What about the fundamentals of nursing-its interventions and its continuity among older people in need of home- or facility-based care: a scoping review

AIM

This scoping review investigated and descriptively summarised previous research about fundamental nursing, its focus (what care needs are described, how is it described and by whom is it described), continuity of care (is it described in relation to fundamental nursing) and possible nursing interventions or activities targeting older people's fundamentals of care needs in home- or facility-based care.

METHODS

This scoping review was carried out following the steps of Arksey and O'Malley's methodology and PRISMA-ScR reporting guidelines. Searches were conducted in PubMed via NIH, CINAHL via EBSCO and PsycInfo via ProQuest for the time period between January 2002 and May 2023.

RESULTS

Forty-two studies were included where the majority had been conducted in a facility-based care context. Nutrition-or rather nutritional care activities targeting eating and drinking-was the most frequently described fundamental care needs addressed. After this came personal care such as cleansing, dressing, oral care, skin, and foot care. Few studies addressed more than one fundamental care need at the time. The nursing staff described fundamental nursing as complex, comprehensive, and demanding. Older people and relatives described a gap between the fundamental nursing provided and their perceived need for support. Less attention was given to older peoples relational and psychosocial needs. Identified nursing interventions mainly targeted physical care needs. Our findings also implied that interventions focusing on fundamental nursing were described as feasible in practice with favourable or moderate results, while long-term effects were difficult to detect. No studies were identified focusing on fundamental nursing in relation to outcomes such as continuity of care.

CONCLUSION

Fundamental nursing was mainly described in relation to physical care needs, which were essentially conducted within facility-based care contexts. Interventions and activities primarily focused on one fundamental need at the time, mainly within the physical domain. No nursing interventions were identified focusing on relational and psychosocial needs where continuity of care can be viewed as a relevant outcome. Such limited focus are especially concerning as research has highlighted the importance of that older people with complex care needs can benefit from a holistic and person-centred approach i.e. fundamental nursing.

TRIAL REGISTRATION

Open Science Framework https://doi.org/10.17605/OSF.IO/XJ39E Protocol: http://dx.doi.org/10.1136/bmjopen-2022-069798.

Child, parent, and family mental health and functioning in Australia during COVID-19: comparison to pre-pandemic data

The COVID-19 pandemic presents significant risks to population mental health. Despite evidence of detrimental effects for adults, there has been limited examination of the impact of COVID-19 on parents and children specifically. We aim to examine patterns of parent and child (0-18 years) mental health, parent substance use, couple conflict, parenting practices, and family functioning during COVID-19, compared to pre-pandemic data, and to identify families most at risk of poor outcomes according to pre-existing demographic and individual factors, and COVID-19 stressors. Participants were Australian mothers (81%) and fathers aged 18 years and over who were parents of a child 0-18 years (N = 2365). Parents completed an online self-report survey during 'stage three' COVID-19 restrictions in April 2020. Data were compared to pre-pandemic data from four Australian population-based cohorts. Compared to pre-pandemic estimates, during the pandemic period parents reported higher rates of parent depression, anxiety, and stress (Cohen's d = 0.26-0.81, all p < 0.001), higher parenting irritability (d = 0.17-0.46, all p < 0.001), lower family positive expressiveness (d = - 0.18, p < 0.001), and higher alcohol consumption (22% vs 12% drinking four or more days per week, p < 0.001). In multivariable analyses, we consistently found that younger parent age, increased financial deprivation, pre-existing parent and child physical and mental health conditions, COVID-19 psychological and environmental stressors, and housing dissatisfaction were associated with worse parent and child functioning and more strained family relationships. Our data suggest wide-ranging, detrimental family impacts associated with the COVID-19 pandemic; and support policy actions to assist families with financial supports, leave entitlements, and social housing.

