Care Clinical Practice Research Articles

Implementing a Hospital-Acquired Pressure Injury Prevention Bundle in Critical Care.

The emerging field of implementation science (IS) facilitates the sustainment of evidence-based practice in clinical care. This article, the third in a series on applying IS, describes how a nurse-led team at a multisite health system used IS concepts, methods, and tools to implement a hospital-acquired pressure injury (HAPI) prevention bundle on six critical care units, with the aim of decreasing HAPI incidence.

A Real-Life Laboratory Setting for Clinical Practice, Education, and Research in Family Systems Care: Protocol for a Transformational Action Research Study.

Burdening health and illness issues such as physical or mental illnesses, accidents, disabilities, and life events such as birth or death influence the health and functioning of families and contribute to the complexity of care and health care costs. Considerable research has confirmed the benefits of a family systems-centered care approach for patients, family caregivers, families, and health care professionals. However, health care professionals face barriers in working with families, such as feeling unprepared. Family systems-centered therapeutic conversations support families' day-to-day coping, resilience, and health. A family systems care unit (FSCU) was recently established as a real-life laboratory at one of the Swiss Universities of Applied Sciences. In this unit, health care professionals offer therapeutic conversations to families and individual family members to support daily symptom management and functioning, soften suffering, and increase health and well-being. These conversations are observed in real time through a 1-way window by other health care professionals, students, and trainees and are recorded with video for research and education. Little is known about how therapeutic conversations contribute to meaningful changes in burdened families and the benefits of vicarious learning in a real-life laboratory setting for family systems care. In this research program, we aim to deepen our understanding of how therapeutic conversations support families and individuals experiencing burdening health and illness issues and how the FSCU laboratory setting supports the learning of students, clinical trainees, and health care professionals. Here we apply a transformational action research design, including parallel and subsequent substudies, to advance knowledge and practice in family systems care. Qualitative multiple-case study designs will be used to explore the benefits of therapeutic conversations by analyzing recordings of the therapeutic conversations. The learning processes of students, trainees, and professionals will be investigated with descriptive qualitative study designs based on single and focus group interviews. The data will be analyzed with established coding methods. Therapeutic conversations have been investigated in 3 single-case studies, each involving a sequence of 3 therapeutic conversation units. Data collection regarding the second research question is planned. Preliminary results confirm the therapeutic conversations to support families' coping. This renders the FSCU a setting for ethically sensitive research. This program will not only support the health and well-being of families, but also contribute to relieving the financial and workforce burdens in the health and social care system. DERR1-10.2196/53090.

Comorbidity neural network model for personalised recommendations in cardiometabolic risk factor management: towards early precision medicine in routine clinical practice

Abstract Background and Aims Hypertension and hypercholesterolaemia often develop in tandem to confer a risk of cardiovascular disease that may be more than additive. The present study explored early comorbid therapeutic intervention, i.e., beyond individual disease silos, while minimising data bias to provide clinical decision support tools that are portable across clinics. Methods A neural network was created to reproduce UK national clinical guidelines with an accuracy higher than 95%. Relying on real-world evidence from the UK primary care Clinical Practice Research Datalink electronic health record resource, a transfer learning methodology was then applied to achieve recommended risk factor goal attainment after two years. Shapley values derived from game theory were used to define similar digital twin cohorts, and to evaluate individualised recommendations that deviated from national clinical guidelines by rejecting a no-benefit hypothesis retrospectively in a classical proportion test. The methodology was ported to an independent hold-out dataset with anonymized records from six primary care clinics in the South of England. Results The adult patient population (n=469,496, mean+SD age 61+11yr; M 56% vs F 44%; primary 84% vs secondary prevention 16%) included 101,255 diagnosed for hypertension and 112,180 for cholesterol management. While a majority of the 52,504 therapeutic decisions in a test set agree with single morbidity guidelines, for 4639 deviations from the guidance, a significant minority was identified for whom alternative therapy was recommended. Rejecting a no-clinical benefit hypothesis at the 95% confidence level in a retrospective analysis, 1367 decisions showed statistically significant better outcomes over guidelines, for example by escalating anti-hypertensive therapies for patients receiving statin therapy (1085) or by complementing anti-hypertensive therapy with a statin (158). Similar findings were obtained when tested in a hold-out dataset with 13,725 decisions for 6531 patients. Conclusions The results support the contention that machine learning can identify patient subgroups for whom comorbid intervention deviating from clinical guidelines may be appropriate. A novel aspect of the study is the demonstration of clinically portable and actionable application of machine learning in the context of comorbid cardiometabolic diseases. The results represent practical steps towards personalised precision medicine for cardiovascular comorbidity in routine clinical practice.

