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Critical care nurses' perception of care coordination competency for management of mechanically ventilated patients

Abstract

Aims and Objectives

To evaluate nurses’ care coordination competency for mechanically ventilated patients in intensive care units (ICUs) of Saudi Arabia (SA).

Background

ICUs are increasingly using multidisciplinary approach to provide critical care. Functionality gaps remain within these teams preventing optimum performance, including a lack of adequate care coordination in the management of mechanically ventilated (MV) patients.

Design

A cross‐sectional survey of ICU nurses working across 20 hospitals in SA.

Methods

The Nurses’ Care Coordination Competency Scale (NCCCS) survey for MV patients was administered to all the nurses to assess their care coordination competence. The data were analysed using Student's t test, ANOVA and linear regression. Reporting of this research follows STROBE guidelines.

Results

A total of 254 nurses participated in the survey. The overall NCCCS mean score was 3.94 (±0.69) out of a 5‐point scale. Also, the “promoting team cohesion factor (Factor 1)” had a mean score of 3.90 (±0.77), the “understanding care coordination needs factor (Factor II)” had a mean score of 4.00 (±0.77), the “aggregating and disseminating information factor (Factor III)” had a mean score of 4.05 (±0.76), and the “devising and clearly articulating the care vision factor (Factor IV)” had a mean score of 3.78 (±0.87). The mean overall NCCCS score was 4.10 among Indians, 3.98 among Filipinos and 3.81 among Saudi nationals.

Conclusion

There were a high overall score and subscale scores of nurses’ care coordination competence for mechanically ventilated patients, but few gaps were identified in some of the items.

Relevance to Clinical Practice

The results provide information on the status and gaps in ICU nurses’ care coordination competencies to address the needs of mechanically ventilated critically ill patients. The NCCCS can be utilised as an educational tool for nurses who are new to the ICU work environment.

Postnatal care following hypertensive disorders of pregnancy: a qualitative study of views and experiences of primary and secondary care clinicians

Por: Bick · D. · Silverio · S. A. · Bye · A. · Chang · Y.-S.
Objectives

To explore clinicians’ views and experiences of caring for postnatal women who had hypertensive disorders of pregnancy (HDP), awareness of relevant National Institute for Health and Care Excellence (NICE) guidance to inform their postnatal management, the extent to which NICE guidance was implemented, barriers and facilitators to implementation and how care could be enhanced to support women’s future health.

Design

A qualitative study using semistructured interviews. Thematic analysis was used for coding and theme generation.

Setting

Four National Health Service maternity units and three general practice clinics in South-East and South-West London.

Participants

A maximum variation, purposive sample of 20 clinicians with experience of providing postnatal care to women following HDP.

Results

Four main themes were generated: variation in knowledge and clinical practice; communication and education; provision of care; locus of responsibility for care. Perceived barriers to implementation of NICE guidance included lack of postnatal care plans and pathways, poor continuity of care, poor antihypertensive medication management, uncertainty around responsibility for postnatal care and women’s lack of awareness of the importance of postnatal follow-up for their future health. Some clinicians considered that women were discharged from inpatient care too soon, as primary care clinicians did not have specialist knowledge of HDP management. Most clinicians acknowledged the need for better planning, communication and coordination of care across health settings.

Conclusions

Evidence of longer term consequences for women’s health following HDP is accumulating, with potential for NICE guidance to support better outcomes for women if implemented. Clinicians responsible for postnatal care following HDP should ensure that they are familiar with relevant NICE guidance, able to implement recommendations and involve women in decisions about ongoing care and why this is important. The continued low priority and resources allocated to postnatal services will continue to promote missed opportunities to improve outcomes for women, their infants and families.

A taxonomy to assess the interaction between nurses and children: Development and reliability

Abstract

Aims and objectives

The aim of this study was to develop a valid and reliable instrument to assess the nurse‐child interaction during medical or nursing interventions.

Background

Communication is an important competency for the professional practice of nurses and physicians. The nurse‐patient relationship is fundamental for high‐quality care. It has been suggested that if nurses have more skills to interact with children, care will be less distressing and less painful for the children.

Design

A qualitative observational psychometric study; the GRRAS checklist was used.

Methods

In‐depth video‐analyses, taxonomy development (19 videos) and testing it is psychometric properties (10 videos). Three observers micro‐analysed video recordings of experienced nurses changing children's wound dressing in a specialised Burn Centre.

Results

The nurse‐child interaction taxonomy (NCIT) was developed to observe and score the interactional behaviour between nurse and child. The taxonomy has three main patterns: being considerate, attuning oneself, and procedural interventions, subdivided in eight dimensions. These dimensions contain 16 elements that can be observed and scored on a 7‐point scale. Intra‐rater, inter‐rater reliability and agreement were good.

