Conectar
Necrotising fasciitis (NF) is a rapidly progressing, life-threatening infection with mortality rates that are exceedingly high. Despite the notably high risks of developing NF in patients with diabetes mellitus (DM), factors associated with mortality in this population are poorly understood. Therefore, to determine at-risk patients and to improve overall clinical outcomes via hastening management, the objective of this systematic review is to determine what factors are associated with mortality for diabetic patients with NF. This systematic review followed the PRISMA guidelines. Patient data pertaining to outcomes and surgical management were extracted, and mortality rates were evaluated. Studies were assessed for quality using the Alberta Heritage Foundation for Medical Research (AHFMR) and Risk of Bias tool. A total of 25 studies were reviewed, covering 7879 patients with NF and DM with a 23.5% mortality rate. The most prevalent comorbidities among those who died included chronic kidney disease (15.95%), hypertension (9.42%) and obesity (9.02%). While limbs were the most common location for the disease, NF in the trunk and groin regions showed the highest mortality rates at 62.07%. Among those who died, common complications were acute renal failure (13.41%), pulmonary issues (20.41%) and septicaemia (12.80%). Mortality rates by surgical management were fasciotomy (42.9%), surgical debridement (40.68%) and amputation (9.09%). Mortality was comparable between patients with NF and DM (23.54%) and those with NF alone (23.61%). Although DM may not independently increase mortality, it can worsen outcomes when combined with other comorbidities, indicating a need for clearer clinical guidance.
Suicide rates have increased over the last couple of decades globally, particularly in the United States and among populations with lower economic status who present at safety-net healthcare systems. Recently, predictive models for suicide risk have shown promise; however, a model for this specific population does not exist.
To develop a predictive risk model of suicide and intentional self-harm (ISH) for patients presenting at the psychiatric emergency department (ED) of JPS Health Network, a safety net medical and mental healthcare system in Texas.
The study used structured and unstructured electronic medical record (EMR) data (2015–2019) and local medical examiner data (2015–2020) to create predictors and outcome variables. All psychiatric ED notes during calendar years 2018 and 2019 were reviewed using natural language processing to identify presentations for any level of self-harm and subsequent manual review of identified visits to accurately classify ED presentations for treatment of an act of intentional self-harm meeting study criteria. Data from 15 987 patients were used to develop and validate a machine learning-based predictive model that leverages rolling window methodology to predict risk repeatedly across a patient’s trajectory. Feature engineering played a prominent role in defining new predictors.
The best model (XGBoost) achieved the area under the receiver operating characteristic curve of 0.81 for 30-day predictions and demonstrated concentration of ISH and suicide attempt events in high-risk quantiles of risk (65% had events in top 0.1% quantile). The predicted risk can be translated into a propensity of events (80% at the highest predicted risk) to facilitate clinical interpretation.
Machine learning-based models can be used with standard EMRs to identify patients presenting at the psychiatric ED with a high risk of ISH and suicide attempts within the next 30 days.
Integration of a predictive model can significantly aid clinical decision-making in safety-net psychiatric EDs.
To detail the development of the Canadian National Questionnaire on Overdose Monitoring (CNQOM), a questionnaire aimed at assessing the perspectives of key stakeholders towards elements of overdose prevention interventions—supervised consumption sites (SCSs) and overdose hotlines and applications (ORHAs).
Cross-sectional survey.
Canadian health system.
English or French speaking adults from four key informant groups: people who use substances (PWUS), health professionals, emergency responders and the general public.
Test–retest reliability of CNQOM items.
A novel questionnaire was developed. Item development followed a standard approach, with face validity verified by representatives from the four informant groups. Input from experts in harm reduction and addiction medicine enhanced content and face validity of the questionnaire. A rigorous response validation approach was undertaken to ensure respondents were human and from Canada. Test–retest reliability items were assessed using Spearman’s rank correlation, Wilcoxon rank-sum test and Cohen’s kappa.
After data cleaning and response validation, 4445 valid responses were obtained from the four key informant groups. Respondents represented a range of sociodemographic backgrounds and housing scenarios from all provinces and territories in Canada. Test–retest reliability was assessed using a small subsample of 142 participants (primarily from general public informants). Questionnaire items demonstrated slight to substantial stability in responses (kappa coefficients: 0.15–0.58; Spearman’s r: 0.08–0.66).
The CNQOM is the first online questionnaire in Canada designed to capture perspectives and attitudes towards specific elements of SCSs and ORHAs among diverse key informant groups. Our questionnaire was administered to a large, geographically diverse sample and designed to capture the perspectives of four key informant groups. Lower than expected test–retest reliability may be explained by lack of participant familiarity with SCS and especially ORHAs and the impersonal nature of the instrument content among some respondents. Future work will elucidate key informant perspectives on these services based on the data.
In Australia, aligned to safety and quality standards, the health system implements standardised practices that include patient involvement in nursing bedside handover. Despite this mandate, it remains unclear whether patients are genuinely participating in nursing bedside handovers and whether their perspectives are being considered.
To explore patient perceptions of their involvement in nursing bedside handovers.
A cross-sectional survey study was conducted in two acute metropolitan hospitals in Western Australia from July 2021 to March 2022. The survey administered to patients, comprised three sections: demographic information; involvement in bedside handover; and perceptions of bedside handovers; utilising close-ended and Likert scale questions. Open-ended questions further explored participation in bedside handovers. Descriptive statistics and comparative analyses were performed and responses to open-ended questions underwent summative deductive content analysis.
