Conectar
In this paper, the development of an evidence-informed, data-driven strategy for implementation of the HIRAID emergency nursing framework in Thailand is reported. HIRAID stands for H istory including I nfection risk, R ed flags, A ssessment, I nterventions, D iagnostics, reassessment and communication.
This exploratory descriptive study was underpinned by the Knowledge-to-Action framework.
The study was conducted in Chiangrai Prachanukroh Hospital (CRH) in Northern Thailand. The identified problem was no standardised approach to patient assessment and management. Adaptation of knowledge to local context occurred by feasibility assessments and experience-based co-design. Surveys designed and analysed using the Behaviour Change Wheel and Theoretical Domains Framework were used to understand the barriers to knowledge use. Selecting, tailoring and implementing the intervention was guided by the Behaviour Change Wheel.
Practice environment and behavioural diagnostics surveys were completed by 49 nurses (response rate 100%) who identified 19 enablers and 33 barriers to HIRAID implementation at CRH. Enablers and barriers were mapped to seven intervention functions (education, modelling, persuasion, enablement, training, environment restructuring, incentivisation) and 19 behaviour change techniques most likely to be effective. The study methods and results culminated in an evidence-informed, data-driven HIRAID Thailand Implementation Strategy.
In-depth understanding of context-specific enablers and barriers, active engagement of end-users was critical to maximising likelihood of successful implementation. Development of an evidence-informed implementation strategy for a limited resource setting was achievable with robust application of theory, key stakeholder and end-user engagement and multi-agency collaboration.
Implementation of clinical interventions in emergency care settings is challenging, even in well-resourced settings. For end-users, knowledge that an intervention would improve patient care was a powerful enabler coupled with meaningful organisational support is critical to sustained implementation in complex nursing environments.
This study addresses the lack of standardised approach to patient assessment and management in the emergency department in a resource-limited setting. Application of robust theory is possible in middle-resource settings, and this study identified 19 behaviour change techniques that were distilled to develop a sustainable, context specific implementation strategy. Development of an evidence-informed implementation strategy for a limited resource setting with robust application of theory is possible with key stakeholder and end-user engagement and multi-agency collaboration.
There is no EQUATOR guideline available for this study.
This study did not include patient or public involvement in its design, conduct or reporting.
by Ratikorn Chaisiwamongkol, Rattapon Uppala, Phanthila Sitthikarnkha, Leelawadee Techasatian, Suchaorn Saengnipanthkul, Pope Kosalaraksa, Kaewjai Thepsuthammarat, Sirapoom Niamsanit
Background and aimsDiabetic ketoacidosis (DKA) remains a major cause of pediatric morbidity and death. This study examined national trends in DKA hospitalizations and factors associated with in-hospital mortality among Thai children.
Materials and methodsA nationwide, retrospective cohort study was conducted using data from the National Health Security Office (NHSO) during 2015–2023. Children aged 1 month to under 18 years hospitalized with DKA were identified using International Classification of Diseases, 10th Revision, Thai Modification (ICD-10-TM) codes. Prevalence and mortality were described by year and region. Factors associated with death were assessed with multivariable logistic regression; model discrimination used area under the curve (AUC).
ResultsAmong 10,669 admissions, national DKA prevalence increased from 4.5 to 11.8 per 10,000 pediatric hospitalizations, with Bangkok showing the highest rates. The overall intubation rate was 10.2%, peaking in infants and older adolescents. Although national mortality declined from 2.2% to 0.6%, regional and age-specific fluctuations persisted. Independent associations with mortality included malignancy (Adjusted odds ratio [AOR] 5.25, 95% CI: 1.63-16.92; p=0.005), septic shock (AOR 2.93, 95% CI: 1.71-5.03; p Conclusion
DKA hospitalizations are increasing in Thailand, with regional variation and persistent mortality risk, particularly among patients with critical complications and vulnerable groups. Although declining mortality trends and lower mortality in recurrent cases suggests improved protocol-based treatment, targeted prevention strategies remain essential for high-risk populations.
by Taylor E. Gin, Charlotte O. Moore, Trey Tomlinson, Grace Wilson, Amiah Gray, Cameron Sutherland, Kamilyah Miller, Krista Li, Michael Canfield, Brian Herrin, Erin Lashnits, Benjamin Callahan
BackgroundCtenocephalides felis is a common ectoparasite of dogs and cats and can transmit a variety of pathogens including Bartonella and Rickettsia species. These bacteria, along with the known endosymbiont Wolbachia, are well-documented members of the C. felis microbiome, but species-level information is limited. Additionally, little is known about the variation in the C. felis microbiome in fleas from different sources and when different sequencing methods are applied to the same samples.
ObjectiveThis study aimed to characterize the flea microbiome using both short-read (V3/V4) and long-read (full-length) 16S rRNA gene sequencing, determine whether long-read sequencing improves species-level identification especially in known pathogenic genera, and evaluate differences in microbial composition between fleas collected from cats, dogs, and environmental traps.
