Alternative methods of follow up in breast cancer: a systematic review of the literature

Regular clinical follow up after breast cancer is a common practice. Evidence from retrospective reviews casts doubt on the efficacy of this practice and the various guidelines for follow up show little concordance. Our aim was to investigate what alternative follow-up methods (including reduced frequency of visits) have been subjected to controlled trial and to establish what evidence exists from controlled trials to advise the guidelines. The study involved systematic review of the literature using MEDLINE, Embase, CancerLit, Web of Sciences and EBM reviews as data sources. Methods included reviewing all randomised controlled trials comparing different follow-up frequencies or comparing an alternative method with clinical follow up after breast cancer. All outcome measures addressed in the trials were analysed. Two trials compared frequency of traditional follow up. Five trials assessed alternative methods. All were of inadequate power or duration to establish ideal frequency of clinic visits or safety of alternative follow-up methods. Alternative follow up had no detrimental effect on satisfaction or outcome. Few trials have been conducted, all of which are underpowered to establish safety of reducing or replacing clinic visits. Alternative methods of follow up are acceptable to patients and may be associated with other benefits. Larger trials are required

Pharmacology as a foreign language: A preliminary evaluation of podcasting as a supplementary learning tool for non-medical prescribing students

<p>Abstract</p> <p>Background</p> <p>Nurses and other health professionals in the U.K. can gain similar prescribing rights to doctors by undertaking a non-medical prescribing course. Non-medical prescribing students must have a thorough understanding of the pharmacology of prescribing to ensure safe practice. Pharmacology education at this level is complicated by the variation in students' prior subject knowledge of, and anxiety about, the subject. The recent advances in technology, particularly the potential for mobile learning, provide increased opportunities for students to familiarise themselves with lecture materials and hence promote understanding. The objective of this study was therefore to evaluate both the subjective (student perception) and objective (student use and exam results) usefulness of podcasts of pharmacology lectures which were provided as an extra learning tool to two cohorts (n = 69) of non-medical prescribing students.</p> <p>Methods</p> <p>The podcasts were made available to students through the virtual learning environment WebCT. Use of podcasts by two successive cohorts of nurse prescribing students (n = 69) was tracked through WebCT. Survey data, which was collected from 44 of these students, investigated patterns of/reasons for podcast use and perceived usefulness of podcasts as a learning tool. Of these 69 students, 64 completed the pharmacology exam. In order to examine any impact of podcasts on student knowledge, their exam results were compared with those of two historical cohorts who did not have access to podcasts (n = 70).</p> <p>Results</p> <p>WebCT tracking showed that 91% of students accessed at least one podcast. 93% of students used the podcasts to revisit a lecture, 85% used podcasts for revision, and 61% used the podcasts when they had a specific question. Only 22% used the podcasts because they had missed a pharmacology session. Most students (81%) generally listened to the entire podcast rather than specific sections and most (73%) used them while referring to their lecture handouts. The majority of students found the podcasts helpful as a learning tool, as a revision aid and in promoting their understanding of the subject. Evaluation of the range of marks obtained, mode mark and mean mark suggested improved knowledge in students with access to podcasts compared to historical cohorts of students who did not have access to pharmacology podcasts.</p> <p>Conclusions</p> <p>The results of this study suggest that non-medical prescribing students utilised podcasts of pharmacology lectures, and have found the availability of these podcasts helpful for their learning. Exam results indicate that the availability of podcasts was also associated with improved exam performance.</p

Estas son algunas de las habilidades blandas demandadas en Colombia

Este producto forma parte de una serie de infografías de divulgación científica que buscan reseñar algunas de las investigaciones más importantes en las que ha tenido participación la Universidad EAFIT, publicadas en las revistas especializadas más prestigiosas del mund

