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En la calle por ellas y por ellos: relato de experiencia en zonas de prostitución de un municipio del sur de Brasil

Objetivo principal: relatar a experiência das práticas de educação em saúde, por um grupo de profissionais, integrantes da Atenção Primária em Saúde, em zonas de prostituição de Rio Grande/RS. Metodologia: Trata-se de um relato de experiência, realizado em 2016, por um grupo de profissionais (Enfermeira, Assistente Social, Educador Social e motorista), vinculados a secretaria de saúde de um município do extremo sul do Brasil. Em uma unidade móvel de saúde, o grupo percorreu as zonas de prostituição (postos de gasolina, ruas e boates). De abril a agosto de 2016, os profissionais de saúde desenvolveram ações de conscientização sobre a importância dos riscos inerentes a profissão, sobre o cuidado de si, através da oferta de testes rápidos, distribuição de preservativos masculinos e femininos e lubrificantes íntimos. Resultados: Vinte zonas de prostituição foram encontradas pela equipe, concentrados em ruas, boates e postos de combustíveis espalhados pela cidade. Cerca de 200 profis-sionais do sexo, foram atendidas pelo grupo, sendo ofertados mensalmente 40 exames de testes rápidos e 40 carteiras sociais. Quanto a pre-venção as ISTs, foram distribuídos 1500 preservativos masculinos, 200 preservativos femininos e 500 lubrificantes íntimos. Conclusão: A equipe, de forma itinerante, atuou de forma exitosa na busca, não somente de orientá-las quanto aos riscos inerentes a profissão, mas também de conhecer um pouco da sua história, do resgate a cidadania e da autoestima, a uma população que tem seus direitos frequentemente violados. Percebe-se nessa vivência a importância da educação em saúde como um instrumento de promoção e prevenção, na busca pela valorização dessas pessoas.

Efficacy of home‐based exercise programme on physical function after hip fracture: a systematic review and meta‐analysis of randomised controlled trials

Abstract

We performed a meta‐analysis to evaluate the effect of home exercise programmes on body function after hip fractures. A computerised literature search was performed for published trials in PubMed, EMBASE, CENTRAL, and Cochrane Database of Systematic Reviews. Randomised trials were selected investigating home‐based exercise programmes vs usual care without home‐based exercise in hip fracture patients. Physical health (measured by Short Form 36), normal gait speed, fast gait speed, balance, instrumental activities of daily living (IADL), activities of daily living (ADL), lower extremity strength, leg strength in fractured leg, leg strength in non‐fractured leg, and Six‐Minute Walk Test (6MWT) per randomised patient were measured as outcomes. Eleven randomised controlled trials of 1068 subjects were included, 533 in the home‐based exercise group and 535 in the control group. The results of this meta‐analysis showed that the home‐based exercise programmes were not significantly associated with physical health, normal gait speed, fast gait speed, balance, IADL, ADL, and lower extremity strength but were significantly associated with leg strength in the fractured leg, leg strength in the non‐fractured leg, and 6MWT. The home‐based exercise programme had a positive, although not significant, effect on physical function after hip fracture. Low‐intensity training and poor patient compliance are unavoidable problems in home‐based exercise rehabilitation. A more task‐oriented rehabilitation programme might possibly yield more benefits for disability outcomes.

The impact of peer attachment on prosocial behavior, emotional difficulties and conduct problems in adolescence: The mediating role of empathy

by Konstanze Schoeps, Estefanía Mónaco, Amparo Cotolí, Inmaculada Montoya-Castilla

Attachment theories postulate that during adolescence, peer relationships become more important as a predictor of positive social, emotional and behavioral outcomes. Adolescents develop the ability to empathize with others, which is related to healthy functioning and positive peer relationships. Empathy has been studied as a potential mechanism that may help to explain how strong and healthy emotional bonds are associated with less emotional disorders and conduct problems in youth. The main purpose of this study was to examine the relationship between peer attachment and strengths and difficulties during adolescence, considering empathy as a potential mediator of this association. A total of 800 Spanish adolescents (56.65% girls), aged between 12 and 15 years (M = 14.02, SD = 1.21), completed measures of peer attachment, empathy, conduct problems, emotional difficulties and prosocial behavior. Structural equation models indicated that peer attachment was negatively associated with conduct problems and emotional difficulties but positively related to prosocial behavior. In general, empathy mediated the link between peer attachment and both emotional and behavioral outcomes, without significant group differences between boys and girls. The discussion focuses on the importance of healthy peer relationships as a powerful predictor of emotional well-being and psychological problems in adolescence.

