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AnteayerEvidence-Based Nursing

Moderate-to-vigorous exercise is beneficial and can improve symptoms of fatigue and depression in young people with paediatric-onset multiple sclerosis and other demyelinating conditions

Por: McGuigan · K. · McGuigan · C. J.

Commentary on: Stephens S, Shams S, Lee J, et al. Benefits of physical activity for depression and fatigue in multiple sclerosis: a longitudinal analysis. J Pediatr 2019;209:226–32. https://doi.org/10.1016/j.jpeds.2019.01.040

Implications for practice and research

  • Young people with paediatric-onset multiple sclerosis (POMS) experience increased depression and fatigue across illness duration; healthcare professionals should be cognisant of the need to address these symptoms to ensure improved well-being and trajectory of these psychosocial aspects over time.

  • Additional longitudinal research among young people with MS is required to address symptomology and improve well-being among this grouping; and also to inform trends, potential interventions and treatment for the adult population.

  • Context

    Paediatric-onset multiple sclerosis presents in childhood or adolescence with fatigue and depression common among those living with POMS.1 Fatigue and depression are often comorbid conditions that have been consistently shown to affect cognitive function, social...

    Pain assessments in emergency departments lack consistency and validity, and this impacts effective pain management

    Por: Wehner · L.

    Commentary on: Sampson FC, Goodacre SW, O’Cathain A. The reality of pain scoring in the emergency department: findings from a multiple case study design. Ann Emerg Med 2019:1–11.

    Implications for practice and research

  • It is imperative that a systematic pain assessment tool is used consistently for healthcare practitioners to transform patient pain assessment data into clinical action.

  • Further research needs to address the effectiveness of a systematic approach to pain assessment and evaluation of this assessment to achieve effective pain management.

  • Context

    Pain scales or tools are a fast, measurable method to objectify the subjective perception of pain. In the emergency department (ED), pain assessments are used for patient triage and assessment for all patients. While routine use of these tools have been shown to improve pain management,1 there is conflicting data about the validity and barriers that accompany the use of...

    Student nurses require a supportive environment when exercising their moral obligation for patient safety

    Por: Sakamoto · R. R.

    Commentary on: Fisher M, Kiernan M. Student nurses’ lived experience of patient safety and raising concerns. Nurse Education Today, 2019, 77: 1–5. https://doi.org/10.1016/j.nedt.2019.02.015

    Implications for practice and research

  • Nursing education, clinical practice and health policies must be aligned to ensure patient safety and quality competencies.

  • Mixed-method studies are needed to fully understand nursing students’ experiences when juggling higher education and healthcare settings.

  • Context

    Patient safety per the National Patient Safety 2019 standards1—is a global concern and central to quality patient care. Nurses and other healthcare providers, health educators and leaders have a moral and professional obligation to ensure patient safety. Acute care and ambulatory patient settings alike uphold patient safety that necessitates patient care stakeholders’ alignment of healthcare safety and health workers’ quality competencies.2 An ongoing pedagogical approach whereby European healthcare students learn patient safety from observations and...

    Maternal weight status before pregnancy is strongly associated with offspring weight status in childhood

    Por: Cooper · R. · Pinto Pereira · S. M.

    Commentary on: Heslehurst N, Vieira R, Akhter Z, et al. The association between maternal body mass index and child obesity: a systematic review and meta-analysis. PLoS Medicine 2019;16:e1002817. doi: 10.1371/journal.pmed.1002817.

    Implications for practice and research

  • When designing strategies to prevent childhood obesity, the weight status of women prepregnancy is a potential target for intervention.

  • Research is needed to identify interventions that are effective in reducing the prevalence of maternal prepregnancy obesity.

  • Context

    Obesity is associated with adverse health outcomes across life. The rise in its global prevalence is therefore one of the most important public health challenges of our time.1

    Obesity tracks across life and so interventions to reduce its prevalence and minimise its lifelong consequences need to commence early in life.2 Parental and offspring weight status are strongly associated,3 and it is recognised that intervening on these...

