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Comparisons of Three Measures of Maternal Engagement Activities in the Neonatal Intensive Care Unit

imageBackground Mothers’ engagement with their hospitalized preterm infant(s) is recognized as an important aspect of treatment in neonatal intensive care units (NICUs). However, no gold standard exists for measuring maternal engagement, and the various methods used to measure mothers’ time have documented limitations. Objectives This study sought to compare three measurement methods of maternal engagement (a five-item maternal cross-sectional survey, time use diaries, and electronic health records [EHRs]) to identify whether these methods capture consistent data and patterns in detected differences in measures of engagement. Methods Maternal engagement was defined as time spent visiting the infant in the NICU (presence), holding (blanket holding in the mother’s arms or by kangaroo care [KC]), and caregiving (e.g., bathing and changing diapers). The survey estimating daily maternal engagement was administered in two Level III NICUs and one Level IV NICU at study enrollment, at least 2 weeks after admission. Mothers then completed the daily time use diaries until infant discharge. Data were also collected from participants’ EHRs, charted by nursing staff. Wilcoxon signed-rank tests were used for pairwise analysis of the three measures for maternal engagement activities. Results A total of 146 participants had data across all three measurement types and were included in the analysis. In the Level III NICUs (n = 101), EHR data showed significantly more time spent with all engagement activities than the diary data. In the Level IV data, only differences in time holding were significant when comparing EHR data with survey data, with mothers reporting more time doing KC and less time blanket holding. Comparison of EHR data with diary data showed more time in all activities except KC. Discussion In most cases, time spent in engagement activities measured in the EHR was higher than in the surveys or time use diaries. Accuracy of measurements could not be determined because of limitations in data collection, and there is no gold standard for comparison. Nevertheless, findings contribute to ongoing efforts to develop the most valuable and accurate strategies for measuring maternal engagement—a significant predictor of maternal and infant health.

Experiences With COVID-19

imageBackground Millions of Americans have tested positive for COVID-19. The illness has a range of clinical symptoms with varying degrees of symptom severity; there is limited research about the lived experience of having COVID-19. Objective The study aim was to understand the lived experience of having COVID-19, provide detail on the length and severity of symptoms as well as coping mechanisms of those with the illness, and identify issues individuals face when accessing healthcare. Methods This phenomenological qualitative study included semistructured interviews of 45 people ages 18 years and older living in the United States who tested positive for COVID-19. Inductive content analysis was employed for subjective interpretation of the text through a systematic coding classification to identify themes for analysis and conclusions. Results This study details a variety of symptom presentations of individuals who tested positive for COVID-19 as well as mental health concerns related to fear and living with COVID-19. Discussion Individuals expressed varying emotions when finding they tested positive for COVID-19. Many conveyed fear of having COVID-19 and indicated it was a traumatic experience. This fear is an important clinical finding that policymakers and providers should consider when treating acute and chronic COVID-19 patients. Finally, many participants, commonly referred to as “long haulers,” experienced ongoing and lingering symptoms highlighting an area in need of further research.

Dutch injection versus surgery trial in patients with carpal tunnel syndrome (DISTRICTS): protocol of a randomised controlled trial comparing two treatment strategies

Por: Palmbergen · W. A. C. · de Bie · R. M. A. · Alleman · T. W. H. · Verstraete · E. · Jellema · K. · Verhagen · W. I. M. · Brekelmans · G. J. F. · de Ruiter · G. C. W. · van de Beek · D. · de Borgie · C. A. J. M. · de Haan · R. · Beekman · R. · Verhamme · C.
Introduction

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. The optimal treatment strategy is still unknown. The objective of the Dutch Injection versus Surgery TRIal in patients with CTS (DISTRICTS) is to investigate if initial surgery of CTS results in a better clinical outcome and is more cost-effective when compared with initial treatment with corticosteroid injection.

Methods and analysis

The DISTRICTS is an ongoing multicenter, open-label randomised controlled trial. Participants with CTS are randomised to treatment with surgery or with a corticosteroid injection. If needed, any additional treatments after this first treatment are allowed and these are not dictated by the study protocol. The primary outcome is the difference between the groups in the proportion of participants recovered at 18 months. Recovery is defined as having no or mild symptoms as measured with the 6-item carpal tunnel symptoms scale. Secondary outcome measurements are among others: time to recovery, hand function, patient satisfaction, quality of life, additional treatments, adverse events, and use of care and health-related costs.

Ethics and dissemination

The study was approved by the Medical Ethical Committee of the Amsterdam University Medical Centers (study number 2017-171). Study results will be disseminated in peer-reviewed journals and conferences.

Trial registration number

ISRCTN Registry: 13164336.

