Category: Nevin Manimala

JBI Evid Synth. 2023 Oct 19. doi: 10.11124/JBIES-22-00409. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this review was to determine the effect of educational programs that have been implemented in acute health care settings to manage or prevent aggressive behaviors toward staff perpetrated by patients, families, and/or visitors.

INTRODUCTION: Health care staff working within acute- and tertiary-level hospitals are at high risk of exposure to aggressive behaviors by patients, their family, and/or visitors. Negative staff and organizational impacts reported in the literature include individual psychological or emotional distress and severe harm, increased absenteeism, high staff turnover, and awarded compensation. Reports of this kind of occupational violence are increasing globally, therefore, strategies to address prevention and/or management are needed to mitigate the risk of harm to staff and the wider hospital service. Various educational activities have been implemented to address the issue, but the overall effect of these is unclear.

INCLUSION CRITERIA: Experimental and quasi-experimental studies were considered for inclusion if they reported on an educational program or intervention for staff working within an acute hospital setting and aimed at managing or preventing occupational violence perpetrated by patients, family, or visitors. Reports of implemented programs to address occupational violence, whether verbal or physical, were included. Studies were excluded if they reported on lateral upward violence or bullying, patients in psychiatric or dementia facilities, and pediatric patients, due to the specific care needs of these cohorts.

METHODS: The following databases were searched: PubMed, CINAHL, PsycINFO, Embase, ERIC, Cochrane Controlled Trials, and Scopus. Unpublished studies were sought from ProQuest Dissertations and Theses. To obtain a wider perspective of the issue, studies published in Chinese were also searched for in WanFang Database, China National Knowledge Infrastructure, and Chongqing VIP. A date filter of 2008-2023 was applied in a deliberate effort to expand from previous work. No language filters were applied. The review was conducted in accordance with JBI methodology for systematic reviews of effectiveness and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analaysis (PRISMA) guidelines.

RESULTS: The search process retrieved 4681 citations with a total of 32 studies representing 3246 health staff. The studies were either before and after or pre-test-post-test study designs. Methodological quality of studies was varied, with the main issues being absence of CIs within statistical analysis, limited detail on participant selection or attrition/non-response, and under-reporting of confounding factors. Educational programs varied in content and duration. Content delivery across the studies also varied, with a variety of didactic, role play, debriefing, group work, and simulation exercises reported. While studies reported some improvement in self-reported confidence levels, results were mixed for other outcomes. Determining overall effect of included studies is challenging due to heterogeneity within and across studies in intervention types, populations, measurement tools, and outcomes.

CONCLUSIONS: This review is unable to determine which workplace educational programs were most effective on staff outcomes or on the number of occupational violence incidents. In future, educators and researchers could use the findings of this review to guide the design of educational programs and employ measures that are comparable to their settings.

REVIEW REGISTRATION: PROSPERO CRD42020190538.

SUPPLEMENTAL DIGITAL CONTENT: A Chinese-language version of the abstract of this review is available [http://links.lww.com/SRX/A33].

PMID:37851359 | DOI:10.11124/JBIES-22-00409

Holist Nurs Pract. 2023 Nov-Dec 01;37(6):E83-E91. doi: 10.1097/HNP.0000000000000609.

ABSTRACT

Job burnout is highly prevalent among health care workers. This study determined the effect of job burnout on decision-making and coping with stress among nurses. Two hundred seventy-seven nurses in Xijing Hospital were investigated using the Job Burnout Scale, Decision Scale, and Simple Stress Coping Style Scale. The total score of job burnout was 107.8 ± 16.479 (severe burnout) and clinical decision-making consciousness was 123.75 ± 16.094 (moderate decision-making consciousness). No statistical differences existed in different gender samples (P > .05). Burnout and clinical decision-making awareness of clinical nurses were stronger than nursing interns and regular trainee nurses, but the occupational pressure of nursing interns was the highest (P < .05). Marital status also showed significant differences in job burnout; unmarried nurses were more prone to burnout (P < .05). In conclusions, burnout is a serious issue among nurses, which is closely related with clinical decision-making awareness, negative coping, and occupational stress. Nurse identity and marital status had significant effects on burnout.

