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Issue 176 - 5 April 2011

Articles on Palliative Care/Nurses Caring for Family Members

1. This man is dying and, as a sign of new times in palliative care, he's decided how he will go
Sunday Age, The (Melbourne), 10341021, Apr 03, 2011
Ron Lennox has terminal cancer. With wife Jo, he tells Gary Tippet how he's dictated the limited intervention he will accept. RON and Jo Lennox have a familiarity with death. Jo saw a lot of it in 39 years of nursing, and she sat in a small room with her father for three days as he slowly but gently passed away after a series of strokes. Over a two-year period in the mid-1990s, Ron lost his brother, mother, sister and former wife. After years driving trucks, he spent seven more in aged-care facilities, looking after people at the end of their days. He's stared down four heart attacks in the past decade. So death doesn't frighten them "billions have done it before us," says Ron. It's the dying. Or dying badly. More particularly, dying on someone else's terms
Citation from Australia/New Zealand Reference Centre Database

2. Respecting a patient's wishes at the end of their life
Sunday Age, The (Melbourne), 03/04/2011
Medical intervention is not always the right choice. Doctors are hard-wired to save lives, wrote Dr William Silvester in The Sunday Age. But when a patient is chronically ill, and suffering from an incurable condition, should doctors do all they can to extend life? Dr Silvester, director of Respecting Patient Choices at Austin Heath, has come to question whether aggressive medical intervention is always the right way to proceed. His thoughtful article about the need to respect what a patient wants struck a chord with many readers, who have welcomed this gentler approach to patient care
Citation from Australia/New Zealand Reference Centre Database

3. Dual roles and conflict -- nurses as mothers of critically ill neonates.
By Lane-Krebs, Katrina. Australian Nursing Journal, 01/04/2011, Vol. 18 Issue 9: p37
Presenting as an emergency admission to a hospital with a critically ill neonate is a mother’s worst nightmare. When the mother is also a nurse, this situation can lead to role conflict, overwhelming grief and a sense of failure on both personal and professional levels. This important issue was the focus of a Masters research project undertaken by Katrina Lane-Krebs.
Citation from Australia/New Zealand Reference Centre Database

4. A delicate balance: Nurses have dual roles when the patient is a loved one
By Trossman, Susan. American Nurse, Nov/Dec 2009, Vol. 41 Issue 6: p1-9
The article discusses the significant role of nurses in a family emergency situation. It cites various situation, wherein nurses play a major role in giving care to their own sick family members. It stresses that nurses could not separate their identity from their identity as a family member when a family member is sick. It also mentions that the advantage of having a nurse as a family member is that he/she can relay information for other family members and can reinforce patient care.
Citation from Nursing and Allied Health Database

5. Staff and family relationships in end-of-life nursing home care
By Gjerberg, Elisabeth et al. Nursing Ethics, 01/01/2011, Vol. 18 Issue 1: p42-53
: This article examines the involvement of residents and their relatives in end-of-life decisions and care in Norwegian nursing homes. It also explores challenges in these staff—family relationships. The article is based on a nationwide survey examining Norwegian nursing homes’ end-of-life care at ward level. Only a minority of the participant Norwegian nursing home wards ‘usually’ explore residents’ preferences for care and treatment at the end of their life, and few have written procedures on the involvement of family caregivers when their relative is in the terminal phase. According to the respondents, most staff seem to comfort relatives well. However, several challenges were described. The study revealed a need for better procedures in the involvement of residents and relatives in nursing home end-of-life care. The findings emphasize a need to strengthen both the involvement of nursing home physicians and staff communication skills. [ABSTRACT FROM PUBLISHER]
Citation from Nursing and Allied Health Database

