Nurses' experiences and perceptions of running nurse-led clinics: A scoping review.

AIM: To explore what is known about nurses' experiences and perceptions of running nurse-led clinics. BACKGROUND: Nurse-led clinics were established to address health care needs. In collaboration with medical practitioners, advanced practice nurses may take a selected group of patients and manage their ongoing healthcare independently. Their experiences in running nurse-led clinics directly impact patient satisfaction and clinical outcomes. DESIGN: Scoping review of the peer-reviewed literature. DATA SOURCE: Systematic search through CINAHL, Medline, PsycINFO and Web of Science databases from January 2010 to September 2023. REVIEW METHODS: This scoping review is guided by the updated methodological guidance for the conduct of scoping review from Joanna Briggs Institute. RESULTS: Of 2747 retrieved articles, 15 were included in this review. Synthesis of the findings revealed that nurses believed implementing nurse-led clinics was beneficial to themselves, patients, and healthcare systems. However, they faced challenges in running nurse-led clinics, including insufficient support, teamwork obstacles and lack of role recognition. CONCLUSION: Nurses need to be proactive in promoting their clinics and overcoming challenges. Healthcare organizations are responsible for creating a positive culture to support nurse-led services. Future research should focus on ways to increase global awareness of nurse-led clinics.

Career Considerations in Nurse-Led Traditional Chinese Medicine Clinics: a Two-Center Qualitative Study.

Background: Growing demand exists for high-quality Traditional Chinese Medicine (TCM) care, particularly through Nurse-led TCM clinics (TCM-NLCs). Nurses with extensive experience in TCM departments represent a potential workforce for this healthcare model. This qualitative study aims to investigate the willingness of these candidates to engage in TCM-NLCs, with a specific focus on their main concerns and apprehensions when facing new challenges. Methods: Individual semi-structured face to face interviews were conducted with senior nurses from two TCM hospitals in Shanghai. Each participant had a minimum of three years of work experience in a TCM related department. Conventional qualitative content analysis was utilized. Results: Fourteen participants were interviewed and data saturation was achieved. Nurses exhibited strong interest in practicing in TCM-NLCs. They believed that such innovative TCM nursing service model not only extends nursing role, provides greater empowerment and opportunities for professional development but also meets patients' diverse healthcare needs, reduces reliance on other healthcare providers such as doctors, and increases hospital revenue. However, challenges such as deficiencies in evidence-based TCM nursing education, the absence of standardized practice guidelines, and limited prescriptive privileges were identified as primary obstacles to engaging in TCM-NLCs practice, potentially undermining the specialization of this advanced nursing practice model. Conclusion: Although the nurses interviewed were highly motivated, they generally lacked confidence to practice independently in TCM-NLCs. A pressing priority is to address their concerns by providing appropriate resources as well as education and policy support to enhance their competency and ensure their practice autonomy, therefore building a more qualified pool of professionals for advanced TCM nursing practice.

The influence of incentive and target assessment mechanism on the operation and management efficien-cy of nurse-led clinics / 现代医院

Objective To study the effect of incentive and target assessment mechanism on the operation and manage-ment efficiency of nurse-led clinics.Methods 45 cases in the nurse-led clinic managed by the target assessment mechanism in our hospital from June to December 2021 were selected as the control group,and 46 cases managed by the incentive joint target assessment mechanism in our hospital from February to July 2022 were selected as the observation group.The annual workload,doctors'recognition of nurses,nursing quality and self-efficacy scale(GSES)scores before and after intervention were compared between the two groups,and the satisfaction of nurses in charge of patients was compared between the two groups.Results Be-fore intervention,there was no difference in the annual workload between the two groups(P＞0.05).After intervention,the an-nual workload of the two groups increased,and the observation group was higher than the control group(P＜0.05).Before inter-vention,there was no difference in the scores of recognition degree between the two groups(P＞0.05).After intervention,the scores of communication ability,quality management ability,emergency ability,independent work ability and specialist problem solving ability of the two groups increased,and the observation group was higher than the control group(P＜0.05).Before inter-vention,there was no difference in nursing quality score between the two groups(P＞0.05).After intervention,the quality of nursing cases,the quality of patient safety management,the quality of post work and the total mean score of the two groups were increased,and the observation group was higher than the control group(P＜0.05).Before intervention,there was no difference in GSES scores between the two groups(P＞0.05).After intervention,GSES scores of the two groups increased,and the obser-vation group was higher than the control group(P＜0.05).The total satisfaction rate of patients in observation group was 96.25% ,higher than 86.25% in control group(P＜0.05).Conclusion The incentive and target assessment mechanism can significantly improve nurses'annual workload and nursing quality,doctors'recognition of nurses and patients'satisfaction with nursing.

