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Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations.
The aim was to use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to assess health policy impact on preventing or treating school-aged children (5 > 18 years) with obesity in underserved populations.
A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction.
Twelve studies included subgroup analysis, with four suggesting an impact of policy on at-risk groups. None of the 24 studies fully applied the RE-AIM framework. Policies positively impacted childhood obesity in 12 studies across the sample.
Our review revealed inconsistent evidence for the effectiveness of policy on childhood obesity, perhaps due to the lack of focus on the social determinants of health. In addition, many studies did not evaluate the outcomes for underserved populations. Therefore, we propose more attention to social determinants in future legislation and evaluation of policy effectiveness on underserved populations. Findings identify an urgent need for the design, implementation, and evaluation of policies specifically directed to address the inequities of racism, social injustices, and social determinants of health that impact childhood obesity in the United States. Future work needs to identify who was reached by the policy, who benefitted from the policy, and how policies were implemented to address obesity-related health disparities. Nurses should advocate for the evaluation of childhood obesity policies, particularly in underserved populations, to determine effectiveness. Nurses, particularly those trained in population and community health and research, should advocate for policy research that considers inequities rather than controls for these variables. Multi-layered interventions can then be tailored to sub-populations and evaluated more effectively.
Trauma contributes to the greatest loss of disability-adjusted life-years for adolescents and young adults worldwide. In the context of global abdominal trauma, the trauma laparotomy is the most commonly performed operation. Variation likely exists in how these patients are managed and their subsequent outcomes, yet very little global data on the topic currently exists. The objective of the GOAL-Trauma study is to evaluate both patient and injury factors for those undergoing trauma laparotomy, their clinical management and postoperative outcomes.
We describe a planned prospective multicentre observational cohort study of patients undergoing trauma laparotomy. We will include patients of all ages who present to hospital with a blunt or penetrating injury and undergo a trauma laparotomy within 5 days of presentation to the treating centre. The study will collect system, patient, process and outcome data, following patients up until 30 days postoperatively (or until discharge or death, whichever is first). Our sample size calculation suggests we will need to recruit 552 patients from approximately 150 recruiting centres.
The GOAL-Trauma study will provide a global snapshot of the current management and outcomes for patients undergoing a trauma laparotomy. It will also provide insight into the variation seen in the time delays for receiving care, the disease and patient factors present, and patient outcomes. For current standards of trauma care to be improved worldwide, a greater understanding of the current state of trauma laparotomy care is paramount if appropriate interventions and targets are to be identified and implemented.
Surgical stress results in immune dysfunction, predisposing patients to infections in the postoperative period and potentially increasing the risk of cancer recurrence. Perioperative immunonutrition with arginine-enhanced diets has been found to potentially improve short-term and cancer outcomes. This study seeks to measure the impact of perioperative immunomodulation on biomarkers of the immune response and perioperative outcomes following hepatopancreaticobiliary surgery.
This is a 1:1:1 randomised, controlled and blinded superiority trial of 45 patients. Baseline and perioperative variables were collected to evaluate immune function, clinical outcomes and feasibility outcomes. The primary outcome is a reduction in natural killer cell killing as measured on postoperative day 1 compared with baseline between the control and experimental cohorts.
This trial has been approved by the research ethics boards at participating sites and Health Canada (parent control number: 223646). Results will be distributed widely through local and international meetings, presentation, publication and ClinicalTrials.gov (identifier: NCT04549662). Any modifications to the protocol will be communicated via publications and ClinicalTrials.gov.
ClinicalTrials.gov identifier: NCT04549662.
The number of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy in Sri Lanka is significantly rising. Most of these patients depend on haemodialysis, carrying a significant burden on their family caregivers. To develop care and support for both the patient and their family caregiver, it is crucial to understand how caregivers experience their caregiving situation. Therefore, this study aimed to explore family caregivers’ experiences of burden and coping when caring for a family member receiving haemodialysis in the Sri Lankan context.
Qualitative study with an exploratory design.
Family caregivers were recruited at a haemodialysis unit of a main government sector hospital in Sri Lanka between October and November 2021.
