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Building a Handoff Communication Virtual Experience for Nursing Students Using Virtual Humans

imageEffective communication among healthcare professionals is critical to delivering safe, high-quality patient care. One important real-world skill that nursing students must acquire is generating accurate handoff communication reports. The central aim of this study was to build, assess, and revise a virtual experience simulation that allows nursing students to observe a standardized clinical situation in an immersive environment and then practice the situation-background-assessment-recommendation communication method. This between-groups experimental study, which was modified in light of COVID-19 concerns, evaluated how well 69 prelicensure nursing students understood a handoff communication report after viewing a virtual human patient and nurse interact during a triage assessment scenario. Results indicate student comprehension levels did not differ based on which of two metacognitive learning strategies was used. Participants in both study groups were able to accurately complete a situation-background-assessment-recommendation instrument based on the virtual experience. Further, they believed that watching a virtual nurse perform a triage assessment would help them perform one themselves in a similar virtual environment. There was also an unexpected study finding related to patient safety within the context of the simulation. This finding warrants further research that will lead to revision of the virtual experience used to train future nurses.

Nursing Documentation Variation Across Different Medical Facilities Within an Integrated Healthcare System

imageThe purpose of this study was to demonstrate nursing documentation variation based on electronic health record design and its relationship with different levels of care by reviewing how various flowsheet measures, within the same electronic health record across an integrated healthcare system, are documented in different types of medical facilities. Flowsheet data with information on patients who were admitted to academic medical centers, community hospitals, and rehabilitation centers were used to calculate the frequency of flowsheet entries documented. We then compared the distinct flowsheet measures documented in five flowsheet templates across the different facilities. We observed that each type of healthcare facility appeared to have distinct clinical care foci and flowsheet measures documented differed within the same template based on facility type. Designing flowsheets tailored to study settings can meet the needs of end users and increase documentation efficiency by reducing time spent on unrelated flowsheet measures. Furthermore, this process can save nurses time for direct patient care.

Stimulating the Involvement of Family Members in the Medication Management Activities of Older Adults Through Ambient Displays: Qualitative Study

imageLittle attention has been paid to how medication management technologies, designed for older adults, modify the participation of family caregivers. We developed a tablet-based ambient display that provides external cues to remind and motivate older adults to take their medications. This study aimed to understand the effect of ambient displays on the involvement of family members in the elderly's medication management. We conducted a 10-week study consisting of interviews administered weekly to nine elderly-caregivers. We identify that new involvement patterns of the family caregivers were provoked through external cues, which made them aware of older adults' medication adherence and encouraged younger relatives to help older adults.

A Guide for Intentional Home Telehealth Assessment: Patient and Caregiver Perceptions

imageTelehealth can provide expanded access to healthcare. The Comprehensive Patient Assessment for Using Telehealth at Home is a comprehensive approach for an intentional remote patient meeting that provides a high-quality patient encounter when using technology. In this study, we describe the perspectives of seriously ill older adults and their caregivers on the usability of the Comprehensive Patient Assessment for Using Telehealth at Home using technology to meet remotely and assess patients in their own homes. This study used qualitative description with semistructured interviews to explore participants' user experience of the telehealth visit using the Comprehensive Patient Assessment for Using Telehealth at Home. The overarching theme of participants' experiences with the Comprehensive Patient Assessment for Using Telehealth at Home intervention was of a continuum of acceptance of technology use. Participants felt that a combination of in-person and telehealth visits was ideal, and telehealth visits were appropriate for routine visits. In-person assessments would be necessary if the communication was not adequately received through remote technology. Other themes were satisfaction and detractors, usability of the technology, privacy and confidentiality, and timing of the telehealth visit. Telehealth presents new opportunities for patients to engage and connect with providers, allowing them to seek care in the comfort of their own home. In some circumstances, telehealth is appropriate but is not a permanent replacement for in-person visits.

