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Commentary on: Altavilla R, Caso V, Bandini F, et al. Anticoagulation after stroke in patients with atrial fibrillation. Stroke 2019;508:2093–100.
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.
Patients with cardioembolic stroke and non-valvular atrial fibrillation are at a high risk of early stroke recurrence.
Commentary on: Cheng Cheng, Bai Jie, Yang Cong-Yan et al. Patients' experiences of coping with multiple chronic conditions: a qualitative descriptive study. J Clin Nurs, 2019, 28: 4400–11.
Healthcare professionals must acknowledge cultural differences in coping strategies and must communicate effectively to inform caregiving. Further qualitative, descriptive studies are required to explore the needs of patients so this information can inform culturally sensitive and appropriate care.
As prevalence of multiple chronic conditions (MCC) increases, financial, personal and institutional burdens will rise.
Commentary on: Byron C, Cornally N, Burton A, et al. Challenges of living with and managing inflammatory bowel disease: a meta-synthesis of patients’ experiences. J Clin Nurs 2020;29:305–19. doi: 10.1111/jocn.15080.
Nurses are well situated to coach people living with chronic conditions to recognise and utilise healthy practical and emotional coping strategies. Future research should not only explore how people with inflammatory bowel disease manage the challenges they face but what the scope is for specialist nurse support.
Inflammatory bowel disease (IBD) is a chronic condition of the gastrointestinal tract that is associated with embarrassing signs and symptoms that include rectal bleeding, diarrhoea, faecal urgency and abdominal pain. Byron et al have provided a meta-synthesis of patients experiences with this condition
Commentary on: Lin CP, Evans CJ, Koffman J, et al. What influences patients' decisions regarding palliative care in advance care planning discussions? Perspectives from a qualitative study conducted with advanced cancer patients, families and healthcare professionals. Palliat Med 2019; Epub ahead of print Aug 1. doi:10.1177/0269216319866641.
More evidence is needed to understand the cultural aspects of palliative care. Paying attention to and acting on cultural context facilitate better culturally sensitive, person-centred advance care planning and palliative care.
Advance care planning is largely derived from Western countries,
Commentary on: Martínez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, et al. Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial. JAMA Inter Med 2019;179:28–36.
The proposed exercise programme can provide significant benefit over usual care and improve patient outcomes in the hospital. Future research may look at a larger scale implementation, additional secondary endpoints (hospital readmission, falls and so on) and the combination of this intervention and others known to impact functional decline. Conceptualising functional status as a clinical vital sign is a paradigm shift that would improve outcomes among very elderly patients.
Functional decline is prevalent among older patients who have been hospitalised. During an acute hospitalisation, there may be significant functional decline with non-disabling (and disabling) conditions causing new disability.
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: 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: Arantzamendi M, Garcia-Rueda N, Carvajal A, et al. People with advanced cancer: the process of living well with awareness of dying. Qual Health Res 2018. doi: 10.1177/1049732318816298. [Epub ahead of print 12 Dec 2018].
The process of living well with advanced cancer revolves around an ‘awareness of dying’. This leads to a focus on living a life rather than living an illness. To support development of the theory, future research should explore its applicability in both a family perspective and different cultural contexts.
Little is known about the process of living well with advanced cancer or how to support it.
Commentary on: Lange P, Lamanna M, Watson R, et al. Undiagnosed delirium is frequent and difficult to predict: results from a prevalence survey of a tertiary hospital. JClin Nurs 2019; 28; 2537–42.
Delirium is common but it is frequently undiagnosed within hospital settings internationally. Older age and dementia are the strongest predictive factors associated with undiagnosed delirium. Validated assessment of all hospitalised patients for delirium is recommended to improve delirium diagnosis among hospitalised patients.
Previous research on delirium prevalence in hospital settings suggests it is a common condition which can affect around 20% of older people.
Commentary on: D. Campbell, N. L. Perkins, A.J. Khan, et al. Deprescribing in the Pharmacologic Management of Delirium: A Randomized Trial in the Intensive Care Unit. J Am Geriatr Soc 2019;67(4):695–702.
Electronic alerts were used with pharmacist support to suggest alternative medications to benzodiazepines and anticholinergics. This had no effect on the use of these medications or the short-term patient outcomes. Deprescribing interventions can have little influence where prescribing levels are already very low.
Delirium is a syndrome characterised by an acute onset of disturbed consciousness, cognitive function or perception. It is associated with higher mortality, increased rates of dementia and longer hospital stays.
Commentary on: Smet L, Heggermont WA, Goossens E, et al. Adherence, knowledge, and perception about oral anticoagulants in patients with atrial fibrillation at high risk for thromboembolic events after radiofrequency ablation. J Adv Nurs 2018;74:2577–87.
Increased knowledge about oral anticoagulants (OACs) and treatment satisfaction may increase the adherence to OAC in patients with atrial fibrillation (AF). There is a need for long-term effects of educational interventions regarding adherence and the intake of OAC in patients with AF.
AF occurs frequently and leads to a higher incidence of thromboembolic events and stroke. Therefore, OACs are crucial and recommended. This therapy can be carried out with vitamin K antagonists (VKAs) or non-VKA OAC (NOACs). Both have demonstrated a significant reduction in the risk of thromboembolic events. Additionally, an effective rhythm control strategy, the catheter ablation, is useful and reduces the...
