Effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections: a systematic review and meta-analysis

OBJECTIVE

The objective of this review was to synthesize the best available research evidence regarding the effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections.

INTRODUCTION

Pain associated with intramuscular injections continues to be a challenge for nurses. Various physical stimulation methods to alleviate pain and improve satisfaction for patients receiving intramuscular injections have been reported; however, the evidence surrounding the effectiveness of these methods remains inconclusive.

INCLUSION CRITERIA

This systematic review considered randomized and quasi-experimental studies that used any physical stimulation strategies (eg, skin tapping, manual pressure, massage, pinch, traction) for adults aged 18 years and over receiving intramuscular injections. Studies that evaluated pain using validated instruments were considered for inclusion.

METHODS

A three-step search strategy was conducted. MEDLINE, Embase, CINAHL, the Cochrane Library (Cochrane CENTRAL), Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar were searched from inception until 2020. We restricted the inclusion of studies to trials published in English. Two independent reviewers conducted the critical appraisal of eligible studies using the JBI checklists for randomized controlled and quasi-experimental trials. Data were extracted using the JBI data extraction tool, and meta-analysis and subgroup analysis were undertaken, where appropriate.

RESULTS

Twenty-five studies were included with a total sample size of 1956 patients. Pooled results demonstrated that pain was significantly less with the use of the Helfer skin tap technique compared to no intervention (two studies; RR 0.73; 95% CI 0.66, 0.81; P <0.00001) or standard intervention (three studies; SMD -2.25; 95% CI -3.65, -0.85; P =0.002). Intervention with acupressure using standard treatment as control showed significant reduction in pain intensity (MD -4.78; 95% CI -5.32, -4.24; P <0.00001). Similarly, pain was significantly lower with manual pressure (two studies; SMD -0.42; 95% CI -0.69, 0.15; P =0.002) when compared to standard treatment. Pain scores were significantly lower in patients who received pinch technique, ShotBlocker, massage, or combination intervention (skin traction, pressure, and rapid muscle release) compared with no intervention, standard treatment, or placebo control.

CONCLUSIONS

The evidence from this review demonstrates that physical stimulation - particularly the Helfer skin tap technique, acupressure, manual pressure, pinch technique, ShotBlocker, massage, and combination - can significantly lower intramuscular injection pain; however, this is based on low or very low certainty of evidence.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020168586.

Life during lockdown: coping strategies used by preregistration nursing students during COVID-19

Aim

To explore the coping strategies used by Australian preregistration nursing students during the COVID-19 pandemic ‘lockdown’ period.

Background

COVID-19 has had a significant impact on preregistration nursing students, both physically and psychologically. As campuses closed and online learning commenced, clinical placement access was reduced, with heightened concern about personal and family safety. As such, nursing students were forced to adopt coping strategies to manage their self and the environment.

Design

A descriptive qualitative study.

Methods

One hundred and fifty-five preregistration nursing students enrolled at a regional Australian university completed a self-administered online survey.

Results

Overwhelmingly, student responses revealed that staying connected was the key coping strategy to ensure emotional and mental health wellbeing. Heightened vigilance in infection control measures was also evident, personally and for others. Routines, including exercise, facilitated physical and mental wellbeing. Overall, coping strategies identified by nursing students demonstrated applied resilience during the isolation period.

Conclusions

Understanding the adaptive coping strategies used by nursing students can enable nurse academics to understand how to best provide support. This study emphasises the importance of recognising that not all students are able to adapt and ‘cope’ without supports in place. Future studies should investigate the longer-term impact of COVID-19 within the broader preregistration nursing experience and how this might impact nursing students’ future careers.

Medication Adherence Rate in Arab Patients With Cardiovascular Disease: A Systematic Review

BACKGROUND

Cardiovascular disease (CVD) is one of the most common chronic illnesses in the Eastern Mediterranean. There have been few studies on medication adherence in Arab patients with CVD.

AIM

To investigate the rates and the reasons for medication adherence in Arab patients with CVD.

METHODOLOGY

The Joanna Briggs Institute methodology for prevalence systematic reviews was used. MEDLINE, EMCARE, CINAHL, Scopus, Science Direct, PsychINFO, and the Cochrane Central Register of Controlled Trials were searched.

RESULTS

Thirteen quantitative studies on medication adherence in Arab adult CVD patients were included.Pooled data from nine studies demonstrated that 53.2% (95% confidence interval = [51.2%, 55.1%]) of patients were adherent to their medications. Reasons for nonadherence to medication include personal factors, understanding, and complexity of treatment regimes, medication knowledge and structural barriers.

CONCLUSION

Medication adherence appears to have a social gradient, and families should be actively involved in future strategies to increase medication adherence.

Biomarkers of systemic inflammation predict survival with first-line immune checkpoint inhibitors in non-small-cell lung cancer

INTRODUCTION

Pembrolizumab is an established first-line option for patients with advanced non-small-cell lung cancer (NSCLC) expressing programmed death-ligand 1 ≥50%. Durable responses are seen in a subset of patients; however, many derive little clinical benefit. Biomarkers of the systemic inflammatory response predict survival in NSCLC. We evaluated their prognostic significance in patients receiving first-line pembrolizumab for advanced NSCLC.

METHODS

Patients treated with first-line pembrolizumab for advanced NSCLC with programmed death-ligand 1 expression ≥50% at two regional Scottish cancer centres were identified. Pretreatment inflammatory biomarkers (white cell count, neutrophil count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, albumin, prognostic nutritional index) were recorded. The relationship between these and progression-free survival (PFS) and overall survival (OS) were examined.