6. Preferences of Patients with Advanced Lung Cancer Regarding the Involvement of Family and Others in Medical Decision-Making.
By Pardon, Koen et al. Journal of Palliative Medicine, Oct  2010, Vol. 13 Issue 10: p1199-1203
To explore the preferences of competent patients with advanced lung cancer regarding involvement of family and/or others in their medical decision-making, and their future preferences in case of loss of competence.
Methods: Over 1 year, physicians in 13 hospitals in Flanders, Belgium, recruited patients with initial non-small-cell lung cancer, stage IIIb or IV. The patients were interviewed with a structured questionnaire every 2 months until the fourth interview and every 4 months until the sixth interview.
Results: At inclusion, 128 patients were interviewed at least once; 13 were interviewed 6 consecutive times. Sixty-nine percent of patients wanted family members to be involved in medical decision-making and this percentage did not change significantly over time. One third of these patients did not achieve this preference. Ninety-four percent of patients wanted family involvement if they lost competence, 23% of these preferring primary physician control over decision-making, 41% shared physician and family control, and 36% primary family control. This degree of preferred family involvement expressed when competent did not change significantly over time at population level, but did at individual level; almost half the patients changed their minds either way at some point during the observation period.
Conclusions: The majority of patients with lung cancer wanted family involvement in decision-making, and almost all did so in case of future loss of competence. However, as half of the patients changed their minds over time about the degree of family involvement they wanted if they lost competence, physicians should regularly rediscuss a patient's preferences. [ABSTRACT FROM AUTHOR]
Citation from Nursing and Allied Health Database

7.The relevance of family-centred medicine and the implications for doctor education
By Gorter, Jan W. et al. Medical Education, Apr 2010, Vol. 44 Issue 4: p332-334
The article focuses on the importance of family-centred medicine in doctor education. It says that the idea of family-centred medicine and competencies must be given with greater attention in school medical curricula because of the significance of family in the management of chronic health conditions. It mentions that hospitals and medical schools should adopt family-centred medicine to address the needs of both the patients and their families.
Citation from Nursing and Allied Health Database

8. How Has Caring for a Family Member With Cancer Affected You as a Nurse?
ONS Connect, Nov 2009, Vol. 24 Issue 11: p6
In this article the author discusses how caring for a family member who is suffering from cancer would affect her profession as an oncology nurse. She notes that she was able to see the dedication and love of the hospice nurses to her mother during the treatment that made her decide to give back what was given to her by serving the field of oncology. She also mentions the importance of constant friendship and communication for the treatment of cancer patients.
Citation from Nursing and Allied Health Database

Articles from:

Journal of Human Nutrition & Dietetics

9. Alcohol – friend or foe?
By Gandy, J. Journal of Human Nutrition & Dietetics, Apr 2010, Vol. 23 Issue 2: p111-112
The article discusses the health risks and advantages of alcohol. It states that drinking alcohol results to health problems, however, a study revealed that moderate drinking provides health benefits particularly on the endothelial lining of blood vessels. It also explains the relationship of obesity and alcohol due to fat distribution.

10. Efficacy of dietary treatments for epilepsy
By Neal, E. G.; Cross, J. H. Journal of Human Nutrition & Dietetics, Apr 2010, Vol. 23 Issue 2: p113-119
The ketogenic diet (KD) is a high fat, restricted carbohydrate regime that has been used as a treatment for seizures since the 1920s, when it was designed to induce a similar metabolic response to fasting. A modification of this early classical version of the KD was introduced in the 1970s using medium chain triglycerides as an alternative fat source. More recently, two alternative, less-restrictive dietary treatments have been developed: the modified Atkins diet and the low glycaemic index diet. There are many case reports and observational studies reporting successful use of the KD, and a growing number of studies reporting similar success with the modified Atkins protocol. A recent randomised controlled trial has shown a significant benefit of the KD compared to no change in treatment. The use of these dietary therapies in the UK is supported by literature evidence, although often is limited by a lack of resources; increasing awareness and knowledge is fundamental to ensure availability for those individuals with intractable epilepsy who may benefit from them. [ABSTRACT FROM AUTHOR]

