Enhancing blood pressure management protocol implementation in patients with acute intracerebral haemorrhage through a nursing-led approach: A retrospective cohort study

AIM

To evaluate the impact of nurse care changes in implementing a blood pressure management protocol on achieving rapid, intensive and sustained blood pressure reduction in acute intracerebral haemorrhage patients.

DESIGN

Retrospective cohort study of prospectively collected data over 6 years.

METHODS

Intracerebral haemorrhage patients within 6 h and systolic blood pressure ≥ 150 mmHg followed a rapid (starting treatment at computed tomography suite with a target achievement goal of ≤60 min), intensive (target systolic blood pressure < 140 mmHg) and sustained (maintaining target stability for 24 h) blood pressure management plan. We differentiated six periods: P1, stroke nurse at computed tomography suite (baseline period); P2, antihypertensive titration by stroke nurse; P3, retraining by neurologists; P4, integration of a stroke advanced practice nurse; P5, after COVID-19 impact; and P6, retraining by stroke advanced practice nurse. Outcomes included first-hour target achievement (primary outcome), tomography-to-treatment and treatment-to-target times, first-hour maximum dose of antihypertensive treatment and 6-h and 24-h systolic blood pressure variability.

RESULTS

Compared to P1, antihypertensive titration by stroke nurses (P2) reduced treatment-to-target time and increased the rate of first-hour target achievement, retraining of stroke nurses by neurologists (P3) maintained a higher rate of first-hour target achievement and the integration of a stroke advanced practice nurse (P4) reduced both 6-h and 24-h systolic blood pressure variability. However, 6-h systolic blood pressure variability increased from P4 to P5 following the impact of the COVID-19 pandemic. Finally, compared to P1, retraining of stroke nurses by stroke advanced practice nurse (P6) reduced tomography-to-treatment time and increased the first-hour maximum dose of antihypertensive treatment.

CONCLUSION

Changes in nursing care and continuous education can significantly enhance the time metrics and blood pressure outcomes in acute intracerebral haemorrhage patients.

REPORTING METHOD

STROBE guidelines.

PATIENT AND PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Artificial nose, NIR and UV-visible spectroscopy for the characterisation of the PDO Chianti Classico olive oil

An authentication study of the Italian PDO (Protected Designation of Origin) olive oil Chianti Classico, based on artificial nose, near-infrared and UV-visible spectroscopy, with a set of samples representative of the whole Chianti Classico production area and a considerable number of samples from other Italian PDO regions was performed. The signals provided by the three analytical techniques were used both individually and jointly, after fusion of the respective variables, in order to build a model for the Chianti Classico PDO olive oil. Different signal pre-treatments were performed in order to investigate their importance and their effects in enhancing and extracting information from experimental data, correcting backgrounds or removing baseline variations. Stepwise-Linear Discriminant Analysis (STEP-LDA) was used as a feature selection technique and, afterward, Linear Discriminant Analysis (LDA) and the class-modelling technique Quadratic Discriminant Analysis-UNEQual dispersed classes (QDA-UNEQ) were applied to sub-sets of selected variables, in order to obtain efficient models capable of characterising the extra virgin olive oils produced in the Chianti Classico PDO area.

The effect of milk and sucrose consumption on caries in 6-to-11-year-old Italian schoolchildren

The effect of milk on dental caries was studied on a sample of 6-to-11-year-old Italian schoolchildren. The daily amount of milk consumed and the frequency of consumption of sucrose-containing foods were obtained by a 24-hour dietary diary. In the subsequent oral examination, the level of visible plaque and the number of decayed, extracted and filled teeth (both primary and permanent) of the children were recorded. 439 children (217 boys) who did not use fluoride prophylaxis and with poor oral hygiene were selected from among 890 children. They were divided into three groups according to the frequency of sucrose consumption. The data were statistically analysed using multiple logistic regression. The children consumed a daily average of 209 +/- 133 ml of milk and there were no differences among the three groups in this respect. As expected, the dental health of the children with low sucrose frequency was significantly better than that of the children with high sucrose frequency. The regression on the whole sample showed a weak, significant, negative association between milk consumption and caries (p < 0.05). In the group of high sucrose-consuming children a negative, highly significant association was found (p < 0.001), while in the two groups of low and moderate sucrose-consuming children no association was found. These data suggest that, in the present sample of children who did not use fluoride and with poor oral hygiene, milk has a caries preventive effect only on those subjects with a high daily sucrose-consuming frequency.

Assessment of some risk factors for hepatocellular carcinoma: a case control study

A case-control study of risk for hepatocellular carcinoma (HCC) was carried out in our Department from December 1980 to December 1983. One hundred and twenty consecutive inpatients with HCC were compared with 360 controls pair-matched by sex and age (within years). For each case three different controls were selected from inpatients at the same hospital: one patient with liver cirrhosis; one patient with solid tumor and one patient with chronic illness other than neoplasm or liver disease. We report here the results on alcohol consumption, smoking habit and hepatitis B virus infection. The risk factors investigated are distributed similarly in HCC and cirrhosis. The prevalence of alcohol abuse in HCC is similar to that in cirrhosis and is significantly higher than in other neoplastic or otherwise chronically ill patients (odds ratio 2 X 3 and 3 X 2 respectively). Thus alcohol abuse is probably a risk factor for HCC as a cause of cirrhosis. Smoking habits were similar among the various disease groups and independent of alcohol consumption. The prevalence of heavy smoking was comparable in cases and controls. HbsAg negative-HCC with an ultrasonographic pattern of 'diffuse' alteration was more frequent in heavy smokers.