RESULTS

Data were available for 219 patients. On multivariate analysis, albumin and neutrophil count were independently associated with PFS (P < 0.001, P = 0.002, respectively) and OS (both P < 0.001). A simple score combining these biomarkers was explored. The Scottish Inflammatory Prognostic Score (SIPS) assigned 1 point each for albumin <35 g/l and neutrophil count >7.5 × 10⁹/l to give a three-tier categorical score. SIPS predicted PFS [hazard ratio 2.06, 95% confidence interval (CI) 1.68-2.52 (P < 0.001)] and OS [hazard ratio 2.33, 95% CI 1.86-2.92 (P < 0.001)]. It stratified PFS from 2.5 (SIPS2), to 8.7 (SIPS1) to 17.9 months (SIPS0) (P < 0.001) and OS from 5.1 (SIPS2), to 12.4 (SIPS1) to 28.7 months (SIPS0) (P < 0.001). The relative risk of death before 6 months was 2.96 (95% CI 1.98-4.42) in patients with SIPS2 compared with those with SIPS0-1 (P < 0.001).

CONCLUSIONS

SIPS, a simple score combining albumin and neutrophil count, predicts survival in patients with NSCLC receiving first-line pembrolizumab. Unlike many proposed prognostic scores, SIPS uses only routinely collected pretreatment test results and provides a categorical score. It stratifies survival across clinically meaningful time periods that may assist clinicians and patients with treatment decisions. We advocate validation of the prognostic utility of SIPS in this and other immune checkpoint inhibitor treatment settings.

Understanding the support needs of Australian nursing students during COVID-19: a cross-sectional study

Background: COVID-19 has caused significant disruption. This has been particularly evident within the university student population where their traditional ways of learning were abruptly reorganised and support structures removed.Objective: This paper aims to explore undergraduate student nurses' perceptions of the support required from the university during COVID-19 using the Achievement Goal Theory framework.Design: Data were collected via an online survey of undergraduate student nurses from an Australian university. This paper is reporting the data from a single open-ended item asking participants about their support needs from the University. Data were analysed using thematic analysis.Results: Of the 178 students who responded 206 individual statements were provided about the support they would like from the university. Four primary themes emerged, Support beyond academia, Academic support, Online learning readiness and Clinical practice units and clinical placement. The students identified that their needs during this pandemic include financial needs, social isolation, needs for more communication and unpreparedness for online teaching.Conclusion: Several factors were identified by participants about the additional support required from the university during COVID-19. Understanding and addressing these factors have the potential to improve student support during COVID-19 and support students in future crises.Impact statement: Understanding what support students perceive they require from the university during significant disruption will assist in future crisis management planning.

Social determinants of health during the COVID-19 pandemic: a systematic review

Introduction

The emergence of COVID-19 has created global transmission. While effective at reducing the spread, public health measures implemented may impact individuals differently leaving them susceptible to the detrimental effects on their health and wellbeing. Therefore this review aims to synthesise the best available evidence on the relationship between the social determinants of health and health outcomes among adults during the COVID-19 pandemic.

Methods

A three-step search strategy was used to find both published and unpublished papers. The databases searched included: MEDLINE, CINAHL, EMBASE, and Google Scholar. Following the search, all identified citations were uploaded into Endnote X9, with duplicates removed. Methodological quality of eligible papers was assessed independently by two reviewers, with meta-synthesis conducted in accordance with JBI methodology.

Results

Fifteen papers were included. Three synthesized conclusions were established a) Vulnerable populations groups, particularly those from a racial minority and those with low incomes, are more susceptible and have been disproportionately affected by COVID-19 including mortality; b) Gender inequalities and family violence have been exacerbated by COVID-19, leading to diminished wellbeing among women; and c) COVID-19 is exacerbating existing social determinants of health through loss of employment/income, disparities in social class leading to lack of access to healthcare, housing instability, homelessness and difficulties in social distancing.

Conclusions

Vulnerable population groups have been disproportionately impacted by COVID-19, including health outcomes such as hospitalisations and mortality. The COVID-19 pandemic has highlighted the need for action on health inequalities and the social determinants of health. Reflection on social and health policies implemented are necessary to ensure that the COVID-19 pandemic does not exacerbate health inequalities into the future.

Key messages

Vulnerable populations including racial minority groups and low income earners have been disproportionately impacted by COVID-19.

Action on social determinants of health is required to ensure COVID-19 does not exacerbate health inequalities into the future.

Life during a pandemic in Australia: wellbeing and social determinants of health

Background

The COVID-19 pandemic has had effects on populations worldwide. The social determinants of health affect an individual's capacity to cope during a crisis which could potentially impact on their wellbeing. The aim of this study was to examine the relationship between wellbeing and the social determinants of health among Australian adults during the COVID-19 pandemic.

Methods

A cross-sectional study of adults residing in Australia was conducted using SurveyMonkey (an online survey) between August - October 2020. Participants were recruited via social media. Wellbeing was measured using the 10-item Multicultural Quality of Life Index and social determinants of health were measured using validated tools and investigator developed questions. Data were analysed using SPSS version 25. Inferential statistics, including independent t-test and one-way ANOVA were undertaken. Multiple regression analysis was used to investigate the predictors of wellbeing.

Results

In total, 1211 responses were received. Females accounted for 80.7% of the responses, men 16.7% and transgender/non-binary 2.6%. The mean age of the respondents was 43 years (SD 14.5). The mean score for total wellbeing was 62.58 (SD 21.22). Housing insecurity (p = 0.000), food insecurity (p = 0.000, social support (p = 0.000) and access to health care (p = 0.000) were all predictors of poor total wellbeing. Being a male (p = .0380) was the only predictor of higher wellbeing.

