Doing Qualitative Research

a c statistic of 0.82 (95% CI, 0.80-0.84), the CHADS2 index was the most accurate predictor of stroke. The stroke rate per 100 patient-years without antithrombotic therapy increased by a factor of 1.5 (95% CI, 1.3-1.7) for each 1-point increase in the CHADS2 score: 1.9 (95% CI, 1.2-3.0) for a score of 0; 2.8 (95% CI, 2.0-3.8) for 1; 4.0 (95% CI, 3.1-5.1) for 2; 5.9 (95% CI, 4.6-7.3) for 3; 8.5 (95% CI, 6.3-11.1) for 4; 12.5 (95% CI, 8.2-17.5) for 5; and 18.2 (95% CI, 10.5-27.4) for 6. Conclusion The 2 existing classification schemes and especially a new stroke risk index, CHADS2, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.

Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation☆

Icmje

World Population Prospects, the 2010 Revision: Estimation and projection methodology

Background: Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal system affecting a large number of people worldwide. Whilst it has no attributable mortality, it has substantial impact on patients' quality of life (QoL) and is associated with considerable healthcare resource use. 

Aim: To review the economic impact of IBS, firstly on the individual, secondly on healthcare systems internationally and thirdly to society. 

Methods: Appropriate databases were searched for relevant papers using the terms: Irritable Bowel Syndrome; IBS; irritable colon; functional bowel/colonic disease; economics; health care/service costs; health expenditure/resources; health care/service utilisation; productivity. 

Results: Irritable bowel syndrome impacts most substantially on patients' work and social life. Reduction in QoL is such that on average patients would sacrifice between 10 and 15 years of their remaining life expectancy for an immediate cure. Between 15% and 43% of patients pay for remedies. No studies quantify loss of earnings related to IBS. Direct care costs are substantial; 48% of patients incur some costs in any year with annual international estimates per patient of: USA $742–$7547, UK £90–£316, France €567–€862, Canada $259, Germany €791, Norway NOK 2098 (€262) and Iran $92. Minimising extensive diagnostic investigations could generate savings and has been shown as not detrimental to patients. Cost to industry internationally through absenteeism and presenteeism related to IBS is estimated between £400 and £900 per patient annually. 

Conclusions: costs to patients, healthcare systems and society. Considerable benefit could be obtained from effective interventions.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/apt.12938

Review article: the economic impact of the irritable bowel syndrome.

Stress, resilience and psychological well-being in Chinese undergraduate nursing students.

Journal of Clinical Nursing 15, 678–684The effect of nurse-led gut-directed hypnotherapy upon health-related quality of lifein patients with irritable bowel syndromeAims and objectives. This study quantiﬁed health-related quality of life in a group ofirritable bowel syndrome patients and measures changes following a treatmentprogramme of nurse-led gut-directed hypnotherapy.Background. It is well recognized that health-related quality of life can be severelyimpaired in patients suffering form the irritable bowel syndrome. Current conven-tional treatment for irritable bowel syndrome is often unsatisfactory. In contrast ithas been shown that gut-directed hypnotherapy is an effective treatment of irritablebowel syndrome with up to three-quarters of patients reporting symptomaticimprovement.Design/method. Seventy-ﬁve patients (55 females/20 males, median age 37AE1 years,age range 18–64) comprised the study group. Physical symptoms of irritable bowelsyndrome were recorded using seven-day diary cards. On presentation the pre-dominant symptoms were abdominal pain (61%), altered bowel habit (32AE5%), andabdominal distension/bloating (6AE5%) in the patient group. An irritable bowelsyndrome quality of life questionnaire was used to deﬁne health-related quality oflife. Psychological well-being was measured using the Hospital Anxiety andDepression Scale. Data analysis was carried out using MINITAB, Release 12 forWindows.Results. Physical symptoms statistically improved after hypnotherapy. There werealso signiﬁcant statistical improvements (P < 0AE001) in six of the eight health-related quality of life domains measured (emotional, mental health, sleep, physicalfunction, energy and social role). These improvements were most marked in femalepatients who reported abdominal pain as their predominant physical symptom.Anxiety and depression improved following treatment.Conclusion. Gut-directed hypnotherapy has a very positive impact on health-relatedquality of life with improvements in psychological well-being and physical symp-toms. It appears most effective in patients with abdominal pain and distension.Relevance to clinical practice. This study demonstrates that by integrating com-plementary therapies into conventional care that gastrointestinal nurses have apotential role in the management of irritable bowel syndrome.Key words: gut-directed hypnotherapy, health-related quality of life, irritable bowelsyndrome, nurse-led clinics, nursing

Effect of nurse-led gut-directed hypnotherapy upon health-related quality of life in patients with irritable bowel syndrome.

