Registered Nurses Association of Ontario's best practice guideline as a tool for creating partnerships

The Best Practice Guidelines project has been instrumental in facilitating a partnership between an acute care community hospital and two long-term care facilities in northwestern Toronto. This article outlines the challenges experienced in the acute care community hospital in developing partnerships, not just with the two long-term care facilities, but also within the organization. This article also offers insight into the strategies used to overcome the challenges and to support the implementation of the guideline at point of care.     

Métis Peoples and Cancer: A Scoping Review of Literature,Programs, Policies and Educational Material in Canada

Much of the existing Indigenous cancer research focuses on First Nation populations or reports on pan-Indigenous data that include First Nations, Métis, and Inuit metrics together, which fails to capture the distinct lived realities, experiences of colonialism, and culture of each Indigenous group. The purpose of this scoping review was to summarize existing knowledge on cancer among Métis peoples in Canada, offering direction to researchers, institutions, and policymakers for future actions that enhance Métis-specific cancer surveillance and cancer care. We searched Embase, Medline, iPortal, and Proquest Theses and Dissertations databases, Google Scholar and Google, alongside ten websites relevant to cancer and Métis peoples. Two reviewers gathered 571 records. After screening, 77 records were included. Data show that Métis peoples experience higher behavioral risk factors, lower screening participation, higher cancer incidence for some cancers, and higher mortality rates compared to the non-Indigenous population. Existing research is piece-meal and researchers emphasize that there is inadequate Métis-specific cancer data. There is a need for targeted, Peoples-specific cancer control interventions to reduce these health inequities and a coordinated, Peoples-specific approach to cancer research. These efforts must involve collaboration among Métis Nations and organizations, provincial governments and agencies, researchers, and policymakers.     

Medical care of obese children and adolescents

So far in Europe, no studies have been published on the structuring of medical care for obese children and adolescents. Besides anthropometric parameters, evaluations of the cardiovascular risk factors hypertension, dyslipidaemia, impaired glucose metabolism and treatment modalities were documented in a standardised multicentre evaluation survey (APV) of 18 primarily outpatient and nine rehabilitation institutions. In total, 3837 children (aged 2–20 years) took part in the years 2000 up to March 2003, of whom 1985 were treated in outpatient institutions and 1852 in rehabilitation institutions. Of these children, 10% were overweight, 37% obese, 49% extremely obese and 4% of normal weight at initial presentation. The frequencies of diagnostic procedures performed and documented were low (measurement of blood pressure 43%, lipids 40%, glucose metabolism 21%). In the subgroup of obese children who were screened for cardiovascular risk factors, 23% suffered from hypertension, 11% displayed increased cholesterol, 9% increased low-density lipoprotein-cholesterol, 29% increased triglycerides, 11% decreased high-density lipoprotein-cholesterol and 6% had impaired glucose metabolism. Conclusion: despite the high prevalence of cardiovascular risk factors in obese children and adolescents confirmed in this report, diagnostic procedures failed in a considerable percentage even in specialised treatment centres for obese children and adolescents. In future, the feedback based on standardised evaluation of diagnostic and treatment procedures should aim to improve the quality of medical care.Abbreviations BMI body mass index - HDL high-density lipoprotein - LDL low-density lipoprotein - SDS standard deviation scoreOn behalf of the APV Study Group, Department of Paediatrics, University of Ulm, Germany     

A reconsideration of visual evoked potentials for fast automated ophthalmic refractions.

Visual evoked potentials (VEP's) recorded from the scalp are sensitive to retinal image sharpness and thus to changes in the refractive state of the eye. Initially the responses to checkerboard flash or reversal stimuli were computer-averaged in order to raise the signal above the noise, primarily the electroencephalogram (EEG). Recently analogue Fourier signal analysis has been proposed for using the VEP for rapid clinical refraction. We have confirmed that this method can measure the spherical refractive state to within +/- 0.50D. However, because of large slow-wave fluctuations, measurements of changes within +/- 1.00D are not always clear. Despite its promise the method does not appear to be clinically useful at present.     

Psychiatric Patients: How Can We Decide if You Are in Pain?

How do psychiatric nurses make decisions about pain management for hospitalized psychiatric patients? This is the question addressed by this research. Using an exploratory, naturalistic interview approach, 20 nurses and managers in varied settings described their decision making when providing pain relief. Analysis of these narratives indicates that decision making about pain, in this unique context, is influenced by a number of intrapersonal and interpersonal factors such as the patients' needs, history, and diagnosis; nurses' beliefs about pain tolerance and drug addiction; collegial pressure; and unit safety. For example, diagnosis and patient history impact pain relief negatively, while the responsibility to maintain a safe environment imposes pressure to administer medication. Although, in a psychiatric unit, the nurse-patient relationship is essential to the healing process, nurses often face a dilemma as to whether the pain medication will contribute to healing or exacerbate the patient's issues. In psychiatric wards, the means of recovery are far less clear, tangible, and immediate than in other clinical settings. Recommendations are made for better preparing and supporting nurses to work effectively in these practice settings where pain relief is confounded by addiction and psychiatric diagnoses.     

Phylogenetic characterization of enterovirus 68 strains in patients with respiratory syndromes in Italy

Enterovirus 68 (EV‐D68) was associated with mild to severe respiratory infections. In the last 4 years, circulation of different EV‐D68 strains has been documented worldwide. In this study, the phylogenetic characterization of nine EV‐D68 strains identified in patients in the 2010–2012 period and 12 additional EV‐D68 Italian strains previously identified in 2008 in Italy was described. From January 2010 to December 2012, a total of 889 respiratory specimens from 588 patients stayed or visited at the Fondazione IRCCS Policlinico San Matteo were positive for HRV or HEV. Extracted nucleic acids were amplified by one‐step RT‐PCR with primer specific for VP1 region of EV‐D68 and purified positive PCR products were directly sequenced. Overall, 9/3736 (0.24%) patients were EV‐D68 positive. Of these, 7/9 (77.8%) were pediatric and two (22.2%) were adults. Five out of seven (71.4%) pediatric patients had lower respiratory tract infection with oxygen saturation <94%. Four cases were detected from August through October 2010, while five other cases from September through December 2012. The Italian EV‐D68 strains in 2008 belonged to clade A (n = 5) and clade C (n = 7). In 2010 all the Italian strains belonged to clade A (n = 4) and in 2012, four Italian strains belonged to clade B and one to clade A. In conclusion, we provide additional evidence supporting a role of EV‐D68 in severe respiratory infection in pediatric patients. In addition, all the three EV‐D68 clades circulating worldwide were identified in Italy in a 5‐year period of time. J. Med. Virol. 86:1590–1593, 2014. © 2013 Wiley Periodicals, Inc.