scholarly journals Early CPAP reduced mortality in covid-19 patients. Audit results from Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

2020 ◽  
Author(s):  
Abdul Ashish ◽  
Alison Unsworth ◽  
Jane Martindale ◽  
Luigi Sedda ◽  
Ramachandran Sundar ◽  
...  
Keyword(s):  
Best Practice ◽  
Small Sample Size ◽  
Clinical Care ◽  
Evidence Base ◽  
Good Evidence ◽  
Small Sample ◽  
Teaching Hospitals ◽  
Sufficient Evidence ◽  
Recent Experience ◽  
Common Clinical Practice

AbstractCOVID-19 infection typically causes pneumonia with bilateral changes on Chest radiograph. There is significant hypoxia and use of oxygen for patients admitted to hospital is standard. The use of Continuous Positive Airway Pressure (CPAP) in patients with COVID-19 has now become established as a common clinical practice based on recent experience. It is given as part of “best endeavours” treatment in the absence of sufficient evidence to guide best practice. The use of CPAP as a step up in clinical care is now common but has a poor evidence base.Using routinely collected data, the use of CPAP as a supportive non-invasive ventilatory treatment is described in 35 patients with COVID infection. Patients given early CPAP and in particular within 48 hours of admission, are shown to have a better outcome (a significant probability of lower mortality) than patients who received late CPAP (more than 48 hours after admission).Although the analysis is affected by a small sample size, the results have shown good evidence that supports the early use of CPAP in patients with COVID-19 infection.

scholarly journals Towards a Treatment for Neuroinflammation in Epilepsy: Interleukin-1 Receptor Antagonist, Anakinra, as a Potential Treatment in Intractable Epilepsy

2021 ◽  
Vol 22 (12) ◽  
pp. 6282
Author(s):  
Gaku Yamanaka ◽  
Yu Ishida ◽  
Kanako Kanou ◽  
Shinji Suzuki ◽  
Yusuke Watanabe ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Small Sample Size ◽  
Interleukin 1 ◽  
Intractable Epilepsy ◽  
Evidence Base ◽  
Small Sample ◽  
Epilepsy Syndrome ◽  
Interleukin 1 Receptor Antagonist ◽  
Epileptic Syndromes ◽  
Systemic Symptoms

Febrile Infection-Related Epilepsy Syndrome (FIRES) is a unique catastrophic epilepsy syndrome, and the development of drug-resistant epilepsy (DRE) is inevitable. Recently, anakinra, an interleukin-1 receptor antagonist (IL-1RA), has been increasingly used to treat DRE due to its potent anticonvulsant activity. We here summarized its effects in 38 patients (32 patients with FIRES and six with DRE). Of the 22 patients with FIRES, 16 (73%) had at least short-term seizure control 1 week after starting anakinra, while the remaining six suspected anakinra-refractory cases were male and had poor prognoses. Due to the small sample size, an explanation for anakinra refractoriness was not evident. In all DRE patients, seizures disappeared or improved, and cognitive function improved in five of the six patients following treatment. Patients showed no serious side effects, although drug reactions with eosinophilia and systemic symptoms, cytopenia, and infections were observed. Thus, anakinra has led to a marked improvement in some cases, and functional deficiency of IL-1RA was indicated, supporting a direct mechanism for its therapeutic effect. This review first discusses the effectiveness of anakinra for intractable epileptic syndromes. Anakinra could become a new tool for intractable epilepsy treatment. However, it does not currently have a solid evidence base.

