Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study

AIMS

To examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings.

DESIGN

A qualitative descriptive study. Data were collected via semi-structured interviews.

METHODS

In March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized.

RESULTS

Six themes and 20 sub-themes were identified. Non-validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed.

CONCLUSION

Introduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness.

IMPACTS

The findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post-cardiac event counselling.

REPORTING METHOD

Adherence to COREQ guidelines was maintained.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution as this study explored health professionals' experiences only.

Enhancing effective healthcare communication in Australia and Aotearoa New Zealand: Considerations for research, teaching, policy, and practice

Objective

In this article we present a conceptual framework for enhancing effective healthcare communication in Australia and Aotearoa New Zealand.

Methods

Through an iterative, deliberative dialogue approach, we, as experts from a variety of health professions and academic disciplines, worked together to identify core values and considerations for healthcare communication across numerous health professions and disciplines and within research, teaching, policy, and practice contexts.

Results

The framework developed includes five core values at its centre: equitable, inclusive, evidence-based, collaborative, reflective. Around this are concentric circles showing key elements of collaborators, modality, context, and purpose. Each of these is explored.

Conclusion

This work may support benchmarking for healthcare providers, researchers, policymakers, and educators across a breadth of professions to help improve communication in clinical practice. The framework will also help to identify areas across disciplines that are shared and potentially idiosyncratic for various professions to promote interprofessional recognition, education, and collaboration.

Innovation

This framework is designed to start conversations, to form the foundation of a dialogue about the priorities and key considerations for developing teaching curricula, professional development, and research programs related to healthcare communication, providing a set of values specifically for the unique contexts of Australia and Aotearoa New Zealand. It can also be used to guide interdisciplinary healthcare professionals in advancing research, teaching, policy, and practice related to healthcare communication.

Gender-based differences in assessment and management of acute abdominal pain in the emergency department: A retrospective audit

BACKGROUND

Previous research has identified gender-based differences in acute pain management in the emergency department [ED]. The aim of this study was to compare pharmacological management of acute abdominal pain in the ED by gender.

METHODS

A retrospective chart audit was conducted at one private metropolitan ED including adult patients (18-80 years) who presented with acute abdominal pain in 2019. Exclusion criteria included: pregnancy, repeat presentation within the study period, pain-free at initial medical review or documented refusal of analgesia, and oligo-analgesia. Comparisons by gender included: (1) analgesia type and (2) time to analgesia. Bivariate analysis was undertaken using SPSS.

RESULTS

There were 192 participants: 61 (31.6 %) men and 131 (67.9 %) women. Men were more likely to get combined opioid and non-opioid medication as first line analgesia (men: 26.2 % n = 16; women: 14.5 % n = 19, p = .049). Median time from ED presentation to analgesia was 80 min for men (IQR: 60) versus 94 min for women (IQR: 58), (p = .119). Women (25.2 % n = 33) were more likely to receive their first analgesic after 90 min from ED presentation compared to men versus men (11.5 %, n = 7 p = .029). In addition, women waited longer before receiving second analgesia (women: 94, men: 30 min, p = .032).

CONCLUSION

Findings confirm there are differences in pharmacological management of acute abdominal pain in the ED. Larger studies are required to further explore differences observed in this study.

Self-reported dignity and factors that influence dignity in hospitalised older adults: A cross-sectional survey

OBJECTIVE

This study examined levels of self-reported dignity and explored factors expected to influence dignity experienced by older adults during acute hospitalisation in Ghana.

BACKGROUND

Dignified care has been recognised as inseparable from quality nursing care and maintaining patients' dignity has been highlighted in professional codes of conduct for nurses. However, there is a lack of research on self-reported dignity and the factors that influence the dignity of older adults during acute hospitalisation in Africa.

SETTING

A large teaching hospital in the northern region of Ghana.

PARTICIPANTS

Hospitalised older adults.

METHODS

A cross-sectional survey was used to gather data from a convenience sample of 270 older inpatients, using the Hospitalized Older Adults' Dignity Scale. Data were analysed using descriptive statistics and stepwise ordinal logistic regression to investigate stratified dignity outcomes. The study was reported following the STROBE checklist.

RESULTS

More than half of the older adults surveyed reported low to moderate levels of dignity. Demographic characteristics such as age, marital status, religious status, occupation, level of education and type of hospital ward did not show any significant associations with dignity levels. However, there was a significant association found between dignity levels and sex and the number of hospitalisations.

CONCLUSION

Most older adults in a Ghanian hospital experienced loss of dignity during their acute hospitalisation. Male older adults reported higher dignity levels during acute hospitalisation than their female counterparts. Further, older adults who were admitted to hospital for the second time reported less dignity compared to those admitted three or more times.

RELEVANCE TO CLINICAL PRACTICE

The results emphasise the importance of healthcare professionals having the necessary knowledge and skills to provide gender-sensitive care, which ultimately promotes the dignity of all patients. Additionally, the results underscore the urgency of implementing measures that guarantee patients' dignity during all hospital admissions.

PATIENT OR PUBLIC CONTRIBUTION

Survey questionnaires were completed by hospitalised older adults at the study setting.

Development and psychometric validation of the hospitalized older adults' dignity scale for measuring dignity during acute hospitalization

AIM

To develop and validate a culturally appropriate patient-reported outcome measure for measuring dignity for older adults during acute hospitalization.

DESIGN

A three-phased exploratory sequential mixed-method design was used.

METHODS

Domains were identified and items were generated from findings of a recent qualitative study, two systematic reviews and grey literature. Content validity evaluation and pre-testing were undertaken using standard instrument development techniques. Two-hundred and seventy hospitalized older adults were surveyed to test construct and convergent validity, internal consistency reliability and test-retest reliability of the measure. Analysis was performed using Statistical Package for the Social Sciences, version 25. The STROBE checklist was used to document reporting of the study.

RESULTS

We established the 15-item Hospitalized Older Adults' Dignity Scale (HOADS) that has a 5-factor structure: shared decision-making (3 items); healthcare professional-patient communication (3 items); patient autonomy (4 items); patient privacy (2 items); respectful care (3 items). Excellent content validity, adequate construct and convergent validity, acceptable internal consistency reliability and good test-retest reliability were demonstrated.

CONCLUSION

We established the HOADS is a valid and reliable scale to measure dignity for older adults during acute hospitalization. Future studies using confirmatory factor analysis are needed to corroborate the dimensionality of the factor structure and external validity of the scale. Routine use of the scale may inform the development of strategies to improve dignity-related care in the future.

IMPACT

The development and validation of the HOADS will provide nurses and other healthcare professionals with a feasible and reliable scale for measuring older adults' dignity during acute hospitalization. The HOADS advances the conceptual understanding of dignity in hospitalized older adults by including additional constructs that have not been captured in previous dignity-related measures for older adults (i.e. shared decision-making and respectful care). The factor structure of the HOADS, therefore, includes five domains of dignity and offers a new opportunity for nurses and other healthcare professionals to better understand the nuances of dignity for older adults during acute hospitalization. For example, the HOADS enables nurses to identify differences in levels of dignity based on contextual factors and to use this information to guide the implementation of strategies that promote dignified care.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved in the generation of items for the scale. Their perspectives and the perspectives of experts were sought in determining the relevance of each item of the scale to patients' dignity.

