ResearchPad - Nursing Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Mobile technology intervention for weight loss in rural men: protocol for a pilot pragmatic randomised controlled trial]]>


Men who are overweight or obese in the rural Midwestern USA are an unrepresented, at-risk group exhibiting rising rates of cardiovascular disease, poor access to preventive care and poor lifestyle behaviours that contribute to sedentary lifestyle and unhealthy diet. Self-monitoring of eating and activity has demonstrated efficacy for weight loss. Use of mobile technologies for self-monitoring eating and activity may address rural men’s access disparities to preventive health resources and support weight loss. Our pilot trial will assess the feasibility and acceptability of two mobile applications for weight loss in rural men to inform a future, full-scale trial.

Methods and analysis

A 6-month randomised controlled trial with contextual evaluation will randomise 80 men using a 1:1 ratio to either a Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention in rural, midlife men (aged 40–69 years). The MT+ intervention consists of a smartphone self-monitoring application enhanced with discussion group (Lose-It premium), short message service text-based support and Wi-Fi scale. The MT group will receive only a self-monitoring application (Lose-It basic). Feasibility and acceptability will be evaluated using number of men recruited and retained, and evaluative focus group feedback. We seek to determine point estimates and variability of outcome measures of weight loss (kg and % body weight) and improved dietary and physical activity behaviours (Behavioral Risk Factor Surveillance System (BRFSS) physical activity and fruit and vegetable consumption surveys, data from Lose-It! application (kcal/day, steps/day)). Community capacity will be assessed using standard best practice methods. Descriptive content analysis will evaluate intervention acceptability and contextual sensitivity.

Ethics and dissemination

This protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB# 594–17-EP). Dissemination of findings will occur through and publish pilot data to inform the design of a larger clinical trial.

Trial registration number

NCT03329079; preresults. Protocol V.10, study completion date 31 August 2020. Roles and responsibilities funder: NIH/NINR Health Disparities Section 1R15NR017522-01.

<![CDATA[SARS - a perspective from a school of nursing in Hong Kong]]>

Background.  Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS.

Aims and objectives.  This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications.

Conclusions.  The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario.

Relevance to clinical practice.  Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large.

<![CDATA[Perceptions of the technical staff of professional teams regarding injury prevention in Spanish national futsal leagues: a cross-sectional study]]>

Futsal is a sport with increasing popularity and level of performance, both in male and female categories. Also, there are several injuries along a season, so it is needed to know how to reduce this burden. The purpose of this study was to describe the perceptions of technical staff on injury risk factors, risk testing and preventive measures, and the strategies used by them within professional male and female futsal teams. A cross-sectional study was designed during the 2017–2018 season. A total of 32 futsal teams involved in male and female Spanish national futsal leagues completed, through an online survey platform, a questionnaire about injury risk factors, risk testing and preventive measures. Findings showed that: (a) most teams reported enough human resources, but insufficient material and time resources, (b) the main risk factors detected were previous injuries, strength deficits and dehydration, (c) functional movement patterns, flexibility tests and self-report questionnaires were the most applied tests for detecting injury risks in their players and (d) most of the main preventive measures used by technical staff matched with the best valued by them. Technical staff defined properly the main risk factors in futsal performance, as well as they applied preventive strategies with scientific support. The information provided in this research could be of interest for sport scientists and technical staff when designing more accurate and efficient injury prevention programs in futsal.

<![CDATA[Knowledge, attitude and self-efficacy of elderly caregivers in Chinese nursing homes: a cross-sectional study in Liaoning Province]]>


This study aimed to investigate the perceptions of elderly caregivers in Chinese nursing homes (NHs) and associated factors with regard to knowledge, attitude about elderly and self-efficacy.


A cross-sectional questionnaire survey was conducted in 12 NHs in Liaoning Province, China.


A total of 403 caregivers from 12 NHs were surveyed.

