What is the Effect of Frequent Basic Life Support Refresher Sessions on Health Care Professionals’ Retention of Cardiopulmonary Resuscitation Skills? A Systematic Review

Abbreviations: AED, Automated External Defibrillator; AHA, American Heart Association; BLS, Basic Life Support; CPR, Cardiopulmonary Resuscitation; EBL, Evidence Based Librarianship; IDG, Instructor Directed Group; NHMRC, National Health and Medical Research Council; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta- Analyses; RCT, Randomised Control Trial; RFST, Repetitive Sessions of Formative Self Testing; RFSTAP, Repetitive Sessions of Formative Self Testing with Additional Practice ROSC, Return of Spontaneous Circulation; SDG, Student Directed Group. Abstract Background: Cardiopulmonary resuscitation training is currently provided to health care professionals at biannual intervals to meet mandatory recertification in accordance with guidelines.  However, literature reports that resuscitation skills decline rapidly and sometimes long before recertification. Inadequate CPR may result in a decrease in the incidence of achieving return of spontaneous circulation and other devastating outcomes. Good quality training and education in cardiopulmonary resuscitation is paramount to patient survival. Brief refresher sessions may prevent skill decay among health care professionals, improving skill retention over time and improving patient outcomes. Objective: The aim of this systematic review is to determine the effect of frequent basic life support refresher sessions on health care professionals’ retention of cardiopulmonary resuscitation skills. Methods: A systematic review using narrative analysis was completed.  A database search was conducted to identify relevant studies for inclusion.  Databases searched include Medline, Embase, CINAHL and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the review. Results: Ten of the 11 studies in this paper concluded that basic life support refresher sessions may increase retention of cardiopulmonary resuscitation skills.  Two of the included studies discussed self-perceived confidence as a secondary outcome.  One of these two studies demonstrated a significant correlation between higher self-confidence and improved retention of cardiopulmonary resuscitation skills. Conclusion: Basic life support refresher sessions can have a positive impact on cardiopulmonary resuscitation skill retention among health care professionals.  However, the most effective method of delivering refresher sessions must be further clarified.  The optimal duration of these sessions as well as the optimal timing of delivering these sessions also requires further clarification through further research

Ethical considerations for the nursing care of Transgender patients in the Intensive Care Unit

There is more discussion than ever surrounding the health and care needs of Transgender communities. However, there is limited research on the care of Transgender patients in the Intensive Care Unit which can contribute to knowledge gaps, inconsistencies and uncertainties surrounding health care practices. This article is not intended to address all of the specific needs of Transgender patients in ICU, but to explore the ethical considerations for caring for a Transgender woman in the ICU. In doing so, this article will explore some specific considerations around gender affirming care, challenging discrimination, physiological changes, and systems change to enhance care.Update citation details during checkdate report - RO

Caring for Transgender patients in the ICU: Current insights for equitable care

There is ever more focus on issues surrounding Transgender/Trans people and their healthcare needs, and while there is a dearth of evidence related to Intensive Care, this paper aims to address considerations for ICU nurses when caring for Trans patients. These include both the overall approach to person-centred care for Trans patients as well as the physiological considerations that necessitate nursing interventions. The term Trans is an umbrella term which refers to a person whose gender identity differs from the biological sex they were assigned at birth. Not everybody ascribes to a gender identity which is either male, nor female; people who identify outside of this binary might be described as Non-Binary or a number of other terms. Further terminology is outlined in Table 1

Ethical Considerations in Caring for Transgender Patients in Acute and Critical Care: Bridging Knowledge Gaps and Promoting Inclusive Practices