Conclusions

This study demonstrates that adults in Australia who had poor social support, had difficultly accessing health care, had insecure housing and food insecurity had significantly poorer wellbeing during the COVID-19 pandemic. This study exposes the social determinants of health that are responsible for health and social inequalities. It shows that the COVID-19 pandemic has exacerbated the social vulnerabilities and highlights the need take action on the social determinants of health and inequalities.

Key messages

The COVID-19 pandemic has further exposed the longstanding health and social inequalities that exist in Australia.

Action on social determinants of health is required in a post COVID-19 world to rebuild social protection and safeguard populations from any future public health emergencies.

Generational differences in psychological wellbeing and preventative behaviours among nursing students during COVID-19: a cross-sectional study

BACKGROUND

Many nursing programmes have had to swiftly move online in response to COVID-19. Nursing students are often a heterogenous group that traverses generational boundaries. Exploring generational differences may assist in developing support systems for specific groups. This study sought to examine psychological wellbeing and preventative behaviours among nursing students from the iGeneration in comparison to older generations.

METHOD

A prospective cross-sectional study was undertaken using a convenience sample of pre-registration nursing students studying at two Australian Universities, one regional and one metropolitan. About 631 pre-registration nursing students completed an online survey.

RESULTS

An independent samples t-test revealed that students from the iGeneration possess higher anxiety compared to nursing students from older generations (p = .000). Compared to iGeneration participants, older generation participants had significantly higher scores for knowledge of COVID-19 (p = .015). iGeneration participants utilised social media to source information about COVID-19 far more than older generations (p = .008). iGeneration participants were significantly more concerned than older generations about the impact of COVID-19 on completing their clinical placement (p = .014). Older generations tended to have higher academic preventative behaviours, with significant mean scores for not attending university if they or others they knew had symptoms of COVID-19.

CONCLUSION

Given the differences between generation groups with regard to psychological wellbeing, knowledge about COVID-19, and concerns about studying in an altered study environment, strategies should be targeted to generational groups. Anxiety negatively impacts the quality of life, educational performance and clinical practice and is experienced more frequently in the iGeneration. Therefore it is crucial for nursing educators to reflect on how they engage this generation in the online space to provide support, stability and a sense of connection. This will contribute towards ensuring a well-prepared future nursing workforce who may encounter other pandemics and isolating events.

IMPACT STATEMENT

Compared with other generations, iGeneration students have a greater likelihood to experience mental health issues, isolation and insecurity. Nursing leaders and educators must be sensitive to such intergenerational differences, to ensure they are developing a skilled and productive workforce.

Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care

Influenza outbreaks in Aged Care Facilities (ACFs) can lead to hospitalizations and deaths. Influenza can spread rapidly through ACFs if precautionary measures are not taken. Along with influenza vaccination and precautionary hygiene measures, Oseltamivir Prophylaxis (OP) may be effective in reducing the attack rate of influenza by preventing new cases. A cohort study was carried out to investigate the effectiveness of OP use during influenza outbreaks in ACFs located within South Western Sydney Local Health District from 1 January 2015 to 31 December 2018. The main outcome assessed was the rate of OP failure (new cases of influenza in patients treated with OP) among ACF residents. Subgroups and various predictors of OP failure were investigated including presence of a dementia ward, high care ward, and days to Public Health Unit (PHU) notification. The cohort consisted of 86 ACF outbreaks involving 10,064 residents. OP prevented 90% of influenza cases during influenza outbreaks [0.1 RR (95% confidence interval (CI): 0.08–0.12); P < 0.0001]. ACFs with dementia wards had a 44% (0.56 relative risk (RR) (95% CI: 0.34–0.93); P < 0.05) lower OP failure rate. ACFs with high level care had an 87% (0.13 RR (95% CI: 0.05–0.38); P < 0.05) lower OP failure rate. OP is highly effective in preventing new cases of influenza during outbreaks in ACFs, especially in ACFs with dementia or high care wards. Mandatory reporting of influenza outbreaks to PHUs would ensure that ACFs are supported throughout the outbreak, which will facilitate reductions in hospitalizations and mortality.

The Adherence to Healthy Lifestyle Among Arab Patients With Cardiovascular Disease: Mixed-Method Review

INTRODUCTION

Cardiovascular disease (CVD) accounts for 25% to 45% of deaths among Arab people. The purpose of this review was to investigate the level, predictors, motivators, and barriers to adherence to lifestyle recommendations among Arab patients with CVD.

METHOD

A systematic search of the literature was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMCARE, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched. Studies that explored adherence to a healthy lifestyle among Arab adult patients with CVD were included.

RESULTS

Twelve studies were included. Quantitative results showed low adherence among Arab people with CVD. Qualitative synthesized results revealed that internal motivators, personal desire as well as structural drivers impact the patient's ability to adhere to a healthy lifestyle.

DISCUSSION

Multidimensional solutions that consider religion and culture and include active involvement of families are required to improve adherence.

Adaptation of the MAUQ and usability evaluation of a mobile phone-based system to promote eye donation

INTRODUCTION

Mobile Applications (apps) are commonly used in the health care settings to improve the quality of care, however prior to the release of the app it is vital to evaluate its usability. Therefore, the aim of this study is to adapt the mobile Health App Usability Questionnaire (MAUQ) and measure the usability of the Eye donor Aust App using the modified instrument (m-MAUQ).

