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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
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.
Paediatric-onset multiple sclerosis presents in childhood or adolescence with fatigue and depression common among those living with POMS.
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.
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.
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,
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
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.
Patient safety per the National Patient Safety 2019 standards
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.
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.
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.
Obesity tracks across life and so interventions to reduce its prevalence and minimise its lifelong consequences need to commence early in life.
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.
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.
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...
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.
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.
There is an ageing population with a related increase in dementia many of whom are likely to experience pain.
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.
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.
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.
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.
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.
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...
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].
Presurgical frailty status needs to be routinely assessed among the elderly. Comprehensive presurgical and postsurgical care needs to be planned for the frail.
Worldwide, the population is ageing and in the context of hospital care, the most problematic consequence of this is the clinical condition of frailty.
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.
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.
A central cause of depression is identified to be prenatal and postnatal stress.
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.
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.
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...
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.
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.
Chronic breathlessness,
Airflow directed at the face using a fan or at the nasal mucosa...
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
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.
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).
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.
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.
There is increasing recognition of intraprofessional bullying and harassment within the nursing workforce contributing to poorer mental health, increased sickness and absence
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.
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.
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...
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.
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.
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 infections
This study by Ullman and colleagues aims to expand on this knowledge by identifying the patient, device and healthcare-related characteristics...
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.
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.
The use of early warning scoring tools plays an important role in the identification and management of patients at risk of deterioration
However, the use of such tools in the practice setting and especially in non-acute settings, such as...
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.
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.
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...
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
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.
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.
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 al
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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