Ischemia and reperfusion injury in superficial inferior epigastric artery-based vascularized lymph node flaps

by David P. Perrault, Gene K. Lee, Antoun Bouz, Cynthia Sung, Roy Yu, Austin J. Pourmoussa, Sun Young Park, Gene H. Kim, Wan Jiao, Ketan M. Patel, Young-Kwon Hong, Alex K. Wong

Vascularized lymph node transfer (VLNT) is a promising treatment modality for lymphedema; however, how lymphatic tissue responds to ischemia has not been well defined. This study investigates the cellular changes that occur in lymph nodes in response to ischemia and reperfusion. Lymph node containing superficial epigastric artery-based groin flaps were isolated in Prox-1 EGFP rats which permits real time identification of lymphatic tissue by green fluorescence during flap dissection. Flaps were subjected to ischemia for either 1, 2, 4, or 8 hours, by temporarily occluding the vascular pedicle. Flaps were harvested after 0 hours, 24 hours, or 5 days of reperfusion. Using EGFP signal guidance, lymph nodes were isolated from the flaps and tissue morphology, cell apoptosis, and inflammatory cytokines were quantified and analyzed via histology, immunostaining, and rtPCR. There was a significant increase in collagen deposition and tissue fibrosis in lymph nodes after 4 and 8 hours of ischemia compared to 1 and 2 hours, as assessed by picrosirius red staining. Cell apoptosis significantly increased after 4 hours of ischemia in all harvest times. In tissue subject to 4 hours of ischemia, longer reperfusion periods were associated with increased rates of CD3+ and CD45+ cell apoptosis. rtPCR analysis demonstrated significantly increased expression of CXCL1/GRO-α with 2 hours of ischemia and increased PECAM-1 and TNF-α expression with 1 hour of ischemia. Significant cell death and changes in tissue morphology do not occur until after 4 hours of ischemia; however, analysis of inflammatory biomarkers suggests that ischemia reperfusion injury can occur with as little as 2 hours of ischemia.

The relationship of workplace violence and nurse outcomes: Gender difference study on a propensity score matched sample 工作场所暴力与护士结局的关系:倾向性评分匹配样本的性别差异研究

Abstract

Aims

To investigate workplace violence and nurse outcomes by comparing gender differences.

Design

A secondary analysis of cross‐sectional survey data.

Methods

Workplace violence was measured by four items from the International Hospital Outcome Study. Nurse outcomes were measured by tools including burnout, job satisfaction and intention to stay. We used propensity score matching to generate a sociodemographic balanced dataset of 108 male and 288 female nurses. A hypothetical relationship model was derived from the affective events theory. Comparative statistics and multi‐group structural equation modelling were conducted to analyze gender differences. Data were collected in China from December 2013 – August 2014.

Results

Male nurses reported more workplace violence from staff and less intention to stay than females. Besides finding the mediation of burnout sharing with female nurses consistent with the affective events theory, workplace violence was directly linked to less intention to stay in male nurses.

Conclusion

Male nurses experience more workplace violence by staff than female nurses. Besides responding emotionally to workplace violence like female nurses, male nurses also respond behaviourally.

Impact

What problem did the study address? Gender differences in workplace violence and its relationship to nurse outcomes. What were the main findings? Male nurses experienced more workplace violence than female nurses, linked directly to less intention to stay. Workplace violence linked to less job satisfaction and intention to stay in nurses was mediated by burnout. Where and on whom will the research have impact? Gender‐based prevention of and coping with workplace violence should be included in nursing training.

目的

通过比较性别差异,探讨工作场所暴力与护士结局的关系。

设计

横向调查数据的二次分析。

方法

通过国际医院结局研究中的四个项目对工作场所暴力进行衡量研究。护士结局以工作倦怠、工作满意度和留任意愿为衡量指标。我们采用倾向性评分匹配,生成一个由108名男性护士和288名女性护士组成的社会人口平衡数据集。基于情绪事件理论提出了一个假设关系模型。通过利用好比较统计方法和多组结构方程建模来分析性别差异。数据于2013年12月至2014年8月在中国收集。

结果

相比于女护士,男护士更容易遭受工作场所暴力,留任意愿较低。除了通过与女护士分享工作倦怠的调解作用(与情绪事件理论一致)外,工作场所暴力与男护士的留任意愿降低直接相关。