METHODS

The study was undertaken using a convenience sample of 94 patients and their carers attending three eye clinics and one outpatient department in a large hospital in Sydney Australia. The study was conducted in two phases. Phase 1 involved the adaptation of the MAUQ, and validity testing of the modified version. Phase 2 included the usability evaluation of the Eye donor Aust App using the modified MAUQ (m-MAUQ).

RESULTS

The m-MAUQ comprised of 15 items and the content validity of the instrument was considered satisfactory. Exploratory factor analysis supported a three-factor structure namely: ease of use and satisfaction (nine items), usefulness in obtaining information (three items), and system information arrangement (three items). The internal consistency for the subscales and the total scale was high with Cronbach's alpha values greater than 0.90. The usability score for the Eye donor Aust App was high (mean 5.99; SD 0.74). The construct validity was supported as there were no differences in usability scores among males and females. Older people found the app less useful for obtaining information about eye donation.

CONCLUSIONS

The results support the use of the m-MAUQ as a valid instrument to measure the usability of the Eye Donor Aust App. This instrument requires further testing in other groups of people. Usability testing of the Eye Donor Aust app demonstrated that the participants were satisfied with the content and functionality of the app stating that it was well organised, visually appealing and user friendly. This result could translate into more people using the app and thereby increasing their knowledge and attitude towards eye donation as well as registering to become a donor.

Effectiveness of physical stimulation on injection pain in adults receiving intramuscular injections: a systematic review protocol

OBJECTIVE

The objective of this review is to evaluate the effectiveness of physical stimulation on injection pain in adults receiving intramuscular injections.

INTRODUCTION

Intramuscular injections are the most commonly used modality for administration of pharmacological treatments. Despite this, pain from intramuscular injections is the most commonly reported side effect. Reducing patients' pain from intramuscular injections is important; however, the challenge is in selecting from the current methods available to alleviate pain, which are varied. The findings of this review may identify the most effective physical stimulation method to reduce the side effect of pain from an intramuscular injection.

INCLUSION CRITERIA

This review will consider studies that include adults aged 18 years and over that use physical stimulation interventions during intramuscular injections. Any physical stimulation strategies used during intramuscular injections including devices, skin tapping, manual pressure, massage, pinch, and traction will be considered. Studies that evaluate pain using validated tools such as pain scales will be included.

METHODS

The review will undertake to find both published and unpublished studies. The key information sources to be searched are MEDLINE, Embase, CINAHL, the Cochrane Library, Cochrane Central Register of Controlled Trials, Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar. Two independent reviewers will conduct a critical appraisal of eligible studies, assess the methodological quality, and extract the data. Studies will, where possible, be pooled in a statistical meta-analysis.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020168586.

Reliability of the BCCT.core software in evaluation of breast cosmesis - A systematic review

Breast cancer conservative treatment software (BCCT.core) has the potential to provide objective results using digital photographs, thus increasing the reliability, limiting the subjective interpretation and standardising the evaluation of breast cosmesis in patients. The aim of this systematic review was to summarise the empirical evidence regarding the agreement between the BCCT.core and other methods used by health professionals and patients to assess breast cosmesis. The Ovid MEDLINE, Embase, CINAHL, PsycINFO and Scopus databases were systematically searched for studies comparing the agreement between BCCT.core and other methods used to assess breast cosmesis. A total of 14 studies involving 2703 patients were included in the review. In studies where patients undertook self-assessment, the percentage agreement ranged from 69.2% to 74.8% and the kappa values ranged from slight (k = 0.12) to fair agreement. There was a low correlation between the BCCT.core and the Harvard scale when patients assessed cosmetic outcomes using photographs of their breasts (r = 0.165). A 75% and 42.8% agreement was reported in studies where clinicians assessed breast cosmesis by directly visualising the patients' breasts and photographs, respectively. Assessment of breast cosmesis by the expert panel using patient photographs reported a percentage agreement ranging from 25% to 83%. The results of this systematic review demonstrated an overall agreement of fair to moderate between the BCCT.core and the subjective scales used to assess breast cosmesis. However, clinician experience and patient values should be considered in clinical decision-making.

COVID-19: Knowledge, anxiety, academic concerns and preventative behaviours among Australian and Indian undergraduate nursing students: A cross-sectional study

AIMS AND OBJECTIVES

To compare knowledge, anxiety, academic concerns and preventative behaviours between undergraduate nursing students in Australia and India during the COVID-19 pandemic.

BACKGROUND

Based on the World Health Organization's direction for containment of the novel coronavirus (COVID-19), countries implemented varying levels of restrictions including closure of university campuses and providing on line undergraduate education.

METHODS

Students in NSW, Australia and Kerala, India completed an online survey assessing their (a) knowledge and source of information about COVID-19; (b) anxiety; and coping strategies; (c) academic concerns; and (d) preventative behaviours. Descriptive and inferential statistics were used to summarise the data.

RESULTS

Data from 99 Australian and 113 Indian undergraduate nurses were analysed. Greater number of Indian students indicated having sufficient knowledge of COVID-19 (OR 0.22; 95% CI 0.08, 0.63), getting information about COVID-19 from social media (OR 0.03; 95% CI 0.01, 0.07) and being concerned about 'attending clinical placement' (MD-1.08; 95% CI -1.94, -0.23). Australian students reported significantly higher levels of anxiety (MD 1.99 95% CI 1.21, 2.78), difficulty sleeping (OR 18.00; 95% CI 6.76, 47.96), concentrating (OR 33.22; 95% CI 13.85, 79.67) and eating (OR 14.05; 95% CI 3.19, 61.84). Greater number of Australian students indicated that they would go to the University if they needed to meet with other students (OR 9.21; 95% CI 3.08, 27.55), had to access the library (OR 7.20; 95% CI 3.26, 15.90) or had a group assignment (OR 2.93; 95% CI 1.26, 6.77).