PMID:37851354 | DOI:10.1097/HNP.0000000000000609

Holist Nurs Pract. 2023 Nov-Dec 01;37(6):330-336. doi: 10.1097/HNP.0000000000000612.

ABSTRACT

This study evaluated the effectiveness of traditional Chinese medicine-based therapeutic acupuncture (TA) in reducing the severity of hot flashes (HFs) in breast cancer patients and compared the effectiveness of TA to “sham” placebo acupuncture (SA). Subjects experiencing more than 10 episodes of HF/week were randomly assigned to TA or SA. The response was assessed by the Menopause-specific Quality of Life (MenQoL) scale, scoring the subject’s perception of the severity of HFs. HFs were scored at baseline, after treatment, and 1-month follow-up. A total of 54 subjects enrolled (28 TA and 26 SA). Seven women withdrew from the study. A hot flash diary documented the number of HFs a subject experienced. Analysis included 47 subjects (27 TA and 20 SA). A statistically significant response in HF scores was noted in the TA group compared with the SA group (P = .0064.) On average HF scores dropped by 1.89 with TA, and only 0.16 with SA. At follow-up, TA subjects had a sustained response. TA is effective in reducing the intensity and severity of HF. With SA, no relative response/change in HF scores was noted. Larger studies and longer follow-up to assess durability of response to TA are needed.

PMID:37851349 | DOI:10.1097/HNP.0000000000000612

Holist Nurs Pract. 2023 Nov-Dec 01;37(6):318-329. doi: 10.1097/HNP.0000000000000613.

ABSTRACT

The present study was conducted to examine the effects of Pranayama applied to hemodialysis patients on fatigue. The study was completed with 91 patients, including Pranayama (n = 30), Relaxation (n = 30), and Control groups (n = 31). The patients in the Pranayama group applied the interventions 15 to 20 minutes every day, once a day, for a total of 3 months, and the patients in the relaxation practice group applied the interventions 15 to 20 minutes every day, once a day, for a total of 3 months. Before the study commenced, permission was obtained from health care institutions, the ethics committee, and the patients. The data were collected with a Questionnaire, Piper Fatigue Scale (PFS), visual analog scale, and Vital Findings Form. Piper Fatigue Scale consists of 4 subdimensions, the total score obtained from the scale varies between 0 and 10, and as the score increases, the level of fatigue also increases. It was found that the patients in the Pranayama Group had decreased PFS total and subdimension mean scores after the procedure (P < .05); however, no significant changes were detected in the PFS total and subdimension mean scores of the patients in the Relaxation and Control groups (P > .05). Although the decrease in the daily fatigue severity of the patients in the Pranayama group was at a statistically significant level (P < .05), no statistically significant changes were detected in the fatigue severity of the patients in the Relaxation and Control groups (P > .05). It was also found that the blood pressure values of the patients in the Pranayama and Relaxation groups decreased (P < .05). It was found in the present study that Pranayama reduced the fatigue levels of hemodialysis patients. In this respect, it is recommended to teach and apply Pranayama techniques to patients with the support of nurses.

PMID:37851348 | DOI:10.1097/HNP.0000000000000613

Pain. 2023 Oct 17. doi: 10.1097/j.pain.0000000000003052. Online ahead of print.

ABSTRACT

Habituation to pain is a fundamental learning process and important adaption. Yet, a comprehensive review of the current state of the field is lacking. Through a systematic search, 63 studies were included. Results address habituation to pain in healthy individuals based on self-report, electroencephalography, or functional magnetic resonance imaging. Our findings indicate a large variety in methods, experimental settings, and contexts, making habituation a ubiquitous phenomenon. Habituation to pain based on self-report studies shows a large influence of expectations, as well as the presence of individual differences. Furthermore, widespread neural effects, with sometimes opposing effects in self-report measures, are noted. Electroencephalography studies showed habituation of the N2-P2 amplitude, whereas functional magnetic resonance imaging studies showed decreasing activity during painful repeated stimulation in several identified brain areas (cingulate cortex and somatosensory cortices). Important considerations for the use of terminology, methodology, statistics, and individual differences are discussed. This review will aid our understanding of habituation to pain in healthy individuals and may lead the way to improving methods and designs for personalized treatment approaches in chronic pain patients.