结论

男护士比女护士更容易遭受工作场所暴力。除了像女护士一样对工作场所暴力做出情绪反应外,男护士还会做出行为上的反应。

影响

本项研究解决了哪些问题?工作场所暴力的性别差异及其与护士去留的关系。主要结果是什么?男护士比女护士更容易遭受工作场所暴力,这与其留任意愿较低直接相关。工作场所暴力与工作满意度和留任意愿降低相关,且通过工作倦怠调解。本项研究将适用于何处且对哪些人产生影响?护理培训应包括基于性别的工作场所暴力预防和应对措施。

Prevalence and Correlates of Depression, Anxiety, Stress, Healthy Beliefs, and Lifestyle Behaviors in First‐Year Graduate Health Sciences Students

Abstract

Background

Graduate and professional students are reported to have higher than average rates of depression compared to age‐ and gender‐matched populations. Further, more than half of student health visits are due to anxiety, yet little is known about the relationships among depression, anxiety, and healthy lifestyle behaviors in this population as well as what factors predict depression and anxiety.

Aims

The purposes of this study were as follows: (a) to examine the prevalence of depression, anxiety, stress, physical health, healthy beliefs, and lifestyle behaviors in incoming first‐year health sciences professional students; (b) to describe the relationships among these variables; and (c) to determine predictors of depression and anxiety.

Methods

A descriptive correlational study design was used with baseline data collected from first‐year graduate health sciences students from seven health professions colleges who were participating in a wellness onboarding intervention program, including Dentistry, Medicine, Nursing, Optometry, Pharmacy, Social Work, and Veterinary Medicine.

Results

Seventeen percent of incoming students reported moderate‐to‐severe depressive symptoms with 6% reporting suicidal ideation. In addition, 14% of the participating students reported moderate‐to‐severe anxiety. Factors that predicted depression and anxiety included having less than 7 hr of sleep per night, worse general health, lower healthy lifestyle beliefs, lower healthy lifestyle behaviors, higher stress, and a perceived lack of control.

Linking Evidence to Action

These findings highlight the need to routinely screen incoming health sciences students for depression and anxiety upon entrance into their academic programs so that evidence‐based interventions can be delivered and students who report severe depression or suicidal ideation can be immediately triaged for further evaluation and treatment. Providing cultures of well‐being and emphasizing self‐care throughout academic programs also are essential for students to engage in healthy lifestyles.

Thirty‐day readmission, length of stay and self‐management behaviour among patients with acute coronary syndrome and type 2 diabetes mellitus: A scoping review

Abstract

Aims and Objectives

To summarise the current evidence on comorbid type 2 diabetes mellitus (T2DM) related to 30‐day readmission and hospital length of stay (LOS) among patients with acute coronary syndrome (ACS) and evidence on the effectiveness of self‐management programmes for patients with both conditions.

Background

Acute coronary syndrome and T2DM remain two major diseases leading to serious consequences. Thirty‐day readmission and LOS were considered indicators of the quality of care, with the understanding that the potential significant effects of these outcomes could be varied.

Design

This scoping review followed the methodology described by Arksey and O'Malley.

Methods

Five databases including PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched, and a total of 20 articles involving 913,807 patients were included. Results were reported in accordance with PRISMA‐ScR guidelines.

Results

The results indicated that patients with both ACS and T2DM have prolonged LOS and increased 30‐day readmission rates. The findings supported that improvements in patient self‐management behaviour for optimal health outcomes were partially successful by effective self‐management programmes; however, few articles on intervention programmes specifically designed for patients with two conditions were found.

Conclusion

Prolonged LOS and increased 30‐day readmission rates are found among patients with ACS and T2DM. Based on few pilot studies building on each other, the effectiveness of self‐management programmes in promoting self‐care behaviour, self‐efficacy and knowledge for patients with ACS and T2DM cannot be concluded.

Relevance to clinical practice

Findings from this review provide valuable information on and a better understanding of readmissions and LOS among patients with ACS and T2DM for healthcare providers. Future developments and implementations of effective self‐management programmes should target patients with dual diagnoses to improve health behaviour and reduce readmission and LOS.

Unmet nursing care needs on medical and surgical wards: A scoping review of patients’ perspectives

Abstract

Aims and objectives

To review and synthesise research studies on surgical and medical inpatients’ perceptions on unmet nursing care needs.

