Study protocol for the online adaptation and evaluation of the 'Reboot' (Recovery-boosting) coaching programme, to prepare critical care nurses for, and aid recovery after, stressful clinical events

Background

Critical care nurses (CCNs) are routinely exposed to highly stressful events, exacerbated during the COVID-19 pandemic. Supporting resilience and wellbeing of CCNs is therefore crucial to prevent burnout. One approach for delivering this support is by preparing critical care nurses for situations they may encounter, drawing on evidence-based techniques to strengthen relevant psychological coping strategies. As such, the current study seeks to tailor a Resilience-boosting psychological coaching programme [Reboot] for CCNs, based on cognitive behavioural therapy (CBT) principles and the Bi-Dimensional Resilience Framework (BDF), and (1) to assess the feasibility of delivering Reboot via online, remote delivery to CCNs, and (2) to provide a preliminary assessment of whether Reboot could increase resilience and confidence in coping with adverse events.

Methods

Eighty CCNs (n=80) will be recruited to the 8-week Reboot programme, comprised of two group workshops and two individual coaching calls. The study uses a single-arm before-after feasibility study design and will be evaluated with a mixed-methods approach, using online questionnaires (all participants) and telephone interviews (25% of participants). Primary outcomes will be confidence in coping with adverse events (the Confidence scale) and resilience (the Brief Resilience Scale) measured at four time points.

Discussion

Results will determine whether it is feasible to deliver and evaluate a remote version of the Reboot coaching programme to CCNs, and will indicate whether participating in the programme is associated with increases in confidence in coping with adverse events, resilience and wellbeing (as indicated by levels of depression).

UV light assisted photocatalytic degradation of textile waste water by Mg0.8-xZnxFe2O4 synthesized by combustion method and in-vitro antimicrobial activities

In this paper, Magnesium Zinc Ferrite (MZF) nanoparticles (Mg_0.8-xZn_xFe₂O₄, where x = 0.2, 0.4 and 0.6) are successfully fabricated by combustion process. The prepared nanoparticles are characterized through XRD, FTIR, UV, SEM, EDS and TEM. It has been confirmed that the samples produced cubic spinel structure with crystal size in the range of 13-15 nm. From the ultraviolet spectrum, the optical band gap is calculated which ranges from 5.6 to 4.6 eV. TEM micrographs confirm the nanocrystalline nature of combustion derived ferrite nanoparticles with average particle diameter of 7-28 nm. Antibacterial studies confirmed that the nanoparticles are toxic to Pseudomonas aeruginosa consists of greatest zone of inhibition of 25 mm. The antibacterial and photocatalytic studies exhibited improved activity which is strongly influenced by the zinc doping. Photocatalytic degradation study reveal that the prepared nanoparticles function as perfect catalyst for degradation of Methylene Blue (MB) dye and Textile Dyeing Waste Water (TDWW) under UV light, thus revealing their potential usage on organic pollutants.

253 Innovative Teaching Early in Medical Career to Expose Medical Students to Surgery

Aim

At Lancashire Teaching Hospitals medical students begin their clinical career in Year 3 and are posted in General Surgery for 4 weeks, a relatively short period to experience the wide variety of surgical specialities and operative techniques. A surgical skills course - Lancashire Teaching Hospitals Surgical Skills for Medical Students (LTHSSMS) was designed and piloted. The aim was to assess the student experience of the LTHSSMS course conducted for Year 3 students at Lancashire Teaching Hospitals in 2019.

Method

This all-day course was optional, taught in groups of 15 students per course with a minimum of 2 experienced tutors. The LTHSSMS course included practical skills such as scrubbing, gloving, surgical knotting, suturing, excision of skin lesions and local anaesthetic techniques. It also included lectures on suture materials, abdominal incisions, laparoscopic and robotic surgery. There were interactive discussions to include non-technical skills, theatre in brief and WHO checklist.

