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European survey on paediatric early warning systems, and other processes used to aid the recognition and response to children's deterioration on hospital wards
Get PDFBACKGROUND: Internationally, there is an increasing trend in using Rapid Response Systems (RRS) to stabilize in-patient deterioration. Despite a growing evidence base, there remains limited understanding of the processes in place to aid the early recognition and response to deteriorating children in hospitals across Europe. AIM: To describe the processes in place for early recognition and response to in-patient deterioration in children in European hospitals. STUDY DESIGN: A cross-sectional opportunistic multi-centre European study, of hospitals with paediatric in-patients, using a descriptive self-reported, web-based survey, was conducted between September 2021 and March 2022. The sampling method used chain referral through members of European and national societies, led by country leads. The survey instrument was an adaptation to the survey of Recognition and Response Systems in Australia. The study received ethics approval. Descriptive analysis and Chi-squared tests were performed to compare results in European regions. RESULT(S): A total of 185 questionnaires from 21 European countries were received. The majority of respondents (n=153, 83%) reported having written policies, protocols, or guidelines, regarding the measurement of physiological observations. Over half (n=120, 65%) reported that their hospital uses a Paediatric Early Warning System (PEWS) and 75 (41%) reported having a Rapid Response Team (RRT). Approximately one-third (38%) reported that their hospital collects specific data about the effectiveness of their RRS, while 100 (54%) reported providing regular training and education to support it. European regional differences existed in PEWS utilization (North=98%, Centre=25%, South=44%, pRESULT(S): A total of 185 questionnaires from 21 European countries were received. The majority of respondents (n=153, 83%) reported having written policies, protocols, or guidelines, regarding the measurement of physiological observations. Over half (n=120, 65%) reported that their hospital uses a Paediatric Early Warning System (PEWS) and 75 (41%) reported having a Rapid Response Team (RRT). Approximately one-third (38%) reported that their hospital collects specific data about the effectiveness of their RRS, while 100 (54%) reported providing regular training and education to support it. European regional differences existed in PEWS utilization (North=98%, Centre=25%, South=44%, pRESULT(S): A total of 185 questionnaires from 21 European countries were received. The majority of respondents (n=153, 83%) reported having written policies, protocols, or guidelines, regarding the measurement of physiological observations. Over half (n=120, 65%) reported that their hospital uses a Paediatric Early Warning System (PEWS) and 75 (41%) reported having a Rapid Response Team (RRT). Approximately one-third (38%) reported that their hospital collects specific data about the effectiveness of their RRS, while 100 (54%) reported providing regular training and education to support it. European regional differences existed in PEWS utilization (North=98%, Centre=25%, South=44%, pCONCLUSION(S): RRS practices in European hospitals are heterogeneous. Differences in the uptake of PEWS and RRS process evaluation emerged across Europe. RELEVANCE TO CLINICAL PRACTICE: It is important to scope practices for the safe monitoring and management of deteriorating children in hospital across Europe. To reduce variance in practice, a consensus statement endorsed by paediatric and intensive care societies could provide guidance and resources to support PEWS implementation and for the operational governance required for continuous quality improvement.Copyright © 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.https://doi.org/10.1111/nicc.1309
Breaking the silence: addressing domestic abuse in mental health settings—identification, screening, and responding
No full textIndividuals experiencing domestic abuse (DA) struggle to disclose victimization, but as frequent users of mental health services, this is a pivotal setting for identification and addressing DA. This systematic review of 20 studies investigates DA identification, screening, and responses within mental health settings. Three databases were searched using these inclusion criteria: adults aged 18 and older accessing mental health services, samples comprising mental health professionals (or combination). No geographical restrictions were applied. All studies were peer-reviewed and published in English between January 2000 and December 2023. Studies had to incorporate screening for DA between (ex-)partners and/or response to disclosure within mental health settings. The findings revealed considerable variation in DA screening methods from direct screening tools