Sensory innervation of the guinea pig colon and rectum compared using retrograde tracing and immunohistochemistry

BACKGROUND

Neurons in lumbar and sacral dorsal root ganglia (DRG) comprise extrinsic sensory pathways to the distal colon and rectum, but their relative contributions are unclear. In this study, sensory innervation of the rectum and distal colon in the guinea pig was directly compared using retrograde labeling combined with immunohistochemistry.

METHODS

The lipophilic tracer, DiI, was injected in either the rectum or distal colon of anesthetized guinea pigs, then DRG (T6 to S5) and nodose ganglia were harvested and labeled using antisera for calcitonin gene-related peptide (CGRP) and transient receptor potential vanilloid 1(TRPV1).

KEY RESULTS

More primary afferent cell bodies were labeled from the rectum than from the distal colon. Vagal sensory neurons, with cell bodies in the nodose ganglia comprised fewer than 0.5% of labeled sensory neurons. Spinal afferents to the distal colon were nearly all located in thoracolumbar DRG, in a skewed unimodal distribution (peak at L2); fewer than 1% were located in sacral ganglia. In contrast, spinal afferents retrogradely labeled from the rectum had a bimodal distribution, with one peak at L3 and another at S2. Fewer than half of all retrogradely labeled spinal afferent neurons were immunoreactive for CGRP or TRPV1 and these included the larger traced neurons, especially in thoracolumbar ganglia.

CONCLUSIONS & INFERENCES

In the guinea pig, both the distal colon and the rectum receive a sensory innervation from thoracolumbar ganglia. Sacral afferents innervate the rectum but not the distal colon. Calcitonin gene-related peptide immunoreactivity was detectable in fewer than half of afferent neurons in both pathways.

Influence of image slice thickness on rectal dose-response relationships following radiotherapy of prostate cancer

When pooling retrospective data from different cohorts, slice thicknesses of acquired computed tomography (CT) images used for treatment planning may vary between cohorts. It is, however, not known if varying slice thickness influences derived dose-response relationships. We investigated this for rectal bleeding using dose-volume histograms (DVHs) of the rectum and rectal wall for dose distributions superimposed on images with varying CT slice thicknesses. We used dose and endpoint data from two prostate cancer cohorts treated with three-dimensional conformal radiotherapy to either 74 Gy (N = 159) or 78 Gy (N = 159) at 2 Gy per fraction. The rectum was defined as the whole organ with content, and the morbidity cut-off was Grade ≥2 late rectal bleeding. Rectal walls were defined as 3 mm inner margins added to the rectum. DVHs for simulated slice thicknesses from 3 to 13 mm were compared to DVHs for the originally acquired slice thicknesses at 3 and 5 mm. Volumes, mean, and maximum doses were assessed from the DVHs, and generalized equivalent uniform dose (gEUD) values were calculated. For each organ and each of the simulated slice thicknesses, we performed predictive modeling of late rectal bleeding using the Lyman-Kutcher-Burman (LKB) model. For the most coarse slice thickness, rectal volumes increased (≤18%), whereas maximum and mean doses decreased (≤0.8 and ≤4.2 Gy, respectively). For all a values, the gEUD for the simulated DVHs were ≤1.9 Gy different than the gEUD for the original DVHs. The best-fitting LKB model parameter values with 95% CIs were consistent between all DVHs. In conclusion, we found that the investigated slice thickness variations had minimal impact on rectal dose-response estimations. From the perspective of predictive modeling, our results suggest that variations within 10 mm in slice thickness between cohorts are unlikely to be a limiting factor when pooling multi-institutional rectal dose data that include slice thickness variations within this range.