MethodsFleas were collected from cats, dogs, and traps in flea-infested homes in Florida, pooled by source, and sequenced using short- (V3/V4) and long-read (full-length) 16S rRNA gene sequencing. Microbial prevalence and abundance were compared across sequencing approaches. Community composition was evaluated for differences between sources and houses. Candidate members of the flea microbiome were identified based on a combination of prevalence, abundance, and statistical signatures of potential contaminant origin. For Rickettsia and Bartonella, species-level taxonomic assignments were refined using a phylogenetic approach.
ResultsWolbachia, Rickettsia, and Bartonella were the most prevalent and abundant taxa. Spiroplasma was identified as a fourth core member of the flea microbiome. Long-read sequencing enabled better, but not perfect, species-level classification of Bartonella and Rickettsia compared to short-read sequencing. Important relationships between specific ASVs and flea sources were identified, for example fleas from cats harbored higher abundances of B. clarridgeiae and B. henselae than fleas from traps.
by Chanavee Toh, Kedsiree Sanit, Pimsiri Sripongpun, Naichaya Chamroonkul, Suthat Liangpunsakul, Teerha Piratvisuth, Apichat Kaewdech
Background and aimsChronic hepatitis B virus (HBV) infection remains a major global health burden and a leading cause of hepatocellular carcinoma (HCC). While cirrhosis is a well-established risk factor, the contributions of metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiometabolic risk factors (CMRFs) are less clearly defined. This study aimed to evaluate the impact of MASLD and CMRFs on HCC risk in patients with chronic hepatitis B (CHB).
MethodsWe conducted a retrospective cohort study of CHB patients at Songklanagarind Hospital between 2011 and 2021, excluding those diagnosed with HCC within six months of follow-up. Clinical and imaging data were analyzed. Cumulative HCC incidence was estimated using Nelson-Aalen plots. Multivariable Cox regression was used to identify independent predictors. The aMAP score was evaluated in subgroups with obesity, CMRFs, and MASLD.
ResultsAmong 4,944 patients, 151 (3.1%) developed HCC. Cirrhosis (adjusted hazard ratio [aHR] 7.22), obesity (aHR 1.85), and male sex (aHR 1.78) were independent risk factors. Statin use (aHR 0.43), higher platelet count (aHR 0.62), and higher albumin (aHR 0.64) were protective. Diabetes and hypertension showed nonsignificant trends, and steatosis and dyslipidemia without statins were not significantly associated with HCC. Risk increased with the number of CMRFs. The aMAP score showed good discrimination in patients with obesity (C-index 0.82), CMRFs (0.79), MASLD (0.74), and in the non-cirrhotic MASLD and non-MASLD (0.69 and 0.71, respectively).
ConclusionsCirrhosis, male sex, and obesity were key HCC risk factors. The aMAP score effectively stratified HCC risk among metabolically at-risk CHB patients.
To characterise neighbourhood food environments in British Columbia (BC) and determine whether food environment characteristics are associated with fruit and vegetable (FV) intake.
A cross-sectional study using geospatial linkage of food environment measures within 1 km residential buffers, analysed with mixed-effects models
Urban neighbourhoods in BC, Canada.
Approximately 25 000 adults aged 35–69 years from the BC Generations Project cohort.
FV intake as a continuous variable (servings/day) and as a binary measure (
Approximately 50% of participants lived in neighbourhoods without chain grocery stores, fast-food outlets or convenience stores within walking distance. Neighbourhoods in the highest density category for fast-food outlets were associated with lower odds of consuming ≥5 servings of FV per day (OR=0.89, 95% CI 0.80 to 0.98). Associations between chain grocery stores, convenience stores and FV intake were attenuated after adjusting for neighbourhood characteristics including walkability, and material and social deprivation.
The findings suggest limited neighbourhood access to retail food outlets across urban areas in BC. Participants living in neighbourhoods with greater density of fast-food restaurants were less likely to consume
To pilot and evaluate the implementation of a structured Evidence-Based Rounds (EBR) education model in critical care.
A mixed data type design was used to evaluate Evidence-Based Rounds in a critical care setting. Structured observational data were captured and open-ended survey responses were submitted by attendees. Content analysis and descriptive statistics were used to analyse survey findings.
Seventeen rounds were completed between March 2023 and January 2024 with a total of n = 83 clinical staff members. From these, n = 55 staff completed and submitted evaluation surveys. Rounds were most frequently attended by nurses of all bandings including senior clinical nurses, support workers and student nurses. Evidence-Based Rounds were globally perceived as a positive and useful education strategy and staff were very willing to attend future sessions. Patient outcomes were not directly assessed and rounds specifically facilitated three outcomes: (1) helping staff apply evidence to practice, (2) building staff confidence in presenting clinical information and (3) supporting staff in identifying local improvements to patient care.
Evidence-Based Rounds are an adaptable effective model of bedside education within critical care. In our setting, staff perceived that this model facilitated the application of evidence in clinical practice and positively influenced feelings of confidence. Importantly, this education strategy empowered nurses to explore and identify improvements locally to patient care. Whilst this model offers a practical education approach to address some of the key critical care workforce issues, such as an expanding curriculum and loss of senior staff, it could also be widely adopted to other clinical areas.
