Jann P Foster

Collaborative care for comorbid depression and diabetes: a systematic review and meta-analysis

Objective The collaborative care model is recommended for depression in adults with a chronic physical health problem like diabetes. We sought to systematically assess the effect of collaborative care on depression and glycaemia in adults with comorbid depression and diabetes to inform guidelines and practice. Design Systematic review and meta-analysis. Data sources We searched PubMed, Scopus, Cochrane Library, CINAHL, Health Source Nursing, MEDLINE, PsychINFO and reference lists of retrieved articles published before August 2013. Inclusion criteria Randomised controlled trials (RCTs) on collaborative care (ie, coordinated multidisciplinary model of care) for depression that reported the effects on depression and glycaemic outcomes in adults with comorbid clinically relevant depression and diabetes were eligible. Data extraction and analysis Data on the mean difference in depression and glycaemic outcomes were extracted and pooled using random effects meta-analysis. Results Seven RCTs included for review reported effects on depression outcomes in 1895 participants, and glycated haemoglobin (HbA1c) level in 1556 participants. Collaborative care significantly improved the depression score (standardised mean difference was −0.32 (95% CI −0.53 to −0.11); I2=79%) and HbA1c level (weighted mean difference was −0.33% (95% CI −0.66% to −0.00%); I2=72.9%) compared with control conditions. Depression remission did not predict better glycaemic control across studies. Conclusions Limited evidence from short-to-medium term RCTs predominantly conducted in the USA suggests that collaborative care for depression significantly improves both depression and glycaemia outcomes, independently, in people with comorbid depression and diabetes.

Continuous Positive Airway Pressure Therapy for Infants With Respiratory Distress in Non–Tertiary Care Centers: A Randomized, Controlled Trial

OBJECTIVE. Our objective was to determine whether continuous positive airway pressure therapy would safely reduce the need for up-transfer of infants with respiratory distress from nontertiary centers. METHODS. We randomly assigned 300 infants at >30 weeks of gestation with respiratory distress to receive either Hudson prong bubble continuous positive airway pressure therapy or headbox oxygen treatment (standard care). The primary end point was “up-transfer or treatment failure.” Secondary end points included death, length of nursery stay, time receiving oxygen therapy, cost of care, and other measures of morbidity. RESULTS. Of 151 infants who received continuous positive airway pressure therapy, 35 either were up-transferred or experienced treatment failure, as did 60 of the 149 infants given headbox oxygen treatment. There was no difference in the length of stay or the duration of oxygen treatment. For every 6 infants treated with continuous positive airway pressure therapy, there was an estimated cost saving of

Procedural pain in neonates in Australian hospitals: A survey update of practices

10000. Pneumothorax was identified for 14 infants in the continuous positive airway pressure group and 5 in the headbox group. There was no difference in any other measure of morbidity or death. CONCLUSIONS. Hudson prong bubble continuous positive airway pressure therapy reduces the need for up-transfer of infants with respiratory distress in nontertiary centers. There is a clinically relevant but not statistically significant increase in the risk of pneumothorax. There are significant benefits associated with continuous positive airway pressure use in larger nontertiary centers.

Parental stress and satisfaction in the non-tertiary special care nursery

The study aims to determine whether there has been improved uptake of the evidence for the management of procedural pain in neonates throughout Australia.

Evidence and leadership: The tools for change

AIM This paper is a report of a study examining the effects of using headbox oxygen and continuous oxygen positive airway pressure treatments for respiratory distress on stress and satisfaction of parents with infants in a special care nursery, and the relationship between parental stress and satisfaction. BACKGROUND Continuous positive airway pressure respiratory support is increasingly used in special care nurseries worldwide. Almost nothing is known about effects of different types of respiratory support on the stress and satisfaction of parents with babies in the special care nursery. METHOD Questionnaires were used from August 2004 to June 2006 in five special care nurseries to measure parental stress using an adaptation of the Parental Stressor Scale: Neonatal Intensive Care Unit and 5-point scales to measure overall stress and satisfaction. FINDINGS Questionnaires were returned from 42 parents of babies receiving headbox oxygen and 51 parents of babies receiving continuous positive airway pressure (62% response rate). High stress was commonly reported. Stress did not differ statistically significantly between the two treatments. Parents with babies receiving continuous positive airway pressure were more satisfied compared to the headbox group. Stress and satisfaction were not statistically significantly correlated. CONCLUSION Clinicians need not favour either method of respiratory support when attempting to minimize parental experience of environmental stress. Further research is needed to test parental stress reduction strategies in the special care nursery.