Nurses' work experiences in hospital wards with single rooms: An integrative review

AIM AND OBJECTIVE

To evaluate evidence that examined nurses' work experiences in hospital wards with single rooms. The research question was 'What does the research tell us about nurses' work experiences in hospital wards with single rooms?'

BACKGROUND

In the last decades, new hospital builds have moved towards including a high proportion of single rooms. Yet, single rooms create 'complex environments' that impact the nurses.

DESIGN

A structured integrative review was undertaken of empirical evidence.

METHODS

Original, peer-reviewed articles, written in English, were sourced from four databases: CINAHL, PubMed, Embase and Web of Science. The initial searches were performed in April 2021 and repeated in December 2022. Quality appraisal was undertaken using the Mixed Methods Appraisal Tool. A narrative synthesis approach was used to analyse the data. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

Twelve studies, published between 2006 and 2022, with an international origin, and representing n = 826 nurses, were included in this review. The synthesis revealed mixed perspectives about nurses' work experiences in wards with single rooms. Whilst single rooms are 'all good in theory (and) a good idea', the reality was quite different. Synthesised findings are presented in four categories: (i) aesthetics and the physical space, (ii) privacy vs. isolation, (iii) safety, which includes situational awareness and (iv) communication and collaboration.

CONCLUSION

This review describes how single rooms affects nurses' work experience. Whilst nurses shared multiple concerns about single rooms and the challenges they also acknowledged patient preference for the privacy and space afforded by single rooms.

RELEVANCE TO CLINICAL PRACTICE

Findings from this review highlight the need for careful planning to maintain and strengthen teamwork, prevent nurses' sense of working in isolation, as well as creating opportunities for mentorship, and collaboration among nurses when working in single-room settings.

Understanding Physical Activity Behavior in Ghanaian Adults with Type 2 Diabetes: A Qualitative Descriptive Study

Despite a relatively low prevalence rate, sub-Saharan Africa bears a substantial diabetes burden. Physical activity (PA) plays a crucial role in managing type 2 diabetes mellitus (T2DM). However, PA levels among this population remain suboptimal. This study aimed to explore patients' perspectives on the barriers and facilitators to PA participation among Ghanaian adults with T2DM. Thirteen adults with T2DM were recruited from Korle-Bu Teaching Hospital, Ghana, for this qualitative descriptive study. Semi-structured interviews were conducted, and the data were analyzed using thematic analysis. Two overarching themes (personal factors and socio-structural factors) and 10 sub-themes relating to PA barriers and facilitators were identified. Participants had limited awareness of the recommended PA guidelines for T2DM management. Chronic illness-related factors hindered exercise participation. Difficulty differentiating between PA and exercise impeded the achievement of PA targets. Socio-structural barriers include concerns about social ridicule or embarrassment, safety during outdoor activities, a lack of culturally appropriate exercise facilities, and high social and work demands. Despite these barriers, participants were motivated by their understanding of the health benefits of PA. They emphasized integrating PA into daily routines through walking, work-related tasks, and household chores. Motivation and PA education from healthcare professionals are valued supports in achieving PA targets. Our findings showed that PA behaviour in Ghanaian adults with T2DM is influenced by both personal and external factors. Tailored PA interventions for this population should address identified barriers while leveraging facilitators to implement successful PA programs.

Expert Opinions about Barriers and Facilitators to Physical Activity Participation in Ghanaian Adults with Type 2 Diabetes: A Qualitative Descriptive Study

Most adults with type 2 diabetes mellitus (T2DM) do not meet their physical activity (PA) goals despite its importance in improving their health outcomes. Our study aim was to explore the opinions of healthcare professionals regarding barriers and facilitators to PA participation in Ghanaian adults with T2DM. Using qualitative descriptive design, data were collected through semi-structured interviews with 13 healthcare professionals experienced in diabetes management in Ghana. Three main themes relating to PA barriers and facilitators were identified in a thematic analysis: health system-related factors, healthcare practitioner factors, and patient factors. Inadequate accessibility to physical therapists and therapy centres hindered the provision of PA programs. Nurses and doctors lacked sufficient knowledge and training on effective PA interventions for individuals with T2DM. Time constraints during patient consultations limited discussions on PA, while the cost associated with accessing physical therapy posed a significant challenge. Patients often disregarded PA advice from physical therapists due to their reliance on doctors, and some perceived PA as irrelevant for diabetes treatment. Despite these barriers, healthcare professionals expressed belief in PA facilitators, including integrating physical therapists and diabetes educators into diabetes care, providing structured exercise resources, improving curriculum planning to emphasise PA in health science education, and addressing knowledge gaps and misconceptions. Overall, this study highlights patient-related and healthcare system-related factors that influence PA behaviour in Ghanaian adults with T2DM. Findings from this study should inform the development of tailored PA programs for this population.

Effect of Physical Activity on Metabolic Syndrome Markers in Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis

People with Type 2 diabetes mellitus (T2DM) are reported to have a high prevalence of metabolic syndrome (MetS), which increases their risk of cardiovascular events. Our aim was to determine the effect of physical activity (PA) on metabolic syndrome markers in people with T2DM. The study design was a systematic review and meta-analysis of randomised controlled trials evaluating the effect of PA on MetS in adults with T2DM. Relevant databases including SPORTdiscus, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PsycINFO, EMBASE, SocINDEX were searched up to August 2022. Primary endpoints were changes in MetS markers (blood pressure, triglyceride, high-density lipoprotein, fasting blood sugar, and waist circumference) after an exercise intervention. Using a random effect model with 95% confidence interval (CI), the mean difference between intervention groups and control groups were calculated. Twenty-six articles were included in the review. Overall, aerobic exercise had a significant effect on waist circumference (Mean Difference: -0.34 cm, 95% CI: -0.84, -0.05; effect size: 2.29, I² = 10.78%). The effect sizes on blood pressure, triglyceride, high-density lipoprotein, fasting blood sugar were not statistically significant. No significant differences were found between exercise and control group following resistance training. Our findings suggest that aerobic exercise can improve waist circumference in people with T2DM and MetS. However, both aerobic and resistance exercise produced no significant difference in the remaining MetS markers. Larger and higher-quality studies are required to determine the full effects of PA on MetS markers in this population.