Background

Missed nursing care is a growing phenomenon that has been shown to adversely affect care outcomes—mainly in adult medical and surgical care settings. However, to date the aggregated and synthesised evidence of missed care comes from research that measures perceptions on missed care in surgical and medical settings from nurses, but not from the patients.

Design

Scoping review.

Methods

In September 2018, three databases were searched: MEDLINE/PubMed, CINAHL and SCOPUS and papers were selected using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Inclusion criteria were as follows: primary studies; published in peer‐reviewed journals; in English or Italian; and regarding routine care provided to adult inpatients. Quality appraisal and a thematic analysis were conducted.

Results

Of the 1541 abstracts initially identified, 44 papers were included. Five themes emerged: “communication,” “self‐management, autonomy and education,” “personal sphere,” “essential physical care” and “emotional and psychological care.” The majority of the unmet needs were related to the “personal sphere” and “emotional and psychological care.” These unmet needs were not identified in previous literature on nurses’ perspectives of missed care. Also, physical care deficits like oral hygiene were identified.

Conclusion

It is important to take into account patients’ perspectives. The themes focusing on patients’ personal sphere, and emotional and psychological care, underline how patients need nurses to pay more attention to their cultural background, consider the person as a whole and for nursing care to be holistic and respectful of patients’ dignity.

Relevance to Clinical Practice

This study intends to raise awareness amongst nurses and policymakers about the importance of addressing missed nursing care and unmet patients’ needs in adult medical or surgical inpatient settings to ensure high‐quality care and patient satisfaction.

Structural empowerment is a strong predictor of organizational commitment in nurses: A systematic review and meta‐analysis

Abstract

Aims

The aim of this systematic review and meta‐analysis is to explore the relationship between structural empowerment and organizational commitment and to examine a theoretical model under which empowerment could potentially affect organizational performance.

Design

PRISMA guidelines for systematic reviews and meta‐analyses were used and quality assessment of articles was performed.

Data sources

Electronic database searches were conducted in Google Scholar, PubMed/Medline, CINAHL, Scopus, and EMBASE from January 1950–1 January 2019, which resulted in 204 retrieved studies, published between 1994–2018.

Review Methods

A random effects model was used to produce a pooled estimate of effect sizes (correlation coefficient, Cronbach's alpha), with analysis of heterogeneity and publication bias. A meta‐analytic structural equation model of the constructs analysed was also performed.

Results

The final review included 22 studies. The meta‐analytic means of structural empowerment, organizational commitment, job satisfaction, and psychological empowerment alpha reliabilities were 0.87, 0.84, 0.85, and 0.87, respectively. Heterogeneity but no publication bias was present in these outcomes. Structural empowerment was strongly correlated with organizational commitment (r = 0.43). The meta‐analytic correlation coefficients of organizational commitment with psychological empowerment and job satisfaction were 0.53 and 0.47, respectively. Structural empowerment was correlated with job satisfaction and psychological empowerment with correlation coefficients of 0.57 and 0.44, respectively. Finally, job satisfaction was correlated with psychological empowerment with a correlation coefficient of 0.53. A meta‐analytic structural equation model was tested with good fit which predicted performance (commitment and job satisfaction) from empowerment (structural and psychological).

Conclusion

Structural empowerment is strongly correlated to organizational commitment and with psychological empowerment, they increase organizational performance. Organizations should attempt to make structural empowerment as widespread as possible to create an effective workplace culture.

Impact

Structural empowerment in nurses is important to help deliver an effective workplace culture where nurses can be committed and have reduced intention‐to‐leave. Structural empowerment was strongly correlated with organizational commitment. Organizational commitment was significantly correlated with psychological empowerment and job satisfaction. Structural empowerment was correlated with job satisfaction and psychological empowerment as well. A meta‐analytic structural equation model with good fit predicted performance. These results will affect nursing researchers and practitioners. Results indicate a need for organizational restructuring that promotes empowerment and formation of theoretical models that connect empowerment to performance.

Effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum: Randomized controlled trial

Abstract

Aims

To evaluate the effectiveness of a brief motivational intervention to increase the breastfeeding duration in the first 6 months postpartum in mothers who began breastfeeding in the first hour after birth and to explore the role of general and breastfeeding self‐efficacy in this relationship.

Design

A multi‐centre randomized controlled clinical trial.