The 2024 Transcare Conference, University College Cork, Ireland, 13 September 2024In recent years, there has been a growing discourse on the healthcare needs of transgender communities. Despite this, there remains a paucity of research concerning the care of transgender patients within the Intensive Care Unit (ICU) or wider acute settings, resulting in significant knowledge gaps, inconsistencies, and uncertainties in healthcare practices. This presentation aims to address the ethical considerations inherent in caring for transgender patients, particularly focusing on the ICU setting. The discussion will primarily revolve around highlighting key ethical considerations that healthcare professionals must navigate. While the presentation does not aim to comprehensively cover all specific needs of transgender patients in the ICU, it endeavors to explore ethical dimensions crucial for delivering quality care to this population. One of the central themes to be explored is gender-affirming care. Providing transgender patients with care that respects and validates their gender identity is paramount for their well-being and recovery. Additionally, the presentation will delve into the ethical imperative of challenging discrimination within healthcare settings, ensuring that transgender patients receive equitable treatment and are shielded from bias and prejudice. Furthermore, the physiological changes experienced by transgender individuals, particularly those undergoing hormone therapy or gender-affirming surgeries, pose unique challenges in critical care management. Understanding these physiological intricacies is crucial for tailoring care plans and optimising patient outcomes. Moreover, the presentation will underscore the necessity of systemic changes within healthcare institutions to enhance the provision of care to transgender patients. This involves implementing policies and protocols that foster inclusivity, sensitivity, and cultural competence among healthcare providers. By centring the ethical dimensions of caring for transgender patients in acute and critical care settings, the presentation hopes to stimulate dialogue, raise awareness, and promote the adoption of inclusive practices within the healthcare community. By addressing these ethical considerations, healthcare professionals can strive towards providing transgender patients with the dignified, respectful, and compassionate care they deserve in the ICU and beyond

Dietary nitrate and diet quality: An examination of changing dietary intakes within a representative sample of Australian women

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. Dietary nitrate is increasingly linked to a variety of beneficial health outcomes. Our purpose was to estimate dietary nitrate consumption and identify key dietary changes which have occurred over time within a representative sample of Australian women. Women from the 1946–1951 cohort of the Australian Longitudinal Study on Women’s Health with complete food frequency questionnaire data for both 2001 and 2013 were included for analysis. Dietary nitrate intakes were calculated using key published nitrate databases. Diet quality scores including the Australian Recommended Food Score, the Mediterranean Diet Score and the Nutrient Rich Foods Index were calculated along with food group serves as per the Australian Dietary Guidelines. Wilcoxon matched pairs tests were used to test for change in dietary intakes and Spearman’s correlations were used to examine associations. In our sample of 8161 Australian women, dietary nitrate intakes were on average 65–70 mg/day, and we detected a significant increase in dietary nitrate consumption over time (+6.57 mg/day). Vegetables were the primary source of dietary nitrate (81–83%), in particular lettuce (26%), spinach (14–20%), beetroot (10–11%), and celery (7–8%) contributed primarily to vegetable nitrate intakes. Further, increased dietary nitrate intakes were associated with improved diet quality scores (r = 0.3, p < 0.0001). Although there is emerging evidence indicating that higher habitual dietary nitrate intakes are associated with reduced morbidity and mortality, future work in this area should consider how dietary nitrate within the context of overall diet quality can facilitate health to ensure consistent public health messages are conveyed

Culturally responsive, trauma-informed, continuity of care(r) toolkits: A scoping review

Background: Models of care that are culturally responsive, trauma-informed and provide continuity of care(r), are important components of care for Aboriginal and Torres Strait Islander parents during the broad perinatal period (pregnancy to 2 years after birth; first 1000 days). Many health services do aim to incorporate these concepts in care provision, but often focus on only one. Aim: To identify practical toolkits that guide implementation of culturally responsive care, trauma-informed care, or continuity of care(r) in the perinatal period, and map the key elements. Methods: A scoping review was conducted. Relevant databases and grey literature were searched to identify toolkits that guided implementation of any one of the aforementioned concepts in the perinatal period. Toolkit context, principles, core components and processes were extracted and synthesised. Findings: Thirteen toolkits, from both Indigenous and non-Indigenous contexts, met the inclusion criteria. Six related to culturally responsive care, nine to trauma-informed care, and eight to continuity of care(r), with some overlap. Key principles included continuity of carer, collaboration, woman (or family) centred care, safety and holistic care. Individualised care, team work, having a safe service environment and continuity of care/r were highlighted as core components. Key processes related to planning, implementation, monitoring and evaluation, and sustainability. Discussion: There are no available resources that support holistic implementation of all three concepts of culturally responsive, trauma-informed continuity of care(r), spanning the first 1000 days, for Aboriginal and Torres Strait Islander families. A synthesised toolkit of key principles, core components and key processes would assist implementation of this. Statement of significance: Problem: Aboriginal and Torres Strait Islander families experience health inequalities and poorer perinatal outcomes due to a legacy of colonisation and ongoing discrimination. What is already known: Culturally responsive care, trauma-informed care and continuity of care(r) are elements of perinatal care shown to improve outcomes and experiences. What this paper adds: This review synthesises key aspects of culturally responsive, trauma-informed and continuity of care(r) models. It highlights the lack of resources to support services implementing models pertaining to these three concepts across the full First 1000 days, for Aboriginal and Torres Strait Islander families

