gaps in pain agitation and delirium management in intensive care outputs from a nurse workshop

Abstract Significant improvements in our understanding of pain, agitation, and delirium management within the Intensive Care Unit have been made in recent years. International guidelines and implementation bundles have become more evidence-based, patient-centred, and provide clear recommendations on the best-practice management of critically ill patients. However, the intensive care community has highlighted the need for higher-order evidence in several areas of pain, agitation and delirium research and studies suggest that a significant number of intensive care patients still receive outdated treatment as a consequence of inadequate guideline implementation. Where do the gaps exist in pain, agitation and delirium management, what are the barriers to guideline implementation and how can these problems be addressed to ensure patients receive optimised care? As an international professional consensus exercise, a panel of seven European intensive care nurses convened to discuss how to address these questions and establish how the provision of pain, agitation and delirium management can be improved in the intensive care unit

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

BACKGROUND: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003889. FUNDING: The National Institute for Health Research Health Technology Assessment programme

PCP- and SCS-pincer palladium complexes immobilized on mesoporous silica: application in C-C bond formation reactions

ECE-pincer palladium(II) complexes {ECE=[C6H3(CH2E)2-2,6]-, E=PPh2 and SPh} thered to a trialkoxysilane moiety through a carbamate linkage were immobilized on ordered mesoporous silicas SBA-15 and MCM-41 using a grafting process. The resulting hybrid materials were characterized by IR spectroscopy, solid-state CP/MAS NMR (13C, 31P, and 29Si), and elemental analyses. These analyses showed the integrity of the pincer-metal complexes on the supports, which highlights their stability under the applied immobilization conditions. An H-bonding interaction between the carbamate carbonyl group of the complex and free silanol groups on the silica surface was also established. The hybrid materials were found to act as Lewis acid catalysts in the aldol reaction between methyl isocyanoacetate and benzaldehyde. SBA-15 modified with the PCP-pincer Pd complex was used in up to five runs without loss of activity. Control experiments showed the true heterogeneous nature of the catalyst in this reaction. Nitrogen physisorption data, XRD, and TEM/EDX analyses of the hybrid materials revealed that the mesoporous structure of these materials was retained during the immobilization process as well as during catalysis

Connectedness and its consequences: a study of relationships with the natural environment

Recent interest in people's engagement with the natural environment has resulted in a series of empirical measures and important research findings. Two studies reported here complement this literature in producing a concise measure of connectedness to the natural environment and assessing its independent predictive impact within the structure of the theory of planned behavior. In Study 1 (n = 71), new measures of connectedness and caring were constructed; in Study 2 (n = 163), the connectedness measure was shown to be an independent predictor of people's intentions to reduce personal energy consumption levels. It is suggested that the measure of connectedness may capture some identity-related and/or affective experience that impacts (independently of more cognitive predictors) upon people's motivation in this domain