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Sub‐epidermal moisture measurement: an evidence‐based approach to the assessment for early evidence of pressure ulcer presence

Abstract

This paper aims to discuss the literature pertaining to early pressure‐shear induced tissue damage detection, with emphasis on sub‐epidermal moisture measurement (SEM). The current method for pressure detection is visual skin assessment (VSA); however, this method is fraught with challenges. Advances in early detection of pressure ulcers are reported in the literature and mainly involve measuring inflammation markers on weight‐bearing anatomical areas in order to capture the first signs of tissue damage. One novel technique currently in use is SEM measurement. This biophysical marker is the product of plasma that leaks as a response to local inflammation arising due to pressure‐shear induced damage over bony prominences. The early detection of tissue damage is beneficial in two different ways. First, it enables early intervention when the damage is still microscopic and reversible and, therefore, has the potential to prevent further aggravation of healthy surrounding tissue. This arises by avoiding the causation of the problem and stopping the knock‐on effect of inflammation, especially when the rapid pressure ulceration pathway of deformation is in place. Second, when the slow ischaemic‐reperfusion related mechanism is undergoing, cell death can be avoided when the problem is identified before the cell reaches the “death threshold,” completely averting a pressure ulcer.

Health discipline students face various direct and indirect types of risks and hazards during education in clinical placements

Por: Booth · R. · O'Connor · S.

Commentary on: Graj E, Sheen J, Dudley A, et al. Adverse health events associated with clinical placement: a systematic review. Nurse Educ Today 2019;76:178–190. doi:10.1016/j.nedt.2019.01.024.

Implications for practice and research

  • Risks and hazards faced by health discipline students in clinical placement settings are commonly subtle, and occur in both direct and indirect fashions to the student.

  • Future research should seek to explore the interrelationship between the type of clinical experience, educational progression and other contextual factors found in clinical placement settings, as related to student risks.

  • Context

    The review completed by Graj et al1 sought to explore the risks and hazards encountered by health discipline students during clinical placements. Primary research completed in this domain has suggested that students commonly face various types of abuse, violence and other health-related occupational hazards during formal training.2 Graj et al1 sought...

    Protocol for Project Fizzyo, an analytic longitudinal observational cohort study of physiotherapy for children and young people with cystic fibrosis, with interrupted time-series design

    Por: Raywood · E. · Douglas · H. · Kapoor · K. · Filipow · N. · Murray · N. · O'Connor · R. · Stott · L. · Saul · G. · Kuzhagaliyev · T. · Davies · G. · Liakhovich · O. · Van Schaik · T. · Furtuna · B. · Booth · J. · Shannon · H. · Bryon · M. · Main · E.
    Introduction

    Daily physiotherapy is believed to mitigate the progression of cystic fibrosis (CF) lung disease. However, physiotherapy airway clearance techniques (ACTs) are burdensome and the evidence guiding practice remains weak. This paper describes the protocol for Project Fizzyo, which uses innovative technology and analysis methods to remotely capture longitudinal daily data from physiotherapy treatments to measure adherence and prospectively evaluate associations with clinical outcomes.

    Methods and analysis

    A cohort of 145 children and young people with CF aged 6–16 years were recruited. Each participant will record their usual physiotherapy sessions daily for 16 months, using remote monitoring sensors: (1) a bespoke ACT sensor, inserted into their usual ACT device and (2) a Fitbit Alta HR activity tracker. Real-time breath pressure during ACTs, and heart rate and daily step counts (Fitbit) are synced using specific software applications. An interrupted time-series design will facilitate evaluation of ACT interventions (feedback and ACT-driven gaming). Baseline, mid and endpoint assessments of spirometry, exercise capacity and quality of life and longitudinal clinical record data will also be collected.

    This large dataset will be analysed in R using big data analytics approaches. Distinct ACT and physical activity adherence profiles will be identified, using cluster analysis to define groups of individuals based on measured characteristics and any relationships to clinical profiles assessed. Changes in adherence to physiotherapy over time or in relation to ACT interventions will be quantified and evaluated in relation to clinical outcomes.