Immunization Coverage in Young People Experiencing Homelessness and the Impact of a Nurse-led Program.

OBJECTIVES: To identify the proportion of young people experiencing homelessness who are immunized against vaccine-preventable diseases, and to evaluate the impact of a nurse-led immunization program to improve vaccination coverage in this population. METHODS: A retrospective audit of electronic medical records included 400 participants aged 15 to 24 years who had an encounter with the Young People's Health Service, a nurse-led clinic co-located with a specialist youth homelessness service in Melbourne, Australia, between February 2019 and May 2021. RESULTS: Integrating an immunization nurse within a youth specialist homelessness service increased the percentage of young people who were up-to-date with routine vaccinations from 6.0% (n = 24) to 38.8% (n = 155). Intersecting social determinants of health that increased participants' risk of vaccine preventable diseases, and of missing routine vaccines, were common. CONCLUSIONS: Incomplete coverage of routine vaccines is common in young people accessing homelessness services, and this coverage was improved when young people encountered an immunization nurse while accessing support from a specialist youth homelessness service. As a service model, nurse-led community health clinics co-located within homelessness providers can improve vaccination coverage, and therefore health outcomes, of young people experiencing or at risk of homelessness.

The development of practice standards for patient education in nurse-led clinics: a mixed-method study.

INTRODUCTION: Educating patients and families about self-care is one of the important roles of nurses in Nurse-led clinics (NLCs). NLCs need standards for guiding the practice of nurses. A standard is an authoritative statement that sets out the legal and professional basis of nursing practice. This paper seeks to report the development of practice standards for patient and family education in NLCs. METHODS: This project used a Sequential-Exploratory mixed methods design. Before the study, we conducted a literature review to identify gaps. Directed content analysis was used in phase 1. The second phase involved two focus groups. The third phase involves two rounds of modified Delphi. RESULTS: Twenty-nine participants were interviewed, and 1816 preliminary codes were formed in phase 1. 95 standards were grouped into three main categories (structure, process, and outcome). In the first focus group, experts eliminate 32 standards. Experts eliminate 8 standards after the second stage of the focus group. After two rounds of Delphi, the final version of the standard consists of 46 standards (13 structure, 28 process and 5 outcome). CONCLUSIONS: Nurses and institutions could benefit from practice standards for patient education in the NLCs, which consist of 46 statements in three domains, as a guide for clinical activities and a tool to gauge the quality of patient education in NLCs. The developed standards in this study can guide new and existing NLCs and help them evaluate ongoing activities. Providing patient education in NLCs based on standards can improve patients' outcomes and promote their health.

Nurse-led emergency department avoidance model of care for patients receiving cancer therapy in the ambulatory setting: a health service improvement initiative.

