Nevin Manimala

Physiotherapy. 2021 Mar 26;112:55-63. doi: 10.1016/j.physio.2021.03.016. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore entry-level physiotherapy students’ attitudes and beliefs relating to weight bias and stigmatisation in healthcare.

DESIGN: Cross sectional survey of physiotherapy students.

METHODS: All final year physiotherapy students (n = 215) enrolled in entry-level physiotherapy programmes in the Republic of Ireland were invited to participate. Each received a questionnaire, consisting of 72 questions, within four key sections. Descriptive statistics and frequencies were used to analyse the data.

RESULTS: A response rate of 83% (179/215) was achieved. Whilst physiotherapy students, overall, had a positive attitude towards people with obesity, 29% had a negative attitude towards people with obesity, 24% had a negative attitude towards managing this population and most (74%) believed obesity was caused by behavioural and individual factors. Over one third of students (35%) reported that they would not be confident in managing patients with obesity and more than half (54%) felt treating patients with obesity was not worthwhile.

CONCLUSION: This study provides preliminary findings to suggest that weight stigma-reduction efforts are warranted for physiotherapy students. Helping students to understand that obesity is a complex, chronic condition with multiple aspects requiring a multi-faceted approach to its management might be the first step towards dispelling these negative attitudes towards patients living with obesity. Inclusion of a formal obesity curriculum should perhaps now be part of the contemporary physiotherapy students’ education.

PMID:34051594 | DOI:10.1016/j.physio.2021.03.016

Int J Nurs Stud. 2021 May 2;120:103955. doi: 10.1016/j.ijnurstu.2021.103955. Online ahead of print.

ABSTRACT

BACKGROUND: Caregivers of patients with chronic conditions or disability experience fatigue, burden and poor health-related quality of life. There is evidence of the effectiveness of support interventions for decreasing this impact. However, little is known about the benefits of home-based nursing intervention in primary health care.

OBJECTIVES: To evaluate the effectiveness of a home-based, nurse-led-intervention (CuidaCare) on the quality of life of caregivers of individuals with disabilities or chronic conditions living in the community, measured at 12-month follow-up.

METHODS: A pragmatic, two-arm, cluster-randomized controlled trial with a 1-year follow-up period was performed between June 2013 and December 2015. Consecutive caregivers aged 65 years or older, all of whom assumed the primary responsibility of caring for people with disabling conditions for at least 6 months a year, were recruited from 22 primary health care centers. Subsequently, 11 centers were randomly assigned to usual care group, and 11 were assigned to the intervention group. The caregivers in the intervention group received the usual care and additional support (cognitive restructuring, health education and emotional support). The primary outcome was quality of life, assessed with the EQ-5D instrument (visual analog scale and utility index score); the secondary outcome variables were perception of burden, anxiety, and depression. Data were collected at baseline, at the end of the intervention, and at the 6- and 12-month follow-up visits. We analyzed the primary outcome as intention-to-treat, and missing data were added using the conditional mean single imputation method.

RESULTS: A total of 224 caregivers were included in the study (102 in the intervention group and 122 in the usual care group). Generalized Estimating Equation models showed that the CuidaCare intervention was associated with a 5.46 point (95% CI: 2.57; 8.35) change in the quality of life, as measured with the visual analog scale adjusted for the rest of the variables at 12 months. It also produced an increase of 0.04 point (95% CI: 0.01; 0.07) in the utilities. No statistically significant differences were found between the two groups at 12 months with respect to the secondary outcomes.

CONCLUSIONS: The findings suggest that incorporating a home-based, nurse-led-intervention for caregivers into primary care can improve the health-related quality of life of caregivers of patients with chronic or disabling conditions.

PMID:34051585 | DOI:10.1016/j.ijnurstu.2021.103955

Early Hum Dev. 2021 May 17;158:105394. doi: 10.1016/j.earlhumdev.2021.105394. Online ahead of print.

ABSTRACT

BACKGROUND: Increased survival of preterm neonates who require hospitalization at the Neonatal Intensive Care Unit has led to an increase in infections. This study aims to describe the temporal trend, risk factors, and outcome of healthcare-associated infections in a NICU of a high complexity hospital, with emphasis on the differences of incidence between bacterial and fungal infections.

