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Development of the Prevent for Work questionnaire (P4Wq) for assessment of musculoskeletal risk in the workplace: part 1--literature review and domains selection

Por: Langella · F. · Christensen · S. W. M. · Palsson · T. S. · Hogh · M. · Gagni · N. · Bellosta-Lopez · P. · Christiansen · D. H. · Delle Chiaie · M. · Domenech-Garcia · V. · Johnston · V. · Szeto · G. P. Y. · Villafane · J. H. · Herrero · P. · Berjano · P.
Objective

This study aims to define appropriate domains and items for the development of a self-administered questionnaire to assess the risk of developing work-related musculoskeletal disorder (WMSD) and the risk of its progression to chronicity.

Design

Literature review and survey study.

Setting and participants

A literature review and a two-round interview with 15 experts in musculoskeletal pain were performed to identify the available domains for WMSD assessment.

Interventions and outcome

To ensure quality, only validated questionnaires were included for the Delphi process. A three-round Delphi method, with three round steps, was used to select the most pertinent and relevant domains and items.

Results

Nine questionnaires were identified through the expert discussion and literature review, comprising 38 candidate domains and 504 items. In the first round of the Delphi group, 17 domains reached more than 70% agreement and were selected. In the second round, 10 domains were rejected, while 11 were selected to complete the pool of domains. In the third and final round, 89 items belonging to 28 domains were defined as significant to develop a WMSDs risk assessment questionnaire.

Conclusions

No specific risk assessment questionnaires for WMSDs were identified from the literature. WMSD risk of presence and chronicity can be defined by an assessment tool based on the biopsychosocial model and the fear-avoidance components of chronic pain. The present study provides the formulation and operationalisation of the constructs in domains and items needed for developing and validating the questionnaire.

The connection of the clinical learning environment and supervision of nursing students with student satisfaction and future intention to work in clinical placement hospitals

Abstract

Aims and objectives

To analyse nursing students’ perceptions of the clinical learning environment and supervision and the connection between their satisfaction and intention of staying in their placement hospitals.

Background

Global nursing shortage necessitates strategies for the recruitment and retention of nurses. It is believed that nursing students’ clinical placement experiences can affect their learning outcomes, as well as influence their choice of future workplace.

Design

Cross‐sectional, correlational study.

Methods

One hundred and eighty nursing students participated in the study. The data were collected in person using The Clinical Learning Environment, Supervision and Nurse Teacher scale tool. Students’ satisfaction with the clinical learning environment and learning process was measured using a 4‐point Likert scale developed by the researchers. The STROBE checklist was used in this paper.

Results

Nursing students perceived a favourable clinical learning environment and supervision in the hospitals where they undertook clinical placements, recording high levels of satisfaction and high levels of intention to stay and work there. The clinical learning environment and supervision established positive correlations with student satisfaction.

Conclusions

This study promotes the development of knowledge and understanding of how student satisfaction and intention to stay and work in their placement hospitals relates to the quality of the clinical learning environment and supervision, which could be helpful to the management of healthcare facilities and faculties in improving nursing education and retention/recruitment strategies.

Relevance to clinical practice

Nursing students represent the future of the nursing workforce, so managers of healthcare facilities and faculties should move towards promoting a clinical learning and supervisory environment where supervisors, tutors and staff are aware of their commitment to student education and promote optimal learning and positive experiences in order for students to feel satisfied and motivated to work in their placement hospitals.

Integration of nursing services provided to patients with heart failure living at home: A longitudinal ethnographic study

Abstract

Aims and objectives

This study aimed to (1) describe the development of integrated services between hospital‐based heart failure nursing services and municipally located home care nurses’ services and (2) identify the benefits of this collaboration for the development of home care nursing services.

Background

Governments have called for better integration of healthcare services to respond to demographic ageing. Clinical pathways have been used to enhance integration and assure continuity between primary and secondary care. Competencies in addressing advanced health issues among home care nurses must be improved.

Design

A longitudinal ethnographic study of the development of home care nursing services for persons living with heart failure.

Methods

Data were field notes from observations at meetings of the steering group designing the services, visits to patients’ homes and from educational sessions. Interviews were conducted with the home care nurses, heart failure nurses and focus group meetings with nurses working in home care nursing. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Studies checklist.

Results

In a collaborative project, nurses from the two settings developed nursing services to address signs indicating exacerbation of heart failure and risk of hospital visits, involving advanced heart failure monitoring and treatment in patients’ homes. A clinical pathway was developed to assure effective assessment of patients’ condition. The home care nurses gained new knowledge and developed work practices that called for different competencies. Access to consultation from specialised heart failure nurses was instrumental in this transition.

Conclusions

The development of nursing services by integrating primary and secondary services facilitates translation of knowledge, competencies and understandings between nurses at different settings. Such integration can foster expertise in nursing services.