Effects of feeding on thermoregulatory behaviours and gut blood flow in white sturgeon (Acipenser transmontanus) using biotelemetry in combination with standard techniques

The effects of thermoregulatory behaviours on gut blood flow in white sturgeon Acipenser transmontanus before and after feeding was studied using a blood flow biotelemetry system in combination with a temperature preference chamber. This is the first study to look at cardiovascular responses to feeding in white sturgeon, and also the first time behavioural tests in fish have been combined with recordings of cardiac output, heart rate, cardiac stroke volume and gut blood flow. The results showed strong correlations between gut blood flow and temperature choice after feeding (R(2)=0.88+/-0.03, 6-8 h postprandially and R(2)=0.89+/-0.04, 8-10 h postprandially) but not prior to feeding (R(2)=0.11+/-0.05). Feeding did not affect the actual temperature preference (18.4+/-0.7 degrees C before feeding, 18.1+/-0.7 degrees C, 6-8 h postprandially and 17.5+/-0.5 degrees C, 8-10 h postprandially). Fish instrumented with a blood flow biotelemetry device, and allowed to move freely in the water, had a significantly lower resting heart rate (37.3+/-0.26 beats min(-1)) compared with the control group that was traditionally instrumented with transit-time blood flow probes and kept in a confined area in accordance with the standard procedure (43.2+/-2.1 beats min(-1)). This study shows, for the first time in fish, the correlation between body temperature and gut blood flow during behavioural thermoregulation.

Regulation of muscular contractions in the human Fallopian tube through prostaglandins and progestagens

BACKGROUND

Transport of gametes and embryos is an important function of the Fallopian tube. Both muscular contractions and cilia activity are involved in the transportation. Prostaglandins (PGs) are known mediators of muscular contractility. PG receptors have previously been demonstrated in the human Fallopian tube. The aim was to study the effect of PGs and progestagens, antiprogestin, hCG and oxytocin on muscular contractions in the human Fallopian tube, and the hormonal regulation of PG receptors.

METHODS

Twenty-two healthy women operated for benign causes were included in the study. The ampullary-isthmic junction of the Fallopian tubes was excised and used for in vitro contractility studies. The effect of PGE(1), PGE(2), PGF(2alpha), progesterone, mifepristone, levonorgestrel, oxytocin and hCG on contractility was studied. Explants of Fallopian tubes were cultured for 24 h to study the effect of progestagens and hCG on the expression of PG receptors using immunohistochemistry and real-time PCR.

RESULTS

Muscular contractions increased after treatment with PGF(2alpha) and PGE(2) (P < 0.05). The contractions decreased after PGE(1), progesterone, levonorgestrel, mifepristone, oxytocin and hCG (P < 0.05). In tubal explant studies, relative mRNA expression of EP1, EP2, EP3 and FP increased after levonorgestrel treatment (P < 0.05). Mifepristone and levonorgestrel treatment increased immunostaining intensity of EP1 and EP2 protein, in lumen, muscle and vessels. Progesterone and mifepristone increased immunostaining of FP in vessels.

CONCLUSIONS

These data suggest that the transport of gametes and embryos involves the action of PGs, progesterone, oxytocin and hCG on muscular contractility.

Research utilization among dental hygienists in Sweden--a national survey

Over the last decade evidence-based practice has become increasingly important in health care as an approach to improve patient outcomes. It is vital that dental hygienists, like other health professionals, use research findings to inform clinical practice. The objective of the present study was to investigate the extent of research utilization among dental hygienists in Sweden and to investigate the relationship between level of education and factors related to research utilization. A random sample of 261 dental hygienists in Sweden, 113 with 1 year and 148 with 2-year education, responded to a postal questionnaire covering various aspects of research utilization, i.e. their attitudes towards research, availability and support for the implementation of research findings, use of research in daily practice, their activity in seeking new research findings and their participation in a range of research-related activities. Dental hygienists with 2-year education had a more positive attitude towards research, used research to a greater extent and were more active in seeking new research findings than dental hygienists with 1-year education. Overall, relatively few dental hygienists reported that they implemented research findings in practice; the most frequently reported activity concerned reading research articles in professional journals. The conclusions are that the length of dental hygiene education is a key factor influencing the application of research findings to practice. One-year education appears to be inadequate to achieve evidence-based practice. Moreover, not even two years of formal education guarantees necessary competence in research for evidence-based dental hygiene practice.

