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Neurocritical Care Jun 2024The objective of this study was to analyze the impact of a structured educational intervention on the implementation of guideline-recommended pain, agitation, and...
BACKGROUND
The objective of this study was to analyze the impact of a structured educational intervention on the implementation of guideline-recommended pain, agitation, and delirium (PAD) assessment.
METHODS
This was a prospective, multinational, interventional before-after trial conducted at 12 intensive care units from 10 centers in Germany, Austria, Switzerland, and the UK. Intensive care units underwent a 6-week structured educational program, comprising online lectures, instructional videos, educational handouts, and bedside teaching. Patient-level PAD assessment data were collected in three 1-day point-prevalence assessments before (T1), 6 weeks after (T2), and 1 year after (T3) the educational program.
RESULTS
A total of 430 patients were included. The rate of patients who received all three PAD assessments changed from 55% (107/195) at T1 to 53% (68/129) at T2, but increased to 73% (77/106) at T3 (p = 0.003). The delirium screening rate increased from 64% (124/195) at T1 to 65% (84/129) at T2 and 77% (82/106) at T3 (p = 0.041). The pain assessment rate increased from 87% (170/195) at T1 to 92% (119/129) at T2 and 98% (104/106) at T3 (p = 0.005). The rate of sedation assessment showed no signficiant change. The proportion of patients who received nonpharmacological delirium prevention measures increased from 58% (114/195) at T1 to 80% (103/129) at T2 and 91% (96/106) at T3 (p < 0.001). Multivariable regression revealed that at T3, patients were more likely to receive a delirium assessment (odds ratio [OR] 2.138, 95% confidence interval [CI] 1.206-3.790; p = 0.009), sedation assessment (OR 4.131, 95% CI 1.372-12.438; p = 0.012), or all three PAD assessments (OR 2.295, 95% CI 1.349-3.903; p = 0.002) compared with T1.
CONCLUSIONS
In routine care, many patients were not assessed for PAD. Assessment rates increased significantly 1 year after the intervention. Clinical trial registration ClinicalTrials.gov: NCT03553719.
Topics: Humans; Delirium; Male; Female; Middle Aged; Aged; Prospective Studies; Pain Management; Europe; Psychomotor Agitation; Germany; Austria; Adult; Analgesia; Critical Care; Switzerland; Intensive Care Units; United Kingdom; Pain Measurement; Conscious Sedation
PubMed: 37697129
DOI: 10.1007/s12028-023-01837-8 -
Annals of General Psychiatry Sep 2023Major depressive disorder (MDD) is the most common mood disorder and a leading cause of disability worldwide. Trazodone, a triazolopyridine serotonin receptor antagonist... (Review)
Review
Major depressive disorder (MDD) is the most common mood disorder and a leading cause of disability worldwide. Trazodone, a triazolopyridine serotonin receptor antagonist and reuptake inhibitor (SARI) antidepressant approved for major depressive disorder (MDD) in adults, has established efficacy that is comparable to other available antidepressants, and is effective for a range of depression symptoms, including insomnia, which is one of the most common and bothersome symptoms of depression. Also, trazodone's pharmacodynamic properties allow it to avoid the side effects of insomnia, anxiety and sexual dysfunction often associated with selective serotonin reuptake inhibitor antidepressants. In this narrative review, we have summarized recent clinical trials and real-world data on trazodone, including the recently introduced once-daily formulation, which has single dose pharmacokinetic properties that maintain effective blood trazodone levels for 24 h, while avoiding concentration peaks associated with side effects. This, combined with a low incidence of weight gain, and sexual dysfunction, may improve adherence to treatment. The most common adverse effects of trazodone are somnolence, headache, dizziness and xerostomia. It has minimal anticholinergic activity but may be associated infrequently with orthostatic hypotension (especially in patients with cardiovascular disease or older adults), QT interval prolongation, cardiac arrhythmias, and rare episodes of priapism. The low liability for activating side effects, the efficacy on symptoms such as insomnia and psychomotor agitation and the rapid onset of action make it useful for many depressed patients, both in monotherapy at nominal dosages of 150-300 mg/day, and in combination with other antidepressants at lower dosages.
PubMed: 37660092
DOI: 10.1186/s12991-023-00465-y -
PloS One 2023Although anthropogenic climate change is causing increased wildfire activity in the United States (US), humans are also an important ignition source. Humans cause a...
