Buruli ulcer – A neglected tropical disease in the Barwon region of Victoria,Australia: An emerging public health threat with local and national ramifications

Mycobacterium ulcerans (MU) is known to be endemic in heavily touristed coastal regions of Victoria and is the cause of Buruli ulcer (BU) disease. The incidence, severity and geographic spread of MU infection/BU disease is increasing, including metropolitan Victorian suburbs. While the specifics of disease transmission and effective prevention strategies remain uncertain, severe complications can be mitigated by health systems that provide vigilant population surveillance to underpin early recognition, early specialist involvement and definitive treatment for the individual. Current theories regarding disease transmission and ‘best practice’ (or best guess) prevention and mitigation measures are presented herein. Opportunities to improve the health system response to this emerging public health threat are identified. It is incumbent upon all healthcare providers, including ED clinicians, to contribute by familiarising themselves with the established and emerging areas of endemicity of MU infection and the array of BU clinical presentations.     

Fever phobia: The impact of time and mortality – A systematic review and meta-analysis

BackgroundFever phobia is a term that has been used to describe the exaggerated and unrealistic fear of fever expressed by parents and carers. Since the term was first used in the early 1980s, there have been numerous publications and guidelines’ stating that fever is not, in itself dangerous, however these fears persist.ObjectivesInvestigate the extent of fever phobia and to explore potential associations with time, under-5 mortality rate and geography.Data sourcesEmbase (1980 to week 1 2015) and Medline (1946 to week 1 2015) were searched using the terms ‘fever’ and ‘phobia’; and ‘fever phobia’ as a free text term. One additional paper was published during the review period.Study eligibility criteriaStudies giving proportion of parents, carers or professionals expressing fear of fever.Study appraisal and synthesis methodsMeta-analysis and cluster analysis using metafor, meta and Cluster in R.ResultsFear of brain damage, coma, convulsions, death and dehydration was high across many of the studies; however there was significant variation as shown by the high I² scores which exceeded 95%. This was not explained by the two predictive variables of year of publication, or background mortality apart from a reduction in the fear of brain damage (−0.0185, CI −0.0313 to −0.0057, p = 0.0046) and dehydration (−0.0831, −0.1477 to −0.0184, p = 0.0118) associated with increased child mortality.LimitationsStudies were all cross-sectional surveys with a high risk of bias. The pooled estimate, although statistically significant is not the outcome of interest and so should be interpreted with caution.Conclusions and implicationsFever phobia is common and has not significantly declined over time. This may suggest that it is a cultural, rather than individually learned trait and that individual educational programmes are unlikely to be successful in the face of widespread cultural transmission.     

The Design and Conduct of a Community‐Based Registry and Biorepository: A Focus on Cardiometabolic Health in Latinos

Background

Latinos are disproportionately impacted by obesity and type 2 diabetes but remain underrepresented in biomedical research. Therefore, the purpose of this project was to develop a research registry and biorepository to examine cardiometabolic disease risk in the Latino community of Phoenix, Arizona. The overarching goal was to establish the research infrastructure that would encourage transdisciplinary research regarding the biocultural mechanisms of obesity‐related health disparities and facilitate access to this research for the Latino community.

Methods

Prior to recruitment, key stakeholders from the local Latino community were engaged to develop a broad rapport within the community and seek advice regarding recruitment, enrollment, and follow‐up. Self‐identified community‐dwelling Latinos underwent a comprehensive cardiometabolic health assessment that included anthropometrics, a fasting laboratory panel, and a 2‐hour oral glucose tolerance test with measures of insulin and glucose to estimate insulin action and secretion. Separate consent was requested for future contact and banking of serum, DNA, and RNA. Research collaborations were sought out based on the cultural and metabolic profile of participants, faculty research agendas, and the potential for generating hypotheses.

Results

A total of 667 participants (20.4% children, and 79.6% adults) were enrolled with 97% consenting to the registry and 94% to banking of samples. The prevalence of overweight/obesity was 50% in children and 81% in adults. Nearly 20% of children and more than 45% of the adults exhibited some degree of hyperglycemia. To date, more than 15 research projects have been supported through this infrastructure and have included projects on the molecular biology of insulin resistance to the sociocultural determinants of health behaviors and outcomes.