Increased fragility in patients with fracture of the proximal humerus: a case control study

The aim of this study was to evaluate whether a fracture of the proximal humerus is associated with an increased prevalence of preceding fractures or a risk of subsequent fractures. All patients who were treated at the Malmö General Hospital in 1987 for a fresh fracture of the proximal humerus were identified, representing practically all fractures of the proximal humerus in Malmö city (250,000) that year. Two hundred fifty-three adult patients, 54 men with an average age of 66 (24-90) and 199 women with a mean age of 74 (22-98) years, were included in the study together with 475 age- and gender-matched control persons. In 1999, fracture prevalence of patients and controls were rated by a survey at the Dept. of Radiology. There was a significantly increased prevalence of previous fractures before 1987 in the humerus fracture group with an odds ratio (OR) of 3.5 [95% confidence interval (95% CI), 2.2-5.5] for a spinal fracture, OR 1.8 (95% CI, 1.3-2.6) for a previous fracture to the upper extremity, and OR 1.8 (95% CI, 1.2-2.6) for a preceding fracture of the lower limb. The proximal humerus fracture also predicted a significantly increased risk of a subsequent fracture. The hazard ratio (HR) was 2.5 (95% CI, 1.7-3.7) for a forthcoming spinal fracture, HR 2.8 (95% CI, 2.0-3.7) for a future fracture of the upper extremity, and HR 2.0 (95% CI, 1.2-3.5) for a lower limb fracture. In a subgroup of male patients, an almost five times increased risk of sustaining subsequent extremity fractures was observed. In summary, a fracture of the proximal humerus is associated both with increased prevalence of previous fractures of the spine and extremities and also predicting an increased risk of future fractures.

Submerged or non-submerged healing of endosseous implants to be used in the rehabilitation of partially dentate patients. A multicenter, randomized controlled clinical trial

OBJECTIVE

To evaluate bone-level alterations that occurred at implants of the Astra Tech(R) System that were placed in the load carrying, posterior parts of the dentition using either a submerged (two-stage) or a non-submerged (one-stage) installation protocol.

MATERIAL AND METHODS

Eighty-four patients that required 115 fixed partial dentures (FPDs or cases) entered the prospective study. All subjects were assigned one patient and > or =one case numbers. For the randomization of cases, a custom-made program based on balanced random permuted blocks was utilized. The cases were assigned to two treatment groups, namely one-stage installation procedure, non-submerged technique (group A) and two-stage installation procedure, submerged technique (group B). Several subjects contributed with cases to both groups A and B. Periodontal, endodontal and open caries lesions were treated prior to implant installation. All patients received careful oral hygiene instruction and training in self-performed plaque control measures. The surgical technique used for fixture installation followed the outline described in the manual for the Astra Tech System. The FPDs were placed 3 months (mandible) and 6 months (maxilla) following implant installation. Immediately following FPD placement, a baseline examination was performed that included assessment of plaque, soft-tissue inflammation and bone level. Clinicians who were otherwise not involved in the study performed the radiographic measurements. Clinical and radiographical examinations were repeated once a year after the baseline examination.

DATA ANALYSIS

The primary outcome variable was the change in the bone level at the implants from the time of placement of the bridge (FPD) to the 1- and 2-year reexaminations. Fisher's permutation test was used to test if differences existed between groups A and B, and between patients (men/women, smokers/non-smokers, age), sites (maxilla/mandible) and implants (length, diameter). Pitman's test was used to study correlations between bone shape and quality data and different radiographic bone-level data.