CONCLUSIONS

Wide variations were present in knowledge, anxiety, academic concerns and preventative behaviours among undergraduate nursing students in two countries.

RELEVANCE TO CLINICAL PRACTICE

Undergraduate students may benefit from additional support from the University and staff in the clinical setting with online learning and resources in order to adjust to the 'new normal' and enable them to achieve academic success.

Perceptions of Aboriginal and Torres Strait Islander Australians toward cardiovascular primary prevention programs: A qualitative systematic review

OBJECTIVE

To synthesize the best available qualitative evidence on the perceptions of Aboriginal and Torres Strait Islander Australians (hereafter, respectfully referred to as Indigenous Australians) toward participation in cardiovascular primary prevention programs.

BACKGROUND

In 2017, cardiovascular disease was the leading cause of premature mortality in Indigenous Australians, accounting for 11.5% of all deaths. Health risk behaviors such as smoking, physical inactivity, poor nutrition, and obesity largely contribute to this burden of disease.

METHODS

A search using MEDLINE, CINAHL, EMBASE, PubMed, Google Scholar, MedNar, ProQuest and Index to Theses for published and unpublished studies was conducted in January 2020. The methodological quality of the included studies was independently assessed by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tool. Data extraction and meta-aggregation were conducted in accordance with JBI methodology.

RESULTS

Eleven studies were included. Three synthesized findings were developed (a) social and community support affect participants' experiences of prevention programs; (b) structural drivers and social determinants influence Indigenous Australians experiences and participation in prevention programs and health risk behavioral change; and (c) a personal desire to change behaviors and participate in prevention programs requires development of knowledge regarding healthy lifestyles and creation of new social norms.

CONCLUSIONS

Indigenous Australians participation in primary prevention for cardiovascular risk factors and adoption of a healthy lifestyle are influenced by social support, social determinants, and personal desire. Future programs need to tackle the structural drivers and facilitate a supportive environment to assist in health risk behavior change.

Implications for COVID-19: A systematic review of nurses' experiences of working in acute care hospital settings during a respiratory pandemic

BACKGROUND

Pandemics and epidemics are public health emergencies that can result in substantial deaths and socio-economic disruption. Nurses play a key role in the public health response to such crises, delivering direct patient care and reducing the risk of exposure to the infectious disease. The experience of providing nursing care in this context has the potential to have significant short and long term consequences for individual nurses, society and the nursing profession.

OBJECTIVES

To synthesize and present the best available evidence on the experiences of nurses working in acute hospital settings during a pandemic.

DESIGN

This review was conducted using the Joanna Briggs Institute methodology for systematic reviews.

DATA SOURCES

A structured search using CINAHL, MEDLINE, EMBASE, PubMed, Google Scholar, Cochrane Library, MedNar, ProQuest and Index to Theses was conducted.

REVIEW METHODS

All studies describing nurses' experiences were included regardless of methodology. Themes and narrative statements were extracted from included papers using the SUMARI data extraction tool from Joanna Briggs Institute.

RESULTS

Thirteen qualitative studies were included in the review. The experiences of 348 nurses generated a total of 116 findings, which formed seven categories based on similarity of meaning. Three synthesized findings were generated from the categories: (i) Supportive nursing teams providing quality care; (ii) Acknowledging the physical and emotional impact; and (iii) Responsiveness of systematised organizational reaction.

CONCLUSIONS

Nurses are pivotal to the health care response to infectious disease pandemics and epidemics. This systematic review emphasises that nurses' require Governments, policy makers and nursing groups to actively engage in supporting nurses, both during and following a pandemic or epidemic. Without this, nurses are likely to experience substantial psychological issues that can lead to burnout and loss from the nursing workforce.

Effective communication is key to intensive care nurses' willingness to provide nursing care amidst the COVID-19 pandemic

Background

The COVID-19 pandemic posed and continues to pose challenges for health care systems globally, particularly to Intensive Care Units (ICU). At the forefront of the ICU are highly trained nurses with a professional obligation to care for patients with COVID-19 despite the potential to become infected. The aim of this study was to explore ICU nurses’ willingness to care during the COVID-19 pandemic.

Methods

A prospective cross-sectional study to explore ICU nurses’ willingness to provide care during the COVID-19 pandemic was undertaken between 25 March and 3 April 2020 at a large principal and referral teaching hospital in Sydney, NSW Australia.

Results

A total of 83 ICU nurses completed the survey. Approximately 60% reported receiving sufficient information from managers regarding COVID-19 and about caring for a patient with COVID-19. Ninety percent of nurses were concerned about spreading COVID-19 to their family. Sixty one percent of the nurses indicated that they were willing to care for patients with COVID-19. Receiving timely communication from managers was the only predictor of willingness to care among ICU nurses.

Conclusions

Effective communication is a vital component during a public health emergency in order to promote nurses’ willingness to care for patients in the ICU.

Teamwork and social cohesion are key: Nurses' perceptions and experiences of working in a new decentralised intensive care unit

BACKGROUND

Decentralised nursing stations (DCNs) have gained popularity in new hospital designs owing to their positive impact on patient safety. However, the impact on the nurses' working environment and on continuity and quality of patient care is limited.

OBJECTIVES

The objective of this study was to describe nurses' perceptions and experiences of the working environment and of patient care in a decentralised intensive care unit (ICU).

