Conectar
To obtain a deeper understanding of peoples' experiences of cancer treatments with immune checkpoint inhibitors (ICIs).
ICIs are transforming survival outcomes for many with certain advanced cancers. Given the possibility of unique immune-related adverse events (irAEs), understanding treatment experiences is crucial to identify support needs and provide safe and effective person-centred care.
A systematic review of qualitative research and thematic synthesis. To report this review, the Preferred Reporting Items for Systematic Analysis and Meta Analysis (PRISMA) checklist and Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidance have been used.
MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science databases were searched in January 2022 for eligible studies published in English from database inception.
Two reviewers independently screened records, identified papers for inclusion and appraised methodological quality using the Critical Appraisal Skills Programme checklist. Themes were developed using thematic synthesis.
Eighteen papers were included and three analytical themes developed: immune checkpoint inhibitor treatment decision-making; the experience and impact of immune checkpoint inhibitor treatments; and appraising and responding to irAEs.
The synthesis renders visible individuals' unmet information, psychological and practical support needs. It identifies shortcomings in immune checkpoint inhibitor treatment decision-making processes and highlights the need for healthcare professionals to recognise and sensitively handle individuals' treatment expectations. Individuals' understandings of and responses to irAEs are also illustrated, and attention drawn to patients' concerns about healthcare professionals' checkpoint inhibitor and irAEs knowledge.
To sensitively manage treatment expectations and uncertainties, and optimise health outcomes, there are distinct points in treatment trajectories where care and support might require adapting and enhancing.
This review addresses people's experiences of immune checkpoint inhibitor treatments. The core findings reveal unmet information, psychological and practical support needs. Insights derived from this review will enhance individuals' experiences and outcomes and healthcare professionals' practice.
No patient or public involvement.
Commentary on: Kuld PB, Frielink N, Zijlmans M, et al. . Promoting self-determination of persons with severe or profound intellectual disabilities: a systematic review and meta-analysis. J Intellect Disabil Res. 2023 Jul;67(7):589–629. doi: 10.1111/jir.13036. Epub 2023 May 11.
Nurses can promote self-determination of people with severe and profound intellectual disabilities through relationship building and learning to read a person’s communication cues to determine their preferences. Future research should use an ecological approach to optimise environments for self-determination and consistent measures to strengthen the evidence base.
Self-determination is a key dimension of quality of life for people with intellectual disabilities, that is, acting freely and willfully to make things happen in one’s own life.
Spasticity is a frequent disabling consequence following a stroke. Local muscle vibrations (LMVs) have been proposed as a treatment to address this problem. However, little is known about their clinical and neurophysiological impacts when used repeatedly during the subacute phase post-stroke. This project aims to evaluate the effects of a 6-week LMV protocol on the paretic limb on spasticity development in a post-stroke subacute population.
This is an interventional, controlled, randomised, single-blind (patient) trial. 100 participants over 18 years old will be recruited, within 6 weeks following a first stroke with hemiparesis or hemiplegia. All participants will receive a conventional rehabilitation programme, plus 18 sessions of LMV (ie, continuously for 30 min) on relaxed wrist and elbow flexors: either (1) at 80 Hz for the interventional group or (2) at 40 Hz plus a foam band between the skin and the device for the control group.
Participants will be evaluated at baseline, at 3 weeks and 6 weeks, and at 6 months after the end of the intervention. Spasticity will be measured by the modified Ashworth scale and with an isokinetic dynamometer. Sensorimotor function will be assessed with the Fugl-Meyer assessment of the upper extremity. Corticospinal and spinal excitabilities will be measured each time.
This study was recorded in a clinical trial and obtained approval from the institutional review board (Comité de protection des personnes Ile de France IV, 2021-A03219-32). All participants will be required to provide informed consent. The results of this trial will be published in peer-reviewed journals to disseminate information to clinicians and impact their practice for an improved patient’s care.
Clinical Trial: NCT05315726
EUDRAct
Antimicrobial resistance (AMR) is a major global health problem. Efforts to mitigate AMR prioritise antimicrobial stewardship (AMS) interventions. These interventions typically focus on deficiencies in practice and providing negative or normative feedback. This approach may miss opportunities to learn from success. We aimed to identify factors that enable success in AMS practices in the paediatric intensive care unit (PICU) by analysing the data obtained from interviews with staff members who had achieved success in AMS.