Methods

Data were collected from February 2018 ‐ March 2019. Women were randomly assigned to an intervention group that received a brief motivational intervention (N = 44) or a control group that was offered standard education on breastfeeding (N = 44). Survival analysis techniques were carried out with a follow‐up of 6 months. In addition, the roles of breastfeeding and general self‐efficacy in the association between BMI and breastfeeding duration were explored through mediation/moderation analysis.

Results

Among 88 randomized patients (mean age, 32.82 years), 81 (92.04%) completed the trial. The survival analyses of exclusive breastfeeding and breastfeeding (exclusive and non‐exclusive) showed reductions in the risk of abandonment in the intervention group of 63% (aHR: 0.37 [0.22–0.60] p < .001) and 61% (aHR: 0.39 [0.20–0.78] p = .008), respectively. We found that self‐efficacy acted as a moderator of the effect of brief motivational intervention on breastfeeding self‐efficacy. A discrete indirect effect of brief motivational intervention through increased breastfeeding self‐efficacy was found on breastfeeding duration, with an index of moderated mediation of 0.08 (95% CI: 0.02–0.19). Greater positive variations in the breastfeeding self‐efficacy scores during follow‐up predicted exclusive and non‐exclusive breastfeeding duration.

Conclusion

A brief motivational intervention conducted in the immediate postpartum period increases breastfeeding and exclusive breastfeeding duration in the first 6 months. Although breastfeeding self‐efficacy seems to moderate the effect of brief motivational intervention on the increase in breastfeeding duration, other factors may influence its effectiveness. Further studies could focus on exploring how brief motivational intervention works and whether it also works for pregnant mothers who have not yet decided whether to breastfeed.

Impact

Brief motivational intervention could be introduced as part of routine care of women who begin breastfeeding to improve the low rates of exclusive breastfeeding at 6 months postpartum.

Trial registration

Unique Protocol ID: Moti003; https://ClinicalTrials.gov ID: NCT03357549.

Development of a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis: cross-sectional study

Por: Verket · N. J. · Falk · R. S. · Qvigstad · E. · Tanbo · T. G. · Sandvik · L.
Objectives

To identify predictors of disease among a few factors commonly associated with endometriosis and if successful, to combine these to develop a prediction model to aid primary care physicians in early identification of women at high risk of developing endometriosis.

Design

Cross-sectional anonymous postal questionnaire study.

Setting

Women aged 18–45 years recruited from the Norwegian Endometriosis Association and a random sample of women residing in Oslo, Norway.

Participants

157 women with and 156 women without endometriosis.

Main outcome measures

Logistic and least absolute shrinkage and selection operator (LASSO) regression analyses were performed with endometriosis as dependent variable. Predictors were identified and combined to develop a prediction model. The predictive ability of the model was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and positive predictive values (PPVs) and negative predictive values (NPVs). To take into account the likelihood of skewed representativeness of the patient sample towards high symptom burden, we considered the hypothetical prevalences of endometriosis in the general population 0.1%, 0.5%, 1% and 2%.

Results

The predictors absenteeism from school due to dysmenorrhea and family history of endometriosis demonstrated the strongest association with disease. The model based on logistic regression (AUC 0.83) included these two predictors only, while the model based on LASSO regression (AUC 0.85) included two more: severe dysmenorrhea in adolescence and use of painkillers due to dysmenorrhea in adolescence. For the prevalences 0.1%, 0.5%, 1% and 2%, both models ascertained endometriosis with PPV equal to 2.0%, 9.4%, 17.2% and 29.6%, respectively. NPV was at least 98% for all values considered.

Conclusions

External validation is needed before model implementation. Meanwhile, endometriosis should be considered a differential diagnosis in women with frequent absenteeism from school or work due to painful menstruations and positive family history of endometriosis.

Bone health in symptomatic carriers of haemophilia A: a protocol for a multicentre prospective matched-cohort study

Por: Tang · G. H. · Norris · E. · Petrucci · J. · James · P. D. · Lee · A. · Poon · M.-C. · Floros · G. · Boma-Fischer · L. · Teitel · J. · Nisenbaum · R. · Sholzberg · M.
Introduction

Haemophilia A is an X linked inherited bleeding disorder, caused by a decrease in coagulation factor VIII. Persons with haemophilia experience repeated musculoskeletal bleeding, which can lead to decreased range of motion, irreversible joint damage, low bone mineral density (BMD), and are at greater risk for osteoporosis. Women heterozygous for this mutation, also known as haemophilia A carriers, can have bleeding symptoms and even experience joint bleeding evidenced by radiological soft tissue and osteochondral changes. The prevalence of low BMD as a risk factor for osteoporosis has never been evaluated in carriers of haemophilia, and given the recent findings which suggest subclinical musculoskeletal bleeding in carrier women, we hypothesise that they too are at risk of impaired bone health.

