Primary healthcare service delivery for older people with progressive multimorbidity in low- and middle-income countries: a systematic review.

Ensuring primary healthcare (PHC) accessibility to older people with multimorbidity is vital in preventing unnecessary health deterioration. However, older people ≥50 y of age in low- and middle-income countries (LMICs) face challenges in effectively accessing and utilizing PHC. A systematic review was conducted adopting the Andersen-Newman theoretical framework for health services utilization to assess evidence on factors that affect access to PHC by older people. This framework predicts that a series of factors (predisposing, enabling and need factors) influence the utilization of health services by people in general. Seven publications were identified and a narrative analytical method revealed limited research in this area. Facilitating factors included family support, closeness to the PHC facility, friendly service providers and improved functional status of the older people. Barriers included long distance and disjointed PHC services, fewer health professionals and a lack of person-centred care. The following needs were identified: increasing the number of health professionals, provision of PHC services under one roof and regular screening services. There is a need for more investment in infrastructure development, coordination of service delivery and capacity building of service providers in LMICs to improve access and utilization of PHC services for older people.

Self-expanding metal stents (SEMS) for patients with advanced esophageal cancer in Malawi: an effective palliative treatment.

BACKGROUND AND OBJECTIVES: Esophageal cancer is common in Malawi and most patients are inoperable at time of diagnosis. The aim of this study was to prospectively evaluate palliative treatment with self-expanding metal stents (SEMS) in Malawi, a low-income country with limited medical resources. METHODS: Data of patients with advanced inoperable esophageal cancer were prospectively collected. Tumor and patient specifics, risk factors, dysphagia scores, complications, and survival were assessed. Follow-up data for 1 year or until death were collected from 118/143 patients (83%) during clinic visits, home visits, or via cell phone. RESULTS: One hundred forty-three patients were treated with 154 SEMS. Median survival was 210 days (95% CI: 150-262 days). Fourteen of 118 patients with complete follow-up (11.9%) survived more than 1 year with longest documented survival of 406 days. The median dysphagia score improved from 3 at the time of presentation to 0 at the time of death. Early complications occurred in 4.2% (6/143), late complications in 11.9% of patients (14/118). The procedure related mortality was 2.1% (3/143). CONCLUSIONS: SEMS is an appropriate palliative treatment in a resource-limited environment. For the vast majority of patients a single intervention provides lasting improvement of dysphagia.

Contrast enhanced ultrasound in the detection of liver metastases: a prospective multi-centre dose testing study using a perfluorobutane microbubble contrast agent (NC100100).

OBJECTIVE: To conduct a dose testing analysis of perfluorobutane microbubble (NC100100) contrast-enhanced ultrasound (CEUS) to determine the optimal dose for detection of liver metastases in patients with extra-hepatic primary malignancy. METHODS: 157 patients were investigated with conventional US and CEUS. CEUS was performed following intravenous administration of perfluorobutane microbubbles (using one dose of either 0.008, 0.08, 0.12 or 0.36 µL/kg body weight). Three blinded off-site readers recorded the number and locations of metastatic lesions detected by US and CEUS. Contrast enhanced CT and MRI were used as the "Standard Of Reference" (SOR). Sensitivity, specificity and accuracy of liver metastasis detection with US versus CEUS, for each dose group were obtained. Dose group analysis was performed using the Chi-square test. RESULTS: 165 metastases were present in 92 patients who each had 1-7 lesions present on the SOR. Sensitivity of US versus CEUS (for all doses combined) was 38% and 67% (p = 0.0001). The 0.12 dose group with CEUS (78%) had significantly higher sensitivity and accuracy (70%) compared to other dose groups (p < 0.05). CONCLUSION: The diagnostic performance of CEUS is dose dependent with the 0.12 µL/kg NC100100 dose group showing the greatest sensitivity and accuracy in detection of liver metastases.

Please don't make me ask 'How did I do?'

Here I am, gaunt, twitching with stress and bug-eyed. Just another nurse revalidation, in other words.

Confusion abounds after a cataract op.

What about my eye pad?' asked a patient after his cataract operation. Funnily enough I had been compiling basic ophthalmology competencies that morning and 'the application of an eye pad' was one of them.

Why don't people use the phone any more?

'Ping me an email'. To most people, those four words are quite innocuous, nothing to stir the soul or incite anyone to wrath. But to a nurse….

Speak out if you see patients being treated insensitively.

I'm often told not to 'interfere', so have learned to rein myself in. But sometimes….

There's nothing like a bit of research to give flagging spirits a boost.

A recent study in Spain suggests that our month of birth can make us more susceptible to certain health conditions.

Keep your carrots, just give us a pay rise.

Golden hellos? I must be dreaming. Employers across the country are offering financial inducements as carrots to entice nurses to work for them.

Watch out for the impatient patient.

'How long will we be, nurse?' This is the question that sends my spirits downhill faster than a mountain bike on skis.

Telling patients the cost of their care is immoral.

My friend, who is an occupational therapist, is dismayed about the lack of joined-up thinking where NHS provision and social care are concerned.

Toilets are no place for resuscitating patients.

Patients are given all kinds of information when introduced to hospital facilities. Maps, parking provisions, you name it.

The big medication information dilemma.

'Don't read the insert,' I advised a friend, whisking away the drug packaging. This was followed by an uncomfortable moment waiting for the Nursing Ethics Squad to burst through the door, but I know this person avidly researches side effects.

The Great Smog of 2017 should be a wake-up call to government.

Yellow, dense and lung-wrenching, the London smogs of my childhood are a vivid memory. We would venture out wrapped up like Egyptian mummies, with only our smarting eyes exposed to the toxic air.

I'm just a girl who can't say no... or yes.

'I'm just a girl who can't say no,' sang Ado Annie in the musical Oklahoma. Well, I'm just a girl who can't say yes or no, I discovered, when taking part in a health questionnaire. 'These are yes or no answers,' said the person grilling me, pointedly.

Well-being is every nurse's top priority - unless it's our own.

The recent survey by Nursing Standard and the Sunday Mirror painted a depressing picture of working in today's NHS.

Banter can help get the message across.

When giving postoperative advice to older ophthalmic patients who have a spouse in tow, I often feel like a stand-up comedian with the audience in the palm of my hand.

Workplace violence is unacceptable.

'No one should feel threatened in the workplace for simply doing their job,' said the newspaper report.

All the world's a stage.

Whenever an actor describes their job as hard work, I have been known to guffaw ungenerously. But I have had to eat humble pie.