11. The influence of alcohol consumed with a meal on endothelial function in healthy individuals
By Hampton, S. M. et al. Journal of Human Nutrition & Dietetics, Apr 2010, Vol. 23 Issue 2: p120-125
Alcohol and polyphenols in wine and fruit juices have been strongly implicated in the favourable effects on of these beverages on vascular function. Despite a wealth of information on the metabolic and vascular effects of alcohol and polyphenols, the combined influences of these substances on vascular function, especially when consumed with food, is poorly understood. A study was designed to determine the effects of a phenolic-rich grape juice, with or without alcohol, on vascular endothelial function in the postprandial state.
Methods: Ten subjects consumed a standard meal with a test drink on three separate occasions. On each occasion, the test drink accompanying the meal was either red grape juice, red grape juice plus alcohol (12% v/v), or water. Endothelial function was measured by flow mediated dilatation (FMD) prior to then 30 and 60 minutes after consuming the meal. Blood samples were taken for the determination of plasma glucose, triacylglycerol (TAG) and non esterified fatty acids (NEFA) at regular intervals.
Results: There was a significant effect of the three treatments ( P = 0.0026) and time ( P = 0.021) on percentage FMD. The meals with the grape juice and grape juice plus alcohol produced similar FMD responses but were both significantly greater than the meal with water. The concentration of plasma glucose, TAG and NEFA were similar after each treatment.
Conclusion: Alcohol had no effect on vascular function in the early postprandial phase. These findings provide new evidence to support the potential benefit of non-alcoholic components within alcoholic beverages on vascular function in the fed state. [ABSTRACT FROM AUTHOR]

12. Use of the ketogenic diet and dietary practices in the UK
By Lord, K. & Magrath, G. Journal of Human Nutrition & Dietetics, Apr 2010, Vol. 23 Issue 2: p126-132
In 2000, a survey showed that use of the ketogenic diet as a treatment for intractable epilepsy in the UK was low. Subsequently, the number of medical publications supporting its efficacy has increased and demand from parents for this treatment has also increased. This survey was undertaken to determine whether there had been an increase in the use of the ketogenic diet and the necessary resources to provide it.
Methods: A survey of paediatric dietitians in the UK was undertaken. Data were collected on their experience of implementing a ketogenic diet, the type of diet used, patient caseloads, other members of the care team, the process for initiation of the diet and funding.
Results: Twenty-eight hospitals offered the ketogenic diet treatment with a total of 152 patients. The caseload per dietitian ranged from 1–36 patients. The classical diet was prescribed for 74% cases. The majority of patients began the diet as outpatients. Six dietitians were specifically funded to provide the treatment. Fifty more dietitians had experience of implementing the diet but currently had no patients. The reasons given for this were no referrals, no funding or not working with patients with epilepsy.
Conclusions: The number of patients on the ketogenic diet had increased since 2000. However, numbers remained low and the main reasons given were the lack of referrals and a lack of funding. Recommendations are made to improve the dietetic and funding resources available so that an efficacious treatment for intractable epilepsy of childhood can be made more widely available. [ABSTRACT FROM AUTHOR]

13. Students’ experiences and perceptions of the use of portfolios in UK preregistration dietetic placements: a questionnaire-based study
By Brennan, K. M. & Lennie, S. C. Journal of Human Nutrition & Dietetics, Apr 2010, Vol. 23 Issue 2: p133-143
Reflective portfolios were introduced to dietetic practice placements in 2005, providing evidence for learning outcomes achieved and acting as a summative assessment tool. Portfolios may measure clinical competence more effectively than conventional examinations, but can be time consuming and subjective. The present study investigated current dietetic students’ experiences and perceptions of the use and effectiveness of portfolio based learning and assessment during practice placements.
Methods: Current UK dietetic students, who had completed a B or B and C placement, were invited to participate, via University course leaders, in an online questionnaire exploring opinions and experiences of portfolio preparation, generation, assessment, and personal and professional development and reflection.
Results: One hundred and fourteen students from 11 Universities participated. Seventy-seven percent would have liked more information about portfolio construction prior to placement. Eighty percent of students believed that reflection helped monitor their strengths and weaknesses. Perceived reflective skills were significantly positively correlated with students’ perceived writing skills ( P < 0.0005) and academic ability ( P = 0.002). Of the respondents, 92% agreed the portfolio was a valuable learning experience; however, 76% agreed that the amount of paperwork involved was excessive and 67% felt there were inconsistencies in portfolio assessment by different supervisors.
Conclusions: Portfolio weaknesses identified are not specific to dietetics but are inherent to portfolio assessment across many professions. The introduction of national standardised assessment processes, practices, tools and training for assessors may help improve inter-departmental and inter-rater reliability, respectively. [ABSTRACT FROM AUTHOR]