Conclusions

The high prevalence of obesity and cardiometabolic disease risk factors coupled with the overwhelming majority of participants consenting to be re‐contacted, highlights the importance of supporting research infrastructure to generate hypotheses about obesity‐related health in Latinos. Future studies that stem from the initial project will likely advance the limited understanding regarding the biocultural determinants of health disparities in the Latino community.     

Conceptual models of nursing: international in scope and substance? The case of the Roy adaptation model

This column focuses on exploration of the international applicability of conceptual models of nursing developed by nurse theorists from the United States. Viewpoints put forward by Marilyn E. Parker and William K. Cody are presented. Then, nurse scholars from Colombia and Japan discuss their experiences with use of the Roy adaptation model in their countries.     

Healthcare professionals’ knowledge and attitudes of surgical site infection and surveillance: A narrative systematic review

AimThis systematic review reports on healthcare professionals’ knowledge and attitudes of surgical site infection and surgical site infection surveillance as well as interventions aimed at enhancing healthcare professionals’ knowledge and attitudes.BackgroundSurgical site infection is a serious adverse outcome following surgery. Despite the presence of international guidelines, the prevention of surgical site infections remains a challenge for patients and hospitals. It is critical that healthcare professionals have sufficient knowledge on surgical site infection and on their role in implementing evidence-based prevention strategies.DesignThis review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines.MethodsA search was undertaken in the following databases: Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2010 and March 2022. Studies that examined healthcare professionals’ knowledge and attitudes in relation to surgical site infection, surgical site infection surveillance and risk factors for their development were included. We also included studies that examined interventions that aimed to enhance healthcare professionals’ knowledge and attitude in relation to surgical site infection, surveillance, and risk factors. We also described the impact of such interventions on the incidence of surgical site infections.ResultsA total of 26 studies were included. Results were synthesised narratively according to the review objectives. Findings from this review show that knowledge of what surgical site infection is and its prevention was poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals’ role in prevention. Only three studies examined the effects of interventions on healthcare professionals’ knowledge of surgical site infection and surgical site infection prevention. Of those, two used multimodal educational interventions and found statistically significant improvement in knowledge.ConclusionsOverall knowledge of surgical site infection and its prevention is poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. There is a need for more experimental research to evaluate interventions which aim to address healthcare professionals’ knowledge and attitudes towards surgical site infection prevention and surveillance. Such studies should include all healthcare professionals involved in the care of a surgical patient.Tweetable abstractKnowledge and attitudes of surgical site infection prevention amongst healthcare professionals.     

The Effects of Inhalation Lavender Aromatherapy on Postmenopausal Women’s Depression and Anxiety: A Randomized Clinical Trial

The main aim of this study was to investigate the effects of inhaled lavender aromatherapy on depression and anxiety levels among postmenopausal women. A randomized clinical trial was performed in which 46 postmenopausal women received 2% inhaled lavender essence or distilled water 20 minutes nightly before bedtime for 4 successive weeks. Depression and anxiety mean scores decreased in the lavender group compared with controls, providing evidence that lavender aromatherapy may be an effective noninvasive treatment during the postmenopausal stage.     

The paradox of an expected level: The assessment of nursing students during clinical practice – A qualitative study

AimThe aim of this study is to increase knowledge about the assessment of nursing students’ clinical practice, particularly concerning how teachers and clinical supervisors identify and assess the expected level of competence in mid-term evaluations and students, teachers and supervisors’ experiences of mid-term assessment. Assessment is important to assure the quality of students’ clinical competence and studies show that further research on this topic is required.DesignThis study has an explorative qualitative design.MethodsThirty semi-structured interviews were conducted with nursing students, teachers and clinical supervisors along with 16 observations of mid-term assessments during clinical practice, as part of a bachelor’s programme in nursing.ResultsTwo main challenges concerning establishing an expected level of competence were identified from the analysis of the interviews and observations: 1) a general formulation of learning outcomes and 2) vague expectations of what is the expected level of achievements at different points in time. Both challenges were at institutional level. Furthermore, at performance level, certain patterns were identified related to these challenges, such as teachers and supervisors needing to concretise the general formulation of learning outcomes and their discretion to set the expected level. Additionally, non-verbal language during mid-term assessment seemed to affect how the assessment situation was perceived.ConclusionWe suggest that the institutional guidelines need to be critically reviewed to include greater focus on clarifying what students are expected to achieve, as well as what constitutes the expected level. We have emphasised that discretion is a necessary premise to identify an expected level of clinical competence at mid-term assessment, in particular when there is lack of a clear standard and the assessment form is vague, but also when there is no clear definition of the expected level of competence at different points in time. The consequences are that the student feel insecure about how the assessment ought to be perceived, what level they are at in their learning process, and subsequently, their level in the process of developing necessary clinical competence.     

