Practice nurses and hepatitis B : Preventative actions and their relationship to health beliefs

Hepatitis B is a major, largely undiagnosed disease in the community and nurses working in doctors\u27 surgeries (practice nurses) undertake many clinical tasks which may expose them to the Hepatitis B virus. Using the Health Belief Model as the theoretical framework, the purpose of this correlational-descriptive study was to determine what actions are taken, by practice nurses in Western Australia to protect themselves against Hepatitis B, and to what extent their health beliefs contribute to those actions. A response rate of 59% (118) was obtained from an anonymous, confidential questionnaire sent to a random sample of 200 practice nurses in Western Australia. Data were analysed using descriptive analysis, t-tests, and one-way analysis of variance (ANOVA). Correlations using Pearson\u27s correlation coefficient were done to discover relationships between components of the Health Belief Model. Results showed the rate of vaccination against Hepatitis B was high (80.5%), but compliance with universal precautions, measured in this study by glove usage, appears to be based on a subjective decision and needs improvement. A high proportion of practice nurses (61.9%) had sustained occupational exposure by needlestick or splash injury, but only 54.2% of the total sample were able to nominate appropriate post-exposure actions. Although 50% of respondents reported involvement in teaching about and/or administration of the vaccine, knowledge about transmission of the Hepatitis B virus was inadequate, and specific education was not associated with higher knowledge scores. These practice nurses believed there was only a low chance they would catch Hepatitis B, and that the disease, if caught, was moderately severe. Vaccination was significantly related (n \u3c .05) to teaching about and/or administering the vaccine to others, knowledge of appropriate post-exposure actions, a low perceived barrier score, and a high belief in vaccine safety. High scores for glove usage were significantly related (p \u3c .05) to Hepatitis D education in the previous 2 years and longer number of years as a practice nurse. Awareness of the disease in well known others, and sustaining a dirty needlestick injury were significantly related (p \u3c .05) to higher perceived susceptibility. Low scores for glove usage, however, were significantly related (p \u3c .05) to higher perceived severity and perceived threat scores. Health beliefs about Hepatitis B appear to have contributed little to practice nurses\u27 actions to protect themselves against the disease. Recommendations include a targeted educational programme to include mode of transmission of the Hepatitis B virus and other bloodborne viruses, universal precautions guidelines, and a protocol for post-exposure management within a practice setting. A study of practice nurse\u27s attitudes towards universal precautions is also advocated. Questionnaire changes are suggested for replication of the study

The challenges in data integration – heterogeneity and complexity in clinical trials and patient registries of Systemic Lupus Erythematosus

From Springer Nature via Jisc Publications RouterHistory: received 2019-09-23, accepted 2020-06-19, registration 2020-06-19, pub-electronic 2020-06-24, online 2020-06-24, collection 2020-12Publication status: PublishedFunder: Medical Research Council; doi: http://dx.doi.org/10.13039/501100000265; Grant(s): MR/M01665X/1, MR/N00583X/1Abstract: Background: Individual clinical trials and cohort studies are a useful source of data, often under-utilised once a study has ended. Pooling data from multiple sources could increase sample sizes and allow for further investigation of treatment effects; even if the original trial did not meet its primary goals. Through the MASTERPLANS (MAximizing Sle ThERapeutic PotentiaL by Application of Novel and Stratified approaches) national consortium, focused on Systemic Lupus Erythematosus (SLE), we have gained valuable real-world experiences in aligning, harmonising and combining data from multiple studies and trials, specifically where standards for data capture, representation and documentation, were not used or were unavailable. This was not without challenges arising both from the inherent complexity of the disease and from differences in the way data were captured and represented across different studies. Main body: Data were, unavoidably, aligned by hand, matching up equivalent or similar patient variables across the different studies. Heterogeneity-related issues were tackled and data were cleaned, organised and combined, resulting in a single large dataset ready for analysis. Overcoming these hurdles, often seen in large-scale data harmonization and integration endeavours of legacy datasets, was made possible within a realistic timescale and limited resource by focusing on specific research questions driven by the aims of MASTERPLANS. Here we describe our experiences tackling the complexities in the integration of large, diverse datasets, and the lessons learned. Conclusions: Harmonising data across studies can be complex, and time and resource consuming. The work carried out here highlights the importance of using standards for data capture, recording, and representation, to facilitate both the integration of large datasets and comparison between studies. Where standards are not implemented at the source harmonisation is still possible by taking a flexible approach, with systematic preparation, and a focus on specific research questions

Pride and Prejudice – what can we learn from peer review?

