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Evaluation of stable chest pain following emergency department presentation: Impact of first-line cardiac computed tomography diagnostic strategy in an Australian setting
No full textObjective: International guidelines provide increasing support for computed tomography coronary angiography (CTCA) in investigating chest pain. A pathway utilising CTCA first-line for outpatient stable chest pain evaluation was implemented in an Australian ED.
Methods: In pre-post design, the impact of the pathway was prospectively assessed over 6 months (August2021 to January 2022) and compared with a 6-month pre-implementation group (February 2021 to July 2021).CTCA was recommended first-line in suspected stable cardiac chest pain, followed by chest pain clinic review. Predefined criteria were provided recommending functional testing in select patients. The impact of CTCA versus functional testing was evaluated. Data were obtained from digital medical records.
Results: Three hundred and fifteen patients were included, 143 pre-implementation and 172 post-implementation. Characteristics were similar except age (pre-implementation:58.9 12.0vspost-implementation:62.8 12.3 years, P=0.004). Path-way-guided management resulted in higher first-line CTCA (73.3%vs46.2%,P\u3c 0.001), lower functional testing (30.2%vs56.6%,P\u3c0.001
Major adverse kidney events predict reduced survival in ventricular assist device supported patients
No full textAims: There is limited data describing major adverse kidney events (MAKE) in patients supported with ventricular assistdevices (VAD). We aim to describe the association between MAKE and survival, risk factors for MAKE, and renal trajectoryin VAD supported patients.
Methods and results: We conducted a single-centre retrospective analysis of consecutive VAD implants between 2010 and2019. Baseline demographics, biochemistry, and adverse events were collected for the duration of VAD support. MAKE wasdefined as thefirst event to occur of sustained drop (\u3e50%) in estimated glomerularfiltration rate (eGFR), progression tostage V chronic kidney disease, initiation or continuation of renal replacement therapy beyond implant admission or deathon renal replacement therapy at any time. One-hundred and seventy-three patients were included, median age 56.8 years,18.5% female, INTERMACS profile 1 or 2 in 75.1%. Thirty-seven patients experienced MAKE. On multivariate analysis,post-implant clinical right ventricular failure and the presence of chronic haemolysis, defined by the presence of schistocyteson bloodfilm analysis, were significantly associated with increased risk of MAKE (adjusted odds ratio 9.88,P\u3c0.001 andadjusted odds ratio 3.33,P= 0.006, respectively). MAKE was associated with reduced survival (hazard ratio 4.80,P\u3c0.001). Patients who died or experienced MAKE did not demonstrate the expected transient 3-month improvement ineGFR, seen in other cohorts.
Conclusions: MAKE significantly impacts survival. In our cohort, MAKE was predicted by post-implant right ventricular failureand chronic haemolysis. The lack of early eGFR improvement on VAD support may indicate higher risk for MAKE
Association between antihypertensive medicine use and risk of ovarian cancer in women aged 50 years and older
No full textBackground: Epithelial ovarian cancer (EOC) has few modifiable risk factors. There is evidence that some antihypertensive medicines may have cancer preventive and/or therapeutic actions; therefore, we assessed the associations between use of different antihypertensive medicines and risk of specific EOC histotypes.
Methods: Our nested case-control study of linked administrative health data included 6070 Australian women aged over 50 years diagnosed with EOC from 2004 to 2013, and 30,337 matched controls. We used multivariable conditional logistic regression to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for the association between ever use of each antihypertensive medicine group, including beta-adrenergic blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, and alpha blockers, and the risk of EOC overall and separately for the serous, endometrioid, mucinous, clear cell and other histotypes.
Results: We found that most antihypertensive medicines were not associated with risk of EOC. However, women who used calcium channel blockers had a reduced risk of serous EOC (OR= 0.89, 95 % CI:0.81,0.98) and use of combination thiazide and potassium-sparing diuretics was associated with an increased risk of endometroid EOC (OR= 2.09, 95 % CI:1.15,3.82).
Conclusion: Our results provide little support for a chemo-preventive role for most antihypertensives, however, the histotype-specific associations we found warrant further investigation
Peripheral nerve catheter securement: A narrative literature review
No full textPeripheral nerve catheters are commonly used to provide analgaesia and improve patient outcomes. Catheter dislodgment, displacement or leakage can result in premature cessation of analgaesic effect. There are currently no published guidelines for how to secure peripheral nerve catheters.
This narrative review explores and integrates the available research into the efficacy of peripheral nerve catheter securement products and techniques to reduce catheter dislodgement and displacement.
All studies looking at peripheral nerve catheter securement methods were included from inception until 19 October 2022 across PUBMED, Scopus, Ovid, Google Scholar, EMBASE and The Cochrane Library. The Jadad scale and Newcastle–Ottawa scale were used to assess the methodological quality of randomised controlled trials and observational studies, respectively.