AIMS: The Symptom and Urgent Review Clinic was a service improvement initiative, which consisted of the implementation and evaluation of a nurse-led emergency department (ED) avoidance model of care. The clinic was developed for patients experiencing symptoms associated with systemic anti-cancer therapy in ambulatory cancer settings. METHODS: The clinic was implemented in four health services in Melbourne, Australia across a six-month period in 2018. Evaluation was by prospective data collection of the frequency and characteristics of patients who used the service, pre- and post-survey of patient reported experience, and a post-implementation survey of clinician engagement and experience. RESULTS: There were 3095 patient encounters in the six-month implementation period; 136 patients were directly admitted to inpatient healthcare services after clinic utilization. Of patients who contacted SURC (n = 2174), a quarter (n = 553) stated they would have otherwise presented to the emergency department and 51% (n = 1108) reported they would have otherwise called the Day Oncology Unit. After implementation, more patients reported having a dedicated point of contact (OR 14.3; 95% CI 5.8-37.7) and ease of contacting the nurse (OR 5.5; 95% CI 2.6-12.1). Clinician reported experience and engagement with the clinic was highly favorable. CONCLUSION: The nurse-led emergency department avoidance model of care addressed a gap in service delivery, while optimizing service utilization by reducing ED presentations. Patients reported improved levels of satisfaction with ease of access to a dedicated nurse and advice provided.

Evaluation of a nurse-led glaucoma assessment clinic for non-complex patients.

AIMS AND OBJECTIVES: The purpose of this study was to assess the safety, feasibility and effectiveness of a nurse-led glaucoma assessment clinic service. BACKGROUND: Glaucoma is a group of serious, irreversible optic neuropathies that progressively damage the optic nerve resulting in blindness. Over 64.3 million people globally are affected by glaucoma with numbers projected to increase to 111.8 million by 2040. Glaucoma is a major public health concern that requires the development of innovative models of care to meet current and future health care demands. METHODS/DESIGN: A mixed method design was used to evaluate the assessment of non-complex glaucoma patients attending a new nurse-led clinic. Under an ophthalmologist's supervision, the glaucoma nurse completed 100 hof clinical training and assessment to ensure they were competent in completing and interpreting the required glaucoma assessment protocols. Interrater reliability between the glaucoma nurse and ophthalmology doctor was undertaken. Glaucoma patient waitlist appointment data were also compared before and after the introduction of the nurse-led clinics. This study adhered to the SQUIRE checklist for the reporting of excellence with quality improvement projects. PATIENT CONTRIBUTION: Patients contributed to the evaluation of this new nurse-led service by providing follow-up feedback on their experience. RESULTS: Agreement between clinicians for appropriate follow-up appointment times was high with 93% (n = 315) agreement achieved. Furthermore in 297 (87.5%) cases, both clinicians agreed on the patient being referred to the doctor for follow-up review. Glaucoma consultations were shown to increase from 3,115 appointments in 2019/20 to 3,504 appointments in 2020/21 after the introduction of the nurse-led clinic. The nurse-led clinics accounted for 14.5% (n = 512) of clinic appointments. CONCLUSIONS: The introduction of the nurse-led glaucoma assessment clinic service allowed patients to be reviewed safely, efficiently and satisfactorily. This new service subsequently allowed for more complex glaucoma patients to be seen by the ophthalmologists. RELEVANCE TO CLINICAL PRACTICE: Findings revealed that suitably trained glaucoma nurses are able to clinically assess and safely monitor stable non-complex glaucoma patients. Highlights the need for appropriate investment in clinical training and supervision to ensure that glaucoma assessment nurses are adequately prepared to undertake this new practice role.

Experience of Patients With Rheumatoid Arthritis: A Qualitative Study of a Nurse-Led Clinic.

Rheumatoid arthritis (RA) is an extremely prevalent chronic inflammatory rheumatic disease. This study explores the experiences of patients with RA under nurse-led care, the roles that nurses play, and the outcomes achieved when applying the patient-centered care (PCC) approach. A purposive sample of 12 participants who had been diagnosed with RA for at least 1 year were recruited from a nurse-led rheumatology clinic. They were also receiving treatment with disease-modifying antirheumatic drugs. All of the participants reported high levels of satisfaction with the care they received in the nurse-led clinic, along with high levels of medication adherence. The nurses were highly accessible to the participants, and they regularly communicated information regarding their symptoms, medication, and treatment management. These findings illustrate the importance of the holistic care that nurses provide to their patients, as the participants agreed that nurse-led services could have a wider outreach in hospitals and the community.