RESULTS

It was demonstrated that tissue healing following implant installation appeared to be independent of the surgical protocol, i.e. whether the marginal portions of the implants during surgery were fully or only partly submerged under the ridge mucosa. Thus, (i) in both treatment groups the number of implants that failed to osseointegrate (early failures) was small (<2%); (ii) at the end of the recommended periods of bone healing prior to loading, - in both groups, maxilla=6 months and mandible=3 months - the level of the marginal bone was close to the coronal rim of the fixture; group A: 1.54+/-0.92 mm, group B: 1.31+/-0.77 mm. The current study also demonstrated that irrespective of surgical protocol (two-stage, one-stage), implants supporting the FPDs exhibited only small amount of radiographic bone loss during the first year of function (group A: 0.02+/-038 mm, group B: 0.17+/-0.64 mm). Moreover, during the second year of function, the amount of additional bone loss that occurred in the two treatment groups was close to zero.

CONCLUSION

Periimplant bone-level change during function seemed to be unrelated to whether initial soft- and hard-tissue healing following implant installation had occurred under submerged or non-submerged conditions.

The Yersinia HPI is present in Serratia liquefaciens isolated from meat

AIMS

The aim of the study was to screen the Enterobacteriaceae flora of meat for the presence of bacteria harbouring the Yersinia high-pathogenicity island (HPI).

METHODS AND RESULTS

Bacteria from 29 meat and 29 liver samples were isolated on violet-red bile glucose agar. A total of 197 isolates were screened for the presence of the irp2 gene, encoded within the HPI, by PCR. One isolate that was positive for irp2 gene was also positive for the fyuA, irp1, ybtP/ybtQ, ybtX/ybtS and int/asn tRNA genes by PCR. The presence of fyuA, irp1 and irp2 genes was confirmed by Southern hybridization.

CONCLUSIONS

The isolate was identified as Serratia liquefaciens by sequencing of the 16S rRNA gene and by ribotyping.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report of a Serratia harbouring the Yersinia HPI. Serratia is a frequently occurring Enterobacteriaceae genus in chill-stored meat.

General anaesthesia or conscious sedation for painful procedures in childhood cancer: the family's perspective

BACKGROUND

Until recently, midazolam sedation was routinely used in our institution for bone marrow aspirates and lumbar punctures in children with cancer. It has been perceived by many doctors and nurses as being well tolerated by children and their families.

AIM

To compare the efficacy of inhalational general anaesthesia and midazolam sedation for these procedures.

METHODS

A total of 96 children with neoplastic disorders, who received either inhalational general anaesthesia with sevoflurane, nitrous oxide, and oxygen (GA) or sedation with oral or nasal midazolam (SED) as part of their routine preparation for procedures were studied. The experiences of these children were examined during their current procedure and during their first ever procedure. Main outcome measures were the degree of physical restraint used on the child, and the levels of distress and pain experienced by the child during the current procedure and during the first procedure. The family's preference for future procedures was also determined.

RESULTS

During 102 procedures under GA, restraint was needed on four occasions (4%) when the anaesthetic mask was first applied, minimal pain was reported, and children were reported as distressed about 25% of the time. During 80 SED procedures, restraint was required in 94%, firm restraint was required in 66%, the child could not be restrained in 14%, median pain score was 6 (scale 0 (no pain) to 6 (maximum pain)), and 90% of the parents reported distress in their child. Ninety per cent of families wanted GA for future procedures. Many families reported dissatisfaction with the sedation regime and raised concerns about the restraint used on their child.

CONCLUSIONS

This general anaesthetic regime minimised the need for restraint and was associated with low levels of pain and distress. The sedation regime, by contrast, was much less effective. There was a significant disparity between the perceptions of health professionals and those of families with respect to how children coped with painful procedures.