Investigating the association between inpatient stroke therapy and disability, destination on discharge, length of stay and mortality: a prospective cohort study using the Sentinel Stroke National Audit Programme

Por: Gittins · M. · Lugo-Palacios · D. G. · Vail · A. · Bowen · A. · Paley · L. · Bray · B. · Gannon · B. · Tyson · S.
Objective

‘More is better’ is a recognised mantra within stroke therapy, however, this has been developed in patients receiving long term rehabilitation. We investigated the relationship between amount of therapy received (from therapists and psychologists) and key patient outcomes during inpatient care.

Design

A secondary analysis of data from a prospective cohort study was performed. Multilevel mixed models adjusting for measured confounders (eg, severity), explored the relationship between therapy dose (average minutes per day of stay) and outcomes (disability, length of stay, home at discharge and mortality). Therapy was explored using simple linear terms and flexible natural cubic splines to allow for more complex relationships.

Setting

Data from the Sentinel Stroke National Audit Programme, covering England, Wales and Northern Ireland between July 2013 and July 2015 contained 94 905 adults with a stroke and still an inpatient after 72 hours. These patients received 92% (physiotherapy), 88% (occupational therapy), 57% (speech and language therapy) and 5% (clinical psychology), respectively.

Results

The average amount of therapy, for individual and ‘any’ therapy combined per day of stay was low. Overall, 41% were discharged with an ‘independent’ modified Rankin Scale (≤2), 14% died, 44% were discharged home, and the median length of stay was 16 days. We observed complex relationships between amount of therapy received and outcomes. An additional minute of ‘any’ therapy, occupational therapy, speech and language therapy and clinical psychology was associated with improved outcomes. Conversely, more physiotherapy was also associated with lower mortality and shorter length of stay, but also lower independence and discharge home.

Conclusions

Our findings suggest for stroke inpatients requiring therapy, ‘More is better’ may be overly simplistic. Strong limitations associated with analysis of routine data restrict further robust investigation of the therapy–response relationship. Robust prospective work is urgently needed to further investigate the relationships observed here.

Antibacterial efficacy and possible mechanism of action of 2-hydroxyisocaproic acid (HICA)

by Amila S. N. W. Pahalagedara, Steve Flint, Jon Palmer, Gale Brightwell, Tanushree B. Gupta

The exploitation of natural antimicrobial compounds that can be used in food preservation has been fast tracked by the development of antimicrobial resistance to existing antimicrobials and the increasing consumer demand for natural food preservatives. 2-hydroxyisocaproic acid (HICA) is a natural compound produced through the leucine degradation pathway and is produced in humans and by certain microorganisms such as lactic acid bacteria and Clostridium species. The present study investigated the antibacterial efficacy of HICA against some important bacteria associated with food quality and safety and provided some insights into its possible antimicrobial mechanisms against bacteria. The results revealed that HICA was effective in inhibiting the growth of tested Gram-positive and Gram-negative bacteria including a multi-drug resistant P. aeruginosa strain in this study. The underlying mechanism was investigated by measuring the cell membrane integrity, membrane permeability, membrane depolarisation, and morphological and ultrastructural changes after HICA treatment in bacterial cells. The evidence supports that HICA exerts its activity via penetration of the bacterial cell membranes, thereby causing depolarisation, rupture of membranes, subsequent leakage of cellular contents and cell death. The current study suggests that HICA has potential to be used as an antibacterial agent against food spoilage and food-borne pathogenic bacteria, targeting the bacterial cell envelope.

Uso y utilidad de planes de cuidados estandarizados con taxonomía NANDA-NIC-NOC en unidades de hospitalización de adultos

Objetivo. Valorar la percepción de las enfermeras que trabajan en unidades de hospitalización de adultos sobre los planes de cuidados estandarizados (PCE) y la taxonomía NANDA-NIC-NOC (NNN) en la práctica asistencial. Material y métodos. Estudio observacional, descriptivo y transversal, realizado con enfermeras de unidades de hospitalización de adultos del Hospital Universitario Reina Sofía de Córdoba y que contaban con una experiencia profesional de 3 meses como mínimo. Fueron seleccionadas mediante muestro no probabilístico accidental. Se ha utilizado un cuestionario modificado de un estudio previo en la materia y se ha realizado análisis descriptivo, bivariante y de regresión múltiple. Resultados. Las enfermeras utilizan los PCE habitualmente, los consideran útiles y piensan que sus compañeras los usan de forma moderadamente correcta. Sin embargo, reflejaron que el lenguaje NNN es poco útil y tuvieron una predisposición alta hacia un lenguaje alternativo. El personal de enfermería con mayor experiencia profesional puntúo más positivamente la frecuencia de uso de PCE (p=0,021). La unidad de Salud Mental destacó porque sus enfermeras valoraron más positivamente las variables sobre los PCE y el lenguaje NNN. Se obtuvo una asociación positiva entre la frecuencia de uso de PCE (variable dependiente) y el uso del lenguaje NNN (OR = 0,564), así como entre nuestra variable dependiente y el uso correcto de PCE (OR = 0,487). Conclusión. Las enfermeras poseen una valoración media tanto de los PCE como del lenguaje estandarizado, siendo esta valoración mayor en la unidad de Salud Mental y entre aquellas enfermeras que utilizan más la NNN y que consideran correcto el uso de PCE.

