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Commentary on: Danne et al. Association Between Treatment Adherence and Continuous Glucose Monitoring Outcomes in People With Diabetes Using Smart Insulin Pens in a Real-World Setting. Diabetes Care. 2024.47 (6),:995-1003
Implications for practice and research Healthcare providers should emphasise consistent insulin adherence for people with diabetes, as even a few missed doses can worsen overall glycaemia. Future research should identify barriers to consistent usage of insulin and develop strategies to enable patients’ adherence, such as increasing patient engagement with smart insulin pens and continuous glucose monitoring systems.
Diabetes is a widespread chronic disease, with steadily rising prevalence in most countries. In 2019, the global prevalence of diabetes was estimated at 9.3%, affecting 463 million people. This figure is projected to rise to 10.2% by 2030 and 10.9% by 2045.
Commentary on: Kearns, RJ, Kyzayeva, A, Halliday, LO, et al. Epidural analgesia during labour and severe maternal morbidity: population based study. BMJ 2024;385.
Implications for practice and research Health research, policy and information should emphasise the advantages of intrapartum epidurals beyond pain relief, especially for women with pre-existing conditions and preterm labour. Health services must provide access to a 24-hour epidural service within their maternity care.
The use of intrapartum epidurals to manage pain during labour and birth has been globally accepted for decades.
Commentary on: Reason M, Acton K, Foulds D. Working it out together: Lessons and insights into inclusive research in an arts context. British Journal of Learning Disabilities 2024:1–11.
Implications for practice and research Inclusive research places a strong emphasis on the active empowered participation, particularly in decision-making and agenda-setting, of marginalised/disadvantaged community members in every step of the research process. Implementation research needs to focus on how research methodologies can be democratised through a continuous commitment to allyship with marginalised/disadvantaged populations towards empowered involvement.
Research in the field of learning disabilities has been influenced by ableist practices, often excluding individuals with learning disabilities and autism from the research process. This exclusionary tradition, which also has been observed in research with other marginalised/disadvantaged groups, has diminished their capacity to drive change within their communities.
Commentary on: Chee, JMP, Rusli KDB, Tan ZYA, Tan AJQ, Ang SGM, Lau ST, Seah B, Liaw SY. Perceptions of community care among nursing students: A cross-sectional study with implications to the nursing workforce. Nurse Education Today. 2024; 137:106162. 10.1016/j.nedt.2024.106162
Implications for education and research With the shift towards delivering healthcare services in homes, communities and primary healthcare settings, nursing curricula should integrate community nursing early in the program and provide diverse placements with mentorship opportunities to highlight career paths in this specialty. Future research should explore effective implementation strategies to enhance student perceptions of community care and address workforce challenges in this field.
The increasing demand for postacute and home-based care programmes creates an urgent need to expand the community nursing workforce.
Commentary on: Feo R, Young JA, Urry K, Lawless M, Hunter SC, Kitson A, Conroy T. ‘I wasn’t made to feel like a nut case after all’: A qualitative story completion study exploring healthcare recipient and carer perceptions of good professional caregiving relationships. Health Expect. 2023 Oct 19;27(1):e13871. doi: 10.1111/hex.13871. Epub ahead of print.
Healthcare providers can foster effective patient–provider relationships by addressing concerns early on and adopting key behaviours, such as showing interest in understanding the patient’s issues, validating their concerns and respecting their choices. Future research should focus on identifying strategies to help healthcare providers develop effective patient–provider relationships. This requires a thorough understanding of these relationships from the perspectives of all involved parties, including healthcare providers, patients and their informal caregivers.
The patient–provider relationship is at the core of effective disease management.
Commentary on: Wu CY, Iskander C, Wang C, et al. Association of sulfonylureas with the risk of dementia: A population-based cohort study. J Am Geriatr Soc. 2023; 71:3059–70.