Conclusions

This study shows that interaction between nurses and children can be assessed reliably with the NCIT by an experienced observer or alternatively, scoring by two observers is recommended.

Relevance to clinical practice

The development of the taxonomy is an important step to find evidence for the best way for nurses to interact with children during nursing interventions or medical events and as such, ultimately, contributes to providing the best care possible.

Open-labelled randomised controlled trial of 12 hours versus 24 hours modified Pritchard regimen in the management of eclampsia and pre-eclampsia in Ghana (MOPEP Study): study protocol

Por: Beyuo · T. · Lawrence · E. · Langen · E. S. · Oppong · S. A.
Introduction

Hypertensive disorders of pregnancy continue to be a major contributor to maternal and perinatal morbidity and mortality. Magnesium sulfate therapy is the standard of care for seizure prophylaxis and treatment for pre-eclampsia and eclampsia respectively, despite wide disparities in dosing regimens and routes of administration. This study compares the clinical efficacy of magnesium sulfate in the reduction of seizure occurrence or recurrence with the 12 hours versus 24 hours modified Pritchard regimens in the management of severe pre-eclampsia and eclampsia.

Methods and analysis

This study is an open labelled randomised controlled trial. The study participants are patients admitted to the Korle Bu Teaching Hospital (KBTH) in Accra, Ghana with a diagnosis of antepartum, intrapartum or postpartum eclampsia or pre-eclampsia with severe features. All study participants will be administered a loading dose of magnesium sulfate, followed by maintenance dosing. Participants in the control group will receive magnesium sulfate for 24 hours after diagnosis, while those in the treatment group will receive magnesium sulfate for 12 hours after diagnosis. The primary outcome of this study is the occurrence of a seizure any time after the completion of treatment in the assigned group. Secondary outcome measures include maternal health outcomes, magnesium sulfate toxicities and fetal health outcomes. Data collection was started in October 2018 with a target enrolment of 1245 participants with severe pre-eclampsia and 844 participants with eclampsia with a projected study period of 2–3 years.

Ethics and dissemination

Ethical approval was obtained from the KBTH Institutional Review Board (IRB) in Ghana. University of Michigan involvement is limited to protocol development and statistical analysis of de-identified data, and has been granted a Not Regulated Determination by the University of Michigan IRB. Results of the study will be shared at clinical forums at the KBTH and will be submitted for publication in an international peer-reviewed journal.

Trial registration number

Pan African Clinical Trial Registry through the South African Medical Research Council (PACTR201811515303983).

Lower secondary school students scientific literacy and their proficiency in identifying and appraising health claims in news media: a secondary analysis using large-scale survey data

Por: Nordheim · L. V. · Pettersen · K. S. · Espehaug · B. · Flottorp · S. A. · Guttersrud · O.
Objectives

Scientific literacy is assumed necessary for appraising the reliability of health claims. Using a national science achievement test, we explored whether students located at the lower quartile on the latent trait (scientific literacy) scale were likely to identify a health claim in a fictitious brief news report, and whether students located at or above the upper quartile were likely to additionally request information relevant for appraising that claim.

Design

Secondary analysis of cross-sectional survey data.

Setting and participants

2229 Norwegian 10th grade students (50% females) from 97 randomly sampled lower secondary schools who performed the test during April–May 2013.

Outcome measures

Using Rasch modelling, we linked item difficulty and student proficiency in science to locate the proficiencies associated with different percentiles on the latent trait scale. Estimates of students’ proficiency, the difficulty of identifying the claim and the difficulty of making at least one request for information to appraise that claim, were reported in logits.

Results

Students who reached the lower quartile (located at –0.5 logits) on the scale were not likely to identify the health claim as their proficiency was below the difficulty estimate of that task (0.0 logits). Students who reached the upper quartile (located at 1.4 logits) were likely to identify the health claim but barely proficient at making one request for information (task difficulty located at 1.5 logits). Even those who performed at or above the 90th percentile typically made only one request for information, predominantly methodological aspects.

Conclusions

When interpreting the skill to request relevant information as expressing students’ proficiency in critical appraisal of health claims, we found that only students with very high proficiency in science possessed that skill. There is a need for teachers, healthcare professionals and researchers to collaborate to create learning resources for developing these lifelong learning skills.

Prevalence and correlates of smoking and nicotine dependence: results of a nationwide cross-sectional survey among Singapore residents

Por: Shahwan · S. · Abdin · E. · Shafie · S. · Chang · S. · Sambasivam · R. · Zhang · Y. · Vaingankar · J. A. · Teo · Y. Y. · Heng · D. · Chong · S. A. · Subramaniam · M.
Background

Since the Singapore Mental Health Study in 2010 which reported a 16.0% prevalence rate for current smokers and 4.5% for nicotine dependence, new anti-smoking strategies have been implemented. The aim of this study was to compare smoking trends from the 2010 study with the second Singapore Mental Health Study in 2016 (SMHS 2016).