METHODS: The study was carried out from January 2013 to December 2016, with daily follow-up of the newborns by the National Healthcare Safety Network.

RESULTS: The study included 881 newborns, of whom 214 had a bacterial infection, 19 had fungi infection, and 12 bacterial and fungal infections associated. The hospital infection rate was 12/1000 patient-days. SNAPPE>24, days of hospitalization and PICC days were independent risk factors for the development of fungal and bacterial infection, respectively, with statistical significance for bacterial and fungal infections. The mortality rate was 2.6 times higher in those who had fungal infection than in those who had a bacterial infection. The occurrence of invasive infections was higher in the years 2015 and 2016 and Gram-negative bacteria and yeasts were more frequent, impacting morbidity and mortality.

CONCLUSIONS: The use of invasive devices is a risk factor for the occurrence of HAI caused by bacteria and fungi. The frequency of deaths was higher in the group of neonates with fungal infection. These results point to the importance of constant epidemiological surveillance and measures of effective control of infections in NICU.

PMID:34051584 | DOI:10.1016/j.earlhumdev.2021.105394

Epilepsy Res. 2021 May 12;174:106670. doi: 10.1016/j.eplepsyres.2021.106670. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine the 30-day readmission rate after Epilepsy Monitoring Unit (EMU) discharge in a nationally representative sample, as well as patient, clinical, and hospital characteristics associated with readmission.

METHODS: This is a retrospective cohort study of adults discharged from an elective hospitalization with continuous video electroencephalography (vEEG) monitoring, sampled from the Healthcare Cost and Utilization Project’s 2014 Nationwide Readmissions Database. Descriptive statistics were used to quantify and characterize readmission within 30 days and logistic regression models were built to examine factors associated with readmission.

RESULTS: 6869 admissions met inclusion criteria, with 292 people (4.2 %) readmitted within 30 days. 79.5 % (n = 232/292) of all readmissions were non-elective. Patient characteristics associated with readmission included a higher Elixhauser comorbidity score [adjusted odds ratio (AOR) 1.03, 95 % confidence interval (CI) 1.02-1.04 per 1 point increase in Elixhauser score], a longer length of stay [AOR 1.05, 95 % CI 1.02-1.09 per one day increase in length], non-routine discharge [AOR 1.85, 95 %CI 102-3.38], and comorbid brain tumor diagnosis [AOR 2.55, 95 %CI 1.46-4.46]. Female sex was inversely associated with 30-day readmission [AOR 0.68, 95 % CI 0.54-0.85]. The most common reason for readmission was epilepsy or convulsion (27.6 %), followed by sepsis (5.8 %) and complications of surgical procedures or medical care (5.5 %).

CONCLUSIONS: Patients electively admitted for continuous vEEG monitoring are infrequently readmitted. These data provide a preliminary national readmission benchmark for patients with elective admissions for vEEG monitoring.

PMID:34051574 | DOI:10.1016/j.eplepsyres.2021.106670

Nurse Educ Today. 2021 May 13;103:104955. doi: 10.1016/j.nedt.2021.104955. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effect of Mobile Augmented Reality (MAR) educational materials on the knowledge and skill levels of nursing students on injection practices.

METHOD: This controlled experimental study was carried out with 122 first-year nursing students, 64 of whom were included in the experimental group and 58 in the control group. Data were collected between March and April 2018 using an information form, a pre-test, a post-test, a persistence test, and injection evaluation checklists. In the study, the experimental group used MAR applications and the control group used traditional teaching methods in learning injection practices.

RESULTS: There was no statistically significant difference between the pre-test scores of the students in the experimental and control groups, which determined the knowledge level of subcutaneous, intramuscular, and intravenous injections before the lesson (p > 0.05). After the lesson, it was found statistically significant that the post-test and persistence test scores of students in the experimental group were higher than the control group (p < 0.05). In the first and second/persistence skill evaluations, the injection skill scores of the students in the experimental group were higher than the control group (p < 0.05), which was also statistically significant. In addition, the students in the experimental group stated that MAR applications increased their motivation and self-confidence and reduced their concerns.