Evidence-Based Rounds are perceived by staff as a successful bedside education model that facilitates nurses to apply evidence in practice. It is feasible that this strategy is a potentially sustainable, low-cost model for continuing professional development centred around routine clinical work.
No patient or public contribution.
Infant feeding practices in the first 2 years of life are linked to long-term weight trajectories. Despite the importance of obesity prevention interventions, there are no randomised controlled trials (RCTs) evaluating early childhood education and care (ECEC) and primary caregiver-targeted interventions on child weight and feeding outcomes.
To assess the efficacy of an 18-month digital health intervention (Tiny Bites) delivered to ECEC services and primary caregivers of children aged 4 to ≤12 months on child age-adjusted and sex-adjusted body mass index-for-age z-score (zBMI) relative to usual care control in the Hunter New England (HNE) region of New South Wales, Australia.
This type 1 hybrid cluster RCT will include up to 60 ECEC services and 540 children/caregiver dyads. The intervention supports ECEC services and caregivers to deliver recommended responsive feeding practices to infants. ECEC services will receive access to an online assessment platform, training and resources, and implementation support. Primary caregivers will receive text messages, monthly e-newsletters, online links and direct communication from ECEC services. We will assess the impact on child zBMI at 18-month follow-up. Secondary outcomes include duration of consuming any breastmilk, child diet and caregiver responsive feeding practices. We will also assess ECEC policy and practice implementation related to targeted feeding practices, programme cost effectiveness, adverse effects and engagement with the programme (ECECs and caregivers). For the primary outcome, between-group differences will be assessed for paired data using two-level hierarchical linear regression models.
Ethics approval has been provided by HNE Human Research Ethics Committee (HREC) (2023/ETH01158), Deakin University (2024-202) and University of Newcastle HREC (R-2024-0039). Trial results will be submitted for publication in peer-reviewed journals, presented at scientific conferences locally and internationally and to relevant practice stakeholders.
ACTRN12624000576527.
To compare birth weight-to-placental weight (BW:PW) ratios between pregnancies complicated by gestational diabetes mellitus (GDM) and normoglycaemic pregnancies, and to evaluate the associations between BW:PW ratio, perinatal outcomes, and placental histopathologic features within the GDM group.
A prospective cohort study.
A university hospital in Bangkok, Thailand.
A total of 200 women with GDM and 100 normoglycaemic controls.
BW:PW ratios were calculated and compared between the two groups. Participants with GDM were stratified into three categories based on the BW:PW ratio percentiles: 90th. Perinatal outcomes and placental histological abnormalities were analysed across these categories.
Median BW:PW ratios were not significantly different between the GDM and normoglycaemic groups: 6.3 (IQR 5.6 to 6.9) versus 6.2 (IQR 5.6 to 6.8); p=0.399. Within the GDM cohort, the BW:PW ratio cut-offs corresponding to the 10th and 90th percentiles were 5.2 and 7.6, respectively. The prevalence of small-for-gestational-age (SGA) neonates differed significantly among the three BW:PW ratio groups: 14.3% (90th); p=0.004. Similarly, the prevalence of chorangiosis varied significantly across these groups (66.7%, 52.9% and 22.7%, respectively; p=0.009). A BW:PW ratio 90th percentile was associated with reduced odds of chorangiosis (aOR 0.35; 95% CI 0.11 to 0.85).
BW:PW ratios did not differ significantly between the GDM and normoglycaemic groups. However, in GDM pregnancies, extremes in the BW:PW ratio were associated with distinct perinatal and placental outcomes, indicating altered placental efficiency and potential clinical relevance.
TCTR20211122001.
To explore the challenges experienced by people with intellectual disability, their carers and health and social care professionals when using and managing medication.
A synthesis of qualitative research using meta-ethnography.
We searched seven databases: MEDLINE, Embase, CINAHL, Science, Social Science and Conference Proceedings Citation Indices (Web of Science), Cochrane Library, PsycINFO and Proquest Dissertations and Theses from inception to September 2022 (updated in July 2023).
We included studies exploring the challenges and perceptions of people with intellectual disability, their carers and health and social care professionals regarding medication management and use.
We reviewed 7593 abstracts and 475 full texts, resulting in 45 included papers. Four major themes were identified: (1) Medication-related issues, (2) navigating autonomy and relationships, (3) knowledge and training needs and (4) inequalities in the healthcare system. We formulated a conceptual framework centred around people with intellectual disability and described the interconnectedness between them, their carers and health and social care professionals in the process of managing and using medication. We identified challenges that could be associated with the person, the medication and/or the context, along with a lack of understanding of these challenges and a lack of capability or resources to tackle them. We developed an overarching concept of ‘collective collaboration’ as a potential solution to prevent or mitigate problems related to medication use in people with intellectual disability.
The effective management of medication for people with intellectual disability requires a collaborative and holistic approach. By fostering person-centred care and shared decision-making, providing educational and practical support, and nurturing strong relationships between all partners involved to form a collective collaboration surrounding people with intellectual disability, improved medication adherence and optimised therapeutic outcomes can be achieved.
CRD42022362903.
FreshRSS 