A purposive sampling of 11 family caregivers who cared for a family member receiving haemodialysis in a main government teaching hospital in Sri Lanka for at least 3 consecutive months. Data were collected through individual semistructured telephone interviews and analysed using qualitative content analysis.
The results showed an overarching theme, ‘striving to hold on and not let go’, with four categories: (1) feeling exhausted by the care burden, (2) feeling burdened as failing the care responsibility, (3) striving to cope and find meaning in caregiving, and (4) coping with caregiving through others’ support.
The results show that the family caregivers have a multifaceted burden. They continued caring for their family member receiving haemodialysis while making adjustments to the burdensome caregiving situation despite many constraints and suffering. Psychosocial support and financial assistance, including family counselling, are needed by family caregivers, through a community support system, to ensure endurance during their family members’ illness trajectory. Advance care planning is vital to alleviate care uncertainty and to meet the care needs of patients with ESKD, particularly in resource-constrained settings.
To explore the role of health communication in Shared Decision-Making (SDM) between nursing staff and older people in the community setting.
Society and healthcare services are marked by an exponentially ageing population, leading to a significant proportion of patients being older adults with highly demanding care needs. Scientific literature supports shared decision-making as a process that engages patients in their care. However, the increasing use of technology and the consequences of the COVID-19 pandemic have influenced how nurses communicate with older patients. Therefore, it is crucial to understand how to develop health communication to reach effective, shared decision-making processes.
Whittemore and Knafl's integrative review method, the literature search comprised five databases: PubMed, CINALH, Web of Science, Scopus and PsycINFO.
The 12 included studies were synthesised into three study patterns: (1) nurse–older patient health communication relationship, (2) older patients' perspectives and (3) nontherapeutic communication in end-of-life care.
This review underscored the crucial role of effective health communication in shaping SDM dynamics between nursing staff and older people in the community setting. Key elements included transparent information exchange, establishing trust and maintaining communication channels with informal caregiving networks. SDM actions were aligned with preserving older people's autonomy, but communication challenges persisted, particularly in end-of-life situations. Advanced care planning was recommended to address these shortcomings and improve communication among older people, healthcare professionals and families.
Implementing educational measures based on verbal and nonverbal health communication in nursing training could be beneficial. Nursing research could continue to develop and refine specific communication strategies adapted to the social determinants of health for diverse clinical situations regarding older adults in the community setting.
The authors have adhered to relevant EQUATOR guidelines through the PRISMA 2020 checklist.
No Patient or Public Contribution.
When children with head and neck cancer receive radiation therapy as part of their treatment, a considerable frequency of hypopituitarism has been recognised. However, in adults, it has been little studied and it is possible that patients may be inadvertently affected. The objective is to estimate the incidence of anterior pituitary dysfunction in adults undergoing radiotherapy for head and neck cancer.
A total of five databases will be used to perform the document search: PubMed, Scopus, Web of Science (Core Collection), Ovid-MEDLINE and Embase. Cohort studies will be included without restriction by language or date. The main outcome will be the incidence of adenohypophyseal dysfunction for each axis: prolactin, growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, luteinising hormone and follicle-stimulating hormone. Incidence meta-analysis will be performed using the Freeman-Tukey double arcsine method. In addition, a random-effects model will be used along with a 95% CI. Subgroup analyses will be performed according to tumour location, radiation dose and endocrine assessment time. Meta-regression will be applied according to patient’s age and time elapsed until diagnosis.
Since this will be a systematic review of published data, no ethics committee approval is required. The results will be presented at conferences and finally published in a peer-reviewed journal.
CRD42021235163.
Mild traumatic brain injury is common in children and it can be challenging to accurately identify those in need of urgent medical intervention. The Scandinavian guidelines for management of minor and moderate head trauma in children, the Scandinavian Neurotrauma Committee guideline 2016 (SNC16), were developed to aid in risk stratification and decision-making in Scandinavian emergency departments (EDs). This guideline has been validated externally with encouraging results, but internal validation in the intended healthcare system is warranted prior to broad clinical implementation.
We aim to validate the diagnostic accuracy of the SNC16 to predict clinically important intracranial injuries (CIII) in paediatric patients suffering from blunt head trauma, assessed in EDs in Sweden and Norway.
