BackgroundPrimary adrenal insufficiency (PAI) is a rare and severe condition requiring lifelong steroid replacement. During acute illness or stressful events, it is important to appropriately adjust glucocorticoid dose; failure to do so may lead to an adrenal crisis. The aim of the study was to explore patients PAI knowledge and understanding of the condition, steroid replacement adjustment during acute illness or stress and provided education.MethodsTen adult patients with PAI were purposefully recruited from two hospitals in a tertiary NHS Trust in England, UK. Data was collected using a mixed method approach utilising semi-structured audio-recorded interviews and hospital case note review. Interviews were transcribed verbatim and analysed using Burnard’s content analysis framework. Information from the hospital case note review was captured using a matrix table based on pre-defined criteria.ResultsFour key themes emerged: ‘Addison’s disease and hydrocortisone replacement’; ‘stress and corticosteroids’; ‘patient compliance/adherence’ and ‘transition’. Patients reported feelings of ‘going through a transition from uncertainty to adaption’ following diagnosis. All participants had a good level of knowledge and understanding of required medication however application in times of need was poor. Medication adherence and prevention of a crisis relied not only on patient knowledge and application but also the support of family and health professionals. Health care professional knowledge required improvement to aid diagnosis and management of PAI.ConclusionPatients with PAI did not apply existing knowledge to adjust steroid dose during acute illness or stress. Although a sample of limited size, our study identified there is a need to further explore why patients with Addison’s disease do not apply existing knowledge during times of increased need. Future research should consider appropriate behaviour change interventions to promote medication adherence to reduce risk of an adrenal crisis.
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Background Reductions in the number of junior doctors and limitation on working hours prompted units in the West Midlands (WM) to look for alternative workforce solutions to populate neonatal rotas and provide neonatal care. A small number of Advanced Neonatal Nurse Practitioners (ANNPs) were already working in the region. A local higher education provider offered a programme in Advanced Practice and a double neonatal Advanced Health Assessment for neonates was developed, awarding a MSc in Advance Practice (Nursing). Aims To record the number of ANNPs trained within the West Midlands since the introduction of the programme. To describe changes in the MSc programme in response to local demand. Results Numbers There have been 4 cohorts of students since the course started. Cohort 1–6 students – 5 MSc (and one Pg Diploma award) Cohort 2–7 students – 5 MSc (two Pg Diploma awards one moved from the area) Cohort 3–3 students – 2 MSc (one MSc in progress) Cohort 4–15 students – ongoing Changes Cohort 1 consisted of a single neonatal module; Cohort 2 progressed to a double neonatal module with a non-medical prescribing qualification. For Cohort 3 the syllabus was revised to map to the RCPCH training programme. All cohorts involved teaching and assessment in practice for neonates with teaching provided by clinicians. Cohort 4 further emphasised differential diagnosis with OSCE in University and in neonatal units as well as using case based learning and simulation activities. Conclusions The course is successfully training and educating an increasing number of ANNPs. Local clinicians shape the education of their student ANNPs and delivery in the WM allows study close to home. Limitations Student numbers have been relatively small. Some who have had limited previous opportunity for academic development lack a first degree, are confronted with a steep learning curve and require substantial support. This is the first large cohort and it will be important to follow this group and obtain information about their progress.
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