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The effectiveness of nurse‐led interventions to prevent childhood and adolescent overweight and obesity: A systematic review of randomised trials

Abstract

Background

Obesity among children and adolescents continues to rise worldwide. Despite the efforts of the healthcare workforce, limited high-quality evidence has been put forward demonstrating effective childhood obesity interventions. The role of nurses as primary actors in childhood obesity prevention has also been underresearched given the size of the workforce and their growing involvement in chronic disease prevention.

Aim

To examine the effectiveness of nurse-led interventions to prevent childhood and adolescent overweight and obesity.

Design

A systematic review of randomised trials.

Data sources

Medline, CINAHL, EMBASE, Cochrane (CENTRAL), ProQuest Central and SCOPUS were searched from inception to March 2020.

Review methods

This review was informed by the Cochrane handbook for systematic reviews of interventions.

Results

Twenty-six publications representing 18 discrete studies were included (nine primary prevention and nine secondary prevention). Nurse-led interventions were conducted in diverse settings, were multifaceted, often involved parents and used education, counselling and motivational interviewing to target behaviour change in children and adolescents’ diet and physical activity. Most studies did not determine that nurse-led interventions were more effective than their comparator(s) in preventing childhood and adolescent overweight and obesity.

Conclusions

Nurse-led interventions to prevent juvenile obesity are feasible but have not yet determined effectiveness. With adequate training, nurses could make better use of existing clinical and situational opportunities to assist in the effort to prevent childhood obesity.

Effectiveness of skin cleanser and protectant regimen on incontinence‐associated dermatitis outcomes in acute care patients: A cluster randomised trial

Abstract

Skin cleansers and protectants protect skin from incontinent matter to reduce the risk of incontinence-associated dermatitis (IAD), but their effectiveness treating established IAD in the tropics is unknown. We conducted an open-label cluster randomised trial to compare the effectiveness of a combined regimen of (1) specialised skin cleansers with disposable body wipes and (2) either an acrylic terpolymer (T1) or zinc oxide (T2) skin protectant against disposable body wipes and zinc oxide protectant (control) in promoting IAD healing and reducing the risk of deterioration. Eighty-four patients were recruited in a tertiary hospital in Singapore between April 2019 and January 2020 (T1: n = 23; T2: n = 37; Control: n = 24). Although not statistically significant, patients treated with T1 and T2 were 1.5 times as likely to experience IAD healing within seven days compared with the control (P = .66). Healing was more pronounced in participants with skin loss treated with T1 or T2. No treatment was superior in preventing IAD deterioration, the prevalence of which remained small (8%-14%). While skin cleaning and protectants reduced the overall risk of skin deterioration, the addition of skin cleansers enhanced IAD healing within a short period, an important consideration for future research examining IAD treatment in acute care.

Assessment of a recombinant protein from <i>Leishmania infantum</i> as a novel tool for Visceral Leishmaniasis (VL) diagnosis in VL/HIV co-infection cases

by Rhaíssa E. M. Ramos, Wagner J. T. Santos, Franklin B. Magalhães, George T. N. Diniz, Carlos H. N. Costa, Osvaldo P. de Melo Neto, Zulma M. Medeiros, Christian R. S. Reis

Visceral Leishmaniasis and HIV-AIDS coinfection (VL/HIV) is considered a life-threatening pathology when undiagnosed and untreated, due to the immunosuppression caused by both diseases. Serological tests largely used for the VL diagnosis include the direct agglutination test (DAT), ELISA and immunochromatographic (ICT) assays. For VL diagnosis in HIV infections, different studies have shown that the use of the DAT assay facilitates the VL diagnosis in co-infected patients, since the performance of the most widely used ELISA and ICT tests, based on the recombinant protein rK39, are much less efficient in HIV co-infections. In this scenario, alternative recombinant antigens may help the development of new serological diagnostic methods which may improve the VL diagnosis for the co-infection cases. This work aimed to evaluate the use of the recombinant Lci2 antigen, related to, but antigenically more diverse than rK39, for VL diagnosis in co-infected sera through ELISA assays. A direct comparison between recombinant Lci2 and rK39 was thus carried out. The two proteins were first tested using indirect ELISA with sera from VL afflicted individuals and healthy controls, with similar performances. They were then tested with two different sets of VL/HIV co-infected cases and a significant drop in performance, for one of these groups, was observed for rK39 (32% sensitivity), but not for Lci2 (98% sensitivity). In fact, an almost perfect agreement (Kappa: 0.93) between the Lci2 ELISA and DAT was observed for the coinfected VL/HIV patients. Lci2 then has the potential to be used as a new tool for the VL diagnosis of VL/HIV co-infections.