PMID:37851343 | DOI:10.1097/j.pain.0000000000003052

Eur J Gastroenterol Hepatol. 2023 Oct 18. doi: 10.1097/MEG.0000000000002674. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate rectal sensitivity and associated factors in patients with different subtypes of functional defecation disorder (FDD).

METHODS: We segregated individuals diagnosed with FDD into two groups based on their defecation patterns: those with dyssynergic defecation and those with inadequate defecatory propulsion. We gathered general information through questionnaires and assessed rectal sensitivity using anorectal manometry. The rectal sensitivity performances of the two groups were compared; the factors related to rectal sensitivity were analyzed to determine the factors associated with rectal sensitivity, and the effect of biofeedback therapy on rectal sensitivity was clarified.

RESULTS: Rectal sensitivity in different subtypes of FDD decreased, and the difference between the two groups was not statistically significant (P > 0.05). There were no statistically significant differences in the first constant sensation volume, defecatory desire volume, and maximum tolerable volume between the different subtypes of FDD (P > 0.05). Multi-factor binary logistic regression analysis showed that age, constipation symptom score, and diabetes were all independent risk factors for decreased rectal sensitivity (P < 0.05). There were no statistically significant differences between the prior- and post-biofeedback therapy in the first constant sensation volume, defecatory desire volume, and maximum tolerable volume (P > 0.05).

CONCLUSION: Rectal sensitivity in different subtypes of FDD decreased. Age, constipation symptom score, and diabetes were independent risk factors for decreased rectal sensitivity. Short-term biofeedback therapy did not improve rectal hyposensitivity in patients with FDD.

PMID:37851333 | DOI:10.1097/MEG.0000000000002674

Indian J Pediatr. 2023 Oct 18. doi: 10.1007/s12098-023-04867-4. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess the impact of restricted vs. usual/liberal maintenance fluid strategy on fluid overload (FO) among mechanically ventilated children.

METHODS: This open-label randomized controlled trial was conducted over a period of 1 y (October 2020-September 2021) in a Pediatric intensive care unit (PICU) in North India. Hemodynamically stable mechanically ventilated children were randomized to 40% (restricted group, n = 50) and 70-80% (usual/liberal group, n = 50) of maintenance fluids. The primary outcome was cumulative fluid overload percentage (FO%) on day 7. Secondary outcomes were FO% >10%; vasoactive inotropic score, sequential organ failure assessment score, pediatric logistic organ dysfunction score and oxygenation index from day 1-7; ventilation free days (VFDs) and PICU free days (PFDs) through day 28; and mortality.

RESULTS: The restricted group had statistically non-significant trend towards lower cumulative FO% at day 7 [7.6 vs. 9.5, p = 0.40]; and proportion of children with FO% >10% (12% vs. 26%, p = 0.21) as compared to usual/liberal group. The increase in FO% from day 1-7 was significant in usual/liberal group as compared to restricted group (p <0.001 and p = 0.134, respectively). Restricted group received significantly lower amount of fluid in the first 5 d; had significantly higher VFDs (23 vs. 17 d, p = 0.008) and PFDs (19 vs. 15 d, p = 0.007); and trend towards lower mortality (8% vs. 16%, p = 0.21).

CONCLUSIONS: Restricted as compared to usual/liberal maintenance fluid strategy among mechanically ventilated children was associated with a trend towards lower rate and severity of FO and mortality; and significantly lower fluid volume received, and higher VFDs and PFDs.

PMID:37851328 | DOI:10.1007/s12098-023-04867-4

CJEM. 2023 Oct 18. doi: 10.1007/s43678-023-00605-z. Online ahead of print.

ABSTRACT

PURPOSE: Pediatric emergency departments are overcrowded, in part due to many non-emergent visits. We aimed to assess the proportion of parents interested in leaving the pediatric emergency department (ED) prior to physician assessment if they could be offered a scheduled community healthcare appointment. We explored differences in care children received in the ED stratified by interest in a community healthcare appointment and parents’ reasons when they were not interested.

METHODS: We conducted a 14-item survey within the pediatric ED at a Canadian tertiary care teaching hospital to assess parents’ interest if a program offered community healthcare appointments and we determined preferred appointment characteristics. All parents presenting with children triaged as CTAS 2-5 who met eligibility criteria were approached by a research assistant prior to physician assessment. Surveys were paired with the medical chart outlining the care received. Descriptive statistics and a regression model were used to describe characteristics of families and care received among those who were and were not interested in a community healthcare appointment.