Sixteen papers were included in this review. The results were mixed and substantial heterogeneity across studies further limited the ability to draw firm or generalisable conclusions. Rather, several products and techniques that may reduce catheter dislodgement, displacement or leakage, that can contribute to dislodgement, were identified for further investigation. There was some evidence to support the use of the catheter over needle technique, adhesive dressings and tissue adhesives. The number of studies investigating subcutaneous tunnelling and anchoring devices was particularly limited
The impact of pandemic disruptions on clinical skills learning for pre-clinical medical students: Implications for future educational designs
No full textBackground: Pandemic disruptions to medical education worldwide resulted in rapid adaptations to clinical skills learning. These adaptations included moving most teaching to the online environment, decreasing the accepted “hands-on” methods of teaching and learning. While studies have shown signifcant impacts on student confdence in skills acquisition, there is a paucity of assessment outcome studies which would contribute a valuable perspective on whether measurable defcits were incurred. Here, a preclinical (Year 2) cohort was investigated for clinical skills learn‑ ing impacts that could infuence their transition to hospital-based placements.
Methods: A sequential mixed methods approach was used on the Year 2 Medicine cohort, including: focus group discussions with thematic analysis; a survey derived from the themes observed; and a cohort comparison of the clini‑ cal skills examination results of the disrupted Year 2 cohort, compared to pre-pandemic cohorts.
Results: Students reported experiencing benefts and disadvantages of the shift to online learning, including a decrease in confdence in their skills acquisition. End of year summative clinical assessments showed non-inferior out‑ comes when compared to previous cohorts for the majority of clinical skills. However, for procedural skills (venepunc‑ ture) the disrupted cohort had signifcantly lower scores compared to a pre-pandemic cohort.
Conclusions: Rapid innovation during the COVID-19 pandemic provided the opportunity to compare online asyn‑ chronous hybrid clinical skills learning with the usual practice of face-to-face synchronous experiential learning. In this study, students’ reported perceptions and assessment performance data indicate that careful selection of skills suitable for online teaching, supported by timetabled “hands-on” sessions and ample practice opportunities, is likely to provide non-inferior outcomes for clinical skills learning in students about to transition to clinical placements. The fndings can be used to inform clinical skills curriculum designs that incorporate the virtual environment, and assist with future-proofng skills teaching in the case of further catastrophic disruptions
Epistemic health, epistemic immunity and epistemic inoculation
No full textThis paper introduces three new concepts: epistemic health, epistemic immunity, and epistemic inoculation. Epistemic health is a measure of how well an entity (e.g. person, community, nation) is functioning with regard to various epistemic goods or ideals. It is constituted by many different factors (e.g. possessing true beliefs, being disposed to make reliable inferences), is improved or degraded by many different things (e.g. research funding, social trust), and many different kinds of inquiry are relevant to its study. Epistemic immunity is the robustness with which an entity is resistant to performing certain kinds of epistemic activity, such as questioning certain ideas, believing certain sources, or making certain inferences. Epistemic inoculation occurs when social, political or cultural processes cause an entity to become immune to engaging in certain epistemic activities. After outlining each of these concepts, we close by considering some of the risks associated with attempts to improve others’ epistemic health
In adults with advanced lung disease, the 1-minute sit-to-stand test underestimates exertional desaturation compared with the 6-minute walk test: An observational study
No full textQuestion In adults with advanced lung disease, do the 6-minute walk test (6MWT) and 1-minute sit-to-stand test (1minSTS) elicit similar cardiorespiratory responses? Can the 6-minute walk distance (6MWD) be estimated from the 1minSTS result? Design Prospective observational study using data collected during routine clinical practice. Participants Eighty adults (43 males) with advanced lung disease, a mean age of 64 years (SD 10) and a mean forced expiratory volume in 1 second of 1.65 L (SD 0.77). Outcome measures Participants completed a 6MWT and a 1minSTS. During both tests, oxygen saturation (SpO2), pulse rate, dyspnoea and leg fatigue (Borg 0 to 10) were recorded. Results Compared with the 6MWT, the 1minSTS resulted in higher nadir SpO2 (MD 4%, 95% CI 3 to 5), lower end-test pulse rate (MD –4 beats/minute, 95% CI –6 to –1), similar dyspnoea (MD –0.3, 95% CI –0.6 to 0.1) and greater leg fatigue (MD 1.1, 95% CI 0.6 to 1.6). Among the participants who demonstrated severe desaturation (SpO2 nadir \u3c 85%) on the 6MWT (n = 18), five and ten participants were classified as moderate (nadir 85 to 89%) or mild desaturators (nadir ≥ 90%), respectively, on the 1minSTS. The relationship between the 6MWD and 1minSTS was: 6MWD (m) = 247 + (7 × number of transitions achieved during the 1minSTS) with poor predictive ability (r2 = 0.44). Conclusion The 1minSTS elicited less desaturation than the 6MWT and classified a smaller proportion of people as ‘severe desaturators’ on exertion. It is therefore inappropriate to use the nadir SpO2 recorded during a 1minSTS to make decisions about whether strategies are needed to prevent severe transient exertional desaturation during walking-based exercise. Further, the extent to which performance on the 1minSTS can estimate a person’s 6MWD is poor. For these reasons, the 1minSTS is unlikely to be helpful when prescribing walking-based exercise
Spirituality is sometimes just a hug : A conceptual analysis from the perspective of nursing students
No full textObjectives: Definitions of spirituality abound; however, the importance of context and need for better understanding within health-care practice has been emphasized. In particular, the understanding of spirituality for nurses has been shown to have an impact both professionally and personally.