Interventions to improve physical activity in colorectal cancer survivors: protocol for a systematic review and meta‐analysis of randomized controlled trials

Abstract

Aim

To examine the effectiveness of physical activity (PA) interventions on changes in PA among colorectal cancer survivors, including an examination of theoretical versus atheoretical-driven approaches, with a special focus on their effectiveness across ethnic and racial minorities.

Design

Systematic review with aggregated data meta-analyses.

Data sources

Using six databases (Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, CINAHL with full text, Scopus and Web of Science), we will screen for randomized controlled trials written in English from May 1, 1993 up to December 31, 2020.

Review methods

Dual study-selection and data abstraction will be performed. The Behavior Change Technique Taxonomy (v1) will be used to examine behavior change techniques among selected studies, while the Theory Coding Scheme will be used to assess the extent of theory use. Risk of bias will be assessed using the revised Cochrane risk-of-bias tool for randomized trials, while the strength of the evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation instrument. In addition, intervention delivery will be appraised using the Template for Intervention Description and Replication. Changes in PA from each study will be calculated using the standardized mean difference effect size (Hedge's g). Results will be pooled using the inverse-variance heterogeneity model. Heterogeneity (Cochran's Q) and inconsistency (I2) will be examined, while small-study effects (publication bias) will be evaluated using the Doi plot and LFK Index. Meta-regression will also be conducted to examine for potential associations between changes in physical activity and selected covariates (theoretical versus atheoretical-driven approaches, race/ethnicity).

Discussion

This systematic review will identify specific racial/ethnic minorities for whom interventions are most effective and summarize the evidence of the effectiveness of theoretical vs. theoretical based intervention.

Impact

This systematic review can direct policymakers and practitioners towards actions that are likely to bring about positive physical activity behaviour change.

Identifying Symptom Information in Clinical Notes Using Natural Language Processing

imageBackground Symptoms are a core concept of nursing interest. Large-scale secondary data reuse of notes in electronic health records (EHRs) has the potential to increase the quantity and quality of symptom research. However, the symptom language used in clinical notes is complex. A need exists for methods designed specifically to identify and study symptom information from EHR notes. Objectives We aim to describe a method that combines standardized vocabularies, clinical expertise, and natural language processing to generate comprehensive symptom vocabularies and identify symptom information in EHR notes. We piloted this method with five diverse symptom concepts: constipation, depressed mood, disturbed sleep, fatigue, and palpitations. Methods First, we obtained synonym lists for each pilot symptom concept from the Unified Medical Language System. Then, we used two large bodies of text (clinical notes from Columbia University Irving Medical Center and PubMed abstracts containing Medical Subject Headings or key words related to the pilot symptoms) to further expand our initial vocabulary of synonyms for each pilot symptom concept. We used NimbleMiner, an open-source natural language processing tool, to accomplish these tasks and evaluated NimbleMiner symptom identification performance by comparison to a manually annotated set of nurse- and physician-authored common EHR note types. Results Compared to the baseline Unified Medical Language System synonym lists, we identified up to 11 times more additional synonym words or expressions, including abbreviations, misspellings, and unique multiword combinations, for each symptom concept. Natural language processing system symptom identification performance was excellent. Discussion Using our comprehensive symptom vocabularies and NimbleMiner to label symptoms in clinical notes produced excellent performance metrics. The ability to extract symptom information from EHR notes in an accurate and scalable manner has the potential to greatly facilitate symptom science research.