    Medication assisted therapy (MAT) for opioid use disorder (OUD) in youth improves outcomes and saves lives

    Por: O'Malley · P.

    Commentary on: Hadland SE, Bagley SM, Rodean J, et al. Receipt of timely addiction treatment and association of early medication treatment with retention in care among youths with opioid use disorder. JAMA Pediatrics. 2018;172(11):1029–1037. doi:10.1001/jamapediatrics.2018.2143.

    Implications for practice and research

  • Medication assisted therapy (MAT) in opioid use disorder (OUD) is an evidence-based lifesaving intervention and may be underused in youth. More research is needed to uncover barriers to timely MAT intervention.

  • Limited evidence suggests that programme outcomes (retention and attrition) for timely MAT (buprenorphine, naltrexone or methadone) in youth with OUD are favourable. More research in the youth population (under age 18) is needed.

  • Context

    Rising morbidity and mortality for adolescents and young adults in the USA is a difficult health issue. Despite recommendations by professional organisations and the government to use MAT for youths with OUD as early as possible, youths are one-tenth...

    The evidence base for pain management of people with dementia in the community is weak and needs to be improved

    Por: Parsons · G.

    Commentary on: Bullock L, Bedson J, Jordan JL, et al. Pain assessment and pain treatment for community-dwelling people with dementia: a systematic review and narrative synthesis. Int J Geriatr Psychiatry 2019;346:807–21. doi: 10.1002/gps.5078.

    Implications for practice and research

  • Currently knowledge and care rely upon evidence from hospital and nursing home settings and this review suggests that this knowledge is not transferable.

  • There is a strong requirement for comparative studies to evaluate the effectiveness of different approaches to pain assessment and treatment among people with dementia in the community.

  • Context

    There is an ageing population with a related increase in dementia many of whom are likely to experience pain.1 Many more people with dementia are likely to be cared for in the community than in a formal care setting. We know that people with dementia cared for in hospital and nursing home settings...

    Engaging teenagers with text-message services for glycaemic control

    Por: Waite · M.

    Commentary on: McGill DE, Volkening DA, Wasserman RM, et al. Text-message responsiveness is associated with HbA1c benefit in teenagers with type 1 diabetes. Diabet Med 2019;36:600–5.

    Implications for practice and research

  • Teenagers with type 1 diabetes (T1D) are at a transition phase in becoming independent for their blood glucose monitoring. Digital interventions may be a key component of behaviour change and management strategies for glycaemic control.

  • Involving the user at the centre of the technology design is critical for research that aims to support adherence with self-management for long-term conditions such as T1D.

  • Context

    There is a growing body of evidence associating the use and functions of mobile devices such as text-message services for people with T1D to promote glycaemic control.1 2 McGill et al3 addressed self-adherent behaviours of teenagers (13–17 years) with T1D through an 18-month text-message intervention...

    The largest meta-analysis of pharmaceutical treatments of Generalised Anxiety Disorder consolidates current knowledge and reveals convincing effectiveness of Venlafaxine

    Por: Roles · S.

    Commentary on: Slee A, Nazareth I, Bondaronek P, et al. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. The Lancet, 2019;393: 768–777.

    Implications for practice and research

  • Largest meta-analysis for Generalised Anxiety Disorder (GAD) to date synthesising 89 trials.

  • Adds ability to make research-based clinical decisions about medications for GAD that were not only funded from pharmaceutical companies.

  • Future research, to determine the benefits of these identified medications concurrently with GAD and depression, may be a clinically helpful next step.

  • Context

    There are often discrepancies in healthcare in relation to the best pharmaceutical approaches to corresponding ailments. Mental health and psychopharmacology are no exception given the multitudes of medication and research which although helpful, may make clinical decisions more confusing. This paper identified the volumes of evidence surrounding psychopharmacology for Generalised Anxiety Disorder (GAD) which existed in isolated databases making...

