Category: Nevin Manimala

J Clin Nurs. 2023 Jun 27. doi: 10.1111/jocn.16810. Online ahead of print.

ABSTRACT

AIM(S): To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration.

DESIGN: This cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses’ vital sign measurement and escalation of care for deteriorating patients.

METHODS: The study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24-h periods within the same week were audited at three time points: pre-intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post-intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi-square test.

RESULTS: A total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre-Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre-Medical Emergency Team (n = 2403) or Medical Emergency Team triggers (n = 273). One or more nursing interventions were documented in 29.5% of audits with pre-Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers.

CONCLUSION: When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration.

RELEVANCE TO CLINICAL PRACTICE: Medical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under-recognised element of the organisational response to deteriorating patients.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date.

IMPACT: This study addresses the gap in the literature regarding nurses’ management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings. When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. The results of this research are relevant to nurses working on medical and surgical wards.

REPORTING METHOD: The trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement.

PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

PMID:37365897 | DOI:10.1111/jocn.16810

J Matern Fetal Neonatal Med. 2023 Dec;36(2):2224489. doi: 10.1080/14767058.2023.2224489.

ABSTRACT

OBJECTIVE: We aim to explore the mediating effect of hypertensive disorders of pregnancy (HDP) on the relationship between pre-pregnancy body mass index (BMI) and the risk of preterm birth (PTB) in women with singleton live births.

METHODS: Demographic and clinical data of 3,249,159 women with singleton live births were extracted from the National Vital Statistics System (NVSS) database in this retrospective cohort study. The associations between pre-pregnancy BMI and HDP, HDP, and PTB, and pre-pregnancy BMI and PTB were evaluated using univariate and multivariate logistic regression analyses, with odds ratios (ORs) and 95% confidence intervals (CIs). Structural equation modeling (SEM) was used to explore the mediating effect of HDP on the relationship between pre-pregnancy BMI and PTB.

RESULTS: In total, 324,627 women (9.99%) had PTB. After adjustment for covariables, there were significant associations between pre-pregnancy BMI and HDP [OR = 2.07, 95% CI: 2.05-2.09)], HDP and PTB [OR = 2.54, 95% CI: (2.52-2.57)], and pre-pregnancy BMI and PTB [OR = 1.03, 95% CI: 1.02-1.03)]. The effect of pre-pregnancy BMI on PTB was significantly mediated by HDP with a mediation proportion of 63.62%, especially in women of different ages and having gestational diabetes mellitus (GDM) or not.

CONCLUSION: HDP may play a mediating role in the effect of pre-pregnancy BMI on PTB risk. Women preparing for pregnancy should pay close attention to BMI, and pregnant women should monitor and develop interventions for HDP to reduce the risk of PTB.

PMID:37365012 | DOI:10.1080/14767058.2023.2224489

J Neurol Neurosurg Psychiatry. 2023 Jun 26:jnnp-2023-331419. doi: 10.1136/jnnp-2023-331419. Online ahead of print.

ABSTRACT

BACKGROUND: Whole genome sequencing is increasingly used in healthcare, particularly for diagnostics. However, its clinically multifaceted potential for individually customised diagnostic and therapeutic care remains largely unexploited. We used existing whole genome sequencing data to screen for pharmacogenomic risk factors related to antiseizure medication-induced cutaneous adverse drug reactions (cADRs), such as human leucocyte antigen HLA-B*15:02, HLA-A*31:01 variants.

METHODS: Genotyping results, generated from the Genomics England UK 100 000 Genomes Project primarily for identification of disease-causing variants, were used to additionally screen for relevant HLA variants and other pharmacogenomic variants. Medical records were retrospectively reviewed for clinical and cADR phenotypes for HLA variant carriers. Descriptive statistics and the χ² test were used to analyse phenotype/genotype data for HLA carriers and compare frequencies of additional pharmacogenomic variants between HLA carriers with and without cADRs, respectively.