Methods

A survey of 6126 individuals aged 18 years and above randomly selected among Singapore residents was conducted using the same methodology as the 2010 study. The measures used in this analysis were sociodemographic questions, the Composite International Diagnostic Interview which assessed for psychiatric disorders, the Fagerstrom Test for Nicotine Dependence and a list of chronic physical conditions that were prevalent in Singapore. Logistic regression analyses were used to test for associations between smoking/nicotine-dependence and other measures.

Results

In the SMHS 2016, 16.1% were current smokers and 3.3% were nicotine-dependent. As compared with non-smokers, current smokers were more likely to be younger, male gender, of ethnic minority and had lower/vocational education level. Younger age, male gender, lower/vocational education and psychiatric disorders (major depression, bipolar disorder and alcohol use disorders) predicted nicotine dependence. No associations were found between nicotine dependence and any of the chronic conditions.

Conclusion

The prevalence of current smokers in the population has plateaued while that of nicotine dependence has decreased from 2010. However, the study did not investigate the use of e-cigarettes. Inequalities in smoking and nicotine dependence continue to pervade the population particularly among those of ethnic minority, lower/vocational education and the mentally ill.

Prolong: a double-blind randomised placebo-controlled trial of broccoli sprout extract in women with early onset preeclampsia. A clinical trial protocol

Por: Langston-Cox · A. G. · Marshall · S. A. · Palmer · K. R. · Wallace · E. M.
Introduction

Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. There is a need for adjuvant, targeted therapies to improve outcomes. Broccoli sprout extract, rich in the antioxidant sulforaphane, reduces oxidative stress and placental secretion of the antiangiogenic factors that contribute to vascular dysfunction in preeclampsia. We propose a phase III trial investigating broccoli sprout extract. We will assess broccoli sprout extract in women with early onset (

Methods

A double-blind, placebo-controlled randomised trial will be conducted at Monash Health, Melbourne, Australia. One hundred and eighty women (45 each arm of each stratum) with early onset preeclampsia (defined as per Society for Obstetric Medicine of Australia and New Zealand guidelines) will be recruited. Consenting women will be randomised to receive an oral dose of either broccoli sprout extract (24 mg of activated sulforaphane) or identical placebo, twice daily until delivery. Maternal blood will be collected antenatally for measurement of biomarkers of preeclampsia, including soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), soluble endoglin (sEng) and activin A, as well as circulating sulforaphane metabolites. Maternal and perinatal outcomes will be monitored throughout. All clinical care decisions, including the timing of delivery, will be made by the treating team, blinded to treatment allocation. Participation in this trial will not affect routine care. At delivery, maternal and cord blood and placentae will be collected to measure sulforaphane metabolites and sFlt-1, PlGF, sEng and activin A.

Ethics and dissemination

Approval to conduct the trial has been granted by Monash Health Human Research and Ethics Committee (RES-18-0000-109A). Deidentified data will be published in peer-reviewed journals and presented at learnt society conferences, both nationally and internationally. This study has not yet commenced and is pre-results.

Trial registration number

ACTRN12618000216213

Using population-wide administrative and laboratory data to estimate type- and subtype-specific influenza vaccine effectiveness: a surveillance protocol

Por: Scott · A. N. · Buchan · S. A. · Kwong · J. C. · Drews · S. J. · Simmonds · K. A. · Svenson · L. W.
Introduction

The appropriateness of using routinely collected laboratory data combined with administrative data for estimating influenza vaccine effectiveness (VE) is still being explored. This paper outlines a protocol to estimate influenza VE using linked laboratory and administrative data which could act as a companion to estimates derived from other methods.

Methods and analysis

We will use the test-negative design to estimate VE for each influenza type/subtype and season. Province-wide individual-level records of positive and negative influenza tests at the Provincial Laboratory for Public Health in Alberta will be linked, by unique personal health numbers, to administrative databases and vaccination records held at the Ministry of Health in Alberta to determine covariates and influenza vaccination status, respectively. Covariates of interests include age, sex, immunocompromising chronic conditions and healthcare setting. Cases will be defined based on an individual’s first positive influenza test during the season, and potential controls will be defined based on an individual’s first negative influenza test during the season. One control for each case will be randomly selected based on the week the specimen was collected. We will estimate VE using multivariable logistic regression.

Ethics and dissemination

Ethics approval was obtained from the University of Alberta’s Health Research Ethics Board—Health Panel under study ID Pro00075997. Results will be disseminated by public health officials in Alberta.