Improving Metabolic Syndrome in Ghanaian Adults with Type 2 Diabetes through a Home-Based Physical Activity Program: A Feasibility Randomised Controlled Trial

There is a high prevalence of metabolic syndrome (MetS) among people with type 2 diabetes mellitus (T2DM). Physical activity has the potential to improve health outcomes for individuals with type 2 diabetes. Our study aim was to determine the effect of a 12-week culturally appropriate home-based physical activity program on metabolic syndrome markers and quality of life in Ghanaian adults with T2DM. A secondary objective was to examine the feasibility of implementing the PA program. A feasibility randomised controlled trial (RCT) was conducted. A purposive sample of 87 adults with T2DM at the Korle-Bu Teaching Hospital, Ghana, were randomized into either the control group (CG) (n = 43) or the intervention group (IG) (n = 44). Participants in the IG received the physical activity program in addition to their usual diabetes care; those in the CG received their usual diabetes care. Measurements for feasibility, MetS markers, and quality of life (SF-12) were performed at baseline and 12-week follow-up. Following the 12-week program, participants in the IG showed a significant improvement in fasting blood glucose (2.4% vs. 0.4%, p < 0.05), waist circumference (5.4% vs. 0.4%, p < 0.05), and systolic blood pressure (9.8% vs. 1.5%, p < 0.05). There were no statistical differences between the IG and CG regarding high-density lipoprotein, triglycerides, and diastolic blood pressure at the 12-week follow-up. Classification of MetS were reduced in the IG compared to the CG (51.2% vs. 83.3%, p < 0.05). The MetS severity score improved in the IG compared to the CG (8.8% vs. 0.5%, p < 0.05). The IG improved in two of the eight SF-12 dimensions (physical function and vitality, p < 0.05) compared to the CG. Thirty-two (72.7%) participants completed all 36 exercise sessions. Another 11 (25%) participants completed 80% of the exercise sessions. No adverse events were reported. In conclusion, a 12-week home-based physical activity program is feasible and safe. The intervention has the potential to improve MetS and quality of life in Ghanaian adults with T2DM. The preliminary findings of this study need to be confirmed in a large-scale multi-centre RCT.

Patient dignity and dignified care: A qualitative description of hospitalised older adults perspectives

AIMS AND OBJECTIVES

The aim of this study was to explore older adults' perspectives about dignity and dignified nursing care during acute hospitalisation in Ghana.

BACKGROUND

Maintaining hospitalised older adults' dignity is an essential component of nursing care and one of the most important determinants of wellbeing. To date, no study has been published on older adults' perspectives of dignified nursing care in the African context.

STUDY DESIGN

A qualitative descriptive research design.

METHODS

Twenty hospitalised older adults were purposively selected from the medical and surgical wards of a teaching hospital in Ghana. Data were gathered through semi-structured interviews between April and August, 2021, and analysed using reflexive thematic analysis techniques. The SRQR checklist was used to document reporting of the study.

RESULTS

The following four themes were identified: Effective nurse-patient communication, Maintaining patients' privacy, Respectful and compassionate care provision and Providing quality and safe care. Dignity was preserved when patients were treated with respect and compassion, provided privacy, and had close family members involved in physical care. Identified barriers to dignity included inadequate information about their health condition, poor communication by the nurses, lack of autonomy, poorly designed healthcare infrastructure and inadequate privacy.

CONCLUSIONS

Several enablers and barriers to dignified nursing care have been identified that have been discussed in previous studies. The unique factors identified in the Ghanaian context were family members' involvement in physical care influenced by cultural and religious beliefs, environmental barriers to privacy and dignity and inadequate involvement in decision making.

RELEVANCE TO CLINICAL PRACTICE

Nurses must treat older patients with respect, educate them about the health condition, involve them in care decisions, and identify their preferences regarding provision of hygiene needs, particularly in consideration of religious and cultural beliefs, including involvement of family members. Future planning of healthcare infrastructure needs to consider the importance of private cubicles with disability-accessible ensuite bathrooms for patients' comfort and privacy.

Novice nurses' experiences in provision of mental ill health care within a regional emergency department: A descriptive qualitative study

Emergency departments are often the first point of contact for individuals presenting to healthcare services for assistance and treatment for mental ill health. Emergency departments, particularly those in regional areas, can experience high staff turnover and rely on novice nurses for workforce sustainability. The aim of this paper is to explore the experiences of novice nurses (nurses with <3 years of experience) in providing care to individuals presenting with mental ill health in the emergency department. Semi-structured interviews were conducted with novice nurses (N = 13) in a regional emergency department, using qualitative description as the guiding framework. The following three main themes were identified: (i) confidence in providing quality and safe nursing care, (ii) perceived barriers to providing quality and safe nursing care, and (iii) factors that increase confidence. Our findings indicate that proving safe and appropriate nursing care is affected in novice nurses by factors that lead to a perceived lack of confidence, such as how individuals present to the emergency department (e.g. intoxicated or violent), an inability to conduct conversations to assess accurately and perceived shortfalls in the emergency department environment itself. Future research should examine the curriculum for relevance of undergraduate education regarding acute mental health presentations and develop training strategies that enhance communication with individuals who present to the emergency department with mental ill health.

Methodological quality of dignity-related patient reported outcome measures used in acute hospital settings: A systematic review using the COSMIN methodology

AIMS AND OBJECTIVE

The aim of this systematic review was to examine the methodological quality of dignity-related patient reported outcome measures (PROMs) used to measure patients' dignity during acute hospitalisation using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic review of PROMs.

BACKGROUND

Previous scoping review studies on the methodological quality of dignity-related PROMs lack specificity for dignity during acute hospital admission. They included PROMs that were developed to measure constructs of care other than patient dignity or designed to measure dignity in contexts outside of the acute hospital setting.

STUDY DESIGN

A systematic review based on COSMIN methodology.

METHODS

A systematic search was undertaken using five databases (CINAHL Complete, Medline Complete, EMBASE, PsycINFo and AgeLine) for articles published between 2000 and 2022. Relevant papers were identified using strict adherence to eligibility criteria, and studies that included development of dignity-related PROMs for use in acute hospital settings were selected. Two reviewers independently screened the identified papers, extracted data and examined the quality of studies.

RESULTS

Six papers met the inclusion criteria. Two PROMs, the 25-item Patient Dignity Inventory and the 34-item Inpatient Dignity Scale, met the COSMIN quality criteria because of their sufficient quality of evidence for content validity and reliable internal consistency. None of the PROMs met the quality criteria for assessment of measurement error, criterion validity, cross-cultural validity and responsiveness.

CONCLUSION

We recommend the Patient Dignity Inventory and the Inpatient Dignity Scale as the PROMs of choice for evaluating patients' dignity and/or dignified care during acute hospital admissions. These PROMs were developed using robust procedures with sufficient overall quality for content validity, internal consistency reliability and other measurement properties, and with moderate to high quality of evidence for these measurement properties. Researchers and clinicians who wish to use other dignity-related PROMs identified in this review should consider the methodological limitations of these PROMs, as highlighted in the present systematic review.

RELEVANCE TO CLINICAL PRACTICE

The review findings will guide healthcare professionals about their choice of patient reported outcome measures for evaluating patients' dignity or dignified care during acute hospitalisation.

CXD101 and nivolumab in patients with metastatic microsatellite-stable colorectal cancer (CAROSELL): a multicentre, open-label, single-arm, phase II trial

BACKGROUND

Patients with microsatellite stable (MSS) colorectal carcinoma (CRC) do not respond to immune checkpoint inhibitors. Preclinical models suggested synergistic anti-tumour activity combining CXD101 and anti-programmed cell death protein 1 treatment; therefore, we assessed the clinical combination of CXD101 and nivolumab in heavily pre-treated patients with MSS metastatic CRC (mCRC).

PATIENTS AND METHODS

This single-arm, open-label study enrolled patients aged 18 years or older with biopsy-confirmed MSS CRC; at least two lines of systemic anticancer therapies (including oxaliplatin and irinotecan); at least one measurable lesion; Eastern Cooperative Oncology Group performance status of 0, 1 or 2; predicted life expectancy above 3 months; and adequate organ and bone marrow function. Nine patients were enrolled in a safety run-in study to define a tolerable combination schedule of CXD101 and nivolumab, followed by 46 patients in the efficacy assessment phase. Patients in the efficacy assessment cohort were treated orally with 20 mg CXD101 twice daily for 5 consecutive days every 3 weeks, and intravenously with 240 mg nivolumab every 2 weeks. The primary endpoint was immune disease control rate (iDCR).

