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Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the circumstances that give rise to a duty of care and the standard expected of nurses in discharging their duty.BACKGROUND Internationally, clinicians face increased demand, pressure on resources and unmet patient needs. A community social support service was co-located within cancer clinics in Glasgow, Scotland to help address some of these needs. AIM To analyse the impact of the service on clinical staff and to propose an explanatory theory of change. METHOD Qualitative exploratory design, using thematic analysis of semistructured interviews with 8 nurse specialists and 2 medical oncologists from lung, breast, head and neck, and gastrointestinal oncology teams in Glasgow in 2018-2019. FINDINGS Four themes captured this process 'The conversation', 'A better experience', 'Freedom to focus' and 'Working hand in hand'. CONCLUSION Together, these four themes explained the process of effective interprofessional working. This process would have been predicted by the J-curve literature on diffusion of innovations. Linking J-curve theory to this successful process provides new understanding that could prove essential for clinical teams who are implementing change within their practice.Lower urinary tract infections account for more than 224 000 hospital admissions each year and nearly all of these have the pathophysiological possibility to develop into pyelonephritis, known clinically as an upper urinary tract infection. Acute pyelonephritis is characterised by inflammation of the renal parenchyma caused by bacteriuria ascending from the bladder, up the ureters to the kidneys. Effective history taking, combined with refined physical examination skills, are the two most powerful tools to differentiate upper and lower urinary tract infections as well as assisting the practitioner to exclude other differential diagnoses. Utilisation of these skills by the practitioner, together with the recognised presenting symptom triad of flank pain, fever and nausea in this case study, enabled the diagnosis of acute pyelonephritis to be given.Emeritus Professor Alan Glasper, from the University of Southampton, discusses a government initiative to increase the number of nurses in the NHS through the reintroduction of student funding.BACKGROUND Hypothermia is a common problem in the surgical context and can lead to serious consequences for the patient and increased costs for society. AIMS To study day-surgery patients' peripheral and core temperatures during the preoperative phase. METHODS In total, 50 day-surgery patients participated in the study. Two sets of measurements of temperatures were made core temperature and peripheral temperatures (two measuring points on the upper body and lower extremities respectively) were measured on arrival at the day-surgery unit, as well as on arrival at the operating theatre. The data were normally distributed and a paired t-test was used for statistical analysis. FINDINGS Peripheral temperatures had significant changes, with measuring points on the upper body decreasing and measuring points on the lower extremities increasing in temperature. The results show no significant change in core temperature. CONCLUSION The measurements show that 28% of the patients were below recommended preoperative temperature on arrival at the operating theatre. Further research is needed to study the development of body temperature perioperatively as well as at what point reheating interventions should be introduced.John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses a Healthwatch report showing that improvements need to take place in the way the NHS reports on patient complaints.BACKGROUND Cultural competence, an important part of patient-centred care, has been on the nursing agenda for many years. AIM The aim of this study was to measure the intercultural effectiveness level of paediatric nurses, and to explore relationships between the level of intercultural effectiveness and some sociodemographic variables in paediatric nurses. METHOD The study was conducted at İzmir Tepecik Training and Research Hospital's children's clinics in Turkey. A convenience sample of 98 paediatric registered nurses practising at the hospital was evaluated. To collect the study data, a sociodemographic characteristics questionnaire, a Cultural Approach in Nursing Care form and the Intercultural Effectiveness Scale (IES) were used. RESULTS The participating paediatric nurses' intercultural effectiveness levels were moderate, the problem they experienced most was the language problem and although many of them had not received adequate training in cultural care, based on their experiences, they regarded themselves as culturally competent. CONCLUSION Cultural competence is vital in multi-ethnic and multicultural societies. Cultural competence training should be provided to nurses during nurse education, or in-service training during their professional life.PURPOSE To analyze long-term outcomes after treatment discontinuation of anti-programmed death-1 (anti-PD-1) therapy in a cohort of patients with melanoma with the longest follow-up yet available to our knowledge, including a majority of patients treated outside of a clinical trial. We also assessed efficacy of retreatment with anti-PD-1 therapy with or without ipilimumab in relapsing patients. METHODS We retrospectively analyzed all patients with nonuveal, unresectable stage III/IV melanoma treated with single-agent anti-PD-1 therapy at Memorial Sloan Kettering from 2009-2018 who had discontinued treatment and had at least 3 months of follow-up after discontinuation (n = 396). Overall survival for patients with complete response (CR) was calculated from time of CR. 2-Hydroxybenzylamine research buy Time to treatment failure for patients with CR was time from CR to the next melanoma treatment or death. RESULTS CRs were seen in 102 of 396 patients (25.8%). The median number of months of treatment after CR was zero (range, stopped before CR to 26 months after CR). With a median follow-up of 21.1 months from time of CR in patients who did not relapse, the probability of being alive and not needing additional melanoma therapy at 3 years was 72.1%. There was no significant association between treatment duration and relapse risk. In multivariable analysis, CR was associated with M1b disease and cutaneous versus mucosal or acral primaries. Among the 78 patients (of 396) retreated after disease progression, response was seen in 5 of 34 retreated patients with single-agent anti-PD-1 therapy and 11 of 44 patients escalated to anti-PD-1 plus ipilimumab. CONCLUSION In our cohort, most patients discontinued treatment at the time of CR. Most CRs were durable but the probability of treatment failure was 27% at 3 years. Responses to retreatment were infrequent. The optimal duration of treatment after CR is not yet established.
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