Methods and analysis

This is a national multicentre prospective matched-cohort study to compare BMD T-scores among symptomatic haemophilia A carriers, 50 years of age or older, with age-matched and body mass index-matched non-carriers (1:1). A total of 40 symptomatic carriers and 40 matched non-carriers will be recruited from St. Michael’s Hospital, Kingston General Hospital in Ontario, Canada and Foothills Medical Centre in Alberta, Canada. Multivariable linear regression models will be used to estimate the effect of haemophilia carriership on BMD T-scores, adjusting for age, body mass index and other relevant covariates.

Ethics and dissemination

The protocol was designed and will be conducted in compliance with applicable laws, rules and regulations. Research ethics approval was obtained from St. Michael’s Hospital, Foothills Medical Centre, and Kingston General Hospital. Findings will be presented at international venues such as the American Society of Haematology and the World Federation of Haemophilia World Congress. The authors of this study will seek publication in journals such as Blood, Journal of Thrombosis and Haemostasis, American Journal ofHematology and British Journal ofHaematology.

Induced pluripotent stem cell-based Drug Repurposing for Amyotrophic lateral sclerosis Medicine (iDReAM) study: protocol for a phase I dose escalation study of bosutinib for amyotrophic lateral sclerosis patients

Por: Imamura · K. · Izumi · Y. · Banno · H. · Uozumi · R. · Morita · S. · Egawa · N. · Ayaki · T. · Nagai · M. · Nishiyama · K. · Watanabe · Y. · Hanajima · R. · Oki · R. · Fujita · K. · Takahashi · N. · Ikeda · T. · Shimizu · A. · Morinaga · A. · Hirohashi · T. · Fujii · Y. · Takahashi · R. · Inou
Introduction

Amyotrophic lateral sclerosis (ALS) is a progressive and severe neurodegenerative disease caused by motor neuron death. There have as yet been no fundamental curative medicines, and the development of a medicine for ALS is urgently required. Induced pluripotent stem cell (iPSC)-based drug repurposing identified an Src/c-Abl inhibitor, bosutinib, as a candidate molecular targeted therapy for ALS. The objectives of this study are to evaluate the safety and tolerability of bosutinib for the treatment of patients with ALS and to explore the efficacy of bosutinib on ALS. This study is the first clinical trial of administered bosutinib for patients with ALS.

Methods and analysis

An open-label, multicentre phase I dose escalation study has been designed. The study consists of a 12-week observation period, a 1-week transitional period, a 12-week study treatment period and a 4-week follow-up period. After completion of the transitional period, subjects whose total ALS Functional Rating Scale-Revised (ALSFRS-R) score decreased by 1–3 points during the 12-week observation period receive bosutinib for 12 weeks. Three to six patients with ALS are enrolled in each of the four bosutinib dose levels (100, 200, 300 or 400 mg/day) to evaluate the safety and tolerability under a 3+3 dose escalation study design. Dose escalation and maximum tolerated dose are determined by the safety assessment committee comprising oncologists/haematologists and neurologists based on the incidence of dose-limiting toxicity in the first 4 weeks of the treatment at each dose level. A recommended phase II dose is determined by the safety assessment committee on completion of the 12-week study treatment in all subjects at all dose levels. The efficacy of bosutinib is also evaluated exploratorily using ALS clinical scores and biomarkers.

Ethics and dissemination

This study received full ethical approval from the institutional review board of each participating site. The findings of the study will be disseminated in peer-reviewed journals and at scientific conferences.

Trial registration number

UMIN000036295; Pre-results, JMA-IIA00419; Pre-results.