Relevance to clinical practice

The transfer of specialised healthcare services to primary care facilitates collaboration and sharing of knowledge, understanding and work practices.

Effects of an optimised approach to home-based respiratory care in individuals with amyotrophic lateral sclerosis: a study protocol for a randomised controlled trial

Por: Pondofe · K. · Fregonezi · G. A. F. · Brito · O. · Dourado Junior · M. E. · Torres-Castro · R. · Resqueti · V. R.
Introduction

This study aims to investigate the effects of an optimal home-based respiratory care protocol in individuals with amyotrophic lateral sclerosis (ALS).

Methods and analysis

This is a randomised, blinded controlled trial involving patients diagnosed with ALS, both sexes, age between 18 and 80 years. Patients will be randomly allocated into the conventional respiratory care (CRC) group and the optimised respiratory care home-based (ORC) group. Primary outcomes will be peak cough flow, the number of exacerbations and ALS Functional Rating Scale Revised. Secondary outcomes will include chest wall volumes, maximal respiratory pressures, sniff nasal inspiratory pressure, nasal expiratory pressure and forced vital capacity (FVC), forced expiratory volume in the 1st second (FEV1) and FEV1/FVC. The CRC group will receive educational information about respiratory care at the clinic. The ORC group will receive conventional care and home-based care. The clinical status of all individuals will be monitored weekly through telephone calls. A 6-month intervention is planned, the outcomes will be assessed every 3 months and 3 and 6 months follow-up after final evaluation. The primary and secondary results will be described as average or median for continuous variables and absolute and relative frequencies for qualitative variables. Treatment effects or differences between the outcomes (baseline, 3 months and 6 months) of the study groups will be analysed using an analysis of variance. The level of significance will be set as p≤0.05.

Ethics and dissemination

The research ethics committee approved the study. It is expected to evaluate respiratory function in patients with ALS in the short, medium and long terms with home-based care protocol applied. The disease’s rapid progression is a limitation for performing a long-term clinical study.

Trial registration number

RBR-3z23ts; Pre-results.

Early Moves: a protocol for a population-based prospective cohort study to establish general movements as an early biomarker of cognitive impairment in infants

Por: Elliott · C. · Alexander · C. · Salt · A. · Spittle · A. J. · Boyd · R. N. · Badawi · N. · Morgan · C. · Silva · D. · Geelhoed · E. · Ware · R. S. · Ali · A. · McKenzie · A. · Bloom · D. · Sharp · M. · Ward · R. · Bora · S. · Prescott · S. · Woolfenden · S. · Le · V. · Davidson · S.-A. · Thorn
Introduction

The current diagnostic pathways for cognitive impairment rarely identify babies at risk before 2 years of age. Very early detection and timely targeted intervention has potential to improve outcomes for these children and support them to reach their full life potential. Early Moves aims to identify early biomarkers, including general movements (GMs), for babies at risk of cognitive impairment, allowing early intervention within critical developmental windows to enable these children to have the best possible start to life.

Method and analysis

Early Moves is a double-masked prospective cohort study that will recruit 3000 term and preterm babies from a secondary care setting. Early Moves will determine the diagnostic value of abnormal GMs (at writhing and fidgety age) for mild, moderate and severe cognitive delay at 2 years measured by the Bayley-4. Parents will use the Baby Moves smartphone application to video their babies’ GMs. Trained GMs assessors will be masked to any risk factors and assessors of the primary outcome will be masked to the GMs result. Automated scoring of GMs will be developed through applying machine-based learning to the data and the predictive value for an abnormal GM will be investigated. Screening algorithms for identification of children at risk of cognitive impairment, using the GM assessment (GMA), and routinely collected social and environmental profile data will be developed to allow more accurate prediction of cognitive outcome at 2 years. A cost evaluation for GMA implementation in preparation for national implementation will be undertaken including exploring the relationship between cognitive status and healthcare utilisation, medical costs, health-related quality of life and caregiver burden.

Ethics and dissemination

Ethics approval has been granted by the Medical Research Ethics Committee of Joondalup Health Services and the Health Service Human Research Ethics Committee (1902) of Curtin University (HRE2019-0739).

Trial registration number

ACTRN12619001422112.

Addressing HIV care, mental health and substance use among youth and young adults in the Bay Area: description of an intervention to improve information, motivation and behavioural skills

Por: McCuistian · C. · Wootton · A. R. · Legnitto-Packard · D. · Gruber · V. A. · Dawson-Rose · C. · Johnson · M. O. · Saberi · P.
Objective

Youth represent a population disparately impacted by the HIV epidemic. With most new HIV diagnoses occurring among adolescents and young adults, novel approaches to address this disparity are necessary. The objective of the current study was to describe the Youth to Telehealth and Text to Improve Engagement in Care (Y2TEC) intervention, which aims to fill this gap. The Y2TEC intervention (trial registration NCT03681145) offers an innovative approach to improve HIV treatment engagement among youth living with HIV by focusing on treatment barriers related to mental health and substance use. This allows for a holistic approach to providing culturally informed intervention strategies for this population.