14. Assessment of dietitians’ nutrition counselling self-efficacy and its positive relationship with reported skill usage
By Lu, A. H. & Dollahite, J. Journal of Human Nutrition & Dietetics, Apr 2010, Vol. 23 Issue 2: p144-153
Previous studies on nutrition counselling self-efficacy have assessed small groups of dietitians in focused practice areas or evaluated the effectiveness of skills training on only a few skills. This descriptive study developed a comprehensive scale to examine self-efficacy in a large, cross-sectional sample of practising dietitians when performing various counselling skills that promote dietary behaviour changes.
Methods: A valid and reliable instrument was developed and administered through the Internet to survey dietitians in the USA from various areas of dietetics and with varying years of experience. Items included counselling self-efficacy, skill usage and counselling-related job characteristics. Of the 612 respondents, one group ( n = 486) conducted counselling for more than 50% of their work week, and the other group ( n = 126) for less than 50%. Factor analysis was used for scale development. Independent samples t-tests and chi-square tests were performed for group comparisons. Correlations and multiple regression analyses further assessed the relationships among variables.
Results: The resultant unidimensional scale contained 25 items. Dietitians reported high self-efficacy scores and frequent skill usage. Those who counsel for more than 50% of their work week were more likely to work in outpatient settings and private practice, reported higher self-efficacy scores, and held longer and repeated sessions. Self-efficacy scores were positively correlated with counselling-related job characteristics. Years of counselling experience and skill usage significantly predicted self-efficacy scores.
 Conclusions: Dietitians perceive themselves to be highly self-efficacious in using counselling skills which may contribute positively to their professional practice. However, the relationship between counselling self-efficacy and actual performance warrants further investigation. [ABSTRACT FROM AUTHOR]

15. Nutritional vitamin A status in northeast Brazilian lactating mothers
By da Silva Ribeiro, K. D. et al. Journal of Human Nutrition & Dietetics, Apr 2010, Vol. 23 Issue 2: p154-161
Vitamin A deficiency is the major cause of morbidity and mortality among children and in women of reproductive age in developing countries. The present study aimed to assess maternal nutritional vitamin A status, as well as analyse the association of preformed vitamin A and pro-vitamin A consumption on the nutritional status of nursing mothers, based on serum retinol and retinol colostrum concentrations coupled with dietary intake.
Methods: Serum and colostrums were collected from 86 healthy parturients, recruited within 16 h postpartum. Blood samples were obtained, the morning after an overnight fast. Retinol was analysed by high-performance liquid chromatography. Dietary vitamin A was assessed using a food frequency questionnaire and the women were separated into two groups according to the predominant dietary source of vitamin A: group A, >50% preformed vitamin A ( n = 37); and group B >50% pro-vitamin A carotenoids, ( n = 49).
Results: Serum retinol and total vitamin A ingestion (mean ± SD) were higher in group A than in group B (1.4 ± 0.4 µmol L-1 and 2072.0 ± 1465.9 µg retinol activity equivalent (RAE) day-1 versus 1.2 ± 0.6 µmol L-1 and 1051.6 ± 920.4 µg RAE day-1, respectively ( P < 0.05), but colostrum retinol (3.4 ± 1.7 µmol L-1 and 3.6 ± 1.9 µmol L-1) was similar in both groups. In group B, 36.7% ( n = 18) of the nursing mothers presented a risk of developing vitamin A deficiency, based on their dietary intake.
Conclusions: On the basis of the intake of the pro-vitamin A carotenoids, some women may be at risk of vitamin A deficiency. However, their status is currently normal, as indicated by serum and milk retinol concentrations. [ABSTRACT FROM AUTHOR]