Results

95% (n- 86) of students posted in surgery attended the course. 86.3% (n-75) felt the course was very relevant for their training. 90.7% (n-78) stated they enjoyed the course and 98.8% (n-85) stated they would recommend the course to fellow third-year students. 97.7% (n-84) stated the tutors delivered the course in an enthusiastic and positive manner. 79.1% (n-68) rated the audio video as excellent.

Conclusions

This course has provided a high impact surgical experience for the medical students at the beginning of their clinical careers. Similar opportunities if made available to students in all medical schools could improve and renew the interest in a surgical career.

Do pharmacy practice standards effectively describe behaviour? Reviewing practice standards using a behavioural specificity framework

Background

Guidelines and practice standards exist to communicate the conduct and behaviour expected of health care professionals and ensure consistent quality practice. It is important that they describe behaviours explicitly so they can be interpreted, enacted and measured with ease. The AACTT framework specifies behaviour in terms of the: Action to be performed, Actor who performs the action, Context where the action occurs, Target who the action is performed with/for and Time when the action is performed (AACTT). It provides the most up to date framework for specifying behaviours and is particularly relevant to complex behavioural problems that involve sequences of behaviours performed by different people. Behavioural specificity within pharmacy practice standards has not been explored.

Aim

To determine if behaviours described in the Professional Practice Standards for Australian Pharmacists specify Action, Actor, Context, Target and Time.

Methods

Two researchers independently reviewed the scope and structure of the practice standards and one extracted action statements (behaviours) verbatim. Through an iterative process, the researchers modified and developed the existing AACTT definitions to operationalise them for application to review of the action statements in the practice standards. The operational definitions, decision criteria and curated examples were combined in a codebook. The definitions were consistently applied through a directed content analysis approach to evaluate all extracted action statements by one researcher. For consistency 20% was independently checked for agreement by a second researcher.

Results

A novel codebook to apply AACTT criteria to evaluate practice standards was developed. Application of this codebook identified 768 independent behaviours. Of these, 300 (39%) described at least one discrete observable action, none specified an actor, 25 (3%) specified context, 131 (17%) specified target and 88 (11%) specified time.

Conclusion(s)

The behaviours detailed in practice standards for Australian pharmacists do not consistently specify behaviours in terms of Action, Actor, Context, Target and Time. Developers in the pharmacy profession, and beyond, should consider the behavioural specificity of their documents to improve interpretability, usability and adherence to the behaviours detailed. This also has implications for the development and evaluation of interventions to change such behaviours and improve quality of care.

Automated quantitative evaluation of fetal atrioventricular annular plane systolic excursion

OBJECTIVES

The primary aim of this study was to evaluate the feasibility of automated measurement of fetal atrioventricular (AV) plane displacement (AVPD) over several cardiac cycles using myocardial velocity traces obtained by color tissue Doppler imaging (cTDI). The secondary objectives were to establish reference ranges for AVPD during the second half of normal pregnancy, to assess fetal AVPD in prolonged pregnancy in relation to adverse perinatal outcome and to evaluate AVPD in fetuses with a suspicion of intrauterine growth restriction (IUGR).

METHODS

The population used to develop the reference ranges consisted of women with an uncomplicated singleton pregnancy at 18-42 weeks of gestation (n = 201). The prolonged-pregnancy group comprised women with an uncomplicated singleton pregnancy at ≥ 41 + 0 weeks of gestation (n = 107). The third study cohort comprised women with a singleton pregnancy and suspicion of IUGR, defined as an estimated fetal weight < 2.5^th centile or an estimated fetal weight < 10^th centile and umbilical artery pulsatility index > 97.5^th centile (n = 35). Cineloops of the four-chamber view of the fetal heart were recorded using cTDI. Regions of interest were placed at the AV plane in the left and right ventricular walls and the interventricular septum, and myocardial velocity traces were integrated and analyzed using an automated algorithm developed in-house to obtain mitral (MAPSE), tricuspid (TAPSE) and septal (SAPSE) annular plane systolic excursion. Gestational-age specific reference ranges were constructed and normalized for cardiac size. The correlation between AVPD measurements obtained using cTDI and those obtained by anatomic M-mode were evaluated, and agreement between these two methods was assessed using Bland-Altman analysis. The mean Z-scores of fetal AVPD in the cohort of prolonged pregnancies were compared between cases with normal and those with adverse outcome using Mann-Whitney U-test. The mean Z-scores of fetal AVPD in IUGR fetuses were compared with those in the normal reference population using Mann-Whitney U-test. Inter- and intraobserver variability for acquisition of cTDI recordings and offline analysis was assessed by calculating coefficients of variation (CV) using the root mean square method.