    Ethics and dissemination

    Ethical approval for this study (IRAS: 228625) was granted by the London-Brighton and Sussex NREC (18/LO/1038). Findings will be disseminated via peer-reviewed publications, at conferences and via CF clinical networks. The statistical code will be published in the Fizzyo GitHub repository and the dataset stored in the Great Ormond Street Hospital Digital Research Environment.

    Trial registration number

    ISRCTN51624752; Pre-results.

    Sub‐epidermal moisture measurement: an evidence‐based approach to the assessment for early evidence of pressure ulcer presence

    Abstract

    This paper aims to discuss the literature pertaining to early pressure‐shear induced tissue damage detection, with emphasis on sub‐epidermal moisture measurement (SEM). The current method for pressure detection is visual skin assessment (VSA); however, this method is fraught with challenges. Advances in early detection of pressure ulcers are reported in the literature and mainly involve measuring inflammation markers on weight‐bearing anatomical areas in order to capture the first signs of tissue damage. One novel technique currently in use is SEM measurement. This biophysical marker is the product of plasma that leaks as a response to local inflammation arising due to pressure‐shear induced damage over bony prominences. The early detection of tissue damage is beneficial in two different ways. First, it enables early intervention when the damage is still microscopic and reversible and, therefore, has the potential to prevent further aggravation of healthy surrounding tissue. This arises by avoiding the causation of the problem and stopping the knock‐on effect of inflammation, especially when the rapid pressure ulceration pathway of deformation is in place. Second, when the slow ischaemic‐reperfusion related mechanism is undergoing, cell death can be avoided when the problem is identified before the cell reaches the “death threshold,” completely averting a pressure ulcer.

    Establishing a taxonomy of potential hazards associated with communicating medical science in the age of disinformation

    Por: Grimes · D. R. · Brennan · L. J. · O'Connor · R.
    Objectives

    Disinformation on medical matters has become an increasing public health concern. Public engagement by scientists, clinicians and patient advocates can contribute towards public understanding of medicine. However, depth of feeling on many issues (notably vaccination and cancer) can lead to adverse reactions for those communicating medical science, including vexatious interactions and targeted campaigns. Our objective in this work is to establish a taxonomy of common negative experiences encountered by those communicating medical science, and suggest guidelines so that they may be circumvented.

    Design

    We establish a taxonomy of the common negative experiences reported by those communicating medical science, informed by surveying medical science communicators with public platforms.

    Participants

    142 prominent medical science communicators (defined as having >1000 Twitter followers and experience communicating medical science on social and traditional media platforms) were invited to take part in a survey, with 101 responses.

    Results

    101 responses were analysed. Most participants experienced abusive behaviour (91.9%), including persistent harassment (69.3%) and physical violence and intimidation (5.9%). A substantial number (38.6%) received vexatious complaints to their employers, professional bodies or legal intimidation. The majority (62.4%) reported negative mental health sequelae due to public outreach, including depression, anxiety and stress. A significant minority (19.8%) were obligated to seek police advice or legal counsel due to actions associated with their outreach work. While the majority targeted with vexatious complaints felt supported by their employer/professional body, 32.4% reported neutral, poor or non-existent support.

    Conclusions

    Those engaging in public outreach of medical science are vulnerable to negative repercussions, and we suggest guidelines for professional bodies and organisations to remedy some of these impacts on front-line members.

    Cows Milk Fat Obesity pRevention Trial (CoMFORT): a primary care embedded randomised controlled trial protocol to determine the effect of cows milk fat on child adiposity

    Por: Vanderhout · S. M. · Aglipay · M. · Birken · C. · Li · P. · O'Connor · D. L. · Thorpe · K. · Constantin · E. · Davis · M.-A. · Feldman · M. · Ball · G. D. C. · Janus · M. · Jüni · P. · Junker · A. · Laupacis · A. · L'Abbe · M. · Manson · H. · Moretti · M. E. · Persaud · N. · Omand · J. A.
    Introduction

    Cow’s milk is a dietary staple for children in North America. Though clinical guidelines suggest children transition from whole (3.25% fat) milk to reduced (1% or 2%) fat milk at age 2 years, recent epidemiological evidence supports a link between whole milk consumption and lower adiposity in children. The purpose of this trial is to determine which milk fat recommendation minimises excess adiposity and optimises child nutrition and growth.