Risk of myocardial infarction among people living with HIV: an updated systematic review and meta-analysis

Por: Eyawo · O. · Brockman · G. · Goldsmith · C. H. · Hull · M. W. · Lear · S. A. · Bennett · M. · Guillemi · S. · Franco-Villalobos · C. · Adam · A. · Mills · E. J. · Montaner · J. S. G. · Hogg · R. S.
Objective

Cardiovascular disease (CVD) is one of the leading non-AIDS-defining causes of death among HIV-positive (HIV+) individuals. However, the evidence surrounding specific components of CVD risk remains inconclusive. We conducted a systematic review and meta-analysis to synthesise the available evidence and establish the risk of myocardial infarction (MI) among HIV+ compared with uninfected individuals. We also examined MI risk within subgroups of HIV+ individuals according to exposure to combination antiretroviral therapy (ART), ART class/regimen, CD4 cell count and plasma viral load (pVL) levels.

Design

Systematic review and meta-analysis.

Data sources

We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews until 18 July 2018. Furthermore, we scanned recent HIV conference abstracts (CROI, IAS/AIDS) and bibliographies of relevant articles.

Eligibility criteria

Original studies published after December 1999 and reporting comparative data relating to the rate of MI among HIV+ individuals were included.

Data extraction and synthesis

Two reviewers working in duplicate, independently extracted data. Data were pooled using random-effects meta-analysis and reported as relative risk (RR) with 95% CI.

Results

Thirty-two of the 8130 identified records were included in the review. The pooled RR suggests that HIV+ individuals have a greater risk of MI compared with uninfected individuals (RR: 1.73; 95% CI 1.44 to 2.08). Depending on risk stratification, there was moderate variation according to ART uptake (RR, ART-treated=1.80; 95% CI 1.17 to 2.77; ART-untreated HIV+ individuals: 1.25; 95% CI 0.93 to 1.67, both relative to uninfected individuals). We found low CD4 count, high pVL and certain ART characteristics including cumulative ART exposure, any/cumulative use of protease inhibitors as a class, and exposure to specific ART drugs (eg, abacavir) to be importantly associated with a greater MI risk.

Conclusions

Our results indicate that HIV infection, low CD4, high pVL, cumulative ART use in general including certain exposure to specific ART class/regimen are associated with increased risk of MI. The association with cumulative ART may be an index of the duration of HIV infection with its attendant inflammation, and not entirely the effect of cumulative exposure to ART per se.

PROSPERO registration number

CRD42014012977.

Accuracy of endoscopic staging and targeted biopsies for routine gastric intestinal metaplasia and gastric atrophy evaluation study protocol of a prospective, cohort study: the estimate study

Por: Nieuwenburg · S. A. V. · Waddingham · W. W. · Graham · D. · Rodriguez-Justo · M. · Biermann · K. · Kuipers · E. J. · Banks · M. · Jansen · M. · Spaander · M. C. W.
Introduction

Patients with chronic atrophic gastritis (CAG) and intestinal metaplasia (IM) are at risk of developing gastric adenocarcinoma. Their diagnosis and management currently rely on histopathological guidance after random endoscopic biopsy sampling (Sydney biopsy strategy). This approach has significant flaws such as under-diagnosis, poor reproducibility and poor correlation between endoscopy and histology. This prospective, international multicentre study aims to establish whether endoscopy-led risk stratification accurately and reproducibly predicts CAG and IM extent and disease stage.

Methods and analysis

Patients with CAG and/or IM on standard white light endoscopy (WLE) will be prospectively identified and invited to undergo a second endoscopy performed by an expert endoscopist using enhanced endoscopic imaging techniques with virtual chromoendoscopy. Extent of CAG/IM will be endoscopically staged with enhanced imaging and compared with standard WLE. Histopathological risk stratification through targeted biopsies will be compared with endoscopic disease staging and to random biopsy staging on WLE as a reference. At least 234 patients are required to show a 10 % difference in sensitivity and accuracy between enhanced imaging endoscopy-led staging and the current biopsy-led staging protocol of gastric atrophy with a power (beta) of 80 % and a 0.05 probability of a type I error (alpha).

Ethics and dissemination

The study was approved by the respective Institutional Review Boards (Netherlands: MEC-2018-078; UK: 19/LO/0089). The findings will be published in peer-reviewed journals and presented at scientific meetings.

Trial registration number

NTR7661; Pre-results.

