Effectiveness of Vasopressin Against Cardiac Arrest: A Systematic Review of Systematic Reviews.

PURPOSE: This systematic review (SR) of SRs evaluates the effectiveness of vasopressin alone or in combination with other drugs in improving the outcomes of cardiac arrest (CA). METHODS: Using a three-step approach, we searched five databases to identify all relevant SRs. Two reviewers independently selected suitable studies, assessed study quality, and extracted relevant data. If an outcome was reported by multiple SRs, a re-meta-analysis was conducted as needed; otherwise, a narrative analysis was performed. RESULTS: Twelve SRs covering 16 original studies were included in this review. The meta-analysis results revealed a significant increase in survival to hospital admission for patients with in-hospital CA (IHCA) or out-of-hospital CA (OHCA) receiving vasopressin alone compared with that for those receiving epinephrine alone. Furthermore, the return of spontaneous circulation (ROSC) was significantly increased in patients with OHCA receiving vasopressin with epinephrine compared with that in those receiving epinephrine alone. Compared with patients with IHCA receiving epinephrine with placebo, those receiving vasopressin, steroids, and epinephrine (VSE) exhibited significant increases in ROSC, survival to hospital discharge, favorable neurological outcomes, mean arterial pressure, renal failure-free days, coagulation failure-free days, and insulin requirement. CONCLUSION: VSE is the most effective drug combination for improving the short- and long-term outcomes of IHCA. It is recommended to use VSE in patients with IHCA. Future studies should investigate the effectiveness of VSE against OHCA and CA of various etiologies, the types and standard dosages of steroids for cardiac resuscitation, and the effectiveness of vasopressin-steroid in improving CA outcomes.

Comparison of depressive symptoms among healthcare workers in high-risk versus low-risk areas during the first month of the COVID-19 pandemic in China.

Introduction: The psychological health of healthcare workers (HCWs) has become a significant concern, particularly during the initial stage of a pandemic. This study compared the depressive symptoms among HCWs in high-risk areas (HRAs) and low-risk areas (LRAs) with matching demographics. Methods: A cross-sectional study was employed to compare the depressive symptoms (Patient Health Questionnaire score ≥ 10), workplace environment characteristics, the Health Belief Model (HBM) and socio-demographics of the HCWs working in HRAs and LRAs in several accessible regions (mainly Hubei Province and Guangdong-Hong Kong-Macao Greater-Bay-Area) in China. Eight hundred eighty-five HCWs were recruited for unmatched analysis between March 6 and April 2, 2020. After matching with occupation and years of service using a 1:2 ratio, 146 HCWs in HRAs and 290 HCWs in LRAs were selected for matched analysis. Subgroup analyzes were performed using two individual logistic regressions to delineate the associated factors in LRAs and HRAs, respectively. Results: HCWs in LRAs (Prevalence = 23.7%) had 1.96 times higher odds of depressive symptoms than those in HRAs (Prevalence = 15.1%) after adjusting for occupation and years of service (p < 0.001). Significant differences in workplace environment characteristics (p < 0.001) and the 5-dimension of the HBM of HCWs (p < 0.001 to p = 0.025) were found between HRAs and LRAs.Logistic regression showed that workers with years of service between 10 and 20 years (OR:6.27), ever had contact with COVID-19 patients (OR:14.33) and had higher scores of "perceived barrier" of HBM (OR:4.48) predicted depressive symptoms in HRAs while working in pneumology departments and infectious disease units (OR:0.06), and high "self-efficacy" in the HBM (OR:0.13) was a protective factor against depressive symptoms.Contrarily, in LRAs, those HCWs who worked in ICUs (OR:2.59), had higher scores of "perceived susceptibility toward the COVID-19 outbreak" (OR:1.41), "perceived severity of the pandemic" (OR:1.25), and "perceived barriers of wearing masks" (OR:1.43) in the HBM predicted depressive symptoms. High "cues to action" (OR:0.79), and better "knowledge" (OR:0.79) in the HBM were protective factors against depressive symptoms. Conclusion: The risk of depressive symptoms of HCWS was double in LRAs than in HRAs in the first month of the COVID-19 pandemic. Furthermore, salient predictors for depressive symptoms among HCWs in HRAs and LRAs were very different.

