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The thriving of older people assessment scale: Psychometric evaluation and short‐form development

Abstract

Aim

To evaluate the psychometric properties and performance of the 32‐item Thriving of Older People Assessment Scale (TOPAS) and to explore reduction into a short‐form.

Background

The 32‐item TOPAS has been used in studies of place‐related well‐being as a positive measure in long‐term care to assess nursing home resident thriving; however, item redundancy has not previously been explored.

Design

Cross‐sectional study.

Method

Staff members completed the 32‐item TOPAS as proxy raters for a random sample of Swedish nursing home residents (N = 4,831) between November 2013 ‐ September 2014. Reliability analysis, exploratory factor analysis and item response theory‐based analysis were undertaken. Items were systematically identified for reduction using statistical and theoretical analysis. Correlation testing, means comparison and model fit evaluation confirmed scale equivalence.

Results

Psychometric properties of the 32‐item TOPAS were satisfactory and several items were identified for scale reduction. The proposed short‐form TOPAS exhibited a high level of internal consistency (α = 0.90) and strong correlation (r = 0.98) to the original scale, while also retaining diversity among items in terms of factor structure and item difficulties.

Conclusion

The 32‐item and short‐form TOPAS’ indicated sound validity and reliability to measure resident thriving in the nursing home context.

Impact

There is a lack of positive life‐world measures for use in nursing homes. The short‐form TOPAS indicated sound validity and reliability to measure resident thriving, providing a feasible measure with enhanced functionality for use in aged care research, assessments and care planning for health‐promoting purposes in nursing homes.

Nurses’ perceptions of high‐alert medication administration safety: A qualitative descriptive study

Abstract

Aims

The aim of this study was to determine nurses’ perceptions of supports and barriers to high‐alert medication (HAM) administration safety.

Design

A qualitative descriptive design was used.

Methods

Eighteen acute care nurses were interviewed about HAM administration practices. Registered nurses (RNs) working with acutely ill adults in two hospitals participated in one‐on‐one interviews from July–September, 2017. Content analysis was conducted for data analysis.

Results

Three themes contributed to HAM administration safety: Organizational Culture of Safety, Collaboration, and RN Competence and Engagement. Error factors included distractions, workload and acuity. Work arounds bypassing bar code scanning and independent double check procedures were common. Findings highlighted the importance of intra‐ and interprofessional collaboration, nurse engagement and incorporating the patient in HAM safety.

Conclusions

Current HAM safety strategies are not consistently used. An organizational culture that supports collaboration, education on safe HAM practices, pragmatic HAM policies and enhanced technology are recommended to prevent HAM errors.

Impact

Hospitals incorporating these findings could reduce HAM errors. Research on nurse engagement, intra‐ and interprofessional collaboration and inclusion of patients in HAM safety strategies is needed.

The mental health needs and concerns of older people who identify as LGBTQ+: A narrative review of the international evidence

Abstract

Aims

To synthesize the best available evidence on the experiences and perceptions of older people who identify as LGBTQ+ regarding their mental health needs and concerns.

Design

A narrative review and critical appraisal of qualitative, quantitative and mixed methods studies.

Data sources

A systematic search was undertaken across all of the databases including PsycINFO, MEDLINE, CINAHL and Sociological Abstracts. International studies published in academic journals in the English language, from January 1995 to January 2019 were appraised. Studies had to involve older people identifying as LGBTQ+ and who had experiences mental health issues.

Review Methods

Fourteen papers were selected for inclusion in the systematic review. A narrative analysis of the papers was used by synthesizing the key findings and organizing them into themes and concepts.

Results

Following analysis of the data, the themes that emerged were: (i) LGBTQ+ identity issues (ii) risk and vulnerability factors, (iii) coping strategies and resilience, (iv) interventions and supports.

Conclusion

This review highlights key mental health‐related issues that need to be taken into account in the creation and provision of appropriate, responsive and inclusive supports and services.

This article is protected by copyright. All rights reserved.

Fuzzy cognitive mapping: an old tool with new uses in nursing research

Abstract

Aims

Describe the implementation and uses of fuzzy cognitive mapping as a constructive method for meeting the unique and rapidly evolving needs of nursing inquiry and practice.

Design

Discussion paper.

Data Sources

Drawing on published scholarship of cognitive mapping from the fields of ecological management, information technology, economics, organizational behavior and health development, we consider how fuzzy cognitive mapping can contribute to contemporary challenges and aspirations of nursing research.