Negative effects of self-help materials: three explorative studies

2015 ◽  
Vol 8 ◽  
Author(s):  
Mark Papworth ◽  
Aileen Ward ◽  
Karen Leeson
Keyword(s):  
Best Practice ◽  
Clinical Presentation ◽  
Small Sample Size ◽  
Postal Survey ◽  
Small Sample ◽  
Small Scale ◽  
Structured Interviews ◽  
Negative Effects ◽  
Self Help ◽  
Training Need

AbstractWithin the field of adult mental health, self-help is now a pivotal treatment modality. However, earlier research indicates that some individuals react negatively to this. Through three, small-scale studies, this paper explores both clinicians’ experience of harm in patients as a response to self-help materials as well as patients’ own reports. In Study 1, a postal survey was administrated to clinicians; in Study 2, semi-structured interviews were conducted with clinicians; and in Study 3, patients were sent a postal survey. Over 18% of clinicians indicated that they had experienced self-help materials resulting in harm to patients. The interviews uncovered four main themes: the patients’ clinical presentation, how the materials were presented within the therapeutic contact, certain personality characteristics in patients, and the characteristics of some materials. Between 12% and 24% of patients reported experience of negative effects (depending upon how this is defined), although the latter finding is limited by a small sample size. Proposals are made that are linked to best practice and it is suggested that there is a generic training need for clinicians in materials’ use.

“It put control back onto my family situation”: family experiences of positive behaviour support

2019 ◽  
Vol 13 (3/4) ◽  
pp. 91-101 ◽  
Author(s):  
Sinead Botterill ◽  
Susan Cottam ◽  
Alex Fowke ◽  
Kate Theodore
Keyword(s):  
Young People ◽  
Best Practice ◽  
Small Sample Size ◽  
Family Relationship ◽  
Family Engagement ◽  
Small Sample ◽  
Support Network ◽  
Future Research ◽  
Content Type ◽  
Positive Behaviour Support

Purpose Positive behaviour support (PBS) is currently considered best practice for managing challenging behaviour in young people with intellectual and developmental disabilities. A key principle of PBS is that all members of the person’s support network participate in the assessment and intervention. It is, therefore, important to understand what factors act as facilitators or barriers to family engagement; however, research in this area is limited. The purpose of this paper is to conduct a novel piece of qualitative research analysis into experiences of family members of young people who have received family-based PBS. Design/methodology/approach Eight parents of a young person with an intellectual or developmental disability who had received PBS were interviewed about their experiences and factors they found helpful and hindering in terms of their engagement. Thematic analysis allowed a detailed and robust interpretation of the qualitative data. Findings Five superordinate themes were identified, namely, PBS is more than just strategies, considering the family context, the therapist/family relationship, acknowledging challenges and the ongoing nature of the problem and supporting family member change. Research limitations/implications Although research was rigorously conducted, the small sample size mean findings should be considered preliminary. Originality/value The literature related to family engagement in PBS is limited and largely based on the opinions of professionals. This study identified factors that parents themselves felt were helpful and hindering in terms of their engagement and offers practical suggestions for services and future research.

scholarly journals Nicotinamide as a Skin Whitener: Evidence and Controversies

2021 ◽  
pp. 300-305
Author(s):  
Nabeel K. Al Hamzawi
Keyword(s):  
Synergistic Effects ◽  
Small Sample Size ◽  
Small Sample ◽  
Sufficient Evidence ◽  
Double Blind ◽  
Whitening Agent ◽  
Electronic Search ◽  
Long Term Follow Up

Background: Topical nicotinamide (NAM) can reduce excessive melanin deposition in cell culture, by reversibly blocking the transfer of melanosomes from melanocytes to the adjacent keratinocytes. Thus, it has been increasingly used as a whitening agent. Objective: To assess the efficacy and safety of topical nicotinamide used for the treatment of melasma and hyperpigmentation. Methods: An electronic search for topical nicotinamide was carried out on Pubmed and Medline databases to identify studies that addressed this topic as a whitening agent. And to review the primary and secondary outcomes. Results: A significant decrease in hyperpigmentation and increased skin lightness was found with the use of topical nicotinamide, compared with the vehicle In two small sample size clinical studies. Combined regimens including nicotinamide and other ingredients offer more synergistic effects than monotherapy. Conclusion: Due to the lack of sufficient evidence, the use of nicotinamide for melasma remains controversial. Extended randomized, double-blind, placebo-controlled trials with long-term follow-up periods are needed to assess the efficacy of nicotinamide as a whitening agent. 