RESULTS

Fetal MAPSE, SAPSE and TAPSE increased with gestational age but did not change significantly when normalized for cardiac size. The fitted mean was highest for TAPSE throughout the second half of gestation, followed by SAPSE and MAPSE. There was a significant correlation between MAPSE (r = 0.64; P < 0.001), SAPSE (r = 0.72; P < 0.001) and TAPSE (r = 0.84; P < 0.001) measurements obtained by M-mode and those obtained by cTDI. The geometric means of ratios between AVPD measured by cTDI and by M-mode were 1.38 (95% limits of agreement (LoA), 0.84-2.25) for MAPSE, 1.00 (95% LoA, 0.72-1.40) for SAPSE and 1.20 (95% LoA, 0.92-1.57) for TAPSE. In the prolonged-pregnancy group, the mean ± SD Z-scores for MAPSE (0.14 ± 0.97), SAPSE (0.09 ± 1.02) and TAPSE (0.15 ± 0.90) did not show any significant difference compared to the reference ranges. Twenty-one of the 107 (19.6%) prolonged pregnancies had adverse perinatal outcome. The AVPD Z-scores were not significantly different between pregnancies with normal and those with adverse outcome in the prolonged-pregnancy cohort. The mean ± SD Z-scores for SAPSE (-0.62 ± 1.07; P = 0.006) and TAPSE (-0.60 ± 0.89; P = 0.002) were significantly lower in the IUGR group compared to those in the normal reference population, but the differences were not significant when the values were corrected for cardiac size. The interobserver CVs for the automated measurement of MAPSE, SAPSE and TAPSE were 28.1%, 17.7% and 15.3%, respectively, and the respective intraobserver CVs were 33.5%, 15.0% and 17.9%.

CONCLUSIONS

This study showed that fetal AVPD can be measured automatically by integrating cTDI velocities over several cardiac cycles. Automated analysis of AVPD could potentially help gather larger datasets to facilitate use of machine-learning models to study fetal cardiac function. The gestational-age associated increase in AVPD is most likely a result of increasing cardiac size, as the AVPD normalized for cardiac size did not change significantly between 18 and 42 weeks. A decrease was seen in TAPSE and SAPSE in IUGR fetuses, but not after correction for cardiac size. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Contextual factors in premature CHD mortality in selected African countries within the SDG framework

Background

The sustainable development goal number 3, target 4 (SDG 3.4) seeks by 2030, a 30% reduction in four premature chronic disease mortality (4CHD) from 2015 values. Since the implementation of SDG 3.4 in 2016, the highest risk of dying from CHD was observed in low and lower-income countries mainly in Africa. This study examined the relationship between contextual factors and diabetes-related deaths as an example of the 4CHD; to enable an improved contextualized evidence-based approach, to attain in part the SDG 3.4 among United Nations Member States in Africa region (UNMSAFR).

Methods

Country-level data was retrieved for post SDG initiative years (2016-2019) from multiple publicly available data sources for 32 selected UNMSAFR located in the International Diabetes Federation (IDF) East and West Africa Region. Multiple linear regression was employed to ascertain the association between diabetes-related deaths in individuals 20-79 years in UNMSAFR and contextual factors identified in the SDGs framework. Two regression models were tested by conducting unweighted and weighted data analysis.