Continuous Blood Pressure Indices During the First 72 Hours and Functional Outcome in Patients with Spontaneous Intracerebral Hemorrhage.

Management of intracerebral hemorrhage (ICH) is challenged by limited therapeutic options and a complex relationship between blood pressure (BP) dynamics, especially BP variability (BPV) and ICH outcome. In an exploratory analysis of prospectively collected data on consecutive patients with nontraumatic ICH between 2015 and 2020, continuous BP accessed via an arterial line extracted from the Intellispace Critical Care and Anesthesia information system (Philips Healthcare) was analyzed over the first 72 h post admission. Arterial lines were used as part of standard clinical practice in the intensive care, ensuring high fidelity and real-time data essential for acute care settings. BPV was assessed through successive variation (SV), standard deviation (SD), and coefficient of variation using all available BP measurements. Multivariate regression models were applied to evaluate the association between BPV indices and functional outcome at 3 months. Among 261 patients (mean age 69.6 ± 15.2 years, 47.9% female, median National Institutes of Health Stroke Scale [NIHSS] score 6 [interquartile range 2-12]) analyzed, lower systolic BP upon admission (< 140 mm Hg) and lower systolic BPV were significantly associated with favorable outcome, whereas higher diastolic BPV correlated with improved outcomes. In the multivariate analysis, diastolic BPV (SD, SV) within the first 72 h post admission emerged as an independent predictor of good functional outcome (modified Rankin Scale score < 3; odds ratio 1.123, 95% confidence interval CI 1.008-1.184, p = 0.035), whereas systolic BPV (SD) showed a negative association. Patients with better outcomes also exhibited distinct clinical characteristics, including younger age, lower median NIHSS scores, and less prevalence of anticoagulation therapy upon admission. This study shows the prognostic value of BPV in the acute phase of ICH. Lower systolic BPV (SD) and higher diastolic BPV (SD, SV) were associated with better functional outcomes, challenging traditional BP management strategies. These findings might help to tailor a personalized BP management in ICH.

Improving the nursing quality of non-pharmacological interventions for elderly constipation patients in the hospital: a best practice implementation project.

Non-pharmacological interventions are the preferred treatment for constipation; however, health care professionals in clinical settings tend to focus more on pharmacological treatments. This best practice implementation project aimed to integrate the best evidence on non-pharmacological interventions for elderly patients with constipation in clinical care practice and to promote the use of non-pharmacological interventions for such patients in the hospital setting. This project is based on the JBI Evidence Implementation Framework, which follows three stages. The first stage involved a baseline audit using two audit criteria derived from the best available evidence. This audit evaluated current clinical scenarios, guided by the i-PARIHS framework. The second stage involved analyzing the results of the baseline audit, identifying barriers to compliance, and developing and implementing strategies to overcome those barriers. Strategies included nursing education, development of constipation information booklets for nurses and patients, establishment of a nursing workflow, and modification of the department environment. In the third stage, a follow-up audit was conducted to evaluate the implementation, using the same data collection indicators and methods as in the baseline audit. Sixty patients participated in the project. Compliance for Criterion 1 (patient education) increased from 0% to 60% (P < 0.001), while compliance for Criterion 2 (monitoring patients' bowel health) increased from 0% to 100% (p < 0.001). The results indicate that this evidence-based implementation project facilitated the application of non-pharmacological interventions for elderly patients with constipation. Nurses played a significant role in developing regular defecation habits in patients and monitoring their defecation. http://links.lww.com/IJEBH/A284.

Telemedicine and time management in primary care.

Information and communication technologies (ICTs) can enable workers to structure work in novel ways, allow for better time management, and increase work scheduling autonomy. Time management and work scheduling are important factors in the field of clinical practice in primary care. Time limits on consultation are a key constraint on the delivery of good care since the length of patient-physician consultation impacts its quality. This research aimed to examine the experiences of primary care physicians (PCPs) when using telemedicine technologies (TTs), a type of ICT, in their communication with patients. During 2023 in-depth interviews were conducted with 20 Israeli PCPs: family physicians and pediatricians. Perception and management of time emerged as a focal subject in the interviews. The PCPs interviewed described several effects of TTs on time management in primary care. They portrayed TTs as saving time for patients and having a mixed effect on the healthcare organization: both saving and wasting their work time. TTs were described as impacting their time management in the context of work-life balance, allowing them to manage their time during and between appointments. For PCPs, TTs can be beneficial for managing time in the clinic, which can contribute to better healthcare. This article, concerning TTs as a type of ICT, contributes to the existing literature which suggests that ICTs can allow for better time management and increase work scheduling autonomy. It also presents several recommendations for better implementation of TTs in healthcare organizations.

Comparison of 4-week versus 8-week dietitian-led FODMAP diet group education sessions in tertiary care clinical practice for irritable bowel syndrome: A service evaluation.

The implementation of the fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet for irritable bowel syndrome (IBS) can be effectively delivered by dietitians in group settings. The initial FODMAP restriction phase is recommended to be followed for 4 weeks; however, limited efficacy data exist for 4-week FODMAP restriction in group education clinical practice. We aimed to compare 4-week versus 8-week FODMAP group treatment pathways on clinical outcomes using a prospective service evaluation design of IBS patients attending FODMAP restriction (baseline) and reintroduction (follow-up) group sessions (between 2015 and 2019). Clinical outcomes included global symptom question (GSQ) measuring satisfactory relief, gastrointestinal symptom rating scale (GSRS), stool frequency (SF), stool consistency using Bristol stool form scale (BSFS), diet acceptability, patient satisfaction with group sessions and dietary adherence. Logistic regression was used to test for differences in treatment effects when clinical outcomes were compared between groups. Patients (n = 284) included were aged 18 to 86 years (mean ± SD [standard deviation], 44.6 ± 15.5), 80% female, and were split into 4-week (41%, 117/284) versus 8-week (59%, 167/284) pathways with no differences in baseline characteristics. Mean ± SD time gap between baseline and follow-up was 4.6 ± 0.9 weeks in the 4-week pathway and 9.6 ± 3.3 weeks in the 8-week pathway. When groups were compared at follow-up, no statistical differences were observed in any measures (GSQ, GSRS, SF, BSFS, dietary adherence, diet acceptability and patient satisfaction). A 4-week dietitian-led group FODMAP treatment pathway is as clinically effective and maintains patient acceptability when compared to 8-weeks and should be considered as part of routine clinical practice.

A pragmatic approach to selecting a grading system for clinical practice recommendations in palliative care.

The limited palliative care evidence base is poorly amenable to existing grading schemes utilized in guidelines. Many recommendations are based on expert consensus or clinical practice standards, which are often considered 'low-quality' evidence. Reinforcing provider hesitancy in translating recommendations to practice has implications for patient care. To rationalize the selection of an appropriate grading system for rating evidence to support recommendations made in palliative care clinical practice guidelines. Review of the methodology sections of international palliative care guidelines published in English identified five grading systems comparison: Grading of Recommendations, Assessment, Development and Evaluations (GRADE); the Scottish Intercollegiate Guidelines Network (SIGN); Infectious Diseases Society of America-European Society for Medical Oncology (IDSA-ESMO); Confidence in the Evidence from Reviews of Qualitative research (CERQual) and the National Service Framework for Long Term Conditions (NSF-LTC). There is heterogeneity among grading systems used in published palliative care or terminal symptom management guidelines. GRADE has been increasingly adopted for its methodological rigour and inter-guideline consistency with other medical associations. CERQual has the potential to support recommendations informed by qualitative evidence, but its role in clinical guidelines is less defined. The IDSA-ESMO system has an intuitive typology with the ability to categorize tiers of lower-quality evidence. It is challenging to apply commonly used grading systems to the palliative care evidence base, which often lacks robust randomized controlled trials (RCTs). Adoption of IDSA-ESMO offers a feasible and practical alternative for lower-resourced guideline developers and palliative clinicians without a prerequisite for methodological expertise.