 

 

ABSTRACT

Objective. To assess the perception of nurses working in adult hospitalisation units on standardised care plans (SCP) and the NANDA-NIC- NOC taxonomy (NNN) in healthcare practice. Methodology. Observational, descriptive, cross-sectional study, carried out with nurses from adult hospitalisation units of the Hospital Universitario Reina Sofía of Córdoba who had at least 3 months' professional experience. They were selected by accidental non-probabilistic sampling. A modified questionnaire from a previous study on the subject was used and descriptive, bivariate and multiple regression analysis was performed. Results. The nurses used the SCP regularly, considered them useful and thought that their colleagues used them moderately correctly. However, they reflected that NNN language is not very useful and had a high predisposition towards alternative language. The nursing staff with more professional experience rated the frequency of use of SCP more positively (p = 0.021). The Mental Health unit stood out because its nurses rated more positively the variables on SCP and NNN language. A positive association was obtained between the frequency of SCP use (dependent variable) and the use of NNN language (OR = 0.564), as well as between our dependent variable and the correct use of SCP (OR = 0.487). Conclusions. The nurses have an average rating of both the PCEs and the standardised language, this rating being higher in the Mental Health unit and among those nurses who use the NNN more and who consider the use of SCP to be correct.

Impacto de la cultura organizacional en las instituciones de salud: énfasis en la seguridad del paciente. Una revisión sistemática

La cultura organizacional, no es igual en todos los ambientes de trabajo, diferentes factores como el entorno, el liderazgo, la educación/entrenamiento pueden impactar positiva o negativamente en el desempeño y resultados de la organización, tales como la seguridad del paciente. Objetivo. Analizar la mejor evidencia disponible que pueda responder cuál es el impacto de la cultura organizacional en los resultados de la medición de cultura de seguridad de paciente en los dominios de comunicación abierta y respuesta no punitiva al error, en las instituciones de salud. Material y Métodos. Revisión sistemática que sigue las recomendaciones de la declaración PRISMA. La estrategia de búsqueda identificó 969 artículos; 356 se excluyeron por duplicación, se revisaron 613 títulos y abstracts, se excluyendo 511, se revisaron 102 estudios completos, de los cuales se descartaron 85, por último se incluyeron en la revisión 17 estudios que cumplen con los criterios de elegibilidad, de los cuales se excluyeron tres por no cumplir requisitos metodológicos. Resultados. El entorno laboral determinado por la satisfacción laboral, horas laborales y el abordaje de la segunda víctima y el liderazgo no punitivo como factor clave para una cultura justa en las instituciones de salud, reportan impacto significativo en los resultados de cultura de seguridad. Conclusión. Los factores como el entorno laboral y el liderazgo, tienen impacto positivo en los resultados de cultura de seguridad y se ve reflejado en mejoras en los dominios de respuesta no punitiva al error y comunicación abierta de la encuesta de cultura de seguridad.

 

 

Abstract

Organizational culture is not the same in all work environments, different factors such as the environment, leadership, education / training can positively or negatively impact the performance and results of the organization, such as patient safety. Objective. To analyse the best available evidence that can answer what is the impact of the organizational culture on the results of the measurement of patient safety culture in the domains of open communication and non-punitive response to error, in health institutions. Material and methods. Systematic review that follows the recommendations of the PRISMA statement. The search strategy identified 969 articles; 356 were excluded due to duplication, 613 titles and abstracts were reviewed, 511 were excluded, 102 complete studies were reviewed, of which 85 were discarded, and finally 17 studies that meet the eligibility criteria were included in the review, of which three were excluded because they did not meet methodological requirements. Results. The work environment determined by job satisfaction, working hours and the approach of the second victim and non-punitive leadership as a key factor for a fair culture in health institutions, report a significant impact on the safety culture results. Conclusion. Factors such as the work environment and leadership have a positive impact on the safety culture results and is reflected in improvements in the domains of non-punitive response to error and open communication of the safety culture survey.

Household food insecurity, maternal nutrition, environmental risks and infants health outcomes: protocol of the IMPALA birth cohort study in Uganda

Por: Terfa · Z. G. · Nantanda · R. · Lesosky · M. · Devereux · G. · Obasi · A. · Mortimer · K. · Khan · J. · Rylance · J. · Niessen · L. W. · IMPALA Consortium · Addo-Yobo · Allwood · Banda · Bates · Binegdie · Sony · Falade · Mbatchou · Meme · Mutayoba · Chakaya · Ntinginya · Bertel Squir
Introduction

In low- and middle-income countries (LMICs), food insecurity and undernutrition disproportionately affect women of reproductive age, infants and young children. The disease burden from undernutrition in these vulnerable sections of societies remains a major concern in LMICs. Biomass fuel use for cooking is also common in LMICs. Empirical evidence from high-income countries indicates that early life nutritional and environmental exposures and their effect on infant lung function are important; however, data from sub-Saharan Africa are scarce.