CONCLUSION: It was determined that MAR applications had a positive effect on the knowledge and skill levels of nursing students regarding injection practices and provided persistence in the learned knowledge and skills.

PMID:34051543 | DOI:10.1016/j.nedt.2021.104955

Nurse Educ Today. 2021 May 19;103:104976. doi: 10.1016/j.nedt.2021.104976. Online ahead of print.

ABSTRACT

BACKGROUND: Workplace violence in healthcare remains a significant issue for healthcare professional, in terms of risk to patients and staff. One part of a workplace violence prevention and management programme is to educate staff in their response to critical events. Drawn from the disaster management literature, tabletop exercises were used in this study to simulate workplace violence and educate staff on the appropriate emergency response during a violent event. The use of tabletop exercise in this context is a novel approach to workplace violence prevention management.

AIM AND OBJECTIVE: This study describes the development and effectiveness of tabletop exercises in preparing health practitioners in violence prevention and management emergency response systems.

METHODS: Using a sequential explanatory mixed method design. The study comprised of two phases 1) quasi-experimental (quantitative) and 2) focus group (qualitative) to evaluate the effectiveness of the violence prevention management tabletop exercises. COREQ guidelines were followed the qualitative arm of the study and the TREND statement for the quantitative part of the study.

RESULTS: Statistically significant improvements in healthcare professional confidence levels were found two weeks post the tabletop exercises. A post focus group revealed three categories concerning the participant’s experiences of the tabletop exercises, (role clarity, adult learning and organisational support).

CONCLUSION: Tabletop exercise may provide a, low cost, context specific novel approach to educating staff in emergency violence response systems at a tertiary referral hospital. Educators and policy makers may consider the use of tabletop exercises in the ongoing work in preparing health care staff for workplace violence.

RELEVANCE TO CLINICAL PRACTICE: Successful tabletop exercises should consider a local ward level context, the use of adult learning principles, have high level organisational support and cover role clarity as a key learning area.

PMID:34051542 | DOI:10.1016/j.nedt.2021.104976

Mar Pollut Bull. 2021 May 26;169:112494. doi: 10.1016/j.marpolbul.2021.112494. Online ahead of print.

ABSTRACT

Catchment impacts on downstream ecosystems are difficult to quantify, but important for setting management targets. Here we compared 12 years of monitoring data of seagrass area and biomass in Cleveland Bay, northeast Australia, with discharge and associated sediment loads from nearby rivers. Seagrass biomass and area exhibited different trajectories in response to river inputs. River discharge was a slightly better predictor of seagrass indicators than total suspended solid (TSS) loads, indicating that catchment effects on seagrass are not restricted to sediment. Linear relationships between Burdekin River TSS loads delivered over 1-4 years and seagrass condition in Cleveland Bay generated Ecologically Relevant Targets (ERT) for catchment sediment inputs. Our predicted ERTs were comparable to those previously estimated using mechanistic models. This study highlights the challenges of linking catchment inputs to condition of downstream ecosystems, and the importance of integrating a variety of metrics and approaches to increase confidence in ERTs.

PMID:34051518 | DOI:10.1016/j.marpolbul.2021.112494

J Psychosom Res. 2021 May 20;147:110511. doi: 10.1016/j.jpsychores.2021.110511. Online ahead of print.

ABSTRACT

OBJECTIVE: Vascular surgery can be common among people with serious mental illness (SMI) given the high prevalence of cardiovascular disease. However, post-operative outcomes following vascular surgery have received little investigation, particularly in a subpopulation of SMI.

METHODS: We conducted a retrospective observational study using data from the South London and Maudsley NHS Foundation Trust (SLaM) via its Clinical Record Interactive Search (CRIS) platform and linkage with Hospital Episode Statistic (HES). Vascular surgery recipients were identified using OPCS version 4 codes. Length of stay (LOS) was modelled using Incidence Rate Ratios (IRRs), and 30-day emergency hospital readmissions using Odds Ratios (ORs) for people with SMI compared with the general population.