Frontline Nurse Feedback During the Development of a System to Track Cleaning of Portable Medical Equipment

imageAs part of the development and testing of an innovative technology for tracking disinfection of portable medical equipment, end-user feedback was obtained during an initial trial on two acute care hospital units. The disinfection tracking device was installed on the computers-on-wheels and vital signs machines. Each device had the capability of detecting a cleaning event, reporting the event to an online database, and displaying the time since last cleaning event on a visual display. End-user feedback regarding functionality, usefulness of information provided, and impact on workflow was obtained by survey and facilitated group discussions. Seventeen frontline nurses completed the anonymous survey, and 22 participated in the facilitated group discussions. End users found the system functionally easy to use and the information about time since last cleaning useful and reported minimum disruption of workflow. Functionality of the system was confirmed by consistency between recorded and self-reported cleaning patterns. Managers found the data on cleaning of portable medical equipment helpful in validating compliance with hospital equipment cleaning policy. Frontline staff expressed appreciation for technology that helps them and improves outcomes but also discussed concerns about the potential for technology that creates extra work and disruption in the busy frontline nursing care delivery environment. Nurses were appreciative of opportunities to provide feedback and input into efforts to develop and introduce technology. Recorded cleaning events coincided with self-reported equipment cleaning patterns and illustrated that the device efficiently collects information deemed useful by the end user.

Impact of COVID-19 on nursing students mental health: a systematic review and meta-analysis

Por: Barrett · D. · Twycross · A.
Background and purpose

  • This is a summary of Mulyadi M et al, 2021, https://doi.org/10.1016/j.nepr.2021.103228.1

  • Since early 2020, the COVID-19 pandemic has impacted on all aspects of education and healthcare delivery.

  • Student nurses are in a position where they may be impacted by COVID-19 from both an educational perspective and in their role as learners in practice.

  • The purpose of this systematic review and meta-analysis was to gather, appraise and synthesise research on student nurses’ well-being during the COVID-19 pandemic, with a particular focus on mental health and sleep disturbances.

  • Methods

    Results and areas for future research

  • Seventeen studies—all cross-sectional design—were included, encompassing data from nine countries and 13 247 student nurses.

  • Eight studies including 8175 student nurses reported on depression levels; 52% of participants suffered depression during the COVID-19 pandemic.

  • Three studies (n=817)...

  • Hope is a crucial factor for patients facing cancer treatment

    Commentary on: Nierop-van Baalen C, Grypdonck M, Van Hecke A, et al. Associated factors of hope in cancer patients during treatment: a systematic literature review. J Adv Nurs 2020; 00:1–18.

    Implications for practice and research

  • In clinical practice, nurses need to focus on factors related to the management of hope levels in patients undergoing cancer treatment.

  • Cohort studies and clinical trials considering the implications of clinical characteristics and levels of hope, in advanced cancer as well as studies with children, are necessary.

  • Context

    Hope is a multidimensional and dynamic mental process; it consists of the relationship between motivational energy and strategies, visions, plans to achieve long-term goals. All of these components are necessary for the normal functioning of hope. One of the factors that should be considered in assisting patients who are undergoing cancer treatment involves emotional and spiritual aspects, among which hope stands...

    International nurses and midwives require individualised support for successful transition to work in the UK

    Por: Afriyie · D.

    Commentary on: Bond, F, Merriman, C, Walthall, H. The experiences of international nurses and midwives transitioning to work in the UK: A qualitative synthesis of the literature from 2010 to 2019. Int J Nurs Stud 110(2020): 103693.

    Implications for practice and research

  • International nurses and midwives (INM) require support to adapt socially, culturally and professionally to work in the UK.

  • Further primary research is required to understand the interventions that most successfully support transition of INM to working in the UK.

  • Context

    The recruitment of INM trained outside of the European Economic Area (EEA) has continued to grow in the UK, in an attempt the meet staff shortages.1 However, international recruitment processes are expensive and time-consuming for both applicants and recruiting agencies.1 This study by Bond et al examined the preparedness and support available to INMs to undertake the objective...

    Ineffectiveness and safety concerns of using aspirin and other NSAIDs in preventing dementia

    Por: Steele · D. · James · K. · Cadet · M.

    Commentary on:D. (2020). Aspirin and other non-steroidal anti-inflammatory drugs for the prevention of dementia. Cochrane Database of Systematic Reviews, (4).