    Methods and analysis

    Cow’s Milk Fat Obesity pRevention Trial will be a pragmatic, superiority, parallel group randomised controlled trial involving children receiving routine healthcare aged 2 to 4–5 years who are participating in the TARGet Kids! practice-based research network in Toronto, Canada. Children (n=534) will be randomised to receive one of two interventions: (1) a recommendation to consume whole milk or (2) a recommendation to consume reduced (1%) fat milk. The primary outcome is adiposity measured by body mass index z-score and waist circumference z-score; secondary outcomes will be cognitive development (using the Ages and Stages Questionnaire), vitamin D stores, cardiometabolic health (glucose, high-sensitivity C-reactive protein, non-high density lipoprotein (non-HDL), low density lipoprotein (LDL), triglyceride, HDL and total cholesterol, insulin and diastolic and systolic blood pressure), sugary beverage and total energy intake (measured by 24 hours dietary recall) and cost effectiveness. Outcomes will be measured 24 months postrandomisation and compared using analysis of covariance (ANCOVA), adjusting for baseline measures.

    Ethics and dissemination

    Ethics approval has been obtained from Unity Health Toronto and The Hospital for Sick Children. Results will be presented locally, nationally and internationally and published in a peer-reviewed journal. The findings may be helpful to nutrition guidelines for children in effort to reduce childhood obesity using a simple, inexpensive and scalable cow’s milk fat intervention.

    Trial registration number

    NCT03914807; pre-results.

    The impact of implementing speech recognition technology on the accuracy and efficiency (time to complete) clinical documentation by nurses: A systematic review

    Abstract

    Introduction

    Speech recognition technology (SRT) recognises an individual's spoken word signals through a microphone and subsequently processes the user's words into digital text by means of a computer. SRT remains well established and continues to grow in popularity among the various health disciplines. Many studies have been done to examine the effects of SRT on nursing documentation, however, no previous systematic review (SR) on the effects of SRT on accuracy and efficiency of nursing documentation was identified.

    Aims and methods

    To systematically review the impact of speech recognition technology on the accuracy and efficiency of clinical nursing documentation. A SR was conducted that measures the accuracy and efficiency (time to complete documentation) of SRT on nursing documentation. An extensive search of the literature included Web of Science, CINAHL via EBSCO host, Cochrane Library, Embase, MEDLINE and Google Scholar. The PRISMA checklist screened eligible papers. The quality of each paper was critically appraised, data extracted and analysed/synthesised.

    Results

    A total of 10 studies were included. Various devices and systems have been used to examine the accuracy, efficiency and impact of SRT on nursing documentation. A positive impact of SRT with significant advances in accuracy/productivity of nursing documentation at the point of care was found. However, a substantial degree of initial costing, training requirements and studied interface modification to individual healthcare units are needful in incorporating SRT systems.

    Conclusions

    Speech recognition technology when applied to nursing documentation could open up a promising new interface for data entry from the point of care, though the full potential of the technology has not been explored.

    Relevance to Clinical Practice

    The compatibility/effectiveness of SRT with existing computer systems remains understudied. SRT training, prompt on‐site technical support, maintenance and upgrades cannot be underestimated towards achieving high‐level accuracy and efficiency (time to complete documentation) with SRT.

    Methamphetamine use in pregnancy, child protection, and removal of infants: Tertiary centre experience from Western Australia

    The Women and Newborn Drug and Alcohol Service (WANDAS) is a specialist antenatal service at King Edward Memorial Hospital, Perth Western Australia, that provides multidisciplinary care to pregnant women who use or have a history of alcohol and other drugs (AOD) misuse. Illicit methamphetamine use along with polysubstance use is a significant health problem in Australia and within the WANDAS population.