RESULTS

Between 2018 and 2020, 55 patients were treated with CXD101 and nivolumab. The combination therapy was well tolerated with the most frequent grade 3 or 4 adverse events being neutropenia (18%) and anaemia (7%). Immune-related adverse reactions commonly ascribed to checkpoint inhibitors were surprisingly rare although we did see single cases of pneumonitis, hypothyroidism and hypopituitarism. There were no treatment-related deaths. Of 46 patients assessable for efficacy, 4 (9%) achieved partial response and 18 (39%) achieved stable disease, translating to an immune disease control rate of 48%. The median overall survival (OS) was 7.0 months (95% confidence interval 5.13-10.22 months).

CONCLUSIONS

The primary endpoint was met in this phase II study, which showed that the combination of CXD101 and nivolumab, at full individual doses in the treatment of advanced or metastatic MSS CRC, was both well tolerated and efficacious.

A systematic review of patient-reported dignity and dignified care during acute hospital admission

AIMS

To synthesize quantitative evidence on levels of dignity during acute hospital admission and identify barriers and facilitators to patients' dignity or dignified care from the perspective of hospitalized patients. The secondary aim was to examine the relationship between dignity and demographic, clinical and psychological characteristics of patients.

DESIGN

A systematic review based on the protocol of the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline for reporting systematic reviews.

DATA SOURCES

Five electronic databases (PubMed, CINAHL, Embase, PsycINFO, AgeLine) were searched in February 2021, followed by backward-forward searching using Web of Science and Scopus databases.

REVIEW METHODS

Potentially eligible articles were scrutinized by two reviewers. Articles that met the eligibility criteria were appraised for quality using the Critical Appraisal Tool for Cross-Sectional Studies. Two reviewers extracted data for the review and resolved differences by consensus.

RESULTS

Out of 3052 potentially eligible studies, 25 met the inclusion criteria. Levels of dignity for hospitalized patients vary widely across geographic locations. Patients' dignity is upheld when healthcare professionals communicate effectively, maintain their privacy, and provide dignity therapy. Patients' perceptions of dignity were, in some studies, reported to be associated with demographic (e.g. age, marital status, gender, employment, educational status), clinical (e.g. hospitalization, functional impairment, physical symptoms) and psychological (e.g. depression, anxiety, demoralization, coping mechanisms) variables whilst other studies did not observe such associations.

CONCLUSION

Patients in acute care settings experience mild to a severe loss of dignity across different geographic locations. Patients' dignity is influenced by several demographic, clinical and psychological characteristics of patients.

IMPACT

The findings of the review support impetus for improvement in dignified care for hospitalized patients, addressing factors that facilitate or impede patients' dignity. Measures aimed at alleviating suffering, fostering functional independence and addressing patients' psychosocial needs can be used to promote dignity.

Responding to nurses' communication challenges: Evaluating a blended learning program for communication knowledge and skills for nurses

OBJECTIVES

To evaluate the effectiveness of the Blended Communication Skills Training Program for Nurses (CSTN). The program aims to improve nurses' knowledge about communication skills and structure for interactions with individuals who a have life limiting illness.

METHODS

This was a quasi-experimental study using a pre- and post-test quiz and self-efficacy questionnaire undertaken in Victoria, Australia. Nurses employed across three wards participated. The Blended CSTN comprised two major components: Asynchronous Web-Based Education Program and Experiential Workshop. The program focused on specific communication challenges: Gathering Information, Dealing with Difficult Questions, and Articulating Empathy. The primary outcome was improvement in knowledge of communication skills and structure. Self-efficacy and perceived importance of communication skills were assessed as secondary outcomes.

RESULTS

Eighteen nurses completed both Web-Based and Workshop components. Statistically significant increases in knowledge regarding communication skills and structure were found, with a large effect size for Gathering Information (r = 0.80) and moderate effect for Articulating Empathy (r = 0.62), and Responding to Difficult Questions (r = 0.532). Self-efficacy significantly increased for all measured communication skills.

CONCLUSIONS

Knowledge improvements and perceived self-efficacy in communication were observed after nurses participated in a blended education program PRACTICE IMPLICATIONS: A blended CSTN may improve nurse-patient communication in the clinical setting, worthy of further study.

NURSE LEADER AGENCY: CREATING AN ENVIRONMENT CONDUCIVE TO SUPPORT FOR GRADUATE NURSES

Aim

The aim of the study was to gain insight on how nurse leaders manage a culture of safety for graduate nurses.

Background

Current theoretical approaches to safety culture tend towards a checklist approach that focuses on institutional characteristics, failing to examine the quality of interpersonal relationships. These interpersonal interactions are often seen as separate from the institutional realities of resource allocation, nurse–patient ratios, patient acuity or throughput. A theoretical approach is required to illuminate the dialectic between the structure of an organisation and the agency created by nurse leaders to promote patient safety.

Design

Qualitative exploratory descriptive study.

Methods

Semi‐structured interviews were undertaken with 24 nurse leaders from hospital and aged care settings. Thematic analysis and Giddens structuration theory was used to describe the findings.

Results

Nurse leaders identified a range of reciprocal communicative and cultural norms and values, decision‐making processes, personal nursing philosophies, strategies and operational procedures to foster patient safety and mentor graduate nurses. The mentoring of graduate nurses included fostering critical thinking, building and affirming formal structural practices such as handover, teamwork, medication protocols and care plans.

Conclusions

The study provides insight into how nurse leaders foster a culture of safety. Emphasis is placed on how agency in nurse leaders creates an environment conducive to learning and support for graduate nurses.

Implications for Nursing Management

Nurse leadership functions and decision‐making capacity hinges on multiple factors including practicing agency and aspects of the social structure such as the rules for safe communication, and the various institutional protocols. Nurse leaders enforce these forms of engagement and practice through their legitimation as leaders. They have both allocative and authoritative resources; they can command resources, direct staff to attend to patients and/or clinical tasks, mentor, guide, assign, correct and encourage with the authority vested in them by the formal structure of the organisation. In doing so, they sustain the structure and reinforce it.

Depression, anxiety and stress among Australian nursing and midwifery undergraduate students during the COVID-19 pandemic: a cross-sectional study

OBJECTIVES

To assess depression, anxiety and stress among undergraduate nursing and midwifery students during the COVID-19 pandemic, and identify socio-demographic and educational characteristics associated with higher depression, anxiety and stress scores.

METHODS

Cross-sectional study during August-September 2020, using an anonymous, online, self-administered survey. E-mail invitations with a survey link were sent to 2,907 students enrolled in the Bachelor of Nursing suite of courses, offered across four campuses of a single university in Victoria, Australia. Depression, anxiety and stress were assessed using the DASS-21. Data on socio-demographic and educational characteristics, self-rated physical health and exposure to COVID-19 were also collected. DASS-21 subscale scores were compared with existing data for various pre-pandemic and COVID-19 samples. Multiple regression was used to investigate factors associated with higher scores on depression, anxiety and stress subscales.