Although anthropogenic climate change is causing increased wildfire activity in the United States (US), humans are also an important ignition source. Humans cause a surge in wildfire ignitions every 4th of July (Independence Day in the US) through the use of fireworks. We examine the 4th of July peak in fireworks-caused wildfire ignitions and show that their spatial distribution varies but has been heavily concentrated in the west and north central US and predominantly on tribal lands. Further, we show that the weekly timing of the 4th of July influences both the number and weekly distribution structure of fireworks-caused ignitions. We interpret these weekly and daily-scale distribution patterns of fireworks-caused ignitions to reflect the influences of human behavioral variations, culture, and fireworks regulations. For example, our analysis suggests that weekends and religious days of rest (e.g., Saturday, Sunday) have a dampening effect on the number on wildfire ignitions due to fireworks, and that weekends and the timing of work holidays likely impact the weekly distribution of fireworks-caused ignitions. Additionally, comparisons of fireworks-caused ignitions before and after the 4th of July at the daily and weekly scale likely reflect the efficacy of firework sales regulations and human behavioral tendencies towards pre-holiday impulsiveness. Given the predictability of the fireworks-caused ignitions and rising costs of wildfire mitigation, these results have several important management and policy implications.
Topics: Humans; Holidays; Seasons; Wildfires; Climate Change; Commerce; Psychomotor Agitation
PubMed: 37656710
DOI: 10.1371/journal.pone.0291026 -
BMC Nursing Aug 2023Psychomotor agitation is increased psychomotor activity, restlessness and irritability. People with psychomotor agitation respond by overreacting to intrinsic and...
BACKGROUND
Psychomotor agitation is increased psychomotor activity, restlessness and irritability. People with psychomotor agitation respond by overreacting to intrinsic and extrinsic stimuli, experiencing stress and/or cognitive impairment. the aim was to analyse the association of nursing diagnoses with the disinhibition dimension, the aggressiveness dimension and the lability dimension of the Corrigan Agitated Behaviour Scale.
METHODS
This study was conducted in Spain using a multicentre cross-sectional convenience sample of 140 patients who had been admitted to psychiatric hospital units and had presented an episode of psychomotor agitation between 2018 and 2021.
RESULTS
The Corrigan Agitated Behaviour Scale was used to assess psychomotor agitation. Associated nursing diagnoses, violence directed at professionals and the environment are shown to be predictive values for the severity of the agitation episode. Moderate-severe psychomotor agitation episodes are shown as predictors of violence directed mainly at professionals and the environment.
CONCLUSIONS
There is an urgent need for mental health nurses to have knowledge of the extended clinic in order to care for users and improve their health conditions in dealing with people, with their social, subjective and biological dimension.
PubMed: 37641035
DOI: 10.1186/s12912-023-01434-2 -
PeerJ 2023Salinity is a main factor in decreasing seed germination, plant growth and yield. Salinity stress is a major problem for economic crops, as it can reduce crop yields and...
PURPOSE
Salinity is a main factor in decreasing seed germination, plant growth and yield. Salinity stress is a major problem for economic crops, as it can reduce crop yields and quality. Salinity stress occurs when the soil or water in which a crop is grown has a high salt content. Biochar improve plant growth and physiological traits under salt stress. The aim of the present study, the impact of biochar on growth, root morphological traits and physiological properties of alfalfa, amaranth and maize and soil enzyme activities under saline sands.
METHODS
We studied the impact of biochar on plant growth and the physiological properties of alfalfa, amaranth and maize under salt stress conditions. After 40 days, plant growth parameters (plant height, shoot and root fresh weights), root morphological traits and physiological properties were measured. Soil nutrients such as the P, K and total N contents in soil and soil enzyme activities were analyzed.
RESULTS
The results showed that the maize, alfalfa, and amaranth under biochar treatments significantly enhanced the plant height and root morphological traits over the control. The biochar on significantly increased the total root length, root diameter, and root volume. Compared to the control, the biochar significantly increased the chlorophyll a and b content, total chlorophyll and carotenoid content under salt stress. Furthermore, the biochar significantly increased enzyme activities of soil under salt stress in the three crops.
CONCLUSIONS
Biochar treatments promote plant growth and physiological traits of alfalfa, amaranth, and maize under the salt stress condition. Overall, biochar is an effective way to mitigate salinity stress in crops. It can help to reduce the amount of salt in the soil, improve the soil structure, and increase the availability of essential nutrients, which can all help to improve crop yields.
