Patient's best interest as viewed by nursing students.

BACKGROUND: In recent years, patient advocacy has emerged as a prominent concept within healthcare. How nursing students decide what is best for their patients is not well understood. OBJECTIVE: The objective is to examine nursing students' views on doing what is best for patients during their clinical experiences and how they seek to establish patient interests when providing care. Research questions guiding the interview were as follows: (1) What are nursing students' perceptions of patient interests? (2) What factors influence nursing students' perceptions of advocating for patient's interests? RESEARCH DESIGN: Qualitative descriptive research using thematic analysis. PARTICIPANTS AND RESEARCH CONTEXT: Data was collected through individual online interviews with nine nursing students with clinical experience. ETHICAL CONSIDERATIONS: The study was approved by the University Research Ethics Committee. Participants provided digital informed consent. RESULTS: The students asserted that they are able to understand the patients' interests by placing emphasis on the patients' needs. They believe that it is crucial to adopt a collaborative strategy for the provision of care to meet these requirements. In addition, some of them expressed concern over the most effective methods of advocating for the interests of patients. Three themes were identified. (1) Focussing on patient needs first, (2) taking a collective approach, and (3) learning how to advocate. CONCLUSIONS: Students understand and value the ethical commitments associated with advocating for the patient's best interest by considering factors such as prioritising the patient's needs, adopting a strategy that involves everyone, and acquiring the ability to undertake the advocacy role. Additionally, nursing education strategies in clinical contexts require additional study to inspire students to do what is in their patient's best interests.

Realist Approach to Qualitative Data Analysis.

BACKGROUND: A realist approach has gained popularity in evaluation research, particularly in understanding causal explanations of how a program works (or not), the circumstances, and the observed outcomes. In qualitative inquiry, the approach has contributed to better theoretically based explanations regarding causal interactions. OBJECTIVE: The aim of this study was to discuss how we conducted a realist-informed data analysis to explore the causal interactions within qualitative data. METHODS: We demonstrated a four-step realist approach of retroductive theorizing in qualitative data analysis using a concrete example from our empirical research rooted in the critical realism philosophical stance. These steps include (a) category identification, (b) elaboration of context-mechanism-outcome configuration, (c) demi-regularities identification, and (d) generative mechanism refinement. RESULTS: The four-step qualitative realist data analysis underpins the causal interactions of important factors and reveals the underlying mechanisms. The steps produce comprehensive causal explanations that can be used by related parties-especially when making complex decisions that may affect wide communities. DISCUSSION: The core process of realist data analysis is retroductive theorizing. The four-step qualitative realist data analysis facilitates this theorizing by allowing the researcher to identify (a) patterns, (b) fluctuation of patterns, (c) mechanisms from collected data, and (d) to confirm proposed mechanisms.

Costs and clinical benefits of enhanced recovery after surgery (ERAS) in pancreaticoduodenectomy: an updated systematic review and meta-analysis.

PURPOSE: ERAS is a holistic and multidisciplinary pathway that incorporates various evidence-based interventions to accelerate recovery and improve clinical outcomes. However, evidence on cost benefit of ERAS in pancreaticoduodenectomy remains scarce. This review aimed to investigate cost benefit, compliance, and clinical benefits of ERAS in pancreaticoduodenectomy. METHODS: A comprehensive literature search was conducted on Medline, Embase, PubMed, CINAHL and the Cochrane library to identify studies conducted between 2000 and 2021, comparing effect of ERAS programmes and traditional care on hospital cost, length of stay (LOS), complications, delayed gastric emptying (DGE), readmission, reoperation, mortality, and compliance. RESULTS: The search yielded 3 RCTs and 28 cohort studies. Hospital costs were significantly reduced in the ERAS group (SMD = - 1.41; CL, - 2.05 to - 0.77; P < 0.00001). LOS was shortened by 3.15 days (MD = - 3.15; CI, - 3.94 to - 2.36; P < 0.00001) in the ERAS group. Fewer patients in the ERAS group had complications (RR = 0.83; CI, 0.76-0.91; P < 0.0001). Incidences of DGE significantly decreased in the ERAS group (RR = 0.72; CI, 0.55-0.94; P = 0.01). The number of deaths was fewer in the ERAS group (RR = 0.76; CI, 0.58-1.00; P = 0.05). CONCLUSION: This review demonstrated that ERAS is safe and feasible in pancreaticoduodenectomy, improves clinical outcome such as LOS, complications, DGE and mortality rates, without changing readmissions and reoperations, while delivering significant cost savings. Higher compliance is associated with better clinical outcomes, especially LOS and complications.