Detection of bacterial fluorescence from in vivo wound biofilms using a point‐of‐care fluorescence imaging device

Abstract

Wound biofilms must be identified to target disruption and bacterial eradication but are challenging to detect with standard clinical assessment. This study tested whether bacterial fluorescence imaging could detect porphyrin-producing bacteria within a biofilm using well-established in vivo models. Mouse wounds were inoculated on Day 0 with planktonic bacteria (n = 39, porphyrin-producing and non-porphyrin-producing species, 107 colony forming units (CFU)/wound) or with polymicrobial biofilms (n = 16, 3 biofilms per mouse, each with 1:1:1 parts Staphylococcus aureus/Escherichia coli/Enterobacter cloacae, 107 CFU/biofilm) that were grown in vitro. Mouse wounds inoculated with biofilm underwent fluorescence imaging up to Day 4 or 5. Wounds were then excised and sent for microbiological analysis. Bacteria-matrix interaction was assessed with scanning electron microscopy (SEM) and histopathology. A total of 48 hours after inoculation with planktonic bacteria or biofilm, red fluorescence was readily detected in wounds; red fluorescence intensified up to Day 4. Red fluorescence from biofilms persisted in excised wound tissue post-wash. SEM and histopathology confirmed bacteria-matrix interaction. This pre-clinical study is the first to demonstrate the fluorescence detection of bacterial biofilm in vivo using a point-of-care wound imaging device. These findings have implications for clinicians targeting biofilm and may facilitate improved visualisation and removal of biofilms.

Changes in prescribing rates of sodium-containing medications in the UK from 2009 to 2018: a cross-sectional study with interrupted time series analysis

Por: Ju · C. · Wei · L. · Mackenzie · I. S. · MacDonald · T. M. · George · J.
Objective

Effervescent, soluble, dispersible formulations contain considerable amounts of sodium. In 2013, we previously confirmed the association between sodium-containing medications and cardiovascular risks. This study aimed to determine the changes in the prescribing pattern in clinical practice following this publication.

Design

A longitudinal cross-sectional study.

Setting

Primary care in the UK from 2009 to 2018.

Participants

Prescribing information in The Health Improvement Network (THIN) and Prescription Cost Analysis (PCA) databases in the UK.

Outcome measurements

Prescription rates per 10 000 inhabitants were calculated using the number of prescriptions or the number of drug-using patients over the total number of inhabitants, and the prescription rates were measured at annual intervals. Prescribing trends from 2009 to 2018 were indexed with yearly data from THIN and PCA. Interrupted time series analysis (ITSA) was conducted with monthly data in THIN.

Results

From the THIN database, a total of 3 651 419 prescription records from 446 233 patients were included. The prescribing rate of sodium-containing medications changed from 848.3/10 000 inhabitants in 2009 to 571.6/10 000 inhabitants in 2018. The corresponding figures from PCA data were of 631.0/10 000 inhabitants in 2009 and 423.8/10 000 inhabitants in 2018. ITSA showed the prescribing trend reduced significantly during the postpublication period (prescribing rate: slope change=–0.26; 95% CI –0.45 to –0.07; p=0.009; proportion of patients: slope change=–0.22; 95% CI –0.35 to –0.09; p

Conclusions

The prescribing of sodium-containing medications in the UK primary care has declined significantly during the postpublication period. Changes in the prescribing trends for sodium-containing medications varied across regions of the UK and patient age groups.

The impact of surgical site infection on hospitalisation, treatment costs, and health‐related quality of life after vascular surgery

Abstract

Surgical site infections (SSI) substantially increase costs for healthcare providers because of additional treatments and extended patient recovery. The objective of this study was to assess the cost and health-related quality of life impact of SSI, from the perspective of a large teaching hospital in England. Data were available for 144 participants undergoing clean or clean-contaminated vascular surgery. SSI development, length of hospital stay, readmission, and antibiotic use were recorded over a 30-day period. Patient-reported EQ-5D scores were obtained at baseline, day 7 and day 30. Linear regressions were used to control for confounding variables. A mean SSI-associated length of stay of 9.72 days resulted in an additional cost of £3776 per patient (including a mean antibiotic cost of £532). Adjusting for age, smoking status, and procedure type, SSI was associated with a 92% increase in length of stay (P < 0.001). The adjusted episode cost was £3040. SSI reduced patient utility between baseline and day 30 by 0.156 (P = 0.236). Readmission rates were higher with SSI (P = 0.017), and the rate to return to work within 90 days was lower. Therefore, strategies to reduce the risk of surgical site infection for high-risk vascular patients should be investigated.

