Objective: Chemotherapy and hormone treatments carry significant implications on the fertility of young women with breast cancer. Increasingly, nulliparous women experience fertility dilemmas due to rising survival rates and pregnancy delay. This qualitative study investigated women's responses to being told that treatments affected their fertility and how their interactions with health services impacted on their experiences.Methods: Twenty-four women under 40 years participated in three focus groups using a flexible interview structure. Data were analysed using content analysis and participants subsequently member checked the themes generated.Results: The priority for most women was survival, although women without children were more willing to take risks. Many women felt that pregnancy after breast cancer and methods of egg harvesting carried a significant risk to survival and fears appeared to be increased by conflicting advice from health professionals. Overall, the women felt the cancer, its treatment options and the health service itself had each robbed them of choice. Hence, with hindsight, many said they would have welcomed an open and honest discussion with a fertility expert to maximise their options.Conclusions: Young women with breast cancer face complex decisions regarding their fertility and treatment options. Survival remains the priority for the majority of women. Although there is a paucity of evidence concerning many fertility issues, it is essential that available options and any potential risks are discussed in a coherent, objective fashion. Early referral to specialist fertility services that provide clear, cohesive advice can aid informed decision making.

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Collaborative learning opportunities for nursing and medical students are feasible and add value to the learning experience. Data indicate positive outcomes of learning in multiprofessional groups, comprising increased confidence levels, increased understanding of others' professional roles and personal development.

This article examines the lived experiences of nurses responsible for administering care to dying patients. To achieve this, the article explores the notion of 'relentless self-care' and why this is an important feature of palliative nursing practice (Renzenbrink, 1998), even though for many nurses, their feelings of loss must remain hidden (Doka, 1989). Because of this, nurses try to protect themselves from distressing symptoms by distancing themselves from death. Consequently, nurses may locate dying patients in side-rooms and hand over part of their caring role to relatives (Sudnow, 1967; Wakefield, 1996, 1999). In view of these responses, the final part of the article will attempt to offer a way forward for the nursing profession, by examining why nurses should treat their own feelings of loss as being analogous to those of a bereaved relative.

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The National Health Service (NHS) has called for the 'eradication of demarcation lines between healthcare professionals' in the UK . Educational institutions are therefore striving to achieve this outcome through integrative interprofessional initiatives. This article discusses the effects of an integrative training course for medical and nursing students in 'breaking bad news' to patients. Triangulation of the qualitative methods enabled the researchers to gather student perspectives on this experience. Data analysis revealed that the 34 student volunteers challenged misconceptions of professional roles through this interprofessional programme. Questionnaires demonstrated that although most students had enrolled on the course to develop communication skills, the interprofessional aspect of the course was one of the main educational benefits. While outcomes were largely positive, some students were anxious about a holistic interprofessional curriculum. Undergraduate healthcare students may need to collaborate earlier, and for longer time-periods, to enhance professional understanding and relationships.

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Aims and objectives:To evaluate current evidence to determine whether oral preoperative carbohydrate drinks shorten hospital stays, reduce insulin resistance and/ or improve postoperative discomfort for patients undergoing abdominal or cardiac surgery.Background: Criticisms of standard preoperative fasting have forced practitioners to explore new ways of preparing patients for theatre. Consequently, the use of preoperative carbohydrate drinks prior to elective surgery has gained momentum. Current evidence regarding the efficacy of this treatment has been inconsistent and contradictory which prompted a review of the current literature. Design: A systematic review of randomised clinical trials (RCTs). Methods: In accordance with Prisma guidelines, the review incorporated a systematic, comprehensive search of English-language-only texts published between 2001-2018. The search focused on five databases (MEDLINE, EMBASE, CINAHL, British Nursing Index and ASSIA). Reference lists of relevant systematic reviews and studies located were also hand-searched for eligibility and further references. All RCTs investigating the effect of preoperative carbohydrate drinks on adult patients undergoing cardiac or abdominal surgery were included. The review excluded RCTs conducted on patients with type 1 or 2 diabetes mellitus and patients under the age of 18. Result: The review included 22 RCTs with a total sample of 2,065 patients across thirteen countries. Nine different types of surgery were identified. No significant reductions in hospital stay were noted in 8 of the ten trials. Preoperative carbohydrate drinks significantly reduced insulin resistance and improved postoperative discomfort especially in patients undergoing laparoscopic cholecystectomy. No definite conclusion regarding the impact of preoperative carbohydrate drinks on gastric volume and gastric pH was noted. Similarly, no adverse events such as pulmonary aspiration were reported.Conclusion: Preoperative carbohydrate drinks were found to be safe and can be administered up to 2 hr before surgery. Such drinks were also found to reduce insulin resistance and improve postoperative discomfort especially in patients undergoing | 3097 NOBA ANd WAKEFIELd | AIM OF THE RE VIE WThe aim of this review was therefore to evaluate the available evidence to establish whether oral preoperative carbohydrate drinks: laparoscopic cholecystectomy. However, there is insufficient evidence to definitively conclude what impact they have on length of hospital stay.Relevance to clinical practice: Patients undergoing surgery are often required to fast from midnight, while in some extreme cases patients are fasted for up to 24 hr prior to surgery. The main purpose of asking patients to undergo this prolonged fasting is to reduce the risk of aspiration. However, there is a general consensus that this traditional practice is out of date, and it is often associated with postoperative complications. On the other hand, current evidence suggests oral intake of fluids up to 90-180 min prior to surgery...