Background: It is thought that people with irritable bowel syndrome (IBS) who consult secondary care have more severe symptomatology than those treated mainly in primary care.

Aims: To describe the physical and psychological symptoms of IBS, and the health-related quality of life of patients managed in primary and secondary care.

Design of study: Cross-sectional observational survey.

Setting: The general population of the United Kingdom (UK).

Methods: A cohort of people with IBS symptoms was recruited via a UK-wide newspaper advertisement. Frequency, duration and severity of symptoms, and health-related quality of life data were collected by semi-structured telephone interviews. Descriptive analysis allowed the comparison of those managed in primary care with those consulting secondary care. Logistic regression was used to identify factors associated with patients consulting secondary care.

Results: Data on 486 participants with confirmed IBS (Rome II criteria) were examined. Similar patterns in symptom severity were found in primary and secondary care groups. Factors associated with IBS patients consulting secondary care were: male sex, a longer length of time since diagnosis, having frequent bowel motions, not having dyspepsia in the past 3 months, and having used medication and alternative therapies. Although patients managed in secondary care have greater impairment to their usual activities, both groups had similar health-related quality-of-life profiles.

Conclusion: High levels of physical and psychological morbidity were present in population-based volunteers managed in both primary and secondary care. This study suggests that patients with IBS managed solely in primary care are affected as much as those attending secondary care.

A comparison of irritable bowel syndrome patients managed in primary and secondary care: the Episode IBS study

Aims. This study aimed to explore nursing staff’s attitudes and use of music for older people with dementia in long-term care facilities.

Background.  Music has shown positive outcomes in managing behavioural symptoms of older people with dementia. Older people living in long-term care facilities often do not have access to trained music therapists. Nursing staff provide the majority of direct care for institutionalised older people with dementia, therefore, will be the most appropriate personnel to learn and implement music therapy for those with dementia. To date, no studies have explored nursing staff’s attitudes and use of music for those with dementia.

Design.  A cross-sectional research design was used.

Methods.  A convenience sample of 285 nursing staff caring for those with dementia in long-term care facilities in Taiwan were recruited. Participants received a self-administered questionnaire consisted of items exploring nursing staff’s attitude and use of music for those with dementia. A total of 214 participants completed the questionnaires, giving a response rate of 75·1%.

Results.  Most nursing staff held positive attitudes towards use of music for older people with dementia (mean = 84·89, range 23–115), but only 30·6% (n = 66) had used music for those with dementia in practice. The majority perceived that they had limited knowledge and skills about use of music (72·9%). Over half of the participants reported that they lacked resources and time to implement music therapy in practice.

Conclusions.  Nursing staff need more formal training to use music for those with dementia. Nursing staff can be the suitable personnel to learn easily and implement music therapy as a part of routine activity programmes for those with dementia.

Relevance to clinical practice.  Appropriately trained nursing staff in long-term care facilities who use music therapy may help improve the mental health of older people with dementia.

Exploring nursing staff's attitudes and use of music for older people with dementia in long-term care facilities.

Introduction Between surgery and radiotherapy patients with a malignant glioma may encounter a number of psychosocial issues that could invoke an anxious or depressive response. This study explored the frequency, severity and cause of anxiety and depression in patients with presumed malignant brain tumours in the period between their surgery and radiotherapy. Methods A prospective study of 51 patients used mixed methods to measure anxiety and depression at three time points; post surgery, three weeks post surgery and pre radiotherapy. Analysis was undertaken using statistical and content analysis of the Hospital Anxiety and Depression (HAD) scores and unstructured interviews respectively. Results Analysis of HAD scores indicated a heightened level of anxiety in patients pre radiotherapy. This anxiety is more prevalent in younger patients and is not related to the patients change in functional state. Five patients had a significant depression at one or more time points between surgery and radiotherapy. Four of the five patients who reported scores consistent with depression had past histories of depression. Content analysis of unstructured interviews indicated that the HAD scores underestimated the presence of anxiety and depression amongst this group of patients. Conclusion Anxiety was more common in younger patients. Anxiety was slightly more frequent pre-radiotherapy. A past medical history of depression is a predictor of significant depression in the post-operative period. The HAD scale although useful is not an adequate measurement tool for detecting anxiety and depression amongst all patients and health care professionals should adopt other means to monitor for these signs and symptoms.

Graeme D Smith

Papers

Stress, resilience and psychological well-being in Chinese undergraduate nursing students.

Effect of nurse-led gut-directed hypnotherapy upon health-related quality of life in patients with irritable bowel syndrome.

A comparison of irritable bowel syndrome patients managed in primary and secondary care: the Episode IBS study

Exploring nursing staff's attitudes and use of music for older people with dementia in long-term care facilities.

The frequency and cause of anxiety and depression amongst patients with malignant brain tumours between surgery and radiotherapy