Unless contraindicated, dipeptidyl peptidase 4 inhibitors (DPP-4i) should be used as first-line choice in older adults with type 2 diabetes in preference to sulfonylurea due to increased risk of dementia. Prospective studies are needed to ascertain if the use of sulfonylurea by older adult patients causes higher risk of developing dementia.
Diabetes is already known as a risk factor for developing dementia. Multiple factors contribute to this association: presence of microvascular and macrovascular complications, chronic inflammation, hyperglycaemia, hypoglycaemia and hyperinsulinemia.
Older adult patients often present with multimorbidities, polypharmacy, malnutrition, sarcopenia, longer duration of diabetes and renal and hepatic dysfunction. Furthermore, low education level, high blood pressure, dyslipidemia, obstructive...
Commentary on: Kristiansen D, Boyle EH, Svec J. The impact of local supply of popular contraceptives on women’s use of family planning: findings from performance-monitoring-for-action in seven sub-Saharan African countries. Reprod Health. 2023 Nov 21;20(1):171.
Implications for practice and research The concept of ‘demand’ and ‘supply’, from the perspective of individual preferences shaped by cultural and societal norms, can be incorporated by health practitioners and policymakers when addressing the root causes of unmet health needs. Understanding women’s empowerment and agency in family planning requires a rights-based community-engaged research approach. Community-level data can illuminate the underlying mechanisms of healthcare utilisation preferences.
The issue of unmet contraceptive needs remains a gap in global healthcare, despite various contraceptive options available now more than ever.
Commentary on: Yeji Hwang, Miranda V. McPhillips, Liming Huang, G. Adriana Perez and Nancy A. Hodgson, Better caregiver mastery is associated with less anxiety in individuals with cognitive impairment, BMC Nursing. 2023; 22:307.
Implications for practice and research Anxiety is one of the common neuropsychiatric symptoms (NPs) in individuals with cognitive impairment. Considering the fluctuating and variable course of NPs in dementia, studies with longer follow-up periods are required to understand the relationship between caregiver mastery and anxiety in patients with dementia. Dementia, an umbrella condition, encompasses various neurogenerative diseases that can cause behavioural problems, movement problems, autonomic dysfunction, gait and balance problems, as well as cognitive impairment. Hence, it is important to develop caregiver skills with different strategies for each type of dementia.
As the population ages, the prevalence of dementia has increased.
Commentary on: Harmon CS, Adams SA, Davis JE, Gephart SM, Donevant SB. Unintended consequences of the electronic health record and cognitive load in emergency department nurses. Appl Nurs Res. 2023 Oct;73:151724. doi: 10.1016/j.apnr.2023.151724. Epub 2023 Aug 5.
The organisation should provide training and support for electronic health record (EHR) use; however, if usability problems do not resolve themselves, system development work is needed. Multimethod research is needed to determine the nurses’ cognitive load (CL) in the work environment where EHR is used.
Unintended consequences (UCs) of the EHR and the CL have been on the discussion in USA. In nursing has been recognised UC of the EHR related to the adverse effects on patient care outcomes, patient safety, nursing workflow and nursing workload.
Commentary on: Lo Faro V, Johansson T, Johansson Å. The risk of venous thromboembolism in oral contraceptive users: the role of genetic factors—a prospective cohort study of 2 40 000 women in the UK Biobank. Am J Obstet Gynecol. 2024;230:360.e1-13
Implications for practice and research Currently, venous thromboembolism (VTE) risk assessment for contraceptive counselling is based on clinical characteristics and family history. Incorporating genetic risk assessment into current practice can significantly enhance the screening of oral contraceptive users at high risk for VTE. Further research is needed to develop a comprehensive model, explore the cost-effectiveness and implementation of genetic risk assessment in contraceptive counselling, address challenges in communicating genetic information and evaluate its applicability across diverse populations.
Venous thromboembolism (VTE) is a complex disorder influenced by both acquired and inherited factors. Oral contraceptive use, an acquired factor, has been linked to an increased risk of...
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