2024 Systematic Review of Evidence-Based Guidelines for Prehospital Care

ABSTRACT Objectives Evidence-based guidelines (EBGs) are widely recognized as valuable tools to aggregate and translate scientific knowledge into clinical care. High-quality EBGs can also serve as important components of dissemination and implementation efforts focused on educating emergency medical services (EMS) clinicians about current evidence-based prehospital clinical care practices and operations. We aimed to perform the third biennial systematic review of prehospital EBGs to identify and assess the quality of prehospital EBGs published since 2021. Methods We systematically searched Ovid Medline and EMBASE from January 1, 2021, to June 6, 2023, for publications relevant to prehospital care, based on an organized review of the literature, and focused on providing recommendations for clinical care or operations. Included guidelines were appraised using the National Academy of Medicine (NAM) criteria for high-quality guidelines and scored using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Tool. Results We identified 33 new guidelines addressing clinical and operational topics of EMS medicine. The most addressed EMS core content areas were time-life critical conditions (n = 17, 51.5%), special clinical considerations (n = 15, 45%), and injury (n = 12, 36%). Seven (21%) guidelines included all elements of the National Academy of Medicine (NAM) criteria for high-quality guidelines, including the full reporting of a systematic review of the evidence. Guideline appraisals by the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool demonstrated modest compliance to reporting recommendations and similar overall quality compared to previously identified guidelines (mean overall domain score 67%, SD 12%), with Domain 5 (“Applicability”) scoring the lowest of the six AGREE II domains (mean score of 53%, SD 13%). Conclusions This updated systematic review identified and appraised recent guidelines addressing prehospital care and identifies important targets for education of EMS personnel. Continued opportunities exist for prehospital guideline developers to include comprehensive evidence-based reporting into guideline development to facilitate widespread implementation of high-quality EBGs in EMS systems and incorporate the best available scientific evidence into initial education and continued competency activities.

Impact of a Registered Dietitian Led Diabetes Nutrition Continuing Education Course on Primary Care Provider's Knowledge, Attitude, and Clinical Practice

Impact of a Registered Dietitian Led Diabetes Nutrition Continuing Education Course on Primary Care Provider's Knowledge, Attitude, and Clinical Practice

Impact of a Nutrition and Diabetes Continuing Education Program on Primary Care Provider's Knowledge, Attitude, and Clinical Practice.

Diet/nutrition is the first-line non-pharmacological therapy in the treatment of diabetes. Diet/nutrition counseling is infrequently provided by primary care providers (PCPs), who have limited nutrition education in both medical and advanced practice provider curricula. This quality improvement project aimed to improve knowledge and attitude, and frequency of diet/nutrition counseling by PCPs among patients with uncontrolled diabetes (glycosylated hemoglobin A1c ≥8%), by providing an online continuing medical education (CME) program on diabetes diet/nutrition. At a community health center in New England, PCPs attended a live 50-minute online CME program that was developed internally, which taught PCPs current diet/nutrition guidelines and recommendations related to diabetes. Knowledge was assessed prior to and two weeks following the program, utilizing a 10-question tool, the Nutrition Management of Diabetes Assessment (NMDA). Similarly, attitude was evaluated using two subscales of the Nutrition in Patient Care Survey (NIPS): Nutrition in routine care and Physician efficacy. Chart audits of patients with uncontrolled diabetes were evaluated to assess PCPs documentation of diet/nutrition counseling four weeks prior to and six weeks following the CME program. In September 2023, PCPs (n = 29) completed the CME program. There was an improvement in knowledge in the NMDA amongst PCPs (36% difference, p < 0.001). Attitude scores from two subscales of the NIPS were evaluated and both showed improvement, however only physician efficacy was significant (15% difference, p < 0.01). There was a positive difference in the trend of diet/nutrition counseling after the education program (p < 0.05). An online CME program improved diabetes diet/nutrition knowledge and attitude of PCPs and improved counseling practices for patients living with uncontrolled diabetes. The education program provided PCPs current standards of care guidelines/recommendations, which they can utilize when counseling patients with diabetes. PCPs would benefit from dedicated continuing education programs regarding diet/nutrition therapy for chronic illnesses.

Incidence, prevalence, and survival of lung cancer in the United Kingdom from 2000-2021: a population-based cohort study.

