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Elizabeth Davies

Publications and source records attributed to Elizabeth Davies.

18 recordsLinked to original sources
PubMed2006

Trends in the treatment of breast cancer in Southeast England following the introduction of national guidelines.

There is little published evidence on trends in the treatment of breast cancer in England following the publication of the Calman-Hine report in 1995. Reliable national data are available for women with screen-detected breast cancer, but data on women presenting symptomatically have been difficult to collect. Using data from both a clinical audit database and a population-based cancer register, we show that between 1996 and 2003 the rates of mastectomy and chemotherapy treatment for women with breast cancer in Southeast England have increased marginally, whereas there has been a steady decline in the use of hormone therapy and radiotherapy recorded within 6 months of diagnosis.

Antineoplastic Agents↗
PubMed2006

Developing an innovative undergraduate curriculum--responding to the 2002 National Review of Nursing Education in Australia.

The Australian government responded to the recent global critical shortage of registered nurses by initiating a national review into nursing education. The 36 recommendatons of the review report published in 2002 supported one or more of three strategies: building a sustainable workforce throuh partnership; maximising health outcomes through quaality education; and capacity building. The review drew extensively on the international research literature, invited submissions, previous reviews and commissioned research. This paper articulates the key features of a new innovative undergraduate nursing curriculum that incorporates several of the recommendations of the national review, specifically a new approach in delivery of the clinical component of the curriculum. The curriculum model emerged from a strategically planned partnership between a university and heath care providers committed to improving graduate outcomes and transition into professional practice. The curriculum was implemented in 2004 in a Faculty of Health Sciences that had not previously offered nursing programs. It is anticipated that the newly implemented undergraduate nursing program, modelled on a clinical schools partnership approach, will graduate registered nurses able to face the challenges of a rapidly changing health sector. The objective of this paper is to describe the key features of the program and share new insights that might challenge traditional curriculum approaches in undergraduate nursing.

Australia↗
PubMed2006

Lessons from developing and running a clinical database for colorectal cancer.

BACKGROUND: Recent policy developments in the UK require the routine monitoring of the performance of cancer services. Developing and using clinical databases is one approach to meet this objective, but to date their implementation has been challenging. OBJECTIVE: To describe the development of the Thames Cancer Registry clinical database for colorectal cancer, and to present the lessons learnt in the first five years since its establishment. METHODS: Planning of this clinical database began in 1998. Detailed variables for the data set were derived by analysis of national standards and guidelines. Structured pro formas were designed to abstract data from clinical notes. A pilot study over 12 months collected 400 cases from seven hospital trusts in one cancer network. Data collection over the wider North Thames area began in 1999. RESULTS: The number of new records entered each year into the database rose from 747 in 1999 to 1107 in 2002. By 2004, it held a total of 8500. However, participation and completeness of data collection varied between trusts. Currently only 18 of 26 trusts in the area submit data and only 12 have done so every year. Overall completeness for key demographic and treatment variables has been between 80 and 100% but less so for more detailed diagnostic and treatment variables (40-60%). Barriers to implementation in trusts could be grouped as organizational, professional and data-related. Organizational barriers have included changes in the cancer networks, variability in trust commitment to different data sets and lack of personnel to enter data consistently. Professional barriers have included competing priorities and varying commitments within the multidisciplinary clinical teams. Data-related barriers include the wide range of database formats that are used in trusts, and a tendency for data to be collected at the end of the year rather than continuously. CONCLUSIONS: Creating and maintaining a clinical database is a time-consuming and complex undertaking. Completeness of ascertainment and quality are major issues of concern. Key lessons from this project have been that the commitment of clinicians and the ability of trusts to provide consistent support for data collection are crucial.

Colorectal Neoplasms↗
PubMed2006

Importance of host plant species, Neotyphodium endophyte isolate, and alkaloids on feeding by Spodoptera frugiperda (Lepidoptera: Noctuidae) larvae.