Groin wound infection after vascular exposure (GIVE) multicentre cohort study

Abstract

Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI.

An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow‐up was 90 days. The primary outcome was the incidence of groin wound SSI.

1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post‐operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90‐day mortality. Female sex, Body mass index≥30 kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI.

Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non‐modifiable variables.

The impact of surgical site infection on hospitalisation, treatment costs, and health‐related quality of life after vascular surgery

Abstract

Surgical site infections (SSI) substantially increase costs for healthcare providers because of additional treatments and extended patient recovery. The objective of this study was to assess the cost and health‐related quality of life impact of SSI, from the perspective of a large teaching hospital in England. Data were available for 144 participants undergoing clean or clean‐contaminated vascular surgery. SSI development, length of hospital stay, readmission, and antibiotic use were recorded over a 30‐day period. Patient‐reported EQ‐5D scores were obtained at baseline, day 7 and day 30. Linear regressions were used to control for confounding variables. A mean SSI‐associated length of stay of 9.72 days resulted in an additional cost of £3776 per patient (including a mean antibiotic cost of £532). Adjusting for age, smoking status, and procedure type, SSI was associated with a 92% increase in length of stay (P < 0.001). The adjusted episode cost was £3040. SSI reduced patient utility between baseline and day 30 by 0.156 (P = 0.236). Readmission rates were higher with SSI (P = 0.017), and the rate to return to work within 90 days was lower. Therefore, strategies to reduce the risk of surgical site infection for high‐risk vascular patients should be investigated.

Group‐randomized trial of tailored brief shared decision‐making to improve asthma control in urban black adults

Abstract

Aims

To assess the intervention effects of BREATHE (BRief intervention to Evaluate Asthma THErapy), a novel brief shared decision‐making intervention and evaluate feasibility and acceptability of intervention procedures.

Design

Group‐randomized longitudinal pilot study.

Methods

In total, 80 adults with uncontrolled persistent asthma participated in a trial comparing BREATHE (N = 40) to a dose‐matched attention control intervention (N = 40). BREATHE is a one‐time shared decision‐making intervention delivered by clinicians during routine office visits. Ten clinicians were randomized and trained on BREATHE or the control condition. Participants were followed monthly for 3 months post‐intervention. Data were collected from December 2017 – May 2019 and included surveys, lung function tests, and interviews.

Results

Participants were Black/multiracial (100%) mostly female (83%) adults (mean age 45). BREATHE clinicians delivered BREATHE to all 40 participants with fidelity based on expert review of audiorecordings. While the control group reported improvements in asthma control at 1‐month and 3‐month follow‐up, only BREATHE participants had better asthma control at each timepoint (β = 0.77; standard error (SE)[0.17]; ≤ 0.0001; β = 0.71; SE[0.16]; ≤ 0.0001; β = 0.54; SE[0.15]; p = .0004), exceeding the minimally important difference. BREATHE participants also perceived greater shared decision‐making occurred during the intervention visit (β = 7.39; SE[3.51]; p = .03) and fewer symptoms at follow‐up (e.g., fewer nights woken, less shortness of breath and less severity of symptoms) than the controls. Both groups reported improved adherence and fewer erroneous medication beliefs.

Conclusion

BREATHE is a promising brief tailored intervention that can be integrated into office visits using clinicians as interventionists. Thus, BREATHE offers a pragmatic approach to improving asthma outcomes and shared decision‐making in a health disparity population.

Impact

The study addressed the important problem of uncontrolled asthma in a high‐risk vulnerable population. Compared with the dose‐matched attention control condition, participants receiving the novel brief tailored shared decision‐making intervention had significant improvements in asthma outcomes and greater perceived engagement in shared decision‐making. Brief interventions integrated into office visits and delivered by clinicians may offer a pragmatic approach to narrowing health disparity gaps. Future studies where other team members (e.g., office nurses, social workers) are trained in shared decision‐making may address important implementation science challenges as it relates to adoption, maintenance, and dissemination.

Trail registration

clinicaltrials.gov # NCT03300752.

Structure, staffing, and factors affecting infection control nurses: Hospital based exploratory survey‐ A study protocol

Abstract

Aim

The overall aim of the study is to develop a module for the structure, staffing, job responsibilities, training and workflow for the hospital Infection Control Department.

