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AnteayerEvidence-Based Nursing

Personalised, patient-inclusive clinical medication reviews can reduce drug-related problems in older patients

Por: Acorn · M.

Commentary on: Verdoorn S, Kwint HF, Blom JW, et al. Effects of a clinical medication review focused on personal goals, quality of life, and health problems in older persons with polypharmacy: a randomised controlled trial (DREAMeR-study). PLoS Med 2019;16:e1002798. doi: 10.1371/journal.pmed.1002798.

Implications for practice and research

  • Optimising personalised and tailored clinical medication reviews (CMRs) for older patients can reduce drug-related problems (DRPs) due to multimorbidity and polypharmacy.

  • An approach to the CMR guided by patient goals and preferences are beneficial to quality of life and well-being.

  • Context

    A CMR is a structured, critical examination of a patient’s medications with the objective of reaching an agreement about treatment, optimising medicine impact, minimising medication-related issues and reducing waste. Limited evidence exists on the CMR intervention ability to improve patient outcomes. The DREAMeR study looks at polypharmacy in older persons who can benefit from a patient-centred CMR...

    Frailty leads to higher mortality and hospital use

    Commentary on: Keeble, E, Parker, SG, Arora, S, et al. Frailty, hospital use and mortality in the older population: findings from the Newcastle 85+ study. Age Ageing 2019;48:797–802. https://doi.org/10.1093/ageing/afz094.

    Implications for practice and research

  • Frailty leads to higher mortality and hospital use.

  • Information about frailty should inform the development of services to meet patient need.

  • Research in the community setting is required to better understand proactive and preventative approaches in frailty management.

  • Context

    Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes including falls, incident disability, hospitalisation and mortality. Frailty is a significant determinant of healthcare use and associated costs, both of which also increase as a person nears death. In the UK, and internationally, those aged over 85 years are the fastest growing demographic group. By 2050, the number of people...

    Frailty is a predictor of mortality in surgical emergency admissions among UK adults

    Por: Nimura · M. · Kojima · G.

    Commentary on: Hewitt J, Carter B, McCarthy K, et al. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing 2019;48:388–94. doi: 10.1093/ageing/afy217.

    Implications for practice and research

  • Frailty assessment for emergency surgical patients may be useful in prognostication and outcome improvement.

  • Further research is needed to improve outcomes by identifying frail older people and administering interventions while still in the community.

  • Context

    Frailty is a term that has been well-established and associated with deteriorated capacity to maintain homoeostasis and vulnerability to stressors.1 Various studies have demonstrated the links between frailty and its adverse outcomes.2 3 While many of the previous studies focused on its negative impacts on older populations, evidence on frailty among emergency surgical patients is scarce. Hewitt et al4 examined frailty status among adult patients aged 18...

    The integration of personal narratives into hospital-based palliative care can relieve patient psychosocial and existential suffering

    Por: Acorn · M.

    Commentary on: Gundtof Rokiaer S, Missel M, Bergenholtz HM, et al. The use of personal narratives in hospital-based palliative care interventions: An integrative literature review. Palliat Med 2019; 1–17.

    Implications for practice and research

  • Personal narrative interventions can be successfully implemented in hospital-based palliative care to ease psychosocial and existential suffering of patients.

  • An opportunity for research exists into the role and impact of personal narrative interventions more broadly in palliative care and beyond the hospital setting.

  • Context

    Patients with life-threatening illnesses continue to primarily receive care in the hospital setting. Although palliative care is evolving, there remains an emphasis on curative care in the hospital setting1. The focus on curative care often leads patients to experience a lack of psychosocial support and unmet emotional needs.2 This review by Roikjaer and colleagues examined the role that narrative interventions can play...

    Combining physical and cognitive interventions positively affects gait in older adults with cognitive impairment

    Por: Mitchell · G. · McTurk · V.

    Commentary on: Zhang W, Low LF, Gwynn JD, et al. Interventions to improve gait in older adults with cognitive impairment: a systematic review. J Am Geriatr Soc 2019;67;381–91.

    Implications for practice and research

  • Gait is not solely a biomechanical process. Cognitive factors need to be considered when employing interventions to improve gait in older people.

  • Physical and cognitive factors affect gait performance, and both should be addressed in intervention programs.

  • To improve gait in older people living with mild cognitive impairment, or the early stages of dementia, gait interventions should include strength, balance and functional mobility training in combination with cognitive control training.

  • Context

    The prevalence of gait and balance disorders significantly increases as a person grows older. These disorders affect around 10% people in their 60s and >60% of people in their 80s.1 Recent studies have found a strong link...

    Support and guide parents on infants problems with home visits and a focus on maternal mental health

    Por: Namnabati · M.