METHODS

Twelve months after the establishment of the new decentralised ICU in a tertiary teaching hospital in Sydney, Australia, a prospective cross-sectional survey of registered nurses working in the unit was undertaken. Nurses' perceptions and experiences of the working environment and patient care were evaluated using a 56-item questionnaire comprising nine domains and optional open-ended comments. Quantitative data were analysed using SPSS, version 25. Qualitative data were used to enhance the quantitative data.

RESULTS

A total of 128 nurses responded to the questionnaire. The mean scores for overall job satisfaction, nursing teamwork, social cohesion, continuity of patient care, and quality of patient care were 3.02 (±0.91), 2.78 (±1.05), 2.68 (1.02), 2.60 (±1.01), and 3.48 (±0.88), respectively, for a maximum obtainable score of 5. Overall mean scores for teamwork, social cohesion, and continuity of patient care were explained by nurses to be a direct result of the physical layout of the new DCN ICU. Nurses believed this influenced their ability to interact with other staff and impacted teamwork and social cohesion and in turn reflected in their current job satisfaction.

CONCLUSIONS

Implementation of a new model of nursing care, whereby staff members are rostered together in a pod for a period of time, along with team-building exercises, is recommended to improve the social cohesion and teamwork within the DCN ICU. Further research on nurses' experiences within a DCN ICU is required to produce robust evidence and generalisability.

Is it or is it not? Lessons learned from a case of suspected vaccine strain measles

Background

Measles continues to be a threat to Australia. While post eradication risks are low, imported measles cases from overseas travellers who are non-immune can cause small outbreaks. This case report discusses the challenge of identifying wild-type measles in an individual who was recently vaccinated with measles - containing vaccine (MCV).

Methods

A positive polymerase chain reaction (PCR) result for measles for an adult who had recently received a measles -containing vaccine was notified. Investigation revealed no known epidemiological link, recent overseas travel or contact with recent measles cases during the incubation period.

Results

The results of the initial sequencing to distinguish between wild-type and vaccine-strain measles were inconclusive. A decision was made to re-run the genotyping, collect additional specimens, and quarantine the case until a definitive result was obtained. Sequencing and genotyping revealed that this indeed was a wild-type measles strain.

Conclusions

Changing epidemiology of measles means distinguishing between wild-type and vaccine-strain measles has become a new challenge. The reflection of the public health management of this case has provided is a valuable teaching tool for public health professionals globally, particularly in low incidence measles countries.

Key messages

The lack of an epidemiological link can create confusion for public health staff when investigating possible measles cases. Changes in the epidemiology of measles means distinguishing between wild type and vaccine strain measles is a challenge.

Perceptions of Indigenous Australians towards cardiovascular primary prevention programs

Background

Indigenous Australians have disproportionately poorer health outcomes than their non-Indigenous counterparts. Preventable chronic diseases, such as cardiovascular disease, are primary factors that contribute to their lower life expectancy. Health risk behaviors such as smoking, physical inactivity, poor nutrition and obesity largely contribute to the enduring health divide. Therefore, the aim of this qualitative review was to synthesize the best available evidence on the perceptions of Indigenous Australians towards cardiovascular primary prevention programs.

Methods

A search using MEDLINE, CINAHL, EMBASE, Google Scholar, MedNar, ProQuest and Index to Theses for published and unpublished studies was conducted in January 2020. The methodological quality of the included studies was assessed by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tool. Meta-aggregation was conducted in accordance with JBI methodology.

Results

Eleven studies involving 249 participants were included. Three synthesized findings were developed 1) External factors can affect participants' experiences of prevention programs. Support from family motivates participation and behavioral change. Support from health professionals that is free from judgment facilitates participation; 2) The complexities of an individual's life influence Indigenous Australian's experiences and participation in prevention programs and health risk behavioral change; 3) A personal desire to change behaviors and participate in prevention programs requires development of knowledge on healthy lifestyles, creation of new social norms and overcoming internal struggles.

Conclusions

Indigenous Australians participation in primary prevention for cardiovascular risk factors and adoption of a healthy lifestyle are influenced by social support, social determinants and personal desire. Future programs need to tackle structural drivers and create a supportive environment to assist in behavior change.

Key messages

Social determinants affect Indigenous Australians experiences and participation in prevention programs for behaviour change. Prevention programs must create a supportive environment with the inclusion of family.

Social Support for Arab People with Chronic Conditions: A Scoping Review

Social support can play a crucial role in psycho-social well-being of people with chronic conditions. There is limited information about the experiences, barriers and sources of social support of Arab people affected by chronic conditions. The purpose of this review is to explore the experiences, barriers and sources of social support of Arab people affected by chronic conditions. A scoping review of the literature, based on Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines. Articles (n = 13) were identified for appraisal based on a group of inclusion and exclusion criteria. Eight articles were included in the final analysis. Three broad themes were identified: (a) Social support benefits-physical, emotional and financial benefits; (b) Source of social support-family and friends support, and (c) Support services utilization-cultural barrier, Arab migrants language and unfamiliarity with the health system barriers. Appropriate future support programs should be tailored based on Arab cultural beliefs and the inherent responsibility of the family together inside the Arab community.

Is it or is it not? Lessons learned from a case of suspected vaccine strain measles

OBJECTIVE

Measles continues to be a threat to Australia. While post-eradication risks are low, imported measles cases from overseas travellers who are non-immune can cause small outbreaks. This case report discusses the challenge of identifying wild-type measles in an individual who was recently vaccinated with measles-containing vaccine (MCV).

METHODS

A positive polymerase chain reaction (PCR) result for measles for an adult who had recently received a measles-containing vaccine was notified. Investigation revealed no known epidemiological link, recent overseas travel or contact with recent measles cases during the incubation period.