Perspectives on barriers and facilitators to lifestyle change after cardiac events among patients in Saudi Arabia: a qualitative study.

AIMS: Lifestyle interventions are an essential element in the prevention of cardiovascular disease. However, promoting a healthy lifestyle is challenging because a multitude of factors interact and influence people's decisions to adopt and maintain healthy lifestyles. The effects of these factors on Saudi cardiac patients are largely unknown. This study aimed to explore the barriers and facilitators to healthy lifestyle changes among Saudis after cardiac events. METHODS AND RESULTS: The study followed an exploratory qualitative research design, using a social ecological approach. Semi-structured interviews were conducted with 21 participants (13 men and 8 women) who had a cardiac event. Participants were purposively recruited from cardiac clinics of two hospitals in Jeddah, Saudi Arabia. Data were analysed using the qualitative framework analysis, and factors were identified as salient based on their frequency and the potential strength of their impact. Six factors were identified as influencing lifestyle behaviours in cardiac patients, categorized as 'major' factors and 'mediating' factors. The 'major' factors were sociocultural norms, family values, and religious beliefs, and the mediating factors were insufficient healthcare services, physical environment, and policy regulations. Depending upon the behaviours reported and the context, the same factor could be classified as both a barrier and a facilitator. CONCLUSION: The findings of this study can be used to inform the development of contextual-based interventions to promote the adoption of healthy lifestyles that meet the population needs and are relevant to Saudi society.

An exploration into registered nurses' knowledge of adult fever in Scotland: A mixed method study.

BACKGROUND: Fever may be a result of many causes, infective or non-infective. Nurses' fever management can be affected by their knowledge and beliefs and also by patients' beliefs. Consequently, an understanding of fever is vital in the diagnosis, treatment and follow-up of various ailments and diseases. Greater knowledge of fever will guide more accurate assessments of the epidemiology of fever and its management. OBJECTIVES: This study explored nurses' knowledge in the context of fever and identified factors that affected this knowledge acquisition. METHODS: A mixed methods approach was used with a validated questionnaire designed to gather information about nurses' knowledge of fever. This was followed up by semi-structured interviews to explore factors associated with the acquisition of fever knowledge. The online survey was distributed to registered nurses in Scotland. RESULTS: A total of 177 questionnaires were completed. The questionnaires were scored with a correct answer 1 point, while a wrong answer -1 point. The mean total score in the knowledge section was 0.47. Only 49.2 % of participants scored above 0. The stepwise linear regression demonstrated working experience in critical care unit, acute care unit and the role of nurse practitioner together could predict 10 % of the total knowledge score (P < 0.05). Through analysis of associations and qualitative data, it was found that many factors had contributed to the nurses' knowledge about fever, specifically educational content, individual confidence and the Sepsis Six bundle. CONCLUSIONS: Considerable misconceptions were found to exist in the nurses' understanding of fever. Only a few factors were found to be associated with the total knowledge score. It was highlighted that the due to the strong influence of the Sepsis Six bundle, participants often assumed a direct causal connection between fever and infectious disease or sepsis. The study result indicated a concern in nurses' acquisition of fever knowledge. TWEETABLE ABSTRACT: Misconceptions from foundational learning were found in nurses' understanding of fever. However, the Sepsis 6 was found to impact their current knowledge of fever.

The characteristics of effective technology-enabled dementia education: a systematic review and mixed research synthesis.

