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Caring: The essence of mental health nursing
No full textAvailable in the library: https://koha.healthlibrariesmidlands.nhs.uk/cgi-bin/koha/opac-detail.pl?biblionumber=156760&query_desc=Mental%20Health%20Nursing%20SkillsNo abstract availablehttps://global.oup.com/academic/product/mental-health-nursing-skills-9780192864048?cc=us&lang=en
Behavioural activation
No full textAvailable in the library: https://koha.healthlibrariesmidlands.nhs.uk/cgi-bin/koha/opac-detail.pl?biblionumber=156760&query_desc=Mental%20Health%20Nursing%20SkillsNo abstract availablehttps://global.oup.com/academic/product/mental-health-nursing-skills-9780192864048?cc=us&lang=en
Immunomodulatory therapy in children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS, MIS-C; RECOVERY): A randomised, controlled, open-label, platform trial
Get PDFBackground: Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS), also known as multisystem inflammatory syndrome in children (MIS-C) emerged in April, 2020. The paediatric comparisons within the RECOVERY trial aimed to assess the effect of intravenous immunoglobulin or corticosteroids compared with usual care on duration of hospital stay for children with PIMS-TS and to compare tocilizumab (anti-IL-6 receptor monoclonal antibody) or anakinra (anti-IL-1 receptor antagonist) with usual care for those with inflammation refractory to initial treatment. Method(s): We did this randomised, controlled, open-label, platform trial in 51 hospitals in the UK. Eligible patients were younger than 18 years and had been admitted to hospital for PIMS-TS. In the first randomisation, patients were randomly assigned (1:1:1) to usual care (no additional treatments), usual care plus methylprednisolone (10mg/kg per day for 3 consecutive days), or usual care plus intravenous immunoglobulin (a single dose of 2 g/kg). If further anti-inflammatory treatment was considered necessary, children aged at least 1 year could be considered for a second randomisation, in which patients were randomly assigned (1:2:2) to usual care, intravenous tocilizumab (12 mg/kg in patients =30 kg, up to a maximum dose of 800 mg), or subcutaneous anakinra (2 mg/kg once per day in patients >=10 kg). Randomisation was by use of a web-based simple (unstratified) randomisation with allocation concealment. The primary outcome was duration of hospital stay. Analysis was by intention to treat. For treatments assessed in each randomisation, a single Bayesian framework assuming uninformative priors for treatment was used to jointly assess the efficacy of each intervention compared with usual care. The trial was registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Finding(s): Between May 18, 2020, and Jan 20, 2022, 237 children with PIMS-TS were enrolled and included in the intention-to-treat analysis. Of the 214 patients who entered the first randomisation, 73 were assigned to receive intravenous immunoglobulin, 61 methylprednisolone, and 80 usual care. Of the 70 children who entered the second randomisation (including 23 who did not enter the first randomisation), 28 were assigned to receive tocilizumab, 14 anakinra, and 28 usual care. Mean age was 9.5 years (SD 3.8) in the randomisation and 9.6 years (3.6) in the second randomisation. 118 (55%) of 214 patients in the first randomisation and 39 (56%) of 70 patients in the second randomisation were male. 130 (55%) of 237 patients were Black, Asian, or minority ethnic, and 105 (44%) were White. Mean duration of hospital stay was 7.4 days (SD 0.4) in children assigned to intravenous immunoglobulin and 7.6 days (0.4) in children assigned to usual care (difference -0.1 days, 95% credible interval CrI] -1.3 to 1.0; posterior probability 59%). Mean duration of hospital stay was 6.9 days (SD 0.5) in children assigned to methylprednisolone (difference from usual care -0.7 days, 95% CrI -1.9 to 0.6; posterior probability 87%). Mean duration of hospital stay was 6.6 days (SD 0.7) in children assigned to second-line tocilizumab and 9.9 days (0.9) in children assigned to usual care (difference -3.3 days, 95% CrI -5.6 to -1.0; posterior probability >99%). Mean duration of hospital stay was 8.5 days (SD 1.2) in children assigned to anakinra (difference from usual care -1.4 days, 95% CrI -4.3 to 1.8; posterior probability 84%). Two persistent coronary artery aneurysms were reported among patients assigned to usual care in the first randomisation. There were few cardiac arrythmias, bleeding, or thrombotic events in any group. Two children died; neither was considered related to study treatment. Interpretation(s): Moderate evidence suggests that, compared with usual care, first-line intravenous methylprednisolone reduces duration of hospital stay for children with PIMS-TS. Good evidence suggests that second-line tocilizumab reduces duration of hospital stay for children with inflammation refractory to initial treatment. Neither intravenous immunoglobulin nor anakinra had any effect on duration of hospital stay compared with usual care. Funding(s): Medical Research Council and National Institute of Health Research.Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licensehttps://doi.org/10.1016/S2352-4642(23)00316-