RESULTS

The results of the initial sequencing to distinguish between wild-type and vaccine-strain measles were inconclusive. A decision was made to re-run the genotyping, collect additional specimens and quarantine the case until a definitive result was obtained. Sequencing and genotyping revealed that this indeed was a wild-type measles strain.

CONCLUSIONS

Changing epidemiology of measles means distinguishing between wild-type and vaccine-strain measles has become a new challenge. Implications for public health: The reflection of the public health management of this case has provided a valuable teaching tool for public health professionals globally, particularly in low incidence measles countries.

Pharmacological Treatment for Obesity in Adults: An Umbrella Review

Objective: To synthesize the evidence from systematic reviews of clinical trials investigating the effectiveness of pharmacological therapies approved by the Australian Therapeutic Goods Administration and the US Food and Drug Administration for the management of obesity in adults. Data Sources: A 3-step literature search of the MEDLINE, EMBASE, CINAHL, and PubMed databases was conducted between March and May 2019. The key terms used were obesity, pharmacological therapy, antiobesity agent, antiobesity medication, weight loss, and systematic review. Study Selection and Data Extraction: Systematic reviews that evaluated the effectiveness of pharmacological therapies for the management of obesity in patients with a body mass index of or greater than 25 kg/m². Data Synthesis: Nine systematic reviews involving three pharmacotherapies, liraglutide, orlistat, and naltrexone-bupropion were identified. The results indicate that the pharmacotherapies reduced weight when compared with placebo. Orlistat was effective in significantly reducing fasting blood glucose, HbA1c, total cholesterol, triglycerides, and systolic and diastolic blood pressure. All reviews discussed the presence or risk of gastrointestinal adverse effects including diarrhea, vomiting, and nausea related to orlistat and liraglutide. Relevance to Patient Care and Clinical Practice: This umbrella review compares the efficacy and safety of antiobesity medications for reducing weight and a discussion on their weight loss and metabolic control to guide clinicians when prescribing medications for obesity. Conclusions: All pharmacological therapies included in this review are superior to placebo in reducing weight. Clinicians should consider patient comorbidities and risk of adverse events when recommending medications for weight loss.

Central Venous Access Device Complications in Patients Receiving Parenteral Nutrition in General Ward Settings: A Retrospective Analysis

BACKGROUND

Central venous access devices (CVADs) are used widely in acute clinical settings for the infusion of parenteral nutrition (PN) in patients who are unable to meet their nutrition requirements via the oral or enteral routes. The aim of this study was to characterize the frequency and nature of CVAD complications in patients receiving PN in general ward settings.

METHODS

A retrospective analysis of CVAD-related outcomes for adult patients who received PN from January 2014 to December 2016 was conducted.

RESULTS

A total of 629 CVADs were placed in 475 patients for parenteral administration in general ward settings during the 3-year study period. A total 104 (16.53%) episodes of CVAD-associated complications were reported during this period, including suspected line infection, leak at site, catheter blockage, and generalized patient sepsis. Overall, 13 CVAD catheter-related bloodstream infections (CRBSIs) were diagnosed in the patient cohort over 8695 PN feeding days, giving an incidence of 1.49 CVAD infections per 1000 PN feeding days.

CONCLUSION

The results showed that patients receiving PN through CVADs within general ward settings experience CRBSI at rates no different from those reported within critical care settings. These findings demonstrate that with appropriate nursing care, CVADs appear safe when used for the administration of PN in general ward settings.

Factors associated with adverse outcomes during influenza outbreaks in aged care facilities

OBJECTIVE

To explore factors associated with adverse outcomes during influenza outbreaks in residential aged care facilities.

METHODS

A retrospective cohort study of all outbreaks reported to three Sydney metropolitan Public Health Units during 2017.

RESULTS

A total of 123 outbreaks affected 1,787 residents and 543 staff. Early notification to a Public Health Unit was associated with shorter outbreak duration (p<0.001; B=0.674). Resident attack rates and resident mortality rates were lower in outbreaks notified early, on univariate analysis (p=0.034 and p=0.048 respectively) but not on an adjusted model. Staff attack rates were significantly associated with resident attack rates (p=0.001; B=0.736). Data on staff vaccination rates was incomplete and reported coverage rates were low (median 39%). Resident vaccination coverage ≥95% was associated with shorter outbreak duration in univariate testing but not on an adjusted model.

CONCLUSIONS

Early public health notification is associated with improved outbreak parameters; sick staff may pose a risk to residents, yet vaccination rates are low. Resident vaccination may also be valuable. Implications for public health: Measures that facilitate early PHU involvement in influenza outbreaks should be implemented, such as compulsory reporting requirements and processes that permit easier notification through technology. Actions that enhance staff and resident vaccination coverage should also be undertaken.

Chitayat syndrome: hyperphalangism, characteristic facies, hallux valgus and bronchomalacia results from a recurrent c.266A>G p.(Tyr89Cys) variant in the ERF gene

BACKGROUND

In 1993, Chitayat et al., reported a newborn with hyperphalangism, facial anomalies, and bronchomalacia. We identified three additional families with similar findings. Features include bilateral accessory phalanx resulting in shortened index fingers; hallux valgus; distinctive face; respiratory compromise.

OBJECTIVES

To identify the genetic aetiology of Chitayat syndrome and identify a unifying cause for this specific form of hyperphalangism.

METHODS

Through ongoing collaboration, we had collected patients with strikingly-similar phenotype. Trio-based exome sequencing was first performed in Patient 2 through Deciphering Developmental Disorders study. Proband-only exome sequencing had previously been independently performed in Patient 4. Following identification of a candidate gene variant in Patient 2, the same variant was subsequently confirmed from exome data in Patient 4. Sanger sequencing was used to validate this variant in Patients 1, 3; confirm paternal inheritance in Patient 5.