This is a prospective, pragmatic, observational cohort study. Children (aged 0–17 years) with blunt head trauma, presenting with a Glasgow Coma Scale of 9–15 within 24 hours postinjury at an ED in 1 of the 16 participating hospitals, are eligible for inclusion. Included patients are assessed and managed according to the clinical management routines of each hospital. Data elements for risk stratification are collected in an electronic case report form by the examining doctor. The primary outcome is defined as CIII within 1 week of injury. Secondary outcomes of importance include traumatic CT findings, neurosurgery and 3-month outcome. Diagnostic accuracy of the SNC16 to predict endpoints will be assessed by point estimate and 95% CIs for sensitivity, specificity, likelihood ratio, negative predictive value and positive predictive value.
The study is approved by the ethical board in both Sweden and Norway. Results from this validation will be published in scientific journals, and a tailored development and implementation process will follow if the SNC16 is found safe and effective.
Long-term benzodiazepine use is common despite known risks. In the original Eliminating Medications Through Patient Ownership of End Results (EMPOWER) Study set in Canada, patient education led to increased rates of benzodiazepine cessation. We aimed to determine the effectiveness of implementing an adapted EMPOWER quality improvement (QI) initiative in a US-based healthcare system.
We used a pre–post design with a non-randomised control group.
A network of primary care clinics.
Patients with ≥60 days’ supply of benzodiazepines in 6 months and ≥1 risk factor (≥65 years of age, a concurrent high-risk medication prescribed or a diazepam equivalent daily dose ≥10) were eligible.
In March 2022, we engaged 22 primary care physicians (PCPs), and 308 of their patients were mailed an educational brochure, physician letter and flyer detailing benzodiazepine risks; the control group included 4 PCPs and 291 of their patients.
The primary measure was benzodiazepine cessation by 9 months. We used logistic regression and a generalised estimating equations approach to control for clustering by PCP, adjusting for demographics, frailty, number of risk factors, and diagnoses of arthritis, depression, diabetes, falls, and pain.
Patients in the intervention and control groups were comparable across most covariates; however, a greater proportion of intervention patients had pain-related diagnoses and depression. By 9 months, 26% of intervention patients (81 of 308) had discontinued benzodiazepines, compared with 17% (49 of 291) of control patients. Intervention patients had 1.73 greater odds of benzodiazepine discontinuation compared with controls (95% CI: 1.09, 2.75, p=0.02). The unadjusted number needed to treat was 10.5 (95% CI: 6.30, 34.92) and the absolute risk reduction was 0.095 (95% CI: 0.03 to 0.16).
Results from this non-randomised QI initiative indicate that patient education programmes using the EMPOWER brochures have the potential to promote cessation of benzodiazepines in primary care.
To evaluate real-world treatment patterns and clinical outcomes in recurrent/advanced endometrial cancer patients who progressed following prior systemic therapy in clinical practice in Europe.
Endometrial Cancer Health Outcomes-Europe (ECHO-EU) is a retrospective patient chart review study.
ECHO-EU is a multicentre study conducted in the UK, Germany, Italy, France and Spain.
Patients with recurrent/advanced endometrial cancer who progressed between 1 July 2016 and 30 June 2019 following prior first-line systemic therapy were eligible and data were collected until last available follow-up through November 2021.
Data collected included patient demographics, clinical and treatment characteristics, and clinical outcomes. Kaplan-Meier analyses were performed since initiation of second-line therapy to estimate time to treatment discontinuation, real-world progression-free survival (rwPFS) and overall survival (OS).
A total of 475 patients were included from EU5 countries. Median age was 69 years at advanced endometrial cancer diagnosis, 78.7% had stage IIIB–IV disease, 45.9% had Eastern Cooperative Oncology Group status ≥2 at second-line therapy initiation. In second line, a majority of patients initiated either non-platinum-based chemotherapy (55.6%) or endocrine therapy (16.2%). Physician-reported real-world overall response rate (classified as complete or partial response) to second-line therapy was 34.5%, median rwPFS was 7.4 months (95% CI 6.2 to 8.0) and median OS was 11.0 months (95% CI 9.9 to 12.3).
