Global perspectives on bipolar disorder treatment: in-depth comparative analysis of international guidelines for medication selection.

BACKGROUND: Bipolar disorder, a chronic mental health condition characterised by fluctuations in mood, energy and functionality, affects millions of individuals worldwide. Its management requires a comprehensive approach, and, as such, treatment guidelines have a pivotal role in guiding clinicians to alleviate symptoms, prevent relapse and enhance overall patient well-being. However, the treatment landscape is far from homogenous, with significant variations existing across different countries. AIMS: This study aimed to explore and compare treatment guidelines for bipolar disorder in various regions, shedding light on the factors that influence therapeutic approaches and thus offering insights that could contribute to the ongoing refinement of evidence-based practices in management. METHOD: The study explores various international treatment guidelines for bipolar disorder that have been updated after 2014. Guidelines from the UK, Canada, Australia/New Zealand, South Korea and the International College of Neuropsychopharmacology are scrutinised to identify factors contributing to the observed differences among them. RESULTS: The variations in recommended drugs across guidelines arise from the approaches employed in guideline development - whether relying on expert consensus or meta-analysis results. Timing disparities in conducting these analyses and the selection of studies also exert influence. Moreover, differences in metabolic enzymes among diverse races and the health policies implemented by individual nations play a significant part in shaping these differences. CONCLUSION: The primary hindrance to consistent treatment conclusions lies in the scarcity of high-quality research results, leading to variations in guidelines. Enhancing evidence-based recommendations necessitates the undertaking of large-scale studies dedicated to assessing treatments for bipolar disorder.

Análise da efetividade do estágio prático internacional de enfermagem em relação ao estágio prático nacional de enfermagem / Análisis de la efectividad de la práctica profesional internacional de enfermería con relación a la práctica profesional nacional de enfermería / Analysis of the effectiveness of international nursing practicum over national nursing practicum

Resumo Objetivo: Este estudo foi conduzido para avaliar a efetividade do estágio prático internacional de enfermagem quanto à autoeficácia, competência cultural e competência global. Foi utilizada a análise fatorial para avaliar a confiabilidade das medidas do estudo. Métodos: Um método de amostragem intencional foi usado para coletar os dados: os participantes eram estudantes de enfermagem (n=66) do segundo semestre do terceiro ano do curso de graduação. Para a análise fatorial, foram agrupados os resultados obtidos dos grupos controle e experimental (n=132) por meio de um questionário. A pesquisa foi realizada antes e após o estágio prático nacional e internacional de enfermagem para os grupos controle e experimental, respectivamente. O teste t foi utilizado para comparar os dois grupos, e Diferença em Diferenças (DD) foi utilizado para determinar a verdadeira alteração entre antes e depois do estágio. A análise do DD também mostrou que o nível de mudança antes e depois de cada estágio de enfermagem foi significativa entre os grupos controle e experimental. Resultados: A análise fatorial demonstrou que o questionário da pesquisa mensurou com confiabilidade os subconceitos. As diferenças na autoeficácia e na competência cultural entre os dois grupos foram estatisticamente significativas antes e depois do tratamento, mas os resultados de DD não foram significativos. Para a competência global, no entanto, tanto o DD quanto a diferença antes e depois do tratamento entre os dois grupos foram estatisticamente significativos. Conclusão: Apesar de algumas limitações do estudo, o desenho inovador gerou resultados que ajudam a preencher uma grande lacuna no conhecimento de enfermagem. Estudos futuros devem incluir um ensaio clínico randomizado para superar as limitações de viés de amostragem e generalização dos resultados do estudo.

