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Effect of electronic health interventions on metabolic syndrome: a systematic review and meta-analysis

Por: Chen · D. · Ye · Z. · Shao · J. · Tang · L. · Zhang · H. · Wang · X. · Qiu · R. · Zhang · Q.
Objective

We aimed to examine whether eHealth interventions can effectively improve anthropometric and biochemical indicators of patients with metabolic syndrome (MetS).

Design

Systematic review and meta-analysis.

Methods

PubMed, the Web of Science, Embase, Medline, CINAHL, PsycINFO, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Wanfang and Weipu databases were comprehensively searched for papers that were published from database inception to May 2019. Articles were included if the participants were metabolic syndrome (MetS) patients, the participants received eHealth interventions, the participants in the control group received usual care or were wait listed, the outcomes included anthropometric and biochemical indicators of MetS, and the study was a randomised controlled trial (RCT) or a controlled clinical trial (CCT). The Quality Assessment Tool for Quantitative Studies was used to assess the methodological quality of the included articles. The meta-analysis was conducted using Review Manager V.5.3 software.

Results

In our review, seven RCTs and two CCTs comprising 935 MetS participants met the inclusion criteria. The results of the meta-analysis revealed that eHealth interventions resulted in significant improvements in body mass index (standardised mean difference (SMD)=–0.36, 95% CI (–0.61 to –0.10), p

Conclusions

The results indicated that eHealth interventions were beneficial for improving specific anthropometric outcomes, but did not affect biochemical indicators of MetS. Therefore, whether researchers adopt eHealth interventions should be based on the purpose of the study. More rigorous studies are needed to confirm these findings.

Anxiety levels, precautionary behaviours and public perceptions during the early phase of the COVID-19 outbreak in China: a population-based cross-sectional survey

Por: Qian · M. · Wu · Q. · Wu · P. · Hou · Z. · Liang · Y. · Cowling · B. J. · Yu · H.
Objective

To investigate psychological and behavioural responses to COVID-19 among the Chinese general population.

Design, setting and participants

We conducted a population-based mobile phone survey between 1 February and 10 February 2020 via random digit dialling. A total of 1011 adult residents in Wuhan (n=510), the epicentre and quarantined city, and Shanghai (n=501) were interviewed. Proportional quota sampling and poststratification weighting were used. Multivariable logistic regression models were used to investigate perception factors associated with the public responses.

Primary outcome measures

We measured anxiety levels using the 7-item Generalised Anxiety Disorder Scale (GAD-7) and asked respondents to report their precautionary behaviours before and during the outbreak.

Results

The prevalence of moderate or severe anxiety was significantly higher (p

Conclusions

Prevalence of moderate or severe anxiety and strict personal precautionary behaviours was generally high, regardless of the quarantine status. Our results support efforts for handwashing education programmes with a focus on hygiene procedures in China and timely dissemination of reliable information.

Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia

Por: Arora · N. · Hanson · K. · Spicer · N. · Estifanos · A. S. · Keraga · D. W. · Welearegay · A. T. · Tela · F. G. · Hussen · Y. A. · Mandefro · Y. S. · Quaife · M.
Objectives

The motivation and retention of community health workers (CHWs) is a challenge and inadequately addressed in research and policy. We sought to identify factors influencing the retention of CHWs in Ethiopia and ways to avert their exit.

Design

A qualitative study was undertaken using in-depth interviews with the study participants. Interviews were audio-recorded, and then simultaneously translated into English and transcribed for analysis. Data were analysed in NVivo 12 using an iterative inductive-deductive approach.

Setting

The study was conducted in two districts each in the Tigray and Southern Nations, Nationalities and People’s Republic (SNNPR) regions in Ethiopia. Respondents were located in a mix of rural and urban settings.

Participants

Leavers of health extension worker (HEW) positions (n=20), active HEWs (n=16) and key informants (n=11) in the form of policymakers were interviewed.

Results

We identified several extrinsic and intrinsic motivational factors affecting the retention and labour market choices of HEWs. While financial incentives in the form of salaries and material incentives in the form of improvements to health facility infrastructure, provision of childcare were reported to be important, non-material factors like HEWs’ self-image, acceptance and validation by the community and their supervisors were found to be critical. A reduction or loss of these non-material factors proved to be the catalyst for many HEWs to leave their jobs.