Objectives: Peer review is a powerful tool that steers the education and practice of medical researchers but may allow biased critique by anonymous reviewers. We explored factors unrelated to research quality that may influence peer review reports, and assessed the possibility that sub-types of reviewers exist. Our findings could potentially improve the peer review process. Methods: We evaluated the harshness, constructiveness and positiveness in 596 reviews from journals with open peer review, plus 46 reviews from colleagues’ anonymously reviewed manuscripts. We considered possible influencing factors, such as number of authors and seasonal trends, on the content of the review. Finally, using machine-learning we identified latent types of reviewer with differing characteristics. Results: Reviews provided during a northern-hemisphere winter were significantly harsher, suggesting a seasonal effect on language. Reviews for articles in journals with an open peer review policy were significantly less harsh than those with an anonymous review process. Further, we identified three types of reviewers: nurturing, begrudged, and blasé. Conclusion: Nurturing reviews were in a minority and our findings suggest that more widespread open peer reviewing could improve the educational value of peer review, increase the constructive criticism that encourages researchers, and reduce pride and prejudice in editorial processes

Predictors of treatment response in a lupus nephritis population: lessons from the Aspreva Lupus Management Study (ALMS) trial

Objectives: To identify predictors of overall lupus and lupus nephritis (LN) responses in patients with LN. Methods: Data from the Aspreva Lupus Management Study (ALMS) trial cohort was used to identify baseline predictors of response at 6 months. Endpoints were major clinical response (MCR), improvement, complete renal response (CRR) and partial renal response (PRR). Univariate and multivariate logistic regressions with least absolute shrinkage and selection operator (LASSO) and cross-validation in randomly split samples were utilised. Predictors were ranked by the percentage of times selected by LASSO and prediction performance was assessed by the area under the receiver operating characteristics (AUROC) curve. Results: We studied 370 patients in the ALMS induction trial. Improvement at 6 months was associated with older age (OR=1.03 (95% CI: 1.01 to 1.05) per year), normal haemoglobin (1.85 (1.16 to 2.95) vs low haemoglobin), active lupus (British Isles Lupus Assessment Group A or B) in haematological and mucocutaneous domains (0.61 (0.39 to 0.97) and 0.50 (0.31 to 0.81)), baseline damage (SDI>1 vs =0) (0.38 (0.16 to 0.91)) and 24-hour urine protein (0.63 (0.50 to 0.80)). LN duration 2–4 years (0.43 (0.19 to 0.97) vs <1 year) and 24-hour urine protein (0.63 (0.45 to 0.89)) were negative predictors of CRR. LN duration 2–4 years (0.45 (0.24 to 0.83) vs <1 year) negatively predicted PRR. The AUROCs of models for improvement, CRR and PRR were 0.56, 0.55 and 0.51 respectively. Conclusions: Baseline variables predicted 6-month outcomes in patients with SLE. While the modest performance of models emphasises the need for new biomarkers to advance this field, the factors identified can help identify those patients who may require novel treatment strategies

Predictors of British Isles Lupus Assessment Group-based outcomes in patients with systemic lupus erythematosus: Analysis from the Systemic Lupus International Collaborating Clinics Inception Cohort

BackgroundWe aimed to identify factors associated with a significant reduction in SLE disease activity over 12&nbsp;months assessed by the BILAG Index.MethodsIn an international SLE cohort, we studied patients from their 'inception enrolment' visit. We also defined an 'active disease' cohort of patients who had active disease similar to that needed for enrolment into clinical trials. Outcomes at 12&nbsp;months were; Major Clinical Response (MCR: reduction to classic BILAG C in all domains, steroid dose of ≤7.5&nbsp;mg and SLEDAI ≤ 4) and 'Improvement' (reduction to ≤1B score in previously active organs; no new BILAG A/B; stable or reduced steroid dose; no increase in SLEDAI). Univariate and multivariate logistic regression with Least Absolute Shrinkage and Selection Operator (LASSO) and cross-validation in randomly split samples were used to build prediction models.Results'Inception enrolment' (n = 1492) and 'active disease' (n = 924) patients were studied. Models for MCR performed well (ROC AUC = .777 and .732 in the inception enrolment and active disease cohorts, respectively). Models for Improvement performed poorly (ROC AUC = .574 in the active disease cohort). MCR in both cohorts was associated with anti-malarial use and inversely associated with active disease at baseline (BILAG or SLEDAI) scores, BILAG haematological A/B scores, higher steroid dose and immunosuppressive use.ConclusionBaseline predictors of response in SLE can help identify patients in clinic who are less likely to respond to standard therapy. They are also important as stratification factors when designing clinical trials in order to better standardize overall usual care response rates