Outcome measures

Data were collected using a self-administered questionnaire composed of the Palmore’s Facts on Aging Quiz I, Kogan’s Attitude Towards Old People Scale, General Self-Efficacy Scale and background characteristics of participants. An average score for knowledge, attitude and self-efficacy was calculated. Differences across groups were evaluated using Student’s t-test and analysis of variance. Multivariable linear regression models were established to estimate the associated factors.


The participating caregivers reported a relative low score on knowledge about the elderly (10.42±2.79), attitude towards old people (127.85±14.36) and self-efficacy (27.12±4.9). Multivariable regression analysis showed that respondents who had high educational level (β=0.212, 95% CI 0.193 to 0.824), received prejob training (β=0.193, 95% CI 0.081 to 1.169) and had high job satisfaction (general satisfaction: β=0.345, 95% CI 0.223 to 1.875; very satisfied: β=0.322, 95% CI 0.210 to 1.283) gave a positive rating on knowledge. Caregivers who were employed as formal staff (β=0.155, 95% CI 0.116 to 1.670), earned a high income (β=0.214, 95% CI 0.117 to 1.461) and had an interest in working with the elderly (β=0.141, 95% CI 0.088 to 1.508) tended to develop a positive attitude towards the elderly. However, caregivers who were female (β=−0.110, 95% CI −1.751 to −0.080) and had long work experience (β=−0.130, 95% CI −1.527 to −0.110) developed negative perception. Caregivers who were older (β=0.215, 95% CI 0.139 to 1.027), received prejob training (β=0.143, 95% CI 0.113 to 1.024), had an interest in working with the elderly (β=0.154, 95% CI 0.114 to 1.015), had high job satisfaction (β=0.177, 95% CI 0.116 to 1.223) and perceived better health status for the elderly (partial disability: β=0.437, 95% CI 0.259 to 1.600; no disability: β=0.288, 95%CI 0.153 to 1.211) gave a positive rating on self-efficacy.


Knowledge about the elderly, attitude towards old people and self-efficacy of elderly caregivers in Chinese NHs were at low levels. Some targeted intervention programmes, such as conducting professional training for aged care and a performance-based payment system, should be given priority to improve these attributes.

<![CDATA[Data on the endogenous conversion of tyrosol into hydroxytyrosol in humans]]>

Here we present new and original data on the endogenous conversion of tyrosol (Tyr) into hydroxytyrosol (OHTyr) in humans and its effects on the cardiovascular system. A randomized, crossover, controlled clinical trial was performed with individuals at cardiovascular risk (n = 33). They received white wine (WW) (females 1, males 2 standard drinks/day), WW plus Tyr capsules (WW + Tyr) (25mg Tyr capsule, one per WW drink), and water (control) ad libitum. Intervention periods were of 4 weeks preceded by three-week wash-out periods. We assessed the conversion of Tyr to OHTyr, its interaction with a polygenic activity score (PAS) from CYP2A6 and CYP2D6 genotypes, and the effects on cardiovascular risk markers. For further details and experimental findings please refer to the article “Cardiovascular benefits of tyrosol and its endogenous conversion into hydroxytyrosol in humans. A randomized, controlled trial” [1].

<![CDATA[The effects of the flipped classroom in teaching evidence based nursing: A quasi-experimental study]]>


Evidence-based nursing (EBN) has been an important training mechanism for improving the quality of clinical care. At present, the pedagogy focuses on the application of e-learning and team-based learning to enhance learners’ engagement and learning effectiveness.


This study applied the flipped classroom approach to conduct evidence-based nursing (EBN) teaching. The aim of this study is to elevate the learning effectiveness of the flipped classroom group to the traditional teaching group in terms of knowledge and self-efficacy in practice.


A pretest-posttest nonequivalent control group with a quasi-experimental quantitative design.


The study recruited 151 nurses, of whom 75 were in the control group and 76 were in the experimental group. During the EBN course, the control group received training via traditional pedagogy while the experimental group engaged the flipped classroom approach. The learning effectiveness of EBN knowledge and self-efficacy in practice were evaluated across the three time points: pre-course, post-course, and one month after the course.