Conclusion

Our study contributes new empirical evidence to the global debate on factors influencing the motivation and retention of CHWs, by being the first to include job leavers in the analysis. Our findings suggest that policy interventions that appeal to the social needs of CHWs can prove to be more acceptable and potentially cost-effective in improving their retention in the long run. This is important for government policymakers in resource constrained settings like Ethiopia that rely heavily on lay workers for primary healthcare delivery.

Impacts of social support on the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis

Por: Wen · S. · Yin · J. · Sun · Q.
Objective

To assess the effectiveness of social support on treatment success promotion or lost to follow-up (LTFU) reduction for patients with drug-resistant tuberculosis (DR-TB).

Design

We searched Pubmed, Web of Science, Embase, Scopus and Medline databases until 18 June 2020 for interventional or mixed-method studies which reported social support and treatment outcomes of DR-TB patients. Two independent reviewers extracted data and disagreements were resolved by consensus with a third reviewer. Random-effects meta-analysis was performed to calculate the OR and 95% CI for the effects of social support on the improvement of treatment outcomes and the heterogeneity and risk of bias were assessed.

Setting

Low-income and middle-income countries.

Participants

DR-TB patients.

Outcomes

Treatment success is defined as the combination of the cured and treatment completion, and LTFU is measured as treatment being interrupted for two consecutive months or more.

Results

Among 173 articles selected for full-text review, 162 were excluded through independent review (kappa=0.87) and 10 studies enrolling 1621 DR-TB patients in eight countries were included for qualitative analysis. In these studies, the most frequently introduced social support was material support (10 studies), followed by informational (eight studies), emotional (seven studies) and companionship support (four studies). Seven studies that reported treatment outcomes in both intervention arm and control arm are qualified for meta-analysis. An encouraging improvement on treatment success rate (OR: 2.58; 95% CI: 1.80 to 3.69) was found when material support was integrated into social support packages and no heterogeneity was observed (I1 of 0%, Q test p=0.72). Reduction on LTFU rate (OR: 0.17; 95% CI: 0.05 to 0.55) was also noted when material support was available but substantial heterogeneity was found (I2 of 80%, Q test p=0.002).

Conclusion

Material support appeared feasible and effective to improve treatment success for DR-TB patients combined with other social support interventions.

PROSPERO registration number

CRD42019140824.

'Hobsons choice: a qualitative study of consent in acute surgery

Por: Howard · A. · Webster · J. · Quinton · N. · Giannoudis · P. V.
Objectives

The study aimed to understand through qualitative research what patients considered material in their decision to consent to an acute surgical intervention.

Participants, setting and intervention

The patients selected aged between 18 and 90, having been admitted to a major trauma centre to undergo an acute surgical intervention within 14 days of injury, where English was their first language. Data saturation point was reached after 21 patients had been recruited. Data collection and analysis were conducted simultaneously, through interviews undertaken immediately prior to surgery. The data were coded using NVIVO V.12 software.

Results

The key theme that originated from the data analysis was patients were unable to identify any individual risk that would modify their decision-making process around giving consent. The patient’s previous experience and the experience of others around them were a further theme. Patients sensed that there were no non-operative options for their injuries.

Conclusion

This is the first study investigating what patient considered a material risk in the consent process. Patients in this study did attribute significance to past experiences of friends and family as material, prompting us to suggest that the surgeon asks about these experiences as part of the consent process. Concern about functional recovery was important to patients but insufficient to stop them from consenting to surgery, thus could not be classified as material risk.

Effect of endotracheal tube plus stylet versus endotracheal tube alone on successful first-attempt tracheal intubation among critically ill patients: the multicentre randomised STYLETO study protocol

Por: Jaber · S. · Rolle · A. · Jung · B. · Chanques · G. · Bertet · H. · Galeazzi · D. · Chauveton · C. · Molinari · N. · De Jong · A.
Introduction

Tracheal intubation is one of the most daily practiced procedures performed in intensive care unit (ICU). It is associated with severe life-threatening complications, which can lead to intubation-related cardiac arrest. Using a preshaped endotracheal tube plus stylet may have potential advantages over endotracheal tube without stylet. The stylet is a rigid but malleable introducer which fits inside the endotracheal tube and allows for manipulation of the tube shape; to facilitate passage of the tube through the laryngeal inlet. However, some complications from stylets have been reported including mucosal bleeding, perforation of the trachea or oesophagus and sore throat. The use of a stylet for first-attempt intubation has never been assessed in ICU and benefit remains to be established.