Effectiveness of a behavioural intervention involving regular weighing and feedback by community midwives within routine antenatal care to prevent excessive gestational weight gain: POPS2 randomised controlled trial

Por: Daley · A. · Jolly · K. · Jebb · S. A. · Roalfe · A. · Mackilllop · L. · Lewis · A. · Clifford · S. · Usman · M. · Ohadike · C. · Kenyon · S. · MacArthur · C. · Aveyard · P.
Objectives

To assess the effectiveness of a brief behavioural intervention based on routine antenatal weighing to prevent excessive gestational weight gain (defined by US Institute of Medicine).

Design

Randomised controlled trial.

Setting

Antenatal clinic in England.

Participants

Women between 10+0 and 14+6 weeks gestation, not requiring specialist obstetric care.

Interventions

Participants were randomised to usual antenatal care or usual care (UC) plus the intervention. The intervention involved community midwives weighing women at antenatal appointments, setting maximum weight gain limits between appointments and providing brief feedback. Women were encouraged to monitor and record their own weight weekly to assess their progress against the maximum limits set by their midwife. The comparator was usual maternity care.

Primary and secondary outcome measures

Excessive gestational weight gain, depression, anxiety and physical activity.

Results

Six hundred and fifty-six women from four maternity centres were recruited: 329 women were randomised to the intervention group and 327 to UC. We found no evidence that the intervention decreased excessive gestational weight gain. At 38 weeks gestation, the proportions gaining excessive gestational weight were 27.6% (81/305) versus 28.9% (90/311) (adjusted OR 0.84, 95% CI: 0.53 to 1.33) in the intervention and UC group, respectively. There were no significant difference between the groups in anxiety or depression scores (anxiety: adjusted mean –0.58, 95% CI:–1.25 to –0.8; depression: adjusted mean –0.60, 95% CI:–1.24 to –0.05). There were no significant differences in physical activity scores between the groups.

Conclusions

A behavioural intervention delivered by community midwives involving routine weighing throughout pregnancy, setting maximum weight gain targets and encouraging women to weigh themselves each week to check progress did not prevent excessive gestational weight gain. There was no evidence of psychological harm.

Trial registration number

ISRCTN67427351

The productivity development of total hip arthroplasty in Sweden: a multiple registry-based longitudinal study using the Malmquist Productivity Index

Por: Goude · F. · Garellick · G. · Kittelsen · S. A. C. · Nemes · S. · Rehnberg · C.
Objective

The increasing demand for total hip arthroplasty (THA) combined with limited resources in healthcare puts pressure on decision-makers in orthopaedics to provide the procedure at minimum costs and with good outcomes while maintaining or increasing access. The objective of this study was to analyse the development in productivity between 2005 and 2012 in the provision of THA.

Design

The study was a multiple registry-based longitudinal study.

Setting and participants

The study was conducted among 65 orthopaedic departments providing THA in Sweden from 2005 to 2012.

Outcome measures

The development in productivity was measured by Malmquist Productivity Index by relating department level total costs of THA to the number of non-cemented, hybrid and cemented THAs. We also break down the productivity change into changes in efficiency and technology.

Results

Productivity increased significantly in three periods (between 1.6% and 27.0%) and declined significantly in four periods (between 0.8% and 12.1%). Technology improved significantly in three periods (between 3.2% and 16.9%) and deteriorated significantly in two periods (between 10.2% and 12.6%). Significant progress in efficiency was achieved in two periods (ranging from 2.6% to 8.7%), whereas a significant regress was attained in one period (3.9%). For the time span as a whole, an average increase in productivity of 1.4% per year was found, where changes in efficiency contributed more to the improvement (1.1%) than did technical change (0.2%).

Conclusions

We found a slight improvement of productivity over time in the provision of THA, which was mainly driven by changes in efficiency. Further research is, however, needed where differences in quality of care and patient case mix between departments are taken into account.

Does initial postgraduate career intention and social demographics predict perceived career behaviour? A national cross-sectional survey of UK postgraduate doctors

Por: Scanlan · G. M. · Cleland · J. · Stirling · S. A. · Walker · K. · Johnston · P.
Objective

Studies indicate that initial career intentions and personal characteristics (eg, gender) can influence medical career decision-making. However, little is known about how personal characteristics and intention interact with career decision-making. To address this gap, we examined the link between career intention at the start of the 2-year UK Foundation Programme (FP) and career intentions on its completion.

Methods

Data came from the 2017 UK National Career Destination Survey, a cross-sectional study completed by all second year foundation doctors. We included respondents’ demographics (gender, graduate status on entry to medical school, career intention on starting the FP) and career intention as an outcome measure (eg, specialty (residency) training (UK), NHS non-training posts/further study, career break, working abroad). Multinomial regression was used to assess the independent relationship between background characteristics and career intention.