In both group the scores of the EBN knowledge and self-efficacy in practice improved after training. The scores of the experimental group increased significantly than in the control group. However, the scores declined in both groups one month after the course. Even so, the experimental group’s score of self-efficacy in practice was still higher than that of the control group.


The implementation of the flipped classroom approach and team-based learning effectively enhanced the learners EBN knowledge accumulation and self-efficacy in practice. The research results can be used as an important reference for improving clinical nursing teaching quality.

<![CDATA[A view to a kill? – Ambient bacterial load of frames and lenses of spectacles and evaluation of different cleaning methods]]>

Surfaces with regular contact with the human body are typically contaminated with microorganisms and might be considered as fomites. Despite spectacles being widespread across populations, little is known about their microbial contamination. Therefore, we swab-sampled 11 worn spectacles within a university setting as well as 10 worn spectacles in a nursing home setting. The microbial load was determined by aerobic cultivation. All spectacles were found to be contaminated with bacteria, with nose pads and ear clips having the highest density, i.e. at sites with direct skin contact. Summed over all sites, the median microbial load of the university spectacles (1.4 ± 10.7 x 103 CFU cm-2) did not differ significantly from the spectacles tested in the nursing home (20.8 ± 39.9 x 103 CFU cm-2). 215 dominant bacterial morphotypes were analyzed by MALDI biotyping. 182 isolates could be assigned to 10 genera, with Staphylococcus being the most common. On genus-level, bacterial diversity was greater on nursing home spectacles (10 genera) compared to the university environment (2 genera). Four cleaning methods were investigated using lenses artificially contaminated with Escherichia coli, Micrococcus luteus, a 1:2 mixture of E. coli and M. luteus, and Staphylococcus epidermidis (the dominant isolate in our study), respectively. Best cleaning results (99% -100% median germ reduction) were obtained using impregnated wipes; dry cleaning was less effective (85% -90% median germ reduction). Finally, 10 additional worn university spectacles were cleaned with wipes impregnated with an alcohol-free cleaning solution before sampling. The average bacterial load was significantly lower (0.09 ± 0.49 x 103 CFU cm-2) compared to the uncleaned university spectacles previously investigated. Spectacles are significantly contaminated with bacteria of mostly human skin origin—including significant amounts of potentially pathogenic ones and may contribute to eye infections as well as fomites in clinical environments.

<![CDATA[The dataset for relationship between the nurses to patients ratio and patients satisfaction with nursing care]]>

The nurse to patient ratio is one of the impressive nursing care features. Evaluation of patient satisfaction with nursing care according to the number of available agents can be a valuable tool for understanding the quality of service the patient receive it used to adjust appropriate strategies. This data article involved 402 patients who were ready for discharge, in East Gilan hospitals in Iran in 2013. Data were collected through questionnaires PSI. Its validity and internal consistency reliability (Cronbach׳s alpha) were 90%. The obtained data showed that there are differences in nurses to patients ratio in hospitals and mean satisfaction was 72.6 ± 17.8. However, no relationship was found between patient satisfaction and nurses to patients ratio. Patients’ satisfaction with nursing care, regardless of the nurses to patients ratio indicates that nurses are trying to attract the patient׳s consent under any circumstances. In the intensive care unit was a decrease in the number of patients each nurse to provide more direct attention leads more satisfaction.

<![CDATA[A positive attitude towards provision of end-of-life care may protect against burnout: Burnout and religion in a super-aging society]]>


The aim of our study was to investigate factors associated with burnout of nurses and care workers in nursing homes and geriatric hospitals in Japan. The use of Buddhist priests, the major religion in Japan, was also explored.


Questionnaires for nurses and care workers were sent to 10 care facilities. The survey questions included basic demographic information, the Japanese Burnout Index and the Japanese version of the Frommelt Attitude Toward Care Of Dying Scale Form B. They also asked questions about use of Buddhist priests for tasks such as helping to manage the anxiety or distress of patients, families, and staff, or providing sutra chanting.