BACKGROUND: Dementia education is required to address gaps in dementia-specific knowledge among health and social care practitioners amidst increasing dementia prevalence. Harnessing technology for dementia education may remove obstacles to traditional education and empower large communities of learners. This systematic review aimed to establish the technological and pedagogical characteristics associated with effective technology-enabled dementia education for health and social care practitioners. METHODS: MEDLINE, PubMed, Web of Science, CINAHL, Scopus, PsycINFO, ERIC and OVID Nursing Database were searched from January 2005 until February 2020. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Study quality was assessed with the Mixed Methods Appraisal Tool. Quantitative evidence was categorised based on Kirkpatrick's Model. Qualitative data was synthesised thematically and integrated with quantitative findings before conclusions were drawn. RESULTS: Twenty-one published papers were identified. Participants were acute, primary and long-term care practitioners, or were students in higher education. Most training was internet-based; CD-ROMs, simulations and tele-mentoring were also described. Technology-enabled dementia education was predominantly associated with positive effects on learning outcomes. Case-based instruction was the most frequently described instructional strategy and videos were common modes of information delivery. Qualitative themes emerged as existing strengths and experience; knowledge gaps and uncertainty; developing core competence and expertise; involving relevant others; and optimising feasibility. DISCUSSION: Technology-enabled dementia education is likely to improve dementia knowledge, skills and attitudes among health and social care practitioners from multiple practice contexts. Confidence in the results from quantitative studies was undermined by multiple confounding factors that may be difficult to control in the educational research context. Convenience and flexibility are key benefits of technology-enabled instructive and simulated pedagogy that can support the application of theory into practice. More research is required to understand the role of online learning networks and provisions for equitable engagement. A future emphasis on organisational and environmental factors may elucidate the role of technology in ameliorating obstacles to traditional dementia education. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ( CRD42018115378 ).

Young Adults Rehabilitation Needs and Experiences following Stroke (YARNS): A review of digital accounts to inform the development of age-appropriate support and rehabilitation.

AIMS: To explore younger adults' experiences of stroke rehabilitation to inform practice, education and future health policy. DESIGN: Qualitative analysis of digital and other media sources on public platforms. METHODS: Between March and June 2020, the experiences of younger adult stroke survivors aged 18 to 45 at the time of the stroke were collected. Data were gathered from publicly available sources, including social media, and from English-speaking users. In total, 117 accounts from 103 participants were identified from films, autobiographical books, blogs, websites, videos, Twitter and Instagram. Data analysis followed narrative and multimodal analysis with a focus on rehabilitation needs. RESULTS: Younger adult stroke survivors make sense of their experience by reflecting on how stroke has impacted their lives. Accounts reflected an emotional journey between the past self, the present self and evolving self, as well as associated challenges such as the impact on relationships and careers. The majority of accounts presented transitions as problematic, including the receipt of the initial diagnosis, or sometimes misdiagnosis, to returning home and achieving long-term rehabilitation goals. Specialist stroke nurses were considered essential in the rehabilitation process. CONCLUSION: A complex process of recovery follows stroke for younger adult stroke populations. Challenges to the rehabilitation process need to be better understood and the role of nursing highlighted in future service provision. A series of age-related challenges were highlighted that require attention to improve the care and support offered. IMPACT: This article informs clinicians, educators, and policymakers of the age-related needs of young adult stroke survivors. Focusing on the individual and the development of age-appropriate person-centred stroke care is important. The study highlights the role of stroke nursing and challenges the current policy focus on older stroke populations as well as arguing for greater awareness of age-appropriate stroke rehabilitation in younger adults following stroke.

Emergency department nurses' role transition towards emergency nurse practitioner: A realist-informed review.

BACKGROUND: The integration of emergency nurse practitioner (ENP) services in emergency departments (EDs) has been well established, especially in high-income countries such as the United Kingdom, the United States and Australia. Different types of reviews, including integrative, literature and systematic, have been carried out to examine evidence regarding the impact of ENPs on the quality of ED services. Unfortunately, there is still limited explanation of the influencing factors that may result in a successful transition process from Registered Nurse to Emergency Nurse Practitioner. This review aims to understand these factors. METHODS: A realist approach (RAMESES) guided this review. CINAHL Plus, MEDLINE, PsycINFO, EMBASE and Web of Science databases were searched to capture studies from 1990 to 2020, combined with policy documents from professional bodies and government websites and relevant references from identified sources. Realist data analysis was carried out on the included articles to understand how context, mechanism and outcomes related to the ED nurses' role transition. RESULTS: Forty-eight articles were included. There were differences in preparatory education and scope of practice of the role. The review configured various contexts, mechanisms and outcomes of the role transition along with their interactions. CONCLUSION: The findings provide a comprehensive understanding regarding the emergency nurses' role transition, with a view to providing better insights and explanations to interested parties who would like to integrate the ENP service in their ED.

Establishing the effectiveness of technology-enabled dementia education for health and social care practitioners: a systematic review.