Lung cancer is the leading cause of cancer-associated mortality worldwide. In the United Kingdom (UK), there has been a major reduction in smoking, the leading risk factor for lung cancer. Therefore, an up-to-date assessment of the trends of lung cancer is required in the UK. This study aims to describe lung cancer burden and trends in terms of incidence, prevalence, and survival from 2000-2021, using two UK primary care databases. We performed a population-based cohort study using the UK primary care Clinical Practice Research Datalink (CPRD) GOLD database, compared with CPRD Aurum. Participants aged 18+ years, with 1-year of prior data availability, were included. We estimated lung cancer incidence rates (IRs), period prevalence (PP), and survival at 1, 5 and 10 years after diagnosis using the Kaplan-Meier (KM) method. Overall, 11,388,117 participants, with 45,563 lung cancer cases were studied. The IR of lung cancer was 52.0 [95% confidence interval (CI): 51.5 to 52.5] per 100,000 person-years, with incidence increasing from 2000 to 2021. Females aged over 50 years of age showed increases in incidence over the study period, ranging from increases of 8 to 123 per 100,000 person-years, with the greatest increase in females aged 80-89 years. Alternatively, for males, only cohorts aged over 80 years showed increases in incidence over the study period. The highest IR was observed in people aged 80-89 years. PP in 2021 was 0.18%, with the largest rise seen in participants aged over 60 years. Median survival post-diagnosis increased from 6.6 months in those diagnosed between 2000-2004 to 10.0 months between 2015-2019. Both short and long-term survival was higher in younger cohorts, with 82.7% 1-year survival in those aged 18-29 years, versus 24.2% in the age 90+ years cohort. Throughout the study period, survival was longer in females, with a larger increase in survival over time than in males. The incidence and prevalence of lung cancer diagnoses in the UK have increased, especially in female and older populations, with a small increase in median survival. This study will enable future comparisons of overall disease burden, so the overall impact may be seen.

Futile therapeutic nursing interventions in adult intensive care: A descriptive study.

Background: Despite the progress made in recent decades on the phenomenon of futility in adult intensive care, recognizing it during clinical care practice remains a complex and sensitive process, during which questions are often raised for which concrete answers are difficult to find. Aims: To analyze the frequency with which futile nursing interventions are implemented in critically ill patients admitted to adult intensive care in specific situations and how often futile autonomous and interdependent nursing interventions are implemented in the same population, as perceived by adult intensive care nurses. Research design: Cross-sectional, quantitative, and descriptive study, which employed a questionnaire constructed specifically for this research to assess the perception of therapeutic futility in nursing in adult intensive care. Following an evaluation of the psychometric properties, the questionnaire was made available in an electronic format on the EUSurvey platform between August and October 2024. The data was analyzed between November 2023 and March 2024 using the statistical software packages SPSS and R. Participants and research context: A simple random sample of nurses working in level II and level III intensive care units in Portugal. Ethical considerations: Research ethical approvals were obtained, and the participants provided informed consent. Findings/results: Four hundred and fourteen valid questionnaires were obtained. The results allow the identification of thirty-three statistically significant associations, the inference of intervals for the mean and median for the perception of futility of nursing interventions with a 95% confidence interval, and enable the hierarchization of nursing interventions implemented in critically ill patients admitted to adult intensive care units according to the nurses' perception of their futility. Conclusion: There is a balance in nurses' perception of the futility of their interventions in the specific situations analyzed. There is statistically significant evidence that interdependent nursing interventions are, in general, more frequently perceived as futile when compared to autonomous nursing interventions.

Training Dental Teams to Address Community Health: Necessary Partnerships and Evaluation of an Evidence-Based Curriculum