Qualitative study design using thematic analysis of appreciative inquiry interviews with healthcare staff.
31-bedded PICU in the UK between January 2017 and January 2018.
71 staff who had achieved success in AMS in the PICU.
Six themes were identified: (1) cultural factors including psychological safety, leadership and positive attitude are important enablers for delivering good clinical care; (2) ergonomic design of the physical environment and ready availability of tools and resources are key elements to support good practice and decision-making; (3) expertise and support from members of the multidisciplinary team contribute to good care delivery; (4) clarity of verbal and written communication is important for sharing mental models and aims of care within the clinical team; (5) a range of intrinsic factors influences the performance of individual HCPs, including organisation skill, fear of failure, response to positive reinforcement and empathetic considerations towards peers; (6) good clinical care is underpinned by a sound domain knowledge, which can be acquired through training, mentorship and experience.
The insights gained in this study originate from frontline staff who were interviewed about successful work-as-done. This strengths-based approach is an understudied area of healthcare, and therefore offers authentic intelligence which may be leveraged to effect tangible improvement changes. The methodology is not limited to AMS and could be applied to a wide range of healthcare settings.
This study aims to calculate the global warming potential, in carbon dioxide (CO2) equivalent emissions, from all in-scope activities involved in a phase-1 clinical study.
Retrospective analysis.
Internal data held by Janssen Pharmaceuticals.
Janssen-sponsored TMC114FD1HTX1002 study conducted between 2019 and 2021.
Measure CO2 equivalents (CO2e) for in-scope clinical trial activities calculated according to intergovernmental panel on climate change 2021 impact assessment methodology.
The CO2e emissions generated by the trial were 17.65 tonnes. This is equivalent to the emissions generated by driving an average petrol-fueled family car 71 004 km or roughly 1.8 times around the circumference of the Earth. Commuting to the clinical site by the study participants generated the most emissions (5419 kg, 31% of overall emissions), followed by trial site utilities (2725 kg, 16% of overall emissions) and site staff travel (2560 kg, 15% of overall emissions). In total, the movement of people (participant travel, site staff travel and trial site staff travel) accounted for 8914 kg or 51% of overall trial emissions.
Decentralised trial models which seek to bring clinical trial operations closer to the participant offer opportunities to reduce participant travel. The electrification of sponsor vehicle fleets and society’s transition towards electric vehicles may result in further reductions.
by Xiaoquan Zhao, Aayushi Hingle, Cameron C. Shaw, Amy Murphy, Breonna R. Riddick, Rochelle R. Davidson Mhonde, Bruce G. Taylor, Phoebe A. Lamuda, Harold A. Pollack, John A. Schneider, Faye S. Taxman
Criminal legal system involvement (CLI) is a critical social determinant of health that lies at the intersection of multiple sources of health disparities. The COVID-19 pandemic exacerbates many of these disparities, and specific vulnerabilities faced by the CLI population. This study investigated the prevalence of COVID-19-related misinformation, as well as its relationship with COVID-19 information sources used among Americans experiencing CLI. A nationally representative sample of American adults aged 18+ (N = 1,161), including a subsample of CLI individuals (n = 168), were surveyed in February-March 2021. On a 10-item test, CLI participants endorsed a greater number of misinformation statements (M = 1.88 vs. 1.27) than non-CLI participants, pThe aims of the study were to determine the types and prevalence of forensic mental health nurse exposure to patient aggression and explore the impact of these exposures on their physical and mental health and work absences.
Cross-sectional survey conducted January to April 2020.
All 205 nurses working in an Australian high-security inpatient forensic mental health hospital were invited to participate. An online survey included the Perception of Prevalence of Aggression Scale to measure respondent exposure to types of patient aggression, and the SF-36v2 to measure mental and physical health. Absence from work and other work and individual characteristics were also explored.