Participants and setting

The Y2TEC intervention was developed for youth with HIV in the large metropolitan area of the San Francisco Bay Area. The Y2TEC intervention was developed based on formative interdisciplinary research and is grounded in the information–motivation–behavioural skills model.

Results

The intervention includes 12 sessions each lasting 20–30 minutes, which are delivered through videoconferencing and accompanying bidirectional text messaging. The intervention sessions are individualised, with session dosage in each major content area determined by participant’s level of acuity.

Conclusions

The Y2TEC intervention is well positioned to help decrease HIV-related disparities in youth living with HIV through its innovative use of video-counselling technologies and an integrated focus on HIV, mental health and substance use.

Study protocol of a systematic review and qualitative evidence synthesis using two different approaches: Healthcare related needs and desires of older people with post-stroke aphasia

Introduction

Stroke is a frequent disease in the older population of Western Europe with aphasia as a common consequence. Aphasia is known to impede targeting treatment to individual patients’ needs and therefore may reduce treatment success. In Germany, the postacute care of patients who had stroke is provided by different healthcare institutions of different sectors (rehabilitation, nursing and primary care) with substantial difficulties to coordinate services. We will conduct two qualitative evidence syntheses (QESs) aiming at exploring distinct healthcare needs and desires of older people living with poststroke aphasia. We thereby hope to support the development of integrated care models based on needs of patients who are very restricted to communicate them. Since various methods of QESs exist, the aim of the study embedding the two QESs was to determine if findings differ according to the approach used.

Methods and analysis

We will conduct two QESs by using metaethnography (ME) and thematic synthesis (ThS) independently to synthesise the findings of primary qualitative studies. The main differences between these two methods are the underlying epistemologies (idealism (ME) vs realism (ThS)) and the type of research question (emerging (ME) vs fixed (ThS)).

We will search seven bibliographical databases. Inclusion criteria comprise: patients with poststroke aphasia, aged 65 years and older, studies in German/English, all types of qualitative studies concerning needs and desires related to healthcare or the healthcare system. The protocol was registered in the International Prospective Register of Systematic Reviews, follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and includes three items from the Enhancing Transparency in Reporting the synthesis of Qualitative Research checklist.

Ethics and dissemination

Ethical approval is not required. Findings will be published in a peer-reviewed journal and presented on national conferences.

Algorithmic surveillance of ICU patients with acute respiratory distress syndrome (ASIC): protocol for a multicentre stepped-wedge cluster randomised quality improvement strategy

Por: Marx · G. · Bickenbach · J. · Fritsch · S. J. · Kunze · J. B. · Maassen · O. · Deffge · S. · Kistermann · J. · Haferkamp · S. · Lutz · I. · Voellm · N. K. · Lowitsch · V. · Polzin · R. · Sharafutdinov · K. · Mayer · H. · Kuepfer · L. · Burghaus · R. · Schmitt · W. · Lippert · J. · Riedel
Introduction

The acute respiratory distress syndrome (ARDS) is a highly relevant entity in critical care with mortality rates of 40%. Despite extensive scientific efforts, outcome-relevant therapeutic measures are still insufficiently practised at the bedside. Thus, there is a clear need to adhere to early diagnosis and sufficient therapy in ARDS, assuring lower mortality and multiple organ failure.

Methods and analysis

In this quality improvement strategy (QIS), a decision support system as a mobile application (ASIC app), which uses available clinical real-time data, is implemented to support physicians in timely diagnosis and improvement of adherence to established guidelines in the treatment of ARDS. ASIC is conducted on 31 intensive care units (ICUs) at 8 German university hospitals. It is designed as a multicentre stepped-wedge cluster randomised QIS. ICUs are combined into 12 clusters which are randomised in 12 steps. After preparation (18 months) and a control phase of 8 months for all clusters, the first cluster enters a roll-in phase (3 months) that is followed by the actual QIS phase. The remaining clusters follow in month wise steps. The coprimary key performance indicators (KPIs) consist of the ARDS diagnostic rate and guideline adherence regarding lung-protective ventilation. Secondary KPIs include the prevalence of organ dysfunction within 28 days after diagnosis or ICU discharge, the treatment duration on ICU and the hospital mortality. Furthermore, the user acceptance and usability of new technologies in medicine are examined. To show improvements in healthcare of patients with ARDS, differences in primary and secondary KPIs between control phase and QIS will be tested.