Experiences of nurses working in nurse-led clinics in Traditional Chinese Medicine hospitals: A focused ethnographic study.

BACKGROUND: Traditional Chinese Medicine (TCM) nurse-led clinics (NLC) is an innovative working model in China, representing the specialization and extension of nurses' role. However, as a pioneer in TCM nursing, this new model of working is facing both opportunities and challenges because it is known little about the operational status of NLCs. AIMS: To explore the experiences of nurses who work in NLC in TCM hospitals. MATERIALS & METHODS: A focused ethnographic study was conducted in three TCM hospitals affiliated with Guangzhou University of Chinese Medicine. We interviewed eleven nurses in those hospitals and observed seven of them working with patients. We used snowball sampling for data collection including interview, non-participant observation and documents from medical records. All the data were processed as following steps: (a) coding for descriptive labels; (b) sorting for patterns; (c) identifying outliers or negative cases; (d) generalizing with construction and theories and (e) noting reflective remarks. RESULTS: Nurse-led clinics help nurses develop their skills and knowledge that are highly recognized by public since they meet the growing needs of patients and also relieve the workload of physicians in the hospitals. However, lack of specialization is still a major challenge in NLCs due to insufficiency of full-time staff with specialized education, nurse-led practice without standardized guidelines, restrictions on prescription right of nurses, and also inadequate support from hospitals. DISCUSSIONS: As a revolutionary innovation of working model for nurses in TCM hospitals, NLCs could improve quality of care and lead to a comprehensive promotion of nursing career. However, there are several challenges on providing high quality care for patients whilst improving educational development of nurses. This study suggests that nurses, hospital administration and the government should cooperate with each other to develop standard nursing programs for NLCs. CONCLUSIONS: It is imperative to identify nursing roles, collect available resources, and develop supportive policies and training programs to enhance the quality of NLCs.

Ambulatory chest drainage with advanced nurse practitioner-led follow-up facilitates early discharge after thoracic surgery.

OBJECTIVES: To demonstrate the safety and feasibility of advanced nurse practitioner-led (ANP-led) outpatient follow-up after discharge with ambulatory chest drains for prolonged air leak and excessive fluid drainage. METHODS: Patients discharged with ambulatory chest drains between January 2017 and December 2019 were retrospectively reviewed. Discharge criteria included air leak < 200 ml/min or fluid drainage > 100 ml/24 h on a digital drain. Patients were reviewed weekly in the clinic by ANPs, a highly skilled cohort of nurses with physician support available. Outcomes included length of stay, duration of air or fluid leak and complications. RESULTS: Two-hundred patients were included, amounting to 368 clinic episodes. The median age was 68 ± 13 years and 119 (60%) were male. 112 (56%) patients underwent anatomical lung resection (total anatomical lung resections during the study period = 917) equating to a discharge with ambulatory chest drain rate of 12.2% in this group. The median length of stay was 6 ± 3 days and 176 (88%) patients were discharged with air leak versus 24 (12%) with excessive fluid drainage. The median time to drain removal was 12 ± 11 days. Complications occurred in 16 patients (8%) and 12 (6%) required readmission. An estimated 2075 inpatient days were saved over the study period equating to an annual cost saving of £123,167 (US$149,032) per annum. CONCLUSIONS: Patients with air leak or excessive fluid drainage can safely be discharged with ambulatory chest drains, allowing them to return to their familiar home environment safely and quickly. ANP-led clinics are a robust and cost-effective follow-up strategy and are associated with a low complication rate.

Safety and outcome of nurse-led syncope clinics and implantable loop recorder implants.