Methods and analysis

The endotracheal tube plus stylet to increase first-attempt success during orotracheal intubation compared with endotracheal tube alone in ICU patients (STYLETO) trial is an investigator-initiated, multicentre, stratified, parallel-group unblinded trial with an electronic system-based randomisation. Patients will be randomly assigned to undergo the initial intubation attempt with endotracheal tube alone (ie,without stylet, control group) or endotracheal tube + stylet (experimental group). The primary outcome is the proportion of patients with successful first-attempt orotracheal intubation. The single, prespecified, secondary outcome is the incidence of complications related to intubation, in the hour following intubation. Other outcomes analysed will include safety, exploratory procedural and clinical outcomes.

Ethics and dissemination

The study project has been approved by the appropriate ethics committee ‘Comité-de-Protection-des-Personnes Nord-Ouest3-19.04.26.65808 Cat2 RECHMPL19_0216/STYLETO2019-A01180-57’". Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If combined use of endotracheal tube plus stylet facilitates tracheal intubation of ICU patients compared with endotracheal tube alone, its use will become standard practice, thereby decreasing first-attempt intubation failure rates and, potentially, the frequency of intubation-related complications.

Trial registration details

ClinicalTrials.gov Identifier: NCT04079387; Pre-results.

Evaluation of cytokines as a biomarker to distinguish active tuberculosis from latent tuberculosis infection: a diagnostic meta-analysis

Por: Qiu · B. · Liu · Q. · Li · Z. · Song · H. · Xu · D. · Ji · Y. · Jiang · Y. · Tian · D. · Wang · J.
Objectives

With a marginally effective vaccine and no significant breakthroughs in new treatments, a sensitive and specific method to distinguish active tuberculosis from latent tuberculosis infection (LTBI) would allow for early diagnosis and limit the spread of the pathogen. The analysis of multiple cytokine profiles provides the possibility to differentiate the two diseases.

Design

Systematic review and meta-analysis.

Data sources

PubMed, Cochrane Library, Clinical Key and EMBASE databases were searched on 31 December 2019.

Eligibility criteria

We included case–control studies, cohort studies and randomised controlled trials considering IFN-, TNF-α, IP-10, IL-2, IL-10, IL-12 and VEGF as biomarkers to distinguish active tuberculosis and LTBI.

Data extraction and synthesis

Two students independently extracted data and assessed the risk of bias. Diagnostic OR, sensitivity, specificity, positive and negative likelihood ratios and area under the curve (AUC) together with 95% CI were used to estimate the diagnostic value.

Results

Of 1315 records identified, 14 studies were considered eligible. IL-2 had the highest sensitivity (0.84, 95% CI: 0.72 to 0.92), while VEGF had the highest specificity (0.87, 95% CI: 0.73 to 0.94). The highest AUC was observed for VEGF (0.85, 95% CI: 0.81 to 0.88), followed by IFN- (0.84, 95% CI: 0.80 to 0.87) and IL-2 (0.84, 95% CI: 0.81 to 0.87).

Conclusion

Cytokines, such as IL-2, IFN- and VEGF, can be utilised as promising biomarkers to distinguish active tuberculosis from LTBI.

PROSPERO registration number

CRD42020170725.

Health, illness and healthcare-seeking behaviour of the street dwellers of Dhaka City, Bangladesh: qualitative exploratory study

Por: Tune · S. N. B. K. · Hoque · R. · Naher · N. · Islam · N. · Mazedul Islam · M. · Ahmed · S. M.
Objective

This study explored the illness experiences and healthcare-seeking behaviour of a cross-section of street dwellers of Dhaka City for designing a customised intervention.

Design

A qualitative exploratory study of a sample of street dwellers of Dhaka City.

Setting

Samples were taken from three purposively selected spots of Dhaka City with a high concentration of the target population.

Participants

Fifteen in-depth interviews and six informal group discussions with 40 street dwellers (≥18 years), and key informant interviews with service providers (n=6) and policymakers (n=3) were conducted during January–June 2019 to elicit necessary data.

Primary outcome measures

Qualitative narrative of illness experiences of the sampled street dwellers, relevant healthcare-seeking behaviour and experiences of interactions with health systems.