    Commentary on: Olsen AL, Ammitzboll J, Olsen EM, et al. Problems of feeding, sleeping and excessive crying in infancy: a general population study. Arch Dis Child 2019;104:1034–41.

    Implications for practice and research

  • This study identified some regulatory problems such as feeding, sleeping and excessive crying during three periods of infancy through a set of preprogrammed home visits.

  • Parental health has been found to be closely related to infant feeding and sleeping patterns.

  • Providing parents with a strategy to cope with problems with infant feeding and sleeping patterns can reduce parental stress and improve the health of infants.

  • Future research can focus on understanding problems in early and late infancy to provide specific support for parents and develop guidelines for policymakers.

  • Context

    The most common problems among infants are excessive crying, and feeding and sleeping problems, which may occur individually or together. These...

    Health discipline students face various direct and indirect types of risks and hazards during education in clinical placements

    Por: Booth · R. · O'Connor · S.

    Commentary on: Graj E, Sheen J, Dudley A, et al. Adverse health events associated with clinical placement: a systematic review. Nurse Educ Today 2019;76:178–190. doi:10.1016/j.nedt.2019.01.024.

    Implications for practice and research

  • Risks and hazards faced by health discipline students in clinical placement settings are commonly subtle, and occur in both direct and indirect fashions to the student.

  • Future research should seek to explore the interrelationship between the type of clinical experience, educational progression and other contextual factors found in clinical placement settings, as related to student risks.

  • Context

    The review completed by Graj et al1 sought to explore the risks and hazards encountered by health discipline students during clinical placements. Primary research completed in this domain has suggested that students commonly face various types of abuse, violence and other health-related occupational hazards during formal training.2 Graj et al1 sought...

    Nursing interventions improve preparedness, competence, reward and burden of family caregivers in end-of-life care at home

    Por: Anagnostou · D.

    Commentary on: Becqué YN, Rietjens JAC, van Driel A, et al. Nursing interventions to support family caregivers in end-of-life care at home: a systematic narrative review. Int J Nurs Stud 2019;7:28–39. https://doi.org/10.1016/j.ijnurstu.2019.04.011

    Implications for practice and research

  • Nurses should provide individualised interventions to support family caregivers in end-of-life-care at home.

  • Multicomponent interventions have the potential to address the complex needs of family caregivers.

  • Future research needs to establish effective interventions and their related components.

  • Context

    Informal family caregivers play a crucial role in end-of-life care, especially in the community. However, family caregivers are known to have high needs and psychological morbidity,1 including fatigue, sleep problems, depression, anxiety and burnout. Palliative care aims to provide psychosocial support to patients and families facing terminal illness. Interventions that aim to support family caregivers are increasing and have been reported in the literature.

    Places of worship can be health promotion spaces for faith-based black, Asian and minority ethnic (BAME) communities

    Por: Ali · P.

    Commentary on: Tomalin E, Sadgrove J, Summers R. Health, faith and therapeutic landscapes: places of worship as black, Asian and minority ethnic (BAME) public health settings in the United Kingdom. Soc Sci Med 2019;230:57–65.

    Implications for practice and research

  • Further research is needed to understand how faith can influence health behaviours of members of faith-based communities.

  • Public health professionals should recognise that places of worship provide a point for people from same faith and especially for those from black, Asian and minority ethnic communities (in the UK context) to come together.

  • Context

    Individuals’ faith plays an important role in their ways of living and day-to-day choices. The relationship between faith and improved health outcomes, especially with regard to individuals from black, Asian and minority ethnic (BAME) community has been a focus of recent research.1 2 While the importance of faith-based...

    Nurses night shift performance improves through taking scheduled naps

    Por: Izadi · N.

    Commentary on: Zion N, Schohat T. Let them sleep: the effects of a scheduled nap during the night shift on sleepiness and cognition in hospital nurses. J Adv Nurs 2019. doi: 10.1111/jan.14031. [Epub ahead of print 22 April 2019].

    Implications for practice and research

  • The implementation of new strategies to allow nurses to nap could have positive impact on nurse performance.

  • Further research is needed to generalise these findings to male shift workers and other shift schedules.

  • Context

    Healthcare workers who work in rotating shifts may experience sleepiness and reduction of job performance.1 2 Further, several studies observed that night shifts can negatively affect physical, psychological well-being and patient safety.3 There are some recommended interventions, including naps, caffeine consumption and brightness exposure, to reduce these adverse effects.4–6 The aim of this study...

    Healthcare professionals must communicate with patients and relatives. They must enable informed, realistic and appropriate decisions in end-of-life pharmacotherapy

    Por: Lee · A. J.

    Commentary on: Morin L, Wastesson JW, Laroche ML, et al. How many older adults receive drugs of questionable clinical benefit near the end of life? A cohort study. Palliat Med 2019;33:1080–90. doi: 10.1177/0269216319854013.

