A formative evaluation of the potential role of nurse practitioners in a central London HIV outpatient clinic.

In-house audit demonstrated that 49% (173/352) of patients attending routine HIV outpatient care are asymptomatic and have needs that could potentially be met by other health care professionals. We therefore evaluated the potential development and acceptability of nurse practitioner roles in contributing to HIV outpatient care. Data were collected through 26 consultation observations, 25 patient interviews, 2 patient focus groups, 22 provider interviews and 8 provider focus groups. Service users were key members of the evaluation team. With increasing HIV incidence and the change in focus of doctor-patient consultations from acute to chronic disease management, there are concerns about the sustainability of easily available routine HIV outpatient appointments using the same model of care that has prevailed over the past 20 years. Nurse practitioner models of care were considered acceptable for asymptomatic patients, including those who do not have complex issues related to highly active antiretroviral therapy (HAART). Key considerations for the role include training, supervision, referral pathways, and a clear understanding of the limitations of nursing practice. There is an emphasis on the need to consider 'new ways of working' throughout the service, rather than merely substituting or transferring clinical roles between professionals. Funding pending, nurse practitioner roles are planned for implementation in late 2004. Evaluation will determine impact on service utilization, health and economic outcomes.

A new device for phototherapy treatment of jaundiced infants.

A new device for phototherapy consisting of a fiberoptic panel attached to an illuminator was compared with traditional phototherapy (4 special blue and 4 daylight bulbs). The panel surrounds the trunk eliminating eye patching and allowing more time for maternal-infant interaction. Forty-six jaundiced term neonates were studied. Two groups, nonhemolytic (n = 26) and hemolytic (ABO) (n = 20) jaundice, received fiberoptic or traditional phototherapy. In both groups, fiberoptic and control patients had similar weights, gestational ages, bilirubin levels and ages at entry. Post-therapy weights and duration of therapy were also similar. In the nonhemolytic fiberoptic group, there was a trend toward greater decreases in mean bilirubin levels at 12, 24, 36, and 60 hours with significant reduction at 48 hours of therapy (-2.8 vs -.5 mg/dL; P = .04). In the hemolytic group, bilirubin fell continuously in the fiberoptic group and after 36 hours in the traditional group. At 36 hours there was a trend toward a greater decrease in mean bilirubin for the fiberoptic group (-1.8 vs + 1.9 mg/dL; P = .08). There were no complications of therapy. The fiberoptic panel proved effective and safe; eliminated the need for eye patches; and permitted greater time for maternal-infant bonding.