Results

The unweighted analysis showed that diabetes-related deaths in individuals 20-79 years/1,000 varied across the selected UNMSAFR in IDF East and West Regions (n = 31), with a range of 0.06 - 0.48/1,000 and an average of 0.24/1,000. Contextual factors, i.e., unemployment rate and geographical region explained 23% variability in diabetes-related deaths across the selected UNMSAFR. However, in the weighted data analysis, voice and accountability explained 47% variability in diabetes-related deaths across selected UNMSAFR in IDF East and West Region (n = 32).

Conclusions

Contextual factors such as unemployment rate, geographical region, and voice and accountability (governance) were associated with diabetes mortality; identifying that salient modifiable features can inform targeted interventions and policies to reduce premature CHD mortality.

Key messages

Contextual factors should be considered in policies and interventions for a comprehensive approach to premature CHD mortality reduction. Spatial clustering of CHD is critical for region interventions.

Optimization of ovine bone decalcification for increased cellular detail: a parametric study

There are many published methods of decalcifying bone for paraffin histology; however, the current literature lacks details regarding the processing of ovine tissue. Ovine bone tissue presents challenges, as samples are often denser and larger than other comparative animal models, thus increasing decalcification times. Trifluoroacetic Acid (TFAA) has previously been used to decalcify ovine bone samples for histological analysis. Unfortunately, TFAA is a strong acid and often results in loss of cellular detail, especially in the connected soft tissue. This is generally manifested as over staining with eosin, and a decrease in cellular features which impacts overall histological interpretation. It is well known that leaving tissue in acid for long periods degrades cellular detail; therefore, minimizing decalcification time is critical to accurately determine cellular morphology. Six decalcification solutions (8% TFAA, 20% TFAA, 8% formic acid, 20% formic acid, Formical-4, and XLCal, and three temperatures (room temperature, 30°C, 37°C), were examined to determine their effects on cellular detail in ovine vertebrae and humeral heads. These data clearly indicate that 20% formic acid at 30°C yielded better decalcification rates (2.6 d ± 0.9 d) and cellular detail (none to mild changes) for the vertebrae samples, and 20% formic acid at RT yielded the best cellular detail (none to minimal loss) for humerus samples with a moderate amount of time (6.5 d ± 1.7). These results should establish the optimal demineralization procedures for ovine bone used in scientific studies resulting in improved cellular detail while minimizing decalcification times.

Trait mindfulness and the mental and physical health of caregivers for individuals with cancer

BACKGROUND

Mindfulness plays a role in moderating the negative mental and physical health outcomes associated with caregiving. The aims of this study were to examine the relationship between trait mindfulness and the (1) psychological functioning, (2) health behaviors, (3) and physical health of caregivers for individuals diagnosed with cancer.

METHODS

Caregivers completed a battery of questionnaires and examinations assessing sociodemographic characteristics, trait mindfulness, depression, perceived stress, caregiver stress, sleep, diet, physical activity, tobacco use, alcohol use, blood pressure, and BMI. Demographics and cancer diagnostics were collected for the individuals whom caregivers supported. Linear regression, multivariate analyses, and moderator analyses were performed.

RESULTS

Of the 78 caregivers, the mean age was 63.9 (S.D.=13.1); 59% identified as female; 97% identified as White. Regression analyses indicated that caregivers who reported higher levels of trait mindfulness reported significantly less perceived stress (b= -4.38, SE= 0.88, p <.001), lower levels of depression (b= -3.74, SE= 1.10, p = .001), greater caregiver quality of life (b= -9.05, SE=2.12, p < .001), better sleep quality (b= -0.98, SE=0.44, p = 0.03), and lower rates of tobacco use (b= -10.12, SE= 3.43, p =.003). Trait mindfulness was not significantly related to diet, alcohol use, blood pressure, or BMI.

CONCLUSIONS

Higher levels of trait mindfulness are associated with positive mental and physical health measure for caregivers. Future research would benefit from further examining mindfulness-based interventions and their impacts in mitigating the negative toll of caregiving in the context of cancer.

