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International Wound Journal Jul 2024We investigated nurses' experiences of hospital-acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised....
Nurses' experiences of hospital-acquired pressure injury prevention in acute healthcare services in Victoria, Australia: A qualitative study using the Theoretical Domains Framework.
We investigated nurses' experiences of hospital-acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence-based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital-acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self-blame related to PI identification, and exacerbating impacts of the COVID-19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital-acquired PI.
Topics: Humans; Pressure Ulcer; Qualitative Research; Victoria; Male; Female; Adult; COVID-19; Nursing Staff, Hospital; Middle Aged; Attitude of Health Personnel; Iatrogenic Disease
PubMed: 38949176
DOI: 10.1111/iwj.14956 -
EFORT Open Reviews Jul 2024The combination of pharmacological and non-pharmacological interventions is strongly recommended by current guidelines for knee osteoarthritis. However, few systematic...
PURPOSE
The combination of pharmacological and non-pharmacological interventions is strongly recommended by current guidelines for knee osteoarthritis. However, few systematic reviews have validated their combined efficacy. In this study, we investigated the effects of the combination of pharmacological agents and exercise on knee osteoarthritis.
METHODS
Randomized controlled trials that investigated the efficacy of pharmacological agents combined with exercise for knee osteoarthritis were searched in PubMed, Embase, and Cochrane Library up to February 2024. The network meta-analysis was performed within the frequentist framework. Standardized mean difference (SMD) with 95% CI was estimated for pain and function. Grading of recommendations, assessment, development, and evaluations were used to evaluate the certainty of evidence.
RESULTS
In total, 71 studies were included. The combination therapy outperformed pharmacological or exercise therapy alone. Among the various pharmacological agents combined with exercise, mesenchymal stem cell injection was ranked the best for short-term pain reduction (SMD: -1.53, 95% CI: -1.92 to -1.13, high certainty), followed by botulinum toxin A, dextrose, and platelet-rich plasma. For long-term pain relief, dextrose prolotherapy was the optimal (SMD: -1.76, 95% CI: -2.65 to -0.88, moderate certainty), followed by mesenchymal stem cells, platelet rich in growth factor, and platelet-rich plasma.
CONCLUSION
Exercise programs should be incorporated into clinical practice and trial design. For patients undergoing exercise therapies, mesenchymal stem cell, dextrose, platelet-rich plasma, platelet rich in growth factor, and botulinum toxin A may be the optimal agents.
PubMed: 38949167
DOI: 10.1530/EOR-23-0136 -
Journal of Cardiovascular Medicine... Aug 2024To systematically evaluate the effectiveness of mobile health (mHealth) interventions on medication adherence in patients with heart failure. (Meta-Analysis)
Meta-Analysis
AIMS
To systematically evaluate the effectiveness of mobile health (mHealth) interventions on medication adherence in patients with heart failure.
METHODS
The literature search was conducted in PubMed, Web of Science, the Cochrane Library databases, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database and China Scientific Journal Database (VIP). The retrieval period was from the establishment of the database to May 2023. The included studies were trials to explore the effectiveness of mHealth interventions on medication adherence in patients with heart failure. Cochrane collaboration's tool was used for assessing risk of bias in randomized controlled trials. Stata 17.0 software was used to conduct data analysis. Continuous data were expressed as standard mean differences, and dichotomous data were expressed as relative risks with 95% confidence intervals (CIs).
RESULTS
A total of 13 studies and 2534 participants were included. One study was rated as Grade A, and the other 12 studies were Grade B. The results of meta-analysis indicate that mHealth interventions are effective in improving medication adherence [relative risk (RR) = 1.26, 95% CI 1.10-1.44, P < 0.05 and standard mean difference = 0.80, 95% CI 0.44-1.15, P < 0.05], and reducing readmission rates (RR = 0.63, 95% CI 0.53-0.76, P < 0.05) and mortality (RR = 0.63, 95% CI 0.43-0.94, P < 0.05) of patients with heart failure.