to retrospective analyses of patient files. Professionals report barriers in identifying DA, including uncertainty about their role, time constraints, and the importance of building trust with service users. Nonetheless, many highlight the importance of routinely asking about DA. A small number of interventions have been effective in enhancing professionals’ readiness to address DA, but it remains unclear what format of training is most effective. Service users report feelings of shame and fear of not being believed when disclosing DA, but are aided by therapeutic engagement and enhanced professional awareness. There is a lack of diverse inclusion in the research. In summary, there is considerable scope to develop good practice to support mental health professionals’ ability to identify and respond to DA across assessment tool and training, but also in understanding what facilitates service users to disclose.https://journals.sagepub.com/doi/10.1177/1524838024128009
The use of echocardiography in the management of shock in critical care: a prospective, multi-centre, observational study
No full textPurpose Echocardiography is recommended as a first-line tool in the assessment of patients with shock. The current provision of echocardiography in critical care is poorly defined. The aims of this work were to evaluate the utilisation of echocardiography in patients presenting to critical care with shock, its impact on decision making, and adherence to governance guidelines. Methods We conducted a prospective, multi-centre, observational study in 178 critical care units across the United Kingdom (UK) and Crown Dependencies, led by the UK’s Trainee Research in Intensive Care Network. Consecutive adult patients (≥ 18 years) admitted with shock were followed up for 72 h to ascertain whether they received an echocardiogram, the nature of any scan performed, and its effect on critical treatment decision making. Results 1015 patients with shock were included. An echocardiogram was performed on 545 (54%) patients within 72 h and 436 (43%) within 24 h of admission. Most scans were performed by the critical care team (n = 314, 58%). Echocardiography was reported to either reduce diagnostic uncertainty or change management in 291 (54%) cases. Patients with obstructive or cardiogenic shock had their management altered numerically more often by echocardiography (n = 15 [75%] and n = 100 [58%] respectively). Twenty-five percent of echocardiograms performed adhered to current national governance and image storage guidance. Conclusion Use of echocardiography in the assessment of patients with shock remains heterogenous. When echocardiography is used, it improves diagnostic certainty or changes management in most patients. Future research should explore barriers to increasing use of echocardiography in assessing patients presenting with shock.https://link.springer.com/article/10.1007/s00134-024-07590-
Upper gastrointestinal signs and symptoms: assessment, management and referral pathways
No full textThis paper considers the common presentation of upper gastrointestinal (GI) signs and symptoms. It discusses their prevalence, aetiology, clinical presentation and the importance of comprehensive history taking and examination. In addition, the article explores investigations, management pathways and criteria for referral to a gastroenterologist, including the two-week referral pathway. While the paper focuses on UK practice, it draws upon evidence and guidance from around the world and therefore guidelines for managing upper GI presentations can vary between countries and continents.https://www.magonlinelibrary.com/doi/abs/10.12968/gasn.2024.22.4.19
Strategies to improve recruitment in mental health clinical trials: A scoping review (RE-MIND study)
Get PDF© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
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regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/.BACKGROUND: Lower-than-expected recruitment continues to be one of the major causes of trial delays, and trials to improve mental health are no exception. Indeed, recruitment challenges in trials of vulnerable populations, such as those living with mental health illness, can even be exacerbated. To address this, researchers are turning to digital and online recruitment strategies, e.g. web-based approaches and multi-media in order to (1) increase recruitment efficiency (recruit to target and on time) and (2) improve diversity in mental health clinical trials to be more inclusive and reduce health inequity. There is, however, inconclusive evidence on the success of digital and online recruitment strategies in mental health clinical trials. The RE-MIND study comprised a scoping review to assess the impact of using such recruitment strategies in mental health clinical trials to inform a more systematic scoping review. METHODS: A cohort of 191 recently published RCTs and randomised feasibility studies were identified