Patients had poor clinical outcomes with a median OS of
This study seeks to review how the use of digital technologies in clinical nursing affects nurses' professional identity and the relations of power within clinical environments.
Literature review.
PubMed and CINAHL databases were searched in April 2023.
We screened 874 studies in English and German, of which 15 were included in our final synthesis reflecting the scientific discourse from 1992 until 2023.
Our review revealed relevant effects of digital technologies on nurses' professional identity and power relations. Few studies cover outcomes relating to identity, such as moral agency or nurses' autonomy. Most studies describe negative impacts of technology on professional identity, for example, creating a barrier between nurses and patients leading to decreased empathetic interaction. Regarding power relations, technologically skilled nurses can yield power over colleagues and patients, while depending on technology. The investigation of these effects is underrepresented.
Our review presents insights into the relation between technology and nurses' professional identity and prevalent power relations. For future studies, dedicated and critical investigations of digital technologies' impact on the formation of professional identity in nursing are required.
Nurses' professional identity may be altered by digital technologies used in clinical care. Nurses, who are aware of the potential effects of digitized work environments, can reflect on the relationship of technology and the nursing profession.
The use of digital technology might lead to a decrease in nurses' moral agency and competence to shape patient-centred care. Digital technologies seem to become an essential measure for nurses to wield power over patients and colleagues, whilst being a control mechanism. Our work encourages nurses to actively shape digital care.
We adhere to the JBI Manual for Evidence Synthesis where applicable. EQUATOR reporting guidelines were not applicable for this type of review.
No patient or public contribution.
Introducción. El objetivo de la siguiente revisión fue determinar los factores de riesgo asociados a las conductas suicidas (intento de suicidio, ideación suicida y suicidio consumado) en adolescentes. Metodología. La presente revisión de la evidencia se llevó a cabo utilizando varios estudios que se hayan publicado en los últimos 10 años en cualquier país a nivel mundial; la búsqueda de la información se realizó con el uso del término de texto libre “conducta suicida” en las bases de datos PubMed, Epistemonikos, Scielo y Dialnet, identificando un total de 424 artículos y de ellos, 12 estudios se incluyeron en esta investigación. Resultados. Se determinó que los principales factores de riesgo que están asociados con la conducta suicida a partir del análisis de la evidencia científica disponible son: ser mujer, antecedentes de suicidios en la familia, violencia familiar, ausencia de padres y grupo familiar, conflictos con los padres, trauma infantil, rechazo, acoso escolar, conflictos con los compañeros, dificultades académicas, influencia de los amigos o conocidos cibernéticos, bullying, problemas para regular las emociones, depresión, desesperación, tristeza, soledad, enfermedad física y mental, eventos estresantes, impotencia, abuso de sustancias psicoactivas y violencia física o psicológica. Discusión. La conducta suicida en los adolescentes continúa siendo una problemática multicausal frecuente de salud pública, los factores de riesgo para desarrollar el comportamiento suicida incluyen aspectos personales, familiares, académicos y sociales, con base a estos hallazgos se pueden construir planes de cuidado enfermero individualizados, ajustados a las necesidades de cada persona.
ABSTRACT
Introduction. The objective of the following review was to determine the risk factors associated with suicidal behaviors (suicide attempt, suicidal ideation, and completed suicide) in adolescents. Methodology. The present evidence review was carried out using several studies that have been published in the last 10 years in any country worldwide; the search for information was carried out using the free text term "suicidal behavior" in the databases PubMed, Epistemonikos, Scielo and Dialnet, identifying a total of 424 articles and of these, 12 studies were included in this research. Results. It was determined that the main risk factors associated with suicidal behavior from the analysis of the available scientific evidence are: being female, history of suicide in the family, family violence, absence of parents and family group, conflicts with parents, childhood trauma, rejection, school bullying, conflicts with peers, academic difficulties, influence of cyber friends or acquaintances, bullying, problems regulating emotions, depression, despair, sadness, loneliness, physical and mental illness, stressful events, helplessness, abuse of psychoactive substances, and physical or psychological violence. Discussion. Suicidal behavior in adolescents continues to be a frequent multicausal public health problem. The risk factors for developing suicidal behavior include personal, family, academic and social aspects; based on these findings, individualized nursing care plans can be constructed, adjusted to the needs of each person.
