Use of wearables for monitoring cardiometabolic health: A systematic review.

INTRODUCTION: Cardiometabolic disorders (CMD) such as hyperglycemia, obesity, hypertension, and dyslipidemia are the leading causes of mortality and significant public health concerns worldwide. With the advances in wireless technology, wearables have become popular for health promotion, but its impact on cardiometabolic health is not well understood. PURPOSE: A systematic literature review aimed to describe the features of wearables used for monitoring cardiometabolic health and identify the impact of using wearables on those cardiometabolic health indicators. METHODS: A systematic search of PubMed, CINAHL, Academic Search Complete, and Science and Technology Collection databases was performed using keywords related to CMD risk indicators and wearables. The wearables were limited to sensors for blood pressure (BP), heart rate (HR), electrocardiogram (ECG), glucose, and cholesterol. INCLUDED STUDIES: 1) were published from 2016 to March 2021 in English, 2) focused on wearables external to the body, and 3) examined wearable use by individuals in daily life (not by health care providers). Protocol, technical, and non-empirical studies were excluded. RESULTS: Out of 53 studies, the types of wearables used were smartwatches (45.3%), patches (34.0%), chest straps (22.6%), wristbands (13.2%), and others (9.4%). HR (58.5%), glucose (28.3%), and ECG (26.4%) were the predominant indicators. No studies tracked BP or cholesterol. Additional features of wearables included physical activity, respiration, sleep, diet, and symptom monitoring. Twenty-two studies primarily focused on the use of wearables and reported direct impacts on cardiometabolic indicators; seven studies used wearables as part of a multi-modality approach and presented outcomes affected by a primary intervention but measured through CMD-sensor wearables; and 24 validated the precision and usability of CMD-sensor wearables. CONCLUSION: The impact of wearables on cardiometabolic indicators varied across the studies, indicating the need for further research. However, this body of literature highlights the potential of wearables to promote cardiometabolic health.

Mastectomy With Flat Closure: What Oncology Nurses Need to Know.

Women choosing to undergo a mastectomy with flat closure encounter a variety of challenges during the decision-making process and throughout their journey with flat closure. Oncology nurses play a critical role in meeting the.

"My body, my choice": A qualitative study of women's mastectomy with flat closure experiences.

This qualitative study aimed to describe and explore the pre and post-mastectomy experiences of women choosing flat closure after a breast cancer diagnosis. Aesthetic flat closure creates a flat contoured chest wall after a mastectomy. There is limited research on women's flat closure experiences. To fill this gap, we interviewed 19 women (Mage = 53, range 31-72) with breast cancer who underwent a bilateral mastectomy with flat closure, examining decision-making, mirror-viewing, and flat closure experiences. Using a hermeneutic phenomenological design, we generated seven themes. Broadly, women choosing flat closure experienced pressure from their clinicians to undergo breast reconstruction. We found flat closure information to be consistently lacking. Mirror-viewing experiences of women obtaining suboptimal flat closure outcomes led to shattered expectations, mirror avoidance, psychological distress, and body image disturbances. Women negotiated their new reality by discovering ways to feel comfortable with their flat bodies. Regardless of surgical outcome, decision satisfaction was high. These findings illustrate the importance of bodily autonomy and supportive healthcare environments for women making flat closure decisions. Providing comprehensive information on all surgical options and addressing post-operative expectations can improve women's decision-making and mirror-viewing experiences and assist women in adapting to their new body image.

The mirror viewing experience of women undergoing a mastectomy: An integrative review.

AIMS: To appraise the current literature on the mirror viewing experience of women undergoing a mastectomy. DESIGN: Whittemore and Knafl's approach to integrative reviews, Braun and Clarke's thematic analysis, and PRISMA guidelines were utilized for this review. DATA SOURCES: A systematic search of primary peer-reviewed articles from April 2012 to 2022 was conducted using PubMed, CINAHL, Academic Search Complete and Google Scholar databases. REVIEW METHODS: Eighteen studies met the inclusion criteria (15 qualitative and 3 quantitative) and were appraised using the Johns Hopkins evidence-based practice appraisal instrument. RESULTS: Five themes describing the mirror viewing experience were revealed: Mirror viewing motives, mirror viewing preparedness, mirror viewing experience, mirror comfort/avoidance and women's mirror viewing recommendations. CONCLUSION: The review findings were found to align with Freysteinson's Neurocognitive Mirror Viewing Model highlighting the occurrence of short-term memory disruptions and an autonomic nervous system response that can lead women to experience a flight/fright or faint response, mirror trauma and mirror avoidance when looking at themselves in the mirror after a mastectomy. IMPACT: Women reported feeling unprepared to look at themselves in the mirror, with some experiencing shock and emotional distress, which led to mirror avoidance behaviours as a way to cope with their new body image. Nursing interventions aimed at improving women's mirror viewing experiences may help mitigate this autonomic nervous system response and minimize mirror trauma and mirror avoidance. Preparing women to view themselves in the mirror for the first time may help reduce psychological distress and body image disturbances in women undergoing a mastectomy. NO PATIENT OR PUBLIC CONTRIBUTION: This integrative review did not involve patient or public contributions. The authors reviewed currently published peer-reviewed literature in writing this manuscript.

What the American Journal of Critical Care Junior Peer Reviewers Were Reading During Year 2 of the Program.