Aim

To estimate the association between infant lung function and household food insecurity, energy poverty and maternal dietary diversity.

Methods and analysis

Pregnant women will be recruited in an existing Health and Demographic Surveillance Site in South-West Uganda. Household food insecurity, sources and uses of energy, economic measures and maternal dietary diversity will be collected during pregnancy and after birth. Primary health outcomes will be infant lung function determined by tidal breath flow and volume analysis at 6–10 weeks of age. Infant weight and length will also be collected.

A household Food Consumption Score and Minimum Dietary Diversity for Women (MDD-W) indicator will be constructed. The involved cost of dietary diversity will be estimated based on MDD-W. The association between household level and mothers’ food access indicators and infant lung function will be evaluated using regression models. The Multidimensional Energy Poverty Index (MEPI) will be estimated and used as an indicator of households’ environmental exposures. The association between household MEPI and infant lung function will be assessed using econometric models.

Ethics and dissemination

Ethical approvals have been obtained from Liverpool School of Tropical Medicine (18-059), the Uganda Virus Research Institute Ethics Committee (097/2018) and Uganda National Council for Science and Technology (SS 4846). Study results will be shared with participants, policy-makers, other stakeholders and published in peer-reviewed journals.

Associations of statin use with 30-day adverse outcomes among 4 801 406 US Veterans with and without SARS-CoV-2: an observational cohort study

Por: Wander · P. L. · Lowy · E. · Beste · L. A. · Tulloch-Palomino · L. · Korpak · A. · Peterson · A. C. · Kahn · S. E. · Danaei · G. · Boyko · E. J.
Objective

To estimate associations of statin use with hospitalisation, intensive care unit (ICU) admission and mortality at 30 days among individuals with and without a positive test for SARS-CoV-2.

Design

Retrospective cohort study.

Setting

US Veterans Health Administration (VHA).

Participants

All veterans receiving VHA healthcare with ≥1 positive nasal swab for SARS-CoV-2 between 1 March 2020 and 10 March 2021 (cases; n=231 154) and a comparator group of controls comprising all veterans who did not have a positive nasal swab for SARS-CoV-2 but who did have ≥1 clinical lab test performed during the same time period (n=4 570 252).

Main outcomes

Associations of: (1) any statin use, (2) use of specific statins or (3) low-intensity/moderate-intensity versus high-intensity statin use at the time of positive nasal swab for SARS-CoV-2 (cases) or result of clinical lab test (controls) assessed from pharmacy records with hospitalisation, ICU admission and death at 30 days. We also examined whether associations differed between individuals with and without a positive test for SARS-CoV-2.

Results

Among individuals who tested positive for SARS-CoV-2, statin use was associated with lower odds of death at 30 days (OR 0.81 (95% CI 0.77 to 0.85)) but not with hospitalisation or ICU admission. Associations were similar comparing use of each specific statin to no statin. Compared with low-/moderate intensity statin use, high-intensity statin use was not associated with lower odds of ICU admission or death. Over the same period, associations of statin use with 30-day outcomes were significantly stronger among individuals without a positive test for SARS-CoV-2: hospitalisation OR 0.79 (95% CI 0.77 to 0.80), ICU admission OR 0.86 (95% CI 0.81 to 0.90) and death 0.60 (95% CI 0.58 to 0.62; p for interaction all

Conclusions

Associations of statin use with lower adverse 30-day outcomes are weaker among individuals who tested positive for SARS-CoV-2 compared with individuals without a positive test, indicating that statins do not exert SARS-CoV-2 specific effects.

Participatory action research intervention for improving sleep in inpatients with cancer

Abstract

Aim

To design and implement a plan to improve oncohaematological patients’ sleep.

Background

The hospital environment can compromise inpatients’ sleep, negatively impacting on health outcomes and patient satisfaction.

Design and Method

The improvement plan was designed in collaboration with 18 professionals, 3 patients and 3 accompanying relatives. The study designed followed the SQUIRE 2.0 guidelines. Outcome variables were self-reported patient satisfaction regarding sleep, measured using a 30-item, ad hoc questionnaire and a 10-point visual analogue scale, completed by 318 oncohaematological inpatients (pre-intervention n = 120, post-intervention, n = 198) in a comprehensive cancer centre in Spain from 2017 to 2019.

Results

Overall, 61.5% (n = 190) of the inpatients reported sleep alterations, and 92.6% reported interruptions in their nightly sleep. Half slept less than 6 h/night, but 58.0% said they felt rested upon waking, despite the interruptions. These outcomes were similar before and after the intervention. The improvement plan identified four domains for work (professionals, care procedures, instruments/environment and patients/relatives), 10 areas for improvement and 35 actions for implementation.

However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. The intervention significantly improved variables related to professionals’ behaviour, including noise during the shift change, conversations at the control desk and the use of corridor lights. Sleep disturbances were mainly caused by pain/discomfort and infuser alarms, and collectively they decreased significantly after the intervention (= .008). However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale.