RESULTS

The response rate was 22% (n=638). Mean scores on all DASS-21 subscales were significantly higher (p<0.001) than means from all comparative sample data. The proportions of students reporting moderate to severe symptoms of depression, anxiety and stress were 48.5%, 37.2% and 40.2% respectively. Being a woman, being younger, having completed more years of study and having poorer self-rated general health were all significantly associated (p<0.05) with higher scores on at least one DASS-21 subscale.

CONCLUSIONS

Almost half of participants reported at least moderate symptoms of depression; more than a third reported at least moderate symptoms of anxiety or stress. Poor psychological wellbeing can impact students' successful completion of their studies and therefore, has implications for nursing and midwifery workforce recruitment and retention. During and after pandemics, universities should consider screening undergraduate students not only for anxiety and stress, but also for depression. Clear, low-cost referral pathways should be available, should screening indicate that further diagnosis or treatment is required.

The impact of covid-19 on psychosocial well-being and learning for australian nursing and midwifery undergraduate students: a cross-sectional survey

Aim

To explore the impact of COVID-19 on psychosocial well-being and learning for nursing and midwifery undergraduate students in an Australian university.

Background

The World Health Organization has reported a substantial psychological impact of COVID-19 on healthcare professionals to date. Evidence is lacking, however, regarding university nursing and midwifery students of the pandemic and its impact on their educational preparation and/or clinical placement during the COVID-19 pandemic.

Design

Cross-sectional survey of nursing and midwifery undergraduate students enrolled in the Bachelor of Nursing suite of courses from the study institution in August- September 2020.

Methods

A cross-sectional self-administered anonymous online survey was distributed to current nursing and midwifery undergraduate students. The survey included three open-ended questions; responses were thematically analysed.

Results

Of 2907 students invited, 637 (22%) responded with 288 of the respondents (45%) providing a response to at least one of the three open-ended questions. Three major themes associated with the impact of the pandemic on psychosocial well-being and learning were identified: psychosocial impact of the pandemic, adjustment to new modes of teaching and learning, and concerns about course progression and career. These themes were underpinned by lack of motivation to study, feeling isolated, and experiencing stress and anxiety that impacted on students’ well-being and their ability to learn and study.

Conclusions

Students were appreciative of different and flexible teaching modes that allowed them to balance their study, family, and employment responsibilities. Support from academic staff and clinical facilitators/mentors combined with clear and timely communication of risk management related to personal protective equipment (PPE) in a healthcare facility, were reported to reduce students’ stress and anxiety. Ways to support and maintain motivation among undergraduate nursing and midwifery students are needed.

Digital intervention increases influenza vaccination rates for people with diabetes in a decentralized randomized trial

People with diabetes (PWD) have an increased risk of developing influenza-related complications, including pneumonia, abnormal glycemic events, and hospitalization. Annual influenza vaccination is recommended for PWD, but vaccination rates are suboptimal. The study aimed to increase influenza vaccination rate in people with self-reported diabetes. This study was a prospective, 1:1 randomized controlled trial of a 6-month Digital Diabetes Intervention in U.S. adults with diabetes. The intervention group received monthly messages through an online health platform. The control group received no intervention. Difference in self-reported vaccination rates was tested using multivariable logistic regression controlling for demographics and comorbidities. The study was registered at clinicaltrials.gov: NCT03870997. A total of 10,429 participants reported influenza vaccination status (5158 intervention, mean age (±SD) = 46.8 (11.1), 78.5% female; 5271 control, Mean age (±SD) = 46.7 (11.2), 79.4% female). After a 6-month intervention, 64.2% of the intervention arm reported influenza vaccination, vers us 61.1% in the control arm (diff = 3.1, RR = 1.05, 95% CI [1.02, 1.08], p = 0.0013, number needed to treat = 33 to obtain 1 additional vaccination). Completion of one or more intervention messages was associated with up to an 8% increase in vaccination rate (OR 1.27, 95% CI [1.17, 1.38], p < 0.0001). The intervention improved influenza vaccination rates in PWD, suggesting that leveraging new technology to deliver knowledge and information can improve influenza vaccination rates in high-risk populations to reduce public health burden of influenza. Rapid cycle innovation could maximize the effects of these digital interventions in the future with other populations and vaccines.

The influence of socio-demographic factors on stress and coping strategies among undergraduate nursing students

BACKGROUND

Nursing students may experience high levels of stress during academic study, which may affect their physical and mental health. Continued severe stress may lead to attrition from a program, particularly if utilised coping strategies are not appropriate or effective. In addition, some socio-demographic factors can influence an individual's perceived stress level and choice of coping strategies.

AIM

To determine if socio-demographic factors have an impact on perceived stress and preferred coping strategies of students enrolled in undergraduate nursing studies.

DESIGN

Descriptive correlational cross-sectional study design.

METHODS

Self-report questionnaires including a demographic questionnaire, Perceived Stress Scale, and Coping Strategy Inventory were utilised. A convenience cross-sectional sample of second- and third-year undergraduate nursing students (N = 377) were surveyed. Independent samples t-test, One-way ANOVA and multiple regression analysis were used to analyse data. Voluntary consent was obtained.

FINDINGS

A moderate of proportion of participants (60%) were International students. The majority (n = 270, 71.6%) of participants had moderate stress levels. Engagement coping strategies (M = 56.33, SD = 10.27) were preferred over disengagement coping strategies (M = 46.29, SD = 11.36) for managing stress. Independent associations were identified for 'gender', 'age', 'marital status', 'country of birth', 'residential status' and 'language spoken' with stress and utilisation of preferred coping strategies.

CONCLUSION

This study has determined that a significant number of students currently enrolled in an undergraduate nursing course may be experiencing a moderate amount of stress. Furthermore, participants' demographic factors may have influenced perceived stress and utilisation of coping strategies. Diversity in background may be contributing to additional stress for some students, who may have migrated alone, without family and support networks. Future research may evaluate strategies to reduce stress for undergraduate nursing students. Students for whom English was second language may require specific support to enhance their educational experience.

Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis

BACKGROUND

A number of clinical guidelines recommend that all cardiac rehabilitation patients should be screened for potential sleep disorders with a validated screening instrument. There is currently no consensus on what specific tools should be used.

OBJECTIVE

To identify tools that are practical to use in the clinical environment and have high diagnostic accuracy.

METHODS

We systematically searched online databases to identify patient reported outcome instruments that have been used in published research studies to assess the likelihood of obstructive sleep apnoea (OSA) in cardiac patients. In studies that provided diagnostic data, these data were extracted and verified via an evidence-based diagnostic calculator. Where sufficient numbers of studies were available, a meta-analysis was conducted to determine pooled estimates of specificity, sensitivity and diagnostic odds ratios. Selected papers were qualitatively assessed using the Standards for Reporting Diagnostic accuracy studies (STARD).

RESULTS

Of the 21 instruments identified, six detected likelihood of OSA, two assessed daytime sleepiness, five assessed insomnia and eight examined sleep quality. A meta-analysis of 14 studies that assessed diagnostic accuracy of moderate OSA, revealed moderate sensitivity for the Berlin Questionnaire, Sens = 0.49 (95% CI 0.45-0.52) and good sensitivity for the Stop-BANG, Sens = 0.93 (95% CI 0.87-0.96) but poor specificity at standard cut-off criteria.