The role of religion in defining and diagnosing death
No full textAvailable to view at the publisher's website here: https://doi.org/10.1111/dmcn.15996.https://doi.org/10.1111/dmcn.1599
Pneumococcal serotypes and risk factors in adult community-acquired pneumonia 2018-20; A multicentre UK cohort study
Get PDFBackground: Higher-valency pneumococcal vaccines are anticipated. We aimed to describe serotype distribution and risk factors for vaccine-serotype community-acquired pneumonia (CAP) in the two years pre-SARS-CoV-2 pandemic., Methods: We conducted a prospective cohort study of adults hospitalised with CAP at three UK sites between 2018 and 2020. Pneumococcal serotypes were identified using a 24-valent urinary-antigen assay and blood cultures. Risk factors associated with vaccine-type pneumonia caused by serotypes in the 13-, 15- and 20-valent pneumococcal conjugate vaccines (PCV13, PCV15, PCV20) and 23-valent pneumococcal polysaccharide vaccine (PPV23) were determined from multivariable analysis., Findings: Of 1921 adults hospitalised with CAP, 781 (40.7%, 95% confidence intervals (CI) 38.5-42.9%) had pneumococcal pneumonia. A single PCV13-serotype was detected in 242 (31.0%, 95% CI 27.8-34.3%) pneumococcal CAP patients, mostly serotype 3 (171/242, 70.7%, 95% CI 64.5-76.0%). The additional two PCV15-serotypes were detected in 31 patients (4%, 95% CI 2.8-5.6%), and PCV20-non13-serotypes in 192 (24.6%), with serotype 8 most prevalent (123/192, 64.1%, 95% CI 57.1-70.5%). Compared to PCV13-serotype CAP, people with PCV20-non13 CAP were younger (median age 62 versus 72 years, p : Of 1921 adults hospitalised with CAP, 781 (40.7%, 95% confidence intervals (CI) 38.5-42.9%) had pneumococcal pneumonia. A single PCV13-serotype was detected in 242 (31.0%, 95% CI 27.8-34.3%) pneumococcal CAP patients, mostly serotype 3 (171/242, 70.7%, 95% CI 64.5-76.0%). The additional two PCV15-serotypes were detected in 31 patients (4%, 95% CI 2.8-5.6%), and PCV20-non13-serotypes in 192 (24.6%), with serotype 8 most prevalent (123/192, 64.1%, 95% CI 57.1-70.5%). Compared to PCV13-serotype CAP, people with PCV20-non13 CAP were younger (median age 62 versus 72 years, p Interpretation: Despite mature infant pneumococcal programmes, the burden of PCV13-serotype pneumonia remains high in older adults, mainly due to serotype 3. PCV20-non13-serotype pneumonia is more likely in younger people with fewer pneumococcal risk factors., Funding: Unrestricted investigator-initiated research grant from Pfizer, United Kingdom; support from National Institute for Health Research (NIHR) Biomedical Research Centre, Nottingham. Copyright © 2023 The Authors.https://doi.org/10.1016/j.lanepe.2023.10081
Professional identity formation of medical students in relation to the care of older persons: A review of the literature
Get PDFWith the growing population of older persons, medical students have to be well prepared for older persons' health care during medical school. Becoming a doctor is an interplay of building competencies and developing a professional identity. Professional identity formation of medical students is a relatively new educational concept in geriatric medical education. This review aims to explore the concept of professional identity formation of undergraduate medical students in relation to the care of older persons. Twenty-three peer-reviewed studies were included and summarized narratively. Patient-centeredness, caring and compassion, collaboration and holistic care are characteristics of the doctor's professional identity in relation to the care of older persons. Participating in the context of older persons' health care contributes to the becoming of a doctor in general. In this context, the building of relationships with older persons, participating in their lives and role models are important influencers of professional identity formation. Furthermore, the perceptions and expectations medical students have of future doctoring influence their feelings about the care of older persons. To prepare medical students for older persons' health care, professional identity formation seems to be a relevant educational concept.https://doi.org/10.1080/02701960.2023.221055
A European survey of older peoples' preferences, and perceived barriers and facilitators to inform development of a medication-related fall-prevention patient portal
