by Takeshi Horii, Kenji Momo, Takeo Yasu, Yusuke Kabeya, Koichiro AtsudaBackground
The extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan.Methods
This retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient’s possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value Results
Of the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50– Conclusions
We surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50–
by Mizuki Tanaka, Shiori Hasegawa, Satoshi Nakao, Kazuyo Shimada, Ririka Mukai, Kiyoka Matsumoto, Mitsuhiro NakamuraMany drugs can cause hearing loss, leading to sensorineural deafness. The aim of this study was to evaluate the risk of drug-induced hearing loss (DIHL) by using the Japanese Adverse Drug Event Report (JADER) database and to obtain profiles of DIHL onset in clinical settings. We relied on the Medical Dictionary for Regulatory Activities preferred terms and standardized queries, and calculated the reporting odds ratios (RORs). Furthermore, we applied multivariate logistic regression analysis, association rule mining, and time-to-onset analysis using Weibull proportional hazard models. Of 534688 reports recorded in the JADER database from April 2004 to June 2018, adverse event signals were detected for platinum compounds, sulfonamides (plain) (loop diuretics), interferons, ribavirin, other aminoglycosides, papillomavirus vaccines, drugs used in erectile dysfunction, vancomycin, erythromycin, and pancuronium by determining RORs. The RORs of other aminoglycosides, other quaternary ammonium compounds, drugs used in erectile dysfunction, and sulfonamides (plain) were 29.4 (22.4–38.6), 18.5 (11.2–30.6), 15.4 (10.6–22.5), and 12.6 (10.0–16.0), respectively. High lift score was observed for patients with congenital diaphragmatic hernia treated with pancuronium using association rule mining. The median durations (interquartile range) for DIHL due to platinum compounds, sulfonamides (plain), interferons, antivirals for treatment of hepatitis C virus (HCV) infections, other aminoglycosides, carboxamide derivatives, macrolides, and pneumococcal vaccines were 25.5 (7.5–111.3), 80.5 (4.5–143.0), 64.0 (14.0–132.0), 53.0 (9.0–121.0), 11.0 (3.0–26.8), 1.5 (0.3–11.5), 3.5 (1.3–6.8), and 2.0 (1.0–4.5), respectively. Our results demonstrated potential risks associated with several drugs based on their RORs. We recommend to closely monitor patients treated with aminoglycosides for DIHL for at least two weeks. Moreover, individuals receiving platinum compounds, sulfonamides (plain), interferons, and antivirals for HCV infection therapy should be carefully observed for DIHL for at least several months.
by Diogo Silva Vilela, Ricardo Koroiva, Adolfo Cordero-Rivera, Rhainer Guillermo-FerreiraThe genus Franciscobasis Machado & Bedê, 2016 is endemic to the Serra da Canastra National Park in Minas Gerais state, Brazil. Two species of Franciscobasis were described simultaneously with the genus description: F. franciscoi and F. sonia, the latter described only from females. Through morphological and molecular analysis, we investigated if F. sonia may represent the young female of F. franciscoi. Resulting data did not present adequate differences between females to characterize them as different species. Therefore, we suggest that F. sonia is a junior synonym of F. franciscoi, and the female of F. franciscoi goes through a complex ontogenetic color change.