scholarly journals Relationship of Hospital Architecture to Nursing Staff Caring for Self, Caring for Patients, and Job Satisfaction

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Mary Ann Hozak ◽  
John Nelson ◽  
Debbie Gregory
Keyword(s):  
Job Satisfaction ◽  
Architectural Design ◽  
Care Delivery ◽  
Small Sample Size ◽  
Clinical Care ◽  
Small Sample ◽  
Care Staff ◽  
Care Recipient ◽  
Replication Studies ◽  
Nursing Health

Historically, the fields of architecture (design) and nursing (health) have been separate disciplines without much intersection. In recent years, the healthcare building boom has created a specialty practice for architects, focusing on healthcare design. With this new focus and specialty within architecture, the science of evidence-based design and the collaboration with clinical care staff have created a new partnership paradigm that is improving the built environment. Ten dimensions of caring have been espoused by Watson’s Caritas Theory to comprise the construct of caring, which in turn facilitates healing for both the care giver and care recipient (Nelson & Watson, 2012). This article describes a study that examined the relationship between selected elements of architectural design and other factors (recent architectural change, unit size and shape, intersecting hallways, number and proximity of bathrooms and supply rooms, availability of nourishment, number and availability of computers, and rooms for staff gathering, for solitude, and for practice of Watson Caring Factors) and outcomes of caring that are important to nursing, including clinical staff caring for self, caring for others, and job satisfaction. The study took place in a hospital that was implementing Watson’s concepts of caring within their framework of care delivery. Statistically significant relationships were: Caring for self was negatively related to number of supply rooms and number of Watson rooms or boxes. Caring for patients as reported by staff was negatively related to number of Watson rooms or boxes. Job satisfaction was positively related to number of bathrooms and negatively related to number of supply rooms. A small sample size required adjustment of the alpha to .15 and an effect size of .25, suggesting that replication studies with larger sample sizes may assist with development of a model of architecture that promotes behaviors as proposed by Watson and better outcomes for both patient and staff.

02 ‘Have you had the surgery?’: A survey of transgender and non-binary patients’ experiences of interacting with the ambulance service

2019 ◽  
Vol 36 (10) ◽  
pp. e2.2-e2
Author(s):  
Chloé Barley ◽  
Alec Tooms
Keyword(s):  
Best Practice ◽  
Small Sample Size ◽  
Demographic Data ◽  
Training Session ◽  
Small Sample ◽  
Ambulance Service ◽  
Free Text ◽  
Health Issues ◽  
Positive Experiences ◽  
Survey Responses

BackgroundPre-hospital research around the experience of transgender and non-binary (TNB) patients is scarce, with existing articles lacking input from TNB patients. This research aimed to collate TNB patients’ experiences of interacting with the ambulance service. A secondary aim was to gather TNB patients’ opinions regarding the education of ambulance clinicians on TNB health issues.MethodAn online-based, mixed-methods survey was created. A range of free text, multiple choice and Likert-scaled questions were used. Advertisement on social media was tailored to target TNB individuals who have had patient contact with the ambulance service. All respondents were anonymous and voluntary. This survey was conducted by TNB individuals in a personal capacity, without funding.Results72% of the 25 respondents rated their experience as satisfactory or above. 40% reported that identifying as TNB affected the way they were treated and 40% reported that they were asked about their gender by the ambulance crew. In free text answers, the main themes identified were the misidentification of gender, the use of incorrect pronouns, hospital handovers, intrusive/irrelevant questioning and the need for training.ConclusionsThe responses suggest that TNB patients feel that being asked about their gender is important however ambulance staff sometimes struggled to address this sensitively. Positive experiences included having gender and pronouns addressed in hospital handover which can form a recommendation for best practice. Negative experiences were associated with being misgendered, using incorrect pronouns and intrusive/irrelevant questioning. Survey responses led to practical recommendations for ambulance staff interacting with TNB patients, including the authors creating a training session which has received positive feedback from clinicians. Limitations include small sample size, potential for response bias due to survey being self-selecting and missing demographic data. Recommendations for further research are to provide a more in-depth exploration of TNB experience and of ambulance staff views.