Results

We focused on three main themes, namely, reported illnesses, relevant healthcare-seeking behaviour and health system experiences of the street dwellers. Findings reveal that most of the street dwellers suffered from fever and respiratory illnesses in the last 6 months; however, a majority did not visit formal facilities. They preferred visiting retail drug shops for advice and treatment or waited for self-recovery. Formal facilities were visited only when treatment from drug shops failed to cure them or they suffered serious illnesses or traumatic injury. The reproductive-age women did not seek pregnancy care and most deliveries took place in the street dwellings. Lack of awareness, financial constraints and fear of visiting formal facilities were some of the reasons mentioned. Those who visited formal facilities faced barriers like the cost of medicines and diagnostic tests, long waiting time and opportunity cost.

Conclusions

The street dwellers lacked access to formal health systems for needed services as the latter lags far behind to outreach this extremely vulnerable population. What they need is explicit targeting with a customised package of services based on their illness profile, at a time and place convenient to them with minimum or no cost implications.

Acupuncture for chronic cancer-related pain: a systematic review and network meta-analysis protocol

Por: Yang · J. · Xu · G. · Yin · Z. · Cheng · Y. · Sun · S. M. · Zheng · Q. · Chen · J. · Liang · F.-r. · Zhao · L.
Introduction

Chronic cancer-related pain is one of the most common excruciating symptom that can be caused by the cancer (by the primary tumour or by metastases) or by its treatment (surgery, chemotherapy and radiotherapy). Although multiple clinical trials and systematic reviews have suggested that acupuncture could be effective in treating chronic cancer-related pain, the comparative efficacy and safety of these acupuncture methods remains unclear. We, therefore, performed this study to evaluate and rank the efficacy and safety of different acupuncture methods for chronic cancer-related pain.

Methods and analysis

Seven databases will be searched, including Cochrane Library, MEDLINE, Embase, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, the Chongqing VIP Chinese Science and Technology Periodical Database and Chinese Biomedical Literature Database (CBM) from their inception to March 2020. The primary outcome is the change of pain intensity. Bayesian network meta-analysis will be conducted using software R3.5.1. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation System (GRADE) to assess the quality of evidence.

Ethics and dissemination

Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publication.

PROSPERO registration number

CRD42020165747

Do measures of physical function enhance the prediction of persistent pain and disability following a whiplash injury? Protocol for a prospective observational study in Spain

Por: Alalawi · A. · Luque-Suarez · A. · Fernandez-Sanchez · M. · Gallina · A. · Evans · D. · Falla · D.
Introduction

Not all factors that predict persistent pain and disability following whiplash injury are known. In particular, few physical factors, such as changes in movement and muscle behaviour, have been investigated. The aim of this study is to identify predictive factors that are associated with the development of persistent pain and disability following a whiplash injury by combining contemporary measures of physical function together with established psychological and pain-related predictive factors.

Methods and analysis

A prospective observational study will recruit 150 consecutive eligible patients experiencing whiplash-related symptoms, admitted to a private physiotherapy clinic in Spain within 15 days of their whiplash injury. Poor outcome will be measured using the Neck Disability Index (NDI), defined as an NDI score of 30% or greater at 6 months post injury. Candidate predictors, including demographic characteristics, injury characteristics, pain characteristics, self-reported psychosocial factors and physical factors, will be collected at baseline (within 15 days of inception). Regression analyses will be performed to identify factors that are associated with persistent neck pain and disability over the study period.

Ethics and dissemination

The project has been approved by the Ethics Committee of the province of Malaga, Spain (#30052019). The results of this study will be published in peer-reviewed journals.

Cross-sectional study of dengue-related knowledge, attitudes and practices in Villa El Salvador, Lima, Peru

Por: Elson · W. H. · Ortega · E. · Kreutzberg-Martinez · M. · Jacquerioz · F. · Cabrera · L. N. · Oberhelman · R. A. · Paz-Soldan · V. A.
Objectives

To describe and quantify the dengue-related knowledge, attitudes and practices of residents in an urban shantytown in Lima, Peru.

Design/setting

A cross-sectional survey of adults between 18 and 80 years living in approximately 120 blocks in Oasis, an urban shantytown situated in the low-to-middle income district of Villa El Salvador in Southern Lima. The survey was adapted from an existing survey previously used in Iquitos, Peru, and included questions relating to knowledge of dengue symptoms, transmission, prevention and current mosquito control practices.