    Implications for practice and research

  • Healthcare professionals must review medications for appropriateness, efficacy and benefits to their patients and must communicate effectively with patients and relatives.

  • We need to re-examine and review drug use and prescribing practices to assert clinically and contextually appropriate care. However, qualitative research is needed to evaluate clinician prescribing with patients.

  • Context

    Use of a variety of drugs (polypharmacy) is required to manage complex disease processes. At the end of life, the focus of ‘treatment’ changes from extending survival to symptom management—therefore, aims of treatments change, requiring different pharmaceutical approaches.1 A recent Delphi study used consensus opinion of 40 experts to label drugs as ‘often...

    Adhering to tobacco dependency medications requires collaborative and personalised interventions for long-term smoking cessation outcomes in adults

    Por: Frazer · K.

    Commentary on: Sanders CJ, Lindenmeyer MA, Marriott J. A meta-ethnography of adult smokers’ exploring the meanings of tobacco dependency medications adherence behaviours during smoking cessation. J Adv Nurs 2019. doi: 10.1111/jan.14146. [Epub ahead of print: 09 Jul 2019].

    Implications for practice and research

  • Understanding smokers’ perspectives and willpower are necessary for effective health communications and smoking cessation practices.

  • Further research is needed to understand resistance to tobacco dependence medications and tailored smoking cessation interventions.

  • Context

    The detrimental effect of smoking on health is well known. Over 8 million deaths worldwide are associated with smoking; 7 million deaths result from direct tobacco use.1 The role of tobacco dependency medications has been established as effective in quitting smoking.2 3 However, factors that influence tobacco dependency medication (TDM) effectiveness in real-world settings, including adherence to treatment regimens, are less well known.

    Bridging anticoagulation therapy with low molecular weight heparin in patients with atrial fibrillation following a stroke is associated with adverse events

    Por: Kennedy · R.

    Commentary on: Altavilla R, Caso V, Bandini F, et al. Anticoagulation after stroke in patients with atrial fibrillation. Stroke 2019;508:2093–100.

    Implications for practice and research

  • Healthcare professionals need to be aware that bridging anticoagulation therapy with low molecular weight heparin (LMWH) in patients with atrial fibrillation following a stroke is associated with a higher rate of recurrent ischaemic and haemorrhagic events compared with patients who do not receive bridging therapy.

  • Strategies to ensure adherence to the guidelines need to be devised and implemented within the clinical setting.

  • Context

    Patients with cardioembolic stroke and non-valvular atrial fibrillation are at a high risk of early stroke recurrence.1 Oral anticoagulation therapy (OAC) in the form of vitamin K antagonists (VKAs) and non–vitamin-K oral anticoagulants (NOACs) are the medical therapy of choice in the secondary prevention of stroke. American Stroke guidelines2 recommend the initiation...

    Pedometer-based walking interventions provide sustained increases in physical activity levels, as well as reductions in cardiovascular events and fractures

    Por: Pavagadhi · D. · Car · J.

    Commentary on: Harris T, Limb ES, Hosking F, et al. Effect of pedometer-based walking interventions on long-term health outcomes: prospective 4-year follow-up of two randomised controlled trials using routine primary care data. PLoS Med 2019;16:e1002836.

    Implications for practice and research

  • A primary care pedometer-based intervention can be an effective and scalable approach for increasing physical activity, and potentially improving long-term health outcomes.

  • Further research is needed for testing the effects of comparable physical activity to identify if outcomes differ across diseases depending on the length of follow-up and change in the physical activity levels.

  • Context

    Long-term diseases are a priority health concern globally, and associated with considerable disease burden,1 lowered quality of life,2 morbidity and mortality.1 2 Prompt and evidence-based approaches for the prevention and optimal management of long-term diseases are imperative. Although the association between...

    Statins used for secondary prevention in patients with stroke reduce the risk of further ischaemic strokes and cardiovascular events

    Por: Hill · J. · Hare · M.

    Commentary on: Tramacere, I, Boncoraglio, GB, Banzi, R, et al. Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis. BMC Med 2019;17:67. doi:10.1186/s12916-019-1298-5.

    Implications for practice and research

  • The secondary use of statins is effective in reducing the absolute risk of ischaemic stroke and cardiac events in patients who previously have had an ischaemic stroke or transient ischaemic attack (TIA).

  • Further research is required to ascertain which statin is the most effective.

  • Context

    Stroke is one of the major causes of worldwide death and disability, with one in four people predicted to experience a stroke within their lifetime.1 After a stroke or a TIA, there remains a substantial long-term risk of recurrent stroke.2 It is recommended that statins should be used to reduce the risk of recurrent stroke...