by Daniel Nyato, Jacqueline Materu, Evodius Kuringe, Jeremie Zoungrana, Deusdedit Mjungu, Ruth Lemwayi, Esther Majani, Baltazar Mtenga, Soori Nnko, Grace Munisi, Amani Shao, Mwita Wambura, John Changalucha, Mary Drake, Albert KombaBackground
Little has been documented about partner violence among adolescent girls and young women (AGYW) who are out of school, a factor associated with HIV acquisition. To understand areas for prioritising HIV prevention intervention efforts, we explored the prevalence and correlates of partner violence among out of school AGYW in Shinyanga, Tanzania.Methods
A cross-sectional analysis of data from AGYW aged 15–23 years recruited in a cluster randomised trial conducted between October and December 2017 was used to examine correlates of partner violence. Data were collected through an Audio Computer-Assisted Self-interview. Multivariate logistic regression analysis was used to evaluate the association.Results
2276 (75.5%) AGYW were sexually active. Of these, 816 (35.9%) reported having experienced violence from partners in the last six months. After adjusting for other covariates, being formerly married (AOR = 1.55, 95% CI:1.02, 2.37), having children (AOR = 1.79, 95% CI:1.47, 2.16), anxiety and depression symptoms (AOR = 3.27, 95%CI: 2.15, 4.96), having engaged in sex work in the past six months (AOR = 1.92, 95% CI: 1.45, 2.53) and economic deprivation (AOR = 1.61, 95% CI: 1.34,1.92) were significantly associated with partner violence.Conclusions
Almost one in three sexually active AGYW had experienced partner violence in the 6 months preceding the survey. The findings underscore the need for future research to focus on understanding the reasons and dynamics underlying high level of partner violence among AGYW. Furthermore, there is a need for implementing intervention programs that aim to reduce economic deprivation among AGYWs and address social norms and structures perpetuating violence against AGYW.Trial registration
by Sarit Kumar Rout, Yashwant R. Gabhale, Ambarish Dutta, Sudha Balakrishnan, Mamatha M. Lala, Maninder Singh Setia, Khanindra Bhuyan, Mamta V. ManglaniBackground
India has recently introduced telemedicine initiatives to enhance access to specialized care at a low cost for the pediatric HIV patients, who face multiple challenges due to growing disease burden and limited preparedness of the health system to address it. There are limited evidences on the cost-effectiveness of these interventions. This study was undertaken in Maharashtra, a province, located in the western region of the country, to inform policy regarding the effectiveness of this programme. The objective was to estimate the unit cost of ART services for pediatric HIV patients and examine the efficiency in the use of resource and treatment compliance resulting from telemedicine initiatives in pediatric HIV compared to usual ART services.Methods
We selected 6 ART centers (3 from linked centers linked to Pediatric HIV Centre of Excellence (PCoE) and 3 from non-linked centers) randomly from three high, middle and low ART centers, categorized on the basis of case load in each arm. A bottom up costing methodology was adopted to understand the unit cost of services. Loss to follow up and timeliness of the visits were compared between the two arms and were linked to the cost.Results
The average cost per-visit was INR 1803 in the linked centers and that for the non-linked centers was INR 3412. There has been 5 percentage point improvement in lost to follow-up in the linked centers compared to non-linked centers against a back-drop of a reduction in per-pediatric patient cost of INR 557. The linkage has resulted in increase in timeliness of the visits in linked centers compared to non-linked centers.Discussion and conclusion
The telemedicine linkage led to an increase in the case load leading to a decrease in cost. The evidence on efficiency in the use of resource and improvement in treatment compliance as suggested by this study could be used to scale up this initiative.
by Hirofumi Kato, Mutsuyo Takayama-Ito, Itoe Iizuka-Shiota, Shuetsu Fukushi, Guillermo Posadas-Herrera, Madoka Horiya, Masaaki Satoh, Tomoki Yoshikawa, Souichi Yamada, Shizuko Harada, Hikaru Fujii, Miho Shibamura, Takuya Inagaki, Kinjiro Morimoto, Masayuki Saijo, Chang-Kweng LimMiddle East respiratory syndrome-coronavirus (MERS-CoV) is an emerging virus that causes severe disease with fatal outcomes; however, there are currently no approved vaccines or specific treatments against MERS-CoV. Here, we developed a novel bivalent vaccine against MERS-CoV and rabies virus (RV) using the replication-incompetent P-gene-deficient RV (RVΔP), which has been previously established as a promising and safe viral vector. MERS-CoV spike glycoprotein comprises S1 and S2 subunits, with the S1 subunit being a primary target of neutralizing antibodies. Recombinant RVΔP, which expresses S1 fused with transmembrane and cytoplasmic domains together with 14 amino acids from the ectodomains of the RV-glycoprotein (RV-G), was developed using a reverse genetics method and named RVΔP-MERS/S1. Following generation of RVΔP-MERS/S1 and RVΔP, our analysis revealed that they shared similar growth properties, with the expression of S1 in RVΔP-MERS/S1-infected cells confirmed by immunofluorescence and western blot, and the immunogenicity and pathogenicity evaluated using mouse infection experiments. We observed no rabies-associated signs or symptoms in mice inoculated with RVΔP-MERS/S1. Moreover, virus-specific neutralizing antibodies against both MERS-CoV and RV were induced in mice inoculated intraperitoneally with RVΔP-MERS/S1. These findings indicate that RVΔP-MERS/S1 is a promising and safe bivalent-vaccine candidate against both MERS-CoV and RV.
