after lockdown, however, the higher levels of pet exercise were not maintained. Just over one-third (35.9%) of owners took steps to prepare their pets to transition out of lockdown. The results indicate that pets may have enjoyed improved welfare during lockdown due to the possibility of increased human-pet interaction. The steps taken by owners to prepare animals for a return to normal life may enhance pet wellbeing long-term if maintained.

The Diets of Companion Cats in Aotearoa New Zealand: Identification of Obesity Risk Factors.

One in four New Zealand cats are overweight or obese, conditions associated with poor health outcomes. As part of an online survey that was conducted from January 2019 to March 2019, NZ residents aged ≥18 years were asked demographic questions along with questions related to the body condition, breed and diet of their cat/s. From the responses, possible owner-related risk factors for developing obesity were identified. Of the respondents, 65.5% (n = 1537) owned cat/s; the owners being more likely to be female, live rurally, or live with children. Most of the respondents fed their cat/s biscuits from the supermarket (63%) and wet food (57%). Almost half (45%) fed their cat/s specialised food from a pet shop or veterinary clinic and gave them treats, with 31% of respondents feeding their cat/s raw meat. Feeding cats a variety of food types may make it difficult to estimate the appropriate amount of each needed to avoid excess caloric intake. In addition, approximately 30% of the respondents did not agree with the correct body condition statement, revealing a need for owner education. These findings highlight important areas of cat nutrition requiring future research to better inform the development of healthy weight interventions for NZ cats.

Understanding the impact and causes of 'failure to attend' on continuity of care for patients with chronic conditions.

AIM: To understand the impact and causes of 'Failure to Attend' (FTA) labelling, of patients with chronic conditions. BACKGROUND: Nurse navigators are registered nurses employed by public hospitals in Queensland, Australia, to coordinate the care of patients with multiple chronic conditions, who frequently miss hospital appointments. The role of the nurse navigator is to improve care management of these patients. Evidence for this is measured through improvement in patient self-management of their conditions, a reduction in preventable hospital admissions and compliance with attendance at outpatient clinics. Failure to attend (FTA) is one measure of hospital utilisation, identifying outpatient appointments that are cancelled or not attended. METHOD: The cohort for this study was patients with multiple chronic conditions, and nurse navigators coordinating their care. Data describing the concept of FTA were thematically analysed twelve months into this three year evaluation. RESULTS: Although the patient is blamed for failing to attend appointments, the reasons appear to be a mixture of systems error/miscommunication between the patient and the health services or social reasons impacting on patient's capacity to attend. Themes emerging from the data were: access barriers; failure to recognise personal stigma of FTA; and bridging the gap. CONCLUSION: The nurse navigators demonstrate their pivotal role in engaging with outpatient services to reduce FTAs whilst helping patients to become confident in dealing with multiple appointments. There are many reasons why a patient is unable to attend a scheduled appointment. The phrase 'Failure to Attend' has distinctly negative connotations and can lead to a sense of blame and shame for those with complex chronic needs. We propose the use of the neutral phrase "appointment did not proceed" to replace FTA. IMPLICATIONS FOR NURSING MANAGEMENT: This article advocates for further consideration of collaborative models that engage the patient in their care journey and for consideration of the language used within the outpatient acute hospital setting, proposing the term 'appointment did not proceed.'

Genetic diversity of selected genes that are potentially economically important in feral sheep of New Zealand.

BACKGROUND: Feral sheep are considered to be a source of genetic variation that has been lost from their domestic counterparts through selection. METHODS: This study investigates variation in the genes KRTAP1-1, KRT33, ADRB3 and DQA2 in Merino-like feral sheep populations from New Zealand and its offshore islands. These genes have previously been shown to influence wool, lamb survival and animal health. RESULTS: All the genes were polymorphic, but no new allele was identified in the feral populations. In some of these populations, allele frequencies differed from those observed in commercial Merino sheep and other breeds found in New Zealand. Heterozygosity levels were comparable to those observed in other studies on feral sheep. Our results suggest that some of the feral populations may have been either inbred or outbred over the duration of their apparent isolation. CONCLUSION: The variation described here allows us to draw some conclusions about the likely genetic origin of the populations and selective pressures that may have acted upon them, but they do not appear to be a source of new genetic material, at least for these four genes.

Mild traumatic brain injury in New Zealand: factors influencing post-concussion symptom recovery time in a specialised concussion service.