    Being non-frail and having an elective procedure are the strongest predictors associated with functional recovery among older survivors of major surgery

    Por: Rolls · K. · Mc Evoy · L. · Ritcher · M. · Frost · S. A.

    Commentary on: Becher RD, Murphy TE, Gahbauer, EA. et al. Factors associated with functional recovery among older survivors of major surgery. Ann Surg 2019; Feb 6. doi:10.1097/SLA.0000000000003233. [Epub ahead of print].

    Implications for practice and research

  • Presurgical frailty status needs to be routinely assessed among the elderly.

  • Comprehensive presurgical and postsurgical care needs to be planned for the frail.

  • Context

    Worldwide, the population is ageing and in the context of hospital care, the most problematic consequence of this is the clinical condition of frailty.1 Frailty develops as a result of age and or chronic disease-related decline in several physiological systems, leaving the individual vulnerable to minor stressor events (eg, change in medications, illness and surgery), leading to an acute deterioration in health and increasing the risk of adverse outcomes, in the hospital setting.1 2 Current data suggest that...

    Fathers get depressed too: lifestyle and relationship factors, stress and sleep quality are associated with depression in new fathers in the first 6 months postbirth

    Por: Oyelade · O. O. · Olowe · A. O.

    Commentary on: Da Costa D, Danieli C, Abrahamowicz M, et al. A prospective study of postnatal depressive symptoms and associated risk factors in first-time fathers. J Affect Disord 2019;249:371–377.

    Implications for practice and research

  • Men’s resilience towards the transition to fatherhood should be assessed as part of prenatal preparation for couples expecting their first baby.

  • Research on psychological management of postdelivery stress for families of new babies should include interventions on adjustment strategies.

  • Context

    A central cause of depression is identified to be prenatal and postnatal stress.1 2 This, pre and postnatal stress, affects both the father and the mother of a baby, and the reaction of both parents to the stress is known to affect child's health and psychology.3 Da Costa et al’s study4 aimed at determining the prevalence of depressive symptoms in first-time fathers...

    It is time to consider labour companionship as a human rights issue

    Por: Dahlen · H. G.

    Commentary on: Bohren MA, Berger BO, Munthe-Kaas H, et al. Perceptions and experiences of labour companionship: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019;3:CD012449.

    Implications for practice and research

  • Labour companionship helps women, babies and families to have an optimal start to life and a positive birth experience.

  • Not all women get to have a labour companion with them, and this is no longer excusable and should be considered a basic human right.

  • More research is needed into the effectiveness of having an appropriate labour companion for women with psychosocial vulnerabilities and/or specific cultural/ethnic backgrounds.

  • Context

    There is now substantial evidence that companionship during labour leads to enhanced birth outcomes for women and babies. These benefits include: increased spontaneous vaginal birth, shorter duration of labour and decreased caesarean birth, instrumental birth, use of any analgesia, use of regional analgesia, low 5 min...

    Fan therapy is a treatment option for relieving of chronic breathlessness

    Por: Ekström · M.

    Commentary on: Swan F, Newey A, Bland M, et al. Airflow relieves chronic breathlessness in people with advanced disease: An exploratory systematic review and meta-analyses. Palliat Med 2019;33:618-633. doi:10.1177/0269216319835393.

    Implications for practice and research

  • Fan therapy and airflow at the face or nasal mucosa might relieve chronic breathlessness.

  • Fan therapy is harmless and could be tried against breathlessness during/after exertion or at rest.

  • Evidence is warranted on the effect using better modes of comparison/blinding, long term effects and on patient acceptability and effectiveness in clinical practice.

  • Context

    Chronic breathlessness,1 is a major cause of suffering in people with severe disease. Treatment includes cardiorespiratory rehabilitation training, supplemental oxygen in hypoxaemia and low dose opioids in selected patients, but is often insufficient and new therapeutic options are needed.2

    Airflow directed at the face using a fan or at the nasal mucosa...

    Mental health nurses can play a key role in supporting gay, bisexual and two-spirit men experiencing mental health challenges and inequalities

    Por: Hughes · E. · Mcdermott · E.

    Commentary on: Ferlatte O, Oliffe JL, Louie DR, et al. Suicide prevention from the perspectives of gay, bisexual, and two-spirit men. Qual Health Res 2018;29:1186-98. ePub Dec 14. doi.10.1177/1049732318816082

    Implications for practice and research

  • People who identify as lesbian, gay, bisexual, transgender and queer have poorer mental health and increased risk of suicide than their heterosexual peers.

  • A significant factor in this health inequality is the experience of homophobia, biphobia and transphobia.

  • Future research should evaluate the impact of these suggested interventions and strategies.

  • Context

    People who identify as lesbian, gay, bisexual, queer and transgender (LGBTQ) experience significant inequalities in health and mental health compared with their peers who identify as ‘straight’ (heterosexual).1–3 The rates of depression and suicidality are especially concerning with the risk of suicide in LGBTQ, which is twice as high. The reasons for...

    Negative workplace behaviour: nurses power games, blame culture and incivility--why nurses do not care for each other

    Por: Heaslip · V. · Nadaf · C.

    Commentary on: Hawkins N, Jeong S, Smith T. New graduate registered nurses’ exposure to negative workplace behaviour in the acute care setting: an integrative review. Int J Nurs Stud 2019;93:41–54.

    Implications for practice and research

    There is a need for:

  • Uniform terminology of negative workplace behaviours.

  • Strategies to support new registrants’ resilience as part of transition programmes.

  • Training for nurse leaders on developing positive workplace cultures.

  • Healthcare organisations to recognise and take action on negative workplace behaviour.

  • Further research exploring the impact of negative workforce behaviour on patient care.

  • Context

    There is increasing recognition of intraprofessional bullying and harassment within the nursing workforce contributing to poorer mental health, increased sickness and absence1 and poor retention. In particular, there is growing attention on recently registered nurses who have been identified as a group at high risk of experiencing bullying and harassment. This...

    Provider-level characteristics are significantly associated with the increased likelihood of mastectomy over conservative surgery among elderly women with breast cancer

    Por: Ferdous · M. · Turin · T. C.

    Commentary on: Boero IJ, Paravati AJ, Hou J, et al. The impact of surgeons on the likelihood of mastectomy in breast cancer. Ann Surg 2019;269(5):951-58. doi:10.1097/SLA.0000000000002698.

    Implications for practice and research

  • The significant association between provider-level (individual physicians and treatment hospitals) characteristics and the likelihood of the type of surgery (mastectomy vs breast-conserving surgery) among patients with breast cancer provides insight on how elements of the healthcare system can influence a treatment choice.

  • Future research is required to clarify the complex interaction between patient-level and provider-level factors and how they influence the decision-making for choosing treatment modality.

  • Context

    Two of the major surgical treatment options available for invasive breast cancer include mastectomy and breast-conserving surgery (BCS). Recent studies have shown a better survival rate for BCS followed by radiation therapy compared with mastectomy, emphasising the importance of understanding the reasons behind choosing mastectomy over...

    Australian secondary analysis reveals that vascular access device procedures aimed at preventing harm may be causing skin complications

    Por: McNamara · A.

    Commentary on: Ullman AJ, Mihala G, O’Leary K, et al. Skin complications associated with vascular access devices: a secondary analysis of 13 studies involving 10,859 devices. Int J Nurs Stud 2019;91:6–13.

    Implications for practice and research

  • Clinicians should routinely consider age, medical diagnosis, skin integrity and location of vascular access device before inserting vascular access devices.