Ethics and dissemination

Ethical approval was obtained from the independent Ethics Committee (EC) at the RWTH Aachen Faculty of Medicine (local EC reference number: EK 102/19) and the respective data protection officer in March 2019. The results of the ASIC QIS will be presented at conferences and published in peer-reviewed journals.

Trial registration number

DRKS00014330.

‘The Woman Gives’: Exploring gender and relationship factors in HIV advance care planning among African American caregivers

Abstract

Aims and objective

Advance care planning (ACP) is the communication process of documenting future healthcare preferences in case patients are unable to make healthcare decisions for themselves. Research suggests ACP discussions among persons living with HIV (PLHIV) are infrequent overall and may differ by gender and/or race.

Background

Previous literature has displayed that African Americans are less likely than other racial groups to use advanced care planning, palliative care or hospice, but does not conclusively account for ACP among PLHIV. African American PLHIV rely on informal care that may be differ by gender and represents an important pathway to increase ACP.

Design

The study was mixed methods and observational.

Methods

Participants completed self‐report surveys (N = 311) and were interviewed (n = 11). Poisson regression (quantitative) and grounded theory analyses (qualitative) were implemented, using COREQ checklist principles to ensure study rigor.

Results

Less than half had discussed ACP (41.2%; N = 267). More ACP knowledge predicted 76% lower likelihood of ACP discussions among women. Men who spent more time caregiving in a given week were nearly 3 times more likely to discuss ACP than men who spent less time caregiving. Women were more likely than men to be caregivers and were also expected to serve in that role more than men, which was qualitatively described as ‘being a woman’.

Conclusions

The present study is one of few studies exploring ACP among caregivers in African American populations hardest hit by HIV. Results suggest that ACP skill building and education are critical for African Americans living with HIV to promote ACP discussions with their caregivers. Knowledge about ACP topics was low overall even when healthcare had recently been accessed. Support reciprocity and gender‐specific communication skill building may facilitate ACP in African American HIV informal caregiving relationships.

Relevance to Clinical Practice

Results underscore the need for ACP education which includes healthcare providers and caregivers, given African Americans' preference for life‐sustaining treatments at end‐of‐life. ACP is crucial now more than ever, as COVID‐19 complicates care for older adults with HIV at high risk of complications.

Prognostic model to identify and quantify risk factors for mortality among hospitalised patients with COVID-19 in the USA

Por: Incerti · D. · Rizzo · S. · Li · X. · Lindsay · L. · Yau · V. · Keebler · D. · Chia · J. · Tsai · L.
Objectives

To develop a prognostic model to identify and quantify risk factors for mortality among patients admitted to the hospital with COVID-19.

Design

Retrospective cohort study. Patients were randomly assigned to either training (80%) or test (20%) sets. The training set was used to fit a multivariable logistic regression. Predictors were ranked using variable importance metrics. Models were assessed by C-indices, Brier scores and calibration plots in the test set.

Setting

Optum de-identified COVID-19 Electronic Health Record dataset including over 700 hospitals and 7000 clinics in the USA.

Participants

17 086 patients hospitalised with COVID-19 between 20 February 2020 and 5 June 2020.

Main outcome measure

All-cause mortality while hospitalised.

Results

The full model that included information on demographics, comorbidities, laboratory results, and vital signs had good discrimination (C-index=0.87) and was well calibrated, with some overpredictions for the most at-risk patients. Results were similar on the training and test sets, suggesting that there was little overfitting. Age was the most important risk factor. The performance of models that included all demographics and comorbidities (C-index=0.79) was only slightly better than a model that only included age (C-index=0.76). Across the study period, predicted mortality was 1.3% for patients aged 18 years old, 8.9% for 55 years old and 28.7% for 85 years old. Predicted mortality across all ages declined over the study period from 22.4% by March to 14.0% by May.

Conclusion

Age was the most important predictor of all-cause mortality, although vital signs and laboratory results added considerable prognostic information, with oxygen saturation, temperature, respiratory rate, lactate dehydrogenase and white cell count being among the most important predictors. Demographic and comorbidity factors did not improve model performance appreciably. The full model had good discrimination and was reasonably well calibrated, suggesting that it may be useful for assessment of prognosis.

Womens childbirth experiences in the Swedish Post-term Induction Study (SWEPIS): a multicentre, randomised, controlled trial

Por: Nilver · H. · Wessberg · A. · Dencker · A. · Hagberg · H. · Wennerholm · U.-B. · Fadl · H. · Wesström · J. · Sengpiel · V. · Lundgren · I. · Bergh · C. · Wikström · A.-K. · Saltvedt · S. · Elden · H.
Objective

To compare childbirth experiences in women randomly assigned to either induction of labour at 41 weeks or to expectant management until 42 weeks, in the Swedish Post-term Induction Study.

Design

A register-based, multicentre, randomised, controlled, superiority trial.