Commentary on: Webster J, Osborne S, Rickard CM, et al. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2019;1:CD007798.
No difference was found in rates of catheter-related bloodstream infections (CRBSI), thrombophlebitis, pain or mortality between routine and clinically indicated peripheral intravenous catheter (PIVC) removal and replacement. Routine PIVC change does decrease infiltration and catheter occlusion. Clinically indicated catheter exchange may be a cost-saving measure for healthcare systems.
PIVCs are the most common invasive procedure with each patient receiving an average of two PIVCs during their admission.
Commentary on: Smit A, Coetzee BJ, Roomaney R, et al. Women’s stories of living with breast cancer: a systematic review and meta-synthesis of qualitative evidence. Soc Sci Med 2019; 222:231–45. doi: 10.1016/j.socscimed.2019.01.020
Findings illustrate the physical, psychosocial and emotional impact of breast cancer on women. A holistic, person-centred approach to breast cancer care is required before, during and after active cancer treatment has been terminated. The proposed trajectory of breast cancer framework will enable future researchers to consider breast cancer experiences relative to particular breast cancer time-points.
Breast cancer is reported to be the most common type of cancer in women.
Commentary on: Hadler RA, Goldstein NE, Bekelman DB, et al. "Why Would I Choose Death?": A Qualitative Study of Patient Understanding of the Role and Limitations of Cardiac Devices. J Cardiovasc Nurs 2019;34:275–82. doi: 10.1097/JCN.0000000000000565.
Stage II-IV heart failure patients with cardiac devices may overestimate their device’s ability to prevent further deterioration and death. This may become a barrier to engaging in advance care planning. Further research is required to evaluate best methods of engaging these patients in discussions around advance care planning and device deactivation.
Guidelines for managing patients with heart failure indicate that discussions about the condition, treatment options and advance care planning should be discussed at an early stage of the disease.
Commentary on: Hong Y and Lee SH. Effectiveness of tele-monitoring by patient severity and intervention type in chronic obstructive pulmonary disease patients: a systematic review and meta-analysis. Int J Nurs Stud 2019;92:1–15.
Monitoring patients’ health remotely at home using technology has been gaining in popularity for a number of years. Evidence suggests that tele-monitoring may have the potential to reduce emergency room visits and hospitalisation for patients with chronic obstructive pulmonary disease (COPD), particularly those with high disease severity. More rigorously conducted trials of tele-monitoring in patients with COPD are required to determine clinical and cost-effectiveness.
COPD is a long-term, debilitating, respiratory condition that impacts the lives of millions of people worldwide. Poor management of COPD can lead to hospital admissions, increased healthcare costs and poorer outcomes for patients and their families.
Commentary on: Wong, P, Liamputtong P, Koch S, et al. Searching for meaning: a grounded theory of family resilience in adult ICU. J Clin Nurs 2018;28:781–91. Doi: 10.111/jocn.14673
To be resilient, families of intensive care unit (ICU) patients must be supported to seek and understand information, advocate for their loved one and find personal meaning and purpose in the admission. Future research is needed to understand the best psychosocial interventions for family during ICU admission.
Intensive care units (ICUs) are evolving to function with increased family involvement. However, unchecked family involvement in the ICU can place a family at risk for psychological problems including anxiety, depression and if severe enough, postintensive care syndrome family (PICS-F). These risk factors may be lessened if a patient and family-centred care (PFCC) model is used. The foundation for PFCC involves dignity and respect, collaboration, information sharing...
Commentary on: Derry S, Bell RF, Straube S, et al. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev 2019:CD007076. doi: 10.1002/14651858.CD007076.pub3.
There is moderate quality evidence that pregabalin is more effective than placebo for postherpetic neuralgia, painful diabetic neuropathy and post-traumatic neuropathic pain. There is no evidence to support its use in HIV neuropathy nor central neuropathic pain. Future studies require greater sample sizes and clearer methodology. There is a need to identify patients who would benefit from pregabalin therapy.
Pregabalin is licensed to treat neuropathic pain which is defined as pain caused by a lesion or disease of the somatosensory nervous system.
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.
In most countries, demand exceeds availability of acute healthcare resources.
Short-stay units (SSU) are speculated to be cost-effective facilities with the potential to...
Commentary on: Sheppard et al. Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension. JAMA Internal Medicine
A risk-based approach that includes tailored targets and comorbidity may be optimal in the management of hypertension. 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.
Hypertension, a growing global burden, affects one-quarter of the world’s population.
Sheppard et...
Commentary on: Neale J, Brown C, Campbell ANC, et al. How competent are people who use opioids at responding to overdoses? Qualitative analyses of actions and decisions taken during overdose emergencies. Addiction. 2018 Nov 26. doi: 10.1111/add.14510.
Opioid users described using take-home naloxone (THN) to deliver emergency treatment to victims of opioid overdose. Insights from opioid users who have responded to overdoses could improve THN. This study provides a foundation for research exploring the competency of individuals delivering first-line treatment to opioid overdose victims.
In the USA, opioid overdose accounted for 42 249 deaths during 2016. Respiratory depression caused by opioid overdose can be reversed by the timely administration of naloxone. THN programmes supply naloxone and advice in responding to opioid overdose crisis to non-medical professionals.
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