Researcher Perceptions of Involving Consumers in Health Research in Australia: A Qualitative Study.

There is growing recognition internationally of the importance of involving consumers, patients, and the public in research. This is being driven by political mandates for policies, funding, and governance that demand genuine and meaningful engagement with consumers. There are many potential benefits to involving consumers in research, including an increased relevance to patient needs, improved quality and outcomes, and enhanced public confidence in research. However, the current literature highlights that efforts to incorporate their contributions are often tokenistic and there is a limited understanding of the psychological factors that can impact researcher attitudes, intentions, and behaviours when working with consumers in research. To address this gap, this study conducted 25 semi-structured interviews with health researchers in Australia using the qualitative case study method. The study aim was to explore the underlying influences on researcher behaviour when involving consumers in health research. The results identified several factors that influence researchers' behaviour, including better quality research, emotional connection and the humanisation of research, and a shift in research culture and expectations as major drivers. However, beliefs that consumers would hinder research and must be protected from risks, paternalism, and a lack of researcher skills and resources were identified as major barriers. This article presents a theory of planned behaviour for consumer involvement in the health research model. The model offers a valuable tool for policymakers and practitioners to understand the factors that influence researcher behaviours. It can also serve as a framework for future research in this area.

The effect of head of bed elevation on sacral and heel subepidermal moisture in healthy adults: A randomised crossover study.

BACKGROUND: Subepidermal moisture (SEM) changes may detect early tissue injury and enhance pressure injury risk assessments. However, little is known how modifiable factors, like head of bed elevation (HOBE), affect SEM. AIM: This study investigated the influence of HOBE on sacral and heel SEM, using the Provizio ® SEM Scanner. METHOD: A 2 × 2 randomised crossover study compared the effects of 30-min of 30° versus 60° HOBE on sacral and heel SEM in healthy adults. RESULTS: 48 participants were randomly allocated to 30° or 60° HOBE and crossed over after a 60-min washout period. The mean age was 40.6 years (SD = 18.3). The study found the sacral and heel SEM values were not statistically different at 30° versus 60° HOBE. No clinically relevant association between SEM and characteristics of age, sex, body mass index and skin type were found. Baseline sacral and heel SEM values recovered after a 60-min washout period. Notably, half of the initial baseline measures suggested pressure injury risk. CONCLUSION: The HOBE may not influence SEM at the sacrum and heels, in healthy adults after 30 min of loading. Standard operating procedures for measuring SEM for pressure injury risk assessment require a stronger body of evidence in varied populations and timeframes before this technology is widely adopted. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12622001456741.

Use of point-of-care subepidermal moisture devices to detect localised oedema and evaluate pressure injury risk: A scoping review.

AIMS AND OBJECTIVES: To map current literature on bedside clinicians' use of point-of-care subepidermal moisture devices to identify increased pressure injury risk. BACKGROUND: Pressure injuries are a substantial healthcare burden. Localised oedema occurs before visible or palpable changes, and therefore is a biomarker of increased pressure injury risk. Novel bedside technologies that detect localised oedema may aid early pressure injury preventative practices. DESIGN: A scoping review. METHODS: Arksey and O'Malley's six-step framework and the PRISMA-ScR guidelines guided this scoping review. CINAHL Complete, Embase, SCOPUS, Cochrane (wounds) and PubMed databases were searched for primary research and quality improvement projects published in English between 2008-2022. Included studies focused on clinicians' bedside use of subepidermal moisture devices to quantify localised oedema and pressure injury risk. The PAGER framework supported narrative synthesis of the extracted data. RESULTS: Nine studies were selected from 1676 sources. Two point-of-care subepidermal moisture devices were identified in clinical use, largely by nurses. Inconsistent use and interpretations revealed significant knowledge gaps in clinical practice. Additionally, no included studies engaged patients or the public in their design. CONCLUSIONS: Nurses recognise the value of objective measures in determining the risk of pressure injury and are the primary end-users of point-of-care subepidermal moisture devices. However, standardising procedural instructions and interpretive criteria to guide preventative measures requires further research. RELEVANCE TO CLINICAL PRACTICE: International pressure injury clinical practice guidelines advocate for subepidermal moisture devices as an adjunct to routine clinical skin assessment, although little is known about bedside use. This scoping review reveals low adoption of such devices and the need to develop standardised procedures in their use and interpretation. REGISTRATION: Open Science DOI https://doi.org/10.17605/OSF.IO/AB6Y5-7th of March 2022.

[The State of the World's Nurses report analyzed by the International Council of Nurses]. / Le rapport sur la situation du personnel infirmier dans le monde, analyse du Conseil international des infirmières.

Released in April 2020 by the World Health Organization, the State of the World's Nurses report marks a turning point for the profession. With a clear set of data on the numbers and composition of this professional group, it makes a compelling case for governments to no longer underfund the education, employment, leadership and practice of nurses. The report includes 10 key actions to shape the future direction of global nursing policy.