Participants

A total of 240 surveys were completed with 80% of respondents being female and approximately 50% of all respondents describing themselves as housewives.

Results

Although 97.9% of respondents had heard of dengue, only 6.2% of people knew someone who had experienced the disease. Approximately half (54.2%) of the respondents knew dengue was transmitted by mosquitoes and 51.7% were able to identify fever and one other correct symptom of dengue. Female sex was significantly associated with greater symptom knowledge (OR 2.22, 95% CI 1.08 to 4.72) and prevention knowledge (OR 2.12, 95% CI 1.06 to 4.21). Past or current higher education attendance was significantly associated with symptom knowledge (OR 2.56, 95% CI 1.25 to 5.44) and transmission knowledge (OR 3.46, 95% CI 1.69 to 7.57). Knowledge of dengue was not significantly associated with carrying out practices to control mosquitoes (OR 1.76, 95% CI 0.87 to 3.54).

Conclusions

This population demonstrated baseline dengue knowledge. However, this was incomplete and substantially less when compared with endemic areas. Given the sporadic nature of dengue transmission in Lima, it is not surprising that knowledge of the disease was not associated with carrying out practices to reduce mosquitoes. However, as dengue transmission in Lima is likely to increase, understanding how best to improve public knowledge of the disease and how to translate this into appropriate community action will be a key public health consideration.

5-HT3 receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials

Por: Shen · Q.-H. · Li · H.-F. · Zhou · X. · Lu · Y. · Yuan · X.-Z.
Objective

Perioperative shivering (POS) is a common complication in patients undergoing spinal anaesthesia. The present study investigated the efficacy of 5-HT3 receptor antagonists in preventing POS following spinal anaesthesia.

Design

Systematic review and meta-analysis.

Data sources

Pubmed, Embase, the Web of Science and Cochrane Library were searched from database establishment on 31 July 2019.

Eligibility criteria

Randomised controlled trials that reported the effects of 5-HT3 receptor antagonists in the prevention of POS in patients after spinal anaesthesia.

Data extraction and synthesis

Two reviewers independently extracted data. The primary outcome of the present study was the incidence of POS. The risk of bias for the included studies was assessed according to the Cochrane Handbook. The quality of primary outcome was evaluated by Grading of Recommendations Assessment, Development and Evaluation. Trial sequential analysis for the primary outcome was performed to reduce the type 1 error caused by repeated meta-analysis and the required information size was calculated.

Results

A total of 13 randomised controlled trials consisting of 1139 patients were included. The overall incidence of POS was significantly lower in the 5-HT3 receptor antagonists group (risk ratio 0.31; 95% CI 0.26 to 0.38; p2=0%). Subgroup analysis for different types of 5-HT3 receptor antagonists and timing of administration produced similar results. Also, patients had a lower incidence of postoperative nausea and vomiting after administrating 5-HT3 receptor antagonists. No statistically significant differences in drug-related adverse effects were observed. Grading of Recommendations Assessment, Development and Evaluation revealed a high level of evidence. The cumulative z-curve crossed the trial sequential monitoring boundary.

Conclusions

The present study revealed that prophylactic 5-HT3 receptor antagonists were an effective measure for reducing the incidence of POS in patients after spinal anaesthesia. However, further studies investigating the different types of surgeries are required.

PROSPERO registration number

CRD42019148191.

Cognitive behavioural therapy in groups for medicated adults with attention deficit hyperactivity disorder: protocol for a randomised controlled trial

Por: Pan · M.-R. · Zhao · M.-J. · Liu · L. · Li · H.-M. · Wang · Y.-F. · Qian · Q.-J.
Introduction

Cognitive behavioural therapy (CBT) is an evidence-based treatment for adults with attention deficit hyperactivity disorder (ADHD). However, it is still inconsistent whether a combination of CBT would have additive effects in medicated ADHD in adulthood. And if CBT would have additional effects, what kind and which dimension would CBT play a part? This study estimates the efficacy of CBT in stable medicated adult ADHD, using long-term outcomes and multidimensional evaluations.