RESULTS: In total, 403 surveys were completed. Overall, 236 participants (58.6%; 95% CI 53.8-63.4) were interested in a community healthcare appointment. In general, parents who were interested in a community healthcare appointment were younger and presented with younger children compared to those who were not interested. Among those interested, there was a preference to have the appointment with a pediatrician or family physician, timely access to an appointment, and appointments scheduled outside of regular business hours.

CONCLUSION: Our study provides evidence that there is interest in an alternative care access model positioned to reduce pediatric ED congestion. We found that parents would be interested in leaving the pediatric ED in favor of a community healthcare appointment, provided it was with a physician and available in a timely manner.

PMID:37851318 | DOI:10.1007/s43678-023-00605-z

J Clin Endocrinol Metab. 2023 Oct 18:dgad601. doi: 10.1210/clinem/dgad601. Online ahead of print.

ABSTRACT

CONTEXT: Although physical activity (PA) is recognized to reduce fracture risk, whether its benefits differ according to the glycemic status remains unknown.

OBJECTIVES: We investigated the effect of PA on incident hip fracture (HF) according to the glycemic status.

METHODS: We studied 3,723,097 patients over 50 without type 1 diabetes mellitus (DM) or past fractures. Hip fracture risks were calculated using Cox proportional hazard regression. Participants were categorized by glycemic status into five groups: normal glucose tolerance, impaired fasting glucose, new-onset type 2 DM, type 2 DM <5 years, and type 2 DM ≥5 years. PA was evaluated using the Korean adaptation of the International Physical Activity Questionnaire Short Form.

RESULTS: The highest HF risk were associated with the lowest PA level (<500 metabolic equivalent task (MET)-min/week). While similar risks emerged across MET 500-1000, 1000-1500, and >1500 categories, the relationship showed variations in different glycemic status groups. Exceptions were particularly noted in women with normoglycemia. However, a consistent inverse pattern, with few exceptions, was observed in both men and women with type 2 DM ≥5 years. Furthermore, the benefit of physical activity in the prevention of hip fractures was most evident in participants with type 2 DM ≥5 years. Compared to the reference group (lowest physical activity level <500 MET-min/week within type 2 DM ≥5 years), the adjusted hazard ratios were 0.74 [0.62-0.88] in men and 0.74 [0.62-0.89] in women, suggesting a significant reduction in risk.

CONCLUSION: Higher PA levels are associated with a lower risk of HF. This protective effect of PA on fracture risk is greatest in patients with DM, particularly in those with DM ≥5 years.

PMID:37850407 | DOI:10.1210/clinem/dgad601

J Esthet Restor Dent. 2023 Oct 18. doi: 10.1111/jerd.13149. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to assess the feasibility of phenotype modification in orthodontic patients using combined bone and soft tissue grafting substitutes.

CLINICAL CONSIDERATION: The surgical procedure was conducted on 18 patients (3 males, 15 females). Periodontal phenotype modification was conducted using demineralized freeze-dried bone allograft and a xenogeneic collagen matrix. The following parameters were recorded for each tooth at baseline and 12-month follow-up: O’Leary plaque index (PI), probing depth (PD), bleeding on probing (BOP), gingival thickness (GT), keratinized tissue width (KTW), gingival recession (GR), and vestibular depth (VD). The results showed a statistically significant increase in GT (2.02 ± 0.39 mm), KTW (1.11 ± 0.82 mm), and VD (0.18 ± 1.16 mm) (p < 0.05). GR was also significantly decreased (1.02 ± 0.99 mm) (p < 0.05).

CONCLUSION: Within the limitation of this study, the proposed approach enhanced the periodontal condition in orthodontic patients. However, further studies with a larger sample size are needed to ensure long-term stability.

CLINICAL SIGNIFICANCE: Hard and soft tissue conditions have paramount importance for long-term periodontal stability. Phenotype modification in orthodontic patients can diminish the probability of adverse consequences and result in optimal esthetic outcomes. The proposed technique using combined bone and soft tissue substitutes indicated promising results and could be recommended in orthodontic patients with thin periodontal phenotypes.

PMID:37850403 | DOI:10.1111/jerd.13149