The need for and value of nurse and midwife prescribing: Findings from an Irish research investigation.

AIM: The aim of this study is to determine the need for and value of nurse and midwife prescribing in Ireland as identified by these prescribers-the people most able to provide relevant insights and information. BACKGROUND: Since 2007, nurses and midwives in Ireland who have passed an additional educational program can prescribe medicinal products relative to their clinical practice areas. Research evidence of efficacy is needed now for prescribing sustainability in Ireland and to encourage, if successful, the adoption or expansion of frontline nurse/midwife prescribing rights in other countries. DESIGN: A qualitative study was undertaken. METHODS: Interviews with registered nurse and midwife prescribers were conducted in 2017 until data saturation. Constant-comparative coding and categorization of data revealed themes and categories, with explanatory quotes for research trustworthiness and credibility purposes. RESULTS: Six data themes emerged: (a) more than just writing prescriptions; (b) highly individualized evidence-based specialist care; (c) assured, timely and rapid accessibility to needed care; (d) health system and healthcare efficiency gains; (e) satisfaction with nurse/midwife prescriber services and (f) quality care improvements. CONCLUSION: Nurse/midwife prescribing in Ireland was identified as needed, safe, effective and cost-effective. Prescribing permitted accessible, thorough and proactive holistic health promotive care to be provided in nurse- or midwife-led outpatient clinics.

Light Therapy for Patients With Bipolar Depression: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: Bipolar disorder (BD) is challenging to treat, and fewer treatments are available for depressive episodes compared to mania. Light therapy is an evidence-based nonpharmacological treatment for seasonal and nonseasonal major depression, but fewer studies have examined its efficacy for patients with BD. Hence, we reviewed the evidence for adjunctive light therapy as a treatment for bipolar depression. METHODS: We conducted a systematic review of databases from inception to June 30, 2019, for randomized, double-blind, placebo-controlled trials of light therapy in patients with BD (CRD42019128996). The primary outcome was change in clinician-rated depressive symptom score; secondary outcomes included clinical response, remission, acceptability, and treatment-emergent mood switches. We quantitatively pooled outcomes using meta-analysis with random-effects models. RESULTS: We identified seven trials representing 259 patients with BD. Light therapy was associated with a significant improvement in Hamilton Depression Rating Scale score (standardized mean difference = 0.43, 95% confidence interval [CI], 0.04 to 0.82, P = 0.03). There was also a significant difference in favor of light therapy for clinical response (odds ratio [OR] = 2.32; 95% CI, 1.12 to 4.81; P = 0.024) but not for remission. There was no difference in affective switches between active light and control conditions (OR = 1.30; 95% CI, 0.38 to 4.44; P = 0.67). Study limitations included different light treatment parameters, small sample sizes, short treatment durations, and variable quality across trials. CONCLUSION: There is positive but nonconclusive evidence that adjunctive light therapy reduces symptoms of bipolar depression and increases clinical response. Light therapy is well tolerated with no increased risk of affective switch.

Barriers and facilitators to the integration of depression services in primary care in Vietnam: a mixed methods study.

BACKGROUND: Although the prevalence of depression in Vietnam is on par with global rates, services for depression are limited. The government of Vietnam has prioritized enhancing depression care through primary healthcare (PHC) and efforts are currently underway to test and scale-up psychosocial interventions throughout the country. With these initiatives in progress, it is important to understand implementation factors that might influence the successful integration of depression services into PHC. As the implementers of these new interventions, primary care providers (PHPs) are well placed to provide important insight into implementation factors affecting the integration of depression services into PHC. This mixed-methods study examines factors at the individual, organizational and structural levels that may act as barriers and facilitators to the integration of depression services into PHC in Vietnam from the perspective of PHPs. METHODS: Data collection took place in Hanoi, Vietnam in 2014. We conducted semi-structured interviews with PHPs (n = 30) at commune health centres and outpatient clinics in one rural and one urban district of Hanoi. Theoretical thematic analysis was used to analyse interview data. We administered an online survey to PHPs at n = 150 randomly selected communes across Hanoi. N = 226 PHPs responded to the survey. We used descriptive statistics to describe the study variables acting as barriers and facilitators and used a chi-square test of independence to indicate statistically significant (p < .05) associations between study variables and the profession, location and gender of PHPs. RESULTS: Individual-level barriers include low level of knowledge and familiarity with depression among PHPs. Organizational barriers include low resource availability in PHC and low managerial discretion. Barriers at the structural level include limited mental health training among all PHPs and the existing programmatic structure of PHC in Vietnam, which sets mental health apart from general services. Facilitators at the individual level include positive attitudes among PHPs towards people with depression and interest in undergoing enhanced training in depression service delivery. CONCLUSIONS: While facilitating factors at the individual level are encouraging, considerable barriers at the structural level must be addressed to ensure the successful integration of depression services into PHC in Vietnam.