16. Association between fruit juice consumption and self-reported body mass index among adult Canadians.
By Akhtar-Danesh, N. et al. Journal of Human Nutrition & Dietetics, Apr 2010, Vol. 23 Issue 2: p162-168
The prevalence of obesity and being overweight is rising among adult Canadians and diet is recognised as one of the main causes of obesity. The consumption of fruit and vegetables is shown to be protective against obesity and being overweight but little is known about the association of fruit juice consumption and obesity and being overweight. The present study aimed to investigate the association between fruit juice consumption and self-reported body mass index (BMI) among adult Canadians.
Methods: This analysis is based on the Canadian Community Health Survey, Cycle 3.1. A regression method was used to assess the association of fruit juice consumption with self-reported BMI in 18–64-year-old Canadians who had been adjusted for sex, age, total household income, education, self-rated health, and daily energy expenditure. Because the analysis is based on a cross-sectional dataset, it does not imply a cause and effect relationship.
Results: Almost 38.6% of adult Canadians reported a fruit juice intake of 0.5–1.4 times per day and 18.2% consumed fruit juice more than 1.5 times per day. Participants with normal weight were likely to consume more fruit juice than obese individuals. Regression analysis showed a negative association between fruit juice consumption and BMI after adjusting for age, sex, education, marital status, income, total fruit and vegetable intake, daily energy expenditure, and self-rated health. On average, for each daily serving of fruit juice, a -0.22 unit (95% confidence interval = -0.33 to -0.11) decrease in BMI was observed.
Conclusions: The results obtained showed a moderate negative association between fruit juice intake and BMI, which may suggest that a moderate daily consumption of fruit juice is associated with normal weight status. [ABSTRACT FROM AUTHOR]

17. Articles from Whitireia Nursing Journal, Issue 17, 2010
Reclaiming nursing scholarship
Ethics and the use of electroconvulsive therapy
17C. we need to grow our own: An evaluation of nurse entry to practice programmes
17D. Evaluating a post anaesthetic care unit orientation programme
A reflection in memory of Cara Leigh
The health status of Maori nursing students: A cross-sectional study
17G. Patients' attitudes to analgesics and expectations of emergency care
17H. I thought it was just a pimple: A study examining the parents of pacific children's understanding and management of skin infections in the home
17I. Making a parallel between Raranga and undertaking a literature review
17J. Psychogeriatric literature review

News - National

18. Why some parents snub child jabs
Bay of Plenty Times - 4 April 2011
New research has shown why some parents do not immunise their babies - and the major reason is simpler than an anti-vaccination attitude frustrating Western Bay vaccinators. Government-commissioned national research has found that, in most cases, people aren't opposed to immunisation but circumstances simply get in the way.

News - International

19. $2.7m 'aid' in generic pill push
The Australian March 31, 2011
Generic drug-makers showered pharmacists with movie tickets, computer software or equipment and other benefits worth $2.7 million last year, triggering concerns that hidden financial deals are deciding what pills patients receive. The first report on the benefits that generic companies paid, other than through price discounting, shows that five out of the industry's six companies provided such benefits. In one of the disclosures, Hospira -- a leading supplier of generic injectable drugs -- revealed it paid $874,006 to a number of unnamed hospitals to help provide nurses qualified to care for patients with mental or movement disorders. The declaration insists the hospitals "have absolutely no obligation to prescribe" the drugs in question, clozapine and apomorphine.

20. FDA advisers want more study of food dye-ADHD link
CNN - 31 March 2011
A Food and Drug Administration advisory committee decided Thursday there is insufficient evidence to support a link between artificial dyes in foods and children with ADHD.  The committee will make no recommendation to ban or regulate dye additives found in food products. But the committee did stress that there seems to be a trend with artificial dyes and side effects in children and that more research is needed

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