Patterns of complementary and alternative medicine use among patients undergoing cancer treatment.

This study aimed to assess the prevalence of complementary and alternative medicine (CAM) use in a representative cancer population prior to and within 6 months of diagnosis. A total of 304 newly diagnosed cancer patients from two UK cancer centres completed a postal survey. Of them, 100 patients (32.9%) used CAM before their cancer diagnosis, 59 of these CAM users continued post diagnosis. Twenty-nine individuals who had not used CAM before began to use it after their cancer diagnosis, creating a total of 88 (28.9%) CAM users in this sample. Reasons for not using CAM included lack of interest, lack of information or endorsement from professionals and satisfaction with conventional care. For those using CAM before diagnosis but not afterwards, the most common reason was a lack of expert guidance on what was safe to use. The use of CAM medicines bought from health food and other retail outlets was high. Complementary and alternative medicine use in cancer patients is common and demonstrates a complex pattern, but CAM use is not significantly greater than in the general population. Some patients purchase CAM medicines without seeking medical advice, thus risking drug interactions. Research to generate information on safety and efficacy of CAM is required.

The role of the multidisciplinary team in recruiting to cancer clinical trials.

This research analyses factors affecting the accrual of women to two breast cancer trials, the British Association of Surgical Oncology (BASO) II trial (a treatment trial) and the International Breast cancer Intervention Study (IBIS) (a prevention trial). The research sought to identify the factors affecting the recruitment of women to breast cancer clinical trials from the multidisciplinary teams' and women's perspectives using multiple methods. This paper reports on the findings from research undertaken with multidisciplinary teams across the United Kingdom and highlights their role in recruiting people to cancer clinical trials. The findings contribute to the debate and knowledge on recruitment in a number of ways by including the views of key stakeholders concerned with these trials, by highlighting the factors affecting recruitment to these two trials, and finally, by making recommendations on methods to enhance recruitment.

Reviewing emergency care systems I: insights from system dynamics modelling.

OBJECTIVES: To describe the components of an emergency and urgent care system within one health authority and to investigate ways in which patient flows and system capacity could be improved. METHODS: Using a qualitative system dynamics (SD) approach, data from interviews were used to build a conceptual map of the system illustrating patient pathways from entry to discharge. The map was used to construct a quantitative SD model populated with demographic and activity data to simulate patterns of demand, activity, contingencies, and system bottlenecks. Using simulation experiments, a range of scenarios were tested to determine their likely effectiveness in meeting future objectives and targets. RESULTS: Emergency hospital admissions grew at a faster annual rate than the national average for 1998-2001. Without intervention, and assuming this trend continued, acute hospitals were likely to have difficulty sustaining levels of elective work, in reaching elective admission targets and in achieving bed occupancy targets. General practice admissions exerted the greatest influence on occupancy rates. Prevention of emergency admissions for older people (3%-6% each year) reduced bed occupancy in both hospitals by 1% per annum over five years. Prevention of emergency admissions for patients with chronic respiratory disease affected occupancy less noticeably, but because of the seasonal pattern of admissions, had an effect on peak winter occupancy. CONCLUSIONS: Modelling showed the potential consequences of continued growth in demand for emergency care, but also considerable scope to intervene to ameliorate the worst case scenarios, in particular by increasing the care management options available in the community.

Reviewing emergency care systems 2: measuring patient preferences using a discrete choice experiment.

OBJECTIVE: To investigate patients' strength of preferences for attributes associated with modernising delivery of out of hours emergency care services in Nottingham. METHODS: A discrete choice experiment was applied to quantify preferences for key attributes of out of hours emergency care. The attributes reflected the findings of previous research, current policy initiatives, and discussions with local key stakeholders. A self complete questionnaire was administered to NHS Direct callers and adults attending accident and emergency, GP services and NHS walk-in centre. Regression analysis was used to estimate the relative importance of the different attributes. RESULTS: Response was 74% (n = 457) although 61% (n = 378) were useable. All attributes were statistically significant. Being consulted by a doctor was the most important attribute. This was followed by being consulted by a nurse, being kept informed about waiting time, and quality of the consultation. Respondents were prepared to wait an extra 2 hours 20 minutes to be consulted by a doctor. There were no measurable preference differences between patients surveyed at different NHS entry points. Younger respondents preferred single telephone call access to health care out of hours. Although having services provided close to home and making contact in person were generally preferred, they were less important than others, suggesting that a range of service locations may be acceptable to patients. CONCLUSIONS: This study showed that local solutions for reforming emergency out of hours care should take account of the strength of patient preferences. The method was acceptable and the results have directly informed the development of a local service framework for emergency care.

Developing your research profile.

This is a pragmatic paper, aimed at nurse teachers and lecturers interested in developing their research profile but unsure of how to go about it. It addresses a range of issues including valuing your past experience, writing for publication, time manage ment, learning from others, considering a sideways move, finding an academic mentor, becoming a reviewer, attending conferences, and seeking research funding. The paper concludes by emphasizing that developing a research profile is a long process, but th at there is a growing interest in having a more clearly defined career pathway to support aspiring nurse researchers.

Enhancing your clinical links and credibility: the role of nurse lecturers and teachersin clinical practice.

In addition to teaching and research, nurse lecturers are expected to maintain clinical credibility and competence by spending at least 20% of their time in practice; this requirement is included in many nurse lecturer/teacher employment contracts. The a imof this paper is to suggest a number of realistic, pragmatic approaches that can be used to enhance clinical credibility and competence, which in turn should result in teaching whichis up-to-date and grounded in the realities of clinical practice. Th e approaches discussed include working clinically, developing the learning environment, getting involved in practice development, developing links with the local trust, involving clinicians in teaching, running a learning set, doing some clinically orien tated research, and running a staff support group. The argument that runs throughout this paper is that nurse lecturers need to develop an individualized practice-based role that enables them to keep in touch with current clinical developments.

Continuing care: developing a policy analysis for nursing.

Continuing care: developing a policy analysis for nursing Many authors have commented on the invisibility of nursing in policy development, implementation and analysis. Some of this invisibility may be attributed to the lack of an easily accessible framework to assist analysis of policy from a nursing perspective. In this paper we offer a framework for nursing policy analysis based on the domain concepts of nursing. We use continuing care for older people, a topical policy issue and fundamental nursing specialty, as a case study to demonstrate the utility and potential of such a framework in action. The resulting analysis helps identify areas of potential policy interest to nurses, raises questions for further policy analysis and offers a coherent position statement for action.

A perspective on lifelong learning and its implications for nurses.

The year 1996 was designated 'European Year of the Lifelong Learner', though there has been little reference or celebration in the nursing press. Much has been written about lifelong learning and lifelong education, but few articles directly address the role of lifelong learning in relation to nurses and nursing. The aim of this paper is to explore the literature on lifelong learning and then relate how lifelong learning might contribute to both nurses and nurse education.

Women, nursing and caring: the issues.

This is the first of three consecutive articles in Nursing Standard dealing with the issues affecting women in nursing. Articles two and three will focus on the specific problems faced by black and ethnic minority women, and on the future of nurse education in relation to recruitment and retention of nurses. This week, the general issues linking women, caring and nursing are examined, and some possible explanations of why so many women are found in nursing are offered.