Topics: Zea mays; Medicago sativa; Chlorophyll A; Amaranth Dye; Amaranthus; Soil; Crops, Agricultural; Psychomotor Agitation; Salt Stress
PubMed: 37609438
DOI: 10.7717/peerj.15684 -
Medicine Aug 2023Family-centered nursing model has been widely used in the care of children patients, but there is still a lack of research on the care of children with primary nephrotic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Family-centered nursing model has been widely used in the care of children patients, but there is still a lack of research on the care of children with primary nephrotic syndrome (PNS). Therefore, the aim of this study was to comprehensively evaluate the effects of family-centered nursing on children with PNS.
METHODS
The electronic databases included China National Knowledge Internet, Wanfang Data Knowledge Service Platform, VIP, PubMed, Web of Science, Cochrane Library, and Embase, were searched to collect randomized controlled trials on family-centered nursing model in the treatment of children with PNS. Fixed effect models or fixed effect models were used to analyze the outcomes. The primary outcomes were length of hospital stay and nursing satisfaction, and the second outcomes were quality of life (QoL) and behavioral problems.
RESULTS
A total of 12 studies involving 996 pediatric patients were included, of which 500 children received family centered care and 496 children received routine care. The results showed that family centered nursing model could significantly improve the QoL of children with PNS (P < .05), increase the nursing satisfaction of family members (P < .0001, SMD = 7.37, 95%CI = 4.15-13.08), reduce the time of hospitalization (P < .0001, standard mean difference [SMD] = -2.30, 95%CI = -2.57 to -2.03), and decrease the scores of psychosomatic disorders and impulsivity hyperactivity in children with PNS (P < .0001, SMD = -3.13, 95%CI = -4.12 to -2.15; P < .0001, SMD = -3.29, 95%CI = -4.29 to -2.28). However, there was no significant statistical difference in the impact on the scores of conduct problems, learning problems, anxiety, and hyperactivity (P > .05).
CONCLUSION
Family-centered nursing model can improve the QoL of children with PNS, increase the nursing satisfaction of family members and reduce the length of hospital stay, but further research need to verify its impact on behavioral problems.
Topics: Humans; Child; Family Nursing; Nephrotic Syndrome; Quality of Life; Anxiety; Anxiety Disorders; Psychomotor Agitation
PubMed: 37603508
DOI: 10.1097/MD.0000000000034601 -
Journal of Affective Disorders Nov 2023Researchers have studied sex differences in typical depressive and anxiety symptoms and their cooccurrence. The World Health Organization (WHO) proposed a mental health...
BACKGROUND
Researchers have studied sex differences in typical depressive and anxiety symptoms and their cooccurrence. The World Health Organization (WHO) proposed a mental health promotion objective that suggests considering protective health-promoting factors when developing strategies for preventing mental disorders between sexes. From a network perspective, psychopathology is viewed as a result of interacting symptoms and influential factors. This study adopted network approach to investigate sex differences in health-promoting lifestyles (HPL) and the cooccurrence symptoms of communities in Shanghai. The aim is to provide health-promoting suggestions on better enhancing the life quality for community members.
METHODS
Depression, anxiety symptoms, and HPL were assessed with PHQ-9, GAD-7 and HPLP-II scales in 2420 adults (1411 females). Networks were constructed by Gaussian Graphical Models and the networks of two sexes using the Network Comparison Test.
RESULTS
Females scored significantly higher on PHQ-9 (p < 0.001) and GAD-7 (p < 0.001), and no differences were found between the two sexes in HPL scores. Restlessness and low energy yielded the highest strength centrality in the female network, while suicide ideation and restlessness were central in male network. Regarding protective HPL, physical activity and stress management were identified as the central mental health-promoting behaviours in female and male network, respectively. However, stress management was positively related to suicide ideation in the male network.
CONCLUSION
Communities should be aware of suicide ideation in males because of its high relationships with other symptoms and also provide stress management courses, especially for males. As for women, chronic energy deficiency deserves more attention for its high probability of cooccurrence with other symptoms in the network. Also, advocating physical activities may be particularly beneficial for the overall mental health among women. Future study should collect time-series data and analyze intraindividual networks to specify personalized health promoting strategies for each individual.
Topics: Adult; Humans; Male; Female; Depression; Sex Characteristics; Psychomotor Agitation; China; Anxiety; Healthy Lifestyle
PubMed: 37499917
DOI: 10.1016/j.jad.2023.07.107 -
JAMA Network Open Jul 2023Limited data exist on the association of gastroesophageal reflux (GER) symptoms with sleep quality.