CONCLUSION
mHealth interventions are beneficial to improve medication adherence in patients with heart failure, and could effectively reduce the readmission rates and mortality of patients in the studies. There is a need to continuously improve the professional abilities of intervention personnel, carry out teamwork, and extend intervention and follow-up time. Convenient, fast and low-cost mobile medical devices should be adopted to reduce the cost of medical treatment. Scientific and reasonable intervention content will be formulated according to evidence-based guidelines and theoretical basis to enhance patients' ability at self-management and understanding of heart failure knowledge.
Topics: Humans; Heart Failure; Telemedicine; Medication Adherence; Female; Male; Middle Aged; Aged; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38949146
DOI: 10.2459/JCM.0000000000001631 -
Journal of Cardiovascular Medicine... Jun 2024To systematically evaluate the effectiveness of mobile health (mHealth) interventions on medication adherence in patients with heart failure.
AIMS
To systematically evaluate the effectiveness of mobile health (mHealth) interventions on medication adherence in patients with heart failure.
METHODS
The literature search was conducted in PubMed, Web of Science, the Cochrane Library databases, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database and China Scientific Journal Database (VIP). The retrieval period was from the establishment of the database to May 2023. The included studies were trials to explore the effectiveness of mHealth interventions on medication adherence in patients with heart failure. Cochrane collaboration's tool was used for assessing risk of bias in randomized controlled trials. Stata 17.0 software was used to conduct data analysis. Continuous data were expressed as standard mean differences, and dichotomous data were expressed as relative risks with 95% confidence intervals (CIs).
RESULTS
A total of 13 studies and 2534 participants were included. One study was rated as Grade A, and the other 12 studies were Grade B. The results of meta-analysis indicate that mHealth interventions are effective in improving medication adherence [relative risk (RR) = 1.26, 95% CI 1.10-1.44, P < 0.05 and standard mean difference = 0.80, 95% CI 0.44-1.15, P < 0.05], and reducing readmission rates (RR = 0.63, 95% CI 0.53-0.76, P < 0.05) and mortality (RR = 0.63, 95% CI 0.43-0.94, P < 0.05) of patients with heart failure.
CONCLUSION
mHealth interventions are beneficial to improve medication adherence in patients with heart failure, and could effectively reduce the readmission rates and mortality of patients in the studies. There is a need to continuously improve the professional abilities of intervention personnel, carry out teamwork, and extend intervention and follow-up time. Convenient, fast and low-cost mobile medical devices should be adopted to reduce the cost of medical treatment. Scientific and reasonable intervention content will be formulated according to evidence-based guidelines and theoretical basis to enhance patients' ability at self-management and understanding of heart failure knowledge.
PubMed: 38949124
DOI: 10.2459/JCM.0000000000001631 -
Journal of Advanced Nursing Jul 2024To identify and reach consensus on dimensions and criteria of a competence assessment instrument for health professionals in relation to the process of evidence-based...
AIMS
To identify and reach consensus on dimensions and criteria of a competence assessment instrument for health professionals in relation to the process of evidence-based healthcare.
DESIGN
A two-round Delphi survey was carried out from April to June 2023.
METHODS
Consensus was sought from an expert panel on the instrument preliminarily established based on the JBI Model of Evidence-Based Healthcare and a rapid review of systematic reviews of relevant literature. The level of consensus was reflected by the concentration and coordination of experts' opinions and percentage of agreement. The instrument was revised significantly based on the combination of data analysis, the experts' comments and research group discussions.
RESULTS
Sixteen national and three international experts were involved in the first-round Delphi survey and 17 experts participated in the second-round survey. In both rounds, full consensus was reached on the four dimensions of the instrument, namely evidence-generation, evidence-synthesis, evidence-transfer and evidence-implementation. In round-one, the instrument was revised from 77 to 61 items. In round-two, the instrument was further revised to have 57 items under the four dimensions in the final version.
CONCLUSION
The Delphi survey achieved consensus on the instrument. The validity and reliability of the instrument needs to be tested in future research internationally.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE
Systematic assessment of nurses and other health professionals' competencies in different phases of evidence-based healthcare process based on this instrument provides implications for their professional development and multidisciplinary team collaboration in evidence-based practice and better care process and outcomes.