In total, 323 questionnaires were returned, of which 260 were used for analysis. Only 18 (6.9%) answered that they had any religious beliefs, which was relatively low compared to 27% from governmental survey data. In total, however, 71% expressed a need for Buddhist priests to help with anxiety or distress among patients. A positive attitude towards providing end-of-life care was a protective factor against depersonalization. It was, however, also related to lower feelings of personal accomplishment.


Care homes and geriatric hospitals may want to consider calling more on religious resources as a support for staff and patients.

<![CDATA[Patients’ Main Concerns About Having a Sibling Stem Cell Donor – A Grounded Theory Study]]>


There is limited knowledge about the perspective of patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) about having a sibling as donor. It is essential to understand the main concerns of stem cell recipients in order to enable nurses to provide person-centred care.


The study aim was to explore patients’ main concerns about having a sibling stem cell donor and how the patients handle them, from immediately before until one year after transplantation.


Twenty-eight interviews were performed prospectively during one year with ten adult sibling stem cell recipients with a mean age of 52 years (range 19-68 years). The interviews were analyzed by the Grounded Theory method.


The core category Recompensation summarises the process in the generated grounded theory including the three main categories; Invest, Compensate and Celebrate. Recompensation is defined as a lasting compensation given by the recipient to the sibling donor for the loss or harm suffered or effort made. The sense of having to reward, protect, appreciate, maintain peace and work on the relationship with the sibling donor at the same time as having to accept a serious illness, cope with their situation and promote their own recovery is strenuous for the recipients.


The main concern for stem cell recipients during their first post-transplant year is to recompensate the sibling donor by investing, compensating and celebrating her/him. Although there is a positive aspect of recompensation, it can also imply pressure and guilt.

<![CDATA[Role of Blood Lipids in the Development of Ischemic Stroke and its Subtypes]]>

Supplemental Digital Content is available in the text.

<![CDATA[Multidisciplinary approach to the management of pulmonary embolism patients: the pulmonary embolism response team (PERT)]]>

Pulmonary embolism (PE) is a potentially fatal disease with a broad range of treatment options that spans multiple specialties. The rapid evolution and expansion of novel therapies to treat PE make it a disease process that is well suited to a multidisciplinary approach. In order to facilitate a rapid, robust response to the diagnosis of PE, some hospitals have established multidisciplinary pulmonary embolism response teams (PERTs). The PERT model is based on existing multidisciplinary teams such as heart teams and rapid response teams. A PERT is composed of clinicians from the range of specialties involved in the treatment of PE, including pulmonology critical care, interventional radiology, cardiology, and cardiothoracic surgery among others. A PERT is a 24/7 consult service that is able to provide expert advice on the initial management of PE patients and convene in real time to develop a consensus treatment plan specifically tailored to the needs of a particular patient and consistent with the capabilities of the institution. In this review, we discuss the rationale for establishing a PERT and its potential benefits. We discuss considerations in forming a PERT and present case studies of several PERTs currently in operation at different institutions. We also discuss potential difficulties in forming a PERT and review evidence that has been generated by some of the PERTs that have been in operation the longest.

<![CDATA[]]> ]]> <![CDATA[Anxiety After Stroke]]>

Supplemental Digital Content is available in the text.

<![CDATA[Neutralization tiers of HIV-1]]>

Purpose of review

HIV-1 isolates are often classified on the basis of neutralization ‘tier’ phenotype. Tier classification has important implications for the monitoring and interpretation of vaccine-elicited neutralizing antibody responses. The molecular basis that distinguishes the multiple neutralization phenotypes of HIV-1 has been unclear. We present a model based on the dynamic nature of the HIV-1 envelope glycoproteins and its impact on epitope exposure. We also describe a new approach for ranking HIV-1 vaccine-elicited neutralizing antibody responses.

Recent findings

The unliganded trimeric HIV-1 envelope glycoprotein spike spontaneously transitions through at least three conformations. Neutralization tier phenotypes correspond to the frequency by which the trimer exists in a closed (tiers 2 and 3), open (tier 1A), or intermediate (tier 1B) conformation. An increasing number of epitopes become exposed as the trimer opens, making the virus more sensitive to neutralization by certain antibodies. The closed conformation is stabilized by many broadly neutralizing antibodies.


