Effectiveness of the “Person First – Please” educational intervention for nurses in older people long-term care –protocol for a cluster RCT v1

Aim. To evaluate effectiveness of “Person First –Please” (PFP) intervention in supporting nurses’ collective competence in Person-centred Care (PCC) in Long-Term Care (LTC) of older people. Design. Cluster randomised controlled trial. Methods. Intervention group comprising nurses working on older people LTC will receive PFP Continuing Education (CE) intervention; control group will work as usual. The primary outcomes are nurses’ individual PCC competence and intervention’s effectiveness for collective competence. Secondary outcomes are PCC climate as perceived by nurses, residents and their families. Measurements are conducted three times (baseline, after PFP intervention and after 6-week follow-up) in both groups. Results. The study will provide evidence of PFP’s effectiveness and its influence on PCC climate of older people LTC. If effective, the educational intervention can be used to improve PCC and quality care for older people. Keywords Person-centred care, older people, long-term care, intervention, continuing education, collective competence

Implementation of evidence-based practices in the perineal pain management in the postpartum period

ABSTRACT Objectives: To implement strategies for managing perineal pain in puerperal women admitted to a public maternity hospital in São Paulo state and to evaluate their compliance with evidence-based practices. Methods: Implementation study using the JBI model conducted with nursing professionals and puerperal women between September and December 2019. Interviews with puerperal women and medical record data were used to audit seven evidence-based criteria. The interventions adopted included a care protocol, professional training, and folder elaboration for puerperal women. Results: Prior to the intervention, deficits in audited practices and obstacles to pain management were identified, which were overcome by the strategies employed. The follow-up audit demonstrated improvements in compliance with best care practices. Conclusion: There was an increase in the criteria compliance evaluated after the implemented strategies, contributing to improving the nursing care results in the perineal pain management based on the best scientific evidence.

Mobile pre-hospital care reorganization during the COVID-19 pandemic: experience report

ABSTRACT Objective: To describe the reorganization of Belo Horizonte’s Mobile Emergency Care Service during the new coronavirus pandemic using the Plan Do-Check-Act quality tool. Methods: Descriptive study, of the experience report type, on the reorganization of care in a mobile pre-hospital care service during the new coronavirus pandemic, from March to July 2020. The Plan-Do-Check-Act quality tool was applied for the process. Results: Preparation of care protocol, meetings, training, addition of ambulances, hiring of professionals, and other actions were carried out, with subsequent evaluation and monitoring. When failures or new needs were identified, actions and changes were implemented while keeping monitoring and evaluation during the work routine. Final considerations: The reorganization of the service through the construction of a protocol and using the Plan-Do-Check-Act as a management tool was essential to promote safe care for professionals and patients.

Application of a Nursing Care Protocol Based on King's Theory of Goal Attainment: a Pre-Experimental Study

Objective: Peripheral Intravenous catheterization is a common clinical procedure that demands a high level of nursing competency. This study intends to assess the effect of nursing care protocol for peripheral intravenous therapy on knowledge and practice of registered nurses and the association between pretest knowledge scores and selected socio-demographic variables using King’s conceptual framework and Goal Attainment Theory. Methodology: One group- pretest-posttest design, was used with self - reports and observation methods to collect knowledge and practice data from 30 registered nurses selected by simple random sampling (lottery method). Structured questionnaire and checklist based on personal, interpersonal, and social system of king’s conceptual system was used to assess the knowledge and practice of registered nurses, respectively. Results: Even though 30% of the nurses had attended previous continuing education on peripheral intravenous therapy, only 3.3% had very good knowledge. There was a significant difference in the knowledge and practice after implementation of the nursing care protocol. The pre-test knowledge scores have association with attendance in previous continuing nursing education. Conclusion: Study findings reveals the advantages of protocol development and improved knowledge and practice of nurses, which in turn obviously increase the health status of the patients and quality index of the hospital. Recommendation: The novice nurses can be educated on the protocol as a hospital policy enhancing the effectiveness of nursing care. Its implication can be evaluated using nursing audit at periodic intervals. Keywords: King’s conceptual framework, Goal Attainment Theory, nursing care protocol, peripheral intravenous therapy, knowledge, and practice.