BACKGROUND: Dementia prevalence is increasing globally and yet evidence suggest that gaps exist in dementia-specific knowledge among health and social care practitioners. Technological modes of educational delivery may be as effective as traditional education and can provide practitioners with increased accessibility to dementia training. Benefits of digitally based dementia education have been established including pedagogical strategies that influence dementia knowledge and care attitudes. This review aimed to appraise and synthesise contemporary experimental evidence that evaluated technology-enabled dementia education for health and social care practitioners. Outcomes based on Kirkpatrick's Model were learner satisfaction; knowledge, skills, and attitudes; behaviours; and results. METHODS: MEDLINE, CINAHL, and Web of Science were among 8 bibliographic databases searched from January 2005 until February 2020. Keywords included dementia and education (and terms for technological modes of education, learning, or training). We included experimental and quasi-experimental studies. Medical Education Research Study Quality Instrument established the overall quality of included studies and pragmatic application of Mixed Methods Appraisal Tool established individual study quality and highlighted methodological features of educational research. Narrative synthesis was conducted as heterogeneous outcome data precluded meta-analysis. RESULTS: We identified 21 relevant studies: 16 evaluated online dementia education and 5 evaluated computer-based approaches. Most studies used before-after designs and study quality was moderate overall. Most studies reported knowledge-based outcomes with statistically significant findings favouring the training interventions. Positive effects were also observed in studies measuring skills and attitudinal change. Fewer studies reported significant findings for behavioural change and results due to training. Case-based instruction was a frequently described instructional strategy in online dementia education and videos were common information delivery modes. CD-ROM training and simulation activities were described in computer-based dementia education. DISCUSSION: Future emphasis must be placed on teaching and learning methods within technology-enabled dementia education which should be role relevant and incorporate active and interactive learning strategies. Future evaluations will require contextually relevant research methodologies with capacity to address challenges presented by these complex educational programmes and multi-component characteristics. SYSTEMATIC REVIEW REGISTRATION: This systematic review is based on a protocol registered with PROSPERO ( CRD42018115378 ).

Increasing cardiovascular medication adherence: A medical research council complex mhealth intervention mixed-methods feasibility study to inform global practice.

AIMS: To evaluate a mHealth intervention to increase medication adherence among Iranian coronary heart disease patients. DESIGN: Quantitative-dominant mixed-methods study. DATA SOURCE: Iranian coronary heart disease patients' responses and most recent clinical documents as well as responses from Iranian cardiac nurses who participated in this study. METHODS: The study was conducted between September 2015-April 2016 drawing on the Medical Research Council's Framework. Phase one comprised of a patients' survey and focus groups with cardiac nurses. The automated short message service reminder was piloted in phase two. We recruited 78 patients and randomized to receive either 12-week daily reminders or usual care. The primary outcome was the effect on medication adherence; secondary outcomes were self-efficacy, ejection fraction, functional capacity, readmission rate and quality of life. RESULTS: Feasibility was evidenced by high ownership of mobile phones and high interest in receiving reminders. Participants in the intervention group showed significantly higher medication adherence compared with the control group. CONCLUSION: The mHealth intervention was well accepted and feasible with early evidence of effectiveness that needs to be confirmed in a fully powered future randomized clinical trial.

Designing and developing core physiology learning outcomes for pre-registration nursing education curriculum.

Physiology is a key element of "bioscience" education within pre-registration nursing programs, but there is a lack of clarity on what is included. Physiology and bioscience content and delivery are highly varied across both higher education institutions and the related programs in the United Kingdom (UK). Despite evidence highlighting concerns over nurses' lack of bioscience knowledge and unsafe practice, there is no universally agreed on curriculum with detailed outcomes of minimum levels of knowledge to support nurses in practice and patient care. This study aimed to inform the construction of discipline-specific physiology learning outcomes to clarify relevant physiological topics required in pre-registration nursing. Initially, 360 learning outcomes were identified from various sources. Using a modified Delphi approach, an expert panel from the Bioscience in Nurse Education group reviewed and modified the list to 195 proposed outcomes. These were circulated to universities in the UK who teach nursing (n = 65). Outcomes that had 80% consensus were automatically included in the next round, with others recommended with modification (response rate 22%). The panel reviewed the modifications, and 182 outcomes were circulated in the second questionnaire (response rate 23%), and further panel review resulting in 177 outcomes agreed. These learning outcomes do not suggest how they should be delivered, but gives the basic level required for qualification as a nurse commensurate with the Nursing and Midwifery Council new standards for the "future nurse."

An Exploration of Comfort and Discomfort Amongst Children and Young People with Intellectual Disabilities Who Depend on Postural Management Equipment.