CONCLUSION

There are promising practical tools available to screen patients with OSA and other sleep disorders in cardiac rehabilitation settings, but specificity could be improved. Additional assessment of sleep quality may enhance prognostic ability with both OSA and insomnia screening.

Effects of diffused essential oils for reducing stress and improving mood for clinical nurses: An interventional time series study

PURPOSE

This study examined the effect of EO diffusion in the clinical setting on nurses' mood.

DESIGN

Interventional interrupted time series study with two data collection points: prior to, and in the second week of diffusion.

METHODS

Self-report questionnaires measured the impact of EO diffusion on nurses' stress, depression, anxiety, distress, and mood. Three EOs (Citrus Bliss, Grapefruit, Wild Orange) were diffused in 2-week blocks, with a 1-week wash-out period. Descriptive statistics and paired sample t test were performed.

RESULTS

A paired sample was returned for 39 participants. There were significant improvements after diffusion of Citrus Bliss for stress (mean difference [MD]: 2.58; 95% confidence interval [CI]: 0.82, 4.35), depression (MD: 1.83; 95% CI: 0.03, 3.64), distress (MD: 2.39; 95% CI: 0.58, 4.19) and mood (MD: 4.89; 95% CI: 0.52, 9.27). A large effect (Cohen's d effect >0.80) for depression and distress was observed for nurses who had previously used EOs and those with no reported external stressors.

CONCLUSION

Diffusion of citrus EOs in the clinical setting positively affected nurses' mood. Future studies could also explore effect for patients and visitors.

Pilates for low risk pregnant women: Study protocol for a randomized controlled trial

BACKGROUND

Pilates has growing appeal to pregnant women, as a form of exercise and relaxation. It is purported to benefit lumbo-pelvic stability, as well as motor control, strength and endurance. Some suggest that modified Pilates exercises may assist low risk pregnant women to enjoy a healthier pregnancy and prepare for the physical demands of labour and birth. The feasibility and safety of Pilates during pregnancy is poorly understood. We describe the protocol for a feasibility study designed to compare a midwife-led 6-week community-based Pilates intervention with standard antenatal care.

METHODS

A convenience sample of 30 low-risk pregnant women will be recruited from private obstetric clinics in Melbourne, Australia. Participants shall be randomly allocated to a six-week, 1-h weekly Pilates exercises group session or to usual care. The Pilates exercise class will have a warm-up phase, Pilates exercises, breathing exercises, and a cool down phase. Exercises have been designed to prepare for active birth. The primary outcome will be feasibility of implementation, determined by recruitment, retention, adherence and safety. Secondary outcomes include women's health (quality of life, pain, mobility for daily activities, lower extremity performance, abdominal separation, continence) and labour and birth outcomes (duration of first stage and second stage labour, analgesia used, mode of birth). Validated questionnaires will include the Quality of life 12-item short form survey; Pregnancy Mobility Index, and International Consultation on Incontinence Questionnaire. Lower extremity performance and abdominal separation will also be measured.

DISCUSSION

This trial will provide preliminary data regarding the feasibility and safety of Pilates exercise in healthy pregnant women. It will also provide preliminary outcome data used to inform the design of a future large scale, multi-centre RCT.

TRIAL REGISTRATION

This clinical trial has been registered with the Australian and New Zealand Clinical Trials Registry 2016 (ACTRN12616000809437).

Perspectives about dignity during acute care for older people and their relatives: A qualitative study

AIMS AND OBJECTIVES

The aim of the study was to enhance understanding about dignified care from older peoples' and their carers' perspectives. The information will contribute to the development of a tool to measure older peoples' dignity during hospitalisation.

BACKGROUND

Older people are a vulnerable cohort at risk of loss of dignity during acute hospitalisation arising from environmental, behavioural and patient factors. It is not clear how older people and their relatives define dignified care in acute care settings.

DESIGN

An interpretative descriptive method was used.

METHODS

A purposive sample of older people (at least 65 years) who had been hospitalised in acute care and subsequently transferred to sub-acute care, and their relatives, were invited to participate. The study was undertaken in one sub-acute ward in a regional healthcare organisation in Victoria, Australia. Individual interviews were audio-recorded then transcribed. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study.

RESULTS

Individual interviews were conducted: 24 patients and 12 relatives. Three main themes were identified: "Involve me in decisions about my care and treatment," "Keep me safe when I am vulnerable" and "Treat me as an individual and with respect." Older people want to be involved in decisions about their care and treatment and to receive adequate, suitable information. They feel vulnerable during hospitalisation and want to feel safe when speaking up about concerns. Individual acknowledgement is an important aspect of dignity.

CONCLUSIONS

Older people and their relatives identified specific elements of care that uphold or threaten dignity during acute hospitalisation. Nurses play a major role in upholding dignity for older people in hospital.

RELEVANCE TO CLINICAL PRACTICE

Clinicians may benefit from systematic dignity-related training. Specific strategies to enhance older persons' dignity, including communication skills training and continence management need to be developed, implemented and evaluated.

The effectiveness of training interventions on nurses' communication skills: A systematic review

OBJECTIVES

The objective of this systematic review was to identify, critically appraise and synthesise evidence for the effectiveness of communication skills training interventions in nursing practice.

DESIGN

A systematic review of literature.

DATA SOURCES

Randomised controlled trials published in English from 1998 to 2018, identified in five computerised databases (Medline, Cinahl, Embase, Psychinfo and Cochrane Database). Studies were included if they reported an educational intervention to enhance nurses' communication with patients and contained an objective measure of communication skills and/or patient outcome measures.

REVIEW METHODS

The Preferred reporting Items for Systematic reviews and Meta-Analyses guided the review. Data were extracted regarding study design and effectiveness on nurses' communication skills. Trial quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The heterogeneity of the included studies prohibited meta-analysis.

RESULTS

Of the 7811 papers identified, seven trials met the eligibility criteria. The quality was modest. Training programs varied significantly in duration, structure, location and use of outcome measurement tools. Five trials focused on communication with cancer patients using simulated patients. All trials found at least one statistically significant improvement for nurses' communication skills.

CONCLUSIONS

Educational interventions to enhance nurses' capacity to communicate with patients show promise. The paper reports the first systematic review of randomised controlled trials concerning the effect of communication skills training on nurses' abilities to communicate with patients, inclusive of non-cancer settings. The direct impact of educational interventions on nurses' communication skills is difficult to measure arising from non-standardised outcome measurement tools. Further research is particularly needed in acute, chronic illness, aged care and community settings.

Challenges for nurses when communicating with people who have life-limiting illness and their families: A focus group study

AIMS AND OBJECTIVES

The proposed study aimed to answer the following question: What communication issues do nurses find challenging when caring for people with life-limiting illness?

BACKGROUND

Evidence suggests that attitudes, skills and knowledge about how nurses communicate effectively with patients and their families could be improved. However, the literature predominantly focuses on nurses working in oncology and the medical profession.

DESIGN

A qualitative descriptive design was used.

METHODS

Focus groups were conducted with 39 nurses from three wards within a regional healthcare organisation in Victoria, Australia. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study.