The use of metronidazole in adult dogs with acute onset, uncomplicated, diarrhoea

PICO question In adult, non-geriatric, dogs with acute onset (<7 days duration) uncomplicated diarrhoea does the addition of metronidazole to a supportive care protocol such as dietary modification or probiotics (excluding other antimicrobials) reduce the time to resolution of diarrhoea compared to supportive care protocols alone? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Four studies were included in this appraisal. Two prospective, double blinded, placebo controlled clinical trials, one prospective treatment trial and one retrospective longitudinal observational study Strength of evidence Weak Outcomes reported One study found a shortened duration of clinical signs (by 1.5 days; p = 0.04) in the metronidazole treated group compared to control. However, a separate study found no significant difference between control and metronidazole groups in the regards to resolution of clinical signs. One study demonstrated a long standing (>28 day) negative impact of metronidazole treatment on gut microbiome with no difference in time to resolution of clinical signs when compared with faecal matter transplant Conclusion The current evidence for the superiority of metronidazole compared to supportive treatment alone is weak and at this time there is no evidence-based rationale for its use in cases of uncomplicated, acute, canine diarrhoea. Furthermore, the negative implications of metronidazole on the intestinal microbiome have been found to be long standing (>28 days as a minimum) and should not be discounted by the prescribing clinician How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Quimioterapia adjuvante para o tratamento do câncer de ovário e o cuidado farmacêutico: uma revisão integrativa

Este estudo teve como objetivo analisar os tratamentos quimioterápicos adjuvantes que vêm sendo adotados para o tratamento do câncer de ovário. Bem como, propor estratégias que podem ser adotadas para o cuidado farmacêutico a este paciente. Inicialmente, foi buscado os artigos na plataforma Capes, sendo incluídos artigos revisados por pares, publicados entre 2016 a 2021 e utilizado os seguintes termos: “pharmaceutical care protocol and câncer ovary and chemotherapy adjuvante”. Foram encontrados 125 artigos e procedeu a leitura dos títulos e resumos, sendo que somente 10 artigos tiveram relação com o tema do trabalho e 7 trabalhos foram incluídos no estudo. Estes artigos, os pacientes faziam a quimioterapia convencional associado a bevacizumabe, indol-3-carbinol, epigalocatequina-3-galato, pegfilgrastin e/ou filgrastin, vígil, lisado de tumor oxidado autólogo (OC-DC) e vacina de dez peptídeos (PEP-DC), everolimo e letrozol. Os estudos demonstraram respectivamente: aumento da sobrevida livre de doença, porém é necessário mais estudos devido algumas controversas; ausência de toxicidade que exigisse alteração no regime de terapia padrão; que ao pacientes com maior pontuação de AIVD tem maior probabilidade de completar 4 ciclos de quimioterapia e menos probabilidade de apresentar toxicidade de grau 3 ou superior; melhora da resposta imune; a segurança, bem como alteração na sobrevida; uma taxa de PFS promissora, sendo que 47% teve 12 semanas e toxicidade leve. Também, o desenvolvimento de formulação Nanopartículas de Paclitaxel-LDE (lipídeos não proteicos- PTX-LDE) levou uma melhora na resposta para o câncer de ovário. O papel do farmacêutico na equipe multiprofissional é muito importante, pois envolve o acompanhamento clínico do paciente, a prevenção de agravos a saúde da equipe devido a exposição aos quimioterápicos, a manipulação dos fármacos e detecção dos problemas relacionados aos medicamentos. Em síntese, ainda são escassos os estudos que visem a busca de alternativas terapêuticas mais eficazes para o tratamento do câncer de ovário.

