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AnteayerEvidence-Based Nursing

Study of electronic records from a south London psychiatric trust suggests that the increased mortality from physical illness linked to depression varies between ethnic groups

Por: McKenzie · K.

Commentary on: Das-Munshi J, Chang CK, Schofield P, et al. Depression and cause-specific mortality in an ethnically diverse cohort from the UK: 8-year prospective study. Psychol Med. 2018:1-13. doi: 10.1017/S0033291718002210.

Implications for practice and research

  • Practitioners need to consider the physical health of all people with depression in order to decrease their excess mortality.

  • A community-based study is required to properly understand ethnic differences in the mortality rates of people with depression.

  • Context

    Studies report that people with depression have increased mortality.1 This is not just because of suicide, it is linked to an increased risk of physical illnesses.2 Those with all severities of depression and even those with subclinical depression have increased mortality. It is unclear whether ethnicity has an impact on mortality rates in depression.


    The study aimed to investigate all cause and cause-specific standardised...

    Co-creation and co-production in health service delivery: what is it and what impact can it have?

    Por: Wolstenholme · D. · Kidd · L. · Swift · A.

    EBN engages through a range of online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates.

    Higher risk of physical frailty in older person is associated with increased levels of loneliness rather than social isolation

    Por: Ganesalingam · G.

    Commentary on: Gale CR, Westbury L, Cooper C. Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal study of aging. Age Ageing 2018;47:392–7.

    Implications for practice and research

  • Health professionals need to have deeper knowledge and understanding to support and prevent older persons experiencing loneliness, social isolation and the increased risk of frailty.

  • Research needs to be carried out with diverse ethnic groups to identify, what they consider experiences of social isolation and loneliness and what support can be provided to prevent physical frailty.

  • Context

    Recently, research has focused on social isolation and loneliness in older person.1 Studies tend to focus on frailty, physical health, mental health, mortality and public health link to risk for social isolation and loneliness in older person. This study by Gale et al identified that social isolation and loneliness were associated with...

    Increased risk of recurrent Clostridium difficile infection among older adults taking antibiotics and acid reducing medications

    Por: Kean · T.

    Commentary on: Haran JP, Bradley E, Howe E, et al. Medication exposure and risk of recurrent Clostridium difficile infection in community-dwelling older people and nursing home residents. J Am Geriatr Soc 2018; 66(2):333–338.

    Implications for practice and research

  • Increased rates of Clostridium difficile in healthcare facilities and in the community mandates comprehensive infection prevention and control (IPAC) strategies including deprescribing proton pump inhibitors and antibiotic stewardship.

  • Research to examine frailty as a predictive marker of recurrent C. difficile infections (rCDI) among older adults who take acid-reducing agents, antibiotics, and corticosteroids may provide greater clarity on the influence of the living environment.

  • Context

    Recognised as the leading cause of antibiotic-associated diarrhoea worldwide,1–3C. difficile disproportionately affects older adults and confers substantial health and economic burden. The study by Haran et al draws necessary attention to rCDI among older adults who...

    Visualising the invisible; why cleaning is important in the control of hospital-acquired infection

    Por: Dancer · S.

    Commentary on: Cohen B, Spirito CM, Liu J, Cato KD, Larson E. Concurrent detection of bacterial pathogens in hospital roommates. Nurs Res 2019;68(1):80–83.

    Implications for practice and research

  • Nurses must give environmental cleaning the same level of priority as hand hygiene for infection prevention.

  • More study is required into the most effective equipment, products and techniques for cleaning hospitals.

  • Context

    The problem with controlling hospital pathogens is that they are invisible to the human eye. From pioneers such as Pasteur, Koch and Lister, who purported microscopic ‘insects’, to early infection preventionists advocating clean hands, air and surfaces, all were shunned by peers and public alike.1 Evidence for the role of cleaning itself is only just gathering pace, probably because it is deemed menial, repetitive and low status - performed only as an aesthetic gesture.2 Yet staff who clean hospitals do a lot...

    Antidepressant discontinuation can be problematic for patients but relapse rates might be reduced with cognitive behavioural therapy or mindfulness-based cognitive therapy

    Por: Raynsford · J.

    Commentary on: Maund E, Stuart B, Moore M, et al. Managing antidepressant discontinuation: a systematic review. Ann Fam Med 2019;17:52-60.

    Implications for practice and research

  • Cognitive behavioural therapy (CBT) or mindfulness-based cognitive therapy (MBCT) may help patients remain well after antidepressants are discontinued. 

  • More research is needed into strategies that help encourage patients to discontinue antidepressants successfully.

  • Context

    Antidepressant prescriptions continue to rise. In many cases consideration should be given to stopping medication at some point. Current UK guidance1 suggests that for first-time users treatment should last for 6 months after remission of symptoms, and for those with a second episode 2-year treatment is advised. Some patients may need long-term antidepressants, but research suggests that many long-term users continue to take them without a clear evidence base.2


    The stated aims of the study were to discover effective interventions...

    Should aspirin be used for primary prevention in the healthy elderly?

    Por: Thompson · D.

    Commentary on: McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med 2018;379:1509–18.

    Implications for practice and research

  • Low-dose aspirin as a primary prevention measure in older adults results in a significantly higher risk of major haemorrhage and does not result in a significantly lower risk of cardiovascular disease (CVD) than placebo.

  • All patients taking aspirin for primary prevention should be informed of the risk of major bleeding and the minimal benefits in terms of CVD events.

  • More research related to low-dose aspirin for primary prevention in younger age groups is warranted.

  • Context

    Aspirin is a wonder drug—it is the most used drug worldwide and recently celebrated its 120th birthday—and has been regarded as a key antiplatelet agent that protects from cardiovascular events and saves lives.1 Although...

    Supporting rural nurses to develop and implement a contextualised, systematic approach to paediatric pain management is vital to improve pain care for children

    Por: Noakes · A.

    Commentary on: Marshall C, Forgeron P, Harrison D, et al. Exploration of nurses’ pediatric pain management experience in rural hospitals: a qualitative descriptive study. Appl Nurs Res 2018;42: 89–97.

    Implication for practice and research

  • Considering the context within which nurses deliver paediatric pain management provides implication for practice via ensuring that there are systematic procedures rather than pain care based on individual beliefs.

  • Further research is required to consider rural contextual specific pain management interventions that could enable long-term improvements to care.

  • Context

    Poor pain management for children can have long-term negative impact.1 Yet it has been recognised that globally hospitalised children continue to experience pain despite the availability of effective management strategies.2 Nurses possess a key role in pain assessment, treatment and escalation of concerns to clinicians. This study by Marshall et al1 considers the interplay between the context within...

    Tai Chi, Wii Fit and rope skipping exercise interventions are particularly effective in improving balance for young people with intellectual disabilities

    Por: Collier · L.

    Commentary on: Maiano C, Hue O, Morin A, et al. Exercise interventions to improve balance for young people with intellectual disabilities: a systematic review and meta-analysis. Dev Med Child Neurol 2019;61:406–18.

    Implications for practice and research

  • Exercise interventions that focus on static and dynamic posture can improve balance in young people with intellectual disabilities.

  • Exercise interventions focussed on Tai Chi, Wii Fit balance board exercises and rope-skipping demonstrated some of the largest effects.

  • Further studies are needed to determine the fidelity of the exercise approach, and who is best placed to carry out the intervention to assist with the carry over into practice.

  • Context

    Falls and risk of falling is a problem for individuals with intellectual disability. Ho et al report that the risk of falling among this population group is higher than that of their peers.1 This risk can impact on activities of daily...

    Relational communication characteristics are an important facet of building effective practitioner-patient care relationships

    Por: Lawal · M.

    Commentary on: Peltola M, Isotalus P, Åstedt-Kurki P, et al. Patients’ interpersonal communication experiences in the context of type 2 diabetes care. Qual Health Res 2018;28:1267–82.

    Implications for practice and research

  • The quality of healthcare practitioner versus patient relational communication may have a negative or positive impact on patient-centred diabetes care.

  • More research is required on approaches to preventing negative patient–practitioner interpersonal communication experiences.

  • Context

    The shift in nature and pattern of disease that has resulted from increased life span and lifestyle changes has led to patient empowerment as a paradigm shift from the traditional approach to long-term condition management.1 Although it is acknowledged that relational communication forms an integral part of this therapeutic relationship, there is paucity of research studies on this phenomenon.2


    The purpose of the study2 was to explore the negative and positive impact of...

    Anger treatment has a therapeutic effect on cardiac function and productive living

    Por: Oyelade · O. O. · Nkosi-Mafutha · N. G.

    Commentary on: McIntyre KM, Mogle JA, Scodes JM, et al. Anger-reduction treatment reduces negative affect reactivity to daily stressors. J Consult Clin Psychol 2019;87(2):141–50. doi: 10.1037/ccp0000359.

    Implications for practice and research

  • It is high time that health practitioners paid greater attention to the psychosocial causes of cardiovascular diseases and on the improvement of public health through mental health.

  • Studies on the impact of anger on close associates of individuals with high aggression tendencies may have managerial implications for leadership assessment quality in the workplace and serve as strategies for need assessment in the rehabilitation of victims of aggression.

  • Context

    The emerging trend in mental health research is moving towards mental health promotion.1 Mental health promotion should be all-encompassing and include stress prevention stress and management.2 Anger is one of the most recognised stressful emotional reaction that requires management.3


    Using draw-and-tell methods to inform clinical nursing assessments with children aged 6-12 years

    Por: Neilson · S.

    Commentary on: Linder LA, Bratton H, Nguyen A, et al. Symptoms and self-management strategies identified by children with cancer using draw-and-tell interviews. Oncol Nurs Forum 2018;45:290–300.

    Implications for practice and research

  • Nurses should consider using arts-based approaches when assessing symptoms experienced by children with cancer and identifying and exploring the self-management strategies employed.

  • Further research exploring the use of draw-and-tell methods to inform clinical nursing assessments could inform practice.

  • Context

    The importance and complexity of effective communication in informing children’s knowledge and understanding of their cancer and care, is recognised1 2 Challenges can arise from the acknowledged need for communication to be appropriate for, and tailored to, each individual child.2 School-aged children aged 6–12 years with cancer should be supported, according to their ability, to describe their symptoms and self-identified strategies for their management: this study demonstrates that arts-based...

    Select groups of older adults may benefit from emergency-based short-stay unit admission, as compared to standard medical admission

    Por: Kerin · U.

    Commentary on: Strøm C, Rasmussen LS, Löwe AS, et al. Short-stay unit hospitalisation vs. standard care outcomes in older internal medicine patients-a randomised clinical trial. Age Ageing 2018;47:810-817. doi: 10.1093/ageing/afy090.


  • Preliminary data suggests emergency-based, short-stay units reduced: functional decline, adverse events, readmission rates and hospital stays.

  • Short-stay units reported similar 90-day mortality rates to standard medical admissions.

  • Multicentre international studies are required.

  • Future research should include a cost-analysis and powered studies to detect minimal differences in 90-day mortality.

  • Context

    In most countries, demand exceeds availability of acute healthcare resources.1 An aged population with complex biopsychosocial needs are an increasing healthcare challenge.2 Older adults regularly require extended periods of hospitalisation, and are more at risk of developing adverse, hospital-acquired sequelae.2 3

    Short-stay units (SSU) are speculated to be cost-effective facilities with the potential to...

    EBN perspectives: nursing issues

    Por: Kidd · L. · Twycross · A.

    EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes

    Chronic skin disorders negatively impact womens quality of life and sexual function

    Por: McGuigan · K. · McGuigan · C. J.

    Commentary on: Hassanin AM, Ismail NN, El Guindi A, et al. The emotional burden of chronic skin disease dominates physical factors among women, adversely affecting quality of life and sexual function. J Psychosom Res 2018;115:53–7. doi: 10.1016/j.jpsychores.2018.10.011.

    Implications for practice and research

  • Psychosocial affects appear to be more acute among those with chronic skin disorders (CSDs) in visible or intimate areas of the body. As such, early intervention from healthcare professionals may be required to manage physical symptoms and ensure better psychosocial adjustment.

  • Future research should explore the mechanisms through which CSDs, and their physical manifestations, affect patient well-being.

  • Context

    The existing literature highlights the association between skin disorders and psychosocial affects; with comorbid psychological conditions including depression and anxiety common among those with dermatological complaints.1 What remains less clear is the impact of various chronic skin disorders (CSDs) that manifest in visible or...

    Childhood obesity is associated with higher incidence of paediatric onset asthma

    Por: Williams · V. · Nunan · D.

    Commentary on: Lang JE, Bunnell HT, Hossain MJ, et al. Being overweight or obese and the development of asthma. Pediatrics 2018;142. pii: e20182119. doi: 10.1542/peds.2018-2119.

    Implications for practice and research

  • The findings of this study further support the importance of reducing childhood obesity levels to reduce the risk for comorbidities, including asthma.

  • This study also found a more modest increase in the risk of childhood asthma in overweight children, highlighting the importance of interventions focusing on preventing further weight gain for overweight children.

  • Future research can focus on understanding causal pathways and developing effective interventions to manage and prevent childhood obesity and associated comorbidities.

  • Context

    There is clear evidence that obesity and asthma both place a significant burden on children, their families and healthcare systems.1 We also know that obesity in adults and adult-onset asthma are linked2; however, we are...

    Is it really bursary or bust? Simon Stevens stirs the pot

    Por: Swift · A. · Twycross · A.

    In England, the bursary for student nurses was removed in 2017 when they also became liable to pay tuition fees.1 The aim was to reduce the cap on student nurse numbers. While the cynics among us may think the real reason was to reduce the £1 billion spent on non-medical pre-registration education each year, the Council of Deans of Health (CoDH) supported the move. They argued that in addition to removing the cap on numbers the change in financing nurse education would leave student nurses better off financially during their pre-registration nursing course.2 The CoDH later acknowledged that the subsequent reduction in applicants was more than expected.3

    The bursary was means-tested with a student living away from home, outside of London with no dependents entitled to £39664 per annum. Most pre-registration nursing courses run over 42 weeks per year (rather than the...

    Study shows lower vaccination rates for younger siblings after autism spectrum disorder diagnosis in older siblings

    Por: Vanderslott · S.

    Commentary on: Zerbo O, et al. Vaccination patterns in children after autism spectrum disorder diagnosis and in their younger siblings. JAMA Pediatr 2018;172(5):46975.

    Implications for practice and research

  • The younger siblings of children who received an autism spectrum diagnosis are shown to have lower vaccination rates than the younger siblings of children who have not received an autism spectrum diagnosis. The benefit of applying this knowledge in practice would be to take steps to target this subpopulation.

  • The research is novel in that previous studies were not as large or focused. The retrospective matched cohort study uses ‘Vaccine Safety Datalink’ information from six integrated healthcare delivery systems across the USA.

  • Future research could explore strategies for engaging with parents who have received an autism spectrum diagnosis for older children when considering vaccinating younger siblings.

  • Context

    Much interest has been placed on the reasons...

    What are cohort studies?

    Por: Barrett · D. · Noble · H.

    In 1951, Richard Doll and Austin Bradford-Hill commenced a ground-breaking research project by writing to all registered doctors in the UK to ask about their smoking habits. The British Doctors Study recruited and followed-up over 40 000 participants, monitoring mortality rates and causes of death over the subsequent years and decades. Even by the time of the first set of preliminary results in 1954, there was evidence to link smoking with lung cancer and increased mortality.1 Over the following decades, the study provided further definitive evidence of the health risks from smoking, and was extended to explore other causes of death (eg, heart disease) and other behavioural variables (eg, alcohol intake).

    The Doctors Health Survey is one of the largest, most ambitious and best-known cohort studies and demonstrates the value of this approach in supporting our understanding of disease risk. However, as a method, cohort studies can have...

    Harm-benefit analysis: treatment of mild hypertension in low-risk individuals

    Por: Kean · T.

    Commentary on: Sheppard et al. Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension. JAMA Internal Medicine

    Implications for practice and research

  • A risk-based approach that includes tailored targets and comorbidity may be optimal in the management of hypertension.1

  • Research to examine risk-over-time as a prognostic indicator in the development of cardiovascular disease (CVD) in low-risk patients may provide greater insight into the benefit of treating mild hypertension in these individuals.1

  • Context

    Hypertension, a growing global burden, affects one-quarter of the world’s population.1–3 Uncontrolled hypertension can lead to life-threatening sequelae, decreased quality of life and increased expenditures by health systems.1–3 Evidence-based guidelines, a mainstay of modern practice, feature prominently in clinical decision-making.3 4 Yet, some guidelines can spur controversy.

    Sheppard et...