Out of the boxes,out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain

In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.     

The relationship between feedback and evaluative judgement in undergraduate nursing and midwifery education: An integrative review

AimThis integrative review aims to explore the relationship between feedback and evaluative judgement in undergraduate nursing and midwifery education.BackgroundResearch in higher education has shown that feedback practices can lead to students’ developing evaluative judgement; thought critical for performance improvement and life-long learning. While literature in nursing and midwifery education has not yet employed the term ‘evaluative judgement’ explicitly, there might be similar concepts and practices that seek to develop students’ judgement of performance that sustain learning beyond the immediate task.DesignAn integrative review of the nursing and midwifery feedback literature.MethodsIn February 2020, six online databases (CINAHL, ProQuest, Scopus, ERIC, PsycINFO, Ovid MEDLINE) were systematically searched for literature published between January 1989-February 2020. Synonyms for feedback and evaluative judgement were used to inform our search. This review included a rigorous team-based, five-stage approach: (1) identifying the problem; (2) conducting the search; (3) evaluating the data; (4) analysing the data; and (5) presenting the integrative review.ResultsA total of 1408 studies were initially retrieved with 543 duplicates. 865 abstracts were screened using eligibility criteria, resulting in the exclusion of 835 studies. Thirty full-text studies were appraised for quality. Eighteen studies with diverse methodologies achieved a medium-high quality score for inclusion in data analysis. Conceptions of feedback and evaluative judgement were identified in all studies; despite none using the term 'evaluative judgement' explicitly. Thematic analysis of the studies resulted in seven themes: conceptions of feedback, purposes of feedback, sources of feedback, modes of feedback, conceptions of evaluative judgement, purposes of evaluative judgement and relationships between feedback and evaluative judgement.ConclusionsWhile our findings supported contemporary higher education research, the feedback-evaluative judgement relationship is novel in nursing education. We encourage educators to design feedback activities privileging students’ active engagement through dialogic feedback, reflection and self-assessment, to develop their evaluative judgement of practice.     

Nurse students’ competences in interprofessional pharmaceutical care in Europe: Cross-sectional evaluation

BackgroundSafe pharmaceutical care requires competent nurses with specific knowledge, skills and attitudes. It is unclear whether nursing students are adequately prepared to perform pharmaceutical care in practice. Mapping their pharmaceutical care competences can lead to a better understanding of the extent to which curricula fit expectations of the labour market.ObjectivesTo assess pharmaceutical care competences of final-year nursing students of different educational levels.DesignA cross-sectional survey design.SettingsIn 14 European countries, nursing schools who offer curricula for level 4 to 7 students were approached.ParticipantsThrough convenience sampling 1741 final-year student nurses of level 4 to 7 were included. Sampling strategies were country-specific.MethodsA web-platform was developed with an assessment of the level in which students mastered pharmaceutical care competences. Knowledge questions, case studies (basic/advanced level), self-reported practical skills and attitudes were evaluated.ResultsMean scores for knowledge questions differed significantly (p < 0.001) between level 5 (56/100), level 6 (68/100) and level 7 students (72/100). For basic cases level 5 students reached lower scores (64/100) compared with level 6 (71/100) and level 7 (72/100) students (p = 0.002 and p = 0.005). For more advanced cases no difference between levels was observed (overall mean 61/100). Most students (63–90 %) considered themselves skilled to perform pharmaceutical care and had positive attitudes towards their participation in pharmaceutical care (65–97 %).ConclusionsRelatively low knowledge scores were calculated for final-year student nurses. In some domains, lower levels of students might be insufficiently prepared to take up responsibilities in pharmaceutical care. Our assessment can be used as a tool for educators to evaluate how prepared nursing students are for pharmaceutical care. Its further implementation for students of different educational levels will allow benchmarking between the levels, both within and between countries.     