Objetivo. Describir los registros enfermeros sobre heridas quirúrgicas en pacientes intervenidos en una unidad de Cirugía General y Digestiva. Metodología. Estudio descriptivo transversal. Se revisaron las historias clínicas electrónicas de adultos hospitalizados en una Unidad de Cirugía General y Digestiva que tuvieron una herida quirúrgica durante su estancia en el hospital. Se revisó la documentación de las heridas quirúrgicas en el registro específico de heridas, las notas de los evolutivos de enfermería, los planes de cuidados y el informe de continuidad de cuidados (alta de enfermería). Resultados: muestra de 200 pacientes con una edad media de 58,24 (±17,12) años. En ningún caso se documentó la herida quirúrgica utilizando el registro específico. Las heridas sí se documentaron en las notas del evolutivo de enfermería, con comentarios sobre realización de curas en el 85,5% de los pacientes y sobre el estado o valoración de la herida en el 41%. En el plan de cuidados no se programó ninguna actividad sobre el cuidado de la herida quirúrgica en el 48% de los casos y en el informe de continuidad de cuidados no se refleja la evaluación de la herida quirúrgica en el 85,5% de los casos. Discusión. El registro de las heridas quirúrgicas se realiza de forma incompleta, desigual y poco sistemática, sin utilizar registros específicos estructurados. Detectando las deficiencias de los registros enfermeros sobre las heridas quirúrgicas podemos plantear estrategias para mejorarlos y así incrementar la calidad y seguridad de los cuidados postquirúrgicos.
ABSTRACT
Objective. To describe nursing records of surgical wounds in patients who underwent surgery in a General and Digestive Surgery Department. Methodology. Cross-sectional descriptive study. Electronic medical records of adult inpatients admitted to a General and Digestive Surgery Department who had a surgical wound during their hospital stay were reviewed. Documentation of surgical wounds in the specific wound register, nursing progress notes, care plans and continuity of care reports (nursing discharge reports) were reviewed. Results. 200 patients with a mean age of 58.24 (±17.12) years were analyzed. There were no surgical wounds documented using the specific register. However, they were documented in the nursing progress notes, with comments on wound/dressing management and wound status or assessment in 85.5% and 41% of patients, respectively. No activity on surgical wound care was scheduled in the 48% of care plans, and surgical wound assessment was not included in the 85,5%m of the continuity of care reports. Discussion. Surgical wound documentation is performed in a incomplete, inconsistent and unsystematic way, without using specific structured registers. By identifying deficiencies in nursing records of surgical wounds, we would be able to suggest strategies to improve them and, therefore, to increase the quality and safety of post-surgery care.
Systematic reviews are considered the highest level of evidence that can help guide evidence-informed decisions in nursing practice, education, and even health policy. Systematic review publications have increased from a sporadic few in 1980s to more than 10,000 systematic reviews published every year and around 30,000 registered in prospective registries.
A cross-sectional design and a variety of data sources were triangulated to identify the journals from which systematic reviews would be evaluated for adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting guidelines and scope. Specifically, this study used the PRISMA 2020 reporting guidelines to assess the reporting of the introduction, methods, information sources and search strategy, study selection process, quality/bias assessments, and results and discussion aspects of the included systematic reviews.
Upon review of the 215 systematic reviews published in 10 top-tier journals in the field of nursing in 2019 and 2020, this study identified several opportunities to improve the reporting of systematic reviews in the context of the 2020 PRISMA statement. Areas of priority for reporting include the following key areas: (1) information sources, (2) search strategies, (3) study selection process, (4) bias reporting, (5) explicit discussion of the implications to policy, and lastly, the need for (6) prospective protocol registration.
The use of the PRISMA 2020 guidelines by authors, peer reviewers, and editors can help to ensure the transparent and detailed reporting of systematic reviews published in the nursing literature.