The tier 2 neutralization phenotype is typical of most circulating strains and is associated with a predominantly closed Env trimer configuration that is a high priority to target with vaccines. Assays with tier 1A viruses should be interpreted with caution and with the understanding that they detect many antibody specificities that do not neutralize tier 2 viruses and do not protect against HIV-1 infection.

<![CDATA[Primary Intravenous Set Consumption Across 3 Branded Infusion Pumps]]>

Supplemental Digital Content is Available in the Text.

<![CDATA[Clinical Evaluation of a Skin Protectant for the Management of Incontinence-Associated Dermatitis]]>


The purpose of this study was to evaluate the efficacy of an investigational skin protectant product at managing severe skin breakdown associated with incontinence.


Open-label, nonrandomized, prospective study.


The sample comprised 16 patients; inclusion criteria were: patients older than 18 years, cared for in the intensive care unit of a level I trauma center hospital or in long-term care facilities in the northeast region of the United States, and had incontinence-associated dermatitis (IAD). Twelve of the patients had epidermal skin loss and 4 had severe redness.


The investigational product is a formulation based on acrylate chemistry. The skin protectant application schedule was twice weekly for up to 3 weeks for a maximum of 6 applications during the study period. The skin was evaluated via a skin assessment instrument specifically designed for use in this study; this instrument has not undergone validation studies. The main outcome measure was changes in the instrument score over time. In addition, complete reepithelialization was recorded when observed, and pain scores (associated with IAD) were noted in participants who were able to report pain.


The IAD score improved in 13 of 16 patients, remained unchanged in 1 patient, and deteriorated in 2 patients. The median percent improvement in the skin assessment instrument was 96% (P = .013). Four of the patients with epidermal skin loss had complete reepithelialization of the skin surface with 4 to 6 applications of the skin protectant, and 5 had substantial improvement. The 4 patients with severe red skin returned to healthy normal skin with 2 to 4 skin protectant applications. Substantial pain reduction was reported by all 9 patients who reported pain at enrollment. No adverse events associated with the skin protectant application were reported during data collection.


Results of this study suggest that an acrylate-based product, evaluated here for the first time in patients, may be effective as a protective barrier in the presence of continued incontinence. Additional research is needed to confirm these findings.

<![CDATA[The Effect of Educational Intervention Regarding the Knowledge of Mothers on Prevention of Accidents in Childhood]]> <![CDATA[Keloid Management: A Retrospective Case Review on a New Approach Using Surgical Excision, Platelet-Rich Plasma, and In-office Superficial Photon X-ray Radiation Therapy]]> <![CDATA[An Automated and Minimally Invasive Tool for Generating Autologous Viable Epidermal Micrografts]]>



A new epidermal harvesting tool (CelluTome; Kinetic Concepts, Inc, San Antonio, Texas) created epidermal micrografts with minimal donor site damage, increased expansion ratios, and did not require the use of an operating room. The tool, which applies both heat and suction concurrently to normal skin, was used to produce epidermal micrografts that were assessed for uniform viability, donor-site healing, and discomfort during and after the epidermal harvesting procedure.


This study was a prospective, noncomparative institutional review board–approved healthy human study to assess epidermal graft viability, donor-site morbidity, and patient experience.


These studies were conducted at the multispecialty research facility, Clinical Trials of Texas, Inc, San Antonio.


The participants were 15 healthy human volunteers.


The average viability of epidermal micrografts was 99.5%. Skin assessment determined that 76% to 100% of the area of all donor sites was the same in appearance as the surrounding skin within 14 days after epidermal harvest. A mean pain of 1.3 (on a scale of 1 to 5) was reported throughout the harvesting process.


Use of this automated, minimally invasive harvesting system provided a simple, low-cost method of producing uniformly viable autologous epidermal micrografts with minimal patient discomfort and superficial donor-site wound healing within 2 weeks.