Implications for nursing

Fuzzy cognitive mapping can generate theory, describe knowledge systems in comparable terms and inform questionnaire design and dialogue. It can help build participant‐researcher partnerships, elevate marginalized voices and facilitate intercultural dialogue. As a relatively culturally safe and foundational approach in participatory research, we suggest fuzzy cognitive mapping should be used in settings of transcultural nursing, patient engagement, person and family centered care and research with marginalized populations. Fuzzy cognitive mapping is amenable to rigorous analysis and simultaneously allows for greater participation of stakeholders.

Conclusion

In highly complex healthcare contexts, fuzzy cognitive mapping can act as a common language for defining challenges and articulating solutions identified within the nursing discipline.

Impact

There is a need to reconcile diverse sources of knowledge to meeting the needs of nursing inquiry. Fuzzy cognitive mapping can generate theory, describe knowledge systems, facilitate dialogue and support questionnaire design. In its capacity to engage multiple perspectives in defining problems and identifying solutions, fuzzy cognitive mapping can contribute to advancing nursing research and practice.

This article is protected by copyright. All rights reserved.

How Career Facilitators and Barriers Influence Nurses' Professional Turnover Intention

Abstract

Aims

Our study investigates the influence of career facilitators and barriers on nurses' improvement of their professional capabilities and their professional turnover intention.

Background

Reducing nurses' professional turnover intention could help alleviate the global nursing shortage. Nevertheless, little research has addressed how career facilitators and barriers, nurses' improvement of their professional capabilities and professional turnover intention are related, indicating a gap.

Design

This study used a cross‐sectional design.

Methods

We surveyed 502 out of 2,660 full‐time nurses who worked for a medical centre in Taiwan between January and March 2018. Our items were adapted from Cunningham et al. and Teng et al. and had adequate reliability and validity. Structural equation modeling was used to test the study hypotheses.

Results

Human capital, social capital and discrimination were positively related to intention to improve professional capabilities. Moreover, intention to improve professional capabilities was positively related to action to improve professional capabilities, which was negatively related to professional turnover intention.

Conclusion

Most of the career facilitators and even barriers, boost the improvement of professional capabilities and are useful for retaining nurses in the nursing profession.

Impact

Findings of this study should have an impact on nursing managers by offering them means to retain nurses, e.g., enhancing human capital and social capital among nurses to reduce their turnover intention.

This article is protected by copyright. All rights reserved.

Rationale and design of a statewide telestroke registry: Lone Star Stroke Consortium Telestroke Registry (LeSteR)

Por: Astudillo · C. · Ankrom · C. · Trevino · A. · Malazarte · R. M. · Bambhroliya · A. B. · Savitz · S. · Topel · C. H. · Milling · T. J. · Wu · T.-C.
Introduction

The Lone Star Stroke Consortium Telestroke Registry (LeSteR) currently consisting of 3 academic hub centres and 27 partner spokes is a statewide initiative organised by leading academic health centres in the State of Texas to understand practice patterns of acute stroke management via telestroke (TS) in Texas, a state with one of the largest rural populations in the USA.

Methods and analysis

All patients who had presumed stroke for whom a TS consultation has been obtained in the network are entered into a web-based, Health Insurance Portability and Accountability Act-compliant database from September 2013 to present. Spokes were enrolled into LeSteR in a staggered approach in two data collection phases: a retrospective phase and a prospective phase. Basic clinical, demographic data and relevant time metrics are collected in the retrospective phase. Starting 1 September 2015, additional outcome data including 90-day modified Rankin score, readmission and 90-day disposition are obtained by a standard phone interview. From the registry initiation to 31 December 2017, there are 8089 patients who had suspected stroke in the registry. Over 60% of patients enrolled after 1 September 2015 have reported outcome data. Enrolment is still active for this registry.

Ethics and dissemination

LeSteR is a statewide TS registry organised by academic health centres that will provide significant insight regarding the impact of TS in the State of Texas. Findings from LeSteR will provide data that can be analysed to improve the allocation of healthcare resources using TS to treat stroke in a state with one of the largest rural populations.