Conclusions

Pain, clinical devices and noise made by professionals are the main causes of sleep disturbances. Involving professionals in decision-making to improve patients’ sleep have a positive impact on noise levels.

Relevance to clinical practice

This study proposes new strategies for improving sleep by increasing staff awareness and changing attitudes towards patients’ sleep. Nurses should be involved in addressing sleep disturbances during hospitalization.

The patient's perspective of diabetic foot ulceration: A phenomenological exploration of causes, detection and care seeking

Abstract

Aims

Diabetic foot ulceration can contribute to lowered life expectancy and quality of life for people with diabetes, and yet, scant attention has been given to improving preventive and educational measures. This article uses a phenomenological approach to explore individuals' lived experiences of diabetic foot ulcerations to explore factors that can be harnessed to achieve improved outcomes.

Design

This was a qualitative study using semi-structured interviews grounded in a phenomenological framework to explore how patients perceive and understand their foot problems.

Methods

Study participants were recruited from February 2020 to February 2021 from a tertiary referral centre that treats foot problems in persons with diabetes. A total of 15 Hispanic, Native American and White patients participated in the study. We conducted in-depth semi-structured interviews which were audio recorded with the participant's consent. Interview data were transcribed and analysed with Dedoose data management software.

Results

Analysis revealed findings in two primary domains: (1) how patients perceive foot ulceration, with themes around limited understandings of foot ulceration, close sensory observation of foot problems and barriers to ulcer perception and (2) how patients experience the timing of foot ulceration, with themes on how time perceptions shifted as foot problems became more serious, which correlated closely to how patients responded to their foot problems.

Conclusion

Despite the close sensory observation of their feet, people with diabetes face an array of barriers to recognizing and understanding the implications of diabetic foot ulceration, which can lead to delayed care seeking. Nurses can play a critical role in promoting patient education and improving patient self-management of foot ulcers.

Impact

This phenomenological study offers important lessons to guide nurses and other providers in enhancing patient self-management of DFUs and improving care outcomes by expanding an understanding of DFU early warning signs, the imperative to seek medical care quickly, and addressing possible barriers.

Co-infection of Hepatitis B and Hepatitis C among HIV-infected patients: A cross-sectional study from tertiary care hospital of eastern Nepal

by Lok Bahadur Shrestha, Gopal K. Yadav, Saugat Pradhan, Abhilasha Sharma, Tejendra Pandit, Roshan Chhetry, Basudha Khanal

Introduction

This study was conducted with an objective to analyze prevalence and risk factors associated with co-infection of hepatitis B virus (HBV) and hepatitis C virus (HCV) in HIV-positive patients with reference to their CD4+ T cell status.

Materials and methods

HIV-positive patients visiting the HIV clinic for CD4+ T cells testing at B.P. Koirala Institute of Health Sciences were tested for Hepatitis B and Hepatitis C. Data regarding age, gender, mode of HIV transmission, duration of HIV diagnosis, antiretroviral therapy status, antiretroviral therapy duration, hepatitis B or C status, and CD4+ T cells count were collected via face-to-face interview, and hospital records. The data were entered in Microsoft Excel 2019 v16.0 (Microsoft, WA, USA) and statistical analysis was performed by using statistical package for social sciences, IBM SPSS® v21 (IBM, Armonk, New York).

Results

Out of 474 HIV-positive patients, HIV-HBV, HIV-HCV, and HIV-HBV-HCV co-infections were seen in 2.95% (14/474), 18.14% (86/474), and 2.53% (12/474) respectively. The primary route of infection was intra-venous drug use (IVDU) in those co-infected with HBV only (8, 57.14%), HCV only (46, 53.49%), and both HBV and HCV (8, 66.67%). HIV patients infected via IVDU were 2.40 times more likely to have HIV-HCV co-infection as compared to those infected via sexual route (AOR 2.40, 95% CI: 1.49,3.86). Similarly, HIV patients with CD4+ T cells count less than 350 cells/mm3 were more likely to have HIV-HBV-HCV co-infection as compared to those with CD4 count equal to and more than 350 cells/mm3 (AOR 13.84, 95% CI: 2.90,66.10).

Conclusion

HIV-positive patients are at high risk of hepatitis B and/or hepatitis C co-infection. Intravenous drug use, and lower CD4+T cells count are the most important risk predictors of co-infection. All HIV-positive patients should be carefully screened with hepatitis B and hepatitis C tests during their follow-up.

Guilt, tears and burnout—Impact of UK care home restrictions on the mental well‐being of staff, families and residents

Abstract

Aims

The aim of this study was to explore the impact of the pandemic on the emotional and mental well-being of family carers, care home staff and residents, in light of changing restrictions, increased testing and vaccination rollout in the UK.

Design

Longitudinal, qualitative semi-structured interview study.