by Kristian Magnus Gundersen, Christoffer Nyborg, Øyvind Heiberg Sundby, Jonny Hisdal
by Robert Hammond, Rodoniki Athanasiadou, Silvia Curado, Yindalon Aphinyanaphongs, Courtney Abrams, Mary Jo Messito, Rachel Gross, Michelle Katzow, Melanie Jay, Narges Razavian, Brian Elbel
by Brett P. Hughes, Torbjorn Falkmer, Anna Anund, Melissa H. BlackWhile road safety in the United States (U.S.) has been continually improving since the 1970's, there are indications that these improvements are becoming increasingly difficult to sustain. Strategic Highway Safety Plans (SHSPs) are prepared by States to guide road safety management, however assessing the appropriateness of these plans remains a significant challenge, especially for the future in which they are to be applied. This study developed a new methodology to assess SHSPs from the perspectives of comprehensive system-based safety management and relevant future issues that can be applied before SHSPs are implemented, thereby avoiding long periods after implementation before assessing the appropriateness of the plans. A rating scale was developed and applied to assess 48 U.S. SHSPs against two key criteria: 1. a comprehensive framework for road safety, and 2. the anticipated changing, difficult and unpredictable nature of future transport and its context. The analysis concluded that current SHSPs have good national oversight with several strengths but were weak in some areas of content and did not address future challenges. Improvements are suggested to strengthen the plans’ thoroughness by being consistent with systems theory and practice, as well as ways that these SHSPs can be more resilient to future circumstances. Implementing the recommendations in this paper provides the opportunity to adopt a system-based safety management practice that has been successful in other hazardous industries. Doing so is expected to most efficiently and effectively continue the recent improvements to road safety, which is likely to be increasingly difficult otherwise.
by Takashi Kanamaru, Kazuyuki AiharaTo understand the effect of attention on neuronal dynamics, we propose a multi-module network, with each module consisting of fully interconnected groups of excitatory and inhibitory neurons. This network shows transitive dynamics among quasi-attractors as its typical dynamics. When the release of acetylcholine onto the network is simulated by attention, the transitive dynamics change into stable dynamics in which the system converges to an attractor. We found that this network can reproduce three experimentally observed properties of attention-dependent response modulation, namely an increase in the firing rate, a decrease in the Fano factor of the firing rate, and a decrease in the correlation coefficients between the firing rates of pairs of neurons. Moreover, we also showed theoretically that the release of acetylcholine increases the sensitivity to bottom-up inputs by changing the response function.
by Allison KoeneckeWe aim to determine whether a game-theoretic model between an insurer and a healthcare practice yields a predictive equilibrium that incentivizes either player to deviate from a fee-for-service to capitation payment system. Using United States data from various primary care surveys, we find that non-extreme equilibria (i.e., shares of patients, or shares of patient visits, seen under a fee-for-service payment system) can be derived from a Stackelberg game if insurers award a non-linear bonus to practices based on performance. Overall, both insurers and practices can be incentivized to embrace capitation payments somewhat, but potentially at the expense of practice performance.
To examine qualified intensive care nurses’ implicit and explicit attitudes towards obese intensive care patients and whether their attitudes are associated with their behavioural intentions towards these patients.
Obese intensive care patients may experience more stress than do normal‐weight patients. Intensive care nurses’ attitudes and the way they address their care are thus vital. Despite a range of studies revealing that health professionals hold anti‐fat attitudes towards obese patients, there is a lack of knowledge about intensive care nurses’ implicit and explicit attitudes and if such attitudes are associated with behavioural intention.
A cross‐sectional survey.
From November 2017 ‐ January 2018, a web‐based survey was conducted with 159 qualified intensive care nurses (84.3% women, mean age 45.52 years) recruited through 16 intensive care units and Facebook. The survey consisted of implicit attitude tests, explicit bias scales, the Anti‐fat Attitude questionnaire, vignettes measuring behavioural intention, and demographic questions.
Intensive care nurses reported implicit preferences for thin over thick people and found obese individuals slightly ‘worse’ and ‘lazy’, comprising less willpower than thin individuals. Attitudes were not associated with behavioural intention.
