Surviving rectal cancer at the cost of a colostomy: global survey of long-term health-related quality of life in 10 countries.

BACKGROUND: Colorectal cancer management may require an ostomy formation; however, a stoma may negatively impact health-related quality of life (HRQoL). This study aimed to compare generic and stoma-specific HRQoL in patients with a permanent colostomy after rectal cancer across different countries. METHOD: A cross-sectional cohorts of patients with a colostomy after rectal cancer in Denmark, Sweden, Spain, the Netherlands, China, Portugal, Australia, Lithuania, Egypt, and Israel were invited to complete questionnaires regarding demographic and socioeconomic factors along with the Colostomy Impact (CI) score, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and five anchor questions assessing colostomy impact on HRQoL. The background characteristics of the cohorts from each country were compared and generic HRQoL was measured with the EORTC QLQ-C30 presented for the total cohort. Results were compared with normative data of reference European populations. The predictors of reduced HRQoL were investigated by multivariable logistic regression, including demographic and socioeconomic factors and stoma-related problems. RESULTS: A total of 2557 patients were included. Response rates varied between 51-93 per cent. Mean time from stoma creation was 2.5-6.2 (range 1.1-39.2) years. A total of 25.8 per cent of patients reported that their colostomy impairs their HRQoL 'some'/'a lot'. This group had significantly unfavourable scores across all EORTC subscales compared with patients reporting 'no'/'a little' impaired HRQoL. Generic HRQoL differed significantly between countries, but resembled the HRQoL of reference populations. Multivariable logistic regression showed that stoma dysfunction, including high CI score (OR 3.32), financial burden from the stoma (OR 1.98), unemployment (OR 2.74), being single/widowed (OR 1.35) and young age (OR 1.01 per year) predicted reduced stoma-related HRQoL. CONCLUSION: Overall HRQoL is preserved in patients with a colostomy after rectal cancer, but a quarter of the patients interviewed reported impaired HRQoL. Differences among several countries were reported and socioeconomic factors correlated with reduced quality of life.

Comparison of nursing aids and registered nurses mixed nursing staffing model with different ratios on the nursing outcomes and cost in Neurology and Neurosurgery Center.

BACKGROUND: This study aimed to investigate the effect of nursing aids (NAs) and registered nurses (RNs) mixed nursing staffing model with different ratios on the nursing outcomes and cost in China. METHODS: Five thousand and ninety-one patients treated at Neurology and Neurosurgery Center were consecutively recruited in this study and divided into three groups according to the proportion of NAs and RNs: 100% RN group (N = 1756), 90% RN group (N = 1654), and 75% RN group (N = 1681). Nursing outcomes including medication error, unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, urinary tract infection, pressure ulcer, ventilator weaning, morality, hospital stay, and nursing cost were recorded. RESULTS: No difference of patients' characteristics or RNs' characteristics among three groups was observed. Three-group comparison disclosed that medication error, urinary tract infection, ventilator weaning, and nursing cost were different among three groups, while no difference of unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, pressure ulcer, mortality, or hospital stay was found. Two-group comparison revealed that medication error and nursing cost were reduced in 75% RN group compared with 90% RN group and 100% RN group, but urinary tract infection was increased while ventilator weaning was decreased in 75% RN group and 90% RN group compared with 100% RN group. Multivariate logistic regression also validated 75% RNs independently correlated with decreased medication error, ventilator weaning, and increased urinary tract infection. CONCLUSIONS: NAs and RNs mixed nursing staffing model with 75% RNs reduces medication error and nursing cost, while increasing urinary tract infection and decreasing ventilator weaning.

Who uses NHS Direct? Investigating the impact of ethnicity on the uptake of telephone based healthcare.