Prevalence of common mental health disorders in adults who are high or costly users of healthcare services: protocol for a systematic review and meta-analysis

Por: Jadhakhan · F. · Lindner · O. C. · Blakemore · A. · Guthrie · E.
Introduction

In all healthcare settings, a small proportion of patients account for a large level of healthcare use and associated high healthcare costs. Depression and anxiety are common co-morbidities in patients who are high users of care. The aims of this systematic review are to: (1) estimate the prevalence of anxiety/depression in adults who are high users of general physical healthcare services and/or who accrue high healthcare costs (2) estimate the magnitude of healthcare use associated with the presence of anxiety/depression.

Methods and analysis

This review will include any studies where patients are high users of primary, secondary or emergency healthcare services and/or accrue high healthcare costs. This is the first systematic review to focus on patients who are over the age of 18, whose degree of anxiety/depression has been evaluated with a standardised questionnaire or by a clinical interview generating a diagnosis according to international diagnostic criteria. The review will include eligible studies indexed in Medline, PsychINFO, Embase, Cumulative Index to Nursing and Allied Health Literature, Prospective Register of Systematic Reviews, Cochrane Library from inception to 1 April 2019. We will estimate the prevalence of anxiety/depression in these populations and the magnitude of use associated with anxiety/depression across various general physical healthcare settings. We will provide a narrative description of findings and factors that may influence them. A meta-analysis may be pursued if the degree of heterogeneity across studies is acceptable.

Ethics and dissemination

This systematic review will use data from existing studies, hence no ethical approvals are required. Findings will be disseminated in a peer-reviewed publication and at relevant academic meetings.

PROSPERO registration number

PROSPERO CRD42018102628.

Zoledronate in the prevention of Pagets (ZiPP): protocol for a randomised trial of genetic testing and targeted zoledronic acid therapy to prevent SQSTM1-mediated Pagets disease of bone

Por: Cronin · O. · Forsyth · L. · Goodman · K. · Lewis · S. C. · Keerie · C. · Walker · A. · Porteous · M. · Cetnarskyj · R. · Ranganath · L. R. · Selby · P. L. · Hampson · G. · Chandra · R. · Ho · S. · Tobias · J. H. · Young-Min · S. · McKenna · M. J. · Crowley · R. K. · Fraser · W. D. · Genna
Introduction

Paget’s disease of bone (PDB) is characterised by increased and disorganised bone remodelling affecting one or more skeletal sites. Complications include bone pain, deformity, deafness and pathological fractures. Mutations in sequestosome-1 (SQSTM1) are strongly associated with the development of PDB. Bisphosphonate therapy can improve bone pain in PDB, but there is no evidence that treatment alters the natural history of PDB or prevents complications. The Zoledronate in the Prevention of Paget’s disease trial (ZiPP) will determine if prophylactic therapy with the bisphosphonate zoledronic acid (ZA) can delay or prevent the development of PDB in people who carry SQSTM1 mutations.

Methods and analysis

People with a family history of PDB aged >30 years who test positive for SQSTM1 mutations are eligible to take part. At the baseline visit, participants will be screened for the presence of bone lesions by radionuclide bone scan. Biochemical markers of bone turnover will be measured and questionnaires completed to assess pain, health-related quality of life (HRQoL), anxiety and depression. Participants will be randomised to receive a single intravenous infusion of 5 mg ZA or placebo and followed up annually for between 4 and 8 years at which point baseline assessments will be repeated. The primary endpoint will be new bone lesions assessed by radionuclide bone scan. Secondary endpoints will include changes in biochemical markers of bone turnover, pain, HRQoL, anxiety, depression and PDB-related skeletal events.

Ethics and dissemination

The study was approved by the Fife and Forth Valley Research Ethics Committee on 22 December 2008 (08/S0501/84). Following completion of the trial, a manuscript will be submitted to a peer-reviewed journal. The results of this trial will inform clinical practice by determining if early intervention with ZA in presymptomatic individuals with SQSTM1 mutations can prevent or slow the development of bone lesions with an adverse event profile that is acceptable.

Trial registration number

ISRCTN11616770

Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: a cross-sectional study in rural South Asia--Bangladesh, Pakistan and Sri Lanka

Por: Feng · L. · Jehan · I. · de Silva · H. A. · Naheed · A. · Farazdaq · H. · Hirani · S. · Kasturiratne · A. · Ranasinha · C. D. · Islam · M. T. · Siddiquee · A. T. · Jafar · T. H.
Objective

To determinate the prevalence and correlates of cardiometabolic multimorbidity (CMM), and their cross-country variation among individuals with hypertension residing in rural communities in South Asia.