    Implications for practice and research

  • Further studies of nonsteroidal anti-inflammatory drugs need to give due attention to the safety concerns arising from these existing studies.

  • Monitoring the risks of bleeding when prescribing aspirin or non-steroidal medications for patients with dementia in clinical practice is important.

  • Context

    According to the Centers for Disease Control and Prevention, 5 million adults were diagnosed with dementia in 2014; projected to rise to approximately 14 million by 2060.1 This is a significant health problem, as dementia prevalence is increasing. Therefore, practitioners need to understand how it can be prevented and treated effectively. To date, no available medication exists to prevent or delay the onset of dementia. It has been reported that the pathogenesis of dementia was associated with inflammation;...

    Perceptions and comorbidities interfere with self-efficacy and medication adherence in patients with type 2 diabetes mellitus

    Commentary on: Kim H, Sereika SM, Lingler JH et al . Percepcões de doenca, autoeficácia e autorrelato de adesão à medicacão em pessoas com 50 anos ou mais com diabetes tipo 2. J Cardiovasc Nurs 2020; Publicar antes da impressão (0).

    Implications for practice and research

  • Identification of barriers to medication adherence refers to the formulation of strategies to achieve holistic care considering the patients’ perceptions.

  • Future study design should focus on identifying nursing diagnoses and interventions based on self-care and medication adherence.

  • Context

    Medication adherence is a major public health apprehension and is defined as taking medication precisely as prescribed by health professionals.1 2 This study conducted by Kim et al correlates consequences, treatment, and personal control, identity, concerns and emotional representations were related as predictors of self-efficacy and medication adherence for managing in persons aged 50 and older...

    Latent Class Analysis of Symptom Burden Among Seriously Ill Adults at the End of Life

    imageBackground Serious illness is characterized by high symptom burden that negatively affects quality of life (QOL). Although palliative care research has highlighted symptom burden in seriously ill adults with cancer, symptom burden among those with noncancer serious illness and multiple chronic conditions has been understudied. Latent class analysis is a statistical method that can be used to better understand the relationship between severity of symptom burden and covariates, such as the presence of multiple chronic conditions. Although latent class analysis has been used to highlight subgroups of seriously ill adults with cancer based on symptom clusters, none have incorporated multiple chronic conditions. Objectives The objectives of this study were to (a) describe the demographic and baseline characteristics of seriously ill adults at the end of life in a palliative care cohort, (b) identify latent subgroups of seriously ill individuals based on severity of symptom burden, and (c) examine variables associated with latent subgroup membership, such as QOL, functional status, and the presence of multiple chronic conditions. Methods A secondary data analysis of a palliative care clinical trial was conducted. The latent class analysis was based on the Edmonton Symptom Assessment System, which measures nine symptoms on a scale of 0–10 (e.g., pain, fatigue, nausea, depression, anxiousness, drowsiness, appetite, well-being, and shortness of breath). Clinically significant cut-points for symptom severity were used to categorize each symptom item in addition to a categorized total score. Results Three latent subgroups were identified (e.g., low, moderate, and high symptom burden). Lower overall QOL was associated with membership in the moderate and high symptom burden subgroups. Multiple chronic conditions were associated with statistically significant membership in the high symptom burden latent subgroup. Older adults between 65 and 74 years had a lower likelihood of moderate or high symptom burden subgroup membership compared to the low symptom burden class. Discussion Lower QOL was associated with high symptom burden. Multiple chronic conditions were associated with high symptom burden, which underlines the clinical complexity of serious illness. Palliative care at the end of life for seriously ill adults with high symptom burden must account for the presence of multiple chronic conditions.

    Culturally safe, high‐quality breast cancer screening for transgender people: A scoping review protocol

    Abstract

    Aim

    To develop evidence-based recommendations for provision of culturally safe, high-quality services for breast cancer screening for transgender people.

    Design

    The scoping review will follow the JBI methodological guidance for scoping reviews.