Sixty-eight respondents completed the survey. Verbal abuse was the most experienced aggression type, followed by physical violence and observing violence, patient self-harming behaviours and sexual violence. Nurses who worked in acute units experienced significantly more exposure to overall aggression than nurses in non-acute units. Higher level of aggression was associated with number of days sick leave taken and days off due to aggression or violence. Higher level of aggression was associated with poorer mental health, and patient self-harming behaviour was associated with poorer physical health.
Nurses in acute units experience higher levels of inpatient aggression and are therefore at increased risk of being impacted by the exposure. Findings indicate a psychological impact of exposure to frequent aggression and potential for an accumulative effect of exposure to traumatic events on nurse well-being. Nurses who are victim of, or witness, physical violence are most likely to take time off work.
This study provides further evidence that forensic mental health nurses are frequently exposed to various forms of patient aggression. For some nurses, this exposure to patient aggression negatively impacted their mental and physical health. Employing organizations should therefore prioritize provision of formal support for nurses.
No patient or public contribution.
Commentary on: MacHale R, Ffrench C, McGuire B. The experiences and views of adults with intellectual disabilities accessing digital mental health interventions: A qualitative systematic review and thematic synthesis. J Appl Res Intellect Disabil. 2023 May;36(3):448-457. doi: 10.1111/jar.13082. Epub 2023 Feb 13.
Digital mental health interventions may be useful to complement in-person mental health services, with sufficient supports for meaningful use. User-centred design research with adults with intellectual disabilities and supporters is needed at all phases of digital mental health intervention development and evaluation.
Providers report that digital interventions are effectively being delivered to adults with intellectual disabilities; there is less research about how digital health interventions are received and experienced by people with intellectual disabilities.
Trans youth experience significantly higher rates of societal violence and ill-health compared to their cisgender peers. Although recent clinical guidelines for trans young people in health have paved the way for revolutionizing care, many trans young people still experience adversity in clinical settings. This discursive literature review provides a novel approach in exploring why trans young people experience violence in health care despite the availability of evidence-based resources and guidelines.
Databases (CINAHL and Scopus) were systematically searched to identify qualitative literature on the experiences of trans young people (<18 years) in health care settings.
Rather than synthesizing and presenting the literature, Fairclough's (2001) CDA methodology was used to critically analyze the literature as texts in a data corpus. The authors engaged with the data from a critical social theory perspective.
Fifteen qualitative articles and one report (n = 16) on the experiences of trans young people (3–24 years) in health care settings were included. Two key discourses were identified in the literature. First, discourses that constituted the trans young person were identified in the definitions of ‘trans’ as a pathological incongruence and as alternate, self-determined ways of being. Further discourses were identified in the constitution of trans young people as victims, extra-pathological, and alternatively problematised as socially dysphoric. Second, discourses in health provider responses were identified in dismissive, gatekeeping, regulatory, and respectful practices.
The discursive constitution of the trans young person as incongruent, vulnerable, and pathological is constituted and generated by dismissive, gatekeeping, and regulatory practices of health care providers. The analysis reveals how trans young people are considered pathological and deemed treatable (at the site of the body), in the interest of ‘protecting’ them from a perceived abject future of trans adulthood. The logic and violence of cisgenderism is uncovered as the foundation of these dominant discourses, whereby growing up cisgender is often presented as the only option in health care settings. The dominant discourses that constitute the trans young person in health care as incongruent, pathological, and vulnerable, alongside the reifying health care responses of dismissal, gatekeeping, and regulation contribute to the erasure of the young trans person.
This paper identified key discourses in the literature in how trans young people are constituted and regulated in health care. This review highlights an urgent need for further critical scholarship in trans health by trans researchers, from critical perspectives. Furthermore, it provides a starting point for critical reflection of health care provider and researcher practices and the re-imagination of trans-futurity for all young people in health care.
Nurses are situated at the forefront of health care delivery and play a crucial role in the advocacy and provision of culturally safe care. With this ideal proximity to clients, nurses can powerfully affect change through better understanding and reflecting on how regulatory practices constitute and position trans young people in health care. Nursing knowledge, such as cultural safety, can offer novel approaches in working towards safer ways of meeting the needs of trans young people.
FreshRSS 