Resumen Objetivo: Este estudio fue llevado a cabo para analizar la efectividad de la práctica profesional internacional de enfermería en cuanto a la autoeficacia, competencia cultural y competencia global. Se utilizó el análisis factorial para evaluar la confiabilidad de las medidas del estudio. Métodos: Fue utilizado un método de muestreo intencional para recopilar los datos: los participantes eran estudiantes de enfermería (n=66) del segundo semestre de tercer año de la carrera de grado. Para el análisis factorial, se agruparon los resultados obtenidos de los grupos de control y experimental (n=132) a través de un cuestionario. La investigación fue realizada antes y después de la práctica profesional nacional e internacional de enfermería en grupos de control y experimental, respectivamente. Se utilizó el test-T para comparar los dos grupos y la técnica Diferencia en Diferencias (DD) para determinar la verdadera modificación entre antes y después de la práctica. El análisis de DD también demostró que el nivel de cambio antes y después de cada práctica de enfermería fue significativo entre los grupos de control y experimental. Resultados: El análisis factorial demostró que el cuestionario de la investigación midió los subconceptos con confiabilidad. Las diferencias de autoeficacia y competencia cultural entre los dos grupos fueron estadísticamente significativas antes y después del tratamiento, pero los resultados de DD no fueron significativos. Sin embargo, en la competencia global, tanto la DD como la diferencia antes y después del tratamiento entre los dos grupos fueron estadísticamente significativas. Conclusión: A pesar de algunas limitaciones del estudio, el diseño innovador generó resultados que ayudan a llenar un gran vacío en el conocimiento de enfermería. Estudios futuros deben incluir un ensayo clínico aleatorizado para superar las limitaciones de perspectiva de muestreo y generalización de los resultados del estudio.

Abstract Objective: This study was conducted to examine the effectiveness of international nursing practicum on self-efficacy, cultural competency, and global competency. Methods: A purposive sampling method was used to collect the data: the participants were nursing students (n=66) who had advanced into the 2nd semester of junior level. For the factor analysis, the results of a questionnaire survey were pooled from the control and experimental groups (n=132). The survey was administered before and after the national and international nursing practicum for the control and experimental groups, respectively. The t-test was used to compare the two groups, and Difference in Difference (DID) was used to determine the true change between before and after the practicum. But if you are describing international nursing practicums and domestic nursing practicums, i.e., many different courses in different countries, and here in Korea in different universities. DID analysis also showed that the level of change before and after each nursing practicum differed significantly between the control and experimental groups. Results: Factor analysis confirmed that the survey questionnaire reliably measured the sub-concepts. The differences in self-efficacy and cultural competency between the two groups were statistically significant before and after the treatment, but DID results were not significant. For global competency, however, both DID and the difference before and after treatment between the two groups were statistically significant. Conclusion: Despite a few study limitations, the innovative study design generated findings that help to fill a large gap in nursing knowledge. Future studies should include a randomized clinical trial to overcome the limitations of sampling bias and generalization of study results.

Changes over time in caregiving demand and difficulty in spousal caregivers of coronary artery bypass graft surgery patients.

Patients who undergo coronary artery bypass graft (CABG) surgery are often dependent on spouses or family members for care during their recovery. The purpose of this study was to examine changes over time in spousal caregivers of coronary artery bypass graft (CABG) patients in caregiving demand and caregiving difficulty and to identify the key demands and difficulties at each time point. Spouses (n=34) of CABG patients comprised the sample. Caregiving demand and caregiving difficulty were measured using the Caregiving Burden Scale at three time points (baseline [early hospital discharge] and 3 and 6months later) and analyzed using repeated measures analysis of variance. Mean scores of each item were used to identify the top four caregiving demands and difficulties at each time point. There was a significant decrease over time in caregiving demands (F [1.696]=13.62, p<0.001) and caregiving difficulties (F [1.613]=4.52, p=0.02). The most demanding and/or difficult caregiving activities at all time points were providing social support, managing behavior problems, taking on additional household tasks, and monitoring symptoms. Early in recovery, providing transportation was a top ranked demand and difficulty. Later in recovery (3 and 6months), managing finances became a top ranked demand and difficulty. In conclusion, caregiving demands and difficulties declined significantly over six months for the caregivers in this study. These results indicate that caregiving demands and difficulties change over time and ongoing assessments of spouses and family members are needed to help them manage the caregiving situation.

Quasi-experimental study on the effectiveness of a flipped classroom for teaching adult health nursing.