Results

There were 6890 participants and 5570 usable responses. 55.9% of respondents were female and 43.1% were male, 77.1% were non-graduates and 22.9% were graduate entrants to medical school. Approximately two-thirds (62.3%, n=2170) of doctors who had an original intention to pursue specialty training after F2, still intended to do so on completion. Most of those who stated at the start of F2 that they did not want to pursue specialty indicated at the end of F2 they would be undertaking other employment opportunities outwith formal training. However, 37.7% of respondents who originally intended to pursue specialty training on FP completion did something different. Graduate entrants to medicine were more likely to immediately progress into specialty training compared with their peers who did medicine as a primary first degree.

Conclusion

Original intention is a strong predictor of career intentions at the end of the FP. However, a considerable proportion of doctors changed their mind during the FP. Further research is needed to understand this behaviour.

Trends in the receipt of medicines information among Finnish adults in 1999-2014: a nationwide repeated cross-sectional survey

Objective

The aim of this study was to examine long-term trends in the receipt of medicines information (MI) among adult medicine users from 1999 to 2014.

Design

Repeated cross-sectional postal survey from the years 1999, 2002, 2005 and 2008–2014.

Setting

Each study year, a new nationally representative sample of 5000 Finns aged 15–64 years was drawn from the Population Register Centre of Finland.

Participants

The range of annual respondents varied from 2545 to 3371 and response rates from 53% to 67%. Of the total responses (n=29 465), 64% were from medicine users (n=18 862, ranging by year from 58% to 68%).

Outcome measures

Receipt of information on medicines in use within 12 months prior to the survey from a given list of consumer MI sources available in Finland.

Results

Physicians, community pharmacists and package leaflets were the most common MI sources throughout the study period. Receipt of MI increased most from the Internet (from 1% in 1999 to 16% in 2014), while decreased most from physicians (62% to 47%) and package leaflets (44% to 34%), and remained stable from community pharmacists (46% to 45%) and nurses (14% to 14%). In 1999, of the medicine users 4% did not report receipt of MI from any of the sources listed in the survey, while this proportion had remarkably increased to 28% in 2014.

Conclusions

Healthcare professionals and package leaflets had still a dominating importance in 2014 despite the growing number of MI sources over time, but still a minority of adult medicine users reported receiving MI via the Internet in 2014. Worrying is that the proportion of adult medicine users who did not receive MI from any of the sources became seven fold during the study period.

Staying Quit After Release (SQuARe) trial protocol: a randomised controlled trial of a multicomponent intervention to maintain smoking abstinence after release from smoke-free prisons in Victoria, Australia

Por: Young · J. T. · Puljevic · C. · Love · A. D. · Janca · E. K. · Segan · C. J. · Baird · D. · Whiffen · R. · Pappos · S. · Bell · E. · Kinner · S. A.
Introduction

Smoke-free policies have been introduced in prisons internationally. However, high rates of relapse to smoking after release from prison indicate that these policies typically result in short-term smoking cessation only. These high rates of relapse, combined with a lack of investment in relapse prevention, highlight a missed opportunity to improve the health of a population who smoke tobacco at two to six times the rate of the general population. This paper describes the rationale and design of a randomised controlled trial, testing the effectiveness of a caseworker-delivered intervention promoting smoking cessation among former smokers released from smoke-free prisons in Victoria, Australia.

Methods and analysis

The multicomponent, brief intervention consists of behavioural counselling, provision of nicotine spray and referral to Quitline and primary care to promote use of government-subsidised smoking cessation pharmacotherapy. The intervention is embedded in routine service delivery and is administered at three time points: one prerelease and two postrelease from prison. Control group participants will receive usual care. Smoking abstinence will be assessed at 1 and 3 months postrelease, and confirmed with carbon monoxide breath testing. Linkage of participant records to survey and routinely collected administrative data will provide further information on postrelease use of health services and prescribed medication.

Ethics and dissemination

Ethical approval has been obtained from the Corrections Victoria Research Committee, the Victorian Department of Justice Human Research Ethics Committee, the Department of Human Services External Request Evaluation Committee and the University of Melbourne Human Research Ethics Committee. Results will be submitted to major international health-focused journals. In case of success, findings will assist policymakers to implement urgently needed interventions promoting the maintenance of prison-initiated smoking abstinence after release, to reduce the health disparities experienced by this marginalised population.

Trial registration number

ACTRN12618000072213; Pre-results.

Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study

Por: Radulovic · N. · Mason · S. A. · Rehou · S. · Godleski · M. · Jeschke · M. G.
Objective

To determine acute and long-term clinical, neuropsychological, and return-to-work (RTW) effects of electrical injuries (EIs). This study aims to further contrast sequelae between low-voltage and high-voltage injuries (LVIs and HVIs). We hypothesise that all EIs will result in substantial adverse effects during both phases of management, with HVIs contributing to greater rates of sequelae.