Design

A cross-sectional study.

Setting

Rural communities in Bangladesh, Pakistan and Sri Lanka.

Participants

A total of 2288 individuals with hypertension aged ≥40 years from the ongoing Control of Blood Pressure and Risk Attenuation- Bangladesh, Pakistan and Sri Lanka clinical trial.

Main outcome measures

CMM was defined as the presence of ≥2 of the conditions: diabetes, chronic kidney disease, heart disease and stroke. Logistic regression was done to evaluate the correlates of CMM.

Results

About 25.4% (95% CI 23.6% to 27.2%) of the hypertensive individuals had CMM. Factors positively associated with CMM included residing in Bangladesh (OR 3.42, 95% CI 2.52 to 4.65) or Sri Lankan (3.73, 95% CI 2.48 to 5.61) versus in Pakistan, advancing age (2.33, 95% CI 1.59 to 3.40 for 70 years and over vs 40–49 years), higher waist circumference (2.15, 95% CI 1.42 to 3.25) for Q2–Q3 and 2.14, 95% CI 1.50 to 3.06 for Q3 and above), statin use (2.43, 95% CI 1.84 to 3.22), and higher levels of triglyceride (1.01, 95% CI 1.01 to 1.02 per 5 mg/dL increase). A lower odds of CMM was associated with being physically active (0.75, 95% CI 0.57 to 0.97). A weak inverted J-shaped association between International Wealth Index and CMM was found (p for non-linear=0.058), suggesting higher risk in the middle than higher or lower socioeconomic strata.

Conclusions

CMM is highly prevalent in rural South Asians affecting one in four individuals with hypertension. There is an urgent need for strategies to concomitantly manage hypertension, cardiometabolic comorbid conditions and associated determinants in South Asia.

Medicines shortages in Pakistan: a qualitative study to explore current situation, reasons and possible solutions to overcome the barriers

Por: Atif · M. · Malik · I. · Mushtaq · I. · Asghar · S.
Objective

This study was conducted to assess current situation of medicines shortages in Pakistan and to identify its impact, reasons and possible solutions to overcome the barriers.

Design

A qualitative study.

Setting

The study was conducted between May 2018 and July 2018 in three cities of Pakistan including Islamabad, Karachi and Bahawalpur, depending on the availability of most relevant key informants.

Participants

Health regulators, pharmaceutical manufacturers, pharmaceutical distributors and pharmacists.

Primary and secondary outcome measure

Study primarily explored current situation, reasons and potential solutions of medicines shortages in Pakistan. Secondary outcome was the issue of particular brand shortage.

Method

Semistructured interviews were conducted. Sample size was determined by using saturation point criteria. Convenient sampling techniques were used to recruit the participants. The interviews were audiorecorded and transcribed verbatim. Data were analysed using inductive thematic analysis.

Results

A total of 41 stakeholders including 12 health regulators, 6 pharmaceutical manufacturers, 8 pharmaceutical distributors and 15 pharmacists participated in this study. Data analysis yielded 4 themes, 16 subthemes, 51 categories. Essential and life-saving medicines were in short supply. The major reasons of short supply of medicines were active pharmaceutical ingredient and raw material availability issues, lack of traditional distribution system and sudden demand fluctuation. Among proposed solutions, three most common were the facilitation and regulation of manufacturers, reasonable price fixation and improvements in the inventory control system.

Conclusion

Medicines were short in supply, and this may have clinical and financial impact on the patients in Pakistan. There were multiple and complex reasons of medicines shortages. Mandatory government leadership is required to resolve the issue on priority basis for improving the access of medicines to the patients.

Operative treatment of displaced midshaft clavicle fractures: has randomised control trial evidence changed practice patterns?

Por: Schneider · P. · Bransford · R. · Harvey · E. · Agel · J.
Objectives

To determine if level 1 evidence from a landmark trial changed practice patterns for treatment of patients with displaced midshaft clavicle fractures.

Design

Retrospective cohort study.

Setting

Two level 1 trauma centres.

Participants

Displaced midshaft clavicle fractures.

Results

686 patients met inclusion criteria. The pretrial cohort (n=108) was 68.5% male, with a mean age of 37.7 (±13.9) years. The post-trial cohort (n=578) was 76.1% male, with a mean age of 41.9 (±12.7) years. There was nearly a 10-fold increase in the patients treated with openreduction and internal fixation (ORIF) in the post-trial cohort (34.1%) compared with the pretrial cohort (3.7%) (p9 (OR=1.6; 95% CI 0.89 to 2.99) or if they were treated at a centre that participated in the Canadian Orthopaedic Trauma Society ( COTS ) trial (OR=5.2; 95% CI 3.31 to 8.21).