BACKGROUND: Implantable loop recorders (ILRs) are effective in achieving symptom-rhythm correlation. Data on the diagnostic yield of ILRs, on nurse-led syncope clinics, and on nurse-led ILR implants are limited. OBJECTIVE: We evaluated the safety and efficacy of our nurse-led syncope clinic and nurse-led ILR implants. METHODS: A retrospective study of all consecutive patients undergoing nurse-led ILR implantations was performed between April 2016 and April 2018. Patients were referred from both nurse-led and physician-led clinics. Data were collected on baseline demographic characteristics, referral source, symptom-rhythm correlation, ILR findings, and subsequent changes to management. All ILRs were enrolled into remote monitoring with automatic arrhythmia detection, and all immediate (≤24 hours) ILR implant complications were recorded. Comparisons were made between nurse-led and physician-led clinics and subsequent outcomes. RESULTS: A total of 432 patients with an ILR were identified: 164 (38%) from nurse-led and 268 (62%) from physician-led clinics; 200 (46%) were women (mean age 66.5 ± 18.2 years; mean follow-up duration 28.9 ± 9.5 months). Primary ILR indications were syncope (n = 251 [58%]), presyncope (n = 33 [7%]), palpitation (n = 39 [9%]), cryptogenic stroke (n = 78 [18%]), and other reasons (n = 31 [7%]). No immediate ILR implant complications occurred. Overall, 156 patients (36%) had a change in management as a direct result of ILR findings, with no overall differences between nurse-led and physician-led clinics (35% vs 36%; P = .7). More patients had newly diagnosed atrial fibrillation in physician-led clinics (15% vs 7%; P = .01), and more patients had pacemaker implants for bradycardia in nurse-led clinics (23% vs 13%; P < .01). CONCLUSION: Nurse-led ILR implantation was safe and effective. Nurse-led syncope clinics achieved good symptom-rhythm correlation with resultant significant changes to management in comparison to physician-led clinics. Larger prospective studies are needed to evaluate their longer-term impact.

Task Sharing for Managing Common Noncommunicable Disease in a Nurse Led Noncommunicable Diseases Clinic in Peri-Urban Community of Chandigarh.

Background: Nurse led noncommunicable diseases (NCD) clinic may address the significant shortage of human resource for health for managing common NCDs. The objective of this study is to assess the feasibility and effectiveness of nurse-led NCD clinic for identification, prevention, and management of common NCDs. Materials and Methods: A quasi experimental study was conducted at a Public Health Dispensary in periurban community of Northern India. Situational analysis and stakeholders' interview were done based on which the clinic was setup and run over a period of 2 months by registered nurses and nursing students to offer screening, health education and appropriate referral. The primary outcome of study was proportion of population screened, prevalence of common NCDs, risk factors modification, medication adherence, and patient satisfaction. Results: It was feasible to run a nurse led clinic in terms of availability of space, equipment to run the clinic and human resource. A total of 455 individuals aged ≥30 years were enrolled using the total enumeration sampling technique. There was a significant increase in screening rates from 0.29% to 3.7% in nurse-led NCD clinic. There was significant mean change in systolic blood pressure (18.75 ± 6.92 mm Hg), diastolic blood pressure (4.4 ± 3.71 mm Hg), random blood sugar (33.36 ± 38.49 mg/dl) Body Mass Index, and waist circumference (P < 0.01) among the population screened. Medication adherence significantly increased from 7.8% to 76.4% (P < 0.01) after 2 months of nurse-led NCD clinic. Conclusion: Task sharing for managing common NCDs in nurse-led NCD clinic was feasible and effective in increasing screening rates, medication adherence, and risk factors modification among studied population.

Adapting a 2-week-wait colorectal service in the pandemic using the quantitative faecal immunochemical test.

