Improving an Aromatherapy Program by Implementing an Evidence-based Clinical Guideline Using Empowered Holistic Nursing Education

A home care agency provided a program for nurse delivered essential oil aromatherapy. Little documentation of the utilization of essential oils in client care was found two years after initial implementation. The aromatherapy program lacked clear guidance on how to apply the six stages of the home care nursing process. The Project Lead wrote an Evidence-Based Clinical Guideline for the home care agency Aromatherapy Program, including all six stages of the nursing process. Empowered Holistic Nurse Education theory guided the creation of nurse education materials to teach nurses to use the clinical guideline. Components of the nurse education theory were paired with the stages of rapid cycle quality improvement, Plan, Do, Study, Act. Improvement in the rate of documentation of the program indicated the project was successful with all participating homes achieving better than zero times of documentation per week and improved nurse scores on a Pre- and Post- Test of aromatherapy knowledge. Difficulties with implementation included lack of training time outside of regular duties and accessing online materials. A finding from the Pre- and Post-Implementation Surveys was an increase in nurses’ perceived authority to implement evidence-based practice change. Nurse education theory is useful for nurse leaders who want to promote changes in nursing practice. Teaching and learning circles of nurses in practice co-create quality improvements in patient care. Empowered nurses contribute practice-based evidence to evidence-based practice. Areas for further study include engaging nurses in the forty to sixty-year-old demographic and working with clients who have their own aromatherapy practices

Economic empowerment of women displaced by conflict requires transformative change

People displaced by conflict want and need to earn money and to provide for their families. In her recent research Zeynep Kaya uncovered the varied experiences of refugee and internally displaced women in the Kurdistan Region of Iraq, and calls for an holistic approach to improving their chances of economic empowerment

What now?: Daily life with chronic graft versus host disease

Norge har en stadig økende befolkningsvekst, og antall mennesker som får en kreftdiagnose er dermed også økende. Grunnet stadig ny behandling og forskning er det flere og flere som overlever kreftsykdom. Denne litteraturstudien vil se nærmere på hvordan pasienter med kGVHD opplever hverdagen etter å ha gjennomgått allogen stamcelletransplantasjon og alvorlig kreftsykdom. Målet er å få en bedre innsikt i hvilke erfaringer, utfordringer og behov denne pasientgruppen har. Problemstilling: “Hvordan påvirker kronisk GVHD hverdagen for pasienter som har gjennomgått. Data fra forskningsartiklene viste at det var flere faktorer som påvirket pasientenes hverdag. Resultatene ble samlet under tre hovedtema: Depresjon og angst, tretthet og fatigue, og begrensninger i hverdagen. Selv om pasienten blir erklært kreftfri etter BMT, kan det være vanskelig å tilpasse seg hverdagen igjen, spesielt for dem som er mye plaget av kGVHD. Fysisk aktivitet og psykologisk støtte kan være til god hjelp for å dempe pasientens plager, men dette er ikke tiltak som kan kurere bivirkningene av kGVHD. Alt i alt viser studien at det er mange faktorer som kan bidra til redusert livskvaliteten i hverdagen til pasienter som har gjennomgått allogen BMT

In what ways do emerging adults with substance use problems experience their communities as influencing their personal recovery processes?

Applying the multiple psychological sense of community concept (MPSOC), this study explored how emerging adults with substance use problems experience the influences of various senses of community and communities on their personal recovery processes. Semi-structured interviews with 21 emerging adults from different urban contexts in Norway were analysed using a collaborative, seven-step, deductive, and reflexive thematic approach. MPSOC is shown to be a key concept for achieving a broad, in-depth understanding of emerging adults' senses of community and personal experiences of community influences on recovery processes from substance use. Positive and negative senses of community in geographical, relational, substance use-related and ideal communities influence the potentials and challenges in emerging adults' recovery processes. Supportive and motivating community relationships, meaningful activities with peers, and distance from recovery-impeding communities were identified as important recovery components. To promote recovery and prevent substance use in emerging adults, community approaches and tools applied in substance use treatment have to take into account and utilise multidimensional and age group-specific aspects of belonging.publishedVersio

Pre-admission interventions to improve outcome after elective surgery-protocol for a systematic review

BACKGROUND: Poor physical health and fitness increases the risk of death and complications after major elective surgery. Pre-admission interventions to improve patients’ health and fitness (referred to as prehabilitation) may reduce postoperative complications, decrease the length of hospital stay and facilitate the patient’s recovery. We will conduct a systematic review of RCTs to examine the effectiveness of different types of prehabilitation interventions in improving the surgical outcomes of patients undergoing elective surgery. METHODS: This review will be conducted and reported according to the Cochrane and PRISMA reporting guidelines. MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, ISI Web of Science and clinical trial registers will be searched for any intervention administered before any elective surgery (including physical activity, nutritional, educational, psychological, clinical or multicomponent), which aims to improve postoperative outcomes. Reference lists of included studies will be searched, and grey literature including conference proceedings, theses, dissertations and preoperative assessment protocols will be examined. Study quality will be assessed using Cochrane’s risk of bias tool, and meta-analyses for trials that use similar interventions and report similar outcomes will be undertaken where possible. DISCUSSION: This systematic review will determine whether different types of interventions administered before elective surgery are effective in improving postoperative outcomes. It will also determine which components or combinations of components would form the most effective prehabilitation intervention. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD4201501919