INTRODUCTION By 2020, traumatic brain injuries (TBIs) are predicted to become the third largest cause of disease burden globally; 90% of these being mild traumatic brain injury (mTBI). Some patients will develop post-concussion syndrome. AIM To determine whether the time between sustaining a mTBI and the initial assessment by a specialised concussion service, along with the post-concussion symptoms reported at the assessment, affected recovery time. METHODS A retrospective medical record review of clients who had completed the Rivermead Post-Concussion Questionnaire (RPQ) at their initial assessment and were discharged from a large metropolitan concussion service in New Zealand was undertaken over a 6-month period in 2014 (n = 107). Using correlations, General Linear Mixed-effects Models (GLMM) and linear regressions, we explored associations between factors including ethnicity, gender and accident type, along with individual RPQ symptom scores and cluster scores, with time from injury to initial assessment by the specialised concussion service and initial assessment to discharge. RESULTS Time from injury to initial assessment by a specialist concussion service was correlated with proportionally more psychological symptoms present at initial assessments (r = 0.222, P = 0.024); in particular, feeling depressed or tearful (r = 0.292, P = 0.003). Time to discharge was correlated with individual RPQ symptom proportions present at initial assessment for headaches (r = -0.238, P = 0.015), sensitivity to noise (r = 0.220, P = 0.026), feeling depressed or tearful (r = 0.193, P = 0.051) and feeling frustrated or impatient (r = 0.252, P = 0.003), along with the psychological cluster proportion (r = 0.235, P = 0.017) and the total RPQ score (r = 0.425, P < 0.001). CONCLUSION Prompt diagnosis and treatment of mTBI may minimise the severity of post-concussion symptoms, especially symptoms associated with mental health and wellbeing.

Variation in the ovine MYF5 gene and its effect on carcass lean meat yield in New Zealand Romney sheep.

Myogenic factor 5 (MYF5) plays an important role in regulating skeletal muscle, but to date there have been no reports on whether the gene is variable and whether this variation is associated with meat yield in sheep. In this study, four variants (A to D) of ovine MYF5 containing two Single Nucleotide Polymorphisms (SNPs) and one basepair (bp) insertion/deletion were detected by Polymerase Chain Reaction - Single Stranded Conformational Polymorphism (PCR-SSCP) analysis. Breed differences in variant frequencies were observed. The effect of variation in ovine MYF5 on lean meat yield, predicted using VIAScan® technology, was investigated in 388 male NZ Romney lambs. Only genotypes AA and AB were found in these lambs. Lambs with genotype AA had a higher leg yield (P=0.044), loin yield (P=0.002) and total yield (P=0.012) than those with genotype AB. No association with shoulder yield was detected. These results suggest that ovine MYF5 may be a valuable genetic marker for improved lean meat yield.

Discharge Planning: Screening Older Patients for Multidisciplinary Team Referral.

The objective was to determine whether the Elders Risk Assessment Index can predict multi-disciplinary team referral of older patients (≥ 65 years) in Emergency Department same-day discharges. The study identified 1,376 qualifying individuals from a regional New Zealand hospital database. Of these, 12.7 % were referred to the multi-disciplinary team. Univariate and multivariate analyses were used to explore associations between the Index, its components, and other demographic factors with referral. With every unit increase in the Index there was a 9% increase in the odds of being referred. When the components of the Index were analysed separately, an increased likelihood of being referred was associated with not being married, having had a previous hospital admission of more than five days, having chronic obstructive pulmonary disease, and being older. Conversely, a decreased likelihood was associated with having diabetes. When non-Index items were analysed it was found that females were more likely to be referred than males and that Maori were less likely to be referred than New Zealand Europeans. With adaptation, the Elders Risk Assessment Index may provide a simple, cost-effective, and timely tool to assist in determining the need for multi-disciplinary team referral for older people who present to the Emergency Department.

Exercise treadmill tests in patients with low cardiovascular risk: are we wasting our time?

INTRODUCTION The efficacy and cost-effectiveness of exercise treadmill testing for patients with low cardiovascular risk is unclear. This is due to the low incidence of coronary artery disease in this population and the potential for false-positive results leading to additional invasive and expensive investigation. AIM To investigate the value of exercise treadmill testing (ETT) as a predictor of coronary artery disease in patients with different levels of cardiovascular risk. METHODS An observational study was completed on an outpatient population from a chest pain clinic (n = 529). Cross-tabulations and binary logistic regressions were used to examine relationships between variables. RESULTS A negative ETT result was recorded for 72.5% of patients with low cardiovascular risk compared to 54.3% of those with moderate or high risk. Within the low cardiovascular risk group, patients with symptoms atypical for cardiac ischaemia were 11.1-fold more likely to have a negative ETT result. Of the patients with positive or equivocal ETT results, coronary artery disease was subsequently confirmed in only 23.1% of the low cardiovascular risk group compared to 77.2% of those with moderate or high cardiovascular risk. DISCUSSION Results show low cardiovascular risk patients are significantly more likely to return negative ETT results, particularly when associated with atypical symptoms. Similarly, positive or equivocal ETTs in this group are significantly more likely to be false positives. This suggests the ETT is not efficacious in predicting coronary artery disease in patients with low cardiovascular risk. Is it therefore appropriate to offer exercise testing to this cohort or should alternative management strategies be considered?

Wool Keratin-Associated Protein Genes in Sheep-A Review.

The importance of sheep's wool in making textiles has inspired extensive research into its structure and the underlying genetics since the 1960s. Wool keratin-associated proteins (KAPs) are a key structural component of the wool fibre. The characterisation of the genes encoding these proteins has progressed rapidly with advances in the nucleotide and protein sequencing. This review describes our knowledge of ovine KAPs, their categorisation into families, polymorphism in the proteins and genes, the clustering and chromosomal location of the genes, some characteristics of gene expression and some potential effects of the KAPs on wool traits. The extent and nature of genetic variation in wool KAP genes and its association with fibre characteristics, provides an opportunity for the development of gene-markers for selective breeding of sheep to produce better wool with properties highly matched to specific end-uses.