Introducing supported self-management for depression to primary care in Vietnam: A feasibility study in preparation for a randomized controlled trial.

INTRODUCTION: Although depression is a major contributor to the global burden of disease, services remain scarce in many low- and middle-income countries. In Vietnam, depression services are limited, and the government has recently prioritized primary care and community-based service integration. We conducted a pilot study in 2 districts of Hanoi to test the feasibility of (a) introducing a supported self-management (SSM) intervention for adult depression in primary care in Vietnam, and (b) conducting a randomized controlled trial (RCT) to test the effectiveness of the intervention. METHOD: We conducted focus groups with providers (n = 16) and community members (n = 32) to assess the appropriateness of an Antidepressant Skills Workbook for use in Vietnam. We trained providers (n = 23) to screen patients using the Self-Reporting Questionnaire-20 (SRQ-20) depression scale and to deliver SSM for a 2-month period. A total of 71 patients were eligible to participate in the study, with depression (SRQ-20) and disability (World Health Organization Disability Assessment Schedule 2.0) scores assessed at baseline and 1 and 2 months. RESULTS: Study results demonstrate the feasibility of conducting a full RCT in Vietnam and suggest that SSM is an appropriate care model for the Vietnamese context. There was a statistically significant decrease in depression symptoms on the SRQ-20 and in functional disability in all domains for the World Health Organization Disability Assessment Schedule 2.). CONCLUSION: Feasibility study results suggested that a full RCT was warranted. An unanticipated outcome of the study was the uptake of the model by the Ministry of Labor, Invalids, and Social Affairs in 2 additional provinces. (PsycINFO Database Record

The effectiveness of a Supported Self-management task-shifting intervention for adult depression in Vietnam communities: study protocol for a randomized controlled trial.

BACKGROUND: Depressive disorders are one of the leading causes of disease and disability worldwide. In Vietnam, although epidemiological evidence suggests that depression rates are on par with global averages, services for depression are very limited. In a feasibility study that was implemented from 2013 to 2015, we found that a Supported Self-management (SSM) intervention showed promising results for adults with depression in the community in Vietnam. This paper describes the Mental Health in Adults and Children: Frugal Innovations (MAC-FI) trial protocol that will assess the effectiveness of the SSM intervention, delivered by primary care and social workers, to community-based populations of adults with depression in eight Vietnamese provinces. METHODS/DESIGN: The MAC-FI program will be assessed using a stepped-wedge, randomized controlled trial. Study participants are adults aged 18 years and over in eight provinces of Vietnam. Study participants will be screened at primary care centres and in the community by health and social workers using the Self-reporting Questionnaire-20 (SRQ-20). Patients scoring >7, indicating depression caseness, will be invited to participate in the study in either the SSM intervention group or the enhanced treatment as usual control group. Recruited participants will be further assessed using the World Health Organization's Disability Assessment Scale (WHODAS 2.0) and the Cut-down, Annoyed, Guilty, Eye-opener (CAGE) Questionnaire for alcohol misuse. Intervention-group participants will receive the SSM intervention, delivered with the support of a social worker or social collaborator, for a period of 2 months. Control- group participants will receive treatment as usual and a leaflet with information about depression. SRQ-20, WHODAS 2.0 and CAGE scores will be taken by blinded outcome assessors at baseline, after 1 month and after 2 months. The primary analysis method will be intention-to-treat. DISCUSSION: This study has the potential to add to the knowledge base about the effectiveness of a SSM intervention for adult depression that has been validated for the Vietnamese context. This trial will also contribute to the growing body of evidence about the effectiveness of low-cost, task-shifting interventions for use in low-resource settings, where specialist mental health services are often limited. TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov, identifier: NCT03001063 . Registered on 20 December 2016.

Improved lung function following dietary antioxidant supplementation in exercise-induced asthmatics.