IMPORTANCE
Limited data exist on the association of gastroesophageal reflux (GER) symptoms with sleep quality.
OBJECTIVE
To prospectively investigate the association between GER symptoms and sleep quality.
DESIGN, SETTING, AND PARTICIPANTS
This prospective cohort study included data from the Nurses' Health Study II of female nurses in the US. Participants self-reported the frequency and duration of GER symptoms beginning June 2005, with updates every 4 years through June 2015. Follow-up was completed June 2019, and data were analyzed from November 15, 2022, to June 4, 2023.
EXPOSURES
Frequency and duration of GER symptoms.
MAIN OUTCOMES AND MEASURES
Poor sleep quality was assessed in 2017 through a modified Pittsburgh Sleep Quality Index, which included difficulty in falling asleep, restlessness of sleep, daytime sleepiness, sleep disturbance, and sleep duration. Relative risk (RR) for poor sleep quality and individual components of poor sleep quality was estimated according to the frequency and duration of GER symptoms.
RESULTS
Among 48 536 women (median age, 59 years [range, 48-69 years]), 7929 (16.3%) developed poor sleep quality during 4 years of follow-up. Compared with those with GER symptoms less than once a month, the multivariable RR for poor sleep quality among women with GER symptoms more than once a week was 1.53 (95% CI, 1.45-1.62). Women who had GER symptoms once or more a week for more than 7 years had an RR of 1.36 (95% CI, 1.30-1.43) compared with women who had not had GER symptoms once or more a week. The frequency and duration of GER symptoms were significantly associated with each individual component of poor sleep quality; for example, the multivariable RRs for GER symptoms 2 or more times per week compared with no GER symptoms were 1.49 (95% CI, 1.39-1.58) for difficulty in falling asleep, 1.47 (95% CI, 1.39-1.56) for excessive daytime sleepiness, and 1.44 (95% CI, 1.36-1.53) for restlessness of sleep.
CONCLUSIONS AND RELEVANCE
In this prospective cohort study of female nurses in the Nurses' Health Study II, the frequency and duration of GER symptoms were associated with subsequent risk of poor sleep quality. The findings suggest that effective treatment of GER disease may be important not only for improvement of symptoms but also for the reduction of comorbidities associated with poor sleep quality.
Topics: Humans; Female; Middle Aged; Sleep Quality; Prospective Studies; Psychomotor Agitation; Gastroesophageal Reflux; Nurses
PubMed: 37466940
DOI: 10.1001/jamanetworkopen.2023.24240 -
Journal of Emergency Nursing Nov 2023Air medical transport during the coronavirus disease 2019 pandemic was essential for transferring critically ill patients. This study aimed to comparatively analyze...
INTRODUCTION
Air medical transport during the coronavirus disease 2019 pandemic was essential for transferring critically ill patients. This study aimed to comparatively analyze air-transported patients with and without coronavirus disease 2019 according to their clinical condition and complications that occurred during the flight.
METHODS
This was a retrospective cohort study that analyzed the digital records of adult patients transported by fixed-wing aircraft from the interior of the state of Amazonas to the state capital Manaus, Brazil, from June 2019 to May 2021. Pearson's chi-squared, Fisher exact, and Wilcoxon-Mann-Whitney tests were applied (significance level of P < .05).
RESULTS
The sample consisted of 741 patients (60.59% men, median age 54 years). The incidence of complications during the flight was 7.28%, with emphasis on dyspnea, psychomotor agitation, and pain. There was a significant difference between patients with (n = 466) and without coronavirus disease 2019 (n = 275) regarding the variables age (P < .001), comorbidities (P < .001), body mass index (P < .001), impact (P < .001) and priority (P = .002) of the transfer, physiological severity (P < .001), use of vasoactive drugs when boarding the aircraft (P = .033), and occurrence of respiratory complications during air medical transport (P = .003).
DISCUSSION
Patients with coronavirus disease 2019 were older, had more comorbidities and were severely ill, and had higher body mass index, frequency of vasoactive drug use, and respiratory complications. Although there are minimal differences among these patients, the role that interhospital transfer plays in reducing burden on local, less well-equipped hospitals is a primary role of medical transport, particularly during pandemics.
Topics: Male; Adult; Humans; Middle Aged; Female; COVID-19; Pandemics; Retrospective Studies; Transportation of Patients; Comorbidity
PubMed: 37462596
DOI: 10.1016/j.jen.2023.06.006