Design

An exploratory research design in two phases. Phase 1: Hospital based exploratory survey design. Phase 2: Delphi technique with Focus Group Discussion.

Method

Data will be collected through interviewing Infection Control Nurses (ICNs) or infection control in‐charge using Infection Prevention and Control Assessment Framework (IPCAF) released by World Health Organization (WHO) in the first phase and Delphi technique in the second phase to determine the problems and solutions for the concerns pertaining to the ICNs. The study is funded by Indian Council of Medical Research from 15 October 2019 for 3 years duration.

Discussion

Healthcare Associated Infection (HAI) affects the care quality of millions of people around the globe. Many researchers have explored the evidence for causes and measures to contain infection. However, there are hardly few researches from the perspective to structure, staffing pattern and factors affecting ICNs. As staffing is considered as a vital component in infection prevention, there is a necessity for optimization to reduce the global burden related to HAI.

Impact

This protocol on Structure, staffing, and factors affecting ICN will provide insight into developing strategy, policy or educational module for the ICNs across the country.

Trial Registration

The trial is registered with Central Trial Registry of India (CTRI) with reference ID: CTRI/2020/07/026286

Challenges, experience and coping of health professionals in delivering healthcare in an urban slum in India during the first 40 days of COVID-19 crisis: a mixed method study

Por: George · C. E. · Inbaraj · L. R. · Rajukutty · S. · de Witte · L. P.
Objectives

To describe the initial dilemmas, mental stress, adaptive measures implemented and how the healthcare team collectively coped while providing healthcare services in a large slum in India, during the COVID-19 pandemic.

Setting

Community Health Division, Bangalore Baptist Hospital, Bangalore.

Study design

We used mixed methods research with a quantitative (QUAN) paradigm nested in the primary qualitative (QUAL) design. QUAL methods included ethnography research methods, in-depth interviews and focus group discussions.

Participants

A healthcare team of doctors, nurses, paramedical and support staff. Out of 87 staff, 42 participated in the QUAL methods and 64 participated in the QUAN survey.

Results

Being cognizant of the extreme vulnerability of the slums, the health team struggled with conflicting thoughts of self-preservation and their moral obligation to the marginalised section of society. Majority (75%) of the staff experienced fear at some point in time. Distracting themselves with hobbies (20.3%) and spending more time with family (39.1%) were cited as a means of emotional regulation by the participants in the QUAN survey. In the QUAL interviews, fear of death, the guilt of disease transmission to their loved ones, anxiety about probable violence and stigma in the slums and exhaustion emerged as the major themes causing stress among healthcare professionals. With positive cognitive reappraisal, the health team collectively designed and implemented adaptive interventions to ensure continuity of care. They dealt with the new demands by positive reframing, peer support, distancing, information seeking, response efficacy, self-efficacy, existential goal pursuit, value adherence and religious coping.

Conclusion

The novel threat of the COVID-19 pandemic threw insurmountable challenges potentiating disastrous consequences; slums becoming a threat to themselves, threat to the health providers and a threat for all. Perhaps, a lesson we could learn from this pandemic is to incorporate ‘slum health’ within universal healthcare.

Evaluation of the performance of clinical predictors in estimating the probability of pulmonary tuberculosis among smear-negative cases in Northern Ethiopia: a cross-sectional study

Por: George · M. · Dinant · G.-J. · Kentiba · E. · Teshome · T. · Teshome · A. · Tsegaye · B. · Spigt · M.
Objectives

To evaluate the performance of the predictors in estimating the probability of pulmonary tuberculosis (PTB) when all versus only significant variables are combined into a decision model (1) among all clinical suspects and (2) among smear-negative cases based on the results of culture tests.

Design

A cross-sectional study.

Setting

Two public referral hospitals in Tigray, Ethiopia.

Participants

A total of 426 consecutive adult patients admitted to the hospitals with clinical suspicion of PTB were screened by sputum smear microscopy and chest radiograph (chest X-ray (CXR)) in accordance with the Ethiopian guidelines of the National Tuberculosis and Leprosy Program. Discontinuation of antituberculosis therapy in the past 3 months, unproductive cough, HIV positivity and unwillingness to give written informed consent were the basis of exclusion from the study.