INTRODUCTION: Oxidative stress is a characteristic of exercise-induced asthma (EIA), however antioxidant supplementation may attenuate EIA. The purpose of this study was to determine if ascorbic (AsA) and α-tocopherol supplementation would improve airway function in subjects with EIA. METHODS: A single-blind randomized crossover design with eight clinically diagnosed EIA subjects (22.0 ± 0.7 year) and five healthy control subjects (28.2 ± 1.4 year) was used. Subjects consumed vitamins (V) (AsA 500 mg; α-tocopherol 300 IU) or placebo (PLA) daily for three weeks, followed by a three week washout period and then three weeks of the alternative treatment. Ten-minute treadmill tests (90% VO2peak) were performed with pulmonary function testing (forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and between 25 and 75% (FEF25-75%), and peak expiratory flow rates (PEFR)) measured pre-exercise and 1, 5, 15, and 30 min post-exercise. RESULTS: Supplementation led to significant improvements at minute 5 and minute 15 in FVC; FEV1; PERF; FEF25-75% and minute 30 in FEV1 and FEF25-75% post-exercise. CONCLUSION: AsA and α-tocopherol may aid the recovery of pulmonary function in subjects with EIA.

La importancia de la percepción de los stakeholders en la comprensión del impacto: el programa del sistema básico de salud integral (Sibasi) y la calidad del servicio de salud primaria en El Salvador / Importance of stakeholder perception in understanding impact: the basic integrated health system (Sibasi) program and quality of primary healthcare in El Salvador

El presente documento recoge los resultados de una evaluación preeliminar, a la fecha, del impacto del programa Sibasi - Sistema Básico de Salud Integral - en la calidad de la atención en salud en El Salvador, utilizando una metodología que examina las percepciones de los stakeholders, entre los cuales se encuentran formuladores de política, profesionales de la salud y miembros de la comunidad. El documento presenta una breve revista a la reforma del sistema de salud en El Salvador y perfila la lógica detrás del sibasi, además de una perspectiva teórica sobre la calidad de la atención de salud. El estudio encontró que si bien el sibasi estaba bien concebido y tenía un potencial definitivo "el papel aguanta todo", no había logrado un éxito notorio. Adicionalmente, las barreras existentes en el sistema de salud en El Salvador - extrema pobreza, gobernabilidad ineficaz, politización, financiación pobre, y discordia en el proceso de reforma- limitaron seriamente el éxito del programa SIBASI.

Using a methodology which examines the perceptions of stakeholders, including policy-makers, healthcare professionals and community members, this paper details a preliminary evaluation of the impact thus far of the Basic Integrated Health System (Sibasi) program on quality of healthcare in El Salvador. The paper gives a brief overview of health systems reform in ElSalvador, outlines the logic behind the sibasi and presents theoretical perspectives on quality in healthcare. The study found that although the sibasi was “good on paper” and had definitepotential, it had not met with a great deal of success. Additionally, existing barriers in the health system in El Salvador- extreme poverty, ineffective governance, politicization, poor financing, and contention in the reform process- severely limited the success of the Sibasi program.

A Phase II study of St. John's Wort for smoking cessation.

OBJECTIVES: To examine the feasibility and efficacy of St. John's Wort (SJW) for smoking cessation. DESIGN: This one-arm Phase II study utilized an exact two-stage group sequential design with a 1-week run-in period between the start of SJW treatment and the designated quit date. A total of 37 smokers (ages 18-65 years, smoking > or = 10 cigarettes/day) were started on SJW. Thirteen failed to make a verified quit attempt on the predesignated date and were taken off study resulting in 24 evaluable subjects. SETTING: Smokers completed clinic visits at a cancer center with interval telephone calls and mailings. INTERVENTION: Standardized SJW, 450 mg capsules taken orally twice daily along with cessation counseling messages. MAIN OUTCOME MEASURES: Subjects completed validated surveys and a focused physical examination at baseline. Evaluable subjects were defined as those subjects who made a confirmed quit attempt on their "quit date" 1 week following initiation of SJW. Smoking status was determined through self-report and bioverification using carbon monoxide (CO) testing. RESULTS: Among evaluable subjects, the 12-week quit rate was 37.5% (9/24). Quitters had no significant change in weight from baseline to 12-weeks cessation. Use of SJW was generally well tolerated. CONCLUSIONS: Based upon these results (which suggest that SJW may be effective in maintaining smoking cessation) and the high compliance and few AEs, we conclude that SJW demonstrates feasibility for use in smoking cessation. If SJW proves to be effective in larger controlled studies, it could represent a less expensive, more readily accessible and well-tolerated agent to promote tobacco cessation.