Routine germline BRCA1 and BRCA2 testing in patients with ovarian carcinoma: analysis of the Scottish real-life experience.

OBJECTIVE: To determine the rates of germline BRCA1 and BRCA2 mutations in Scottish patients with ovarian cancer, before and after a change in testing policy. DESIGN: Retrospective cohort study. SETTING: Four cancer/genetics centres in Scotland. POPULATION: Patients with ovarian cancer undergoing germline BRCA1 and BRCA2 (gBRCA1/2) sequencing before 2013 (under the 'old criteria', with selection based solely on family history), after 2013 (under the 'new criteria', with sequencing offered to newly presenting patients with non-mucinous ovarian cancer), and in the 'prevalent population' (who presented before 2013, but were not eligible for sequencing under the old criteria but were sequenced under the new criteria). METHODS: Clinicopathological and sequence data were collected before and for 18 months after this change in selection criteria. MAIN OUTCOME MEASURES: Frequency of germline BRCA1, BRCA2, RAD51C, and RAD51D mutations. RESULTS: Of 599 patients sequenced, 205, 236, and 158 were in the 'old criteria', 'new criteria', and 'prevalent' populations, respectively. The frequency of gBRCA1/2 mutations was 30.7, 13.1, and 12.7%, respectively. The annual rate of gBRCA1/2 mutation detection was 4.2 before and 20.7 after the policy change. A total of 48% (15/31) 'new criteria' patients with gBRCA1/2 mutations had a Manchester score of <15 and would not have been offered sequencing based on family history criteria. In addition, 20 patients with gBRCA1/2 were identified in the prevalent population. The prevalence of gBRCA1/2 mutations in patients aged >70 years was 8.2%. CONCLUSIONS: Sequencing all patients with non-mucinous ovarian cancer gives a much higher annual gBRCA1/2 mutation detection rate, with the frequency of positive tests still exceeding the 10% threshold upon which many family history-based models operate. TWEETABLE ABSTRACT: BRCA sequencing all non-mucinous cancer patients increases mutation detection five fold.

Nurturing the transformation from staff nurse to leader.

A major component of nurse job satisfaction is autonomy of clinical practice, recognition by colleagues, and participation in decision making relative to patient outcomes. Shared governance provides the framework for autonomy and control of practice, yet implementation of this model implies staff participation as leaders. Staff nurses describe a transformation of perspective when adopting decision-making, leadership-oriented roles and recount the factors that influence and nurture their confidence and acceptance.

Choosing a clinical information system.

To best represent nurses' interest in selecting a new clinical information system, nurse leaders can target problem areas, consider nursing's future needs, and pinpoint areas to streamline.

Changes in isometric force of mouse soleus muscle during the oestrous cycle.

Muscles excised from young female mice at known phases of the oestrous cycle were studied in vitro to determine if there are variations in force analogous to those that occur in vivo during the menstrual cycle in women. Oestrous phase was determined from vaginal smears. The maximum isometric and eccentric forces of pairs of isolated soleus muscles were measured. The first muscle was studied immediately after dissection, the second after incubation in Ringer solution for up to 2 h. Normalised isometric muscle force in the first muscle of each pair depended on the oestrous phase, the force being greatest during dioestrus. There was a negative correlation between normalised force and the eccentric/isometric force ratio. Neither of these phenomena was found with the second muscle of each pair. These results show that in mouse soleus muscle cross-bridge function does vary according to the phase of the oestrous cycle. However, the rise in force does not follow the pattern of the rise in blood oestrogen levels as it does in humans, and in the mouse the effect on cross-bridge function washes out after a few hours in vitro.

Factors associated with a perceived harmful outcome from medication errors: a pilot study.

The purpose of this pilot study was: 1) to describe factors associated with a perceived harmful outcome following medication errors made by nurses and 2) to refine the Medication Error Risk Profile (MERP) (Wolf, 1992). Ninety-four registered nurses and licensed practical nurses completed the MERP. Multiple stepwise regression analyses were used to explain the variance in the dependent variable of perceived patient harm with: 1) phases of preparation and administration; 2) categories of person responsible for the error; 3) interventions needed following the error and symptoms related to the error. The exploratory regression analysis suggests a model in which the dispensing phase of administration, the physician and pharmacist categories of persons responsible for the error, and the interventions of patient transfer to another unit and additional medications given following the error explain 53% of the variance in perceived harmful outcome for patients consequent to medication errors. A moderately strong correlation (r = .46, P < .001) existed between perceived patient harm as measured on the four-point scale and total intervention score following medication errors.

The challenge for education in a transformed health care system.

A focus on health promotion, disease prevention, and health education for all members of society has emerged from the federal guidelines of Healthy People 2000 and, more important, from the demonstrated needs of vulnerable populations. New and potent organisms and diseases have stressed the health care system. Nursing administrators face significant challenges in managing health care delivery and nursing within the multidisciplinary team in the transformed system. In all areas, education must be directed to meet the challenges and nursing must assume the leadership for ensuring the health care needs of individuals and communities, now and in the future.

Effect of three teaching methods on a nursing staff's knowledge of medication error risk reduction strategies.

The authors' purpose in this study was to (1) compare the effects of three teaching methods on registered nurses' and licensed practical nurses' knowledge of medication error risk reduction strategies, and (2) to compare registered nurses' and licensed practical nurses' knowledge of medication error risk reduction strategies using a pretest/posttest design. Registered nurses (n = 129) and licensed practical nurses (n = 21) employed by two hospitals constituted the study sample. Subjects were assigned alternately to three intervention groups: videotape (n = 50); instructional booklet (n = 50); and lecture (n = 50). A 38-item test, including true-false, multiple choice, matching items and dosage calculation problems, was administered to subjects in each group before and after the teaching intervention. On the basis of the results, there was no statistically significant difference in total knowledge scores for the three intervention groups (F = 2.07, P = 0.130). Staff development instructors should consider the advantages of a videotape and instructional booklet over the time-intensive lecture strategy.

Nurses' perceptions of harmful outcomes from medication errors.

To determine if factors associated with medication errors explained perceived harmful outcome from such errors, perceptions of vividly recollected medication errors were reported by a convenience sample of 206 hospital-employed RNs and LPNs who completed the Medication Error Risk Profile (MERP). Symptoms related to the error, radiology studies performed, the toxicity of the medication given, adverse drug reaction unrecognized at first, and transfer of the patient to another unit explained 38% of the variance in perceived harmful outcome. The implications of the this study for medical-surgical nurses are explored.

Organizational innovations that nourish staff leadership.

Health care is experiencing a paradigm shift that has the potential to redefine traditional roles, systems, and practices. At Albert Einstein Medical Center in Philadelphia, Pennsylvania, the nursing organization has capitalized on this potential and has been energized by the array of opportunities for innovation and experimentation. The results of these efforts suggest that many of these changes not only are positive approaches to patient care but also promote staff leadership and an entrepreneurial spirit at the front line.

Needs assessment for a patient education program in a nursing department. A Delphi approach.

Nursing staff members reported patient education activities in a teaching hospital during a needs assessment conducted as a three-round modified Delphi study. Members of the clinical practice committee and nursing staff members from all patient units were surveyed during three consecutive rounds. Results include the characteristics and priorities of nursing staff members' current interventions related to patient education. Programmatic directions for the nursing service organization, including the development of inservice education programs for creating a formal teaching plan, were identified.