Primary and secondary outcome measures

A total of 354 patients were included in the final analysis, while 72 patients were excluded because culture tests were not done.

Results

The strongest predictive variables of culture-positive PTB among patients with clinical suspicion were a positive smear test (OR 172; 95% CI 23.23 to 1273.54) and having CXR lesions compatible with PTB (OR 10.401; 95% CI 5.862 to 18.454). The regression model had a good predictive performance for identifying culture-positive PTB among patients with clinical suspicion (area under the curve (AUC) 0.84), but it was rather poor in patients with a negative smear result (AUC 0.64). Combining all the predictors in the model compared with only the independent significant variables did not really improve its performance to identify culture-positive (AUC 0.84–0.87) and culture-negative (AUC 0.64–0.69) PTB.

Conclusions

Our finding suggests that predictive models based on clinical variables will not be useful to discriminate patients with culture-negative PTB from patients with culture-positive PTB among patients with smear-negative cases.

Psychiatry peer review groups in Australia: a mixed-methods exploration of structure and function

Por: Lancaster · J. · Prager · S. · Nash · L. · Karageorge · A.
Objectives

The purpose of this study was to examine Australian psychiatrists’ experience of participation in a small group learning format of continuing professional development, known as peer review groups (PRGs), with a particular emphasis on group structure and functions.

Method

An exploratory mixed-methods study comprising a survey (n=77) and semistructured interviews (n=6) with Australian psychiatrists participating in a PRG in the previous 12 months.

Results

Qualitative findings indicate that PRGs address experiential learning through a focus on both breadth and specificity of work, as well as participants’ experiences. Participants described using PRGs as a forum to manage difficult and complex work (through critiquing work, learning from one another, considering theory and guidelines, benchmarking, validating, reflecting and generalising learning) and to manage stress and well-being associated with crises, everyday stress and professional isolation. Particular structural aspects of PRGs considered essential to achieve these functions were self-selection of members, self-direction of meeting content and provision of a safe environment. These findings were convergent with the quantitative findings from scale survey data. Difficulties experienced during PRG participation are also described.

Conclusion

Qualitative and quantitative findings from psychiatry PRGs demonstrate how practice-based professional experience functions as both a source of learning and of collegial connection that contributes to well-being and reduction in professional stress. Study limitations and future research directions are discussed.

The efficacy and safety of varenicline alone versus in combination with nicotine lozenges for smoking cessation among hospitalised smokers (VANISH): study protocol for a randomised, placebo-controlled trial

Por: Gobarani · R. K. · Abramson · M. J. · Bonevski · B. · Weeks · G. R. · Dooley · M. J. · Smith · B. J. · Veale · A. · Webb · A. · Kirsa · S. · Thomas · D. · Miller · A. · Gasser · R. · Paul · E. · Parkinson · J. · Meanger · D. · Coward · L. · Kopsaftis · Z. · Rofe · O. · Lee · P. · George · J.
Introduction

Smoking is a leading cause of premature deaths globally. The health benefits of smoking cessation are many. However, majority of quit attempts are unsuccessful. One way to potentially improve success rates is to evaluate new combinations of existing smoking cessation therapies that may work synergistically to decrease the intensity of withdrawal symptoms and cravings.

Aims

To evaluate the feasibility, efficacy and safety of the combination of varenicline and nicotine replacement therapy (NRT) lozenges versus varenicline alone in assisting hospitalised smokers to quit.

Methods and analysis

This is a multicentre, randomised, placebo-controlled trial. Adults with a history of smoking ≥10 cigarettes per day on average in the 4 weeks prior to their hospitalisation will be recruited. Participants will be randomly assigned to either the intervention group and will receive varenicline and NRT lozenges, or the control group and will receive varenicline and placebo lozenges. All participants will be actively referred to behavioural support from telephone Quitline. Participants are followed up at 1 and 3 weeks and 3, 6 and 12 months from the start of treatment. The primary outcome is carbon monoxide validated prolonged abstinence from 2 weeks to 6 months after treatment initiation. Secondary outcomes include self-reported and biochemically validated prolonged and point prevalence abstinence at 3, 6 and 12 months, self-reported adverse events, withdrawal symptoms and cravings, adherence to treatment, Quitline sessions attended and others. According to the Russell Standard, all randomised participants will be accounted for in the primary intention-to-treat analysis.