RESULTS: 1043 people with epilepsy were included. Four HLA-B*15:02 and 86 HLA-A*31:01 carriers were identified. One out of the four identified HLA-B*15:02 carriers had suffered antiseizure medication-induced cADRs; the point prevalence of cADRs was 16.9% for HLA-A*31:01 carriers of European origin (n=46) and 14.4% for HLA-A*31:01 carriers irrespective of ancestry (n=83).

CONCLUSIONS: Comprehensive utilisation of genetic data spreads beyond the search for causal variants alone and can be extended to additional clinical benefits such as identifying pharmacogenomic biomarkers, which can guide pharmacotherapy for genetically-susceptible individuals.

PMID:37364985 | DOI:10.1136/jnnp-2023-331419

Rev Infirm. 2023 Jun-Jul;72(292):37-39. doi: 10.1016/j.revinf.2023.05.010. Epub 2023 Jun 12.

ABSTRACT

Experimentation with psychoactive substances (PAS), such as alcohol, tobacco or cannabis, is common in adolescence, and continues to pose a public health issue that can lead to failure at school and university. Most of the work on these issues focuses on addiction-related aspects, and little on the underlying causes of addiction. This article sheds psycho-social theoretical light on the causes of first-time use of APS, and cannabis in particular. It is particularly aimed at school nurses and university preventive medicine nurses.

PMID:37364976 | DOI:10.1016/j.revinf.2023.05.010

Rev Infirm. 2023 Jun-Jul;72(292):32-33. doi: 10.1016/j.revinf.2023.05.008. Epub 2023 Jun 12.

ABSTRACT

In the units for difficult patients (UMD) and the intensive psychiatric care units (Usip), patients whose mental pathologies have or could generate violent acts which can go as far as committing homicide are taken care of. If, during the psychiatric care of these patients, isolation and restraint measures can be put in place as a last resort, in general it is the symptomatological and behavioral appeasement of these persons that is sought in an alternative way.

PMID:37364974 | DOI:10.1016/j.revinf.2023.05.008

Rev Infirm. 2023 Jun-Jul;72(292):23-25. doi: 10.1016/j.revinf.2023.05.005. Epub 2023 Jun 12.

ABSTRACT

The units for difficult patients (UMD) and the intensive psychiatric care units (Usip) are psychiatric services that are not successively sectorized, created to meet the needs of intensive care in a closed environment and sometimes of a forensic nature. These two systems are used to care for patients whose clinical condition often makes it too complex to maintain them in sector psychiatric units, and many of their operating rules differ. This is not the case for seclusion and restraint measures and the application of the law governing these measures.

PMID:37364971 | DOI:10.1016/j.revinf.2023.05.005

Rev Infirm. 2023 Jun-Jul;72(292):15. doi: 10.1016/j.revinf.2023.05.002. Epub 2023 Jun 13.

NO ABSTRACT

PMID:37364968 | DOI:10.1016/j.revinf.2023.05.002

Respirology. 2023 Jun 26. doi: 10.1111/resp.14537. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Weight and muscle loss are predictors of poor outcomes in chronic obstructive pulmonary disease. However, to our knowledge, no study has investigated the predictors of longitudinal weight loss or its composition from functional and morphological perspectives.

METHODS: This longitudinal observational study with a median follow-up period of 5 years (range: 3.0-5.8 years) included patients with COPD and ever-smokers at risk of COPD. Using chest computed tomography (CT) images, airway and emphysematous lesions were assessed as the square root of the wall area of a hypothetical airway with an internal perimeter of 10 mm (√Aaw at Pi10) and the percentage of low attenuation volume (LAV%). Muscle mass was estimated using cross-sectional areas (CSAs) of the pectoralis and erector spinae muscles, and fat mass was estimated using the subcutaneous fat thickness at the level of the 8th rib measured using chest CT images. Statistical analyses were performed using the linear mixed-effects models.

RESULTS: In total, 114 patients were enrolled. Their body mass index remained stable during the study period while body weight and muscle CSA decreased over time and the subcutaneous fat thickness increased. Reduced forced expiratory volume in 1 s and peak expiratory flow (PEF) at baseline predicted the future decline in muscle CSA.