Abstract: Background: Annually, 27 million Americans visit a dental professional but not a physician. Dental professionals must recognize that they are members of their patients’ primary care teams. Continuing education must then prepare them to appropriately serve their specific communities. Objectives: The objective of this paper was to describe the implementation of an evidence-based model to train dental professionals on how to respond to community-level health needs. The paper details crucial partnerships and provides evidence and key considerations for replicating the curriculum to improve population health. Methods: The Extension for Community Healthcare Outcomes (ECHO) model was used in one state where dental health care use is challenging for persons living rural, eligible for Medicaid, aging, and those who are American Indian. This formative evaluation knowledge assessments, data on participants’ changes in clinical care practice, web analytics, and artifact review to assess effective implementation strategies and necessary community partnerships. Conclusions: Successful implementation of the curriculum required active participation and partnership with state provider associations, the office of Medicaid, the state Board of Dental Licensure, and others. Without engaged partners, the curriculum would not have been community relevant, nor would it have had case presentation from local providers. In a state with only 427 practicing dentists, live attendance ranged between 9 and 22 dental team members, with between 11 and 91 views of the recorded sessions. Using the evidence-based ECHO model, which requires community health partnerships, is a cost-effective, and accessible, method to offering community specific education for dental providers across a large geographic region.

Perspectives on the Practice of Collaborative Care: Topical Themes and Future Directions From the Lens of a Collaborative Care Child Psychiatrist.

The increasing shortage of psychiatrists in the workforce is a well-documented and alarming trend. In light of this workforce shortage, psychiatrists bear a professional and ethical responsibility to identify strategies to increase access to mental health treatment and thereby reduce the impact of the psychiatrist shortage on patients and on the greater health system. One such strategy is the collaborative care model (CoCM), which has demonstrated efficacy in the mental health treatment of both pediatric and adult populations. In this article, the CoCM is presented as one effective strategy to address the behavioral workforce shortage. Current themes observed from the clinical practice of psychiatric collaborative care in a pediatric collaborative care setting are discussed with contemplation of future directions.

Abstract P406: Transforming Clinical Practices for Blood Pressure Management in Community Health Centers through Timely Data and Technical Support

Introduction: Blood pressure (BP) control can prevent major adverse cardiac events and is monitored through various means, including the Centers for Medicare and Medicaid Services 165 metric for BP control - an annual reporting metric for community health centers (CHCs) within the Uniform Data System framework that becomes accessible 6 months after the conclusion of the reporting period. In pursuit of more immediate indicators related to BP management, the National Hypertension Control Initiative (NHCI) initiated collaboration with a population health platform to support select CHCs with rapidly available data on 19 BP-related metrics. Hypothesis: With technical support and regular access to data, CHCs can implement timely clinical practice and process changes. Methods: To support CHCs in using the population health platform, NHCI staff provided technical assistance in a rapid cycle performance improvement (RCPI) to 10 interested CHCs. This opportunity allowed CHCs to partner with NHCI staff to review BP related metrics in the population health platform and to identify opportunities for clinical process and practice changes. Over an 8-week period from October to December 2023, 7 CHCs were actively involved in a series of 5-6 structured 30–60-minute meetings with both NHCI registered nurse and quality improvement staff. These meetings reviewed BP metrics, mapped clinical workflows for improvement, and supported data analytics. CHCs often chose 1-2 BP metrics for focus, concentrating on incremental change and short-term improvement. Results: Among participating CHCs that reported, they revealed successful or anticipated adjustments in team responsibilities and clinical processes, including leadership involvement and new methods. Limitations included CHC staff engagement, time, concerns with data reliability, and familiarity with the population health platform. Most reporting CHCs shared that their goals were greatly impacted by access to readily available performance data and that they plan to continue using the population health platform to affect performance moving forward. Conclusions: For participating CHCs, individualized guidance based on timely data may have been helpful in analyzing workflows and procedures, assessing clinical care practices, and implementing quality improvement plans. Frequent data may allow CHCs to make clinical practice and process changes to efficiently measure impact and more quickly improve BP control than standard methods.

"It Empowers You to Empower Them": Health Professional Perspectives of Care for Hyperglycaemia in Pregnancy Following a Multi-Component Health Systems Intervention.

The Northern Territory (NT) and Far North Queensland (FNQ) have a high proportion of Aboriginal and Torres Strait Islander women birthing who experience hyperglycaemia in pregnancy. A multi-component health systems intervention to improve antenatal and postpartum care in these regions for women with hyperglycaemia in pregnancy was implemented between 2016 and 2019. We explored health professional perspectives on the impact of the intervention on healthcare. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) underpinned this mixed-methods evaluation. Clinicians were surveyed before (n = 183) and following (n = 137) implementation. The constructs explored included usual practice and satisfaction with care pathways and communication between services. Clinicians, policymakers and the implementation team were interviewed (n = 36), exploring the impact of the health systems intervention on practice and systems of care. Survey and interview participants reported improvements in clinical practice and systems of care. Self-reported glucose screening practices improved, including the use of recommended tests (72.0% using recommended first-trimester screening test at baseline, 94.8% post-intervention, p < 0.001) and the timing of postpartum diabetes screening (28.3% screening at appropriate interval after gestational diabetes at baseline, 66.7% post-intervention, p < 0.001). Health professionals reported multiple improvements to care for women with hyperglycaemia in pregnancy following the health systems intervention.

Remember sustainability when identifying low-value clinical care practices in critical care.

Remember sustainability when identifying low-value clinical care practices in critical care.

The Effect of Supine, Semi-Fowler’s, and Fowler’s Positions on the Blood Pressure Values of Patients Hospitalized in Surgical Clinics

&lt;b&gt;Aim:&lt;/b&gt; Blood pressure measurement is an integral part of clinical practice in patient care and treatment, as well as being of critical importance in the early diagnosis, treatment, and prevention of the complications of hypertension. This study was carried out to determine the effect of supine, semi-Fowler’s, and Fowler’s positions on the blood pressure values of patients hospitalized in surgical clinics.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; This quasi-experimental study was carried out with 112 preoperative surgical patients hospitalized in the surgical clinics of a training and research hospital. Using a bedside monitor, the patients' systolic and diastolic blood pressures were measured in the supine, Fowler’s, and semi-Fowler’s positions. The Pearson correlation coefficient, Mauchly's sphericity, ANOVA, and Bonferroni correction were used in the data analysis.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt;&lt;i&gt; &lt;/i&gt;While systolic blood pressure values did not differ between the supine and semi-Fowler’s positions (F = .007, p = .934), there was a significant difference between the semi-Fowler’s and Fowler’s positions (F =5.534, p = .020). Diastolic blood pressure values differed significantly between the supine and semi-Fowler’s (F = 7.406, p = .008) and semi-Fowler’s and Fowler’s (F = 9.038, p = .003) positions.&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; It is vital for nurses to establish procedures for blood pressure measurement and evaluation in the clinic and other team members and periodically revise the existing procedures.

Trends in incidence, prevalence, and survival of breast cancer in the United Kingdom from 2000 to 2021

Breast cancer is the most frequently diagnosed cancer in females globally. However, we know relatively little about trends in males. This study describes United Kingdom (UK) secular trends in breast cancer from 2000 to 2021 for both sexes. We describe a population-based cohort study using UK primary care Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases. There were 5,848,436 eligible females and 5,539,681 males aged 18+ years, with ≥ one year of prior data availability in the study period. We estimated crude breast cancer incidence rates (IR), prevalence and survival probability at one-, five- and 10-years after diagnosis using the Kaplan–Meier method. Analyses were further stratified by age. Crude IR of breast cancer from 2000 to 2021 was 194.4 per 100,000 person-years for females and 1.16 for males. Crude prevalence in 2021 was 2.1% for females and 0.009% for males. Both sexes have seen around a 2.5-fold increase in prevalence across time. Incidence increased with age for both sexes, peaking in females aged 60–69 years and males 90+ . There was a drop in incidence for females aged 70–79 years. From 2003–2019, incidence increased > twofold in younger females (aged 18–29: IR 2.12 in 2003 vs. 4.58 in 2018); decreased in females aged 50–69 years; and further declined from 2015 onwards in females aged 70–89 years. Survival probability for females after one-, five-, and ten-years after diagnosis was 95.1%, 80.2%, and 68.4%, and for males 92.9%, 69.0%, and 51.3%. Survival probability at one-year increased by 2.08% points, and survival at five years increased by 5.39% from 2000–2004 to 2015–2019 for females, particularly those aged 50–70 years. For males, there were no clear time-trends for short-term and long-term survival probability. Changes in incidence of breast cancer in females largely reflect the success of screening programmes, as rates rise and fall in synchronicity with ages of eligibility for such programmes. Overall survival from breast cancer for females has improved from 2000 to 2021, again reflecting the success of screening programmes, early diagnosis, and improvements in treatments. Male breast cancer patients have worse survival outcomes compared to females, highlighting the need to develop male-specific diagnosis and treatment strategies to improve long-term survival in line with females.