Methods

Remote semi-structured interviews were conducted with family carers of care home residents with dementia and care home staff from different care homes across the UK. Baseline and follow-up interviews were conducted in October/November 2020 and March 2021, respectively. Data were analysed using inductive thematic analysis involving members of the public with caring experiences.

Results

In all, 42 family carers and care home staff participated at baseline, with 20 family carers and staff followed up. We identified four themes: (1) Developing anger and frustration; (2) Impact on relationships; (3) Stress and burnout; and (4) Behavioural changes, and perceived impact on residents. The mental health of everyone involved, including family carers, care home staff and residents, has been negatively affected, and relationships between family carers and staff have been severely strained. There was a general lack of adequate mental health support, with little relief.

Conclusions

The pandemic has had a detrimental impact on the lives of those surrounding care homes—from residents and staff to family carers. Consideration should be given on how to best support the mental health needs of all three groups, by providing adequate easily accessible mental health care for all. This should also focus on rebuilding the relationships between family carers and care home staff.

Impact

This is the first paper to highlight the effects of the long-lasting and miscommunicated restrictions on residents, carers and care home staff, and highlight the urgent need for continued mental health support.

Life and death of a leprosy sufferer from the 8<sup>th</sup>-century-CE cemetery of Kiskundorozsma–Kettőshatár I (Duna-Tisza Interfluve, Hungary)—Biological and social consequences of having Hansen’s disease in a late Avar Age populati

by Olga Spekker, Balázs Tihanyi, Luca Kis, Csaba Szalontai, Tivadar Vida, György Pálfi, Antónia Marcsik, Erika Molnár

The aim of our paper is to demonstrate a middle-aged male (KK61) from the 8th-century-CE cemetery of Kiskundorozsma–Kettőshatár I (Duna-Tisza Interfluve, Hungary), who appears to represent the lepromatous form of Hansen’s disease. Leprosy has affected not only the rhinomaxillary region of his face but also his lower limbs, with severe deformation and disfigurement of the involved anatomical areas (saddle-nose and flat-foot deformity, respectively). Consequently, he would have experienced disability in performing the basic activities of daily living, such as eating, drinking, standing or walking; and thus, he would have required regular and substantial care from others to survive. Despite his very visible disease and associated debility, it seems that KK61 was accepted as a member of the community in death, since he has been buried within the cemetery boundaries, among others from his community. In addition, his grave has conformed to the mortuary practices characteristic of the Kiskundorozsma–Kettőshatár I cemetery (e.g., burial orientation, position of the body in the grave, and type and quantity of accompanying grave goods). Although distinction or segregation in life do not preclude normative treatment in death, the long-lasting survival of KK61 with Hansen’s disease implies that he would not have been abandoned but cared for by others. KK61 is one of the few published historic cases with leprosy from the Avar Age of the Hungarian Duna-Tisza Interfluve. His case gives us a unique insight into the biological consequences of living with Hansen’s disease and illustrates the social attitude toward leprosy sufferers in early mediaeval Hungary.

Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study)

Por: Johnson · M. I. · Paley · C. A. · Jones · G. · Mulvey · M. R. · Wittkopf · P. G.
Objective

To investigate the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for relief of pain in adults.

Design

Systematic review and meta-analysis.

Data sources

Medline, Cochrane Central, Embase (and others) from inception to July 2019 and updated on 17 May 2020.

Eligibility criteria for study selection

Randomised controlled trials (RCTs) comparing strong non-painful TENS at or close to the site of pain versus placebo or other treatments in adults with pain, irrespective of diagnosis.

Data extraction and synthesis

Reviewers independently screened, extracted data and assessed risk of bias (RoB, Cochrane tool) and certainty of evidence (Grading and Recommendations, Assessment, Development and Evaluation). Mean pain intensity and proportions of participants achieving reductions of pain intensity (≥30% or >50%) during or immediately after TENS. Random effect models were used to calculate standardised mean differences (SMD) and risk ratios. Subgroup analyses were related to trial methodology and characteristics of pain.

Results

The review included 381 RCTs (24 532 participants). Pain intensity was lower during or immediately after TENS compared with placebo (91 RCTs, 92 samples, n=4841, SMD=–0·96 (95% CI –1·14 to –0·78), moderate-certainty evidence). Methodological (eg, RoB, sample size) and pain characteristics (eg, acute vs chronic, diagnosis) did not modify the effect. Pain intensity was lower during or immediately after TENS compared with pharmacological and non-pharmacological treatments used as part of standard of care (61 RCTs, 61 samples, n=3155, SMD = –0·72 (95% CI –0·95 to –0·50], low-certainty evidence). Levels of evidence were downgraded because of small-sized trials contributing to imprecision in magnitude estimates. Data were limited for other outcomes including adverse events which were poorly reported, generally mild and not different to comparators.

Conclusion

There was moderate-certainty evidence that pain intensity is lower during or immediately after TENS compared with placebo and without serious adverse events.

PROSPERO registration number

CRD42019125054.