Systematic reviews are considered strong research evidence that can guide evidence-based practice and even clinical decision-making. This paper addresses some common methodological and process issues among systematic reviews that can guide clinicians and practitioners to be more critical in appraising research evidence that can shape nursing practice.
To understand the strategies used to continue providing psychosocial support to cancer patients during the pandemic, including outcomes and implications beyond the pandemic.
A systematic review of original research.
ProQuest Health & Medicine, CINAHL Complete (via EBSCOhost), Scopus, and PubMed were searched for original work published between January 2020 and December 2022.
Abstract and title screening identified eligible articles for full-text review. Following a full-text review, data were extracted from eligible articles, and a risk of bias assessment was conducted. A synthesis without meta-analysis was performed.
Thirty-four articles met the selection criteria. These articles provide evidence that systematic adaptations during the pandemic improved the assessment and screening of psychological needs and/or increased the number of clients accessing services. Additionally, while the pandemic was associated with decreased psychosocial well-being for cancer patients, five intervention studies reported improvements in psychosocial well-being. Barriers, strategies, and recommendations were described.
Adapting psychosocial support during a pandemic can be successful, achieved relatively quickly, and can increase the uptake of support for people experiencing cancer.
It is imperative that these adaptations continue beyond the pandemic to maximize adaptive psychosocial outcomes for a group vulnerable to ongoing mental health concerns.
While the COVID-19 pandemic was associated with increased psychosocial need for cancer patients, evidence in the review suggested that adaptations made to service delivery facilitated increased access for patients who may not previously have been able to access support. Additionally, improvements in psychosocial well-being were achieved. These findings are relevant for clinicians and decision-makers who fund and design psychosocial support services for cancer patients.
The review was guided by PRISMA Guidelines and the SWiM Reporting Guideline.
No patient or public contribution.
The American Nurses Credentialing Center's (ANCC's) Practice Transition Accreditation Program (PTAP) establishes standards for nurse residency programs to elevate and optimize the skills, knowledge, and attitudes of new nurses participating in nurse residency programs. Evidence-based practice (EBP) is foundational to providing safe nursing care. One of the National Academy of Medicine's (NAM's) 2020 goals stated that 90% of clinical decisions would be supported by the best available evidence to attain the best patient outcomes. Nurse residency programs can benefit from evidence-based strategies to develop EBP competencies in new nurses.
The purpose of this scoping review was to synthesize the literature around strategies for incorporating EBP into nurse residency programs across the United States.
This scoping review was informed by the JBI (formerly known as the Joanna Briggs Institute) methodology for scoping reviews. Searches were conducted by a health science librarian in PubMed and CINAHL with Full Text. Keywords and their synonyms, Medical Subject Headings (MeSH; PubMed), and Subject Headings (CINAHL with Full Text) were used. Covidence, a literature review management program, was used to organize the literature and manage the review. Title, abstract, and full-text reviews were completed within Covidence using three teams of two independent reviewers.
Four hundred and thirty-eight citations were imported into Covidence. Ten articles were retained for the final review. Three strategies for incorporating EBP into nurse residency programs emerged from the literature: (1) exposure of nurse residents to existing organizational resources, (2) completion of online EBP modules, and (3) completion of an EBP project.
The incorporation of EBP competencies in nurse residency programs aligns with NAM's and ANCC's goals, yet a paucity of evidence exists to guide curriculum development in nurse residency programs. This scoping review corroborates the need for further research to inform best practices for implementing EBP into nurse residency programs.
Commentary on: Zhang M, Zhang C, Chen C, et al. The experience of diabetic retinopathy patients during hospital-to-home full-cycle care: a qualitative study. BMC Nurs. 2023 Mar 3;22(1):58. doi: 10.1186/s12912-023-01206-y.
Consideration of patients' life experiences, which aids in examining their feelings and patient’ experiences. Future research should further investigate the phenomenological approach in diverse healthcare contexts.
The transition from hospital to home treatment for patients with diabetic retinopathy (DR) is the subject of a study by Zhang and colleagues. The authors attempt to comprehend the substance of this phenomenon a shift towards patient-centric healthcare research by using a phenomenological method.
The descriptive phenomenology method was used to implement this...
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