Conclusions

This study demonstrated a significant shift towards more frequent ORIF for displaced midshaft clavicle fractures following the COTS trial. Quantifying changes in practice pattern following publication of level 1 evidence is important to further our understanding of the impact large randomised clinical trails are having on clinical practice.

Open carpal tunnel release and diabetes: a retrospective study using PROMs and national quality registries

Por: Zimmerman · M. · Eeg-Olofsson · K. · Svensson · A.-M. · Aström · M. · Arner · M. · Dahlin · L.
Objectives

To study patient-reported outcome after open carpal tunnel release (OCTR) for carpal tunnel syndrome (CTS) in patients with or without diabetes using national healthcare quality registries.

Design

Retrospective cohort study.

Setting

Data from the Swedish National Quality Registry for Hand Surgery (HAKIR; www.hakir.se) were linked to data from the Swedish National Diabetes Register (NDR; www.ndr.nu).

Participants

We identified 9049 patients (10 770 hands) operated for CTS during the inclusion period (2010–2016).

Primary outcome measures

Patient-reported outcome measures were analysed before surgery and at 3 and 12 months postoperatively using the QuickDASH as well as the HAKIR questionnaire with eight questions on hand symptoms and disability.

Results

Patients with diabetes (n=1508; 14%) scored higher in the QuickDASH both preoperatively and postoperatively than patients without diabetes, but the total score change between preoperative and postoperative QuickDASH was equal between patients with and without diabetes. The results did not differ between patients with type 1 or type 2 diabetes. Patients with diabetic retinopathy scored higher in QuickDASH at 3 months postoperatively than patients with diabetes without retinopathy. In the regression analysis, diabetes was associated with more residual symptoms at 3 and 12 months postoperatively.

Conclusions

Patients with diabetes experience more symptoms both before and after OCTR, but can expect the same relative improvement from surgery as patients without diabetes . Patients with retinopathy, as a proxy for neuropathy, may need longer time for symptoms to resolve after OCTR. Smoking, older age, higher HbA1c levels and receiving a diabetes diagnosis after surgery were associated with more residual symptoms following OCTR.

Hospital Survey on Patient Safety Culture (HSPSC): a systematic review of the psychometric properties of 62 international studies

Por: Waterson · P. · Carman · E.-M. · Manser · T. · Hammer · A.
Objective

To carry out a systematic review of the psychometric properties of international studies that have used the Hospital Survey on Patient Safety Culture (HSPSC).

Design

Literature review and an analysis framework to review studies.

Setting

Hospitals and other healthcare settings in North and South America, Europe, the Near East, the Middle East and the Far East.

Data sources

A total of 62 studies and 67 datasets made up of journal papers, book chapters and PhD theses were included in the review.

Primary and secondary outcome measures

Psychometric properties (eg, internal consistency) and sample characteristics (eg, country of use, participant job roles and changes made to the original version of the HSPSC).

Results

Just over half (52%) of the studies in our sample reported internal reliabilities lower than 0.7 for at least six HSPSC dimensions. The dimensions ‘staffing’, ‘communication openness’, ‘non-punitive response to error’, ‘organisational learning’ and ‘overall perceptions of safety’ resulted in low internal consistencies in a majority of studies. The outcomes from assessing construct validity were reported in 60% of the studies. Most studies took place in a hospital setting (84%); the majority of survey participants (62%) were drawn from nursing and technical staff. Forty-two per cent of the studies did not state what modifications, if any, were made to the original US version of the instrument.

Conclusions

While there is evidence of a growing worldwide trend in the use of the HSPSC, particularly within Europe and the Near/Middle East, our review underlines the need for caution in using the instrument. Future use of the HSPSC needs to be sensitive to the demands of care settings, the target population and other aspects of the national and local healthcare contexts. There is a need to develop guidelines covering procedures for using, adapting and translating the HSPSC, as well as reporting findings based on its use.