Setting

Women were recruited at 14 hospitals in Sweden, 2016–2018.

Participants

Women with an uncomplicated singleton pregnancy were recruited at 41 gestational weeks.

Interventions

The women were randomly assigned to induction of labour at 41 weeks (induction group, n=1381) or expectant management until 42 weeks (expectant management group, n=1379).

Outcome measures

As main outcome, women’s childbirth experiences were measured using the Childbirth Experience Questionnaire version 2 (CEQ2), in 656 women, 3 months after the birth at three hospitals. As exploratory outcome, overall childbirth experience was measured in 1457 women using a Visual Analogue Scale (VAS 1–10) within 3 days after delivery at the remaining eleven hospitals.

Results

The total response rate was 77% (2113/2760). There were no significant differences in childbirth experience measured with CEQ2 between the groups (induction group, n=354; expectant management group, n=302) in the subscales: own capacity (2.8 vs 2.7, p=0.09), perceived safety (3.3 vs 3.2, p=0.06) and professional support (3.6 vs 3.5, p=0.38) or in the total CEQ2 score (3.3 vs 3.2, p=0.07), respectively. Women in the induction group scored higher in the subscale participation (3.6 vs 3.4, p=0.02), although with a small effect size (0.19). No significant difference was observed in overall childbirth experience according to VAS (8.0 (n=735) vs 8.1 (n=735), p=0.22).

Conclusions

There were no differences in childbirth experience, according to CEQ2 or overall childbirth experience assessed with VAS, between women randomly assigned to induction of labour at 41 weeks or expectant management until 42 weeks. Overall, women rated their childbirth experiences high.

Trial registration number

ISRCTN26113652.

Sociodemographic differences in self-reported exposure to high fat, salt and sugar food and drink advertising: a cross-sectional analysis of 2019 UK panel data

Por: Yau · A. · Adams · J. · Boyland · E. J. · Burgoine · T. · Cornelsen · L. · de Vocht · F. · Egan · M. · Er · V. · Lake · A. A. · Lock · K. · Mytton · O. · Petticrew · M. · Thompson · C. · White · M. · Cummins · S.
Objectives

To explore sociodemographic differences in exposure to advertising for foods and drinks high in fat, salt and sugar (HFSS) and whether exposure is associated with body mass index (BMI).

Design

Cross-sectional survey.

Setting

UK.

Participants

1552 adults recruited to the Kantar Fast Moving Consumer Goods panel for London and the North of England.

Outcome measures

Self-reported advertising exposure stratified by product/service advertised (processed HFSS foods; sugary drinks; sugary cereals; sweet snacks; fast food or digital food delivery services) and advertising setting (traditional; digital; recreational; functional or transport); BMI and sociodemographic characteristics.

Results

Overall, 84.7% of participants reported exposure to HFSS advertising in the past 7 days. Participants in the middle (vs high) socioeconomic group had higher odds of overall self-reported exposure (OR 1.48; 95% CI 1.06 to 2.07). Participants in the low (vs high) socioeconomic group had higher odds of reporting exposure to advertising for three of five product categories (ORs ranging from 1.41 to 1.67), advertising for digital food delivery services (OR 1.47; 95% CI 1.05 to 2.05), traditional advertising (OR 1.44; 95% CI 1.00 to 2.08) and digital advertising (OR 1.50; 95% CI 1.06 to 2.14). Younger adults (18–34 years vs ≥65 years) had higher odds of reporting exposure to advertising for digital food delivery services (OR 2.08; 95% CI 1.20 to 3.59), digital advertising (OR 3.93; 95% CI 2.18 to 7.08) and advertising across transport networks (OR 1.96; 95% CI 1.11 to 3.48). Exposure to advertising for digital food delivery services (OR 1.40; 95% CI 1.05 to 1.88), digital advertising (OR 1.80; 95% CI 1.33 to 2.44) and advertising in recreational environments (OR 1.46; 95% CI 1.02 to 2.09) was associated with increased odds of obesity.

Conclusions

Exposure to less healthy product advertising was prevalent, with adults in lower socioeconomic groups and younger adults more likely to report exposure. Broader restrictions may be needed to reduce sociodemographic differences in exposure to less healthy product advertising.

Feasibility of a prehabilitation programme dedicated to older patients with cancer before complex medical-surgical procedures: the PROADAPT pilot study protocol

Por: Roche · M. · Ravot · C. · Malapert · A. · Paget-Bailly · S. · Garandeau · C. · Pitiot · V. · Tomatis · M. · Riche · B. · Galamand · B. · Granger · M. · Barbavara · C. · Bourgeois · C. · Genest · E. · Stefani · L. · Haïne · M. · Castel-Kremer · E. · Morel-Soldner · I. · Collange · V. · Le
Background

Ageing is associated with an increased prevalence of comorbidities and sarcopenia as well as a decline of functional reserve of multiple organ systems, which may lead, in the context of the disease-related and/or treatment-related stress, to functional deconditioning. The multicomponent ‘Prehabilitation & Rehabilitation in Oncogeriatrics: Adaptation to Deconditioning risk and Accompaniment of Patients’ Trajectories (PROADAPT)’ intervention was developed multiprofessionally to implement prehabilitation in older patients with cancer.