RESULTS

In their view, nurses have the potential to develop a strong bond with patients and their families. Three key themes were identified: (a) feeling unskilled to have difficult conversations with patients who have life-limiting illness; (b) interacting with family members adds complexity to care of patients who have life-limiting illness; and (c) organisational factors impede nurses' capacity to have meaningful conversations with patients and their families.

CONCLUSIONS

Caring for individuals with life-limiting illness is complex and often occurs in an emotionally charged environment. However, nurses report being hampered by time restraints and lack of information about the patient's condition and goals of care. Limitations in conversation structure and a comprehensive range of core communication skills affect their ability to confidently engage in conversations, particularly when they are responding to prognostic questions.

RELEVANCE TO CLINICAL PRACTICE

Whilst nurses are responsible for performing technical skills, they can maximise care by developing a trusting relationship with patients and their relatives. Increased acuity limits the time nurses have to talk with patients. In addition, they lack confidence to deal with difficult questions. Specific training may increase nurses' confidence and efficiency when communicating with patients and their families.

TECRA® Unique™ Test for Rapid Detection of Salmonella in Food: Collaborative Study

The TECRA® Unique™ Salmonella test uses the principle of immunoenrichment to allow rapid detection of Salmonellae in food. A collaborative study was conducted to compare the TECRA Salmonella Unique test with the reference culture method given in the U.S. Food and Drug Administration's Bacteriological Analytical Manual. Three food types (milk powder, pepper, and soy flour) were analyzed in Australia and 2 food types (milk chocolate and dried egg) were analyzed in the United States. Forty-one collaborators participated in the study. For each of the 5 foods at each of the 3 levels, a comparison showed no significant differences (p ≥ 0.05) in the proportion of positive test samples for Unique and that for the reference method using the Chi-square test for independence with continuity correction.

Predicting changes in the status of patient-reported outcome measures after Birmingham Hip Resurfacing: an observational cohort study with a median follow-up of ten years

AIMS

It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up.

PATIENTS AND METHODS

Patients undergoing Birmingham Hip Resurfacing completed the Veteran's Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups.

RESULTS

Overall, 18% of patients reported reductions in mHHS total score exceeding MCID, and 21% reported similar reductions for WOMAC function scores. Nonetheless, almost all patients remained above PASS thresholds for WOMAC function (98%) and mHHS (93%). Overall, 66% of patients with mHHS scores < PASS at two years reported scores > PASS at latest follow-up. Conversely, 6% of patients deteriorated from > PASS to < PASS between follow-ups. Multivariable modelling indicated body mass index (BMI) > 27 kg/m², VR-36 Physical Component Score (PCS) < 51, VR-36 Mental Component Score (MCS) > 55, mHHS < 84 at two years, female sex, and bone graft use predicted these deteriorating patients with 79% accuracy and an area under the curve (AUC) of 0.84.

CONCLUSION

Due to largely acceptable results at a later follow-up, extensive monitoring of multiple PROMs is not recommended for Birmingham Hip Resurfacing patients unless they report borderline or unacceptable hip function at two years, are female, are overweight, or received a bone graft during surgery. Cite this article: Bone Joint J 2019;101-B:1431-1437.

Effect of Intranasal vs Intramuscular Naloxone on Opioid Overdose: A Randomized Clinical Trial

IMPORTANCE

Previous unblinded clinical trials suggested that the intranasal route of naloxone hydrochloride was inferior to the widely used intramuscular route for the reversal of opioid overdose.

OBJECTIVE

To test whether a dose of naloxone administered intranasally is as effective as the same dose of intramuscularly administered naloxone in reversing opioid overdose.

DESIGN, SETTING, AND PARTICIPANTS

A double-blind, double-dummy randomized clinical trial was conducted at the Uniting Medically Supervised Injecting Centre in Sydney, Australia. Clients of the center were recruited to participate from February 1, 2012, to January 3, 2017. Eligible clients were aged 18 years or older with a history of injecting drug use (n = 197). Intention-to-treat analysis was performed for all participants who received both intranasal and intramuscular modes of treatment (active or placebo).

INTERVENTIONS

Clients were randomized to receive 1 of 2 treatments: (1) intranasal administration of naloxone hydrochloride 800 μg per 1 mL and intramuscular administration of placebo 1 mL or (2) intramuscular administration of naloxone hydrochloride 800 μg per 1 mL and intranasal administration of placebo 1 mL.

MAIN OUTCOMES AND MEASURES

The primary outcome measure was the need for a rescue dose of intramuscular naloxone hydrochloride (800 μg) 10 minutes after the initial treatment. Secondary outcome measures included time to adequate respiratory rate greater than or equal to 10 breaths per minute and time to Glasgow Coma Scale score greater than or equal to 13.

RESULTS

A total of 197 clients (173 [87.8%] male; mean [SD] age, 34.0 [7.82] years) completed the trial, of whom 93 (47.2%) were randomized to intramuscular naloxone dose and 104 (52.8%) to intranasal naloxone dose. Clients randomized to intramuscular naloxone administration were less likely to require a rescue dose of naloxone compared with clients randomized to intranasal naloxone administration (8 [8.6%] vs 24 [23.1%]; odds ratio, 0.35; 95% CI, 0.15-0.66; P = .002). A 65% increase in hazard (hazard ratio, 1.65; 95% CI, 1.21-2.25; P = .002) for time to respiratory rate of at least 10 and an 81% increase in hazard (hazard ratio, 1.81; 95% CI, 1.28-2.56; P = .001) for time to Glasgow Coma Scale score of at least 13 were observed for the group receiving intranasal naloxone compared with the group receiving intramuscular naloxone. No major adverse events were reported for either group.

CONCLUSIONS AND RELEVANCE

This trial showed that intranasally administered naloxone in a supervised injecting facility can reverse opioid overdose but not as efficiently as intramuscularly administered naloxone can, findings that largely replicate those of previous unblinded clinical trials. These results suggest that determining the optimal dose and concentration of intranasal naloxone to respond to opioid overdose in real-world conditions is an international priority.

TRIAL REGISTRATION

anzctr.org.au Identifier: ACTRN12611000852954.

The outcome and survival of metal-on-metal hip resurfacing in patients aged less than 50 years

Aims

The aim of this study was to report the implant survival and patient-reported outcome measures (PROMs) in a consecutive series of patients aged less than 50 years at the time of arthroplasty using the Birmingham Hip Resurfacing system (BHR), with a minimum follow-up of ten years.

Patients and Methods

A total of 226 patients with osteoarthritis of the hip, who underwent BHR and presented to a single surgeon, were included in the study. Survival of the implant was confirmed by cross-checking with the Australian Orthopaedic Association National Joint Replacement Registry. Kaplan–Meier survival curves with 95% confidence intervals (CIs) were constructed. Pre- and postoperative PROMs were compared with t-tests, and postoperative scores were compared using anchor analysis with age and gender matched normative data.