Analysis of anticholinergic and sedative medicine effects on physical function, cognitive function, appetite and frailty: a cross-sectional study in Australia

Por: Lim · R. · Kalisch Ellett · L. M. · Widagdo · I. S. · Pratt · N. L. · Roughead · E. E.
Objective

To test the association between use of medicines with anticholinergic or sedative properties and physical function, cognitive function, appetite and frailty.

Design, setting and participants

This cross-sectional study analysed baseline data collected as part of the Australian Longitudinal Study of Ageing, a population-based cohort of 2087 participants aged 65 years or over living in South Australia.

Main outcome measures

Physical function was measured at baseline using measures including hand grip strength, walking speed, chair stands, activities of daily living and instrumental activities of daily living (IADL). Cognitive function was measured using Mini-Mental State Examination. Appetite was measured using Center for Epidemiologic Studies Depression question 2. Frailty was measured using frailty index. The association between use of anticholinergics or sedatives and physical or cognitive function, appetite, or frailty was assessed using analysis of covariance and ordinal or binary logistic regression.

Results

Almost half of the population were using anticholinergics or sedatives (n=954, 45.7%). Use of anticholinergics was significantly associated with poorer grip strength, slower walking speed, poorer IADL and poorer appetite. Use of sedatives was significantly associated with poorer grip strength, slower walking speed and poorer IADL. We found no significant association between medicine use and cognitive function. Users of anticholinergics or sedatives were significantly more likely to be frail compared with non-users.

Conclusion

Use of medicines with anticholinergic or sedative properties is significantly associated with poorer physical function, poorer appetite and increased frailty. Early identification of signs and symptoms of deterioration associated with medicine use is particularly important in older people so that worsening frailty and subsequent adverse events are prevented.

Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases: a retrospective study

Por: Alvarez-Madrazo · S. · Kavanagh · K. · Siebert · S. · Semple · Y. · Godman · B. · Maciel Almeida · A. · Acurcio · F. d. A. · Bennie · M.
Objectives

To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service.

Design

Retrospective cohort.

Setting

Patients in secondary care receiving SC biologics in the largest Scottish Health Board.

Participants

A new bespoke cohort was created from routine data gathered as part of a health board Homecare Service Database. Patients over 18 years who received a supply of SC biologic from January 2012 to May 2015 with a diagnosis for rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) were included.

Outcomes measured

A standardised framework was applied by measuring discontinuation rates, persistence using Kaplan-Meier analysis and Cox regression and adherence using medication refill adherence (MRA) and compliance rate (CR).

Results

751 patients were identified (AS: 105, PsA: 227, RA: 419) of whom 89.3% had more than one biologic delivery (median days’ follow-up: AS: 494; PsA: 544; RA: 529) and 83.2% did not switch biologic. For all conditions, approximately half were persistent on their index biologic (52% AS, 54% PsA, 48%RA). Of patients who discontinued treatment, the majority reinitiated with the same biologic (19% AS, 18% PsA and 21% RA). Overall adherence during the period of treatment was over 80% when calculated using MRA (median %MRA: AS: 84.0%, PsA: 85.0%, RA: 82.4%) or CR (median %CR: AS: 96.6%, PsA: 97%, RA: 96.6%).

Conclusion

Use of linked routine data is a sustainable pathway to enable ongoing evaluation of biologics use. A more consistent approach to studying use (discontinuation, persistence and adherence metrics) should be adopted to enable comparability of studies.

Quality appraisal of clinical practice guidelines for diabetes mellitus published in China between 2007 and 2017 using the AGREE II instrument

Por: Gao · Y. · Wang · J. · Luo · X. · Song · X. · Liu · L. · Ke · L. · Liao · Z. · Wang · D. · Mu · Y. · Chen · Y. · Estill · J. A. M.
Objective

The aim of this study was to systematically evaluate the quality of the clinical practice guidelines (CPGs) for diabetes mellitus published in China over the period of January 2007 to April 2017.

Methods

We searched the China National Knowledge Infrastructure, Chinese Biomedical Literature database, VIP database and WanFang databases and guideline websites for CPGs for diabetes mellitus published between January 2007 and April 2017 in China. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and extracted data. We used the the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool (Canadian Institutes of Health Research, Ottawa, Canada) to evaluate the quality of the included guidelines, calculated the scores of each domain and evaluated the consistency among the assessors via use of the intragroup correlation coefficient. And then we compared the results with Chinese CPGs and international CPGs. We conducted a subgroup analysis based on different classification criteria and compared scores of each domain subgroup analyses.

