How can hospitals change practice to better implement smoking cessation interventions? A systematic review

Smoking cessation reduces the risk of death, improves recovery, and reduces the risk of hospital readmission. Evidence and policy support hospital admission as an ideal time to deliver smoking-cessation interventions. However, this is not well implemented in practice. In this systematic review, the authors summarize the literature on smoking-cessation implementation strategies and evaluate their success to guide the implementation of best-practice smoking interventions into hospital settings. The CINAHL Complete, Embase, MEDLINE Complete, and PsycInfo databases were searched using terms associated with the following topics: smoking cessation, hospitals, and implementation. In total, 14,287 original records were identified and screened, resulting in 63 eligible articles from 56 studies. Data were extracted on the study characteristics, implementation strategies, and implementation outcomes. Implementation outcomes were guided by Proctor and colleagues' framework and included acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. The findings demonstrate that studies predominantly focused on the training of staff to achieve implementation. Brief implementation approaches using a small number of implementation strategies were less successful and poorly sustained compared with well resourced and multicomponent approaches. Although brief implementation approaches may be viewed as advantageous because they are less resource-intensive, their capacity to change practice in a sustained way lacks evidence. Attempts to change clinician behavior or introduce new models of care are challenging in a short time frame, and implementation efforts should be designed for long-term success. There is a need to embrace strategic, well planned implementation approaches to embed smoking-cessation interventions into hospitals and to reap and sustain the benefits for people who smoke.     

A neurosurgical approach to traumatic brain injury and post-traumatic hypopituitarism

Purpose

Traumatic brain injury (TBI) is a common cause of mortality and major disability worldwide. The initial management often depends on the severity of the injury. Pituitary dysfunction can develop as a sequela of TBI, and can have long-term, debilitating impact on the patients. Early identification and prompt intervention of post-traumatic hypopituitarism (PTHP) is essential to prevent or minimize the adverse consequences of this condition. We hereby provide an overview of the current management of TBI from a neurosurgical standpoint. We then review the pathophysiology and risk factors of developing PTHP, as well as our recommendations for its management.

Methods

A review of current literature on TBI and PTHP, including primary research articles, reviews and clinical guidelines.

Results

The current neurosurgical approach to the management of TBI is presented, followed by the pathophysiology and risk factors of PTHP, as well as our recommendations for its management.

Conclusions

Post-traumatic hypopitutiarism is a serious and potentially debilitating condition that is likely under-recognised and under-diagnosed. From a neurosurgical perspective, we advocate a pragmatic approach, i.e. screening those considered at high risk of developing PTHP based on clinical features and biochemical/endocrinological testings; and referring them to a specialist endocrinologist for further management as indicated.

     

Sperm fishing: antigen-antibody complexes for the capture and enrichment of spermatozoa in mixed cell substrates

ABSTRACT

In many sexual assault cases, the most common evidence gathered comes in the form of intimate swabs. These swabs contain cells from both the female and male. In these cases the most common cell present is epithelial cells from the female with relatively few spermatozoa from the male. To produce an STR DNA profile suitable for an investigation, separation of the cell types is required to prevent a mixed profile that may complicate interpretation. While there are methods that can achieve this separation, they are labour intensive and have no guarantee of complete separation of the spermatozoa. Immunomagnetic bead separation techniques are being adapted from other scientific fields to be used in forensic biology to separate spermatozoa from mixed substrates. This study tested the binding of a Hyaluronidase PH-20 (SPAM1) antibody to spermatozoa in mixed cell samples that have been dried and stored for a short period of time. Fluorescently tagged antibodies were incubated with cellular mixtures and visualized using fluorescent microscopy. Successful binding of the antibodies to spermatozoa was observed in all samples. The SPAM1 antibody appears to be suitable for selection of spermatozoa and creates opportunities for linking with magnetic beads facilitate cell separation and DNA profiling.     

Partner Discussion as a Mediator of the Effects of Mass Media Exposure to FP on Contraceptive Use among Young Nigerians: Evidence from 3 Urban Cities

Evidence suggests that despite high knowledge of family planning (FP), unwanted pregnancies and birth rates remain high among young Nigerians. There is a critical gap in understanding the nexus between exposure to FP information and contraception practices among this population. This study aimed to fill this gap and tested a pathway of the impact of media exposure to FP messages on modern contraceptive use. Data came from a 2018 cross-sectional baseline survey of young people aged 15–24 in three urban centers in Nigeria – Lagos, Kaduna, and Kano. This was part of an impact evaluation of a television-based drama designed to improve contraceptive use among young individuals. The study was limited to 777 young men and women who were sexually active. We found evidence of the mediation effect of media exposure to FP messages on partner discussion about FP, which in turn was associated with an increased likelihood of modern contraceptive use. Contraceptive self-efficacy also had positive associations with contraception. Our study elucidated a potential pathway through which media communication programs can significantly contribute to increased modern contraceptive use and underlined the importance of providing young people in Nigeria with opportunities to learn and practice obtaining and using contraception.     

Point-of-care ultrasound use for vascular access assessment and cannulation in hemodialysis: A scoping review

Point-of-care ultrasound (POCUS) for access assessment and guided cannulation has become more common in hemodialysis units. The aims of this scoping review were to determine: circumstances in which renal nurses and technicians use POCUS; the barriers and facilitators; and evidence of the effects of POCUS in guiding assessment and cannulation. A search was conducted of CINAHL, Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ProQuest, Trove and Google Scholar as grey literature sources. Of 1904 publications, 21 studies met inclusion criteria (11 full text and 10 abstracts). These included primary research publications (n = 5), clinical observational cohort studies (n = 5), case studies (n = 3), published guidelines (n = 2), and published position papers (n = 6). POCUS was used for: assessing arteriovenous fistula (AVF) maturation; identifying landmarks and abnormalities; assessing alternate cannulation sites; performing new AVF cannulation; performing difficult cannulation; increasing cannulation accuracy; performing cannulation through stents; and patient self-cannulation training. There were scant data on the barriers to, and facilitators of the use of POCUS, and a distinct lack of empirical evidence to support its use. These knowledge gaps highlight the need for further clinical studies, particularly randomized clinical trials, to test the effectiveness of POCUS in hemodialysis for assessment and guided cannulation.     

Relationship Between Measures of Cerebrovascular Reactivity and Intracranial Lesion Progression in Acute TBI Patients: an Exploratory Analysis

Neurocritical Care - Failure of cerebral autoregulation and progression of intracranial lesion have both been shown to contribute to poor outcome in patients with acute traumatic brain injury...