Design

Retrospective cohort study evaluating EI admissions between 1998 and 2015.

Setting

Provincial burn centre and rehabilitation hospital specialising in EI management.

Participants

All EI admissions were reviewed for acute clinical outcomes (n=207). For long-term outcomes, rehabilitation patients, who were referred from the burn centre (n=63) or other burn units across the province (n=65), were screened for inclusion. Six patients were excluded due to pre-existing psychiatric conditions. This cohort (n=122) was assessed for long-term outcomes. Median time to first and last follow-up were 201 (68–766) and 980 (391–1409) days, respectively.

Outcome measures

Acute and long-term clinical, neuropsychological and RTW sequelae.

Results

Acute clinical complications included infections (14%) and amputations (13%). HVIs resulted in greater rates of these complications, including compartment syndrome (16% vs 4%, p=0.007) and rhabdomyolysis (12% vs 0%, p

Conclusions

This is the first investigation to determine acute and long-term patient outcomes post-EI as a continuum. Findings highlight substantial rates of neuropsychological and social sequelae, regardless of voltage. Specialised and individualised early interventions, including screening for mental health concerns, are imperative to improvingoutcomes of EI patients.

Primary Care SHOPping intervention for cardiovascular disease prevention (PC-SHOP): protocol for a randomised controlled trial to reduce saturated fat intake

Por: Piernas · C. · Tsiountsioura · M. · Astbury · N. M. · Madigan · C. · Aveyard · P. · Jebb · S. A.
Introduction

A diet high in saturated fat (SFA) increases the risk of cardiovascular disease (CVD) and intakes in the UK exceed dietary recommendations. The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study aims to test the effect of an intervention for people with raised low-density lipoprotein (LDL) cholesterol involving health professional (HP) advice alone, or in combination with personalised feedback based on nutritional analysis of grocery store loyalty card data, on SFA intake and blood lipids in comparison with no intervention.

Methods and analysis

PC-SHOP is a three-arm parallel randomised controlled trial with an allocation ratio of 1:3:3 (‘no intervention’: n=16, ‘brief support’: n=48, ‘brief support plus shopping feedback’: n=48, respectively). Participants with raised LDL will be recruited from general practitioner (GP) practices for a 3-month intervention period. In brief support, an HP will deliver a behaviourally informed 10 min consultation and provide a written self-help guide to inform and motivate people to reduce their SFA intake. In brief support plus shopping feedback, the participants will receive the same HP-led behavioural support and, based on data from their grocery store loyalty card, personalised feedback on the SFA content of their grocery shopping, identifying high SFA purchases and suggesting swaps to similar but lower SFA items.

Measurements for the primary and secondary outcomes will be collected at baseline and at follow-up (3 months). The primary outcome measure will be the between-group difference in the reduction of SFA intake between baseline and follow-up. Secondary outcomes include changes in blood lipids and SFA content of food purchases, with process measures to consider the feasibility and acceptability of the intervention.

Ethics and dissemination

This study has been reviewed and approved by the National Health Service Health Research Authority Research Ethics Committee (Ref: 17/SC/0168). The trial findings will be disseminated to academic and HPs through presentations at meetings and peer-reviewed journals and to the public through the media. If the intervention is effective, the results will be communicated to relevant stakeholders, including policymakers and retailers.

Trial registration number

ISRCTN14279335; Pre-results.

Integrated management of type 2 diabetes and gestational diabetes within multi-morbidity conditions in Africa: a systematic review protocol

Por: Mutabazi · J. C. · Werfalli · M. M. · Rawat · A. · Musa · E. · Norris · S. A. · Murphy · K. · Trottier · H. · Levitt · N. · Zarowsky · C.
Introduction

Multi-morbidity, defined as the co-existence of more than one chronic condition in one person, has been increasing due to comorbid non-communicable and infectious chronic diseases (CNCICDs). Type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) incidences within the CNCICDs conditions are increasing and overwhelming already weak and under-resourced healthcare systems in Africa. There is then an urgent need for the integrated management of CNCICDs. We aim to review the integrated management of T2D and GDM within multi-morbidity conditions in Africa.