IMPACT
This study addresses a research gap of lacking an instrument to systematically assess interprofessional competencies in relation to the process of EBHC. The instrument covers the four phases of EBHC process with minimal criteria, highlighting essential aspects of ability to be developed. Identification of health professionals' level of competence in these aspects helps strengthen their capacity accordingly so as to promote virtuous EBHC ecosystem for the ending purpose of improving global healthcare outcomes.
REPORTING METHOD
This study was reported in line with the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies.
PATIENT AND PUBLIC CONTRIBUTION
No patient or public contribution.
PubMed: 38949102
DOI: 10.1111/jan.16300 -
JPMA. the Journal of the Pakistan... Jun 2024To assess the effect of haemodialysis practice guidelines on dialysis indicators and haemodynamic complications, the comparative study was conducted at the dialysis unit...
To assess the effect of haemodialysis practice guidelines on dialysis indicators and haemodynamic complications, the comparative study was conducted at the dialysis unit of Sheikh Zayed Hospital, Lahore, Pakistan, and comprised patients undergoing haemodialysis who were divided into intervention group A in which updated haemodialysis practice guidelines were used, and control group B in which routine base dialysis was given. Data was collected using a self-structured tool. Data was analysed using McNemar test and Mann-Whitney U-test with p<0.05. Compared to baseline, there was a significant improvement in post-intervention ratio of effective removal of clearance (K) resulting from the treatment characterised by time (t) in the patient with a specific volume of distribution (V), or Kt/V, median & IQR 0.83(0.355) vs 1.21(0.11) and percentage of urea reduction ratio with median & IQR 49(12) vs. 66.5(18.65) (p<0.05). Intradialytic hypotension was found in 17(56.6%) subjects in group B and in 4(13.4%) in group A (p=0.002). Intradialytic hypertension was found in 8(25.6%) patients in group B and 1(3.4%) in group A (p=0.039). It is recommended that dialysis be performed in accordance with the most recent clinical guidelines in order to improve practices and to increase haemodialysis effectiveness.
Topics: Humans; Renal Dialysis; Female; Male; Practice Guidelines as Topic; Middle Aged; Hypotension; Pakistan; Adult; Kidney Failure, Chronic; Hemodynamics; Hypertension; Aged; Urea
PubMed: 38948988
DOI: 10.47391/JPMA.8532 -
JPMA. the Journal of the Pakistan... Jun 2024To evaluate the effectiveness of peer education on changing the knowledge and frequency of smoking of high school students.
OBJECTIVE
To evaluate the effectiveness of peer education on changing the knowledge and frequency of smoking of high school students.
METHODS
The quasi-experimental study was conducted at the Vocational and Technical Anatolian High School, Turkey, during the 2021-22 academic year, and comprised students of either gender from the 9th to the 11th grade. After baseline assessment, training that blended peer education with the photovoice technique was administered between March 2021 and January 2022. Post-intervention assessment included smoking frequency, cigarette exposure and health literacy. Data was analysed using R version 4.0.5.
RESULTS
Of the 465 students available, 395(84.95%) were part of the baseline assessment, while 434(93.3%) took the postintervention assessment. At the baseline, 365(93.8%) participants were males and 24(6.2%) were femaes. The overall median age was 15 years (interquartile range: 15-16 years). Post-training, smoking rate and indoor exposure to cigarette smoke among the students were statistically lower than the baseline values (p<0.05). The mean health literacy score postintervention was significantly higher than the baseline score (p<0.05).
CONCLUSIONS
Photovoice combined with peer education seemed beneficial in terms of positive effect on smoking behaviour among youths.
Topics: Humans; Adolescent; Female; Male; Peer Group; Turkey; Health Knowledge, Attitudes, Practice; Students; Health Literacy; Health Education; Smoking; Vulnerable Populations; Tobacco Smoke Pollution
PubMed: 38948977
DOI: 10.47391/JPMA.10129 -
Frontiers in Neuroscience 2024The nucleus tractus solitarii (NTS) plays a critical role in the homeostatic regulation of respiration, blood pressure, sodium consumption and metabolic processes....