This study provides new knowledge about qualified intensive care nurses’ anti‐fat attitudes and behavioural intention towards obese intensive care patients. These findings should be acknowledged by policymakers, clinical healthcare providers and educators to secure optimal care for these patients.
These results should be used in nursing attitude change programmes, in intensive care units, and among nursing educators, focusing on increasing nurses’ knowledge of the complexities of obesity. Further research on obese intensive care patients’ healthcare experiences and the impact that healthcare providers’ anti‐fat attitudes and behaviours has on patients’ perceived care quality is needed.
To develop a theory describing the processes and actions involved with school nurse case management for school‐aged children with chronic conditions in the K12 system.
Case management is an essential practice for the school nurse. Little is known about actual case management practice in real‐world settings. Grounded theory methodology following a literature‐based conceptual model of school nurse case management.
A purposive maximum variation sampling was used for data collection and analysis. Semi‐structured interviews conducted in‐person and via conferencing software from January to March 2017 with school nurses practicing in Washington State until data saturation was achieved. A condition lasting at least 6 months was also used to define a chronic condition.
In all, 14 school nurses with an average of 12 years of experience were interviewed. Analysis revealed that the core strategy used by participating nurses for case management involved navigating through ambiguity; balancing multiple roles; seeking guidance and training; acknowledging imperfect functioning and navigating poor system supports.
The findings suggest that actual school nurse case management practice differs from best practice recommendations. Participants did not discuss health promotion or environmental management and did not act to set goals or prioritize care as suggested in the literature.
This article informs nursing leadership of the real‐world challenges faced by nurses performing case management in the school setting. These findings indicate that improvements in system supports and training, together with tolerance for the challenges nurses face in providing such care, might improve case management practice in the schools.
To obtain a comprehensive insight of the impact of patient and family engagement on patient safety and identify issues in implementing this approach.
Patient and family engagement is increasingly emerging as a potential approach for improving patient safety.
Mixed method multi‐level synthesis.
PubMed, CINAHL, Embase and Cochrance Library (January 2009 ‐ April 2018).
The review was conducted according to the principles recommended by the Cochrane Handbook for Systematic Review and in accordance with the PRISMA guidelines.
Forty‐two relevant studies were identified. Common intervention groups included “direct care” and “organization” levels with “consultation” and “involvement” approaches, while the “health system” level and “partnership and shared leadership” approaches were rarely implemented. Findings revealed positive effects of the interventions on patient safety. Most study participants expressed their willingness to engage in or support patient and family engagement. However, existing gaps and barriers in implementing patient and family engagement were identified.
Future research should further focus on issuing consensus guidelines for implementing patient and family engagement in patient safety, extending the research scope for all aspects of patient and family engagement and patient safety and identifying priority areas for action that is suitable for each health facility.
Policymakers should issue guidelines for implementing patient and family engagement in health‐care systems which would enable health‐care providers to implement patient and family engagement and improve patient safety appropriately and effectively.
To assess randomized controlled trials evaluating the impact of nurse practitioner‐led cardiovascular care.
Systematic review of nurse practitioner led‐care in patients with cardiovascular disease has not been completed.
Systematic review and meta‐analysis.
The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, Web of Science, Scopus, & ProQuest were systematically searched for studies published January 2007‐ June 2017.
Cochrane methodology was used for risk of bias, data extraction and meta‐analysis. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach.
Out of 605 articles, five articles met inclusion criteria. There was no statistical difference between nurse practitioner‐led care and usual care for 30‐day readmissions, health related quality of life and length of stay. A 12% reduction in Framingham risk score was identified.
There are few randomized control trials assessing nurse practitioner‐led cardiovascular care.
Low to moderate quality evidence was identified with no statistically significant associated outcomes of care.
Nurse practitioner roles need to be supported to conduct and publish high quality research.
To examine the role of community‐based nursing interventions in improving outcomes for community‐dwelling individuals exhibiting risk factors of cardiovascular disease.
A systematic review and narrative synthesis.
Seven electronic databases (MEDLINE, CINAHL, Global Health, LILACS, Africa‐Wide Information, IMEMR and WPRIM) were searched from inception to 16 March 2018.
This review included outcomes from studies that were led by or delivered primarily by nurses for individuals exhibiting risk factors of cardiovascular diseases in community settings. At least two independent reviewers performed study selection, data extraction and risk of bias.