International Council of Nurses President Annette Kennedy reflects on her 4-year tenure as president.

Annette Kennedy's four year term as President of the International Council of Nurses ended during the organisation's virtual Congress in November. Here she writes about her time in office and the state of the world's nursing after 2 years of the pandemic. She acknowledges the strains that COVID-19 has put on nursing but affirms that nurses and nursing have come through the pandemic as a stronger, more influential and more cohesive profession.

The International Council of Nurses in the time of the COVID-19 pandemic.

International Council of Nurses President Annette Kennedy reviews the organization's contribution to nursing during the COVID-19 pandemic. She describes the Council's efforts to support nurses around the world and bring its National Nursing Associations together to share their experiences and best practices, and the lessons learned with other nations who are at different stages of the pandemic.

[Nursing leadership and the International Council of Nurses]. / Le leadership infirmier et le Conseil international des infirmières.

The development of nursing leadership constitutes a key objective for the International Council of Nurses. This international organisation proposes numerous initiatives, notably training actions, in order to obtain positive results in this area.

Challenge of global nursing care and health policy

Dear Colleagues, It is no secret that the frenetic pace at which globalization has advanced in the past few decades has brought with it a set of highly critical questions for governments and many challenges for us in our role as nurses and advocates of good quality patient care. We are not averse to challenges, but we need to meet these challenges with information, competence, and skill. We need to participate in all conversations about our patients and their health care needs. In every country in the world nurses are facing similar challenges but we can learn together and from each other.

Queridos colegas, No es secreto que el ritmo frenético al que la globalización ha avanzado en las últimas décadas con él, un conjunto de preguntas muy críticas para los gobiernos y muchos desafíos para nosotros en nuestro papel de enfermeras y Defensores de la atención al paciente de buena calidad. No estamos enfrentando desafíos, pero tenemos que enfrentarlos Con información, competencia y habilidad. Necesitamos participar en todas las conversaciones sobre nuestros pacientes y sus necesidades de salud. En todos los países del mundo, las enfermeras enfrentan desafíos similares, pero podemos aprender juntos y unos de otros.

Quetiapine for the treatment of cocaine use disorder.

BACKGROUND: Cocaine addiction continues to be a significant healthcare issue, yet there are no FDA approved medications for the treatment of cocaine use disorder within the United States. METHODS: This 12-week, prospective, double-blind, randomized, placebo-controlled study examined the effectiveness of quetiapine (Seroquel XR™) versus matched placebo for the treatment of DSM-IV cocaine dependence in non-psychotic individuals. Subjects randomized to quetiapine (N = 29) were titrated up to a target dose of 400mg/day of quetiapine, while those in the placebo arm (N = 31) were given a matched placebo. All subjects had weekly clinic visits and a cognitive-behavioral therapy group session. Outcome measures included self-report of cocaine use and money spent on cocaine as well as urine drug screens (UDS). RESULTS: The drop-out rate was substantial at 68%. Logistic regression analysis did not find significant differences between groups in predicting end-of trial abstinence, defined as three consecutive weekly negative UDS (13.7% in the quetiapine group versus 12.9% in the placebo group; p = .92). Based upon a repeated measures analysis of variance, subjects in this study, as a whole, demonstrated reductions in their self-reported use of cocaine, self-reported money spent on cocaine, and number of days per week using cocaine. However, the quetiapine group did not differ significantly from the placebo group. CONCLUSIONS: This study did not find group differences between the quetiapine and placebo arms, suggesting that quetiapine is not an efficacious treatment for DSM-IV cocaine dependence.

Open trial of injectable risperidone for methamphetamine dependence.

We tested acceptability and tolerability of long-acting injectable risperidone for methamphetamine (MA) dependence in an open trial with the hypothesis that participants would reduce MA use. Participants were also evaluated for changes in neurocognitive function and psychiatric symptomology. Participants with MA dependence (n = 34) entered a 7-day open-label run-in with oral risperidone. Participants who tolerated oral risperidone (n = 22) were begun on long-acting injectable risperidone 25 mg intramuscular medication with subsequent injections q 2 weeks to a total of 4 injections. Participants remained on oral risperidone during the first 3 weeks after initial injection. Participants were offered 8 weekly individual sessions of relapse prevention counseling. At baseline, participants reported using MA an average of 4.1 days per week (SD = 1.9). Estimated mean days of MA use per week while on injections was 1.0 (95% confidence interval = 0.6-1.4), with days of use decreasing significantly from baseline through week 8 (ß = -0.27; 95% confidence interval: - 0.38--0.16; P < 0.001). Mean week 6 risperidone + 9-OH risperidone plasma levels for participants abstinent from MA from weeks 5 to 8 (n = 7, 63.6%) were 18.8 ng/mL (SD = 6.6) compared with 12.3 (SD = 4.0) for those not abstinent (n = 4; P = 0.075). No serious adverse events occurred. Verbal memory improved at week 4 compared with baseline (P < 0.05). Participation in this trial of injectable risperidone was associated with reductions in MA use as well as some positive benefits on verbal memory. However, these results are limited by the use of an open trial design with a high dropout rate. Risperidone deserves further study in controlled trials as a pharmacotherapy for MA dependence.