The coronavirus pandemic has brought about an economic and healthcare crisis. This has resulted in delays in virtually all areas of patient care and has forced clinicians to review and adapt their processes, in order to ensure patients continue to have access to timely and effective services. In the author's local Trust, this manifested in altered protocols, developed in order to maintain patient and staff safety while conducting invasive and potentially virus-spreading investigations. A new (temporary) standard operating procedure was developed in conjunction with Cancer Alliance South West to introduce the quantitative faecal immunochemical test (qFIT) as an indicator for diagnostic testing after the majority of diagnostic services were suspended or drastically reduced. Patients would then have their investigation(s) deferred on the basis of a negative result (<10 mcg Hb/g). This cohort (n=120) were revisited once diagnostic services were resumed and referred for CT examination. Audits carried out on the data showed that nine cancers had been identified in the negative qFIT population (lung, prostate, breast, bladder, small bowel carcinoid, oesophageal and three occurrences of caecal carcinoma. This article provides an overview of the experiences and outcomes of a colorectal 2-week-wait service in response to this global pandemic and how this experience will shape the service in the future.

Factors and health-related quality of life associated with participation in a post-ICU follow-up. A register study.

BACKGROUND: Follow-up for heterogeneous intensive care patients presents challenges for rehabilitation interventions and outcome measurements. The aim was to describe and explore characteristics and determinants for visiting/not visiting a nurse-led clinic (NLC) at different time-points, and to describe physical and mental health (HRQoL) over time. METHODS: Patients with a length of stay (LOS) of ≥72 hours, discharged from a general intensive care unit 2004-2014, who participated in a 6-month follow-up programme offering visits to NLC at 2 and 6 months were included. The register study includes information regarding patients' participation in NLC, clinical and demographic data from the Patient Administrative System within Intensive care, and data on 2-, 6- and 12-month HRQoL by using SF-36 from the Swedish Intensive Care Registry. RESULTS: Of 656 patients, 57% visited the NLC on some occasion. These patients were younger (P = .000), had lower Simplified Acute Physiology scores (P = .001) and higher SF-36 physical health domain scores at 2 months (P < .05) compared to those not visiting at all. Visitors at 2 months only were younger, had shorter LOS and higher physical and mental domain scores than patients visiting at 6 months only. Patients visiting the NLC scored significantly higher in all domains from 2 to 12 months, whereas non-visiting-patients' did this in four out of eight domains during the same time frame. CONCLUSION: Individual patient's characteristics and current health conditions seem to influence visits to NLC or not. The findings may contribute to the development of existing routines to match the diversity of patients' needs and life situations.

Establishing a nurse-led thyroid cancer follow-up clinic.

Thyroid cancer is a complex disease requiring management by a large multidisciplinary team. The number of patients with a diagnosis of thyroid cancer is significantly increasing year-on-year, and traditional models of consultant-led follow up are no longer sustainable. Although nurse-led cancer follow-up clinics are becomining increasingly common, thyroid cancer nurse-led follow-up clinics are rare. An excellent understanding of the disease, treatment and management of risk of disease recurrence is essential for safe patient care, and is discussed in this article. The clinic discussed uses the skill set of head and neck nurse specialists, including psychological support, coping strategies for long-term side effects of treatment and non-medical prescribing. A patient survey of the service revealed high levels of patient satisfaction and a desire to continue face-to-face consultations rather than telephone clinics.

Repair of central venous access devices in intestinal failure patients is safe and cost-effective: A retrospective single centre cohort study.

