Essential elements nurses have to address to promote a safe discharge in paediatrics: A systematic review and narrative synthesis

Aim: The aim of the study was to synthesize the evidence on the essential elements, nurses must address when they perform therapeutic education to patients and their caregivers to promote a safe paediatric hospital-to-home discharge. Design: A systematic review and narrative synthesis. Methods: The search strategy identifies studies published between 2016 and 2023. The quality of the included studies was assessed using the Critical Appraisal Skills Programme checklists. The protocol of this review was not registered. A search of three electronic databases (PubMed, CINAHL and Web of Science) and a search in the reference lists of the included studies was conducted in February 2021 and June 2023. Results: Fifteen studies met the inclusion criteria. The essential elements identified are grouped into the following topics: emergency management, physiological needs, medical device and medications management, long-term management and short-term management. Nurses have a critical role in ensuring patient safety and quality of care, and the nurses' competence makes the difference in the discharge's related outcomes. Our results can help the nursing profession implement comprehensive discharge projects. Our results support the improvement of nurse-led paediatric discharge programmes. Nurse managers can identify the grey areas of therapeutic education provided in their units and work for their improvement. Following the implementation of therapeutic education on these topics, measuring the discharge's related outcomes could be interesting. This study addresses the problem of managing a safe and efficient nurse-led discharge in a paediatric setting. It presents evidence on the essential elements to promote a safe paediatric discharge at home. These could impact nursing practice by using them to implement project and discharge pathways. We have adhered to relevant EQUATOR guidelines—PRISMA guidelines for reporting systematic review. No patients, service users, caregivers or public members were involved in this study due to its nature (systematic review)

Acute carpal tunnel syndrome: early nerve decompression and surgical stabilization for bony wrist trauma

Background We undertook this study to investigate the outcomes of surgical treatment for acute carpal tunnel syndrome following our protocol for concurrent nerve decompression and skeletal stabilization for bony wrist trauma to be undertaken within 48-hours. Methods We identified all patients treated at our trauma centre following this protocol between 1 January 2014 and 31 December 2019. All patients were clinically reviewed at least 12 months following surgery and assessed using the Brief Michigan Hand Outcomes Questionnaire (bMHQ), the Boston Carpal Tunnel Questionnaire (BCTQ) and sensory assessment with Semmes-Weinstein monofilament testing. Results The study group was made up of 35 patients. Thirty-three patients were treated within 36-hours. Patients treated with our unit protocol for early surgery comprising nerve decompression and bony stabilization within 36-hours, report excellent outcomes at medium term follow up. Conclusions We propose that nerve decompression and bony surgical stabilization should be undertaken as soon as practically possible once the diagnosis is made. This is emergent treatment to protect and preserve nerve function. In our experience, the vast majority of patients were treated within 24-hours however where a short period of observation was required excellent results were generally achieved where treatment was completed within 36-hours

Implications for school nurses using simulator dolls to manage unplanned teen pregnancy.

Background: School nurses are key professionals in the promotion of sexual and reproductive health which should include using high fidelity baby simulator dolls. Aim: To explore teenager’s perceptions of their practical parenting skills and their attitudes towards experiential learning from using high fidelity baby simulators. Methods: Virtual baby simulator dolls were used as part of sex and relationship education with school pupils (aged 15-16 years) to look after over a weekend. Pupils were recruited from a UK Academy and completed a diary of their experiences while parenting, received quantitative feedback simulator reports and completed a post-study evaluation questionnaire. Findings: Pupils saw the virtual baby project as beneficial and important in schools and perceived an improvement in their understanding of practical parenting skills, sexual health and contraception. Conclusion: The implications of this paper are towards involving school nurses more actively in sexual health education in schools via the use of high fidelity simulators as creative pedagogy in Personal Sexual Health Education (PSHCE)

Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial

Background: Extracranial carotid and vertebral artery dissection is an important cause of stroke, especially in young people. In some observational studies it has been associated with a high risk of recurrent stroke. Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of stroke but whether one treatment strategy is more effective than the other is unknown. We compared their efficacy in the Cervical Artery Dissection in Stroke Study (CADISS), with the additional aim of establishing the true risk of recurrent stroke. Methods: We did this randomised trial at hospitals with specialised stroke or neurology services (39 in the UK and seven in Australia). We included patients with extracranial carotid and vertebral dissection with onset of symptoms within the past 7 days. Patients were randomly assigned (1:1) by an automated telephone randomisation service to receive antiplatelet drugs or anticoagulant drugs (specific treatment decided by the local clinician) for 3 months. Patients and clinicians were not masked to allocation, but investigators assessing endpoints were. The primary endpoint was ipsilateral stroke or death in the intention-to-treat population. The trial was registered with EUDract (2006-002827-18) and ISRN (CTN44555237). Findings: We enrolled 250 participants (118 carotid, 132 vertebral). Mean time to randomisation was 3·65 days (SD 1·91). The major presenting symptoms were stroke or transient ischaemic attack (n=224) and local symptoms (headache, neck pain, or Horner's syndrome; n=26). 126 participants were assigned to antiplatelet treatment versus 124 to anticoagulant treatment. Overall, four (2%) of 250 patients had stroke recurrence (all ipsilateral). Stroke or death occurred in three (2%) of 126 patients versus one (1%) of 124 (odds ratio [OR] 0·335, 95% CI 0·006–4·233; p=0·63). There were no deaths, but one major bleeding (subarachnoid haemorrhage) in the anticoagulant group. Central review of imaging failed to confirm dissection in 52 patients. Preplanned per-protocol analysis excluding these patients showed stroke or death in three (3%) of 101 patients in the antiplatelet group versus one (1%) of 96 patients in the anticoagulant group (OR 0·346, 95% CI 0·006–4·390; p=0·66). Interpretation: We found no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid and vertebral artery dissection but stroke was rare in both groups, and much rarer than reported in some observational studies. Diagnosis of dissection was not confirmed after review in many cases, suggesting that radiographic criteria are not always correctly applied in routine clinical practice. Funding: Stroke Association.H.S. Markus ... T. Kleinig ... et al. (CADISS trial investigators

Efficacy of supplementation of probiotics on maternal glycaemic control – A systematic review and meta-analysis of randomized controlled trials

Aim: To evaluate the evidence pertaining to the efficacy of the supplementation of probiotics on the blood glucose level of pregnant women with gestational diabetes mellitus (GDM). Background: Women with the GDM are subsequently at risk to develop type 2 diabetes mellitus, within three to six years after delivery. This makes it crucial for all pregnant women with the GDM, to monitor their blood glucose levels regularly to minimize the adverse pregnancy outcomes. The earlier studies revealed that the probiotics could improve glycaemic control and mitigate the adverse effects of type 2 diabetes mellitus. Design: A systematic review and meta-analysis. Data sources: The Google Scholar, Pubmed/Medline, Cochrane library, ProQuest, Ovid, and EMBASE were systematically searched for the available clinical trials. Review methods: Randomized clinical trials (RCTs) for evaluating the effects of the probiotics on the pregnancy outcomes such as glycaemic control as primary outcome were included to achieve the aim of this review and meta-analysis. Two reviewers from the team extracted the data and assessed the risk of bias in the eligible studies independently. The meta-analysis was performed by applying a model of fixed effects using the Revman 5.3 software. Results: Nine clinical trials involving 1053 participants were included in the meta-analysis. Though the components of probiotics varied significantly, Lactobacillus species was given to all the participants in all the trials included in this review. The results showed that the probiotics asignificantly improved the glycaemic control biomarkers (Fasting blood glucose and insulin sensitivity level) (P < 0.005). Conclusion: Probiotic-supplements seemed to improve the glycaemic control biomarkers. Thus, this review highlights the considerable evidence that the supplementation of probiotics has the beneficial effects on the glycaemic control markers and may be useful as a supplementary therapy among the women with the GDM. This finding would foster the health care professionals and the nurses to create awareness on the potential benefits of the supplementation of the probiotics among the women with the GDM and elevated glycaemic control biomarkers

Chronic inflammatory arthritis drives systemic changes in circadian energy metabolism

SignificanceRheumatoid arthritis (RA) is a debilitating chronic inflammatory disease in which symptoms exhibit a strong time-of-day rhythmicity. RA is commonly associated with metabolic disturbance and increased incidence of diabetes and cardiovascular disease, yet the mechanisms underlying this metabolic dysregulation remain unclear. Here, we demonstrate that rhythmic inflammation drives reorganization of metabolic programs in distal liver and muscle tissues. Chronic inflammation leads to mitochondrial dysfunction and dysregulation of fatty acid metabolism, including accumulation of inflammation-associated ceramide species in a time-of-day-dependent manner. These findings reveal multiple points for therapeutic intervention centered on the circadian clock, metabolic dysregulation, and inflammatory signaling

Positive psychology of Malaysian students: impacts of engagement, motivation, self-compassion and wellbeing on mental health

Malaysia plays a key role in education of the Asia Pacific, expanding its scholarly output rapidly. However, mental health of Malaysian students is challenging, and their help-seeking is low because of stigma. This study explored the relationships between mental health and positive psychological constructs (academic engagement, motivation, self-compassion, and wellbeing), and evaluated the relative contribution of each positive psychological construct to mental health in Malaysian students. An opportunity sample of 153 students completed the measures regarding these constructs. Correlation, regression, and mediation analyses were conducted. Engagement, amotivation, self-compassion, and wellbeing were associated with, and predicted large variance in mental health. Self-compassion was the strongest independent predictor of mental health among all the positive psychological constructs. Findings can imply the strong links between mental health and positive psychology, especially selfcompassion. Moreover, intervention studies to examine the effects of self-compassion training on mental health of Malaysian students appear to be warranted.N/

Interaction model for magnetic holes in a ferrofluid layer

Nonmagnetic spheres confined in a ferrofluid layer (magnetic holes) present dipolar interactions when an external magnetic field is exerted. The interaction potential of a microsphere pair is derived analytically, with a precise care for the boundary conditions along the glass plates confining the system. Considering external fields consisting of a constant normal component and a high frequency rotating in-plane component, this interaction potential is averaged over time to exhibit the average interparticular forces acting when the imposed frequency exceeds the inverse of the viscous relaxation time of the system. The existence of an equilibrium configuration without contact between the particles is demonstrated for a whole range of exciting fields, and the equilibrium separation distance depending on the structure of the external field is established. The stability of the system under out-of-plane buckling is also studied. The dynamics of such a particle pair is simulated and validated by experiments.Comment: 15 pages, 11 figures (18 with subfigures). to appear in Phys. Rev.

What lies beneath: exploring links between asylum policy and hate crime in the UK

This paper explores the link between increasing incidents of hate crime and the asylum policy of successive British governments with its central emphasis on deterrence. The constant problematisation of asylum seekers in the media and political discourse ensures that 'anti-immigrant' prejudice becomes mainstr earned as a common-sense response. The victims are not only the asylum seekers hoping for a better life but democratic society itself with its inherent values of pluralism and tolerance debased and destabilised