Methods and analysis

It is a two-armed, randomised controlled trial on the superiority of the efficacy of 12 weeks of CBT on medicated adult ADHD. We compare the short-term and long-term outcomes between CBT combined with medication (CBT+M) group and the medication-only (M) group, including ADHD core symptoms, emotional symptoms, executive function, self-esteem, life quality and brain function using functional near-infrared spectroscopy data. Participants are outpatients of the Peking University Sixth Hospital and those recruited online, diagnosed as adult ADHD and with stable medication treatment. We estimate ADHD core symptoms and combined symptoms at baseline (T1) and week 12 (T2), week 24 (T3), week 36 (T4) and week 48 (T5).

Ethics and dissemination

This trial has been approved by the Ethics and Clinical Research Committees of Peking University Sixth Hospital and will be performed under the Declaration of Helsinki with the Medical Research Involving Human Subjects Act (WMO). The results will be disseminated in a peer-reviewed journal and a conference presentation.

Trial registration number

ChiCTR (ChiCTR1900021705).

Scalable solution for delivery of diabetes self-management education in Thailand (DSME-T): a cluster randomised trial study protocol

Por: Angkurawaranon · C. · Papachristou Nadal · I. · Mallinson · P. A. C. · Pinyopornpanish · K. · Quansri · O. · Rerkasem · K. · Srivanichakorn · S. · Techakehakij · W. · Wichit · N. · Pateekhum · C. · Hashmi · A. H. · Hanson · K. · Khunti · K. · Kinra · S.
Introduction

Type 2 diabetes mellitus is among the foremost health challenges facing policy makers in Thailand as its prevalence has more than tripled over the last two decades, accounting for considerable death, disability and healthcare expenditure. Diabetes self-management education (DSME) programmes show promise in improving diabetes outcomes, but this is not routinely used in Thailand. This study aims to test a culturally tailored DSME model in Thailand, using a three-arm cluster randomised controlled trial comparing a nurse-led model, a peer-assisted model and standard care. We will test which model is effective and cost effective to improve cardiovascular risk and control of blood glucose among people with diabetes.

Methods and analysis

21 primary care units in northern Thailand will be randomised to one of three interventions, enrolling a total of 693 patients. The primary care units will be randomised (1:1:1) to participate in a culturally-tailored DSME intervention for 12 months. The three-arm trial design will compare effectiveness of nurse-led, peer-assisted (Thai village health volunteers) and standard care. The primary trial outcomes are changes in haemoglobin A1c and cardiovascular risk score. A process evaluation and cost effectiveness evaluation will be conducted to produce policy relevant guidance for the Thai Ministry of Public Health. The planned trial period will start in January 2020 and finish October 2021.

Ethics and dissemination

Ethical approval has been obtained from Thailand and the UK. We will share our study data with other researchers, advertising via our publications and web presence. In particular, we are committed to sharing our findings and data with academic audiences in Thailand and other low-income and middle-income countries.

Trial registration number

NCT03938233.

Nursing discharge teaching for hospitalized older people: A rapid realist review

Abstract

Aim

To develop, refine and put forward a programme theory that describes configurations between context, hidden mechanisms and outcomes of nursing discharge teaching.

Design

Rapid realist review guided by Pawson's recommendations and using the Realist and Meta‐narrative Evidence Syntheses: Evolving Standards.

Data Sources

We performed searches in MEDLINE, Embase, CINAHL Full text, Google Scholarand supplementary searches in Google. We included all study designs and grey literature published between 1998‐2019.

Review Methods

We followed Pawson's recommended steps: initial programme theory development; literature search; document selection and appraisal; data extraction; analysis and synthesis process; presentation and dissemination of the revised programme theory.

Results

We included nine studies and a book to contribute to the synthesis. We developed 10 context–mechanisms–outcome configurations which cumulatively refined the initial programme theory. These configurations between context, mechanisms and outcome are classified in four categories as follows: relevancy of teaching content; patients’ readiness to engage in the teaching–learning process; nurses’ teaching skills and healthcare team approach to discharge teaching delivery. We also found that some of the same contexts generated similar outcomes, but through different mechanisms, highlighting interdependencies between context–mechanisms–outcome configurations.

Conclusion

This rapid realist review resulted in an explanatory synthesis of how discharge teaching works to improve patient‐centred outcomes. The proposed programme theory has direct implications for clinical practice by giving meaning to the ‘hidden’ mechanisms used by nurses when they prepare patients to be discharged home and can inform curricula for nursing education.