    Methods

    A search using MEDLINE (PubMed), Embase (Ovid), Scopus, the Cochrane Library, including the Cochrane Methodology Register, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and the World Health Organization, Australia Government Department of Health and Google Scholar will be undertaken. The review will include people of any age and ethnicity defined in the source of evidence as transgender. The review will include individuals who have used gender-affirming interventions or not and sources of evidence that report information relevant to the provision of culturally safe, high-quality breast cancer screening services for transgender people. English language sources of evidence published from database inception with information from any country will be eligible for inclusion. Sources will be screened for inclusion by three independent reviewers. Results will be extracted using a purpose-built tool and presented in relation to the review questions and objective in the final report using tables, figures and corresponding narrative. Project funding was approved by the Australian Government Department of Health in June 2020.

    Discussion

    There are a range of factors that impact on the equity of health access and outcomes for people who are not cisgender. Transgender people are at risk of breast cancer but there is relatively little evidence about how their risks may or may not differ substantially from cis-gendered individuals and little guidance for health providers to ensure inclusive, culturally safe, high-quality breast cancer screening services for both transgender males, transgender females and gender diverse people who may not identify as male or as female.

    Impact

    It is important to provide culturally safe, high-quality services for breast cancer screening for transgender people.

    Experiences of home as an aspect of well‐being in people over 80 years: A mixed method study

    Abstract

    Aims

    To (1) describe experiences of home from a well-being perspective, (2) describe participant characteristics and well-being measures in relation to housing type (3) and how the aforementioned aspects may affect well-being in very old persons.

    Design

    Cross-sectional, convergent parallel-results mixed method design with semi-structured interviews analysed by qualitative content analysis, in relation to descriptive statistics and specific well-being outcome measures related to home.

    Methods

    A total of 50 persons 80 years or older living in ordinary housing were interviewed (July 2017 to November 2018) about home in relation to well-being, along with collection of participant characteristics and well-being measures related to home.

    Results

    Participants described how home had become increasingly important as it provided autonomy and acted as a social and occupational hub. However, autonomy was not unconditional, and home could also be perceived as a place of inactive solitude. Results were interpreted as relating to being in the margins of home and had a major impact on well-being. Housing type seemed of importance with higher measures of well-being for participants in single-living housing compared with those living in apartment.

    Conclusion

    Home is increasingly central to well-being in old age; however, very old persons also have to relate to being physically and mentally in the margins of being able to remain in the home. These aspects of home potentially have a major impact on well-being.

    Impact

    As very old persons living in ordinary housing will constitute a larger segment of society in coming years, aspects of home can potentially have a considerable impact on well-being for this age-group. This study describes aspects of home that contribute to, or has adverse impact on well-being. These aspects need thorough consideration in policy-making and planning of health care that can affect experiences of home.

    Unexplained mortality during the US COVID-19 pandemic: retrospective analysis of death certificate data and critical assessment of excess death calculations

    Por: Fairman · K. A. · Goodlet · K. J. · Rucker · J. D. · Zawadzki · R. S.
    Objectives

    Cause-of-death discrepancies are common in respiratory illness-related mortality. A standard epidemiological metric, excess all-cause death, is unaffected by these discrepancies but provides no actionable policy information when increased all-cause mortality is unexplained by reported specific causes. To assess the contribution of unexplained mortality to the excess death metric, we parsed excess deaths in the COVID-19 pandemic into changes in explained versus unexplained (unreported or unspecified) causes.

    Design

    Retrospective repeated cross-sectional analysis, US death certificate data for six influenza seasons beginning October 2014, comparing population-adjusted historical benchmarks from the previous two, three and five seasons with 2019–2020.

    Setting

    48 of 50 states with complete data.

    Participants

    16.3 million deaths in 312 weeks, reported in categories—all causes, top eight natural causes and respiratory causes including COVID-19.

    Outcome measures

    Change in population-adjusted counts of deaths from seasonal benchmarks to 2019–2020, from all causes (ie, total excess deaths) and from explained versus unexplained causes, reported for the season overall and for time periods defined a priori: pandemic awareness (19 January through 28 March); initial pandemic peak (29 March through 30 May) and pandemic post-peak (31 May through 26 September).