CONCLUSION: Severe airflow limitation predicted future muscle wasting in patients with COPD and ever-smokers at risk of COPD. Airflow limitation with a PEF slightly below 90% of the predicted value may require intervention to prevent future muscle loss.

PMID:37364930 | DOI:10.1111/resp.14537

BMJ Mil Health. 2023 Jun 25:e002375. doi: 10.1136/military-2023-002375. Online ahead of print.

ABSTRACT

INTRODUCTION: Veterans experience a high incidence of chronic and complex health conditions requiring a holistic approach to health and well-being. The Adapted Physical Activity Program (APAP) is a theory-based programme developed to support the physical activity (PA) participation of community-dwelling people with disabilities. Although available to all people with disabilities, of the 214 clients referred between 2015 and 2019, two hundred and three were veterans. This study aimed to understand this unexpected predominance by describing the characteristics of the veterans referred to APAP, including client goals, as well as describing the characteristics of the rehabilitation consultants who made the referrals.

METHODS: Descriptive statistics were used to describe specific characteristics of the veterans and the rehabilitation consultants. Content analysis was used to analyse client goals.

RESULTS: Client data highlighted the complexity of this clinical population. All clients had been diagnosed with more than one health condition, with most experiencing both a physical injury and a mental health diagnosis. Content analysis revealed six overarching client goals, including supporting sustainable PA participation, mental health and well-being, participation in meaningful activities, community and social engagement, management of condition and physical health and fitness. Data from the referring organisations showed that each organisation had multiple health professionals that made repeated referrals to APAP. The most common health profession to make a referral to APAP was occupational therapy.

CONCLUSION: Veterans have a high incidence of chronic and complex health conditions including physical injury and mental illness. Programmes and services that look beyond addressing the diagnosis and treatment of specific conditions to supporting the overall health and well-being of the individual are required. Person-centred, community-based PA programmes such as APAP might offer this solution. Further research is required to assess the efficacy of such programmes with this population.

PMID:37364900 | DOI:10.1136/military-2023-002375

Arch Dis Child Fetal Neonatal Ed. 2023 Jun 23:fetalneonatal-2023-325376. doi: 10.1136/archdischild-2023-325376. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to study neurodevelopmental outcomes and healthcare utilisation at age 5-6 years in very preterm children with bronchopulmonary dysplasia (BPD).

DESIGN: Prospective and national population-based study.

SETTING: All the neonatal units in 25 French regions (21 of the 22 metropolitan regions and 4 overseas regions).

PATIENTS: Children born before 32 weeks’ gestation in 2011.

INTERVENTIONS: Blind, comprehensive and standardised assessment by trained neuropsychologists and paediatricians at age 5-6 years.

MAIN OUTCOME MEASURES: Overall neurodevelopmental disabilities, behavioural difficulties, developmental coordination disorders, full-scale IQ, cerebral palsy, social interaction disorders, rehospitalisation in the previous 12 months and detailed developmental support.

RESULTS: Of the 3186 children included, 413 (11.7%) had BPD. The median gestational age of children with BPD was 27 weeks (IQR 26.0-28.0) and without BPD was 30 weeks (28.0-31.0). At age 5-6 years, 3150 children were alive; 1914 (60.8%) had a complete assessment. BPD was strongly associated with mild, moderate and severe overall neurodevelopmental disabilities (OR 1.49, 95% CI 1.05 to 2.20; 2.20, 1.41 to 3.42 and 2.71, 1.67 to 4.40). BPD was associated with developmental coordination disorders, behavioural difficulties, lower IQ score as well as rehospitalisation in the last 12 months and developmental support. The association between BPD and cerebral palsy was statistically significant before adjustment but not in adjusted analyses.

CONCLUSIONS: BPD was strongly and independently associated with many neurodevelopmental disabilities. Improving medical and neurodevelopmental management of BPD in very preterm children should be a priority to reduce its long-term consequences.

PMID:37364896 | DOI:10.1136/archdischild-2023-325376