Aim To evaluate the impact of implementing Advanced Nurse Practitioner roles on patients, staff members and organizational outcomes in an acute hospital. Background The worldwide development of advanced practice roles in nursing has been influenced by increasing demands and costs of health care. A key issue in the UK has been the reduction in hours junior doctors can work. While there is evidence these roles can have a positive impact in a variety of clinical specialties, little is known about the impact advanced nurses substituting for junior doctors can have on patients, staff members and organizational outcomes in general hospital care settings. Design Collective case study. Methods A collective case study in a district general hospital in England was undertaken in 2011–2012. Interviews with strategic stakeholders (n = 13) were followed by three individual case studies. Each case study represented the clinical area in which the roles had been introduced: medicine, surgery and orthopaedics and included interviews (n = 32) and non‐participant observation of practice. Findings The ANPs had a positive impact on patient experience, outcomes and safety. They improved staff knowledge, skills and competence and enhanced quality of working life, distribution of workload and team‐working. ANPs contributed to the achievement of organizational priorities and targets and development of policy. Conclusion ANPs undertaking duties traditionally performed by junior doctors in acute hospital settings can have a positive impact on a range of indicators relating to patients, staff members and organizational outcomes which are highly relevant to nursing.

kennedy f., mcdonnell a., gerrish k., howarth a., pollard c. & redman j. (2011) Evaluation of the impact of nurse consultant roles in the United Kingdom: a mixed method systematic literature review. Journal of Advanced Nursing 68(4), 721–742. Abstract Aim.  This paper reports a mixed methods systematic review examining the impact of nurse consultant roles in adult healthcare settings, with a view to identifying indicators for demonstrating their impact on patient and professional outcomes. Background.  Nurse consultants were introduced in England in 2000 with the intention to achieve better outcomes for patients by improving quality and services. Previous studies have investigated the impact of nurse consultants, but attempts to amalgamate this evidence have been methodologically limited. Since these reviews were published, the importance of demonstrating the contribution of nurse consultants has prompted new research. A robust review of the evidence is now required. Data sources.  A broad search strategy was adapted for eight databases. Grey literature was sought from various sources. Review methods.  Quantitative and qualitative studies were included. Study quality was assessed using appropriate instruments. Cross‐study synthesis combined the quantitative and qualitative findings in relation to the dimensions of impact identified. Measures of impact were mapped against a framework for assessing clinical and professional outcomes. Results.  Thirty‐six studies were included. The findings suggest a largely positive influence of nurse consultants on a range of clinical and professional outcomes, which map onto the proposed framework of impact. However, there was very little robust evidence and the methodological quality of studies was often weak. Conclusion.  Further robust research is required to explore nurse consultants’ impact on patient and professional outcomes. The proposed framework for assessing impact could be used to guide future research and assist nurse consultants assess their impact.

Following the introduction of the National Health Service Breast Screening Programme (NHSBSP) in the UK increasing numbers of women are diagnosed with ductal carcinoma in situ (DCIS). In DCIS, the cancer cells are confined to the ducts of the breast but considerable uncertainty surrounds the condition. Patients are often reassured that it is non-invasive and not life-threatening but they are recommended similar treatments to patients with invasive breast cancer. Little research has investigated the psychosocial impact of DCIS; therefore the aim of this qualitative study was to explore women's experiences of the condition. Semi-structured interviews were conducted with a purposive sample of 16 women previously diagnosed and treated for DCIS. Thematic analysis identified six key themes: 1) Invisibility of DCIS, 2) Uncertainty, 3)Perceptions of DCIS, 4) Acceptance of Treatment, 5) Social Support and 6) Moving On.The results highlight the substantial challenges faced by women diagnosed with DCIS.These findings have clear significance for healthcare professionals, especially specialist nurses, who work closely with DCIS patients.

Next-generation sequencing has been invaluable in the elucidation of the genetic etiology of many subtypes of intellectual disability in recent years. Here, using exome sequencing and whole-genome sequencing, we identified three de novo truncating mutations in WAS protein family member 1 (WASF1) in five unrelated individuals with moderate to profound intellectual disability with autistic features and seizures. WASF1, also known as WAVE1, is part of the WAVE complex and acts as a mediator between Rac-GTPase and actin to induce actin polymerization. The three mutations connected by Matchmaker Exchange were c.1516C>T (p.Arg506Ter), which occurs in three unrelated individuals, c.1558C>T (p.Gln520Ter), and c.1482delinsGCCAGG (p.Ile494MetfsTer23). All three variants are predicted to partially or fully disrupt the C-terminal actin-binding WCA domain. Functional studies using fibroblast cells from two affected individuals with the c.1516C>T mutation showed a truncated WASF1 and a defect in actin remodeling. This study provides evidence that de novo heterozygous mutations in WASF1 cause a rare form of intellectual disability.

Aim To develop a framework to evaluate the impact of nurse consultants on patient, professional and organizational outcomes and identify associated indicators of impact. Background Since nurse consultants were introduced into the UK in 2000, there has been growing interest in demonstrating their impact, although robust evidence of impact is lacking. Existing frameworks for evaluating the impact of advanced practice roles do not cover the four dimensions of the nurse consultant role sufficiently. Design Multiple case study. Method Individual case studies of six nurse consultants in England were undertaken between December 2009–October 2010. Each case study involved interviews with the nurse consultant, healthcare staff, managers, patients and carers. Interviews explored participants' perceptions of the impact of the nurse consultant and indicators of actual and/or potential impact. Data were analysed using framework approach. Findings Three domains of impact of nurse consultant roles were identified: clinical significance, professional significance and organizational significance. Each domain included three to four indicators of impact. All nurse consultants showed some evidence of impact in all three domains although the primary focus varied across the different nurse consultants. Due to the wide diversity in nurse consultant roles there was little commonality in the specific indicators of impact across all nurse consultants. Conclusion The framework for capturing the impact of nurse consultants could be used by researchers and by nurse consultants to demonstrate their impact. Further research is required to assess the suitability of the framework for capturing the impact of other advanced practice roles.