AIM: The effectiveness of flipped learning as one of the teaching methods of active learning has been left unexamined in nursing majors, compared to the frequent attempts to uncover the effectiveness of it in other disciplines. The purpose of this study was to reveal the effectiveness of flipped learning pedagogy in an adult health nursing course, controlling for other variables. METHODS: The study applied a quasi-experimental approach, comparing pre- and post-test results in learning outcomes. Included in this analysis were the records of 81 junior nursing major students. The convenience sampling method was used to select the participants. Those in the experimental group were exposed to a flipped classroom experience that was given after the completion of their traditional class. The students' learning outcomes and the level of critical thinking skills were evaluated before and after the intervention of the flipped classroom. RESULTS: After the flipped classroom experience, the scores of the students' achievement in subject topics and critical thinking skills, specifically intellectual integrity and creativity, showed a greater level of increase than those of their controlled counterparts. This remained true even after controlling for previous academic performance and the level of creativity. CONCLUSION: This study confirmed the effectiveness of the flipped classroom as a measure of active learning by applying a quantitative approach. But, regarding the significance of the initial contribution of flipped learning in the discipline of nursing science, carrying out a more authentic experimental study could justify the impact of flipped learning pedagogy.

Spousal Caregivers of Coronary Artery Bypass Surgery Patients: Differences between Caregivers with Low vs. High Caregiving Demands.

PURPOSE: Compared to non-caregivers, caregivers have higher rates of depressive symptoms, caregiver strain, less mutuality, and health care visits. However, few investigators have examined family caregivers after coronary artery bypass (CAB) surgery. The purpose of this study was to examine differences in caregiving difficulties, mutuality (i.e., open communication; avoiding sad thoughts), and depressive symptoms based on low vs. high caregiving demands among spousal caregivers. DESIGN: A descriptive, comparative design was used to examine 33 spousal caregivers of CAB surgery patients (16 in low and 17 in high caregiving demand groups). METHODS: Measures included: Caregiving Burden Scale, Mutuality and Interpersonal Sensitivity Scale, and Patient Health Questionnaire-9. Groups were compared using Mann-Whitney U statistics. FINDINGS: It was found that caregivers with high caregiving demands reported more caregiving difficulties and more open communication about the surgery compared to caregivers with low demands. CONCLUSION: Caregivers with greater caregiving demands may need additional support to assist them with the caregiving situation. CLINICAL RELEVANCE: Priority should be given to family caregivers, who take care of patients in cardiac rehabilitation, with higher caregiving demand.

The state of the science of family caregiver-care receiver mutuality: a systematic review.

This review critically examines the current state of the science on the concept of family caregiver-care receiver mutuality, summarizes accomplishments and gaps and identifies directions for future theory development and research. Mutuality between family caregivers and care receivers is of increasing interest to researchers. However, no analysis of the current state of the science of this important concept has been published. Our literature search revealed 34 research articles that met inclusion criteria. The studies were assessed in terms of conceptualization of mutuality, instrument development, populations studied, research designs and methods and findings. Significant scientific progress during the past 30 years includes the development of clear definitions and new instruments, expansion of research beyond the clinical populations in which mutuality was first studied, the use of a variety of research designs, and increasingly sophisticated methods of data analysis. Growing evidence suggests that mutuality is associated with caregiver emotional health outcomes and may decrease over time in the context of chronic illness. Directions for future research include development of new theoretical frameworks grounded in relational theory, development of theory on the dynamics of mutuality over time, exploration of mutuality in diverse cultures and populations, and intervention studies aimed at enhancing mutuality.

Caregiving demand and difficulty in older adult spousal caregivers after coronary artery bypass surgery.

The purpose of this study was to describe the caregiving demands and difficulties for older adult spousal caregivers of coronary artery bypass (CAB) surgery patients. Caregiving demands and difficulties were measured by the Caregiving Burden Scale. The sample size was 35 caregivers of CAB surgery patients who were, on average, 60 years old and 19 days since hospital discharge. Descriptive analysis revealed that the top four most demanding caregiving activities perceived by spousal caregivers were providing transportation, additional household tasks, providing emotional support, and two tied for fourth: monitoring symptoms and additional tasks outside the home. The top four most difficult caregiving tasks were additional household tasks, providing transportation, and two tied for third: additional tasks outside home and managing behavior problems. Also, caregivers reported experiencing more demands than difficulties. Examining the demanding and difficult caregiving tasks provides information from which to develop and test tailored interventions for caregivers of this population.