RESULTS

A recurrent, novel variant NM_006494.2:c.266A>G p.(Tyr89Cys) in ERF was identified in five affected individuals: de novo (patient 1, 2 and 3) and inherited from an affected father (patient 4 and 5). p.Tyr89Cys is an aromatic polar neutral to polar neutral amino acid substitution, at a highly conserved position and lies within the functionally important ETS-domain of the protein. The recurrent ERF c.266A>C p.(Tyr89Cys) variant causes Chitayat syndrome.

DISCUSSION

ERF variants have previously been associated with complex craniosynostosis. In contrast, none of the patients with the c.266A>G p.(Tyr89Cys) variant have craniosynostosis.

CONCLUSIONS

We report the molecular aetiology of Chitayat syndrome and discuss potential mechanisms for this distinctive phenotype associated with the p.Tyr89Cys substitution in ERF.

Cytomegalovirus Infection in Kidney Transplant Recipients: Evolution of Approach Through Three Eras

Cytomegalovirus (CMV) prophylaxis is recommended for high-risk patients, while preemptive therapy is considered acceptable for patients at moderate/low risk. After reviewing kidney transplant patients from 1992-1995 and 1996-1999, we decided to replace prophylaxis by preemptive therapy. Herein we have presented our data. From 1996-1999 we treated 129 patients with ganciclovir prophylaxis for 3 months if D+/R- or if they received depleting antibodies. The incidence of CMV was 13.2% versus 3.7% in the 1992-1995 cohort. The increase was associated with mycophenolate mofetil (MMF) use (P = .002). Forty-two percent of the D+/R- developed an infection with 89% of bouts occurring in the first month after cessation of prophylaxis. From 2002-2004, we never gave prophylaxis to 129 patients except when they received thymoglobulin. High-risk D+/R- patients were monitored by polymerase chain reaction (PCR) CMV for 3 months. The incidence of CMV was 17.1% with 54% of the D+/R- developing CMV. CMV infection occurred mostly during the first trimester posttransplantation. Creatinine at 1 year posttransplantation was worse in the presence of CMV infection (154.3 mumol/L-1.75 mg % versus 130.2 mumol/L-1.47 mg %, P = .03). Time to cure CMV infection was longer when MMF was discontinued: 36.7 days versus 69.9 days (P = .026). Our results indicated that CMV incidence is increasing: 3.7% (1992-1995) --> 13.2% (1996-1999) -->17.1% (2002-2004) and that it impairs 1 year graft function. Recovery was faster among patients still receiving MMF compared with those discontinuing MMF. Although MMF inhibits synthesis of anti-CMV IgM, it increases the anti-herpes virus effect of ganciclovir and may protect against chronic allograft nephropathy. Based on our experience, we plan to reintroduce prophylaxis in high-risk patients and to continue MMF when treating CMV infection.

Microextraction of drugs

This review will attempt to provide an overview as well as a theoretical and practical understanding of the use of microextraction technologies for drug analysis. The majority of the published reports to date focus on the use of fibre solid-phase microextraction and so the review is significantly focused on this technology. Other areas of microextraction such as single drop and solvent film microextraction are also described. Where there are insufficient examples in the literature to illustrate important concepts, examples of non-drug analyses are presented. The review is intended for readers new to the field of microextraction or its use in drug extraction, but also provides an overview of the most recent advances in the field which may be of interest to more experienced users. Particular emphasis is placed on the effect various sample matrices have on extraction characteristics.

Automated in-tube solid-phase microextraction coupled with liquid chromatography-electrospray ionization mass spectrometry for the determination of selected benzodiazepines

A simple, rapid, and sensitive method, which allowed us to simultaneously determine seven benzodiazepines (diazepam, nordiazepam, temazepam, oxazepam, 7-aminoflunitrazepam, N-desmethylflunitrazepam, and clonazepam) in buffer solution and in urine and serum samples, was investigated by automated in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-electrospray ionization mass spectrometry (LC-ESI-MS). In-tube SPME, in which the analytes were extracted from the sample directly into an open tubular capillary column by repeated draw/eject cycles of sample solution, is an extraction technique for organic compounds in aqueous samples. The separation of benzodiazepines was carried out under ion-suppressed reversed-phase conditions by using methanol/50mM ammonium acetate in water (60:40) as a mobile phase with a Supelco LC-18 column. The optimal extraction condition was 10 draw/eject cycles of 30 mL of sample in 100mM Tris-HCl (pH 8.5) at a flow rate of 0.3 mL/min using a piece of 60-cm length Supelco-Q plot capillary column as the extraction capillary. The quantitative study was explored by operating in selected-ion monitoring (SIM) mode. The calibration curves were linear in the range from 0.5 ng/mL or 2 ng/mL to 500 ng/mL. The detection limits were from 0.02 ng/mL to 2 ng/mL. At the optimized capillary and fragmentor voltages, the characteristic ions for each compound clearly showed up in the spectra and it is possible to use the LC-MS to identify these compounds. The method was applied to the analysis of biological samples without interfering peaks. However, the recoveries for some of the compounds in serum samples need to be further improved.

Evolution of solid-phase microextraction technology

The main objective of this contribution is to describe the development of the concepts, techniques and devices associated with solid-phase microextraction, as a response to the evolution of understanding of the fundamental principles behind this technique. The discussion begins with an historical perspective on the very early work conduced almost a decade ago. As new fundamental understanding about the functioning of the technology developed, new ways of constructing and using the SPME devices evolved.