Results

A total of 98 guidelines were identified. The correlation coefficient within the group was 0.93, suggesting that the consistency between the evaluators was good. The scores of the six domains of AGREE II were described in median (IQR) as follows: scope and purpose 53.7 (50.0–59.7), stakeholder involvement 31.5 (27.3–37.0), rigour of development 19.1 (15.3–22.2), clarity of presentation 59.3 (50.0–64.8), applicability 18.1 (13.9–25.7) and editorial independence 0.0 (0.0–0.0). The mean score in each domain of quality of Chinese diabetes CPGs was lower than that of CPGs published worldwide but higher than the mean score of Chinese guidelines of all topics. A funding source, the updated version, organisation and publishers of the guidelines and target fields are all the factors influencing the quality of CPGs to a certain degree.

Conclusions

A large number of Chinese diabetes CPGs have been produced. Their quality remain unsatisfactorily low compared with CPGs worldwide, there is still room for improvement. Chinese guideline developers should pay more attention to the transparency of methodology, and use the AGREE II instrument to develop and report guidelines.

Physical activity and sport participation among adolescents: associations with mental health in different age groups. Results from the Young-HUNT study: a cross-sectional survey

Por: Guddal · M. H. · Stensland · S. O. · Smastuen · M. C. · Johnsen · M. B. · Zwart · J.-A. · Storheim · K.
Objectives

Knowledge of how physical activity (PA) and sport participation are related to mental health throughout adolescence is scarce. Our objective was to describe PA levels and sport participation in a population-based sample of adolescents, and to explore how they relate to mental health in different age groups.

Design

A population-based cross-sectional study.

Setting and participants

The adolescent part of the Nord-Trøndelag Health Study, a Norwegian population-based health survey, conducted from 2006 to 2008. Of 10 464 invited participants (age 13–19 years), 7619 (73%) participated, of whom 3785 (50%) were boys.

Outcome measures

Mental health outcomes included psychological distress assessed using a short version of the Hopkins Symptom Check List Five items, self-esteem assessed using a short version of the Rosenberg Self-Esteem Scale and life satisfaction assessed with a single-item satisfaction with life measure.

Method

Logistic regression models were used to estimate the likelihood of psychological distress, low self-esteem and low life satisfaction, according to self-reported PA level and type of sport participation, stratified by gender and school level (junior vs senior high school).

Results

Fewer senior high school students participated in team sports compared with junior high school students (p

Conclusion

A high PA level was favourably associated with various dimensions of mental health, especially for adolescents in senior high school. Team sport participation may have a positive impact on mental health and should, therefore, be encouraged.

Healthcare under siege: a qualitative study of health-worker responses to targeting and besiegement in Syria

Por: Fardousi · N. · Douedari · Y. · Howard · N.
Objectives

To explore health-worker perspectives on security, improving safety, managing constrained resources and handling mass casualties during besiegement in Syria.

Design

A qualitative study using semi-structured key informant interviews, conducted remotely over WhatsApp and Skype, and analysed thematically using inductive coding.

Setting

Secondary and tertiary health facilities affected by besiegement in Aleppo (from July to December 2016) and Rural Damascus (from August 2013 to February 2018).

Participants

Twenty-one male Syrian health-workers and service-users who had experienced besiegement and targeting of their health facilities.

Results

Participants described four related challenges of: (i) conflict-related responses, particularly responding to mass casualties; (ii) targeted attack responses, particularly preventing/surviving facility bombings; (iii) besiegement responses, particularly mitigating severe resource constraints; and (iv) chronic risk responses, particularly maintaining emotional resilience. Mass casualty response involved triage and training to prioritise mortality reduction and available resources, for example those with greatest need and likelihood of survival. Targeting response was largely physical, including fortification, working underground, reducing visibility and services dispersal. Besiegement response required resource conservation, for example, controlling consumption, reusing consumables, low-technology equipment, finding alternative supply routes, stockpiling and strengthening available human resources through online trainings and establishing a medical school in Ghouta. Risk responses included managing safety worries, finding value in work and maintaining hope.

Conclusion

Besieged health-workers were most affected by severe resource constraints and safety concerns while responding to overwhelming mass casualty events. Lessons for targeting/besiegement planning include training staff and preparing for: (i) mass casualties, through local/online health-worker training in triage, emergency response and resource conservation; allowing task-shifting; and providing access to low-technology equipment; (ii) attacks, through strengthened facility security, for example, protection and deterrence through fortification, working underground and reducing visibility; and (iii) besiegement, through ensuring access to internet, electricity and low-technology/reusable equipment; securely stockpiling fuel, medicines and supplies; and establishing alternative supply routes.