Methods

The PROADAPT pilot study is an interventional, non-comparative, prospective, multicentre study. It will include 122 patients oriented to complex medical–surgical curative procedures (major surgery or radiation therapy with or without chemotherapy). After informed consent, patients will undergo a comprehensive geriatric assessment and will be offered a prehabilitation kit that includes an advice booklet with personalised objectives and respiratory rehabilitation devices. Patients will then be called weekly and monitored for physical and respiratory rehabilitation, preoperative renutrition, motivational counselling and iatrogenic prevention. Six outpatient visits will be planned: at inclusion, a few days before the procedure and at 1, 3, 6 and 12 months after the end of the procedure. The main outcome of the study is the feasibility of the intervention, defined as the ability to perform at least one of the components of the programme. Clinical data collected will include patient-specific and cancer-specific characteristics.

Ethics and dissemination

The study protocol was approved by the Ile de France 8 ethics committee on 5 June 2018. The results of the primary and secondary objectives will be published in peer-reviewed journals.

Trial registration number

NCT03659123. Pre-results of the trial.

Long-term physical and psychological outcomes after out-of-hospital cardiac arrest--protocol for a national cross-sectional survey of survivors and their relatives (the DANCAS survey)

Por: Joshi · V. L. · Tang · L. H. · Borregaard · B. · Zinckernagel · L. · Mikkelsen · T. B. · Taylor · R. S. · Christiansen · S. R. · Nielsen · J. F. · Zwisler · A. D.
Introduction

The number of out-of-hospital cardiac arrest (OHCA) survivors is increasing. However, there remains limited knowledge on the long-term physical and psychological problems suffered by survivors and their relatives. The aims of the DANCAS (DANish cardiac arrest survivorship) survey are to describe the prevalence of physical and psychological problems, identify predictors associated with suffering them and to determine unmet rehabilitation needs in order to make recommendations on the timing and content of future rehabilitation interventions.

Methods and analysis

The DANCAS survey has a cross-sectional design involving a survey of OHCA survivors and their relatives. OHCA survivors will be identified through the Danish Cardiac Arrest Registry as having suffered an OHCA between 1 January 2016 and 31 December 2019. Each survivor will be asked to identify their closest relative to complete the relatives’ survey. Contents of survivor survey: EQ-5D-5Level, Hospital Anxiety and Depression Scale, Two Simple Questions, Modified Fatigue Impact Scale, 12-item WHO Disability Assessment Scale 2.0, plus questions on unmet rehabilitation and information needs. Contents of relatives’ survey: World Health Organisation-Five Well-Being Index, Hospital Anxiety and Depression Scale, Informant Questionnaire on Cognitive Decline in the Elderly—Cardiac Arrest and the Modified Caregiver Strain Index. Self-report outcome data collected through the surveys will be enriched by data from Danish national registries including demographic characteristics, circumstances of cardiac arrest and comorbidities. The survey will be completed either electronically or by post December 2020–February 2021.

Ethics and dissemination

The study will be conducted in accordance with the Declaration of Helsinki. Surveys and registry-based research studies do not normally require ethical approval in Denmark. This has been confirmed for this study by the Region of Southern Denmark ethics committee (20192000-19). Results of the study will be disseminated via several peer-reviewed publications and will be presented at national and international conferences.

A two-arm parallel-group individually randomised prison pilot study of a male remand alcohol intervention for self-efficacy enhancement: the APPRAISE study protocol

Por: Holloway · A. · Guthrie · V. · Waller · G. · Smith · J. · Boyd · J. · Mercado · S. · Smith · P. · Stenhouse · R. · Sheikh · A. · Parker · R. A. · Stoddart · A. · Conaglen · P. · Coulton · S. · Stadler · G. · Hunt · K. · Bray · J. · Ferguson · J. · Sondhi · A. · Lynch · K. · Rees · J. · Newbury
Introduction

The prevalence of at-risk drinking is far higher among those in contact with the criminal justice system (73%) than the general population (35%). However, there is little evidence on the effectiveness of alcohol brief interventions (ABIs) in reducing risky drinking among those in the criminal justice system, including the prison system and, in particular, those on remand. Building on earlier work, A two-arm parallel group individually randomised Prison Pilot study of a male Remand Alcohol Intervention for Self-efficacy Enhancement (APPRAISE) is a pilot study designed to assess the feasibility and acceptability of an ABI, delivered to male prisoners on remand. The findings of APPRAISE should provide the information required to design a future definitive randomised controlled trial (RCT).