62cuatsm and 62cuptsm PET is a useful imaging tool for hypoxia and perfusion in lung cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e22166-e22166
Author(s):  
Tian Zhang ◽  
Shiva K. Das ◽  
Jeffrey Crawford ◽  
Terence Wong ◽  
Mark W. Dewhirst ◽  
...  
Keyword(s):  
Pet Imaging ◽  
Lung Tumor ◽  
Imaging Techniques ◽  
Small Sample Size ◽  
Medical Center ◽  
Clinical Care ◽  
Tumor Hypoxia ◽  
Small Sample ◽  
Unique Challenge ◽  
Pet Scans

e22166 Background: Hypoxia is a characteristic of many tumors and portends a worse prognosis in lung, cervical, prostate, and rectal cancers. Unlike the others, lung cancers present a unique challenge in measuring hypoxia, with invasive biopsies and higher rates of complications. Noninvasive imaging studies detecting hypoxia using isotopes of copper-diacetyl-bis (N4-methylthiosemicarbazone), CuATSM, have predicted prognosis and treatment outcomes in some small feasibility trials. These images, however, may not identify all areas of hypoxia. Hence, we hypothesize that the addition of another positron emission tomography (PET) imaging agent, copper-pyruvaldehyde-bis (N4-methylthiosemicarbazone), 62CuPTSM, which can detect areas of perfusion, can augment the information obtained in 62CuATSM PET scans. Methods: In order to characterize tumors based on both perfusion and hypoxia, ten patients were studied using both 62CuATSM and 62CuPTSM PET scans. All patients signed informed consent; the protocol was approved by the Duke University Medical Center institutional review board. 62CuATSM and 62CuPTSM SUV values at steady state were tabulated and the ratios of 62CuATSM to 62CuPTSM calculated. In addition, proteomic arrays looking at specific proangiogenic, survival, and proinflammatory targets were assessed. Results: Six out of ten patients had fully evaluable PET scans. Our initial experience of characterizing lung tumor hypoxia using 62CuATSM/62CuPTSM PET scans showed that visualization of areas with hypoxia normalized for perfusion is feasible. All studied tumors exhibited some hypoxia. Despite the small sample size, a positive relationship was noted between serum epidermal growth factor (EGF) levels and 62CuATSM detected hypoxia. Conclusions: This initial series of 62CuATSM/62CuPTSM PET scans demonstrate that evaluating pulmonary lesions by visualizing hypoxia and perfusion is a feasible and novel technique to provide more information. Further investigation is warranted to assess the potential role of 62CuATSM and 62CuPTSM PET imaging techniques combined with proteomics as alternatives to invasive biopsy techniques in clinical care.

Feline musculoskeletal ageing: How are we diagnosing and treating musculoskeletal impairment?

2020 ◽  
Vol 22 (11) ◽  
pp. 1069-1083
Author(s):  
Nathalie Dowgray ◽  
Eithne Comerford
Keyword(s):  
Chronic Pain ◽  
Best Practice ◽  
Clinical Situation ◽  
Evidence Base ◽  
Degenerative Joint Disease ◽  
Visual Observation ◽  
Good Evidence ◽  
Joint Disease ◽  
High Prevalence ◽  
Central Stimulation