Käsihygienian toteutuminen vuodeosaston lääkehoitohuoneessa

Opinnäytetyö koostuu kahdesta erillisestä osiosta; teoreettisesta viitekehyksestä ja havainnointitutkimuksesta. Käsihygieniaan tulee nykyisin kiinnittää enemmän huomiota, koska merkittävin yksittäinen keino estää infektioiden leviäminen on käsihygienian asianmukainen toteuttaminen. Lääkkeitä käsitellessä on ehdottoman tärkeää toteuttaa aseptiikkaa, jotta työntekijä välttää altistumisen lääkeaineille sekä lääkeaineet eivät kontaminoituisi. Tämä opinnäytetyö toteutettiin yhteistyössä projektina KiiltoClean Oy:n, Laurea-ammattikorkeakoulun ja Pirkanmaan sairaanhoitopiirin erään yhteistyöosaston kanssa. Projektiraportin tarkoituksena oli kuvata yhteistyöosaston hoitohenkilökunnan lääkehoitohuoneessa toteutunutta aseptista työskentelyä. Tavoitteena oli näyttöön perustuen lisätä tietoa käsihygieniasta ja sen toteutumisesta vuodeosaston lääkehoitohuoneessa. Projektiraportissa havainnoitiin 22,5 tuntia hoitohenkilökunnan aseptista toimintaa lääkehoitohuoneessa. Aineistonkeruumenetelmänä oli tarkkaileva havainnointi. Aineiston analyysissä käytettiin tutkittuun tietoon ja kokemusperäiseen näyttöön perustuvaa strukturoitua havainnointimatriisia, jossa oli 20 aseptiseen toimintaan liittyvää toimintoa. Toimintoja tarkasteltiin toteutumisen kannalta. Tuloksissa todettiin käsihygienian toteutumisen olevan kohtuullista ja aseptisessa toiminnassa havainnoitiin selkeitä puutteita. Automaattiannostelijaa käyttäneiden hoitotyöntekijöiden käsien desinfiointiaika oli keskimäärin 16 sekuntia. Lanka-annostelijan käyttäjistä saatu keskiarvo oli puolet alhaisempi, kahdeksan sekuntia. Oikeat työmenetelmät edistävät hyvän käsihygienian toteutumista. Hyvä käsihygienia, tavanomaiset varotoimet, oikeanlaiset työvälineet lääkkeenjaossa ja jatkuva koulutus auttavat aseptisen toiminnan toteutumisessa. Opinnäytetyön tuloksia voidaan hyödyntää terveydenhuoltoalalla.Implementing hand hygiene in a medication room on the ward This thesis consists of two separate parts: a theoretical framework and an observational study. Hand hygiene now requires greater attention, since the single most significant way to prevent the spread of infection is through a proper implementation of hand hygiene. When handling medicines it is essential to carry out aseptic precautions in order to avoid exposure to drug ingredients and to prevent contaminating the pharmaceuticals. This study was carried out as a project in cooperation with KiiltoClean Ltd, Laurea University of Applied Sciences, and a cooperation partner ward in the Pirkanmaa Hospital District. The purpose of the project report was to describe the aseptic procedures carried out by the nursing staff in the medication room of the cooperation partner ward. The aim was to use the evidence gained to provide additional information on hand hygiene and its implementation in the medication room on the ward. The project report covered 22.5 hours of observing the aseptic procedures carried out by the nursing staff in the medication room. The data was collected through observations. To analyse the data the authors applied a structured observation matrix, combining research-based and empirical evidence, covering 20 functions related to aseptic procedures. The results showed that the implementation of hand hygiene was at a moderate level and that evident limitations existed in aseptic procedures. The average time used for the hand disinfection by the nursing staff using automatic dispensers was 16 seconds. The average time spent by the nursing staff using manual dispensers was half as long as the time spent by the nursing staff using automatic dispensers, eight seconds. Correct working procedures promote good implementation of hand hygiene. Good hand hygiene, standard precautions, appropriate tools for the administration of medication, and professional development, help in the implementation of aseptic procedures. The results of this thesis can be used in the health sector

The impact of audit quality reviews on audit fees of New Zealand listed companies

This study examines the impact of audit quality reviews by the Financial Markets Authority (FMA) on the audit fees of New Zealand listed companies. The FMA commenced audit quality reviews in 2013. This study examines audit fees from 2009 to 2016 and compares audit fees over the three years before and the four years after quality reviews began. We find evidence of significantly higher audit fees for smaller listed companies after the introduction of audit quality reviews, with minimal impact for larger companies. The New Zealand results suggest that increased costs associated with regulation were able to be absorbed by audit firms in respect of their larger audit clients but not their smaller clients. This may be a reflection of the small and concentrated audit market for listed companies in New Zealand. In conclusion, the introduction of mandatory audit quality reviews has had greater economic consequences for smaller listed companies, which have experienced a significant increase in audit fees

The impact of audit quality reviews on audit fees of New Zealand listed companies

This study examines the impact of audit quality reviews by the Financial Markets Authority (FMA) on audit fees of New Zealand listed companies. The FMA commenced audit quality reviews in 2013. This study examines audit fees from 2009 to 2016 and compares audit fees over the three years before and the four years after quality reviews began. We find that the mean constant annual compound growth rate in audit fees declined -1.6% over the 2009-2016 period indicating a very competitive audit market. Further analysis shows that audit fees of smaller listed companies increased by approximately 11% after the introduction of independent quality reviews. The results suggest that auditors of larger companies have been able to absorb additional costs associated with the reviews, while this has not been possible for smaller firms. In conclusion, the introduction of mandatory audit quality reviews has had greater economic consequences for smaller listed companies which have had a significant increase in audit fees