Strategies and Resources for Increasing the PhD Pipeline and Producing Independent Nurse Scientists

Abstract

Nurse scientists play an indispensable role in developing new knowledge to advance the health of patients, families, and communities. Yet PhD nurse enrollment has significantly dropped, and many later career nurse scientists are nearing retirement. The purpose of this article is to outline potential strategies to enhance the PhD nurse pipeline. Potential strategies are identified at three distinct time points along the PhD trajectory: (a) prior to a PhD program (increasing the pipeline), (b) during a PhD program (enhancing graduation rates and transitioning into research‐focused careers), and (c) in the postdoctoral or early career period (establishing scholarly independence and an active program of research). Talented students should be approached early on in their education to ascertain interest in a scientific research‐based career, and all students could be engaged in research opportunities while in undergraduate programs. During a PhD program, supportive mentors are a key component for student success and may provide assistance in obtaining ongoing funding and scholarship support. Throughout doctoral study and into early career, less structured opportunities can be influential, including conference support, online and face‐to‐face training, and ongoing funding and scholarship support for postdoctoral study or fellowships. At each career stage, there should be a focus on designing scientifically sound nursing research that will impact outcomes in measurable and sustainable ways. We must not focus our attention only on student recruitment. Public messaging efforts are needed to raise awareness of the role of nurse researchers. In addition, several stakeholders play a role in increasing the PhD pipeline and producing independent nurse scientists, and they should be acknowledged in these efforts. The strategies described may be beneficial for any nurse contemplating a research career as well as for those who may serve as mentors to these individuals. More broadly, these strategies may be employed by colleges and universities, funding bodies, professional nursing societies, and healthcare organizations in the United States and abroad. Increasing the PhD pipeline, and fostering a more robust field of independent nurse scientists, will translate into improved patient outcomes.

Integrative Review of Recruitment of Research Participants Through Facebook

imageBackground Facebook (FB) has been widely used recently to recruit participants for adult health research. However, little is known about its effectiveness, cost, and the characteristics of participants recruited via FB when compared to other recruitment methods. Objectives The purpose of this integrative review was to examine the published evidence concerning the use of FB in participant recruitment for adult health research, as compared to other social media, online, and traditional recruitment methods. Methods In this integrative review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, SCOPUS, and Web of Science were the electronic databases used to identify the published articles. In regard to language, the search was limited. Results The efficacy and cost-effectiveness of using FB for recruitment in healthcare research as compared to more traditional forms of recruitment remain unclear. Reporting of recruitment strategies is inconsistent, and costs are often not included. FB is being used for recruitment frequently with other methods and, although often effective, can be costly. Discussion FB is used to recruit participants for a variety of studies, with researchers using both free and paid ads to reach potential participants. Reporting of recruitment methods needs to be more rigorous, streamlined, and standardized in scientific papers.

Systematic review of negative pressure wound therapy for head and neck wounds with fistulas: Outcomes and complications

Abstract

Fistula formation in head and neck wounds is considered one of the most challenging complications that a head and neck reconstructive surgeon may encounter. The current mainstay of treatment is aggressive surgical debridement followed by vascularised soft tissue coverage. Negative pressure wound therapy (NPWT) has been successfully used for the closure of complicated wounds for decades. This study analysed the outcomes and complications of NPWT in the management of head and neck wounds with fistulas. A systematic search of studies published between January 1966 and September 2019 was conducted using the PubMed, MEDLINE, EMBASE, and SCOPUS databases and using the following key words: “negative pressure wound therapy,” “head and neck,” and “fistula.” We included human studies with abstract and full text available. Analysed endpoints were rate of fistula closure, follow‐up duration, and complications if present. Nine retrospective case series (Level IV evidence) that collectively included 122 head and neck wounds with orocutaneous fistulas, pharyngocutaneous fistulas, and salivary contamination were examined. The number of patients included in each study ranged from 5 to 64. The mode of NPWT varied among the included studies, with most adopting a continuous pressure of −125 mm Hg. Mean durations of NPWT ranged from 3.7 to 23 days, and the reported fistula closure rate ranged from 78% to 100%. To achieve complete wound healing, six studies used additional procedures after stopping NPWT, including conventional wound dressings and vascularised tissue transfer. Information regarding follow up was provided in only three of the nine studies, where patients were followed for 5, 10, and 18 months. No serious adverse events were reported. NPWT for head and neck wounds with fistulas may be considered a safe treatment method that yields beneficial outcomes with a low risk of complications. The current data originated mainly from studies with low levels of evidence characterised by heterogeneity. Therefore, definitive recommendations based on these data cannot be offered. Additional high‐quality trials are warranted to corroborate the findings of this systematic review.