    Double bereavement, mental health consequences and support needs of children and young adults—When a divorced parent dies

    Abstract

    Aims and objectives

    To explore how children and young adults from divorced families experience double bereavement when they lose a divorced parent with cancer and how the double bereavement influences their mental health consequences and need of support.

    Background

    Children and young people who are confronted with the cancer and death of a parent is a highly stressful life event, which is associated with an increased risk of mental health problems, especially when children experience divorced parental cancer and death.

    Design

    Participant observations and interviews with a phenomenological‐hermeneutic approach and COREQ standards for reporting qualitative research.

    Methods

    We conducted 340 hr of participant observations within nine different support groups totalling 27 children and young adults from divorced families and included 28 interviews with participants and relatives. Analyses are based on Ricoeur's theory of interpretation: naïve reading, structural analysis, interpretation and discussion.

    Results

    The experiences with double bereavement identified three main themes: 1. navigating through multiple transitions and disruptions within two family worlds; 2. consequences for mental health including stress overload and disruptions to well‐being; and 3. need for accessible support derived from close relationships and professionals within and in‐between family worlds.

    Conclusion

    Children and young adult's double bereavement includes multiple transitions and disruptions often related to stress overload and mental health problems. Support from close relationships and professionals is experienced as helpful in the prevention and mitigation of mental health problems.

    Relevance to clinical practice

    There is a need for targeted accessible support availability to children, young adults and their families when a divorced parent is dying of cancer in clinical practice. Our findings suggest that specific health policies for health professionals should be developed to target improved support for these families.

    Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives

    Por: McCaughan · D. · Booth · A. · Jackson · C. · Lalor · S. · Ramdharry · G. · O'Connor · R. J. · Phillips · M. · Bowers · R. · McDaid · C.
    Objectives

    Adults with knee instability related to neuromuscular disorders or central nervous conditions often experience mobility problems and rely on orthoses to improve function and mobility. Patient views of device effectiveness and acceptability are underexplored. Our study aimed to elicit device users’ perspectives regarding fitting, acceptability, effectiveness and use of orthoses, and identify important treatment outcomes.

    Design

    Qualitative descriptive study using in-depth semistructured interviews. Interview transcriptions were coded and thematically analysed, using ‘Framework’.

    Setting and participants

    A purposive sample of 24 adult users of orthotic devices. Nineteen patients were recruited across three National Health Service sites, and five people through charities/patient support groups in England. Half of the participants had been diagnosed with poliomyelitis, and the remainder with multiple sclerosis, Charcot-Marie-Tooth disease, spinal injury or spina bifida, and stroke. The median age of participants was 64.5 years (range 36–80 years).

    Results

    Patients’ medical condition impacted significantly on daily life. Participants relied on orthotic devices to enable engagement in daily activities. Patient goals for mobility were linked to individual circumstances. Desired treatment outcomes included reduction in pain, trips and falls, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses and associated with reported use. Obtaining suitable footwear alongside orthotic devices was a significant concern. Time pressures during device fitting were viewed negatively.

    Conclusions

    Orthotic devices for knee instability play a crucial role in promoting, maintaining and enhancing physical and psychological health and well-being, enabling patients to work, engage in family life and enjoy social activities. Future research should consider how best to measure the impact of orthotic devices on patient quality of life and daily functioning outside the clinic setting, as well as device use and any adverse effects.

    Trial registration number

    This qualitative study was retrospectively registered as Current Controlled Trials ISRCTN65240228.

    Partners' experiences of living with a person with an eating disorder: A grounded theory study 合作伙伴与饮食失调者生活的经历:一项扎根理论研究;

    Abstract

    Aim

    To explore the experiences of intimate partners of people with an eating disorder.

    Design

    Qualitative grounded theory study.

    Methods

    In‐depth interviews were conducted with 18 partners of people with an eating disorder from 2013–2016. Data were analysed using the principles of classic grounded theory including, concurrent data collection and analysis, theoretical sampling, constant comparative analysis and memo writing.

    Results

    Partners encounter disruptions to their lives when their significant other experiences an eating disorder. As a result, partners engage in a four‐stage cyclical process involving: encountering a disruption; becoming an informed self; countering the disruption and reclaimed livability. By engaging in this process partners learn to support their significant other, remain committed to the relationship and recover their own lives. The process is drawn together and defined as the theory of ‘Reconstructing Livability’.

