Thirty patients with human immunodeficiency virus (HIV)-associated non-Hodgkin's lymphoma (NHL) receiving chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) were randomized to receive either subcutaneous recombinant human granulocyte-macrophage colony-stimulating factor (rGM-CSF) or no additional therapy. Recombinant rGM-CSF (at a dose of 10-20 micrograms/kg/d) was given on days 1 to 10 (early rGM-CSF) to the first five patients, but was changed to days 4 to 13 (delayed rGM-CSF) of each chemotherapy cycle in subsequent patients. Compared with the control group (N = 10), the delayed rGM-CSF group (N = 11) had higher mean nadirs of the absolute neutrophil count (0.36 v 0.89 x 10(9)/L; P = .009), shorter mean durations of neutropenia (4.9 v 1.3 days; P = .02), fewer chemotherapy cycles complicated by neutropenia and fever (67% v 27%; P = .001), fewer days hospitalized for fever and neutropenia (4.9 v 1.8; P = .004), fewer reductions in chemotherapy dosages, and less frequent delays in chemotherapy administration. No significant differences were observed between patients in the control group and those in the early rGM-CSF group (N = 5). Median levels of serum HIV-1 p24 antigen decreased to 18% and 17% of baseline values in control (N = 4) and rGM-CSF groups (N = 6), respectively, 1 week following administration of the first cycle of chemotherapy. In the third week after chemotherapy, median antigen levels remained below baseline in the control group, but rose to 243% of baseline values in the rGM-CSF group (P = .01), suggesting stimulation of HIV replication. The effect of this change in HIV activity on clinical outcome of treated patients could not be determined, and therefore the clinical significance of this finding remains unclear. Complete response rates of 67%, 70%, and 60% were observed in the control, delayed rGM-CSF, and early rGM-CSF groups, respectively, with corresponding survival times of 9.0, 11.4, and 8.0 months.

The first 6 months of being a registrant has challenges for both the preceptee and the preceptor. The implementation of preceptorship models that include preparation and support for preceptors is essential to alleviate issues of transition, retention and stress. Preceptors identified areas for improvement such as regular update sessions, formal peer support, and protected time to discuss and complete the documentation.

No abstract

Star Babies is an enhancement of the universal Child Health Promotion Programme in Northern Ireland, where first-time parents are offered additional regular health visiting support from the antenatal period until the baby is 12 months of age. This study was carried out to evaluate outcomes of first-time parents who received the core Child Health Programme or the enhanced Star Babies programme to identify the areas where the programmes are successful and to quantitatively assess the magnitude of their impact. First-time parents were invited to participate in the study and were divided into two groups: those in the Star Babies programme (n=189) and those in the core Child Health Promotion Programme (n=125). The study found differences between the two groupings of first-time parents and the evaluation of the health visiting services received in terms of infant feeding, knowledge of preventing home accidents and overall satisfaction varied across the two groups. The findings highlight the positive outcomes from an enhanced health visitor-led programme such as Star Babies, with implications for policy, practice and service development.