Self-efficacy of emergency management of domestic helpers in pediatric home accidents: A cross-sectional survey in Hong Kong.

Background: Accidental injuries are the leading cause of deaths and disabilities in children globally and most of them occur at home. To save life and prevent sequelae, domestic helpers (DHs) require providing emergency management (i.e., first aid) to children involved in home accidents. However, their self-efficacy in emergency management for children is rarely investigated. Hence, this study aimed to tap that research gap. Methods: This study adopted a cross-sectional descriptive survey design. A convenience sample of 385 DHs was obtained in Hong Kong. DHs' self-efficacy in emergency management for children involved in home accidents was measured using a 12-item well-validated survey instrument "Self-Efficacy of First Aid in Unintentional Injury at Home". The total score ranged from 0 to 48. A higher score indicates greater confidence in emergency management for children involved in home accidents. Results: All the participants were women and most of them were aged between 31 and 35 years (N = 103, 26.8%). The mean score for DHs' self-efficacy in emergency management was 29.0 (SD 10.1). The three items with the lowest self-efficacy were managing bone fractures, performing cardiopulmonary resuscitation, and providing artificial respiration. Bivariate analysis showed that DHs' self-efficacy was significantly related to their educational level, first aid training, caring experience, and working experience. Multiple linear regression indicated that DHs' educational level (ß = 0.136, p = 0.001) and first aid training (ß = 0.532, p < 0.001) were significantly predicting their self-efficacy. Conclusion: DH's self-efficacy of emergency management for children involved in home accidents was low, particularly in those severe situations and complicated first aid procedures.

Effectiveness of Tai Chi on older adults: A systematic review of systematic reviews with re-meta-analysis.

This overview study examined and synthesized the effect of Tai Chi (TC) on the physical conditions, psychological conditions, cognitive abilities, and quality of life (QoL) of older adults. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Using Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, PubMed, Scopus, and Web of Science, English-language systematic reviews (SRs) published within the latest decade (2010-2020) were included. SRs with meta-analysis were selected if TC was the examined intervention and older adults was the targeted population. A total of 16 SRs covering 89 original studies were included. A number of the pooled results of the included SRs were inconclusive. Taking into consideration of the new meta-analyses of this study, TC significantly improved most outcomes, including the mobility, pain level, physical function, psychological distress, depressive symptoms, anxiety, global cognitive function, mental speed and attention, learning ability, verbal fluency, executive function, and QoL of older adults. TC can be an effective intervention for older adults for improving physical and psychological conditions, cognitive abilities, and QoL. Additional high-quality studies with larger samples investigating the effectiveness of TC in older adults are warranted.

Capability of emergency nurses for electrocardiogram interpretation.

INTRODUCTION: Electrocardiogram is the first-line diagnostic imaging modality for evaluating patients with chest pain. The present study aimed to determine the capability of emergency nurses for electrocardiogram interpretation by using a more appropriate questioning method. METHODS: This was a cross-sectional descriptive survey. A convenience sample of 96 emergency nurses was obtained from two emergency departments in Hong Kong. The electrocardiogram-interpretation capability of the emergency nurses was determined using a self-developed well-designed questionnaire comprising 10 questions on electrocardiogram interpretation. Each question carried one point, such that the maximum score was 10 points. The higher the score, the more capable was the emergency nurse at electrocardiogram interpretation. RESULTS: The mean score achieved by the participants was 7.7 ±â€¯1.8. Only 12.5% of the participants were able to answer all questions correctly. A considerable proportion of the participants were unable to recognize first-degree heart block (74.0%), second-degree heart block type I (52.1%), or third-degree heart block (39.6%). Gender, electrocardiogram training, nursing experience, and emergency department experience had significant associations with mean score. CONCLUSIONS: The electrocardiogram-interpretation capability of the emergency nurses was fair. Better training should be implemented to help emergency nurses recognize potentially fatal heart blocks, enabling prompt and appropriate patient treatment.