from the NIHR Journals Library and top two mental health journals (based on citation metrics), Lancet Psychiatry and JAMA Psychiatry. Population characteristics including gender, ethnicity and age were summarised for inclusivity using descriptive statistics, and recruitment strategies were compared to examine differences in their success in recruiting to target. RESULTS: After screening, 97 articles were included for review. The review findings showed no evidence that offline or mixed strategies were superior for achieving recruitment targets in mental health trials. However, there was a suggestion that trials using a mixed recruitment strategy improved inclusivity and tended to recruit closer to the target. CONCLUSIONS: The key finding was that consideration should be given to a mixed methods approach to recruitment not only to enable wider and more diverse participation in mental health trials but also to realize greater efficiency.https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-024-08665-
Cerebral CT angiography as an ancillary investigation to support a clinical diagnosis of death using neurological criteria: A reply
No full textAvailable to read on the publisher's website here: https://doi.org/10.1111/anae.16143.https://doi.org/10.1111/anae.1614
Systematic review: Mortality associated with raised faecal immunochemical test and positive faecal occult blood results
Get PDFBackground: Faecal haemoglobin (f-Hb) testing is used in colorectal cancer (CRC) screening and increasingly to guide the investigation in patients with symptoms suggestive of CRC. Studies have demonstrated increased mortality with raised f-Hb. Aim(s): To assess the association of raised f-Hb with all-cause, non-CRC (any cause excluding CRC) and cause-specific mortality. Method(s): We searched Medline and Embase on 9 February 2024 to identify papers reporting mortality after faecal immunochemical (FIT) or guaiac faecal occult blood tests (gFOBT). The primary outcome was all-cause mortality following a positive compared to a negative test. Result(s): The search identified 3155 papers. Ten met the inclusion criteria: three reported gFOBT and seven reported FIT results, as screening tests. These reported a total of 14,687,625 f-Hb results. Elevated f-Hb was associated with an increased risk of all-cause, non-CRC and cause-specific mortality including death from cardiovascular, digestive and respiratory diseases. Crude risk ratios for all-cause mortality with a positive versus negative test were derived from six papers (three reporting gFOBT, three FIT). An increased risk was demonstrated in five, with RRs ranging from 1.11 (95% CI: 1.06-1.16) to 2.95 (95% CI: 2.85-3.05). For non-CRC mortality risk, RRs ranged from 1.09 (95% CI: 1.04-1.15) to 2.79 (95% CI: 2.70-2.89). We did not perform meta-analysis due to a limited number of papers reporting suitable results for each type of f-Hb test. Conclusion(s): All-cause, non-CRC and cause-specific mortality appear higher in those with raised f-Hb. Population-based studies are warranted to elicit whether this association occurs in symptomatic patients.Copyright © 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.https://doi.org/10.1111/apt.1820
Endovascular thrombectomy vs best medical management for late presentation acute ischaemic stroke with large vessel occlusion without CT perfusion or MR imaging selection: A systematic review and meta-analysis
Get PDFBackground: The efficacy and safety of endovascular thrombectomy (EVT) beyond 6 hours from stroke onset for patients with large vessel occlusion (LVO) selected without CT perfusion(CTP) or MR imaging(MRI) is undetermined. We conducted a systematic review and meta-analysis of the current literature comparing outcomes for late presenting patients with LVO treated by best medical management (BMM) with those selected for EVT based only on non-contrast CT(NCCT)/CT angiography(CTA) (without CTP or MRI). Method(s): PRISMA guidelines were employed. The primary outcome was functional independence (modified Rankin Scale 0-2) at 3 months. Secondary outcomes were symptomatic intracranial haemorrhage (sICH) and mortality at 3 months. Data were analysed using the random-effects model. Result(s): Six studies of 2083 patients, including three randomised controlled trials, were included; 1271 patients were treated with EVT and 812 patients with BMM. Compared to BMM, patients treated with EVT demonstrated higher odds of achieving functional independence (39.0 % EVT vs 22.0 % BMM; OR = 2.55, 95 %CI 1.61-4.05,p Result(s): Six studies of 2083 patients, including three randomised controlled trials, were included; 1271 patients were treated with EVT and 812 patients with BMM. Compared to BMM, patients treated with EVT demonstrated higher odds of achieving functional independence (39.0 % EVT vs 22.0 % BMM; OR = 2.55, 95 %CI 1.61-4.05,p 2 = 74 %). The rates of sICH (OR = 2.09, 95 %CI 0.86-5.04,p = 0.10) and mortality (OR = 0.62, 95 %CI 0.35-1.10,p = 0.10) were not significantly different between each cohort. Conclusion(s): Compared to BMM, late presenting stroke patients selected for EVT eligibility with NCCT/CTA only and treated with EVT achieved significantly higher rates of functional independence at 90 days, without increasing the incidence of sICH or mortality. Whilst these findings indicate that NCCT/CTA only may be used for EVT eligibility selection for patients who present beyond 6 hours from stroke onset, the results should be interpreted with caution due to the substantial heterogeneity between studies.Copyright © 2024 The Authorshttps://doi.org/10.1016/j.jstrokecerebrovasdis.2024.10800