Results

At median follow-up of 12 years (interquartile range (IQR) 10 to 13), six BHRs were revised, with a cumulative rate of survival of 96.8% (95% confidence interval (CI) 94.2 to 99.4) at 15 years, and with a significantly lower (p = 0.019) cumulative rate of revision than the national average for the same device at ten years. Most revisions (n = 4) were undertaken early, less than three years postoperatively, and occurred in women. Patient-reported general health (Veteran’s Rand-36), disease state (Western Ontario and McMaster Universities Osteoarthritis Index), function (modified Harris Hip Score) and level of activity (Tegner activity score) maintained significant (p < 0.01 for each) improvements beyond ten years postoperatively and were equal to, or exceeded, age- and gender-matched normative data in more than 80% of the patients.

Conclusion

Longer term PROMs after BHR, from a single surgeon, for patients aged less than 50 years remain under-reported. We found that the outcome after a BHR, at a minimum of ten years postoperatively, remained satisfactory, particularly for self-reported hip function.

Evaluation of Clinical Efficacy of New Medical Treatments in Advanced Colorectal Cancer. Results of a Workshop Organized by the Eortc Gitccg

During the last few years several factors have contributed to an increasing change in the medical treatment of advanced colorectal cancer. Among them are the more general acceptance of the impact of chemotherapy on quality of life and survival in first as well as in second-line treatment, the introduction of new drugs and the definition of novel endpoints which can roughly be defined as “patient benefit”. For this reason the European Organization for Research and Treatment of Cancer (EORTC) Gastrointestinal Tract Cancer Cooperative Group (GITCCG) felt it was appropriate to organize a workshop with experts from different countries and national groups to discuss in depth several aspects concerning the treatment of patients with advanced colorectal cancer.

Diabetes and technology in 2030: a utopian or dystopian future?

The ability of an individual living with diabetes to have human-to-human contact with their healthcare provider is not keeping pace with the number of people developing diabetes. From a futurist perspective, however, this dichotomy of diabetes care represents an opportunity for digital healthcare. The focus of technological innovation is unlikely to be the replacement of the multidisciplinary diabetes team but rather the provision of meaningful individual and family support between clinic visits and, on a larger scale, the facilitation of population health management for diabetes. We can also expect to see new therapies, including implantable drug delivery systems, automated closed-loop systems and miniaturized non-invasive glucose monitoring systems. New digital health technologies will create a 'digital diabetes ecosystem' to enhance rather than devolve care from humans. Concerns related to data privacy and ownership will inevitably rise, thus a future for diabetes care relying heavily on technology is not inevitably utopian. Nevertheless, revolutions in the development of novel sensors, accumulation of 'big data', and use of artificial intelligence will provide exciting opportunities for preventing, monitoring and treating diabetes in the near future.

Effects of early motivational interviewing on post-stroke depressive symptoms: A pilot randomized study of the Good Mood Intervention program

AIMS

The aim of this pilot randomized study was to investigate the feasibility of early motivational interviewing, for reducing mood after acute stroke.

BACKGROUND

Depression is a frequent consequence of stroke that can adversely affect recovery.

METHODS

DESIGN: Pilot randomized study. Intervention group patients received 3, individual motivational interviewing sessions by nurses or social workers prior to hospital discharge.

PARTICIPANTS

Adult patients with acute stroke during 2013 to 2014.

BLINDING

Research assistant who collected data was blind to group assignment.

OUTCOMES

Data were collected at 3 time points: baseline, 1-month, and 3-month follow-up. Outcome measures (anxiety, depression, quality of life) were analysed by descriptive statistics.

RESULTS

Forty-eight patients were enrolled, and 79% retention was achieved at 3 months. Eight participants withdrew (16.7%), and 2 were unable to participate (death: 2.1% and new onset aphasia: 2.1%), leaving 38 participants in the final cohort (Intervention: N = 18, Control: N = 20). Anxiety, depression, and quality of life measures did not alter significantly in the study period.

CONCLUSIONS

Carefully designed studies are required to investigate the effectiveness of early motivational interviewing for improving mood after stroke. The therapy can be administered by nurses, but significant resources are required in terms of training and fidelity.

OECI TuBaFrost Tumor Biobanking

OECI TuBaFrost harbors a complete infrastructure for the exchange of frozen tumor samples between European countries. OECI TuBaFrost consists of: • A code of conduct on how to exchange human residual samples in Europe • A central database application accessible over the Internet ( www.tubafrost.org ) where data can be uploaded and searched from samples that can be selected and ordered • Access rules with incentives for collectors • Standardization needed to enable the analysis of high quality samples derived from different centers • Virtual Microscopy to support sample selection with difficult pathology

The entire infrastructure was, after completion, which was entirely financed by the European Commission, implemented in the OECI. But so far it has not been used to its capacity. A recent survey held amongst the OECI members shed light on the causes. The main conclusion is that all responders see OECI TuBaFrost as a good platform for exchange of samples, however, the biggest bottleneck found was that potential users are too unfamiliar with the communication between their own biobank tracking system and the TuBaFrost central database application. Therefore, new future plans are drawn. In addition, new infrastructure plans have been developed and the first preparatory steps have been set. For biobanks the BBMRI project has started aiming for Pan-European Biobanking and Biomolecular Resources Research Infrastructure.

A Snapshot of Chronic Obstructive Airways Disease in Australian Emergency Departments

Objectives

To characterise emergency department (ED) attendances for chronic obstructive airways disease (COAD) by patient demographics and severity, to determine treatment and disposition of patients and to determine use of diagnostic tests and treatment provided to different severity groups. A secondary aim was to compare treatment given to established treatment guidelines.

Methods

Prospective, observational cohort study of patients who presented to nine Australian ED with a primary diagnosis of acute exacerbation of COAD in October 2002. Information collected included demographics, duration of symptoms, co-morbidities, assessment findings, severity, treatment, disposition, tests, in-hospital mortality and length of stay.

Results

A total of 137 patients were studied. Two-thirds (65%) of the group were male, and most (90%) were aged greater than 60 years. COAD severity was mild in 11%, moderate in 30% and severe in 59%, and 23% were receiving home oxygen therapy. As anticipated, patients with severe COAD were more likely to be admitted to hospital (mild: moderate: severe = 13%: 68%: 99%; p<0.0001) and to require ventilatory support (0%: 0%: 23%; p<0.002). There was under-utilisation of corticosteroids and antibiotics in the moderate and severe groups, and only 35% of the group had received influenza vaccination within the past year.

Conclusion

This study showed that adherence to best practice guidelines with respect to the use of corticosteroids and antibiotics for patients who presented to the ED with COAD was sub-optimal, as was the prevalence of prior influenza vaccination. Other aspects of treatment and investigation were consistent with available evidence. Efforts to address these deficiencies should be developed.

Is Cardiac Monitoring Necessary for Intermediate Risk Acute Coronary Syndrome Patients who Have a Normal Electrocardiogram and Cardiac Markers in the Emergency Department?

This study aimed to investigate the safety of managing selected patients with suspected acute coronary syndrome without cardiac monitoring by determining the rate of complications occurring in chest pain patients classified as intermediate risk according to the National Heart Foundation of Australia guidelines and with normal cardiac marker levels and a normal/unchanged ECG in the emergency department. One patient suffered a critical adverse event within 24 hours (0.3%, 95% CI 0.1–1.7%) and 24 patients suffered other adverse events (6.3%, 95% CI 4.2–9.4%). This study provides further evidence that this group of patients are at low risk of experiencing a critical adverse event within 24 hours of hospital presentation and may be safely managed without continuous cardiac monitoring.