Ethics and dissemination

The trial will be conducted in compliance with the protocol, the principles of Good Clinical Practice, the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research (updated 2015) and the Australian Code for the Responsible Conduct of Research (2018). Approval will be sought from the Human Ethics Committees of all the participating hospitals and the university. Written informed consent will be obtained from each participant at the time of recruitment.

Trial registration number

Australia New Zealand Clinical Trials Registry (ACTRN12618001792213).

Examining the UK Covid‐19 mortality paradox: Pandemic preparedness, healthcare expenditure, and the nursing workforce 研究英国新冠肺炎死亡率悖论:大流行防范工作、医疗支出和护理人员队伍

Abstract

Aim

To examine the UK pandemic preparedness in light of health expenditure, nursing workforce, and mortality rates in and relation to nursing leadership.

Background

The Global Health Security Index categorized the preparedness of 195 countries to face a biological threat on a variety of measures, producing an overall score. The United States of America and the United Kingdom were ranked 1st and 2nd most prepared in 2019.

Method

A cross‐nation comparison of the top 36 countries ranked by Global Health Security Index score using a variety of online sources, including key data about each nation's expenditure on health and the nursing workforce, and compared these with mortality data for COVID‐19.

Results

The extent of a country's pandemic preparedness, expenditure on healthcare and magnitude of the nursing workforce does not appear to impact mortality rates at this stage of the pandemic which is something of a paradox.

Conclusion

It is important that arrangements for dealing with future global pandemics involve a range of agencies and experts in the field, including nurse leaders.

Implications for Nursing

To achieve the best outcomes for patients, nurse leaders should be involved in policy forums at all levels of government to ensure nurses can influence health policy.

Comparable, but distinct: Perceptions of primary care provided by physicians and nurse practitioners in full and restricted practice authority states 虽有类似,但却不同:对全科和非全科执业机构的医生和护理师提供初级保健的看

Abstract

Aims

To understand patients’ and providers’ perceptions of primary care delivered by nurse practitioners (NPs) in the Veterans Affairs Healthcare System.

Design

Qualitative exploratory study (in convergent mixed‐methods design).

Methods

Semi‐structured interviews in 2016 with primary care providers and patients from facilities in states with full and restricted practice authority for NPs. Patient sample based on reassignment to: (a) a NP; or (b) a different physician following an established physician relationship. Data were analysed using content analysis.

Results

We interviewed 28 patients, 17 physicians and 14 NPs. We found: (a) NPs provided more holistic care than physicians; (b) patients were satisfied with NPs; and (c) providers’ professional experience outweighed provider type.

Conclusions

Patients’ preferences for NPs (compared with prior physicians) contributed to perceptions of patient centredness. Similarities in providers’ perceptions suggest NPs and physicians are both viable providers for primary care.

Impact

Nurse Practitioners (NPs): practice authority Veterans Affairs Health care: nurse practitioners will continue to be a viable resource for primary care delivery United States Health care: challenges notions patients may not be satisfied with care provided by NPs and supports expanding their use to provide much‐needed access to primary care services; expanding Full Practice Authority would allow states to provide acceptable primary care without diminishing patient or provider experiences

摘要

目标

了解患者和医疗机构对退伍军人医疗保健系统中护理师提供初级护理的看法。

设计

探索性的定性研究(收敛混合方法设计)。

方法

2016年进行的半结构化访谈,采访了州内拥有护理师的全科和非全科执业机构的初级护理提供者和患者。重新分配患者样本:(a) 一名护理师;或(b)确立医生关系的另一名医生。采用内容分析法对数据进行分析。

结果

我们采访了28名患者,17名医生和14名护理师。我们发现:(a)护理师比医生提供的护理更全面;(b)患者对护理师感到满意;(c)医疗机构的专业经验的权重比医疗机构类型的权重更大。