BACKGROUND: The natural response to the intrusive bodily sensation is positional change. This study explored how children and young people (CYP) with intellectual disabilities had their comfort needs met when using adaptive positioning equipment. METHODS: Thirteen qualitative case studies were undertaken. A parent, a teacher/key worker and a therapist for each CYP were interviewed, and daily routines were observed, with selective video recording. Single case and cross case analyses were undertaken. RESULTS: Attentive caregivers read the behavioural expressions of the CYP and responded reassuringly, safeguarding them from discomforting experiences. Threats to comfort include the restrictive nature of some equipment accessories, positioning errors and procedural stretching. CONCLUSIONS: The same item of equipment can be both comfortable and uncomfortable. Given the social and interactional world in which the CYP live and learn, it is others who must accept responsibility for ensuring their optimal level of comfort.

Telephone management of severe wasp stings in rural Nepal: a case report.

We describe a young woman from a rural village in Nepal who suffered multiple wasp and hornet stings. She collapsed and was managed by a telephone consultation between a village health worker and a hospital specialist. The patient recovered fully. Not only was the telephone consultation efficient in terms of cost savings from avoided hospital treatment, but it was also effective since, with conventional care, there was a strong possibility that the patient would have died on her way to hospital. This case illustrates the potential for telephone-delivered rural care and management in emergency situations.

Sustaining employment after vocational rehabilitation in acquired brain injury.

PURPOSE: To explore factors affecting sustaining employment in people with acquired brain injury (ABI). METHOD: A multiple case study approach using semi-structured interviews in eight cases (29 individuals). Each case included an individual with ABI, a family member, a job coach and a co-worker (triangulation). The eight individuals with ABI had completed vocational rehabilitation and were purposely selected based on whether they had sustained employment (4) or not (4). RESULTS: Similarity between pre-injury work or leisure interest and post-injury work, unconditional motivation, insight and the ability to cope with cognitive and behavioural sequelae were beneficial in sustaining employment. Post-injury instances of poor cognitive or behavioural function did not necessarily affect sustained employment. The vocational rehabilitation programme was beneficial in building up confidence, providing continued follow up and providing co-worker 'twins' in the work place. Employers with a personal experience of disability helped individuals with ABI to sustain employment. CONCLUSIONS: Similarities between pre-injury work or leisure interests and post-injury work improved motivation. Factors associated with sustained employment were insightful, unconditional, internal motivation providing an ability to cope, confidence provided by ongoing vocational rehabilitation support through job coaches, supportive co-workers and employers with a personal experience of disability. People with ABI can be outstanding employees.

The supervision of professional doctorates: experiences of the processes and ways forward.

The doctoral research terrain is changing, as new-styles, for example professional doctorates, are being developed (Park, C., 2005. New variant PhDL the changing nature of the doctorate in the UK. Journal of Higher Education Policy and Management 27(2), 189-207). There is a scarcity of literature aimed at supervisors (Gatfield, T., 2005, An investigation into PhD supervisory management styles: development of a dynamic conceptual model and its managerial implications. Journal of Higher Education Policy and Management 27(3), 311-325) and this is particularly so in relation to professional doctorates. In this position paper we argue that the supervisory approach required for a professional doctorate student is different than that required for a PhD. Professional doctorate students, like PhD students, are required to make an explicit contribution to knowledge. Their emphasis, however, needs to be in producing knowledge that is theoretically sound, original, and of relevance to their practice area. This is of increasing importance within healthcare with the growing emphasis on patient driven translational research. As such, the students and their supervisors face unique challenges of balancing academic requirements with praxis. We suggest this requires specific tools to make explicit the dialogical relationship between a particular project and the cultural, social, educational and political aspects of its environment. We expose the potential of soft systems methodology as a means to highlight the emergent aspects of a doctoral practice development project, their respective and evolving supervisory interactions. This focus of this paper is therefore not about guiding supervision in a managerial sense, but rather at offering methodological suggestions that could underpin applied research at doctoral level.

Preconception counseling in women with diabetes: a population-based study in the north of England.