The effect of massage therapy on pain after surgery: A comprehensive meta-analysis

BackgroundFindings on the usefulness of massage therapy (MT) in postoperative pain management are often inconsistent among studies.ObjectivesThis study’s aim is to conduct a meta-analysis of randomized controlled trials (RCT) to clarify the effects of massage therapy in the treatment of postoperative pain.MethodsThree databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) were searched for RCTs published from database inception through January 26, 2021. The primary outcome was pain relief. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The random-effect model was used to calculate the effect sizes and standardized mean difference (SMD) with 95 % confidential intervals (CIs) as a summary effect. The heterogeneity test was conducted through I². Subgroup and sensitivity analyses were used to explore the source of heterogeneity. Possible publication bias was assessed using visual inspection of funnel plot asymmetry.ResultsThe analysis included 33 RCTs and showed that MT is effective in reducing postoperative pain (SMD, −1.32; 95 % CI, −2.01 to −0.63; p = 0.0002; I² = 98.67 %). A similar significant effect was found for both short (immediate assessment) and long terms (assessment performed 4–6 weeks after the MT). Remarkably, we found neither the duration per session nor the dose had an impact on the effect of MT and there seemed to be no difference in the effects of different MT types. In addition, MT seemed to be more effective for adults. Furthermore, MT had better analgesic effects on cesarean section and heart surgery than orthopedic surgery.LimitationsPublication bias is possible due to the inclusion of studies in English only. Additionally, the included studies were extremely heterogeneous. Double-blind research on MT is difficult to implement, and none of the included studies is double-blind. There was some heterogeneity and publication bias in the included studies. In addition, there is no uniform evaluation standard for the operation level of massage practitioners, which may lead to research implementation bias.ConclusionsMT is effective in reducing postoperative pain in both short and long terms.     

基于真实世界数据探讨中医药治疗糖尿病肾病用药规律的研究＊

目的 基于临床信息系统分析总结真实世界的数据，采用数据挖掘的方法探讨中医药治疗糖尿病肾病的用药规律。方法 收集2018年1月-2020年12月上海中医药大学附属曙光医院宝山分院健康信息系统确诊的糖尿病肾病的门诊或住院患者的诊疗信息，建立Excel数据库，采用Excel 2010软件统计高频药物的四气、五味、归经及功效；使用SPSS Modeler 18.0软件中的Apriori算法分析关联规则，采用web节点建构药对关联网状图；运用SPSS 25统计软件进行因子分析。结果 本研究最终纳入477例接受中药饮片治疗的DKD患者，在1203条方剂信息中，涉及中药462种；使用频数排名前5位的中药分别是黄芪、黄精、石斛、山茱萸、麦冬；使用频数前5类的中药类别分别是补气药、补阴药、清热燥湿药、活血调经药、息风止痉药；在30味高频药物中，苦、甘、辛药味最为常见；药性寒、温数量接近；归脾经、肝经、肺经、肾经居多；关联规则提示，药物组合中置信度最高的组合为地龙-当归-僵蚕，因子分析共得到5个有效因子，累积贡献率为47.33%。结论 中医药治疗DKD在补益气血阴阳的同时，兼顾对瘀血、湿邪和痰饮的治疗，结合证型，可考虑使用黄芪、黄精、石斛、山茱萸、麦冬、金蝉花等药物的使用，清热燥湿药物如黄连、黄芩、黄柏可适当加入，为使邪有去处，大黄、车前子或可增添疗效。     

精神科护士夜班经历创伤事件后成长体验的质性研究

目的 探讨精神科护士夜班经历创伤事件后的成长体验,以期为护士不同阶段心理情况进行针对性干预和指导,并为护士职业生涯早期心理建设提供方向。方法 采用扎根理论的研究方法,2020年3月—7月对广东省某三级甲等医院12名夜班经历创伤事件的精神科护士进行深度访谈,采用Strauss和Corbin扎根理论分析资料,分为开放式登录、轴心式登录和选择式登录3个阶段,持续比较分析资料。结果 发现精神科护士夜班经历创伤事件后经历了应激期、调适期、成长期3个不同阶段。结论 精神科护士夜班经历创伤事件后的成长为动态过程,管理者或干预者可根据不同阶段进行针对性干预和指导,并在护士早期培训中促使其提前做好相关知识、技能的储备和必备心理素质的塑造。     

1例重型弥漫性轴索损伤伴肺挫裂伤患者的肺康复护理

总结1例重型弥漫性轴索损伤伴肺挫裂伤患者的肺康复护理经验。护理要点包括：组建多学科肺康复管理团队,实施个性化呼吸支持与降阶梯序贯氧疗护理,精准廓清呼吸道,开展一体化的早期肺功能康复锻炼。经过多学科团队合作,患者入院后第12天撤离呼吸机,第17天拔除气管插管,第20天下床活动,第37天顺利出院,随访6个月,患者恢复良好。