Eliminating trachoma in Africa: the importance of environmental interventions
No full textSubsequent to the failure of the World Health Organisation (WHO) of achieving their target to eliminate trachoma by the year 2020, the most effective strategy in eliminating trachoma must be re-examined to accomplish the new target of eradication by the year 2030. Whilst antibiotic therapy is a core foundation of this elimination strategy, another important factor is the state of the environmental conditions in trachoma endemic countries. This manuscript aimed to identify the impact of environmental improvement strategies on the prevalence of trachoma and the significance of environmental improvement alongside the use of antibiotic treatment to achieve trachoma elimination. Two independent literature searches were conducted up until the 5th of July 2021. Two main databases were used to carry out these literature searches, namely, Ovid EMBASE and Ovid MEDLINE. All of the relevant references were found using MeSH and free text terms. Key terms used were 'trachoma', 'water', 'sanitation', 'hygiene' and 'environmental Improvement'. The exclusion criteria included non-African-based studies, review papers, protocols and case reports. A total of 17 studies were included for this review. Living within a close range of a water source was significantly associated with reduced risk of trachoma infection. Water obtained from piped water sources was associated with the lowest rates of active trachoma. Studies on facial cleanliness evidenced a strong association with reduced prevalence of trachoma. Whilst the provision of latrine facilities found was significantly associated with reduced prevalence of trachoma, there was no significant difference between the use of private latrine facilities over communal latrine facilities. The use of repeated scheduled antibiotic treatments over single-use antibiotic distribution had a greater impact both short term and long term on the prevalence rates of trachoma. Nonetheless, prevalence rates increased again following the commencement of treatment. Mass antibiotic treatment has been proven to have a greater impact on lowering the prevalence of trachoma initially, but this impact is not sustainable due to the rise in prevalence rates following the completion of treatment. A holistic approach, therefore, must be implemented with evidence showing that an emphasis on longer-term environmental methods should be implemented to compliment antibiotic distribution. Prioritisation of specific interventional measures should be tailored according to local epidemiology; nonetheless, these measures form the backbone of a trachoma elimination strategy to eliminate trachoma by the year 2030.https://www.cureus.com/articles/217802-eliminating-trachoma-in-africa-the-importance-of-environmental-interventions#!
Top ten research priorities for alcohol use disorder and alcohol-related liver disease: Results of a multistakeholder research priority setting partnership
No full textAlcohol is a preventable leading cause of liver disease and over 200 other acute or chronic medical conditions. In the UK, 25% of the population drinks at an increasing risk level (ie, 15–34 units per week for women and 15–49 units per week for men) and 10% at a higher risk level (≥35 units per week for women and ≥50 units per week for men). The UK has observed a 400% rise in mortality due to liver disease in the last three decades; it is now the third most common cause of premature death. In 2020, the UK recorded 8974 deaths from an alcohol-specific cause, an 18·6% increase compared with 2019. The 2020 death rate due to wholly alcohol-attributable conditions reached 14·0 deaths per 100 000, the highest since 2001. In the same year, Dame Carol Black's independent review of drugs, treatment, and recovery, emphasised the need for an increased focus on prevention. Alcohol-related disorders are among the most common reasons for admission to hospital; in 2019–20, 5·7% of all hospital admissions in England were alcohol related. The estimated cost to the UK National Health Service (NHS) to treat alcohol-related problems is over £3·5 billion annually, with an estimated overall cost to society of £21 billion per year.https://www.thelancet.com/journals/langas/article/PIIS2468-1253(24)00009-8/abstrac