Impact

The essential components, process mechanisms, contexts and impacts of the nursing discharge teaching are not consistently or clearly described, explained or evaluated for effectiveness. This review uncovers underlying contexts and mechanisms in the teaching/learning process between patients and nurses. The resulting programme theory can guide nurse clinicians and managers towards improvements in conducting discharge teaching.

Nurses’ protocol‐based care decision making: a multiple case study

Abstract

Aim

To describe and explain nurses’ Protocol‐Based Care decision making.

Background

Protocol‐Based Care is a strategy to reduce variability in clinical practice. There are no studies looking at Protocol‐Based Care decision making. Understand this process is key to successful implementation.

Method

A multiple embedded case study was carried out. Nurses’ Protocol‐Based Care decision making was studied in three inpatient wards (medical, surgical and medical‐surgical) of a university hospital in northern Spain. Data collection was performed between 2015 and 2016 including documentary analysis, non‐participant observations, participant observations and interviews. Analysis of quantitative data involved descriptive statistics and qualitative data was submitted to Burnard's method of content analysis (1996). The data integration comprised the integration of the data set of each case separately and the integration of the findings resulting from the comparison of the cases. The following the thread method of data integration was used for this purpose. The SRQR guideline was used for reporting.

Results

The multiple embedded case study revealed Protocol‐Based Care decision‐making as a linear and variable process that depends on the context and consists of multiple interrelated elements, among which the risk perception is foremost.

Conclusion

This study has allowed progress in Protocol‐Based Care decision‐making characterization. This knowledge is crucial to support the design of educational and management strategies aimed at implementing Protocol‐Based Care.

Relevance to clinical practice

Strategies to promote Protocol‐Based Care should address the contexts of practice and the ability of professionals’ to accurately assess the degree of risk of clinical activity. Hence, it will promote quality of care, patient safety and efficiency in healthcare cost.

The experiences of carers looking after people with Parkinson’s disease who exhibit impulsive and compulsive behaviours: An exploratory qualitative study

Abstract

Aim

To understand the experiences of carers who were confronted by the development of impulsive and compulsive behaviours.

Background

Impulsive and compulsive behaviours (ICBs) are a serious complication in Parkinson's disease (PD) strongly associated with dopamine replacement therapy used to treat patients. These behaviours comprise abnormal activities such as pathological gambling, binge eating, compulsive shopping and hypersexuality. These behaviours place a considerable burden on patients and on their carers and families.

Design

An exploratory qualitative study.

Methods

Using a convenience sampling approach, 13 carers were recruited to participate in semi‐structured interviews. Interviews were conducted over the telephone. Verbatim transcripts were analysed using a thematic analysis approach. COREQ guidelines were adhered to in the reporting of this study.

Results

Five main themes were identified: (a) realisation—developing awareness of ICB symptoms and their causes; (b) reacting—confronting and attempts to manage ICBs; (c) reaching out—help‐seeking and selective disclosure; (d) reframing—shifting perspectives on ICBs over time; and (e) resignation—impact on relationships and facing the future.

Conclusions

The profound impact of ICBs on quality of life, relationships and economic stability was clear in the carers’ accounts. Possible avenues for future clinical research are suggested.

Relevance to clinical practice

The potentially devastating effects of ICBs provide a strong imperative for nurses and other health professionals to ensure that close monitoring for symptom development together with patient education is always part of practice.

Examining the prevalence, correlates and inequalities of undiagnosed hypertension in Nepal: a population-based cross-sectional study

Por: Hasan · M. M. · Tasnim · F. · Tariqujjaman · M. · Ahmed · S. · Cleary · A. · Mamun · A.
Objective

To examine the prevalence, correlates and sociodemographic inequalities of undiagnosed hypertension in Nepal.

Design

This study used cross-sectional 2016 Nepal Demographic and Health Survey (NDHS) data. Undiagnosed patients with hypertension were defined as an NDHS respondent who was diagnosed as hypertensive (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) during the survey, but never took any prescribed anti-hypertensive medicine to lower/control blood pressure and was never identified as having hypertension by a health professional prior the survey. Multiple binary logistic regression analysis was performed, and Concentration Index was measured.

Setting

Nepal.

Participants

Adult patients with hypertension.