Qualitative analysis of the impact of the SARS-CoV-2 pandemic response on paediatric health services in North of Scotland and North of England

Por: Gadsby · E. W. · Christie-de Jong · F. · Bhopal · S. · Corlett · H. · Turner · S.
Objective

To capture the extent and impact of changes in the delivery of child health services in the UK, resulting from the SARS-CoV-2 pandemic response, from the perspectives of a range of child healthcare providers.

Setting

National Health Service commissioned/delivered healthcare services in two regional settings in the UK: North of Scotland (NOS) and North East and North Cumbria (NENC) in England.

Participants

Purposive sample of 39 child healthcare professionals including paediatricians, community/specialist nurses, allied health professionals and mental health professionals, from across the two regions (22 in NOS, 17 in NENC).

Methods

Semistructured qualitative interviews conducted via telephone between June and October 2020, fully transcribed and analysed in NVivo V.11 using thematic analysis.

Results

Extensive changes across a range of paediatric services were rapidly implemented to support the pandemic response and ongoing healthcare delivery. New ways of working emerged, principally to control the spread of the virus. Keeping users and their families out of hospital was an urgent driver for change. The changes had considerable impact on the health and well-being of staff with many experiencing radical changes to their working conditions and roles. However, there were some positive changes noted: some practitioners felt empowered and listened to by decision makers; some of the usual bureaucratic barriers to change were lifted; staff saw improved collaboration and joint working across the system; and some new ways of working were seen to be more efficient. Interviewees perceived the implications for children and their families to be profound, particularly with regard to self-care, relationships with practitioners and timely access to services.

Conclusions

Despite the challenges experienced by staff, the pandemic provided an opportunity for positive, lasting change. It is vital to capitalise on this opportunity to benefit patient outcomes and to ‘build back’ services in a more sustainable way.

Assessing tobacco smoke exposure in pregnancy from self-report, urinary cotinine and NNAL: a validation study using the New Hampshire Birth Cohort Study

Por: Peacock · J. L. · Palys · T. J. · Halchenko · Y. · Sayarath · V. · Takigawa · C. A. · Murphy · S. E. · Peterson · L. A. · Baker · E. R. · Karagas · M. R.
Objectives

Accurate assessment of tobacco smoke exposure is key to evaluate its effects. We sought to validate and establish cut-offs for self-reported smoking and secondhand smoke (SHS) exposure during pregnancy using urinary cotinine and 4-(methylnitrosamino)-1-(-3-pyridyl)-1-butanol (NNAL) in a large contemporary prospective study from the USA, with lower smoking prevalence than has previously been evaluated.

Design

Prospective birth cohort.

Setting

Pregnancy clinics in New Hampshire and Vermont, USA.

Participants

1396 women enrolled in the New Hampshire Birth Cohort Study with self-reported smoking, urinary cotinine, NNAL and pregnancy outcomes.

Primary and secondary outcome measures

Cut-offs for urinary cotinine and NNAL concentrations were estimated from logistic regression models using Youden’s method to predict SHS and active smoking. Cotinine and NNAL were each used as the exposure in separate multifactorial models for pregnancy outcomes.

Results

Self-reported maternal smoking was: 72% non-smokers, 5.7% ex-smokers, 6.4% SHS exposure, 6.2% currently smoked, 10% unreported. Cotinine and NNAL levels were low and highly intercorrelated (r=0.91). Geometric mean cotinine, NNAL were 0.99 ng/mL, 0.05 pmol/mL, respectively. Cotinine cut-offs for SHS, current smoking were 1.2 ng/mL and 1.8 ng/mL (area under curve (AUC) 95% CI: 0.52 (0.47 to 0.57), 0.90 (0.85 to 0.94)). NNAL cut-off for current smoking was 0.09 pmol/mL (AUC=0.82 (95% CI 0.77 to 0.87)). Using cotinine and NNAL cut-offs combined gave similar AUC to cotinine alone, 0.87 (95% CI 0.82 to 0.91). Cotinine and NNAL gave almost identical effect estimates when modelling pregnancy outcomes.

Conclusions

In this population, we observed high concordance between self-complete questionnaire smoking data and urinary cotinine and NNAL. With respect to biomarkers, either cotinine or NNAL can be used as a measure of tobacco smoke exposure overall but only cotinine can be used to detect SHS.

Core elements and potential of nurse‐led care models in residential long‐term care: A scoping review

Abstract

Aims and objective

To identify and summarise core elements, resident-, staff- and process-related outcomes and challenges of nurse-led care models in residential long-term care.

Background

Due to demographic trends, the complexity of residential long-term care has increased. To address this complexity, the implementation of nurse-led care models has been recommended.

Design

Scoping review.