46 studies met the eligibility criteria. Community nursing interventions were found to be effective in improving clinical outcomes of symptom control, symptom awareness, symptom management and social outcomes. Effective interventions were found to be facilitated by a community‐centric approach, participant empowerment, reinforcement strategies, a targeted approach towards underserved populations, as well as home visits. These resulted in positive outcomes such as significant reductions in HbA1c for diabetic patients, attainment of blood pressure targets for hypertensive patients and greater improvement in self‐reported dietary intake for patients with hyperlipidemia.
Community‐based nurse‐led interventions can result in positive outcomes for patients with risk factors of cardiovascular disease. However, the success of such interventions needs to be facilitated by appropriate funding, thoughtful intervention design and training opportunities for nurses.
Community‐based nursing interventions are largely effective in improving clinical and social outcomes for community‐dwelling individuals with risk factors of cardiovascular disease.
Professionalism in nursing has long been steeped in controversy. For many years some argued nurses were only semi‐professional due to a lack of university education and qualifications and a knowledge base and skillset that were not distinctly unique (Adams & Miller, 2001). Nurses are now an established profession with clear and robust educational frameworks, codes of professional conduct and standards of practice (Sills, 1998), regulated by an independent agency or governing body.
To examine the relationship between sleep‐wake disturbances and frailty among older adults.
A systematic review.
Peer‐reviewed and English‐written studies were sourced in CINAHL Complete, PsycINFO, Ovid‐Medline and by hand searching from inception to December 2018.
This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. The Cochrane Collaboration Risk of Bias Tool was used to appraise the methodological quality. A quantitative meta‐analysis was not conducted due to the heterogeneous effect estimates statistics and measurements of sleep‐wake disturbances. Instead, a narrative synthesis was carried out conforming to the Centre for Reviews and Dissemination's guidance.
Six cross‐sectional studies and one longitudinal study were included in this review. There was consistent evidence on the association between perceived sleep quality and frailty among older adults; whereas the results for insomnia symptoms, excessive daytime sleepiness and sleep‐wake pattern were inconclusive.
Despite a comprehensive search, this review has identified limited research in this field of study. Nevertheless, this review has identified consistent evidence on the relationship between perceived sleep quality and frailty. Future rigorous research with more validated use of measurement tools are needed to explore whether insomnia symptoms, excessive daytime sleepiness and sleep‐wake pattern are related to frailty.
Due to the indefinite role of sleep‐wake disturbances in the pathophysiology of frailty, nearly all nurse‐led care programmes for frail older adults did not include any sleep‐related screening and interventions. Nevertheless, the consistent evidence on the association between poor sleep quality and higher risk of frailty shows the need of incorporating assessments and interventions for improving sleep quality in nurse‐led care programmes for frail older adults. Moreover, such evidence also generates casual hypothesis for future prospective longitudinal studies that explore the causality of this relationship.
It is widely accepted that nursing research is paramount to help address the challenges facing the international nursing workforce in caring for a growing and ageing population. Nursing, midwifery and care staff make up the largest proportion of the workforce across the NHS. In the UK, there are over 693,000 registered nurses and midwives (Nursing and Midwifery Council, 2018), all striving to prevent and tackle health inequalities and improve the care experience for patients, individuals and populations.
To understand how health‐related street outreach is perceived by homeless people with experience of sleeping rough. Specialist nursing and primary care services are expected to provide street outreach but there is no specific guidance on how to deliver it.
A Qualitative Description study.
Purposive opportunistic sampling was used to recruit participants from three drop‐in centres in London. 10 semi‐structured interviews were conducted between 4th and 28th of June 2018 and Braun and Clarke's thematic analysis was used.
Health‐related street outreach was perceived as being able to offer a human connection that reduced the sense of isolation and exclusion commonly experienced on the street. People with experience of sleeping rough felt it could overcome access barriers and provide a bridge to healthcare services. Crucially the right approach was deemed to be essential and was defined by participants in terms of location, timing, the outreach team and the verbal and non‐verbal styles used by outreach workers.
Health‐related street outreach is a valuable health promotion tool for people experiencing homelessness that should be financially supported by healthcare commissioners and employers. Providers of health‐related street outreach must adopt the right approach and the development of guidelines could assist services to achieve this.
The findings of this study can inform planning and review of health‐related street outreach, to ensure that the approach taken by healthcare workers is acceptable to and based on the views of, the people these services are provided for.