INTRODUCTION: NHS Direct, a leading telephone healthcare provider worldwide, provided 24/7 health care advice and information to the public in England and Wales (1998-2014). The fundamental aim of this service was to increase accessibility, however, research has suggested a disparity in the utilisation of this service related to ethnicity. This research presents the first national study to determine how the diverse population in England have engaged with this service. METHODS: NHS Direct call data from the combined months of July, 2010 October, 2010, January 2011 and April, 2011 was analysed (N = 1,342, 245) for all 0845 4647 NHS Direct core service calls in England. Expected usage of NHS Direct was determined for each ethnic group of the population by age and gender and compared by actual usage using Chi-square analysis. A one-way analysis of variance (ANOVA) was used to determine variations of uptake by ethnic group and Index for Multiple Deprivation (IMD) 2010 rank. RESULTS: Results confirmed that all mixed ethnic groups (White and Black Caribbean, White and Black African, White and Asian) had a higher than expected uptake of NHS Direct which held consistent across all age groups. Lower than expected uptake was found for Black (African/Caribbean) and Asian (Bangladeshi/Indian/Chinese) ethnic group which held consistent by age and gender. For the Pakistani ethnic group usage was higher than expected in adults aged 40 years and older although was lower than expected in younger age groups (0-39). CONCLUSION: Findings support previous research suggesting a variation in usage of NHS Direct influenced by ethnicity, which is evidenced on a national level. Further research is now required to examine the underlying barriers that contribute to the ethnic variation in uptake of this service.

Nursing values in China: the expectations of registered nurses.

Abstract The purpose of this study was to identify the essential professional values of Chinese nurses and their manifestations in the current health-care environment. Data were collected from 29 nurse experts by semi-structured individual interviews or focus groups in Beijing and Shanghai, China. Thematic analysis was used to analyze the data. Seven themes were identified: altruism, caring, trustworthiness, dignity, responsibility for the development of the profession, autonomy, and justice. On the whole, these values were in accordance with the codes of the International Council of Nurses and the Chinese Nursing Association. Additionally, culture and socioeconomic trends were found to have an influence on nurses' understanding and explanation of professional values. The findings of this study provided insight into Chinese nurses' professional values and might contribute to the future development of a culturally sensitive scale to measure nursing values in China.

Urinary concentrations of toxic substances: an assessment of alternative approaches to adjusting for specific gravity.

Alternative approaches of adjusting urinary concentration of cadmium for differences in specific gravity of biological samples were assessed. The main analysis used 2922 cadmium-in-urine samples collected in the period 1968-1989 from workers at a UK nickel-cadmium battery facility. Geometric means of cadmium-in-urine, adjusted and unadjusted for specific gravity, were obtained for 21 different values of specific gravity ranging from 1.010 to 1.030. There was a highly significant positive trend (P < 0.001) of unadjusted cadmium-in-urine with specific gravity. Conventional adjustment for specific gravity led to a highly significant negative trend (P < 0.001) of adjusted cadmium-in-urine with specific gravity, SG. An approach proposed by Vij and Howell, involving the introduction of a z coefficient, led to satisfactory adjustment. Conventional adjustment of specific gravity leads to overcompensation of the confounding effects of specific gravity. An alternative method is available and should probably be adopted when interpreting urine biological samples for all chemical substances.

Communication channels to help build an international community of education and practice.

Two-way communication is required if nurses are to build knowledge networks of international communities of nursing education and practice. Are expensive new technologies feasible or preferred for effective communication and productive outcomes? In this report from a longstanding partnership between schools of nursing at Peking University and the University of Michigan, case study methodology is used to evaluate more than a decade of experience with communication modalities: in person, postal mail, express mail, e-mail, fax, telephone, hand delivery by other travelers, and Web sites. Although each education and practice community develops unique ways to build its shared knowledge, a communications plan is suggested, with use of multiple communication techniques, especially those that are low cost and the most dependable. High-cost technologies are not always feasible or preferred. For the project described, they were not necessary to the major outcome, a nursing education and practice network that resulted in the first nurse-managed community-based clinic in China.