Dietary nitrate and diet quality: An examination of changing dietary intakes within a representative sample of Australian women

Dietary nitrate is increasingly linked to a variety of beneficial health outcomes. Our purpose was to estimate dietary nitrate consumption and identify key dietary changes which have occurred over time within a representative sample of Australian women. Women from the 1946–1951 cohort of the Australian Longitudinal Study on Women’s Health with complete food frequency questionnaire data for both 2001 and 2013 were included for analysis. Dietary nitrate intakes were calculated using key published nitrate databases. Diet quality scores including the Australian Recommended Food Score, the Mediterranean Diet Score and the Nutrient Rich Foods Index were calculated along with food group serves as per the Australian Dietary Guidelines. Wilcoxon matched pairs tests were used to test for change in dietary intakes and Spearman’s correlations were used to examine associations. In our sample of 8161 Australian women, dietary nitrate intakes were on average 65–70 mg/day, and we detected a significant increase in dietary nitrate consumption over time (+6.57 mg/day). Vegetables were the primary source of dietary nitrate (81–83%), in particular lettuce (26%), spinach (14–20%), beetroot (10–11%), and celery (7–8%) contributed primarily to vegetable nitrate intakes. Further, increased dietary nitrate intakes were associated with improved diet quality scores (r = 0.3, p \u3c 0.0001). Although there is emerging evidence indicating that higher habitual dietary nitrate intakes are associated with reduced morbidity and mortality, future work in this area should consider how dietary nitrate within the context of overall diet quality can facilitate health to ensure consistent public health messages are conveyed

Multiethnic meta-analysis identifies ancestry-specific and cross-ancestry loci for pulmonary function

Nearly 100 loci have been identified for pulmonary function, almost exclusively in studies of European ancestry populations. We extend previous research by meta-analyzing genome-wide association studies of 1000 Genomes imputed variants in relation to pulmonary function in a multiethnic population of 90,715 individuals of European (N = 60,552), African (N = 8429), Asian (N = 9959), and Hispanic/Latino (N = 11,775) ethnicities. We identify over 50 additional loci at genome-wide significance in ancestry-specific or multiethnic meta-analyses. Using recent fine-mapping methods incorporating functional annotation, gene expression, and differences in linkage disequilibrium between ethnicities, we further shed light on potential causal variants and genes at known and newly identified loci. Several of the novel genes encode proteins with predicted or established drug targets, including KCNK2 and CDK12. Our study highlights the utility of multiethnic and integrative genomics approaches to extend existing knowledge of the genetics of l

Pressure ulcers in patients with COVID ‐19 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: a pre‐ and post‐intervention study

Background: Prone positioning has been widely used to improve oxygenation and reduce ventilator‐induced lung injury in patients with severe COVID‐19 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs). Aim: This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID‐19 ARDS undergoing prone positioning in the intensive care unit. Study Design: This was a single‐centre pre and post‐test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs. Results: In the pre‐intervention study, 20 patients were included and 80% (n = 16) of these patients developed PUs, comprising 34 ulcers in total. In the post‐intervention study, a further 20 patients were included and 60% (n = 12) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, n = 22; 88%, n = 28, respectively). In the post‐intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre‐intervention 6%, n = 2 grade III, 6% n = 2 deep tissue injuries; post‐intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post‐intervention group with 6% (n = 2) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre‐intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries). Conclusion: The use of a new evidence‐based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings. Relevance to Clinical Practice: The use of a new, evidence‐based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs