To develop and validate a difficult intravenous access risk assessment and escalation pathway, to increase first time intravenous insertion success in paediatrics.
Mixed methods underpinned by ...literature and co-production principles. Iterative development of the instrument was informed through semi-structured interviews and stakeholder workshops. The instrument includes a risk assessment, inserter skill self-assessment, and escalation pathways. Reproducibility, reliability, and acceptability were evaluated in a prospective cohort study at a quaternary paediatric hospital in Australia.
Interview data (three parents, nine clinicians) uncovered two themes: i) Recognition of children with DIVA and subsequent escalation is ad hoc and problematic; and ii) Resources and training impact inserter confidence and ability. Three workshops were delivered at monthly intervals (February-April 2020) involving 21 stakeholders culminating in the co-production of the "DIVA Key". The DIVA Key was evaluated between May-December 2020 in 78 children; 156 clinicians. Seventy-eight paired assessments were undertaken with substantial agreement (concordance range = 81.5 to 83.0%) between the assessors. Interrater reliability of the DIVA risk assessment was moderate (kappa = 0.71, 95% CI 0.63-0.80). The DIVA Key predicted multiple insertion attempts for red (high risk) DIVA classification (relative risk ratio 5.7, 95% CI 1.2-27.1; reference low risk). Consumer and clinician satisfaction with DIVA Key was high (median (IQR) = 10 8-10; 8 8-10 respectively).
The DIVA Key is a straightforward, reliable instrument with inbuilt escalation pathway to support the identification of children with difficult intravenous access.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The twist-bend nematic (NTB) phase of bent-shaped molecules has recently attracted much attention due to the spontaneous bend of its director field and the doubly-degenerate chirality of its ...heliconical structure. Despite intensive experimental and theoretical investigation worldwide, the main structural characteristics (pitch and conical angle) and elastic properties of the phase are still barely understood. This is mainly due to the difficulty in growing large single domains of the NTB phase, which prevents the application of the powerful electro-optical techniques developed for the nematic (N) phase. Moreover, the twist and bend distortions of the optic axis are forbidden by the pseudo-layered structure of the NTB phase, which makes its response to the field smectic-like instead of nematic-like. Therefore, the only macroscopic electric effect that can be observed deep in the NTB phase is the smectic-like “electroclinic” effect (ECENTB). Here, we achieve large monochiral NTB domains which remain uniform over a wide temperature range (20–60 °C) in thin (1.5 µm) planar cells, thus avoiding the so-called stripe- and rope-like textural instabilities. This allowed us to experimentally determine, using electro-optical measurements, the temperature dependence of the ECENTB response in four different NTB materials: namely the dimers CB7CB, CB9CB, CB6OCB, and BNA76. For all compounds, the thermal dependences of conical angle and pitch in the vicinity of the N-NTB transition follow the theoretically predicted power law behaviour. However, the agreement between the measured and predicted power law exponents remains only qualitative, which calls for improvement of the theoretical models.
Abstract
Background
Hypoxia resulting from ascent to high-altitude or pathological states at sea level is known to increase platelet reactivity. Previous work from our group has suggested that this ...may be adenosine diphosphate (ADP)-specific. Given the clinical importance of drugs targeting ADP pathways, research into the impact of hypoxia on platelet ADP pathways is highly important.
Methods
Optimul aggregometry was performed on plasma from 29 lowland residents ascending to 4,700 m, allowing systematic assessment of platelet reactivity in response to several platelet agonists. Aggregometry was also performed in response to ADP in the presence of inhibitors of the two main ADP receptors, P2Y
1
and P2Y
12
(MRS2500 and cangrelor, respectively). Phosphorylation of vasodilator-stimulated phosphoprotein (VASP), a key determinant of platelet aggregation, was analysed using the VASPFix assay.
Results
Hypobaric hypoxia significantly reduced the ability of a fixed concentration of cangrelor to inhibit ADP-induced aggregation and increased basal VASP phosphorylation. However, in the absence of P2Y receptor inhibitors, we did not find evidence of increased platelet sensitivity to any of the agonists tested and found reduced sensitivity to thrombin receptor-activating peptide-6 amide.
Conclusion
Our results provide evidence of increased P2Y
1
receptor activity at high altitude and suggest down-regulation of the P2Y
12
pathway through increased VASP phosphorylation. These changes in ADP pathway activity are of potential therapeutic significance to high-altitude sojourners and hypoxic sea level patients prescribed platelet inhibitors and warrant further investigation.
This literature review aims to explore the role of telehealth during the COVID-19 pandemic across the interdisciplinary cancer care team.
Electronic databases including CINAHL, MEDLINE, PsychINFO, ...Scopus, and gray literature were searched using Google Scholar up until September 2020.
Although the safe and effective delivery of cancer care via telehealth requires education and training for health care professionals and patients, telehealth has provided a timely solution to the barriers caused by the COVID-19 pandemic on the delivery of interdisciplinary cancer services. Globally, evidence has shown that telehealth in cancer care can leverage an innovative response during the COVID-19 pandemic but may provide a long-lasting solution to enable patients to be treated appropriately in their home environment. Telehealth reduces the travel burden on patients for consultation, affords a timely solution to discuss distressing side effects, initiate interventions, and enable possible treatment additions and/or changes.
Global public health disasters pose significant and unique challenges to the provision of necessary services for people affected by cancer. Oncology nurses can provide a central contribution in the delivery of telehealth through transformational leadership across all domains and settings in cancer care. Oncology nurses provide the “hub of cancer care” safely embedded in the interdisciplinary team. Telehealth provides a solution to the current global health crisis but could also benefit the future provision of services and broad reach clinical trials.
High adolescent pregnancy rates in New Zealand (NZ) are influenced by limited access to contraception. In this paper, we discuss using a proactive contraception provision (PCP) model to overcome ...barriers that prevent effective contraceptive uptake. After outlining steps taken to assess acceptability of PCP in NZ, we cover three issues to consider with PCP: the range of contraceptives that should be offered, the age range that should be approached, and finally whether to include adolescents without uteruses. We conclude that PCP is an approach worth considering in the NZ context and should be piloted to assess feasibility and effectiveness.
Background
Peripheral venous cannulation is considered a routine procedure, yet 50% of first attempt insertions fail, necessitating repeat insertion attempts. Identification of children with ...difficult intravenous access (DIVA) can help promote prompt escalation to an appropriately skilled clinician.
Objective
To describe current international practice regarding the identification and management of children with DIVA, and to systematically review clinical tools and clinical pathways for children with DIVA.
Methods
A cross‐sectional, international survey; followed by a systematic review and critical appraisal of clinical pathways using the Appraisal of Guidelines for Research Evaluation (AGREE) II checklist.
Results
A total of 148 clinicians from eight countries completed the survey. The majority were nurses (n = 92; 62%), practicing as vascular access specialists (n = 27; 18%). Twenty‐three respondents (16%) reported using a DIVA tool, of which the DIVA Score was most common (n = 5; 22%). Five clinical pathways were identified from the survey and review. Based on the AGREE II domains, pathways generally scored well for scope and purpose, and for clarity of presentation areas. Information on the rigor of development and editorial independence was infrequently detailed. Based on AGREE II findings, one pathway was recommended for clinical practice, and four were recommended for use with modification.
Conclusions
Resources for the identification and escalation of children with DIVA are not standardized or consistently used. Further work is needed to streamline processes for DIVA identification and escalation to the appropriate clinician, with technology‐assisted insertion capability. This will enhance patient experiences and reduce harm from multiple insertion attempts.
Clinical Relevance
Multiple failed insertion attempts come at great cost to the child, family, and healthcare service. Early identification and management of the child with DIVA can ensure prompt escalation and management, improving the patient and family experience.
Negative affective states contribute to the chronic-relapsing nature of addiction. Mesolimbic dopamine D3 receptors are well placed to modulate emotion and are dysregulated in substance dependence. ...Selective antagonists might restore dopaminergic hypofunction, thus representing a potential treatment target. We investigated the effects of selective D3 antagonist, GSK598809, on the neural response to negative emotional processing in substance dependent individuals and healthy controls.
Functional MRI BOLD response was assessed during an evocative image task, 2 h following acute administration of GSK598809 (60 mg) or placebo in a multi-site, double-blind, pseudo-randomised, cross-over design. Abstinent drug dependent individuals (DD,
= 36) comprising alcohol-only (AO,
= 19) and cocaine-alcohol polydrug (PD,
= 17) groups, and matched controls (
= 32) were presented with aversive and neutral images in a block design (contrast of interest: aversive > neutral). Whole-brain mixed-effects and
ROI analyses tested for group and drug effects, with identical models exploring subgroup effects.
No group differences in task-related BOLD signal were identified between DD and controls. However, subgroup analysis revealed greater amygdala/insular BOLD signal in PD compared with AO groups. Following drug administration, GSK598809 increased BOLD response across HC and DD groups in thalamus, caudate, putamen, and pallidum, and reduced BOLD response in insular and opercular cortices relative to placebo. Multivariate analyses in
ROIs revealed differential effects of D3 antagonism according to subgroup in substantia nigra; GSK598809 increased BOLD response in AO and decreased response in PD groups.
Acute GSK598809 modulates the BOLD response to aversive image processing, providing evidence that D3 antagonism may impact emotional regulation. Enhanced BOLD response within D3-rich mesolimbic regions is consistent with its pharmacology and with attenuation of substance-related hypodopaminergic function. However, the lack of group differences in task-related BOLD response and the non-specific effect of GSK598809 between groups makes it difficult to ascertain whether D3 antagonism is likely to be normalising or restorative in our abstinent populations. The suggestion of differential D3 modulation between AO and PD subgroups is intriguing, raising the possibility of divergent treatment responses. Further study is needed to determine whether D3 antagonism should be recommended as a treatment target in substance dependence.
The synthesis and characterisation of four series of liquid crystal dimers based on benzylideneaniline mesogenic units, and in which the lengths of terminal alkyloxy chains are varied are reported. ...The series differ in terms of their flexible spacers, namely, heptamethylene, nonamethylene, hexyloxy, and oxypentyloxy chains. The heptamethylene- and nonamethylene-linked dimers both show conventional nematic, N, and twist-bend nematic, NTB, phases with short terminal chains, and smectic behaviour emerges on increasing terminal chain length. This is attributed to increased molecular inhomogeneity driving microphase separation. The dimers containing the shorter heptamethylene spacer show a smectic A phase whereas those with the longer nonamethylene spacer exhibit an anticlinic smectic C phase. Smectic behaviour is not observed for the dimers containing either a hexyloxy spacer which exhibit nematic and twist-bend nematic phases, or with an oxypentyloxy spacer which show only a conventional nematic phase. A general observation is that TNTBN and TNI alternate in the same sense in a homologous series on varying the length of the terminal alkyl chains suggesting that the spatial uniformity of the molecular curvature is an important factor in stabilising the NTB phase. The transitional properties of the four corresponding dimers possessing nitrile terminal substituents are also described. These show enantiotropic nematic phases, and in addition, for those containing either polymethylene or hexyloxy spacers, a twist-bend nematic phase is observed. Differences in the thermal behaviour of the dimers may be attributed largely to changes in molecular shape arising from the nature of the link between the spacer and mesogenic units.
Display omitted
•New examples of twist-bend nematogens are reported.•Effects of nature of spacer, and length of terminal alkyl chains in dimers reported•Differences in liquid crystal behaviour attributed to changes in molecular shape.•Liquid crystal transition temperatures alternate in same sense.•Uniformity of molecular curvature important in stabilising twist-bend nematic phase
Background:
Prevalence of immunosuppressant nonadherence in renal transplant recipients is high despite negative clinical outcomes associated with nonadherence. Simplification of dosing has been ...demonstrated to improve adherence in renal transplant recipients as measured through electronic monitoring and self-report.
Objective:
The purpose of this study was to replicate and extend previous findings by measuring adherence with multiple methods in a Canadian sample.
Design:
The study design was a randomized controlled medication dosing trial in adult renal transplant patients. The trial length was 4 months.
Setting:
This study was conducted within the Solid Organ Transplant (SOT) Clinic at Vancouver General Hospital (VGH; Vancouver, Canada).
Patients:
A total of 46 adult renal recipients (at least 1 year post-transplant) were recruited through the SOT clinic. With 8 withdrawals, 38 individuals completed all phases of the study.
Measurements:
Medication adherence was measured for a period of 4 months using multiple methods, including electronic monitoring (MEMS Medication Event Monitoring System), pharmacy refill data (medication possession ratio MPR), and by self-report using the Adherence subscale of the Transplant Effects Questionnaire (TEQ).
Methods:
Participants were randomized to twice-daily (n = 19) or once-daily tacrolimus dosing (n = 19) and followed over a 4-month period via monthly clinic study visits. Comparisons between the treatment groups were performed using the Mann-Whitney U and chi-square tests, for continuous and categorical variables, respectively.
Results:
As outlined in Table 3, the once-daily dosing group showed significantly better MEMS Dose Adherence (P = .001), whereas MEMS Timing Adherence showed a tendency toward better adherence for this group, but was not significant (P = .052). MEMS Days Adherent (P = .418), MPR% (P = .123), and self-reported adherence (P = .284) did not differ between the once- and twice-daily dosing groups when measured as continuous variables. The MPR% was significantly better for the once-daily dosing group when measured dichotomously but not continuously (P = .044). Notably, most of those exposed to once-daily dosing (63.2%) preferred this to the twice-daily regimen.
Limitations:
Limitations included small sample size and short follow-up period, precluding the examination of clinical outcome differences.
Conclusions:
Results for dose adherence replicate the finding that dose simplification increases adherence to immunosuppressants as measured through electronic monitoring. Such an advantage for the once-daily dosing group was not seen across the 2 other electronic monitoring measurement variables (days and timing adherence). This study extends previous research by examining adherence in once versus twice-daily dosing via prescription refill data in a Canadian sample. Given the gravity of potential health outcomes associated with nonadherence, although results indicate inconsistencies in significance testing across measurement methods, the medium to large effect sizes seen in the data favoring better adherence with once-daily dosing provide an indication of the potential clinical significance of these findings.
Trial registration:
This study was registered with ClinicalTrials.gov (NCT01334333) on April 11, 2011.
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