Get PDFPurpose Falls are a major and growing health care problem in older adults. A patient portal has the potential to provide older adults with fall-prevention advice to reduce fall-risk. However, to date, the needs and preferences regarding a patient portal in older people who have experienced falls have not been explored. This study assesses content preferences, potential barriers and facilitators with regard to using a patient portal, as perceived by older people who have experienced falls, and explores regional differences between European participants. Methods We conducted a survey of older adults attending an outpatient clinic due to a fall or fall-related injury, to explore their content preferences, perceived barriers, and facilitators with respect to a fall-prevention patient portal. Older adults (N = 121, 69.4% female, mean age: 77.9) were recruited from seven European countries. Results Almost two-thirds of respondents indicated they would use a fall-prevention patient portal. The portal would preferably include information on Fall-Risk-Increasing Drugs (FRIDs), and ways to manage other related/relevant medical conditions. Facilitators included a user-friendly portal, with easily accessible information and physician recommendations to use the portal. The most-commonly-selected barriers were privacy issues and usage fees. A family member’s recommendation to use the portal was seemingly more important for Southern and Eastern European participants compared to the other regions. Conclusion The majority of older people with lived falls experience expressed an interest in a fall-prevention patient portal providing personalized treatment advice to prevent further falls. The results will be used to inform the development of a fall-prevention patient portal. The fall-prevention patient portal is intended to be used in addition to a consultation with a physician. Future research is needed to explore how to prevent falls in older patients who are not interested in a fall-prevention patient portal.https://doi.org/10.1007/s41999-024-00951-
Role of staging laparoscopy on oesophageal and junctional cancer management
No full textAvailable to read online at the publisher's website here: https://doi.org/10.1093/bjs/znae271.146.https://doi.org/10.1093/bjs/znae271.14
Diagnostic performance of axial T2-weighted MRI sequence for exclusion of brain tumour in paediatric patients with non-localizing symptoms
No full textOBJECTIVE: To establish diagnostic performance of a single axial T2-weighted sequence for detection of brain tumours in children with non-localizing symptoms, compared to a standard MRI protocol. METHOD(S): Retrospective analysis of children undergoing MRI brain imaging for suspected brain tumours with non-localizing symptoms over a 3-year period. Axial T2-weighted images were blindly reviewed by 2 experienced paediatric neuroradiologists. Primary analysis was calculation of diagnostic performance metrics for tumour identification using axial T2-weighted image only compared to the standard MRI protocol. RESULT(S): For 312 children undergoing MRI brain during the study period, sensitivity and specificity for brain tumour detection based on axial T2-weighted images in children with non-localizing symptoms were 1.000 (95% CIs 0.598, 1.000) and 0.998 (95% CI 0.990, 0.999), respectively. Based on T2-weighted images alone, 50 patients (16%) were flagged as needing recall for further imaging compared to 14 (4.5%) recalled after the standard protocol. CONCLUSION(S): Axial T2-weighted images have high sensitivity and specificity for detection of brain tumours in children with non-localizing symptoms but are associated with increased imaging recall rates. Prospective evaluation of this approach to identify patients requiring more comprehensive imaging is warranted. ADVANCES IN KNOWLEDGE: A truncated MRI protocol with single axial T2-weighted sequence has high diagnostic performance for brain tumour detection in children with non-localizing features. Radiologists can be reassured that a child with this presentation who is unable to complete the full MRI scan protocol is very unlikely to have a brain tumour missed provided an axial T2-weighted sequence is obtained.Copyright © The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology. All rights reserved. For permissions, please email: [email protected]://doi.org/10.1093/bjr/tqae24
The impact of COVID-19 lockdown and post-lockdown period on acute psychiatric admissions for emotionally unstable personality disorder
No full textThe COVID-19 pandemic negatively impacted the mental health of people with emotionally unstable personality disorder (EUPD), with reports of maladaptive coping mechanisms, reduced mental health support and quality of life. In this study, the authors examine the impact of COVID-19 lockdown and post-lockdown period on acute psychiatric admission rates in an NHS Trust in people diagnosed with EUPD. In addition, the authors analyse whether patient profiles and the seasonal pattern of admission were impacted by COVID-19 in this population. The study highlights the need for preventative clinical care pathways with increased access and service responsiveness, adjusted to fit local needs at times of confinement policies and additionally more research into seasonal patterns of admission in those with EUPD.https://onlinelibrary.wiley.com/doi/10.1002/pnp.1201