Methods: This study used a conceptual analysis to explore the understanding of spirituality by German-speaking nurses in an educational context.
Results: A total of 91 nursing students (83.5% female, 16.5% male) took the spiritual care course between January 2022 and January 2023. The majority of participants (n = 63, 69.6%) were in the 26- to 40-year age bracket, 50 (54.9%) identified themselves as Christian, 15 (16.5%) chose other, 12 (13.2%) atheist, 6 (6.6%) humanist or agnostic, and 2 (2.2%) Buddhist. A conceptual analysis of nursing students’ written responses to the question “What is spirituality to me?” was conducted. Two overarching categories were identified. The first category was titled “What aspects or characters are linked to spirituality?” and included 5 subcategories: people, life, experience, a sense of security, and capacity. The second category was titled “How is spirituality experienced, practiced and lived?” and included 5 subcategories: sometimes just a hug, to align one’s life with that purpose, to be content with myself, conscious attention to oneself, and demarcation from religion. These subcategories were interrelated to one another.
Significance of results: These findings have implications for how spirituality is introduced in nursing education
Is a whole school approach to inclusion really meeting the needs of all learners?
No full textThis paper examines issues impacting parental choice for home-schooling in one state in Australia. Data were collected from 99 parents home-schooling at least one child during the 2022 academic year. Utilizing the newly developed Parent Perceptions of Home-Schooling scale, consideration was given to proactive and reactive reasons perceived by parents as impacting their decision-making. Proactive reasons consisting of philosophical beliefs and needs of the child were cited more frequently by parents who had always home-schooled their child. Reactive reasons were mostly employed to confirm parent decisions to remove a child from school due to concerns regarding the school, the child, and the needs of parents. A range of school, child, and parental issues, and different child needs were identified as impetus for home-schooling learners with and without a diagnosed disability or an additional learning need. Discussion centers around whether current whole school approaches to inclusion are addressing the needs of all learners and parents, as perceived by this cohort. By gaining a better understanding of parental reasons for withdrawing their children with specific educational needs from regular schooling, this study is significant as it highlights a range of pertinent school-based issues to be considered to ensure effective inclusion for all
A deep learning neural network to classify obesity risk in portuguese adolescents based on physical fitness levels and body mass index percentiles: Insights for national health policies
No full textThe increasing prevalence of overweight and obesity among adults is a risk factor for many chronic diseases and death. In addition, obesity among children and adolescents has reached unprecedented levels and studies show that obese children and adolescents are more likely to become obese adults. Therefore, both the prevention and treatment of obesity in adolescents are critical. This study aimed to develop an artificial intelligence (AI) neural network (NNET) model that identifies the risk of obesity in Portuguese adolescents based on their body mass index (BMI) percentiles and levels of physical fitness. Using datasets from the FITescola® project, 654 adolescents aged between 10–19 years old, male: 334 (51%), female: n = 320 (49%), age 13.8 ± 2 years old, were selected to participate in a cross-sectional observational study. Physical fitness variables, age, and sex were used to identify the risk of obesity. The NNET had good accuracy (75%) and performance validation through the Receiver Operating Characteristic using the Area Under the Curve (ROC AUC = 64%) in identifying the risk of obesity in Portuguese adolescents based on the BMI percentiles. Correlations of moderate effect size were perceived for aerobic fitness (AF), upper limbs strength (ULS), and sprint time (ST), showing that some physical fitness variables contributed to the obesity risk of the adolescents. Our NNET presented a good accuracy (75%) and was validated with the K-Folds Cross-Validation (K-Folds CV) with good accuracy (71%) and ROC AUC (66%). According to the NNET, there was an increased risk of obesity linked to low physical fitness in Portuguese teenagers