The American Journal of Critical Care's Junior Peer Reviewer program aims to mentor novice reviewers in the peer review process. To grow their critical appraisal skills, the participants take part in discussion sessions in which they review articles published in other journals. Here we summarize the articles reviewed during the second year of the program, which again focused on the care of critically ill patients with COVID-19. This article aims to share these reviews and the reviewers' thoughts regarding the relevance, design, and applicability of the findings from the selected studies. High rates of delirium associated with COVID-19 may be impacted by optimizing sedation strategies and allowing safe family visitation. Current methodology in crisis standards of care may result in inequity and further research is needed. The use of extracorporeal carbon dioxide removal to facilitate super low tidal volume ventilation does not improve 90-day mortality outcomes. Continued research to better understand the natural history of COVID-19 and interventions useful for improving outcomes is imperative.

A concept analysis of decision regret in women with breast cancer.

The aim of this article is to understand the components of decision regret for women making breast cancer treatment decisions. Patient-centered care models encourage women to become more active in the decision-making process, inadvertently exposing them to the risk of experiencing decision regret. Enhancing the understanding of the concept of decision regret can offer insight into ways to mitigate this phenomenon. The Walker and Avant method was used to analyze this concept. Using PubMed, CINAHL, ERIC, Academic Search Complete, PsychINFO, SocINDEX, Joanna Briggs Institute of EBP Database, and an online dictionary, articles from 2011 to 2021 were analyzed to identify concept uses, attributes, antecedents, and consequences. Decision regret in women making breast cancer healthcare decisions is a negative cognitive-emotional response to a treatment decision that involves counterfactual thinking with three targets of regret: outcome regret, chosen option regret, and process regret. Experiencing decision regret can reduce a woman's quality of life, inflict psychological distress, and impact future decision-making. Unfavorable outcomes, decision uncertainty, and breakdowns in the decision-making process can lead to decision regret. Findings provide information on identifying women experiencing decision regret and illustrate opportunities to address causative factors through patient education and support to promote optimal patient outcomes.

Satisfaction Outcomes in Women Who "Choose to Go Flat" After Mastectomy: An Integrative Review.

A considerable number of women undergoing mastectomies are "choosing to go flat," forgoing reconstruction. This integrative review sought to identify satisfaction outcomes and relevant factors among these women. Using variations of the key word "going flat," a systematic search of 7 databases was conducted. Fifteen articles met the inclusion criteria and were reviewed. Decisional and breast/chest appearance satisfaction in women who did not have reconstruction was mixed when compared with other surgical options. Body image, body mass index, radiation therapy, and access to information/resources affected satisfaction. Nurses are in a pivotal role to address the communication and informational needs of these women to support optimal surgical decision-making processes and improve patient satisfaction and clinical outcomes.

Parenteral nutrition: a clear and present danger unabated by tight glucose control.

BACKGROUND: The infectious risks of parenteral nutrition (PN) in critical illness are well described, although most literature predates tight glucose control (TGC) practice. The authors hypothesized that PN-related complications are ameliorated by TGC and are equivalent to those in enteral nutrition (EN) patients. METHODS: A prospective cohort study of patients admitted to the surgical intensive care unit was conducted, comparing PN and EN patients. TGC target was 80 to 110 mg/dL. Univariate and multivariate logistic regression was used to explore the association between infectious outcomes and PN use. RESULTS: One hundred fifty-five patients were studied. Mean daily glucose values were lower for the PN group than for the EN patients (118.2 vs 125.6 mg/dL, P = .002). Nonetheless, the incidence of bloodstream infection and catheter-related bloodstream infection was significantly associated with the administration of PN. In a multivariate logistic regression model, PN was associated with a >4-fold increase in the odds of having a catheter-related bloodstream infection (odds ratio, 4.48; 95% confidence interval, 1.14-17.49; P = .03). CONCLUSIONS: Despite the successful implementation of TGC, PN is still a significant risk factor for infectious complications among surgical intensive care unit patients.

Universal consent practice in academic intensive care units (ICUs).

UNLABELLED: The purpose of this study was to determine national practice for obtaining consent in academic adult intensive care units (ICUs) for routine bedside procedures and to define universal consent rates by patient demographics within our own institution's ICUs. METHODS: A 10-question survey was sent to the program directors for all U.S. surgical and pulmonary critical care directors regarding consent practices. Further, the adoption of a universal consent protocol in an academic county hospital was studied. RESULTS: Cross-sectional study: Thirty-seven percent of program directors completed the survey. Consent rates varied from 35% to 97% by procedure, with only 14% using a universal consent document. Providers in Medical ICUs obtained consent more often than in Surgical ICUs for both central line and pulmonary artery catheter placement (82.8% and 93.1% vs. 52.6% and 52.6%, respectively). Prospective cohort study: At our institution, 90% of 363 patients or their proxies signed universal consent for procedures, 4.4% consent with exemptions, while 5.2% refused. Insured patients were 2.7 times more likely to sign full universal consent for bedside ICU procedures than uninsured patients. CONCLUSION: There was a national variation in ICU consent practices with an interest in a wider usage of universal consent protocols. The latter was adopted differentially based on patient demographics. Universal consent was widely accepted at our institution.

Nurses' implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention.

BACKGROUND: Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. OBJECTIVE: To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. METHODS: Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. RESULTS: Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. CONCLUSIONS: The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.