Tridentate imidazole-based Schiff base metal complexes: molecular docking, structural and biological studies

A novel Schiff base was synthesized by the condensation of imidazole-2-carboxaldehyde with l-histidine in an equimolar ratio. The prepared Schiff base was characterized by elemental analysis and spectral characterization techniques. It was then complexed with a series of 3-d metal(II) ions like manganese, iron, cobalt, nickel, copper and zinc. The coordination properties, nature of bonding and stability of the complexes were deduced from elemental analysis, IR, UV-vis, ¹H NMR, mass, electronic spectra, magnetic, conductivity and thermogravimetric analysis. IR studies support the tridentate behaviour of Schiff base as well as its coordination to the central metal ion through an azomethine nitrogen, deprotonated carboxylic oxygen and imidazole ring nitrogen atoms of histidine. The electronic spectra and magnetic moment data demonstrate that the complexes have an octahedral geometry, except zinc complex, which has a tetrahedral geometry. In vitro antimicrobial activity of the synthesized compounds has been shown to exhibit excellent antibacterial and antifungal activities. The antibacterial property of the prepared Schiff base was further confirmed by conducting a docking study of target proteins involved in the antibacterial mechanism.Communicated by Ramaswamy H. Sarma.

A training model to teach early management of priapism

BACKGROUND

Ischaemic priapism is a urological emergency with early treatment required to prevent irreversible loss of erectile function. Corporal aspiration is the first step in management. Currently, there are no satisfactory training models to develop skills in a controlled environment. We have therefore developed a novel training model to teach trainees the steps of penile aspiration in a safe and representative way.

MATERIALS AND METHODS

We have developed a priapism model using an old catheterisation teaching model. Face validity of the model was assessed by participants and experienced urologists teaching on a urology boot camp. All had managed at least 5 cases of actual priapism. Responses were reported using a 5-point Likert Scale. Data were analysed using IBM SPSS Statistics V25. The intra-class correlation was calculated using a «One-way Random model».

RESULTS

Eleven urologists and seven trainees participated in the evaluation. The model appearance was reported as the best simulation trait of the priapism model. Tactile feedback from needle insertion for aspiration was also felt to be realistic with 72.6% reporting it as «Good» or «very good» and 85.7% reported the model to be realistic for needle insertion. Intra-class correlation amongst experts was 0.552. Majority of trainees (83.3%) reported a realistic simulation. All evaluators agreed or strongly agreed that the model provided a good simulated experience that would be useful in training.

CONCLUSION

Our model provides a realistic simulation of corporal aspiration. It can be used repeatedly. Overall, the proposed model appears to be a promising tool for training junior doctors in the initial management of ischaemic priapism.

Mechanisms of Atomization from Rotary Dental Instruments and Its Mitigation

Since the onset of coronavirus disease 2019, the potential risk of dental procedural generated spray emissions (including aerosols and splatters), for severe acute respiratory syndrome coronavirus 2 transmission, has challenged care providers and policy makers alike. New studies have described the production and dissemination of sprays during simulated dental procedures, but findings lack generalizability beyond their measurements setting. This study aims to describe the fundamental mechanisms associated with spray production from rotary dental instrumentation with particular focus on what are currently considered high-risk components-namely, the production of small droplets that may remain suspended in the room environment for extended periods and the dispersal of high-velocity droplets resulting in formites at distant surfaces. Procedural sprays were parametrically studied with variables including rotation speed, burr-to-tooth contact, and coolant premisting modified and visualized using high-speed imaging and broadband or monochromatic laser light-sheet illumination. Droplet velocities were estimated and probability density maps for all laser illuminated sprays generated. The impact of varying the coolant parameters on heating during instrumentation was considered. Complex structured sprays were produced by water-cooled rotary instruments, which, in the worst case of an air turbine, included droplet projection speeds in excess of 12 m/s and the formation of millions of small droplets that may remain suspended. Elimination of premisting (mixing of coolant water and air prior to burr contact) resulted in a significant reduction in small droplets, but radial atomization may still occur and is modified by burr-to-tooth contact. Spatial probability distribution mapping identified a threshold for rotation speeds for radial atomization between 80,000 and 100,000 rpm. In this operatory mode, cutting efficiency is reduced but sufficient coolant effectiveness appears to be maintained. Multiple mechanisms for atomization of fluids from rotatory instrumentation exist, but parameters can be controlled to modify key spray characteristics during the current crisis.