Three grass host species--tall fescue, Festuca arundinacea Schreber; meadow fescue, Festuca pratensis Hudson; and perennial ryegrass, Lolium perenne L.--each infected with a number of different Neotyphodium endophyte isolates, were investigated for their effects on fall armyworm, Spodoptera frugiperda (J.E. Smith). Alkaloid profiles varied among associations. Choice and no-choice tests comparing feeding and early development of S. frugiperda larvae on endophyte-infected and endophyte-free leaf blade material were performed. Endophyte-mediated resistance to S. frugiperda was greatest in meadow fescue and weakest in tall fescue. Some endophyte isolates, particularly in perennial ryegrass and meadow fescue, had a major effect on feeding and development of S. frugiperda, whereas others had no effect or were only weakly efficacious. In tall fescue, some associations deterred S. frugiperda from feeding in choice tests but had no effect on development, whereas larvae reared on other associations weighed significantly more than control larvae fed endophyte-free grass. It was concluded that the deleterious consequences of endophyte infection were easily masked by other factors in tall fescue. Relative leaf age had no effect on feeding preferences in the three host species. Chemical analysis of herbage from the plants used, and results from a no-choice study using spiked artificial diets, failed to individually implicate any of the major known alkaloids (peramine, lolitrem B, ergovaline, and lolines) in the observed effects on S. frugiperda. Hypotheses explaining these observations, and their impact on creating desirable grass-endophyte associations for use in pastures, are discussed.

Alkaloids↗
PubMed2005

Systematic review of specialist palliative day-care for adults with cancer.

GOAL OF WORK: To inform future practice, research and policy in specialist palliative day-care by systematically reviewing the evidence for how the structure and process of this form of care relate to outcomes for adults with cancer. PATIENTS AND METHODS: Medical, nursing and social science computerized databases were searched up until December 2003 for studies of palliative day-care reporting information on service structure, care processes or outcomes including symptom control, quality of life, social and psychological support, and patient and relative satisfaction with care. Qualitative and quantitative studies were assessed for methodological quality and graded, and the findings synthesized into the review. MAIN RESULTS: Twelve observational studies were found that showed the difficulties of evaluating a service already operating and of recruiting a vulnerable population of patients as they deteriorated. Most services are nurse-led, but varied in the facilities, staff mix, care models, activities and places they offered. Patients attending seemed a selected group of those already receiving palliative care who were mostly white, aged over 60 years and retired, with needs for emotional and social support and pain control. There were insufficient studies to provide conclusive evidence of improved symptom control or health-related quality of life, but all qualitative studies found patients valued the social support and opportunity to take part in activities that day-care provided. CONCLUSIONS: There is evidence for high satisfaction among patients selected into day-care, but not yet sufficient to judge whether this improves symptom control or health-related quality of life. Further research should explore selection and access into care, the most effective models of care, its cost, and potential benefits for relatives and carers. Comparison with models of care for older adults and those with mental illness would also be informative.

Adult↗
PubMed2005

Adherence to trizivir and tenofovir as a simplified salvage regimen is associated with suppression of viraemia and a decreased cholesterol.

BACKGROUND: Treatment failure during highly active antiretroviral therapy (HAART) is ultimately common and associated with the development of resistance mutations. Trizivir (zidovudine/lamivudine/abacavir) and tenofovir disoproxil fumarate may improve adherence and enhance virological suppression in individuals who have failed previous regimens. METHODS: Individuals were identified who had failed previous HAART and who were then prescribed trizivir and tenofovir. Viral load and genotypic information were obtained to assess virological response. RESULTS: One hundred and twenty-two individuals were identified from a database containing 5883 patients. In a last observation carried forward intention to treat analysis, 34% of individuals achieved an undetectable viral load of <50 copies/mL at 1 year. Of those who were able to remain on treatment for 1 year, 65% achieved undetectability. We observed no effect regarding previous regimens on viral outcome. Accumulation of TAMs (thymidine analogue mutations) was associated with a decrease in the number of patients achieving an undetectable viral load (with <2 TAMs present 38% of patients developed undetectable viral loads, > or =1;2 TAMs 17% undetectable; P = 0.03). Using the mean cell volume as a measure of compliance, those with higher values were more likely to achieve a viral load <50 copies/mL (P = 0.04). A beneficial effect on cholesterol was noted regardless of virological outcome. CONCLUSIONS: In compliant heavily pre-treated individuals with less than 2 TAMs, salvage therapy with trizivir and tenofovir is associated with suppression of viraemia and an improved lipid profile.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Biochemical outcome of blocking the ergot alkaloid pathway of a grass endophyte.