Methods

Studies that have assessed the integrated management of T2D and GDM within multi-morbidity conditions in Africa will be considered based on the Population, Intervention, Comparator and Outcome method: population (adult diagnosed with T2D and GDM, who also have other diseases, non-communicable diseases (NCDs) and infectious, in public primary and secondary healthcare facilities in Africa); Intervention (integrated management of T2D and GDM, also suffering from other diseases in Africa), Comparator (Unintegrated management of T2D and GDM in Africa) and Outcomes (integrated management of T2D and GDM in Africa). The following databases Cochrane Library, MEDLINE, PubMed and SCOPUS, the WHO International Clinical Trials Registry Platform, among others will be searched. Two reviewers (JCM and MW) will independently screen, select eligible studies and extract data. Discrepancies will be resolved by consensus or by a discussion with the third author (AR). Quality of included studies will be assessed using both the newly developed tool, ‘the Cochrane Collaboration Risk of Bias Tool’ and ‘Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I)". A narrative synthesis of extracted data and meta-analysis, if necessary will be conducted and then reported according to the preferred reporting items for systematic review and meta-analysis.

Ethics consideration and dissemination

By only using the published data, there is no ethics approval required for this study. This systematic review will be included in JCM’s PhD thesis and its findings will also be disseminated through peer-reviewed publication and conference presentation.

PROSPERO registration number

CRD42016046630.

Association between access to social service resources and cardiometabolic risk factors: a machine learning and multilevel modeling analysis

Por: Berkowitz · S. A. · Basu · S. · Venkataramani · A. · Reznor · G. · Fleegler · E. W. · Atlas · S. J.
Objectives

Interest in linking patients with unmet social needs to area-level resources, such as food pantries and employment centres in one’s ZIP code, is growing. However, whether the presence of these resources is associated with better health outcomes is unclear. We sought to determine if area-level resources, defined as organisations that assist individuals with meeting health-related social needs, are associated with lower levels of cardiometabolic risk factors.

Design

Cross-sectional.

Setting

Data were collected in a primary care network in eastern Massachusetts in 2015.

Participants and primary and secondary outcome measures

123 355 participants were included. The primary outcome was body mass index (BMI). The secondary outcomes were systolic blood pressure (SBP), low-density lipoprotein (LDL) cholesterol and haemoglobin A1c (HbA1c). All participants were included in BMI analyses. Participants with hypertension were included in SBP analyses. Participants with an indication for cholesterol lowering were included in LDL analyses and participants with diabetes mellitus were included in HbA1c analyses. We used a random forest-based machine-learning algorithm to identify types of resources associated with study outcomes. We then tested the association of ZIP-level selected resource types (three for BMI, two each for SBP and HbA1c analyses and one for LDL analyses) with these outcomes, using multilevel models to account for individual-level, clinic-level and other area-level factors.

Results

Resources associated with lower BMI included more food resources (–0.08 kg/m2 per additional resource, 95% CI –0.13 to –0.03 kg/m2), employment resources (–0.05 kg/m2, 95% CI –0.11 to –0.002 kg/m2) and nutrition resources (–0.07 kg/m2, 95% CI –0.13 to –0.01 kg/m2). No area resources were associated with differences in SBP, LDL or HbA1c.

Conclusions

Access to specific local resources is associated with better BMI. Efforts to link patients to area resources, and to improve the resources landscape within communities, may help reduce BMI and improve population health.

Study protocol for a randomised, double-blind, placebo-controlled clinical trial of duloxetine for the treatment and prevention of musculoskeletal pain: altering the transition from acute to chronic pain (ATTAC pain)

Por: Strauss · D. H. · Santhanam · D. R. · McLean · S. A. · Beaudoin · F. L.
Introduction

Chronic musculoskeletal pain affects a substantial portion of adults visiting the emergency department (ED). Current treatment is limited in scope and does not effectively reduce musculoskeletal pain in patients. The study will evaluate the use of duloxetine, a serotonin-norepinephrine reuptake inhibitor Food and Drug Administration approved for the treatment of chronic pain, as a promising option in its prevention. The proposed study may present a well-tolerated and effective non-opioid treatment for patients with acute musculoskeletal pain that may also be effective in preventing the transition to persistent or chronic musculoskeletal pain.

Methods and analysis

The primary outcome of this study will be to assess the tolerability and preliminary effectiveness of duloxetine in patients with acute musculoskeletal pain. The study will take place at two EDs in Rhode Island, USA. The study will involve randomisation to one of three arms: duloxetine 30 mg, duloxetine 60 mg or placebo. Tolerability will be assessed by comparing the proportion of participants that report an adverse event and that drop-out across the three study arms. Effectiveness will be determined by self-reported pain over 6 weeks of follow-up. Specifically, we will compare the proportion of participants with persistent pain (ongoing pain at 6-week follow-up), across the three study arms. 60 adults (aged 18–59) presenting to the ED with acute axial musculoskeletal pain within 7 days of onset are expected to be enrolled in the proposed study.

Ethics and dissemination

Ethics approval was obtained by the Institutional Review Board (IRB). These results will be published in a peer reviewed scientific journal and presented at one or more scientific conferences.

Trial registration number

NCT03315533.

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