Nurse-initiated radiographic-test protocol for ankle injuries: A randomized controlled trial.

INTRODUCTION: Nurse-initiated radiographic-test protocol was compared with usual practice in reducing unnecessary ankle and foot radiographic-test requests and shortening patients' length of stay (LOS) in an emergency department (ED) by reducing their waiting time for physician reassessment. METHODS: Patients with ankle injuries were enrolled in an unblinded randomized controlled trial. Participants were randomized to receive either the protocol (n = 56) or usual practice (n = 56). Primary outcome was the proportion of radiographic-test requests. Secondary outcomes were the proportion of fractures detected and patients' LOS and waiting times. RESULTS: The proportions of ankle and foot radiographic tests requested by triage nurses implementing the Ottawa Ankle Rules (OARs) in protocol group were smaller than those requested by physicians using their expertise in usual practice group. The proportions of malleolar and midfoot fractures detected by triage nurses implementing the OARs in protocol group were higher than those detected by physicians using their expertise in usual practice group. Patients' LOS and waiting time from consultation to discharge in protocol group were shorter than those in usual practice group. CONCLUSIONS: Implementing the nurse-initiated radiographic-test protocol reduced unnecessary ankle and foot radiographic-test requests and shortened patients' LOS in the ED by reducing their waiting time for physician reassessment.

Effectiveness of emergency nurses' use of the Ottawa Ankle Rules to initiate radiographic tests on improving healthcare outcomes for patients with ankle injuries: A systematic review.

BACKGROUND: The Ottawa Ankle Rules provide guidelines for clinicians on the recommendation of radiographic tests to verify fractures in patients with ankle injuries. The use of the Ottawa Ankle Rules by emergency nurses has been suggested to minimise unnecessary radiographic-test requests and reduce patients' length of stay in emergency departments. However, the findings of studies in this area are inconsistent. DESIGN: A systematic review was conducted to synthesise the most accurate evidence available on the extent to which emergency nurses' use of the Ottawa Ankle Rules to initiate radiographic tests improves healthcare outcomes for patients with ankle injuries. DATA SOURCES: The systematic review attempted to identify all relevant published and unpublished studies in English and Chinese from databases such as Ovid MEDLINE, EMBASE, ProQuest Health and Medical Complete, EBM Reviews, SPORTDiscus, CINAHL Plus, the British Nursing Index, Scopus, the Chinese Biomedical Literature Database, China Journal Net, WanFang Data, the National Central Library Periodical Literature System, HyRead, the Digital Dissertation Consortium, MedNar and Google Scholar. REVIEW METHODS: Two reviewers independently assessed the eligibility of all of the studies identified during the search, based on their titles and abstracts. If a study met the criteria for inclusion, or inconclusive information was available in its title and abstract, the full text was retrieved for further analysis. The methodological quality of all of the eligible studies was assessed independently by the two reviewers. RESULTS: The search of databases and other sources yielded 1603 records. The eligibility of 17 full-text articles was assessed, and nine studies met the inclusion criteria. All nine studies were subjected to narrative analysis, and five were meta-analysed. All of the studies investigated the use of the refined Ottawa Ankle Rules. The results indicated that emergency nurses' use of the refined Ottawa Ankle Rules minimised unnecessary radiographic-test requests and reduced patients' length of stay in emergency departments. However, the use of these rules in urgent-care departments did not reduce unnecessary radiographic-test requests or patients' length of stay. The implementation of the refined Ottawa Ankle Rules by emergency nurses with different backgrounds, including nurse practitioners or general emergency nurses was found to reduce patients' length of stay in emergency departments. CONCLUSIONS: The results of the systematic review suggested that a nurse-initiated radiographic test protocol should be introduced as standard practice in emergency departments.