INTRODUCTION: Patients with chronic intestinal failure (IF) require home parenteral nutrition (HPN). Central venous access is needed for prolonged use of PN, usually via a long term central venous access device (CVAD). Post insertion there may be mechanical complications with a CVAD such as catheter rupture or tear. Repair of damaged CVADs is possible to avoid risks associated with catheter replacement in patients with IF. However, catheter related blood stream infections (CRBSI) are a concern when CVAD's are accessed or manipulated. AIMS: To investigate the success of repair of CVADs in patients with IF on HPN, related to repair longevity and incidence of CRBSI following repair. METHOD: Nutrition team records of CVAD repairs carried out in patients with IF were reviewed retrospectively for the period April 2015 to March 2019. RESULTS: Nutrition Clinical Nurse Specialists carried out 38 repairs in 27 patients. Male n = 5, female n = 22; mean age 55 years. Catheter longevity before first repair (n = 27): median 851 days, IQR 137-1484 days. 30/38 (78.9%) of repairs were successful lasting ≥30days. Hospital admission was avoided in 76% of cases. 4 patients in the failed repair group underwent catheter re-insertion where 4 had a further, subsequently successful, repair, an overall success rate of 89.4% (34/38). 30-day CRBSI rate was 0.09/1000 catheter days in repaired catheters. In comparing costs, there is a potential cost saving of 2766GBP for repair compared to replacement of damaged CVADs. CONCLUSION: Repair of tunnelled CVADs in patients with IF is successful and safe with no increased risk of CRBSI. Significant cost savings may be made.

Impact of Nurse-Led Titration Versus Physician Prescription of Hypoglycaemic Agents on HbA1c Level in Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

A nurse-led diabetic clinic to manage type 2 diabetes, which emphasizes medication adherence, titration of hypoglycemic agents, behavior modification, and motivation for lifestyle changes, is widely recommended and practiced in western countries. This review aims to examine the impact of a nurse-led diabetic clinic versus a standard physician-led diabetic clinic on glycaemic control of type 2 diabetes patients. Studies were obtained using a comprehensive search in the electronic databases of PubMed, Embase, SCOPUS, Cochrane Library, and gray literature through March 2021. We calculated the pooled effect estimate with 95% confidence intervals (CIs) comparing subjects with and without nurse-led titration of hypoglycemic agents using standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes. Four trials comprising 470 participants (241 intervention group and 229 control group) met the inclusion criteria. Glycated hemoglobin (HbA1c levels and BMI were lower in participants with a nurse-led diabetic clinic (SMD = -0.54, 95% CI -0.89 to -0.20, I2 = 67%, p = 0.002) and (SMD = -0.26 (95% CI -0.45 to -0.07, I2 = 0%, p = .008), respectively, than in those attending a standard physician-led diabetic clinic. Similarly, the pooled result shown that patients attending the nurse-led diabetic clinic had a 31% higher satisfaction level (RR 0.69; 95% CI, 0.51 to 0.92, I2 = 0%, p= 0.01). On the other hand, there was no significant association of the nurse-led diabetic clinics on patients' blood pressure and intensification of hypoglycemic agents. The certainty of the evidence assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was moderate for outcomes like HbA1c level, intensification of hypoglycemic agents, and patients' satisfaction and low for other secondary outcomes. Our meta-analysis allows for the conclusion that nurse-led titration of hypoglycemic agents is associated with better glycemic control and enhances patients' satisfaction. Therefore, it is recommended to establish and strengthen nurses-led diabetic clinics for better HbA1c control where physician-led diabetic services are limited. Further research is needed to enhance the quality of the evidence.

Effectiveness of nurse-led clinics in the early discharge period after percutaneous coronary intervention: A systematic review.