Differential expression of microRNA-206 and its target genes in preeclampsia.

OBJECTIVES: Preeclampsia is a multisystem disease that significantly contributes to maternal and foetal morbidity and mortality. In this study, we used a nonbiased microarray approach to identify novel circulating miRNAs in maternal plasma that may be associated with preeclampsia. METHODS: Plasma samples were obtained at 16 and 28 weeks of gestation from 18 women who later developed preeclampsia (cases) and 18 matched women with normotensive pregnancies (controls). We studied miRNA expression profiles in plasma and subsequently confirmed miRNA and target gene expression in placenta samples. Placental samples were obtained from an independent cohort of 19 women with preeclampsia matched with 19 women with normotensive pregnancies. RESULTS: From the microarray, we identified one miRNA that was significantly differentially expressed between cases and controls at 16 weeks of gestation and six miRNAs that were significantly differentially expressed at 28 weeks. Following qPCR validation, only one miR-206 was found to be significantly increased in 28-week samples in women who later developed preeclampsia (1.4-fold change ±â€Š0.2). The trend for increase in miR-206 expression was mirrored within placental tissue from women with preeclampsia. In parallel, IGF-1, a target gene of miR-206, was also found to be downregulated (0.41 ±â€Š0.04) in placental tissue from women with preeclampsia. miR-206 expression was also detectable in myometrium tissue and trophoblast cell lines. CONCLUSION: Our pilot study has identified miRNA-206 as a novel factor upregulated in preeclampsia within the maternal circulation and in placental tissue.

In preeclampsia, maternal third trimester subcutaneous adipocyte lipolysis is more resistant to suppression by insulin than in healthy pregnancy.

Obesity increases preeclampsia risk, and maternal dyslipidemia may result from exaggerated adipocyte lipolysis. We compared adipocyte function in preeclampsia with healthy pregnancy to establish whether there is increased lipolysis. Subcutaneous and visceral adipose tissue biopsies were collected at caesarean section from healthy (n=31) and preeclampsia (n=13) mothers. Lipolysis in response to isoproterenol (200 nmol/L) and insulin (10 nmol/L) was assessed. In healthy pregnancy, subcutaneous adipocytes had higher diameter than visceral adipocytes (P<0.001). Subcutaneous and visceral adipocyte mean diameter in preeclampsia was similar to that in healthy pregnant controls, but cell distribution was shifted toward smaller cell diameter in preeclampsia. Total lipolysis rates under all conditions were lower in healthy visceral than subcutaneous adipocytes but did not differ after normalization for cell diameter. Visceral adipocyte insulin sensitivity was lower than subcutaneous in healthy pregnancy and inversely correlated with plasma triglyceride (r=-0.50; P=0.004). Visceral adipose tissue had lower ADRB3, LPL, and leptin and higher insulin receptor messenger RNA expression than subcutaneous adipose tissue. There was no difference in subcutaneous adipocyte lipolysis rates between preeclampsia and healthy controls, but subcutaneous adipocytes had lower sensitivity to insulin in preeclampsia, independent of cell diameter (P<0.05). In preeclampsia, visceral adipose tissue had higher LPL messenger RNA expression than subcutaneous. In conclusion, in healthy pregnancy, the larger total mass of subcutaneous adipose tissue may release more fatty acids into the circulation than visceral adipose tissue. Reduced insulin suppression of subcutaneous adipocyte lipolysis may increase the burden of plasma fatty acids that the mother has to process in preeclampsia.

Implementing a Continuity of Cancer Care nursing role into a New Zealand primary health organisation - the patient's perspective.

INTRODUCTION: A Continuity of Cancer Care pilot project was established in two urban general practices, with the goal of improving cancer care and patient access to services. Practice nurses were engaged as coordinators to implement a model of care and patient navigation to offer continued and consistent care, and to assist the patient to navigate their cancer experience. AIM: The aim was to evaluate the effectiveness of the Continuity of Cancer Care pilot project. METHODS: Patients enrolled in the pilot project were invited to participate. Each participant completed a Patient Satisfaction Questionnaire and SF-12 Health Survey, and was then invited to take part in an interview. The evaluation framework utilised concepts of informational, management and relational continuity. RESULTS: The SF-12 subcategories of physical functioning, role physical, bodily pain and role emotional were lower than other results from cancer patients in the literature. The Patient Satisfaction Questionnaire and interviews indicated patients were satisfied with the relational continuity components of the project, but that gaps existed within the management and informational continuity aspects of care. DISCUSSION: Overall, the participants were satisfied with the Continuity of Cancer Care programme and valued the support, clarification and listening aspects of the programme. However, when evaluated in relation to a more comprehensive definition of continuity of care, there were distinct gaps. While the relational aspects of continuity of care were mostly achieved, the management and informational aspects appeared to be limited primarily to nurses acting to interpret hospital and general practitioner comments for patients.