    Results

    Depending on seasonal benchmark, 287 957–306 267 excess deaths occurred through September 2020: 179 903 (58.7%–62.5%) attributed to COVID-19; 44 022–49 311 (15.2%–16.1%) to other reported causes; 64 032–77 054 (22.2%–25.2%) unexplained (unspecified or unreported cause). Unexplained deaths constituted 65.2%–72.5% of excess deaths from 19 January to 28 March and 14.1%–16.1% from 29 March through 30 May.

    Conclusions

    Unexplained mortality contributed substantially to US pandemic period excess deaths. Onset of unexplained mortality in February 2020 coincided with previously reported increases in psychotropic use, suggesting possible psychiatric or injurious causes. Because underlying causes of unexplained deaths may vary by group or region, results suggest excess death calculations provide limited actionable information, supporting previous calls for improved cause-of-death data to support evidence-based policy.

    Identifying womens preferences for treatment of urinary tract infection: a discrete choice experiment

    Por: van der Worp · H. · Brandenbarg · D. · Boek · P. A. · Braams · J. H. W. · Brink · L. J. F. · Keupers · J. · Blanker · M. H.
    Objective

    To identify the preferences of women regarding management of urinary tract infections (UTIs).

    Design

    A discrete choice experiment of the preferences for certain treatment attributes was conducted by survey. Attributes included treatment duration, time to complaint resolution, complication risk, side effect risk and contribution to antimicrobial resistance.

    Setting

    General population in the Netherlands, recruited via social media.

    Participants

    Women aged 18 years or older.

    Primary and secondary outcome measures

    The primary outcome was the relative importance of the attributes for treatment choice, using a conditional logit model. The secondary outcome was the heterogeneity in these preferences.

    Results

    The discrete choice experiment was completed by 833 women. Most attributes were important to decisions for UTI treatment. Women were willing to accept management with, for example, a higher chance of complications or longer time to resolution, if it could help avoid antimicrobial resistance. However, there was heterogeneity in the preferences. Women who had one previous UTI had a stronger preference for faster symptom resolution compared with those who had no previous UTI. Younger women also preferred faster symptom resolution. Finally, women with a low or middle education level gave less importance to preventing antimicrobial resistance than women with a high education level.

    Conclusions

    The current study indicated that a considerable part of women valued alternatives to antimicrobial treatment and were prepared to tolerate management that was less optimal in certain respects to avoid antimicrobial treatment.

    Association of apolipoprotein Cs with new-onset type 2 diabetes mellitus: findings from the Chinese multi-provincial cohort study

    Por: Li · J. · Zhao · D. · Liu · J. · Wang · M. · Sun · J. · Liu · J. · Li · Y. · Deng · Q. · Qi · Y.
    Objectives

    Apolipoprotein Cs (apoCs), especially apoC-II and apoC-III, as the components of triglyceride-rich lipoproteins, play a key role in the pathophysiology of diabetes. However, prospective studies examining direct associations between apoCs and diabetes are not reproducible. The aim of this study was to evaluate the impact of apoCs on the risk of developing diabetes in a middle-aged population, and to explore possible mediators responsible for the relationship between apoCs and diabetes.

    Design

    Prospective cohort study.

    Setting

    Community-based study carried out in Beijing.

    Methods

    ApoCs were measured in 1085 participants aged 45–74 years and free of type 2 diabetes mellitus (T2DM) at baseline from the Chinese Multi-Provincial Cohort Study-Beijing Project. Multivariate logistic regression was performed to examine the association of apoCs with a 5-year risk of new-onset T2DM. The impacts of triglycerides, insulin and high-sensitivity C reactive protein (hs-CRP) on the association between apoC-III and the risk of T2DM were explored by a mediation test.

    Results

    During the 5 years of follow-up, 97 (8.9%) participants developed T2DM. ApoC-III was significantly associated with the risk of developing T2DM after multivariable adjustment (OR=1.40; 95% CI 1.07 to 1.82). This association was mainly mediated by triglyceride levels with a significant indirect effect (OR 1.61; 95% CI 1.19 to 2.18), followed by hs-CRP and insulin.