Quetiapine for the treatment of cocaine dependence: an open-label trial.

The monaminergic properties of second generation antipsychotics are prompting research on their use to treat cocaine dependence, with inconclusive results to date. In preliminary reports, the atypical antipsychotic quetiapine has shown promise for the treatment of substance abuse disorders. The primary objective of the current study was to assess the efficacy of quetiapine in reducing cocaine cravings and use in nonpsychotic subjects with cocaine dependence over 6 weeks of open-label treatment. Twenty-two cocaine-dependent, nonpsychotic men were initiated to open-label treatment with quetiapine (300-600 mg/d). The primary outcome measure was weekly self-report of cocaine cravings as assessed with the Brief Substance Craving Scale. Cocaine use was captured with a self-report Timeline Follow-back calendar, administered every 2 weeks. Side effect monitoring was conducted weekly, and movement disorders were assessed every 2 weeks. Intent-to-treat regression analyses (n = 22) indicated that the Brief Substance Craving Scale total score decreased significantly overtime (P < 0.001). Self-reports also suggested decreased cocaine use. There was no treatment-related increase in movement disorders, and most side effects were mild. However, all subjects did experience sedation, and several subjects dropped out because of it. What is more, weight increased significantly over time (P < 0.001). Open-label quetiapine treatment reduced cravings and improved some aspects of cocaine dependence in nonpsychotic individuals. Additional research is needed to confirm the current findings and to further delineate the role quetiapine may play in the treatment of cocaine use disorders.

Time to discontinuation and self-discontinuation of olanzapine and risperidone in patients with schizophrenia in a naturalistic outpatient setting.

BACKGROUND: Although efficacy of antipsychotic medications is well documented, their effectiveness in real-world practice is less robust. We examined the effectiveness of olanzapine and risperidone in schizophrenia in a naturalistic setting. METHODS: We used an electronic medical records database at a Veterans Affairs Medical Center to conduct a retrospective study of all new outpatient medication trials of olanzapine (n = 221) and risperidone (n = 274) over a 2-year period beginning January 1999 in patients diagnosed with schizophrenia or schizoaffective disorder. We defined medication discontinuation as a switch between the 2 agents (most switches) or self-discontinuation when a patient is without medication supply for longer than 1 month. RESULTS: Sample mean age (+/-SD) was 48.4 (+/-11.6) years; 91% were men. Discontinuation rates were high (73%), trending lower in olanzapine (70%) than risperidone (76%) (P = 0.12). Median time to discontinuation was 120 days (95% confidence interval [CI], 105-135), longer for olanzapine (150 days; 95% CI, 120-180) than risperidone (90 days; 95% CI, 71-109) (P = 0.04). Self-discontinuation was high (48%), with no significant difference between olanzapine (50%) and risperidone (46%). Switching rate was 25% and more likely to occur in risperidone (30%) than olanzapine (20%) (odds ratio, 1.72; 95% CI, 1.13-2.61). CONCLUSIONS: Effectiveness of antipsychotic medications in schizophrenia may be hampered by high rates of medication self-discontinuation in outpatient practice settings. Time to discontinuation suggests that olanzapine may be more effective than risperidone. Strategies to address causes of poor adherence should be incorporated in medication algorithms to optimize their effectiveness.

Abstinence, anticipation, reduction, and treatment (AART): a stepwise approach to the management of atypical antipsychotic side effects.

Antipsychotic medications, specifically the atypical agents, serve as first-line treatment options for patients with psychotic disorders, including individuals with schizophrenia or schizoaffective disorder. Atypical antipsychotics are also often prescribed off-label as either the primary treatment or as an adjunctive treatment for individuals with other disorders, including mood disorders without psychosis, behavioral disorders, and insomnia. Despite the generally superior side-effect profiles of atypical antipsychotics compared with typical antipsychotic agents, the atypicals have been associated with a number of serious side effects, including metabolic disorders, cardiovascular disorders, seizures, hyperprolactinemia, and movement disorders. This article offers a stepwise approach to the management of antipsychotic side effects: Abstinence, Anticipation, Reduction, and Treatment (AART). The steps in AART are hierarchical, but often overlap in the areas of risk prevention and minimization. The authors discuss issues relevant to each level of intervention and provide suggestions for integrating the AART approach into a comprehensive treatment plan. By incorporating this stepwise approach into their clinical decision-making process, prescribers may be able to optimize the risk:benefit ratio associated with the prescription of atypical antipsychotics.