Targeted oxygen therapy in special care nurseries: Is uniformity a good thing?

Abstract Evidence based practice is seen to be a vehicle through which nurses can deliver more cost-effective care and improve patient outcomes. Despite this, however, ‘evidence’ does not always appear to influence policy and practice. Routine and traditional practices such as pre-operative fasting protocols seem particularly resistant to change. The research literature which repeatedly argues for reduced pre-operative fasting periods for clear fluids dates back to the 1800s. Current research indicates that the ingestion of clear fluids is safe two to four hours pre-operatively. Despite this evidence, however, pre-operative fasting for clear fluids, even for healthy young adults undergoing elective surgery, still persist for periods of up to twelve hours’ duration. ‘Evidence’ was used in a surgical unit in a private hospital in Sydney to reduce pre-operative clear fluid fasting periods for patients requiring elective bowel surgery. This paper will describe the process of implementation of the reduced fasting guidelines. More specifically, it will detail what was done and how it was done; it will also demonstrate the crucial role of strong nursing leadership in this evidence based change to existing practice.

A multicentre, randomised controlled, non-inferiority trial, comparing nasal high flow with nasal continuous positive airway pressure as primary support for newborn infants with early respiratory distress born in Australian non-tertiary special care nurseries (the HUNTER trial): study protocol

Aim:  There is wide variation in the commencement of inspired oxygen (FiO2) and the oxygen saturation (SpO2) targets set in special care nurseries (SCNs). Evidence supports minimising unnecessary oxygen exposure. Does the introduction of a protocol advocating the uniform approach of commencing FiO2 at 30% and targeting SpO2 of 94–96% for infants ≥33 weeks gestation with respiratory distress reduce oxygen exposure?

Experiences of new graduate nurses working in a neonatal intensive care setting: a systematic review protocol of qualitative evidence.

Introduction Nasal high-flow (nHF) therapy is a popular mode of respiratory support for newborn infants. Evidence for nHF use is predominantly from neonatal intensive care units (NICUs). There are no randomised trials of nHF use in non-tertiary special care nurseries (SCNs). We hypothesise that nHF is non-inferior to nasal continuous positive airway pressure (CPAP) as primary support for newborn infants with respiratory distress, in the population cared for in non-tertiary SCNs. Methods and analysis The HUNTER trial is an unblinded Australian multicentre, randomised, non-inferiority trial. Infants are eligible if born at a gestational age ≥31 weeks with birth weight ≥1200 g and admitted to a participating non-tertiary SCN, are <24 hours old at randomisation and require non-invasive respiratory support or supplemental oxygen for >1 hour. Infants are randomised to treatment with either nHF or CPAP. The primary outcome is treatment failure within 72 hours of randomisation, as determined by objective oxygenation, apnoea or blood gas criteria or by a clinical decision that urgent intubation and mechanical ventilation, or transfer to a tertiary NICU, is required. Secondary outcomes include incidence of pneumothorax requiring drainage, duration of respiratory support, supplemental oxygen and hospitalisation, costs associated with hospital care, cost-effectiveness, parental stress and satisfaction and nursing workload. Ethics and dissemination Multisite ethical approval for the study has been granted by The Royal Children’s Hospital, Melbourne, Australia (Trial Reference No. 34222), and by each participating site. The trial is currently recruiting in eight centres in Victoria and New South Wales, Australia, with one previous site no longer recruiting. The trial results will be published in a peer-reviewed journal and will be presented at national and international conferences. Trial registration number Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001203640; pre-results.

Experiences of African women who migrate to a developed country and encounter domestic violence: a systematic review protocol of qualitative evidence

REVIEW QUESTION/OBJECTIVE The overall objective of this systematic review is to identify, critically appraise and synthesize the experiences of new graduate nurses in the neonatal intensive care unit (NICU). The specific review question is: what are the experiences of new graduate nurses working in a NICU setting?

The seminar: how to develop and deliver a dynamic presentation.

REVIEW QUESTION/OBJECTIVE The objective of this systematic review is to identify, critically appraise and synthesize the literature regarding the experiences of African women who have migrated to a developed country and have encountered domestic violence.