The nucleus tractus solitarii (NTS) plays a critical role in the homeostatic regulation of respiration, blood pressure, sodium consumption and metabolic processes. Despite their significance, the circuitry mechanisms facilitating these diverse physiological functions remain incompletely understood. In this study, we present a whole-brain mapping of both the afferent and efferent connections of Phox2b-expressing and GABAergic neurons within the NTS. Our findings reveal that these neuronal populations not only receive monosynaptic inputs primarily from the medulla oblongata, pons, midbrain, supra-midbrain and cortical areas, but also mutually project their axons to these same locales. Moreover, intense monosynaptic inputs are received from the central amygdala, the paraventricular nucleus of the hypothalamus, the parasubthalamic nucleus and the intermediate reticular nucleus, along with brainstem nuclei explicitly engaged in respiratory regulation. In contrast, both neuronal groups extensively innervate brainstem nuclei associated with respiratory functions, although their projections to regions above the midbrain are comparatively limited. These anatomical findings provide a foundational platform for delineating an anatomical framework essential for dissecting the specific functional mechanisms of these circuits.
PubMed: 38948926
DOI: 10.3389/fnins.2024.1427384 -
Journal of Family Medicine and Primary... May 2024Osteoarthritis (OA) is a noninflammatory joint disease. If OA of the knee causes pain, decreased muscle strength and joint stiffness, exercise therapy is one of the most...
INTRODUCTION AND AIM
Osteoarthritis (OA) is a noninflammatory joint disease. If OA of the knee causes pain, decreased muscle strength and joint stiffness, exercise therapy is one of the most effective treatments for the disease. The aim of the present study was to evaluate the effect of aquatherapy on pain intensity and performance in women with OA with the assumption that it causes weightlessness.
METHODS
This is a quasiexperimental study. The sample size included 60 people who were randomly divided into experimental and control groups. The visual analogue scale was used to assess pain and timed up and go test (TUG), 30 Second Sit to Stand Test (30-S-CS), and 40-meter fast-paced walk test (40 MW) were used to assess performance. Data analysis was carried out using SPSS ver. 22.
RESULTS
The results of the present study showed a decrease in pain intensity from moderate to mild intensity. Also, physical performance dimensions in patients with OA were improved, so that the average TUG increased from 14.06 to 8.8 s. The average S-CS frequency increased from 4.86 to 8.4 s and 90 MW decreased from the average 93.43 to 72.66 s.
DISCUSSION AND CONCLUSION
Lower limb muscle strength, and physical performance can be improved and pain intensity can be reduced in patients with OA by performing aquatherapy three times a week for 8 weeks.
PubMed: 38948627
DOI: 10.4103/jfmpc.jfmpc_1088_23 -
Journal of Family Medicine and Primary... May 2024The danger of sexual activities among adolescents is worrisome worldwide. This study aimed to delineate total contraception knowledge of university students and the...
Contraceptive knowledge, prevalence of contraception use, and the association between sex education and contraception knowledge among university students in Michigan, USA.
BACKGROUND
The danger of sexual activities among adolescents is worrisome worldwide. This study aimed to delineate total contraception knowledge of university students and the prevalence of contraceptive use, in addition to the association between sex education in school and the students' contraception knowledge.
MATERIALS AND METHODS
A school-based cross-sectional study was carried out.
RESULTS
The mean total level of contraceptive knowledge was 16.53 ± 2.38, which ranged from 5 to 18. In response to which method was the most suitable for the youngsters, 36.3% responded pills, 49.2% condoms, 6.3% injection, 0.7% withdrawal, 0.5% periodic abstinence, and 5.9% other. Adjusted to sociodemographic characteristics and other confounders, students with a history of sex education in school tended to have a higher level of contraceptive knowledge than those without [AOR: 1.06; 95% CI: 0.15, 2.64]. Moreover, adjusted to the characteristics of one-night stands, students with a high level of contraceptive knowledge agreed that one-night stands were OK compared with those without the knowledge [AOR: 0.65; 95% CI: 0.16, 1.13].
CONCLUSION
Although the total contraceptive knowledge was satisfactory, more attention should be paid to male students' education. Modern and long-term effective contraceptive methods had better be included in the training program.
PubMed: 38948568
DOI: 10.4103/jfmpc.jfmpc_1212_23