    Primary care suicide screening: the importance of comprehensive clinical assessment

    Por: Clibbens · N.

    Commentary on: Richards JE, Hohl SD, Whiteside U, et al. If you listen, I will talk: the experience of being asked about suicidality during routine primary care. J Gen Intern Med 2019;34:2075–82. doi: 10.1007/s11606-019-05136-x.

    Implications for practice and research

  • Suicide screening in primary care is acceptable to people when they feel cared for, the assessor has time to listen and they are informed about what will happen.

  • Suicide screening should not be limited to the use of measurement tools, more accurate assessment is achieved using a comprehensive clinical assessment.

  • Context

    Suicide is preventable yet worldwide ~800 000 people die by suicide every year. Suicide prevention is a global public health priority1 and primary care providers are important gatekeepers in identifying people experiencing suicidal thoughts. Factors influencing the accuracy of suicide assessment include stigma preventing disclosure and fear of consequences of disclosure. Suicidal thoughts...

    There is an urgent need for evidence-based internationally agreed guidelines for minimising readmissions after paediatric sepsis

    Por: Paul · S. P. · Walsh · H. R.

    Commentary on: Carlton E, Kohne J, Shankar-Hari, et al. Readmission diagnoses after paediatric severe sepsis hospitalisation. Crit Care Med 2019;47:583–90.

    Implications for practice and research

  • Children with coexisting comorbidities when discharged following severe sepsis have a higher rate of readmission as compared with matched hospitalisations for other acute medical conditions.

  • There is a need for internationally agreed evidence-based guidelines/consensus paper to minimise post-sepsis readmissions through identification of potentially preventable factors, appropriate discharge criteria and parental education.

  • More research is required into strategies towards prevention of readmissions following discharge after an episode of severe sepsis in children.

  • Context

    Sepsis is a leading cause of avoidable death across all age groups.1 Attempts have been made to streamline the management pathways in the UK and elsewhere through publication of national guidelines.1 While robust guidelines exist for management of initial sepsis episodes, strategies...

    When a parent is dying: how we can do more to support families and children with a dying parent

    Por: Pinto · C. · Pinto · S.

    Commentary on: Hanna JR, McCaughan E, Semple CJ. Challenges and support needs of parents and children when a parent is at end of life: a systematic review. Palliat Med 2019;338:1017–1044. doi: 10.1177/0269216319857622.

    Implications for practice and research

  • When a parent is dying, an honest discussion should be made with the children to prepare them for an imminent bereavement. Community awareness is important for better support networks for grieving families.

  • Further research is needed to explore ways of supporting dying parents to have conversations with children of different ages, family settings and cultural backgrounds.

  • Context

    Dying parents of dependent children are faced with accepting their own impending death as well as supporting their children to understand what is happening and prepare them for when death occurs. Such a challenge needs support from healthcare professionals to facilitate a positive approach that prepares the children for loss...

    Producing a successful PhD thesis

    Por: Barrett · D. · Rodriguez · A. · Smith · J.

    All doctoral students strive for the day—after years of often all-consuming study—that their thesis is ready to submit. For both doctoral students and supervisors there is often trepidation about whether the thesis will meet the criteria to merit the award of a Doctor of Philosophy (PhD). As anxieties increase, doctoral students often ask what makes a good PhD, something we explored in a recent ‘Research Made Simple’ article,1 but perhaps the more important question is ‘what makes a PhD student successful?’ In this article we outline the core criteria on which PhD theses are judged and offer suggestions for achieving success.

    How are PhDs assessed

    Traditionally, a PhD involves 3 to 4 years of full-time study (or a longer part-time programme), which is assessed by the student submitting the work they have undertaken as a thesis or—less commonly—a portfolio of published papers and an associated narrative (sometimes...

    Physical activity reduces symptoms of anxiety, but further research is needed to determine a preventative effect

    Por: Singh · S. · Yang · L.

    Commentary on: McDowell, C, Dishman, RK, Gordon, BR, et al. Physical activity and anxiety: a systematic review and meta-analysis of prospective cohort studies. Am J Prev Med 2019;574:545–56.

    Implications for practice and research

  • The burden of anxiety disorders and symptoms can potentially be reduced by increasing physical activity at the population level.

  • More studies require using prospective designs and rigorous measures for assessing anxiety and dosing of physical activity.

  • Context

    Anxiety is a debilitating1 and costly chronic illness.2 Pharmacological treatment of anxiety disorders and symptoms can be challenging with side effects and expensive for many,3 which makes prevention strategies critical. Physical activity has been previously shown to reduce the symptoms of anxiety and depression.4 Whether physical activity may be effective in preventing anxiety has not yet been previously investigated, presenting a knowledge gap and an opportunity...

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