Practical relevance: An understanding of the process of musculoskeletal ageing – which all senior and geriatric cats will experience – is vital to maintaining the health and welfare of our ageing cat population. Clinical challenges: Assessment of the feline musculoskeletal system is not always straightforward. Diagnosis of impairment relies on input from owners and veterinarians in terms of visual observation, and clinical and orthopaedic examination, in addition to diagnostic imaging Audience: This review is written for the primary care veterinary team. Aims: The goals are to raise awareness and improve clinical diagnosis of musculoskeletal impairment as a result of ageing. The article also reviews therapeutic options and considers the evidence available for the prevention/deceleration of musculoskeletal ageing and impairment. Evidence base: There is good evidence of a high prevalence of osteoarthritis (OA) and degenerative joint disease (DJD) in older cats. There is also good evidence to indicate that functional impairment and chronic pain are sequelae of musculoskeletal disease. However, there is a paucity of information for what is best practice for the management and treatment of musculoskeletal impairment in a clinical situation. There is also a lack of evidence on how prevention of central stimulation of the nervous system caused by musculoskeletal impairment and, in turn the development of chronic pain, can be avoided.

Rapid tranquilization: new approaches in the emergency treatment of behavioral disturbances

2004 ◽  
Vol 19 (5) ◽  
pp. 243-249 ◽  
Author(s):  
Jürgen De Fruyt ◽  
Koen Demyttenaere
Keyword(s):  
Atypical Antipsychotics ◽  
Care Setting ◽  
Evidence Base ◽  
Small Sample ◽  
Emergency Psychiatry ◽  
Behavioral Disturbances ◽  
Treatment Regimens ◽  
Small Sample Sizes ◽  
Common Clinical Practice ◽  
Definition Of

AbstractPsychiatric emergencies are often accompanied by behavioral disturbances that interfere with normal assessment and call for immediate intervention. Different pharmacological treatment regimens have been used for this purpose. Most of these regimens are based upon common clinical practice and have limited evidence base. Recently, a major publication by experts in the field of emergency psychiatry has covered this topic and the therapeutic armamentarium has been extended with the atypical antipsychotics. However, research is still hampered by different methodological limitations: unclear definition of the agitated state and therapeutic goal, idiosyncratic measurement, small sample sizes. The perspective of the patient and the interaction between the emergency care setting and treatment regimen also need further attention. All these important, but often neglected issues are covered in a selective review of the literature.

scholarly journals Innovation strategies in CKD prevention and treatment – challenges, opportunities and sharing best practice

2019 ◽  
pp. 3-12 ◽  
Author(s):  
M. Kolesnyk
Keyword(s):  
Best Practice ◽  
Scientific Evidence ◽  
Clinical Care ◽  
Cognitive Disorders ◽  
Public Health Problem ◽  
Evidence Base ◽  
Adverse Outcomes ◽  
Global Public Health ◽  
Early Screening ◽  
Self Testing

Abstract. Chronic kidney disease (CKD) is a global public health problem, with cardiovascular disease being the major cause of mortality in these patients. CKD is associated with elevated risks of all-cause mortality and other adverse outcomes. This review is highlighting the consistency of the evidence about the hazards that are associated with CKD. The challenge that clinicians now face is to search for CKD, to manage it aggressively, to evaluate novel means of detecting CKD and to expand the therapeutic strategies for patients with CKD. The evidence base for informing effective kidney care is limited, and the translation of existing knowledge to routine clinical care is slow. Innovative approaches are described – patient-oriented care, complex care individualization, early screening for cognitive disorders, anxiety, renal education including education aids & e-Kidney application, teletechnology approach and CKD-self-testing in rural area, novel therapeutic targets for innovative CKD-oriented drugs, etc. Trials with the aim of re-purposing of generic therapeutics should be prioritized if sufficient scientific evidence is available. Furthermore, strategies used to extend patent life of drugs, but without investment to assess re-purposing, should be discouraged. Finally, if the above goals are achieved, new therapies will certainly become available to stop, slow, or reverse CKD. These therapies should be made accessible to populations around the globe.

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