BACKGROUND: Readmission after percutaneous coronary intervention is common in the early postdischarge period, often linked to limited opportunity for education and preparation for self-care. Attending a nurse-led clinic within 30 d after discharge has the potential to enhance health outcomes. OBJECTIVE: The aim of the study was to synthesise the available literature on the effectiveness of nurse-led clinics, during early discharge (up to 30 d), for patients who have undergone percutaneous coronary intervention. REVIEW METHOD USED: A systematic review of randomised and quasi-randomised controlled trials was undertaken. DATA SOURCES: The databases included PubMed, OVID, CINAHL, EMBASE, the Cochrane Library, SCOPUS, and ProQuest. REVIEW METHODS: Databases were searched up to November 2018. Two independent reviewers assessed studies using the Cochrane risk-of-bias tool. RESULTS: Of 2970 articles screened, only four studies, representing 244 participants, met the review inclusion criteria. Three of these studies had low to moderate risk of bias, with the other study unclear. Interventions comprised physical assessments and individualised education. Reported outcomes included quality of life, medication adherence, cardiac rehabilitation attendance, and psychological symptoms. Statistical pooling was not feasible owing to heterogeneity across interventions, outcome measures, and study reporting. Small improvements in quality of life and some self-management behaviours were reported, but these changes were not sustained over time. CONCLUSIONS: This review has identified an important gap in the research examining the effectiveness of early postdischarge nurse-led support after percutaneous coronary intervention on outcomes for patients and health services. More robust research with sufficiently powered sample sizes and clearly defined interventions, comparison groups, and outcomes is recommended to determine effectiveness of nurse-led clinics in the early discharge period.

Adherence and sustained virologic response among vulnerable people initiating an hepatitis C treatment at a nurse-led clinic: A non-experimental prospective cohort study based on clinical records.

Background: There is a need to develop specific care route for vulnerable people with hepatitis C virus. Objective: At a nurse-led clinic, we aimed to: (1) report the prevalence of patients initiating an hepatitis C treatment who (a) achieved sustained virologic response and (b) were adherent to their treatment; and (2) explore factors associated with adherence and sustained virologic response. Design: A clinical record-based prospective cohort study. Setting: A community-based nurse-led clinic coordinating outreach services for people with hepatitis C virus in Québec City, Québec, Canada. Population: All patients initiating an hepatitis C treatment at the nurse-led clinic from January 1, 2012 to December 31, 2017 (end of data collection). Methods: Patients were followed from the day they initiated their hepatitis C treatment, up to 24 weeks after the end of the treatment. Sustained virologic response was achieved if hepatitis C virus ribonucleic acid (RNA) was undetectable or below the lower limit of quantification at week 12 or later. Patients who reported hepatitis C treatment completion without missing any doses were considered adherent. Factors associated with adherence and sustained virologic response were identified using adjusted prevalence ratios. Results: A total of 171 patients infected with hepatitis C virus (women: n = 51, 30%; criminal record: n = 102, 60%; substance addiction: n = 99, 58%) initiated an hepatitis C treatment at the nurse-led clinic. Overall, 126/171 (74%) patients were adherent. Patients using illicit drugs were less likely to be adherent (adjusted prevalence ratio 0.77, 95% confidence interval 0.67-0.89). Among 156/171 (91%) patients with an hepatitis C virus RNA test post-treatment, 96% (n = 149) achieved sustained virologic response. Patients who were less likely to achieve sustained virologic response were those who were non-adherent (adjusted prevalence ratio 0.81, 95% confidence interval 0.68-0.98) or who had a criminal record (adjusted prevalence ratio 0.87, 95% confidence interval 0.79-0.97). Conclusions: A nurse-led clinic could fill an important gap in hepatitis C health services targeted at vulnerable people in a community setting, to drive adherence and achievement of sustained virologic response.

Pilot study of a nurse-led adult lacrimal clinic at a tertiary ophthalmic centre.

This article provides the reader with an outline of the anatomy and physiology of the lacrimal system and illustrates how a variety of pathologies within this system can result in the development of a watery eye. It describes the role of the nurse consultant in the diagnosis and management of patients with watery eye in the lacrimal clinic, and how the training programme for the development of such skills was implemented. Following training, within the realms of an established pilot study, the nurse consultant began to implement her skills in a newly established nurse-led lacrimal clinic. Patients seen in the lacrimal clinic would previously have been assessed and managed by a doctor. To confirm the accuracy of this approach, an audit was undertaken comparing the nurse-led diagnosis and management plans with that of an oculoplastic doctor. In addition, patient waiting times in the clinic and patient satisfaction were assessed, as important indicators of quality of care.