Methods and analysis

APPRAISE will use mixed methods, with two linked phases, across two prisons in the UK, recruiting 180 adult men on remand: 90 from Scotland and 90 from England. Phase I will involve a two-arm, parallel-group, individually randomised pilot study. The pilot evaluation will provide data on the likely impact of A two-arm parallel group individually randomised Prison Pilot study of a male Remand Alcohol Intervention for Self-efficacy Enhancement (APPRAISE), which will be used to inform a future definitive multicentre RCT. Phase II will be a process evaluation assessing how the ABI has been implemented to explore the change mechanisms underpinning the ABI (figure 1) and to assess the context within which the ABI is delivered.

Ethics and dissemination

The APPRAISE protocol has been approved by the East of Scotland Research Ethics Committee (19/ES/0068), National Offender Management System (2019-240), Health Board Research and Development (2019/0268), Scottish Prison Service research and ethics committee, and by the University of Edinburgh’s internal ethics department. The findings will be disseminated via peer-reviewed journal publications, presentations at local, national and international conferences, infographics and shared with relevant stakeholders through meetings and events.

Trial registration number

ISRCTN27417180.

Randomised clinical trial for the cost-utility evaluation of two strategies of perineal reconstruction after abdominoperineal resection in the context of anorectal carcinoma: biological mesh repair versus primary perineal wound closure, study protocol for

Por: Buscail · E. · Canivet · C. · Ghouti · L. · Kirzin · S. · Carrere · N. · Molinier · L. · Rosillo · A. · Lauwers-Cances · V. · Costa · N. · French Research Group of Rectal Cancer Surgery (GRECCAR Group) · Venara · Lakkis · Alves · Regimbeau · Rullier · Piessen · Germain · Dubois
Introduction

Abdominoperineal resections performed for anorectal tumours leave a large pelvic and perineal defect causing a high rate of morbidity of the perineal wound (40%–60%). Biological meshes offer possibilities for new standards of perineal wound reconstruction. Perineal fillings with biological mesh are expected to increase quality of life by reducing perineal morbidity.

Methods and analysis

This is a multicentre, randomised and single-blinded study with a blinded endpoint evaluation, the experimental arm of which uses a biological mesh and the control arm of which is defined by the primary closure after abdominoperineal resection for cancer. Patients eligible for inclusion are patients with a proven history of rectal adenocarcinoma and anal canal epidermoid carcinoma for whom abdominoperineal resection was indicated after a multidisciplinary team discussion. All patients must have social security insurance or equivalent social protection. The main objective is to assess the incremental cost–utility ratio (ICUR) of two strategies of perineal closure after an abdominoperineal resection performed for anorectal cancer treatment: perineal filling with biological mesh versus primary perineal closure (70 patient in each arm). The secondary objectives focus on quality of life and morbidity data during a 1-year follow-up. Deterministic and probabilistic sensitivity analyses will be performed in order to estimate the uncertainty surrounding the ICUR. CIs will be constructed using the non-parametric bootstrap approach. A cost-effectiveness acceptability curve will be built so as to estimate the probability of efficiency of the biological meshes given a collective willingness-to-pay threshold.

Ethics and dissemination

The study was approved by the Regional Ethical Review Board of ‘Nord Ouest 1’ (protocol reference number: 20.05.14.60714; national number: 2020-A01169-30).

The results will be disseminated through conventional scientific channels.

Trial registration number

ClinicalTrials.gov Registry (NCT02841293).

Association between engagement in COVID-19-related work and depressive symptoms among hospital workers in a designated COVID-19 hospital in Japan: a cross-sectional study

Por: Inoue · Y. · Yamamoto · S. · Fukunaga · A. · Hoang · D. V. · Miki · T. · Islam · Z. · Miyo · K. · Ishii · M. · Ishiwari · H. · Konishi · M. · Ohmagari · N. · Mizoue · T.
Objectives

To examine whether engagement in COVID-19-related work was associated with an increased prevalence of depressive symptoms among the staff members working in a designated medical institution for COVID-19 in Tokyo, Japan.

Design

A cross-sectional study.

Setting

Data were obtained from a health survey conducted in July 2020 among the staff members of a designated medical institution for COVID-19 in Tokyo, Japan.

Participants

A total of 1228 hospital workers.

Exposure of interest

Engagement in COVID-19-related work (qualitatively (ie, the risk of SARS-CoV-2 infection at work or affiliation to related departments) as well as quantitatively (ie, working hours)) and job categories.

Outcome measures

Depressive symptoms.