Are Differences in Dysphagia Assessment, Oral Care Provision, or Nasogastric Tube Insertion Associated with Stroke-Associated Pneumonia? A Nationwide Survey Linked to National Stroke Registry Data

<b><i>Introduction:</i></b> Stroke-associated pneumonia (SAP) is a common complication associated with poor outcomes. Early dysphagia screening and specialist assessment is associated with a reduced risk of SAP. Evidence about oral care and nasogastric tube (NGT) placement is equivocal. This study aimed to expose variations in dysphagia management practices and explore their associations with SAP. <b><i>Participants and Methods:</i></b> Speech pathologists from 166 stroke units in England and Wales were surveyed about dysphagia assessment and management, oral care, and NGT placement. Survey data were then linked to the Sentinel Stroke National Audit Programme (SSNAP), the national register of stroke. Univariable and multivariable linear regression models were fitted to estimate the association between dysphagia management practices and SAP incidence. <b><i>Results:</i></b> 113 hospitals completed the survey (68%). Variation was evident in dysphagia screening protocols (DSPs), oral care, and NGT practice while specialist swallow assessment data patterns were more consistent. Multivariable analysis showed no evidence of an association in incidence of SAP when using a water-only hospital DSP compared to a multiconsistency DSP (B −0.688, 95% CI: −2.912 to 1.536), when using written swallow assessment guidelines compared to not using written guidelines (B 0.671, 95% CI: −1.567 to 2.908), when teams inserted NGTs overnight compared to teams which did not (B −0.505, 95% CI: −2.759 to 1.749), and when teams had a written oral care protocol compared to those which did not (B −1.339, 95% CI: −3.551 to 0.873). <b><i>Discussion and Conclusion:</i></b> Variation exists in dysphagia screening and management, but there was no evidence of an association between clinical practice patterns and incidence of SAP. Further research with larger sample sizes is needed to examine association with SAP.

Maternal and Child Healthcare Service by Portable Health Clinic System Using a Triage Protocol

The number of deaths of a mother and child caused by maternal and child healthcare (MCH) issues has been greatly decreased recently, but still, the number is extremely high especially in developing countries. Although the governments have been given a priority in this issue, the lack of financial and human resources brings a limit. Thus, the use of low-cost but appropriate technology is required. Portable Health Clinic (PHC), a telemedicine system developed for providing primary healthcare, is such a technology. This study aimed to address this MCH issue with the aid of a low-cost PHC service involving a continuum-of-care protocol to the rural communities of Bangladesh. Moreover, this study introduces a triage protocol to distinguish high-risk patients from the early stage of the continuum of care who need special care and refer to specialized physicians to prevent unwanted deaths.

Efficacy of a multidisciplinary care protocol for the treatment of operated hip fracture patients

To assess the effects of a multidisciplinary care protocol on cost, length of hospital stay (LOS), and mortality in hip-fracture-operated patients over 65 years. Prospective cohort study between 2011 and 2017. The unexposed group comprised patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. Variables analyzed were demographics, medical comorbidities, treatment, blood parameters, surgical delay, LOS, re-admissions, mortality, and a composite outcome considering in-hospital mortality and/or LOS > 10 days. We performed a Poisson regression and cost analysis. The cohort included 681 patients: 310 unexposed and 371, exposed. The exposed group showed a shorter surgical delay (3.0 vs. 3.6 days; p < 0.001), and a higher proportion received surgery within 48 h (46.1% vs. 34.2%, p = 0.002). They also showed lower rates of 30-day readmission (9.4% vs. 15.8%, p = 0.012), 30-day mortality (4.9% vs. 9.4%, p = 0.021), in-hospital mortality (3.5% vs. 7.7%; p = 0.015), and LOS (8.4 vs. 9.1 days, p < 0.001). Multivariable analysis showed a protective effect of the protocol on the composite outcome (risk ratio 0.62, 95% CI 0.48–0.80, p < 0.001). Hospital costs were reduced by EUR 112,153.3. A multidisciplinary shared care protocol was associated with a reduction in the LOS, surgical delay, 30-day readmissions, and in-hospital and 30-day mortality, in hip-fracture-operated patients.