Results

Among 3334 patients with hypertension, 50.4% remained undiagnosed during the survey in Nepal. Adjusted model reveals that patients who were male, belonged to households other than the highest wealth quintile, and lived in province 4 and province 5 were at higher risk of remaining undiagnosed for hypertension. Patients who were ≥65 years of age and were overweight/obese were at lower risk of remaining undiagnosed for hypertension. The poor-rich gap was 24.6 percentage points (Q1=64.1% vs Q5=39.6%) and poor:rich ratio was 1.6 (Q1/Q5=1.6) in the prevalence of undiagnosed hypertension. Undiagnosed hypertension was disproportionately higher among lower socioeconomic status groups (Concentration Index, C=–0.18). Inequalities in the prevalence of undiagnosed hypertension further varied across other geographic locations, including place of residence, ecological zones and administrative provinces.

Conclusions

Undiagnosed hypertension was highly prevalent in Nepal and there were substantial inequalities by sociodemographics and subnational levels. Increasing awareness, strengthening routine screening to diagnose hypertension at primary health service facilities and enactment of social health insurance policy may help Nepal to prevent and control this burden.

Changes in preventive care utilisation and its influencing factors among Chinese adults before and after the healthcare reform: cross-sectional evidence from the China Health and Nutrition Survey in 2004-2015

Por: Wu · T. T. · Liu · W. W. · Zou · M. · Lei · X. · Yang · Q. · Sharma · M. · Zhao · Y. · Shi · Z. M.
Objective

China launched its health reform in 2009. This study aimed to assess changes in preventive care utilisation (PCU) and its relationship with the healthcare reform.

Design

A cross-sectional study using demographic characteristics, socioeconomic status, environmental factors, and lifestyle and health status data of adults from five waves (2004–2015) of the China Health and Nutrition Survey (CHNS) was conducted. Multilevel mixed-effects logistic regression models were used.

Setting

Data were derived from urban and rural communities of nine provinces in China.

Participants

Data were obtained from five waves of the CHNS, with 9960 participants in 2004, 9888 in 2006, 10 286 in 2009, 9709 in 2011, and 10 628 in 2015.

Outcome

The primary outcome was PCU.

Results

PCU in 2004–2015 among adults was 3.29%, 3.13%, 3.77%, 4.95% and 2.73%, respectively. Whether before or after the health reform, having a history of disease and female gender were positive influencing factors of PCU. Before 2009, PCU was significantly associated with gender, income, medical insurance status and region. Age, medical insurance status, history of drinking and education level significantly affected PCU in 2009–2011. Having medical insurance was no longer a positive influencing factor of PCU, while high income had a negative effect on PCU, in 2011–2015.

Conclusions

PCU from 2004 to 2015 was low and the health reform in China may lack sustainable effect on PCU. Further studies on how to ensure sustainability of PCU are necessary, and further reforms on preventive care services should be aimed at different ages, rural areas and participants without history of disease.

The relative effectiveness of different types of exercise for people with Mild Cognitive Impairment or dementia: Systematic review protocol

Abstract

Aims

To investigate which type of exercise is the most effective for people with mild cognitive impairment (MCI) or dementia.

Background

Exercise is recommended as a promising intervention for people with cognitive impairment. However, which type of exercise is the most beneficial for people with MCI or dementia seems still unclear. The objective of this article is to assess the relative effectiveness of different types of exercise on cognitive function in people with MCI or dementia using network meta‐analysis.

Design

Systematic review, meta‐analysis, and network meta‐analysis.

Methods

We will systematically search electronic databases including PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, SPORTDiscus, and PsycINFO. To avoid missing the eligible literature, we will examine the reference lists of systematic reviews publication since 2017. WHO International Clinical Trials Registry Platform and ClinicalTrials.gov will also be retrieved to identify eligible trials. Two independent researchers will identify the eligible trials according to selection criteria and extract data. The risk of bias for included studies will be assessed by two pairs of reviewers based on the modified Cochrane Risk of Bias Tool. Discrepancies or disagreement will be discussed and resolved. Data will be analysed using pairwise meta‐analysis and network meta‐analysis.

Discussion

This study will compare the relative effectiveness of different types of exercise and identify which type of exercise is the most effective for people with MCI or dementia.

Impact

The results of this review will provide evidence on which domains of cognitive function are more responsive to what type of exercise. It will also help guide nursing clinical practice to optimize exercise therapy in people with MCI or dementia.

PROSPERO registration number: CRD42020160620.

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