Pre-Flight Calibration of the Mars 2020 Rover Mastcam Zoom (Mastcam-Z) Multispectral, Stereoscopic Imager

The NASA Perseverance rover Mast Camera Zoom (Mastcam-Z) system is a pair of zoomable, focusable, multi-spectral, and color charge-coupled device (CCD) cameras mounted on top of a 1.7 m Remote Sensing Mast, along with associated electronics and two calibration targets. The cameras contain identical optical assemblies that can range in focal length from 26 mm ( 25.5 ∘ × 19.1 ∘ FOV ) to 110 mm ( 6.2 ∘ × 4.2 ∘ FOV ) and will acquire data at pixel scales of 148-540 μm at a range of 2 m and 7.4-27 cm at 1 km. The cameras are mounted on the rover's mast with a stereo baseline of 24.3 ± 0.1  cm and a toe-in angle of 1.17 ± 0.03 ∘ (per camera). Each camera uses a Kodak KAI-2020 CCD with 1600 × 1200 active pixels and an 8 position filter wheel that contains an IR-cutoff filter for color imaging through the detectors' Bayer-pattern filters, a neutral density (ND) solar filter for imaging the sun, and 6 narrow-band geology filters (16 total filters). An associated Digital Electronics Assembly provides command data interfaces to the rover, 11-to-8 bit companding, and JPEG compression capabilities. Herein, we describe pre-flight calibration of the Mastcam-Z instrument and characterize its radiometric and geometric behavior. Between April 26 t h and May 9 t h , 2019, ∼45,000 images were acquired during stand-alone calibration at Malin Space Science Systems (MSSS) in San Diego, CA. Additional data were acquired during Assembly Test and Launch Operations (ATLO) at the Jet Propulsion Laboratory and Kennedy Space Center. Results of the radiometric calibration validate a 5% absolute radiometric accuracy when using camera state parameters investigated during testing. When observing using camera state parameters not interrogated during calibration (e.g., non-canonical zoom positions), we conservatively estimate the absolute uncertainty to be < 10 % . Image quality, measured via the amplitude of the Modulation Transfer Function (MTF) at Nyquist sampling (0.35 line pairs per pixel), shows MTF Nyquist = 0.26 - 0.50 across all zoom, focus, and filter positions, exceeding the > 0.2 design requirement. We discuss lessons learned from calibration and suggest tactical strategies that will optimize the quality of science data acquired during operation at Mars. While most results matched expectations, some surprises were discovered, such as a strong wavelength and temperature dependence on the radiometric coefficients and a scene-dependent dynamic component to the zero-exposure bias frames. Calibration results and derived accuracies were validated using a Geoboard target consisting of well-characterized geologic samples.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11214-021-00795-x.

Let's talk virtual! Online focus group facilitation for the modern researcher

BACKGROUND

Focus group discussions typically involve face-to-face facilitation. There is growing interest in utilising digital technologies to facilitate aspects of focus group research. To date, no study in the pharmacy profession has comprehensively described and evaluated a fully virtual process to focus group research, from recruitment to reimbursement.

OBJECTIVE(S)

This study aims to describe an entirely online approach to: recruiting for and facilitating virtual focus group discussions, and reimbursement of participants within the pharmacy profession. Specifically, our objectives were to identify 1) the dropout rate, 2) the geographic diversity of focus group participants, and 3) the occurrence of technological issues.

METHOD

Traditional face-to-face focus group recruitment and facilitation methods were adapted, pre-tested, and conducted using online platforms for advertising, participant expressions of interest, participant consent, focus group facilitation, and participant reimbursement. Populations of interest included community pharmacists, specialty practice pharmacists, hospital pharmacists, and pharmacy assistants and technicians across Australia.