The care of the pre-viable and questionably viable infant – A midwife and a neonatal nurse dilemma

This article is intended to stimulate debate and suggest areas of perinatal and neonatal practice which could be usefully reviewed. There are legal and ethical constraints on current practice and arguably this is not always in the best interest of the neonate. Given that current technology has limits we need to be realistic as to the success of our current forms of management. While not wishing to stifle research and progress in any way, we as midwives and neonatal nurses, need to be kind and not inflict suffering on the infants most directly involved and their families.     

Molecular Imaging of Brain Tumors: A Bridge Between Clinical and Molecular Medicine?

As the research on cellular changes has shed invaluable light on the pathophysiology and biochemistry of brain tumors, clinical and experimental use of molecular imaging methods is expanding and allows quantitative assessment. The term molecular imaging is defined as the in vivo characterization and measurement of biologic processes at the cellular and molecular level. Molecular imaging sets forth to probe the molecular abnormalities that are the basis of disease rather than to visualize the end effects of these molecular alterations and, therefore, provides different additional biochemical or molecular information about primary brain tumors compared to histological methods "classical" neuroradiological diagnostic studies. Common clinical indications for molecular imaging contain primary brain tumor diagnosis and identification of the metabolically most active brain tumor reactions (differentiation of viable tumor tissue from necrosis), prediction of treatment response by measurement of tumor perfusion, or ischemia. The interesting key question remains not only whether the magnitude of biochemical alterations demonstrated by molecular imaging reveals prognostic value with respect to survival, but also whether it identifies early disease and differentiates benign from malignant lesions. Moreover, an early identification of treatment success or failure by molecular imaging could significantly influence patient management by providing more objective decision criteria for evaluation of specific therapeutic strategies. Specially, as molecular imaging represents a novel technology for visualizing metabolism and signal transduction to gene expression, reporter gene assays are used to trace the location and temporal level of expression of therapeutic and endogenous genes. Molecular imaging probes and drugs are being developed to image the function of targets without disturbing them and in mass amounts to modify the target's function as a drug. Molecular imaging helps to close the gap between in vitro and in vivo integrative biology of disease.     

The impact of rapid response systems on mortality and cardiac arrests – A literature review

BackgroundRapid response systems were created to improve recognition of and response to deterioration of general ward patients.AimThis literature review aimed to evaluate the evidence on whether rapid response systems decrease in-hospital mortality and non-intensive care unit cardiac arrests.MethodSix databases (MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, SCOPUS, Web of Science and PubMed) were systematically searched for primary studies published between 1st January 2014 and 31st October 2017, recruiting general ward patients, where the intervention involved introducing/maintaining a rapid response system, the comparison referred to a hospital setting without a rapid response system and the outcomes included mortality and cardiac arrests.ResultsFifteen studies met eligibility criteria: one stepped wedge cluster randomised controlled trial, one concurrent cohort controlled study and thirteen historically controlled studies. Thirteen studies investigated mortality of which seven reported statistically significant findings in favour of rapid response systems. Thirteen studies investigated cardiac arrests, of which eight reported statistically significant findings in favour of rapid response systems.ConclusionEvidence suggests that when the process of introducing/maintaining a rapid response system is successful and under certain favourable conditions, rapid response systems significantly decrease mortality and cardiac arrests.     

Acquired hemophilia A following COVID-19 vaccination – The importance of prompt diagnosis: A case report

Acquired hemophilia A (AHA) is a rare coagulopathy characterized by hemorrhagic manifestations. It has been linked to various conditions, including autoimmune disorders, drugs, tumors, lymphoproliferative disorders, and infections. We present a case of AHA in a 71-year-old male patient with cutaneous hematoma occurring 8 days after vaccination for COVID-19. This report aims to highlight the risk of FVIII inhibitor development following an immune stimulus, thus improving our knowledge regarding possible vaccination-related adverse events. Furthermore, we underline how the potential risk of not recognizing disease manifestations promptly, together with specific coagulation alterations, could significantly affect the patient's outcome. Adequate management plans and the diffusion of shared guidelines are of fundamental importance in order to prevent the development of life-threatening complications and initiate appropriate treatment as soon as possible.Data AvailabilityAll data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.