    Conclusions

    Our findings demonstrated that higher serum apoC-III was independently associated with increased 5-year risk of new-onset T2DM in the Chinese population, and triglyceride plays a crucial role in mediating this relationship. More attention should be paid to preventive strategies of T2DM targeting apoC-III.

    Efficacy of tofacitinib in reduction of inflammation detected on MRI in patients with Psoriatic ArthritiS presenTing with axial involvement (PASTOR): protocol of a randomised, double-blind, placebo-controlled, multicentre trial

    Por: Proft · F. · Torgutalp · M. · Muche · B. · Rios Rodriguez · V. · Verba · M. · Poddubnyy · D.
    Introduction

    Psoriatic arthritis (PsA) is an inflammatory disease characterised by synovitis, enthesitis, dactylitis and axial involvement. The prevalence of axial involvement ranges from 25% to 70% in this patient group. Treatment recommendations for axial PsA were mainly extrapolated from guidelines for axial spondyloarthritis, and the main treatment options are non-steroidal anti-inflammatory drugs and biological disease-modifying antirheumatic drugs (tumour necrosis factor, IL-17 and IL-23 inhibitors). Tofacitinib was approved for the treatment of PsA and its efficacy on axial inflammation has been demonstrated in a phase II study of ankylosing spondylitis (AS). This prospective study aims to evaluate the efficacy of tofacitinib in reducing inflammation in the sacroiliac joints (SIJs) and spine on MRI in patients with axial disease of their PsA presenting with active axial involvement compatible with axial PsA.

    Methods and analyses

    This is a randomised, double-blind, placebo-controlled, multicentre clinical trial in patients with axial PsA who have evidence of axial involvement, active disease as defined by a Bath AS Disease Activity Index score of ≥4 and active inflammation on MRI of the SIJs and/or spine as assessed by and independent central reader. The study includes a 6-week screening period, a 24-week treatment period, which consist of a 12-week placebo-controlled double-blind treatment period followed by a 12-week active treatment period with tofacitinib for all participants, and a safety follow-up period of 4 weeks. At baseline, 80 subjects shall be randomised (1:1) to receive either tofacitinib or matching placebo for a 12-week double-blind treatment period. At week 12, an MRI of the whole spine and SIJs will be performed to evaluate the primary study endpoint.

    Ethics and dissemination

    The study will be performed according to the ethical principles of the Declaration of Helsinki and the German drug law. The independent ethics committees of each centre approved the ethical, scientific and medical appropriateness of the study before it was conducted.

    Trial registration number

    NCT04062695; ClinicalTrials.gov and EudraCT No: 2018-004254-22; European Union Clinical Trials Register.

    Virtual team-based care planning with older persons in formal care settings: a scoping review protocol

    Por: Gao · H. · Yous · M.-L. · Connelly · D. · Hung · L. · Garnett · A. · Hay · M. E. · Snobelen · N. · Salatino · S.
    Introduction

    COVID-19 has necessitated greater adoption of virtual care (eg, telephone (audio), videoconference) delivery models. Virtual care provides opportunities for innovative practice in care planning with older persons and meaningful family engagement by synchronously involving multiple care providers. Nevertheless, there remains a paucity of summarising evidence regarding virtual team-based care planning for older persons. The purpose of this scoping review is to summarise evidence on the utilisation of virtual team-based care planning for older persons in formal care settings. Specifically, (1) what has been reported in the literature on the impact or outcomes of virtual team-based care planning? (2) What are the facilitators and barriers to implementation?

    Methods and analysis

    This scoping review will follow a rigorous and well-established methodology by the Joanna Briggs Institute, supplemented by the Arksey & O’Malley and Levac, Colquhoun, & O’Brien frameworks. A three-step search strategy will be used to conduct a search on virtual team-based care planning for older persons in formal care settings. Keywords and index terms will be identified from an initial search in PubMed and AgeLine, and used to conduct the full search in the databases PubMed, EMBASE, CINAHL, AgeLine, PsycInfo and Scopus. Reference lists of included articles and grey literature retrieved through Google and Google Scholar will also be reviewed. Three researchers will screen titles and abstracts, and will conduct full-text review for inclusion. Extracted data will be mapped in a table.