Methods

A systematic search was conducted of English and German articles in CINAHL via EBSCO, MEDLINE via PubMed, Cochrane Library and Scopus. Forward and backward citation tracking via reference lists and Google Scholar supplemented the search. The final update was made on 19 January 2021. To draw conclusions about the potential of nurse-led care models, evaluation studies of the described models for residents in nursing homes were included. Full texts were independently screened and assessed for methodological quality. Data were extracted and summarised in tables and synthesised for analysis. The core elements of the models were described using the Sustainable intEgrated chronic care modeLs for multimorbidity: delivery, FInancing and performancE (SELFIE) framework. The review followed the PRISMA-ScR guideline.

Results

We included 13 studies of 12 nurse-led care models. The different models comprised many of the core elements suggested in the SELFIE framework, particularly in the components service delivery, workforce, and leadership and governance. The studies reported a broad range of resident-, staff- and process-related outcomes and challenges considered relevant to the success of the models.

Conclusions

Studies evaluating nurse-led care models in nursing homes are limited and of moderate quality. This review demonstrates that nurse-led care models include many elements for care coordination and could improve resident-, staff- and process-related outcomes.

Relevance to clinical practice

This review highlights that nurse-led care models share common core elements despite their heterogeneity. It also shows that highly qualified nurses in nurse-led care models can advance nursing practice in nursing homes.

Factors associated with recruitment success in the phase 2a study of aztreonam-avibactam development programme: a descriptive qualitative analysis among sites in Spain

Por: Jimenez-Rodriguez · R. M. · Martin-Gutierrez · G. · Jimenez-Jorge · S. · Rosso-Fernandez · C. M. · Tallon-Aguilar · L. · Roca-Oporto · C. · Padillo · J. · Luckey · A. · Cano · A. · Lopez-Ruiz · J. · Gomez-Zorrilla · S. · Bonnin-Pascual · J. · Boix-Palop · L. · Montejo · J. M. · Tor
Objective

Successful clinical trials are subject to recruitment. Recently, the REJUVENATE trial, a prospective phase 2a open-label, single-arm interventional clinical trial conducted within the Innovative Medicines Initiative-supported Combatting Bacterial Resistance in Europe-Carbapenem Resistance project, was published, with 85% of the recruitment performed in Spain. We analysed the recruitment success in this trial by establishing a model of recruitment practice.

Methods

A descriptive qualitative study was performed from May 2016 to October 2017 at 10 participating Spanish centres. Data were extracted from: (1) feasibility questionnaires to assess the centre’s potential for patient enrolment; (2) delegation of responsibility records; (3) pre-screening records including an anonymised list of potentially eligible and (4) screening and enrolment records. A descriptive analysis of the features was performed by the participating centre. Pearson’s and Spearman’s correlation coefficients were calculated to determine factors of recruitment success.

Results

The highest recruitment rate was observed in Hospitals 3 and 6 (58.8 and 47.0 patients per month, respectively). All the study teams were multidisciplinary with a median of 15 members (range: 7–22). Only Hospitals 3, 5 and 6 had dedicated nursing staff appointed exclusively to this study. Moreover, in those three hospitals and in Hospital 9, the study coordinator performed exclusive functions as a research planner, and did not assume these functions for the other hospitals. The univariate analysis showed a significant association between recruitment success and months of recruitment (p=0.024), number of staff (p

Conclusions

The existence of broad multidisciplinary teams with staff dedicated exclusively to the study as well as the implementation of a well-designed local patient assessment strategy were the essential optimisation factors for recruitment success in Spain.

Trial registration number

NCT02655419; EudraCT 2015-002726-39; analysis of pre-screened patients.

Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: a scoping review

Por: Herke · M. · Moor · I. · Winter · K. · Hack · M. · Hoffmann · S. · Spallek · J. · Hilger-Kolb · J. · Herr · R. · Pischke · C. · Dragano · N. · Novelli · A. · Richter · M.
Objectives

To synthesise the evidence on the role of compositional or contextual characteristics of schools in the association between students' socioeconomic position and their health in primary and secondary education in developed economies.

Design

Scoping review. We included studies examining the role of at least one school or class characteristic on students’ health inequalities and was published since 1 January 2000, in English or German. We searched PubMed/Medline, Web of Science and Education Resources Information Center. We provided a narrative synthesis and an overview of findings. School characteristics were grouped into five broad categories: school composition, school climate, school policies and organisation, food environment and facilities.

Results

Of 8520 records identified, 26 studies were included. Twelve studies found a moderating and 3 a mediating effect. The strongest evidence came from studies examining the moderating effect of school composition, that is, the negative impact of a low individual socioeconomic position on mental health and well-being was aggravated by a low average socioeconomic position of schools. Evidence concerning the role of school climate, school stratification (eg, performance base tracking) and sponsorship, food environment and sport facilities and equipment was generally weak or very weak and mostly based on singular findings. Overall, favourable meso-level characteristics mitigated the negative impact of low individual socioeconomic position on health outcomes.

Conclusions

School characteristics affect health inequalities in children and adolescents to some degree, but future research is necessary to strengthen the existing evidence and address under-represented aspects in school characteristics and health outcomes.

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