  • The use of retrospective studies can adversely impact results due to the limitations in data collected, primarily misclassification bias, the data are subject to confounding and temporal relationships which are often difficult to assess.

  • Context

    There is a wealth of evidence focusing on the prevention of harm when using vascular access devices with the focus being on both reducing systemic and local infections1 and the promotion of device performance.

    This study by Ullman and colleagues aims to expand on this knowledge by identifying the patient, device and healthcare-related characteristics...

    Study of nurses use of early warning scoring systems for patient deterioration highlights the need to strengthen nurses knowledge and confidence in their clinical judgement in using these tools

    Por: Rehman · S. · Ali · P.

    Commentary on: Wood C, Chaboyer W, Carr P. How do nurses use Early warning scoring systems to detect and act on patient deterioration to ensure patient safety? A scoping review. Int J Nursing Studies 2019;94:166–178.

    Implications for practice and research

  • Educational opportunities involving simulation and reflective practice may help nurses improve their confidence in using their clinical judgement skills, as well as early warning scoring tools to identify and respond to deteriorating patients.

  • Further research is needed to explore nurses’ reluctance to activate the rapid response team when patients meet specific criteria in early warning scoring systems.

  • Context

    The use of early warning scoring tools plays an important role in the identification and management of patients at risk of deterioration1 in acute and non-acute settings.

    However, the use of such tools in the practice setting and especially in non-acute settings, such as...

    Compounded creams no better than placebo creams for localised chronic pain

    Por: Hu · J.

    Commentary on: Brutcher RE, Kurihara C, Bicket MC, et al. Compounded topical pain creams to treat localized chronic pain: a randomized controlled trial. Ann Intern Med 170:309–18. doi: 10.7326/M18-2736.

    Implications for practice and research

  • Considering the increased costs and minor benefit from compounded creams, clinicians need to caution against routine use of compounded creams for chronic pain.

  • Future studies are warranted to determine whether targeting specific types of chronic pain or adding other agents would lead to better results of compounded creams.

  • Context

    The use of compounded topical creams for localised chronic pain has increased dramatically. The participants in this study, military personnel, are one of the populations who might benefit from this treatment as opioid therapy may have a negative effect on their judgement and motor skills. In 2015, the Centers for Medicare and Medicaid Services spent >500 million dollars on compounded topical pain...

    Qualitative research shows that preferences for place of end-of-life care and death are shaped by the uncertainty of living with a life-limiting illness for patients and family caregivers and are neither synonymous nor stable

    Por: Robinson · J. · Gott · M.

    Commentary on: Gerber K, Hayes B, Bryant C, et al. ‘It all depends!’: a qualitative study of preferences for place of care and place of death in terminally ill patients and their family caregivers. Palliat Med 2019; 33:802-811. doi:10.1177/0269216319845794

    Implications for practice and research

  • Healthcare professionals need to be aware of the unstable nature of preferences for place of end-of-life care and death, include caregivers in place of care discussions and pay attention to the context within which decisions are made.

  • Research that captures preferences for place of care and death at one point in time must be treated with caution given the instability of these preferences when living with, or caring for someone with, a life-limiting illness.

  • Context

    Palliative care philosophy positions home as the optimum place of death, and survey research has concluded that most people would prefer to die at home.

    Easing lockdown for school children: why so contentious?

    Por: Swift · A.

    The past week has seen an explosion of media commentary about whether children in the UK should go back to school. Since ‘lockdown’ (23 March 2020) began schools have been open to vulnerable children and young people, and to the children of ‘key workers’. Right from the start there have been differing opinions about the necessity or wisdom of closing schools. Viner et al1 produced a rapid systematic review that concludes that school closures have less impact on infection rate and mortality than other social distancing measures. Many countries have closed their schools for less time than the UK and have already started to reopen with several protective measures in place.2

    Concerns about the long-term economic, social and mental impact of lockdown led to the generation of plans to ‘get back to business’. This was conveyed to the population of the UK on 10 May...

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