Neotyphodium sp. Lp1, an endophytic fungus from perennial ryegrass (Lolium perenne), produces the mycotoxin ergovaline in infected grasses, whereas a mutant in which a particular peptide synthetase gene is knocked out does not. We examined the impact of this knockout on other constituents of the ergot alkaloid pathway. Two simple lysergic acid amides, ergine and a previously undescribed amide, were eliminated by the knockout. Lysergic acid accumulated in the knockout endophyte, but quantities were only 13% of the total lysergic acid derivatives accumulated in the wild type. Concentrations of several clavines were not substantially affected. However, a novel clavine accumulated to higher concentrations in perennial ryegrass containing the knockout strain. The results indicate that production of simple lysergic acid amides requires the activity or products of the ergovaline-associated peptide synthetase and that the regulation of ergot alkaloid production is modified in response to the relatively late block in the pathway.

Ascomycota↗
PubMed2002

Simplified extraction of ergovaline and peramine for analysis of tissue distribution in endophyte-infected grass tillers.

An improved extraction and cleanup procedure for quantitative analysis of ergovaline in Neotyphodium-infected grass tissues by high-performance liquid chromatography was developed, utilizing aqueous 2-propanol-lactic acid as extraction solvent. Losses of sample material and time requirements were significantly reduced, handling procedures simplified, and ergovaline and internal standard ergotamine recovered with similar efficiency from extracts. Analyses can be carried out on very small amounts (2-5 mg of dry weight) of samples and another endophyte-alkaloid, peramine, determined in the same extracts. Calibration curves with 2-propanol-lactic acid were linear over the range 0.004-0.938 microM ergovaline (= 2-500 ng/mL) in extracts, corresponding to 0.04-10 microg/g in samples. The distribution of ergovaline in the plant was extremely heterogeneous, indicating low in-planta mobility and strong regulation of accumulation by the internal plant environment. In contrast, peramine was much more uniformly distributed. These results clearly demonstrate very large differences in the tissue specificities of ergovaline and peramine.

2-Propanol↗
PubMed2002

Communication, information and support for adults with malignant cerebral glioma : a systematic literature review.

The goal of this work was a systematic review of communication, information and support for adults with malignant cerebral glioma. Medical, nursing and social science computerised databases up to spring 2000 were searched. Key organisations were contacted, and specialist journals were searched. Inclusion criteria were publication in English, inclusion of patients with malignant cerebral glioma, measurement of patients' and relatives' awareness of the prognosis, distress, satisfaction with information or care received, uptake of service or professional communication skills. Studies of patients with other cancers were excluded. Qualitative and quantitative studies were assessed, graded for methodological quality and combined. Twelve observational studies were found, although many were limited by sample selection, description and setting. Patient awareness of the prognosis varied, and relatives appeared more aware. There was no direct evidence about what patients and relatives wanted to know, but qualitative studies suggested that an individual approach to disclosure and maintaining hope were important. Most patients and relatives valued specialist nurse support highly. No specific studies of interventions to break bad news, giving information or training staff were found for these patients. Evidence from observational studies suggests that these patients need individually tailored communication and information, and specialist support. Existing intervention studies of patients with other cancers may suggest effective strategies.

Adult↗
PubMed2002

Validating a scope of nursing practice decision-making framework.

This paper describes processes used to validate the Scope of Nursing Practice Decision-Making Framework developed and implemented by the nurse regulatory authority in Queensland, Australia. Various components of the Framework are also outlined. The validity and usefulness of the Framework were tested through survey research and validation in practice. The majority of participants in both validation processes found all components of the Framework completely or mostly understandable, useful and applicable in practice. Results confirmed that education and experience are used by nurses to explain the advancement in their practice and that the context of nursing practice influences roles and relationships with other health professionals.

Adult↗
PubMed2002

Views of Directors of Public Health about NICE Appraisal Guidance: results of a postal survey. National Institute for Clinical Excellence.