Musculoskeletal care pathways for adults with hip and knee pain referred for specialist opinion: a systematic review

Por: Button · K. · Morgan · F. · Weightman · A. L. · Jones · S.
Objective

Musculoskeletal care pathways are variable and inconsistent. The aim of this systematic review was to evaluate the evidence for the clinical and/or cost effectiveness of current care pathways for adults with hip and/or knee pain referred for specialist opinion.

Design

Systematic review.

Data sources

Electronic database searches were carried out in MEDLINE, MEDLINE In-Process, Cumulative Index of Nursing and Allied Health Literature, Embase, PEDro, PubMed, Web of Science, Cochrane Central and Health Management Information Consortium without language restriction from 1990 onwards. Websites were reviewed for grey literature.

Eligibility criteria

All study designs and documents that considered care pathways for adults with musculoskeletal hip and/or knee pain referred for specialist opinion were screened by two reviewers. Risk of bias was assessed using The Critical Appraisal Skills Programme checklist for randomised controlled trials and the Joanna Briggs Institute checklists.

Data extraction and synthesis

Data extraction and quality assessment were performed by one reviewer and checked by a second. Findings are reported narratively.

Results

The titles and abstracts of 1248 articles were screened and 140 full-text articles retrieved. 19 papers reporting 17 studies met the study inclusion criteria. Quality was low due to study design and methodological flaws. Most of the outcomes relate to organisational process at the ‘meso’ level of a whole systems approach.

Conclusion

It can be concluded that the pathway is not linear, containing variations and activity loops. The available evidence suggests that, from the point of referral for specialist opinion, a model is required that integrates the skills of all the different healthcare professionals and streamlining is required to ensure that individuals are seen by the healthcare professional that best meets their needs. There is very limited evidence of patient experience informing knee and hip care pathways.

PROSPERO registration number

CRD42016035510.

Prevalence of maternal psychological disorders after immediate postpartum haemorrhage: a repeated cross-sectional study - the PSYCHE* study protoco

Por: Pranal · M. · Legrand · A. · de Chazeron · I. · Llorca · P.-M. · Vendittelli · F.
Introduction

The main objective of this study is to assess the prevalence of depression at 2, 6 and 12 months postpartum in women who have had an immediate postpartum haemorrhage (PPH) (blood loss ≥500 mL within 24 hours of delivery). The secondary objectives are to assess the prevalence of anxiety and post-traumatic stress disorder among these women and to evaluate the prevalence of psychological disorders according to the severity of the PPH.

Methods and analysis

This repeated, cross-sectional, single-centre study will take place at the Clermont-Ferrand University Hospital (France). The population will comprise a cohort of women giving birth at a term ≥22 weeks of gestation.

For each woman with a PPH (exposed), two women without PPH (unexposed) will be included: the women who give birth immediately before and immediately after her. The PPH will be managed according to French guidelines. The principal endpoint is the prevalence of depression, measured by the Edinburgh Postnatal Depression Scale (EPDS). The intervention will consist of four surveys including various self-completed questionnaires: the first during the immediate postpartum (Post-Delivery Perceived Stress Inventory (PDPSI), Spielberger'sState-Trait Anxiety Inventory (STAI)-Y-A and Y-B and Mini-International Neuropsychiatric Interview (M.I.N.I.) 5.0.0), then at 2 months (EPDS, STAI-Y-A, Generalised Anxiety Disorder (GAD-7) and Revised Impact of Event Scale (IES-R)), and finally at 6 months and 1 year postpartum (EPDS, STAI-Y-A, GAD-7, M.I.N.I. 5.0.0 and IES-R). The study will include 1542 women — 514 with PPH.

Ethics and dissemination

The institutional review board (IRB) approved the study on 14 February 2017 (IRB Sud Est VI: N°AU1243).

Results will be reported in peer-reviewed journals and at scientific meetings. Findings from the study will be useful for individualising medical follow-up after childbirth, especially for woman who experienced a PPH, but also more generally in increasing birth professionals' awareness of effects of trauma. The evidence obtained might also lead to modifying practices and including this recommendation in French guidelines on PPH.

Trial registration number

NCT03120208.

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