    Conclusion

    The theory of ‘Reconstructing Livability’ provides a unique conceptualization of the experiences of partners who are living with a person with an eating disorder. It highlights the challenges faced by partners when supporting the recovery of their significant other and the intimate relationship, while reclaiming their own lives.

    Impact

    This study addresses the dearth of knowledge and understanding of partners' experiences. Partners engage in a process to enable them support recovery of their significant other and their own lives, but this is hindered by the challenges and unmet needs they experience. The theory provides a basis on which nurses can provide effective and timely supports to partners.

    目的

    探讨饮食失调患者亲密合作伙伴的体验。

    设计

    定性扎根理论研究。

    方法

    2013至2016年对18名饮食失调患者的合作伙伴进行了深度访谈法。采用了经典扎根理论的原理来进行数据分析,包括并行数据收集和分析、理论抽样、持续比较分析和备忘录撰写。

    结果

    当合作伙伴的另一半经历饮食失调时,他们的生活会受到干扰。因此,合作伙伴们参与了一个四阶段的循环过程,包括:遇到中断;成为一个了解情况的自我;对抗中断和再生存活率。通过参与这个过程,合作伙伴们学会了支持他们重要的另一半,保持对关系的承诺,并恢复他们自己的生活。这个过程被整合在一起,并被定义为‘重建存活率’的理论。

    结论

    ‘重建存活率’理论为与饮食失调患者的生活合作伙伴的经历提供了独特的概念化。它强调了合作伙伴在支持他们重要的另一半和亲密关系的重获,同时恢复他们自己的生活时所面临的挑战。

    影响

    本研究解决了知识匮乏和理解合作伙伴经验的问题。合作伙伴们参与一个进程,以便于使他们能够支持重获他们重要的另一半和自己的生活,但这受到他们所经历的挑战和未满足需求的阻碍。该理论为护士向合作伙伴提供有效和及时的支持提供了基础。

    Do safety briefings improve patient safety in the acute hospital setting? A systematic review 在紧急入院条件下,安全简报的发出是否可帮助提高患者的安全性?系统评估

    Abstract

    Aims

    To synthesize current knowledge about the impact of safety briefings as an intervention to improve patient safety.

    Background

    Improving safety in health care remains an ongoing challenge. There is a lack of evidence underpinning safety enhancing interventions.

    Design

    Mixed method multi‐level synthesis.

    Data Sources

    Four health literature databases were searched (Cinahl, Medline, Scopus and Health Business Elite) from January 2002 – March 2017.

    Review Methods

    Thomas and Harden approach to mixed method synthesis.

    Results

    Following quality appraisal, 12 studies were included. There was significant heterogeneity in study aims, measures, and outcomes. Findings showed that safety briefings achieved beneficial outcomes and can improve safety culture. Outcomes included improved risk identification, reduced falls, enhanced relationships, increased incident reporting, ability to voice concerns, and reduced length of stay.

    Conclusion

    Healthcare leaders should embrace the potential of safety briefings by promoting their effective use whilst allowing for local adaptation.

    目的

    综合目前有关将安全简报作为改善患者安全状况的干预措施等影响。

    背景

    设计

    采用混合法,实现多级合成。

    数据来源

    2002年1月至2017年3月间,共对四大健康文献数据库进行文献检索(Cinahl、Medline、Scopus以及Health Business Elite)。

    评估方法

    Thomas和Harden两位作者都采用混合法,实现多级合成。

    结果

    完成质量评估之后,共开展了12项研究。其中,研究目的、研究方法和研究结果均存在显著的异质性。研究结果表明,安全简报的发布可产生有益的效果,并可同时改善安全文化。结果包括:风险识别性能改善、失败率降低、关系增进、事件报告数量增加、表达担忧能力的获取以及住院时间的缩短。

    结论

    医疗保健领导者应充分利用安全简报的潜力,促进其有效使用,并应在使用过程中充分考虑当地具体的适应情况。

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