RESULTS: Vascular surgery was received by 152 patients with SMI diagnoses (schizophrenia, schizoaffective disorder, bipolar disorder) and 8821 catchment residents without any mental health conditions. People with active SMI symptoms more likely to be admitted to hospital via emergency route OR: 1.80 (95% CI: 1.06, 3.07) and more likely to stay longer in the hospital for vascular surgery IRR: 1.35 (1.01, 1.80) and more likely to be readmitted to hospital via emergency route within 30 days OR: 1.53 (1.02, 2.67). People with SMI who had major open vascular surgery and peripheral endovascular surgery more likely to have worse post-operative outcomes.

CONCLUSION: Our study highlights the risks faced by people with SMI following vascular surgery. These suggest tailored guidelines and policies are needed, based on the identification of pre-operative risk factors, allowing for focused post-vascular surgery care to minimise adverse outcomes.

PMID:34051514 | DOI:10.1016/j.jpsychores.2021.110511

Sci Total Environ. 2021 May 21;789:147876. doi: 10.1016/j.scitotenv.2021.147876. Online ahead of print.

ABSTRACT

Governments may relax physical distancing interventions for coronavirus disease 2019 (Covid-19) containment in warm seasons/areas to prevent economic contractions. However, it is not clear whether higher temperature may offset the transmission risk posed by this relaxation. This study aims to investigate the associations of the effective reproductive number (R_t) of Covid-19 with ambient temperature and the implementation of physical distancing interventions in the United States (US). This study included 50 states and one territory of the US with 4,532,650 confirmed cases between 29 January and 31 July 2020. We used an interrupted time-series model with a state-level random intercept for data analysis. An interaction term of ‘physical distancing×temperature’ was included to examine their interactions. Stratified analyses by temperature and physical distancing implementation were also performed to analyse the modifying effects. The overall median (interquartile range) R_t was 1.2 (1.0-2.3). The implementation of physical distancing was associated with a 12% decrease in the risk of R_t (relative risk [RR]: 0.88, 95% confident interval [CI]: 0.86-0.89), and each 5 °C increase in temperature was associated with a 2% decrease (RR: 0.98, 95%CI: 0.97-0.98). We observed a statistically significant interaction between temperature and physical distancing implementation, but all the RRs were small (close to one). The containing effects of high temperature were attenuated by 5.1% when physical distancing was implemented. The association of COVID-19 R_t with physical distancing implementation was more stable (0.88 vs. 0.89 in days when temperature was low and high, respectively). Increased temperature did not offset the risk of Covid-19 R_t posed by the relaxation of physical distancing implementation. Our study does not recommend relaxing the implementation of physical distancing interventions in warm seasons/areas.

PMID:34051508 | DOI:10.1016/j.scitotenv.2021.147876

Sci Total Environ. 2021 May 23;789:147945. doi: 10.1016/j.scitotenv.2021.147945. Online ahead of print.

ABSTRACT

Soil microbial communities act on important environmental processes, being sensitive to the application of wastes, mainly those potential contaminants, such as tannery sludge. Due to the microbiome complexity, graph-theoretical approaches have been applied to represent model microbial communities interactions and identify important taxa, mainly in contaminated soils. Herein, we performed network and statistical analyses into microbial 16S rRNA gene sequencing data from soil samples with the application of different levels of composted tannery sludge (CTS) to assess the most connected nodes and the nodes that act as bridges to identify key microbes within each community. The network analysis revealed hubs belonging to Proteobacteria in soil with lower CTS rates, while active degraders of recalcitrant and pollutant chemical hubs belonging to Proteobacteria and Actinobacteria were found in soils under the highest CTS rates. The majority of classified connectors belonged to Actinobacteria, but similarly to hubs taxa, they shifted from metabolic functional profile to taxa with abilities to degrade toxic compounds, revealing a soil perturbation with the CTS application on community organization, which also impacted the community modularity. Members of Actinobacteria and Acidobacteria were identified as both hub and connector suggesting their role as keystone groups. Thus, these results offered us interesting insights about crucial taxa, their response to environmental alterations, and possible implications for the ecosystem.

PMID:34051496 | DOI:10.1016/j.scitotenv.2021.147945