OBJECTIVE To investigate the association of preconception counseling with markers of care and maternal characteristics in women with pregestational diabetes. RESEARCH DESIGN AND METHODS The study includes data from a regional multi-center survey on 588 women with pregestational diabetes who delivered a singleton pregnancy between 2001 and 2004. Logistic regression was used to obtain crude and adjusted estimates of association. RESULTS Preconception counseling was associated with better glycemic control 3 months preconception (odds ratio 1.91, 95% CI 1.10-3.04) and in the first trimester (2.05, 1.39-3.03), higher preconception folic acid intake (4.88, 3.26-7.30), and reduced risk of adverse pregnancy outcome (P = 0.027). Uptake of preconception counseling was positively associated with type 1 diabetes (1.87, 1.14-3.07) and White British ethnicity (2.56, 1.17-5.6) and negatively with deprivation score (0.78, 0.70-0.87). CONCLUSIONS Efforts are needed to improve preconception counseling rates. Uptake is associated with maternal sociodemographic characteristics.

Aneurysmal subarachnoid hemorrhage: management strategies and clinical outcomes in a regional neuroscience center.

BACKGROUND AND PURPOSE: Aneurysmal subarachnoid hemorrhage (SAH) affects six to eight people per 100,000 annually, yet the optimum management of this condition remains controversial. Although the International Subarachnoid Aneurysm Trial (ISAT) explored this area, only 28% of patients from our center were randomized in that study. Our purpose was to evaluate the treatment and outcomes of patients not recruited into ISAT. METHODS: Procedural data, adverse events, additional procedures, and length of hospital stay were recorded for 122 patients who came to our center with aneurysmal SAH. Modified Rankin Scale (MRS) was assessed at 2 months and at 1 year by a postal questionnaire and telephone interview. RESULTS: Nine patients were treated conservatively, 67 underwent surgical clipping, and 46 underwent endovascular therapy. At 2 months, a good grade (MRS 0-2) was achieved in 67% of patients treated with endovascular therapy and in 45% of patients treated with surgery. At 1 year, a good grade was achieved in 72% in the endovascular group and 49% in the surgical group. CONCLUSION: Endovascular therapy was a safe and effective treatment in a series of subjects who were not randomized in ISAT and in whom endovascular therapy was chosen over surgical clipping. The outcomes at 2 months and 1 year for those subjects treated with endovascular therapy were superior to the outcomes in those treated with surgical clipping. Our study was small and from a single center, but in this population the outcomes of endovascular treatment were similar to those reported by ISAT.

An exploration of German and British physiotherapists' views on the effects of hippotherapy and their measurement.

Hippotherapy (Greek hippos = horse) is a specialised physiotherapy treatment that makes use of the horses' unique three-dimensional movement impulses at a walk to facilitate movement responses in patients sitting on the horse's back (Strauss, 2000). Despite a substantial body of anecdotal and clinical evidence for its benefits, research evidence for hippotherapy is sparse. This questionnaire survey was the first study in a series of investigations exploring the views of physiotherapists and people with cerebral palsy who use hippotherapy. These investigations, in turn, form the basis from which the authors will recommend outcome measures for individuals with cerebral palsy in a hippotherapy environment. This study aimed to: (a) establish the pattern of hippotherapy practice in Germany and the U.K.; (b) examine the perceived main effects of hippotherapy on people with cerebral palsy in Germany and the U.K.; and (c) investigate how these effects are being measured in both countries. The results highlighted considerable differences in how hippotherapy is practised in the U.K. compared with in Germany. In spite of this, the study revealed agreement among respondents on the overall perceived effects of hippotherapy on individuals with cerebral palsy, namely, the regulation of muscle tone, improvement of postural control and psychological benefits. The results also indicate scant use of outcome measures to evaluate these effects. The impact of these findings is discussed in the light of published research, and suggestions for further research are made.

Survival in Duchenne muscular dystrophy: improvements in life expectancy since 1967 and the impact of home nocturnal ventilation.

We reviewed the notes of 197 patients with Duchenne muscular dystrophy whose treatment was managed at the Newcastle muscle centre from 1967 to 2002, to determine whether survival has improved over the decades and whether the impact of nocturnal ventilation altered the pattern of survival. Patients were grouped according to the decade of death and whether or not they were ventilated. Kaplan Meier survival analyses showed significant decade on decade improvement in survival. Mean age of death in the 1960s was 14.4 years, whereas for those ventilated since 1990 it was 25.3 years. Cardiomyopathy significantly shortened life expectancy from 19 years to a mean age of 16.9 years. Better coordinated care probably improved the chances of survival to 25 years from 0% in the 1960s to 4% in the 1970s and 12% in the 1980s, but the impact of nocturnal ventilation has further improved this chance to 53% for those ventilated since 1990.