    Ethics and dissemination

    Research ethics approval is not required for data collection from publicly accessible information. Findings will be presented at conferences, submitted for open-access publication in a peer-reviewed journal and made accessible to multiple stakeholders. The scoping review will summarise the literature on virtual team-based care planning for the purpose of informing the implementation of a virtual PIECES™ intervention (Physical/Intellectual/Emotional health, Capabilities, Environment, and Social).

    Association between neighbourhood deprivation, fetal growth, small-for-gestational age and preterm birth: a population-based prospective cohort study

    Por: Gootjes · D. V. · Posthumus · A. G. · Jaddoe · V. W. V. · Steegers · E. A. P.
    Objective

    To study the associations between neighbourhood deprivation and fetal growth, including growth in the first trimester, and adverse pregnancy outcomes.

    Design

    Prospective cohort study.

    Setting

    The Netherlands, Rotterdam.

    Participants

    8617 live singleton births from the Generation R cohort study.

    Exposition

    Living in a deprived neighbourhood.

    Main outcome measures

    Fetal growth trajectories of head circumference, weight and length.

    Secondary outcomes measures

    Small-for-gestational age (SGA) and preterm birth (PTB).

    Results

    Neighbourhood deprivation was not associated with first trimester growth. However, a higher neighbourhood status score (less deprivation) was associated with increased fetal growth in the second and third trimesters (eg, estimated fetal weight; adjusted regression coefficient 0.04, 95% CI 0.02 to 0.06). Less deprivation was also associated with decreased odds of SGA (adjusted OR 0.91, 95% CI 0.86 to 0.97, p=0.01) and PTB (adjusted OR 0.89, 95% CI 0.82 to 0.96, p=0.01).

    Conclusions

    We found an association between neighbourhood deprivation and fetal growth in the second and third trimester pregnancy, but not with first trimester growth. Less neighbourhood deprivation is associated with lower odds of adverse pregnancy outcomes. The associations remained after adjustment for individual-level risk factors. This supports the hypothesis that living in a deprived neighbourhood acts as an independent risk factor for fetal growth and adverse pregnancy outcomes, above and beyond individual risk factors.

    'Care co-ordinator in my pocket: a feasibility study of mobile assessment and therapy for psychosis (TechCare)

    Por: Gire · N. · Caton · N. · McKeown · M. · Mohmed · N. · Duxbury · J. · Kelly · J. · Riley · M. · J Taylor · P. · Taylor · C. D. J. · Naeem · F. · Chaudhry · I. B. · Husain · N.
    Objectives

    The aim of the project was to examine the acceptability and feasibility of a mobile phone application-based intervention ‘TechCare’, for individuals with psychosis in the North West of England. The main objectives were to determine whether appropriate individuals could be identified and recruited to the study and whether the TechCare App would be an acceptable intervention for individuals with psychosis.

    Methods

    This was a mixed methods feasibility study, consisting of a test-run and feasibility evaluation of the TechCare App intervention.

    Setting

    Early Intervention Services (EIS) for psychosis, within an NHS Trust in the North West of England.

    Participants

    Sixteen participants (test-run n=4, feasibility study n=12) aged between 18 and 65 years recruited from the East, Central and North Lancashire EIS.

    Intervention

    A 6-week intervention, with the TechCare App assessing participants’ symptoms and responses in real-time and providing a personalised-guided self-help-based psychological intervention based on the principles of Cognitive Behaviorual Therapy (CBT).

    Results

    A total of 83.33% (n=10) of participants completed the 6-week feasibility study, with 70% of completers achieving the set compliance threshold of ≥33% engagement with the TechCare App system. Analysis of the qualitative data suggested that participants held the view that the TechCare was both an acceptable and feasible means of delivering interventions in real-time.

    Conclusion

    Innovative digital clinical technologies, such as the TechCare App, have the potential to increase access to psychological interventions, reduce health inequality and promote self-management with a real-time intervention, through enabling access to mental health resources in a stigma-free, evidence-based and time-independent manner.

    Trial registration number

    ClinicalTrials.gov Identifier: NCT02439619.

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