Association between syphilis seroprevalence and age among blood donors in Southern China: an observational study from 2014 to 2017

Por: Wu · X. · Guan · Y. · Ye · J. · Fu · H. · Zhang · C. · Lan · L. · Wu · F. · Tang · F. · Wang · F. · Cai · Y. · Yu · W. · Feng · T.
Objective

This study investigated the association between syphilis seroprevalence and age among blood donors, and described the distribution of serological titres among syphilis-infected donors, aiming to confirm the syphilis epidemic characteristics and to promote effective interventions for older adults.

Methods

Data were obtained from the Shenzhen Programme for Syphilis Prevention and Control in 2014–2017. Blood samples were screened using the ELISAs, and confirmed using the Treponema pallidum particle agglutination assay (TPPA) and toluidine red unheated serum test (TRUST).

Results

Among 394 792 blood donors, 733 tested TPPA and TRUST positive (active infection), and 728 tested only TPPA positive (historical infection). The overall prevalence of syphilis seropositivity was 370.1 per 100 000 (95% CI 351.1 to 389.0 per 100 000); the prevalence of active infection was 185.7 per 100 000 (95% CI 172.2 to 199.1 per 100 000). People aged ≥45 years displayed a prevalence of 621.8 per 100 000 in syphilis seropositivity and 280.5 per 100 000 in active infection, which were 3.8 times and 2.4 times higher than that for people aged 2 trend=311.9, p trend2 trend=72.1, p trendtrend

Conclusions

The findings confirm the high prevalence of syphilis among older adults, and suggest the need to increase awareness among healthcare providers and deliver more targeted prevention interventions for older adults to promote early testing.

Negative pressure wound therapy with instillation: International consensus guidelines update

Abstract

The use of negative pressure wound therapy with instillation and dwell time (NPWTi‐d) has gained wider adoption and interest due in part to the increasing complexity of wounds and patient conditions. Best practices for the use of NPWTi‐d have shifted in recent years based on a growing body of evidence and expanded worldwide experience with the technology. To better guide the use of NPWTi‐d with all dressing and setting configurations, as well as solutions, there is a need to publish updated international consensus guidelines, which were last produced over 6 years ago. An international, multidisciplinary expert panel of clinicians was convened on 22 to 23 February 2019, to assist in developing current recommendations for best practices of the use of NPWTi‐d. Principal aims of the meeting were to update recommendations based on panel members' experience and published results regarding topics such as appropriate application settings, topical wound solution selection, and wound and patient characteristics for the use of NPWTi‐d with various dressing types. The final consensus recommendations were derived based on greater than 80% agreement among the panellists. The guidelines in this publication represent further refinement of the recommended parameters originally established for the use of NPWTi‐d. The authors thank Karen Beach and Ricardo Martinez for their assistance with manuscript preparation.

Depression‐Linked Beliefs in Older Adults with Depression

Abstract

Aims and objectives

To clarify beliefs linked with depression among older adults with depression in Japan.

Background

As a result of global population aging, caring for older adults with depression has become an important issue worldwide. In this paper, the concept of “beliefs” pertains to phenomena that lead to distress about disease and can be alleviated through talk therapy. While previous studies focused on illness beliefs in people with mental illness and depression, no studies have yet focused on such beliefs among older adults with depression.

Design

Qualitative, narrative‐research–based method.

Methods

Observation and 1–5 narrative interviews lasting 60–90 min were conducted with each of 19 older adults with depression in a Japanese psychiatric ward. The resulting narratives were thematically analyzed to derive relevant themes and subthemes. Reporting of this research adheres to COREQ guidelines.

Results

Four themes and twelve subthemes were revealed. Depression‐linked beliefs among older adults with depression were (1) “guilt and regret,” (2) “pessimism,” (3) “futility of treatment,” and (4) “desire to be needed by loved ones and society.”

Conclusion

Depression‐linked beliefs among older adults with depression constituted spiritual pain reflecting character tendencies, including experiences of loss and developmental challenges related to aging as well as subjects’ natural diligence and consideration for others.

Relevance to clinical practice

(1) Helping nurses better understand distress experienced by older adults with depression, who are prone to feel guilt and regret when reflecting on the past, and to alleviate distress through dialogue and providing positive affirmation for patients. (2) To understand and assuage distress over experiences of loss in old age. (3) To help older adults with depression form a more relaxed attitude toward life, so that even if they have experienced loss as a result of old age, they can maintain their self‐esteem and existential sense of self‐worth.

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