BACKGROUND: We aimed to determine the views of Directors of Public Health about the Health Technology Appraisal Programme of the National Institute for Clinical Excellence (NICE) before the move to strategic health authorities and primary care trusts in April 2002. METHOD: In December 2001 we sent a questionnaire asking about the work programme, products, decision-making, general approach, resource allocation and success of NICE to all Directors of Public Health in England and Wales. Ninety-two of 100 responded. RESULTS: Three-quarters or more agreed that NICE has covered a number of priority and controversial areas, produced good-quality health technology appraisals, well-presented reports and readable guidance in a consistent format, that it has raised the profile of clinical effectiveness, provided a focus for debate about health technology, and succeeded in making the National Health Service (NHS) set aside resources for approved technologies. A similar proportion, however, also agreed that guidance was not timely, did not address 'whole systems' and made some disappointing recommendations, and that decision-making was not influenced enough by the needs of the NHS. They considered that NICE did not address implementation, decide between competing technologies or help the service prioritization debate, and that guidance sent unrealistic signals about affordability to patients and politicians and caused difficulty for the implementation of other technologies locally. CONCLUSIONS: A majority of Directors are positive about NICE's role of providing high-quality appraisal and central guidance but negative about its influence on local priority setting. Major concerns remain about the affordability of competing demands, whether this is NICE's responsibility or not.

Administrative Personnel↗
PubMed2002

Age differences in alcohol and cocaine expectancies and attitudes.

Positive and negative expectancies regarding the behavioral effects of alcohol and cocaine were assessed and used to predict attitudes toward their use across four age groups (5-7, 8-10, 11-14, and 18-25, N = 121). Regardless of gender and minority status, children and early adolescents appeared to overgeneralize their beliefs about alcohol to a less familiar drug, cocaine, perceiving the effects of the two drugs similarly. Only college students differentiated between drugs, perceiving cocaine as less likely than alcohol to produce drunkenness and more likely to have stimulant and elation/empowerment effects. With age and other expectancies controlled, expectancy of drunkenness was the best predictor of disapproval of alcohol use; attitudes toward cocaine use were unrelated to expectancies but became more negative with age. Drug prevention programs should rest on data regarding children's preexisting beliefs about the consequences of drug use and should help them understand that different drugs (for example, stimulants and depressants) pose different dangers.

Adolescent↗
PubMedDate not supplied

Educating home carers on faecal continence in people with dementia.

AIM: To measure the effect of education on the knowledge of home carers in maintaining faecal continence for people with dementia. METHOD: The quasi-experimental study involved pre-testing of carer knowledge, educational intervention and post-testing of their knowledge. The Carer Knowledge Questionnaire, specifically developed for use in the study, measured pre- and post-intervention knowledge levels. Knowledge scores and associations between categorical variables of interest were analysed. RESULTS: Before education, carers demonstrated high knowledge levels of factors that can cause faecal incontinence and low knowledge levels of strategies to promote and maintain faecal continence. Post-testing revealed a statistically significant increase in total knowledge scores (p < 0.001). Specifically, knowledge regarding faecal continence increased in four main areas: contributing factors, implications of constipation, effectiveness of specific strategies and awareness of factors unrelated to dementia that can have an impact on faecal continence. CONCLUSION: Education of home carers has been shown to increase knowledge of faecal continence.

Aged↗
PubMedDate not supplied

Pain assessment and cognitive impairment: part 1.

People with cognitive impairment are often unable to inform others of their pain. Nurses need to be able to assess pain in cognitively impaired adults so that appropriate pain management strategies can be implemented. Evidence suggests that certain verbal, facial and behavioural signs may be indicative of pain. This article describes the process undertaken in developing a specific tool to facilitate pain assessment. The tool was developed after extensive analysis of pain research literature, input from experienced nurses and critical review by a panel of experts in dementia care. The research study will be published in next week's Nursing Standard.

Aged↗
PubMedDate not supplied

Pain assessment and cognitive impairment: part 2.

AIM: To evaluate the use of a tool for pain assessment in cognitively impaired adults. METHOD: A multi-dimensional tool was implemented and evaluated in relation to use rate; frequency of specific pain indicators; staff perceptions of advantages and disadvantages of pain assessment in this patient group; and factors that aid or impede this assessment. RESULTS: Some indicators are more likely to be observed and documented. There was a lack of compliance by nurses in making and recording pain observations on every shift. Observations that were recorded occurred most frequently on the morning shift. Factors that were identified as assisting in the assessment of pain related to nursing staff having the appropriate knowledge and skills gained through experience of caring for cognitively impaired adults. CONCLUSION: Pain assessment for cognitively impaired adults should continue to be based on a combination of physiological and behavioural indicators. Assessment should be conducted as indicated by the nurse's clinical judgement and follow-up pain assessment should be undertaken after implementation of appropriate comfort measures.

Activities of Daily Living↗