RESULTS

Of the 153 potential participants who either completed an expression of interest to participate (135/153) or agreed to participate after direct contact (18/153), 59 confirmed that they would attend the focus group discussion (39%); 49 of the 59 (dropout rate: 17%) participated in one of eight focus groups. Collectively, there was representation from all States and Territories in Australia, as well as representation in each of the populations of interest. Three of 49 participants (6%) experienced minor technological issues during the process; no participant encountered major technological issues that precluded successful participation.

CONCLUSIONS

Our study demonstrates that an entirely online approach to focus group methodology is possible, has the potential to recruit demographically and geographically-diverse participants with low dropout rates, and can be successfully conducted with minimal technological issues. Despite the recent COVID-19 pandemic making physical focus group facilitation untenable, this fully-online approach enables research to be completed uninterrupted.

Ultrasound-guided Fascia Iliaca Plane Block for the treatment of donor site pain in the burn injured patient: a randomized control trial

Burn injuries requiring surgical intervention often result in split- thickness skin grafting procedures, with donor skin frequently harvested from the patient's anterolateral thigh. The donor site is often reported as the primary site of post-operative pain due to the damage sustained to localised nociceptors.A randomised control trial was undertaken to evaluate the impact an ultrasound-guided regional nerve block would have on patient reported pain scores in donor site wounds, and associated rescue analgesia consumption. Twenty participants requiring split-skin grafting for burn injuries of <15% total body surface area were enrolled from a tertiary burns unit and randomised to control (10 participants) or intervention group (10 participants). The intervention group received the addition of an ultrasound-guided facia iliaca plane block prior to their surgery. Primary outcome was pain score in the donor site during the postoperative phase; while secondary outcome was pain on day 1 post-surgery as measured by the numeric pain score (0-10). During the post-operative phase, the intervention group had a significantly lower median donor site pain score of 0 (interquartile range (IQR) 0 - 0), compared to the control group median 6 (IQR 4 - 7) (p < 0.001). Day 1 post-surgery the intervention group had a median pain score of 0 (IQR 0 - 4) compared to control group median 4.5 (IQR 2 - 6) (p= 0.043).The study findings demonstrated that regional anaesthesia was an effective way to reduce pain scores and requirement for additional analgesics during the postoperative phase.

Stakeholders' Perceptions of Factors Influencing the Use of Take-Home-Naloxone

Background and Aims: Opioid associated death and overdose is a growing burden in societies all over the world. In recent years, legislative changes have increased access to naloxone in the take-home setting for use by patients with a substance use disorder and bystanders, to prevent opioid overdose deaths. However, few studies have explored the factors influencing the uptake by its multiple stakeholders. The aim of this scoping review was to explore the factors influencing the use of take-home naloxone from the perspectives of different stakeholders. Methods: A scoping review methodology was adopted with a systematic search of databases EMBASE, MEDLINE and PubMed. A variation of the search words “naloxone”, “opioid” and “overdose” were used in each database. The articles were screened according to the predetermined inclusion/exclusion criteria and categorized based on their key perspective or target population. Results: The initial database search yielded a total of 1483 articles. After a series of screening processes, 51 articles were included for analysis. Two key stakeholder perspectives emerged: patients and bystanders (n = 36), and healthcare professionals (n = 15). Within the patient and bystander group, a strong consensus arose that there were positive outcomes from increased access to take-home naloxone and relevant training programs. Despite these positive outcomes, some healthcare professionals were concerned that take-home naloxone would encourage high-risk opioid use. Conclusion: Take-home naloxone is slowly being introduced into community practice, with a sense of enthusiasm from patients and bystanders. There are still a number of barriers that need to be addressed from healthcare professionals’ perspective. Future research should be aimed at emergency care professionals outside of the US, who are most experienced with naloxone and its potential impact on the community.