Relative toxicity of benzodiazepines and hypnotics commonly used for self-poisoning:an epidemiological study of fatal toxicity and case fatality

The relative toxicity of anxiolytic and hypnotic drugs commonly used for self-poisoning was assessed using data on suicides, prescriptions and non-fatal self-poisonings in England, 2005-2012. Data on suicide by self-poisoning were obtained from the Office for National Statistics (ONS), information on intentional non-fatal self-poisoning was derived from the Multicentre Study of Self-harm in England and data on prescriptions in general practice from the Clinical Practice Research Datalink (CPRD). We used two indices of relative toxicity: fatal-toxicity (the number of fatal self-poisonings relative to the number of individuals prescribed each drug) and case-fatality (the number of fatal relative to non-fatal self-poisonings). Diazepam was the reference drug in all analyses. Temazepam was 10 times (95% CI 5.48-18.99) and zopiclone/zolpidem nine times (95% CI 5.01-16.65) more toxic in overdose than diazepam (fatal-toxicity index). Temazepam and zopiclone/zolpidem were 13 (95% CI 6.97-24.41) and 12 (95% CI 6.62-22.17) times more toxic than diazepam, respectively (case-fatality index). Differences in alcohol involvement between the drugs were unlikely to account for the findings. Overdoses of temezepam and zopiclone/zolpidem are considerably more likely to result in death than overdoses of diazepam. Practitioners need to exercise caution when prescribing these drugs, especially for individuals who may be at risk of self-harm, and also consider non-pharmacological options

BRCA2 polymorphic stop codon K3326X and the risk of breast, prostate, and ovarian cancers

Background: The K3326X variant in BRCA2 (BRCA2*c.9976A>T; p.Lys3326*; rs11571833) has been found to be associated with small increased risks of breast cancer. However, it is not clear to what extent linkage disequilibrium with fully pathogenic mutations might account for this association. There is scant information about the effect of K3326X in other hormone-related cancers. Methods: Using weighted logistic regression, we analyzed data from the large iCOGS study including 76 637 cancer case patients and 83 796 control patients to estimate odds ratios (ORw) and 95% confidence intervals (CIs) for K3326X variant carriers in relation to breast, ovarian, and prostate cancer risks, with weights defined as probability of not having a pathogenic BRCA2 variant. Using Cox proportional hazards modeling, we also examined the associations of K3326X with breast and ovarian cancer risks among 7183 BRCA1 variant carriers. All statistical tests were two-sided. Results: The K3326X variant was associated with breast (ORw = 1.28, 95% CI = 1.17 to 1.40, P = 5.9x10- 6) and invasive ovarian cancer (ORw = 1.26, 95% CI = 1.10 to 1.43, P = 3.8x10-3). These associations were stronger for serous ovarian cancer and for estrogen receptor–negative breast cancer (ORw = 1.46, 95% CI = 1.2 to 1.70, P = 3.4x10-5 and ORw = 1.50, 95% CI = 1.28 to 1.76, P = 4.1x10-5, respectively). For BRCA1 mutation carriers, there was a statistically significant inverse association of the K3326X variant with risk of ovarian cancer (HR = 0.43, 95% CI = 0.22 to 0.84, P = .013) but no association with breast cancer. No association with prostate cancer was observed. Conclusions: Our study provides evidence that the K3326X variant is associated with risk of developing breast and ovarian cancers independent of other pathogenic variants in BRCA2. Further studies are needed to determine the biological mechanism of action responsible for these associations

Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders.

Irritable bowel syndrome (IBS) results from disordered brain-gut interactions. Identifying susceptibility genes could highlight the underlying pathophysiological mechanisms. We designed a digestive health questionnaire for UK Biobank and combined identified cases with IBS with independent cohorts. We conducted a genome-wide association study with 53,400 cases and 433,201 controls and replicated significant associations in a 23andMe panel (205,252 cases and 1,384,055 controls). Our study identified and confirmed six genetic susceptibility loci for IBS. Implicated genes included NCAM1, CADM2, PHF2/FAM120A, DOCK9, CKAP2/TPTE2P3 and BAG6. The first four are associated with mood and anxiety disorders, expressed in the nervous system, or both. Mirroring this, we also found strong genome-wide correlation between the risk of IBS and anxiety, neuroticism and depression (rg > 0.5). Additional analyses suggested this arises due to shared pathogenic pathways rather than, for example, anxiety causing abdominal symptoms. Implicated mechanisms require further exploration to help understand the altered brain-gut interactions underlying IBS