Results

There was no significant association between depressive symptoms and engagement in work with potential exposure to SARS-CoV-2 or affiliation to COVID-19-related departments. However, working for longer hours in March/April, when Japan witnessed a large number of infected cases, was significantly associated with depressive symptoms (≥11 hours/day: prevalence ratio (PR)=1.45, 95% CI=1.06 to 1.99, compared with ≤8 hours/day). Nurses were more likely to exhibit depressive symptoms than did doctors (PR=1.70, 95% CI=1.14 to 2.54).

Conclusions

This study suggests that the risk of SARS-CoV-2 infection at work or having an affiliation to related departments might not be linked with a higher prevalence of depressive symptoms among Japanese hospital workers; contrarily, long working hours appeared to increase the prevalence of depressive symptoms.

Administration of 3% Sodium Chloride Through Peripheral Intravenous Access: Development and Implementation of a Protocol for Clinical Practice

Abstract

Background

Patients with traumatic brain injury, cerebral edema, and severe hyponatremia require rapid augmentation of serum sodium levels. Three percent sodium chloride is commonly used to normalize or augment serum sodium level, yet there are limited data available concerning the most appropriate route of administration. Traditionally, 3% sodium chloride is administered through a central venous catheter (CVC) due to the attributed theoretical risk of phlebitis and extravasation injuries when hyperosmolar solution is administered peripherally. CVCs are associated with numerous complications, including arterial puncture, pneumothorax, infection, thrombosis, and air embolus. Peripherally infused 3% sodium chloride may bypass these concerns.

Aims

To explore the evidence for peripherally infused 3% sodium chloride and to implement the findings.

Methods

The Iowa Model of Evidence‐Based Practice (EBP) was used to guide the project. A multidisciplinary team was established, and they developed an evidence‐based protocol for the administration of 3% sodium chloride using peripheral intravenous catheters (PIVs), identified potential barriers to implementation, and developed targeted education to implement this practice change in a large academic medical center.

Results

Of the 103 patients in this project, only three (2.9%) identified adverse events. Two were associated with continuous infusions, and one was associated with a bolus infusion.

Linking Action to Evidence

This is the first study to describe a multidisciplinary protocol development and implementation process for the administration of 3% sodium chloride peripherally. Utilizing a multidisciplinary team is critical to the success of an EBP project. Implementing an evidence‐based PIV protocol with stringent monitoring criteria for the administration of 3% sodium chloride has the potential to reduce adverse events related to CVC injury.

Using Twitter for Nursing Research: A Tweet Analysis on Heat Illness and Health

Abstract

Aim

To provide an example of a tweet analysis for nurse researchers using Twitter in their research.

Design

A content analysis using tweets about “heat illness + health.”

Methods

Tweets were pulled from Twitter’s application programming interface with premium access using Postman and the key words “heat illness + health.” All data cleaning and analysis was performed in R Version 3.5.2, and the tweet set was analyzed for term frequency, sentiment, and topic modeling. Principal R packages included LDAvis, tidytext, tm, and zyuzhet.

Results

6,317 tweets were analyzed with a date range of April 6, 2009, to December 30, 2019. The most common terms in the tweets were heat (n = 4,532), illness (n = 4,085), and health (n = 2,257). Sentiment analysis showed that the majority of tweets (55%) had a negative sentiment. Topic modeling showed that there were three topics within the tweet set: increasing impact, prevention and safety, and symptoms.

Conclusions

Twitter can be a useful tool for nursing researchers, serving as a viable adjunct to current research methodologies. This practical example has facilitated a deeper understanding of the social media representation of heat illness and health that can be applied to other research.

Clinical Relevance

Twitter serves as a tool for collecting health information for multiple groups, ranging from clinicians and researchers to patients. By utilizing the plethora of data that comes from the platform, we can work towards developing theories and interventions related to numerous health conditions and phenomena.

A workplace sales ban and motivational intervention can reduce sugar-sweetened beverage intake and improve cardiometabolic health

Por: Duong · T. V.

Commentary on: Epel ES, Hartman A, Jacobs LM, et al. Association of a workplace sales ban on sugar-sweetened beverages with employee consumption of sugar-sweetened beverages and health. JAMA Intern Med 2019;180:9–16.

Implications for practice and research

  • The impact of a workplace sales ban and motivational interventions on reducing sugar-sweetened beverages (SSBs) consumption and health should be investigated in other settings.

  • SSB sales bans and brief motivation may be a useful combination within public health strategy.

  • Context

    The interventions targeting SSB intake reduction have been implemented in different settings, for example, schools, retailing and food service establishments.1 The environmental interventions include labelling, nutrition standards in public institutions and economic tools (eg, taxes). The association between taxes on SSB consumption has been investigated previously.2 Epel et al sought to explore the potential benefits of an environmental intervention (sales ban, a brief motivation)...

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