结论

患者对护理师的偏好(与以前的医生相比)有助于建立以患者为中心的认知。提供者的观念类似,表明护理师和医生都是可行的初级护理提供者。

影响

•护理师:执业机构 •退伍军人医疗保健系统:护理师将继续作为提供初级护理服务的可用资源。 •美国卫生保健:挑战观念患者可能不满意由护理师提供的护理,其会支持扩大使用范围,以提供急需的初级保健服务;扩大全科执业机构将使各州能够提供可接受的初级保健服务,而不会减弱患者或提供者的体验。

Newborn signal functions in Bangladesh: identification through expert consultation and assessment of readiness among public health facilities--study protocol using Delphi technique

Por: Rahman · A. E. · Banik · G. · Mhajabin · S. · Tahsina · T. · Islam · M. J. · Uddin Ahmed · F. · Islam · M. U. · Mannan · M. A. · Dey · S. K. · Sharmin · S. · Mehran · F. · Khan · M. · Ahmed · A. · Al Sabir · A. · Sultana · S. · Ahsan · Z. · Rubayet · S. · George · J. · Karim · A. · Shahidull
Introduction

There is a set of globally accepted and nationally adapted signal functions for categorising health facilities for maternal services. Newborn resuscitation is the only newborn intervention which is included in the WHO recommended list of emergency obstetric care signal functions. This is not enough to comprehensively assess the readiness of a health facility for providing newborn services. In order to address the major causes of newborn death, the Government of Bangladesh has prioritised a set of newborn interventions for national scale-up, the majority of which are facility-based. Effective delivery of these interventions depends on a core set of functions (skills and services). However, there is no standardised and approved set of newborn signal functions (NSFs) based on which the service availability and readiness of a health facility can be assessed for providing newborn services. Thus, this study will be the first of its kind to identify such NSFs. These NSFs can categorise health facilities and assist policymakers and health managers to appropriately plan and adequately monitor the progress and performance of health facilities delivering newborn healthcare.

Methods and analysis

We will adopt the Delphi technique of consensus building for identification of NSFs and 1–2 indicator for each function while employing expert consultation from relevant experts in Bangladesh. Based on the identified NSFs and signal function indicators, the existing health facility assessment (HFA) tools will be updated, and an HFA survey will be conducted to assess service availability and readiness of public health facilities in relation to the new NSFs. Descriptive statistics (proportion) with a 95% CI will be used to report the level of service availability and readiness of public facilities regarding NSFs.

Ethics and dissemination

Ethical approval was obtained from Research Review and Ethical Review Committee of icddr, b (PR-17089). Results will be disseminated through meetings, seminars, conference presentations and international peer-review journal articles.

COVID‐19 in a state of Brazilian Northeast: Prevalence and associated factors in people with flu‐like syndrome

Abstract

Aims and objectives

To estimate the prevalence and associated factors of COVID‐19 in people with flu‐like syndrome in Ceará, Brazil.

Background

COVID‐19 is an infectious disease that has led to a worldwide public health emergency. More than 30,000 cases were confirmed in Brazil, especially in the States of São Paulo, Rio de Janeiro and Ceará. The capital of the Ceará State is the one with the highest incidence of COVID‐19 in Brazil. Estimating the prevalence of the disease and its associated factors is important to offer adequate health care.

Design

A cross‐sectional study with secondary data of people notified with flu‐like syndrome and COVID‐19 test results.

Methods

19,967 cases of flu‐like syndrome were analysed according to the result of the COVID‐19 test. Predictive variables were as follows: age range, sex, women in puerperium, presence or absence of cardiovascular diseases, diabetes, haematological illness, immunodeficiencies, neurological diseases, obesity, renal diseases and Down syndrome. Robust Poisson regression models estimated the prevalence ratios of COVID‐19. The research was reported via STROBE guidelines for cross‐sectional studies.

Results

The prevalence of COVID‐19 in the population was 10.37%. In the final model, the following variables were associated with COVID‐19: aged people, male sex, cardiovascular diseases and diabetes.

Conclusion

Among the flu‐like syndrome cases, COVID‐19 prevalence was high. In the Ceará State, clinical factors such as aged people, male sex, cardiovascular diseases and diabetes can enhance the prevalence of COVID‐19 by up to 2.57 times.

Relevance to clinical practice

The identification of factors that are associated with the enhanced prevalence of COVID‐19 facilitates early diagnosis, and adequate and prompt treatment. This knowledge may avoid an unfavourable prognosis of the disease.

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