Unexpectedly high allelic diversity at the KIT locus causing dominant white color in the domestic pig

Mutations in KIT encoding the mast/stem cell growth factor receptor (MGF) are responsible for coat color variation in domestic pigs. The dominant white phenotype is caused by two mutations, a gene duplication and a splice mutation in one of the copies leading to skipping of exon 17. Here we applied minisequencing and pyrosequencing for quantitative analysis of the number of copies with the splice form. An unexpectedly high genetic diversity was revealed in white pigs. We found four different KIT alleles in a small sample of eight Large White females used as founder animals in a wild boar intercross. A similar number of KIT alleles was found in commercial populations of white Landrace and Large White pigs. We provide evidence for at least two new KIT alleles in pigs, both with a triplication of the gene. The results imply that KIT alleles with the duplication are genetically unstable and new alleles are most likely generated by unequal crossing over. This study provides an improved method for genotyping the complicated Dominant white/KIT locus in pigs. The results also suggest that some alleles may be associated with negative pleiotropic effects on other traits.

The level of the mitochondrial mutation A3243G decreases upon ageing in epithelial cells from individuals with diabetes and deafness

We have in a longitudinal study determined the proportion of the mitochondrial A3243G mutation in DNA obtained from cervical cell samples collected from three individuals affected with mitochondrial diabetes and hearing loss during a period of up to 18 years. Using the minisequencing method we were able to sensitively determine the proportion between mutant and normal mitochondrial DNA. Our results demonstrate a constant decrease in the levels of the pathogenic mutation in mitotic tissues of affected individuals with time.

Autonomic dysfunction and ambulatory blood pressure in renal transplant recipients

BACKGROUND

Abnormal circadian blood pressure (BP) rhythm (nondipping) and autonomic dysfunction are both common in end-stage renal disease (ESRD). It is not known whether these abnormalities are related or if they are associated with greater left ventricular hypertrophy.

METHODS

Nineteen renal transplantation (RT) recipients, aged 22-67 years, who were transplanted at least 12 months (1-29 years) previously, were studied with 24-hr ambulatory blood pressure monitoring (ABPM). Autonomic function was tested by automated analysis of heart rate variations and echocardiography was used to estimate left ventricular mass index (LVMI).

RESULTS

Thirteen patients (68%) were nondippers. Although seven (37%) patients had significant parasympathetic dysfunction, this was not related to dipper status. Neither abnormality showed a tendency to diminish with time after RT. Systolic hypertension, diagnosed by ABPM, occurred in 5% of patients during the awake period and in 52% during sleep, whereas diastolic hypertension occurred in 47% when awake and in 63% when asleep. Awake systolic BP was the strongest predictor of LVMI (r=0.7, P<0.001), and was considerably better than systolic BPs recorded at the clinic (r=0.48, P<0.05).

CONCLUSIONS

Nondipping is common after RT but is not related to the degree of autonomic dysfunction. These findings suggest that autonomic dysfunction is not a major contributor to nondipping in ESRD. In RT patients, ABPM is a more sensitive measure of hypertension and a stronger predictor of LVMI than clinic BP.

Nitric oxide, a potent vasodilator of the aortic anastomosis in the estuarine crocodile, Crocodylus porosus

The effects of five neuropeptides (CGRP, SOM, SP, NPY, VIP), L-NAME (nitric oxide synthase inhibitor), and adrenaline on the contractile tone of the aortic anastomosis in the estuarine crocodile, Crocodylus porosus, were investigated. None of the neuropeptides, which had previously been found to be present in the aortic anastomosis, had any direct effect on the tension developed by ring preparations. L-NAME itself significantly increased the basal tone of the vascular ring preparations, suggesting a tonic release of nitric oxide in the preparation. Adrenaline produced concentration-dependent vasoconstrictions that were counteracted by profound reflex vasodilatations that were susceptible to blockade by L-NAME. Immunohistochemistry revealed the presence of nitric oxide synthase and tyrosine hydroxylase-containing (indicating the presence of a adrenergic innervation) nerve fibres in the adventitia and adventitio-medial border of the aortic anastomosis. These data demonstrate opposing actions of adrenaline and nitric oxide on the vascular smooth muscle in the anastomosis of the C. porosus. The morphology of the anastomosis, with the extremely thick muscular vessel wall, suggests a sphincter-like function for this vessel that could be controlled mainly by adrenergic and nitrergic mechanisms.