Of the 390 participants, over half reported five or more bedside handovers (n = 197, 50.7%). Most perceived the importance of (n = 334, 79.0%), and expressed their satisfaction with (n = 327, 89.6%), involvement in bedside handover. Perceptions of handover were mostly positive. There were a few significant differences throughout based on type of hospital, gender and age-group. Open ended responses shared perceptions on the perceived benefits, challenges and barriers and ways to enhance involvement in bedside handover. Patients expressed several challenges, including lack of awareness of their right to participate, the approach of nurses and the timing of handovers as hindering their participation in bedside handovers.
Patients perceived the importance of, were mostly satisfied with, and had positive perceptions of bedside handover. However, several challenges hindered effective patient participation. Further research is needed into bedside handover as it is essential to enhance patient-centred quality care that aligns with national safety and quality healthcare standards.
Understanding the significance of patient involvement in bedside handovers motivates patients to actively share information about their care, leading to increased patient satisfaction and the promotion of patient-centred care. Addressing challenges through targeted strategies can enhance patient participation, communication, increased patient satisfaction and foster a more patient-centred approach to care.
The conduct of this study was supported by the consumer advisory group in the participating hospitals who also reviewed the survey questionnaires and conducted face validity of the survey.
To identify facilitators and barriers and tailor implementation strategies to optimize emergency clinician's use of adult and paediatric sepsis pathways.
A qualitative descriptive study using focus group methodology.
Twenty-two emergency nurses and ten emergency medical officers from four Australian EDs participated in eight virtual focus groups. Participants were asked about their experiences using the New South Wales Clinical Excellence Commission adult and paediatric sepsis pathways using a semi-structured interview template. Facilitators and barriers to use of the sepsis pathways were categorized using the Theoretical Domains Framework. Tailored interventions were selected to address facilitators and barriers, and a re-implementation plan was devised guided by the Behaviour Change Wheel.
Thirty-two facilitators and 58 barriers were identified corresponding to 11 Theoretical Domains Framework domains. Tailored strategies were selected to optimize emergency clinicians' use of the sepsis pathways including refinement of existing education and training programmes, modifications to the electronic medical record system, introduction of an audit and feedback system, staffing strategies and additional resources.
The implementation of sepsis pathways in the Emergency Department setting is complex, impacted by a multitude of factors requiring tailored strategies to address facilitators and barriers and optimize uptake.
This study presents a theory-informed systematic approach to successfully implement and embed adult and paediatric sepsis pathways into clinical practice in the Emergency Department.
Optimizing uptake of sepsis pathways has the potential to improve sepsis recognition and management, subsequently improving the outcome of patients with sepsis.
The Consolidated Criteria for REporting Qualitative research guided the preparation of this report.
Nil.
To explore the challenges experienced by people with intellectual disability, their carers and health and social care professionals when using and managing medication.
A synthesis of qualitative research using meta-ethnography.
We searched seven databases: MEDLINE, Embase, CINAHL, Science, Social Science and Conference Proceedings Citation Indices (Web of Science), Cochrane Library, PsycINFO and Proquest Dissertations and Theses from inception to September 2022 (updated in July 2023).
We included studies exploring the challenges and perceptions of people with intellectual disability, their carers and health and social care professionals regarding medication management and use.
We reviewed 7593 abstracts and 475 full texts, resulting in 45 included papers. Four major themes were identified: (1) Medication-related issues, (2) navigating autonomy and relationships, (3) knowledge and training needs and (4) inequalities in the healthcare system. We formulated a conceptual framework centred around people with intellectual disability and described the interconnectedness between them, their carers and health and social care professionals in the process of managing and using medication. We identified challenges that could be associated with the person, the medication and/or the context, along with a lack of understanding of these challenges and a lack of capability or resources to tackle them. We developed an overarching concept of ‘collective collaboration’ as a potential solution to prevent or mitigate problems related to medication use in people with intellectual disability.
The effective management of medication for people with intellectual disability requires a collaborative and holistic approach. By fostering person-centred care and shared decision-making, providing educational and practical support, and nurturing strong relationships between all partners involved to form a collective collaboration surrounding people with intellectual disability, improved medication adherence and optimised therapeutic outcomes can be achieved.
CRD42022362903.
Progressive supranuclear palsy (PSP) is a devastating neurodegenerative disease characterised by cognitive, behavioural and motor problems. Motor symptoms are highly disabling, while cognitive and behavioural changes have a major impact on carer burden, quality of life and prognosis. Apathy and impulsivity are very common, often coexistent in PSP, and negatively predict survival. In preclinical models and other diseases, apathy and impulsivity are associated with noradrenergic deficits, which can be severe in PSP.
Noradrenaline for Progressive Supranuclear Palsy Syndromes trial is a randomised, double-blind, placebo-controlled, crossover design, Phase IIb clinical trial to evaluate the efficacy and safety of oral atomoxetine for the treatment of cognitive and behavioural changes in PSP. Participants receive atomoxetine 40 mg (10 mg/mL oral solution) once daily or a matched placebo solution, in random order, each for 8 weeks. An ‘informant’, who knows the patient with PSP well, is co-recruited to complete some of the trial outcome measures. Participants remain in the trial for 22 weeks after randomisation. The primary objectives are to assess (1) safety and tolerability and (2) efficacy versus placebo on challenging behaviours as reported in a subscale of the Cambridge Behavioural Inventory. Secondary and exploratory measures relate to cognition, the PSP Rating Scale, mood and potential baseline predictors of individual response to atomoxetine computed from imaging, genetic and cognitive measures at baseline.
The trial was approved by the South Central-Oxford B Research Ethics Committee (REC) and the Medicines and Healthcare products Regulatory Agency (REC reference: 20/SC/0416). Dissemination will include publication in peer-reviewed journals, presentations at academic and public conferences and engagement with patients, the public, policymakers and practitioners.
ISRCTN99462035; DOI:
FreshRSS 