Partner behaviours improving breastfeeding outcomes: An integrative review.

PROBLEM: The impact of specific supportive behaviours of a woman's partner on breastfeeding outcomes is unclear. BACKGROUND: Breastfeeding is beneficial for the infant, mother, and society. Partner support plays a significant role in promoting breastfeeding. Strategies to improve breastfeeding rates have had limited success with rates worldwide remaining well below World Health Organization recommendations, contributing to significant morbidity, mortality, and economic burden globally. AIM: To determine what specific supportive behaviours of a breastfeeding woman's partner increase breastfeeding initiation, exclusivity, and duration rates in Western-culture settings. METHODS: A Population-Interest-Context framework-based search strategy was applied to the Cumulative Index to Nursing Allied Health Literature Plus with full-text, Web of Science, Scopus, and PubMed databases, limited to primary research published January 2008-December 2018 in English conducted in Western-culture settings. FINDINGS: From 652 articles, after critical appraisal seven articles (eight studies) satisfied the requirements of this integrative review. Supportive behaviours were categorised as knowledge, help, encouragement, and responsiveness. Help and encouragement behaviours were associated with increased initiation. Results were mixed regarding behaviours affecting exclusivity and duration; however, responsiveness was found to ameliorate otherwise generally negative effects of knowledge, help, and encouragement on these outcomes. DISCUSSION: Consistent with wider social support research, awareness of receiving support is associated with negative health consequences. However, where partner support is provided in a responsive manner as part of a 'breastfeeding team', thereby promoting the woman's sense of autonomy and self-efficacy, breastfeeding outcomes improve. CONCLUSION: Responsive partner behaviours improved breastfeeding outcomes in Western-culture settings. Further primary research is needed.

The acute haemodynamic effect of nebulised frusemide in stable, advanced heart failure.

PURPOSE: To assess the acute haemodynamic effects of nebulised frusemide in a stable advanced heart failure population. PROCEDURE: In this randomised, double blind, placebo controlled trial, people with stable, advanced heart failure undergoing right heart catheterisation were randomised to receive either 40 mg (4 ml) of nebulised frusemide or 4 ml of normal saline. Following inhalation of the study medication, subjects' pulmonary pressures were recorded every 15 min for 1 h. FINDINGS: There were no significant changes in the weighted average time course data of the subjects (n=32) in either group over the study period, in particular no differences were observed in haemodynamic parameters between the two groups. Weighted average pulmonary capillary wedge pressure after 60 min in the frusemide group was 22.5 (SD 6.5) mmHg (n=14) compared to the placebo group's 24.0 (SD 7.3) mmHg (n=18), p=0.55. The frusemide group had a significantly greater change in the median volume of urine in the bladder over the study period (186 ml IQR 137.8-260.8) compared to the placebo group (76 ml IQR 39.0-148.0) p=0.02. CONCLUSION: This study showed that nebulised frusemide had no significant clinical effect on the haemodynamic characteristics of the subjects.

Disaster medical assistance teams: what psychosocial support is needed?

OBJECTIVE: The objective of this preliminary study was to evaluate the perceptions of internationally deployed Disaster Medical Assistance Team (DMAT) personnel regarding the psychosocial support needs of these teams. METHODS: The DMAT questionnaire was sent to 34 members of Australian medical teams involved in deployments to the 2004 Southeast Asian tsunami and the 2006 Java earthquake. Twenty personnel (59%) completed this survey, which reviewed key deployment stressors, specific support strategies, and the support needs of team members, their families, and team leaders. A key aspect of the survey was to determine whether the perceived psychosocial needs would be supported best within with existing provisions and structures, or if they would be enhanced by further provisions, including the deployment of mental health specialists. RESULTS: There was strong support for brief reviews of stress management strategies as part of the pre-deployment briefing, and access to written stress management information for both team members and their families. However, more comprehensive provisions, including pre-deployment, stress-management training programs for personnel and intra-deployment family support programs, received lower levels of support. The availability of mental health-related training for the team leader role and access to consultation with mental health specialists was supported, but this did not extend to the actual deployment of mental health specialists. CONCLUSIONS: In this preliminary study, clear trends toward the maintenance of current mental health support provisions and the role of the DMAT leader were evident. A follow-up study will examine the relationship between team-leader, psychosocial support strategies and team functioning.

Nebulized furosemide for the management of dyspnea: does the evidence support its use?

Dyspnea is a common and distressing symptom associated with multiple chronic illnesses and high levels of burden for individuals, their families and health care systems. The subjective nature dyspnea and a poor understanding of pathophysiological mechanisms challenge the clinician in developing management plans. Nebulized furosemide has been identified as a novel approach to dyspnea management. This review summarizes published studies, both clinical and experimental, reporting the use of nebulized furosemide. The search criteria yielded 42 articles published in the period 1988 to 2004. Although nebulized furosemide appeared to have a positive influence on dyspnea and physiological measurements, caution must be taken with the results primarily coming from small-scale clinical trials or observation trials. Despite the limitations of the studies reported, given the range of conditions reporting effectiveness of nebulized furosemide, further investigation of this potential novel treatment of dyspnea is warranted.

Nurses in Australian general practice: implications for chronic disease management.

AIMS: The purpose of this study was to describe the demographic and employment characteristics of Australian practice nurses and explore the relationship between these characteristics and the nurses' role. BACKGROUND: Nursing in general practice is an integral component of primary care and chronic disease management in the United Kingdom and New Zealand, but in Australia it is an emerging specialty and there is limited data on the workforce and role. DESIGN: National postal survey embedded in a sequential mixed method design. METHODS: 284 practice nurses completed a postal survey during 2003-2004. Descriptive statistics and factor analysis were utilized to analyse the data. RESULTS: Most participants were female (99%), Registered Nurses (86%), employed part-time in a group practice, with a mean age of 45.8 years, and had a hospital nursing certificate as their highest qualification (63%). The tasks currently undertaken by participants and those requiring further education were inversely related (R2 = -0.779). Conversely, tasks perceived to be appropriate for a practice nurse and those currently undertaken by participants were positively related (R2 = 0.8996). There was a mismatch between the number of participants who perceived that a particular task was appropriate and those who undertook the task. This disparity was not completely explained by demographic or employment characteristics. Extrinsic factors such as legal and funding issues, lack of space and general practitioner attitudes were identified as barriers to role expansion. CONCLUSION: Practice nurses are a clinically experienced workforce whose skills are not optimally harnessed to improve the care of the growing number of people with chronic and complex conditions. Relevance to clinical practice. Study data reveal a need to overcome the funding, regulatory and interprofessional barriers that currently constrain the practice nurse role. Expansion of the practice nurse role is clearly a useful adjunct to specialist management of chronic and complex disease, particularly within the context of contemporary policy initiatives.

A survey of commitment and compassion among nurses in residential aged care.

AIM: To assess the views and attitudes of aged care staff providing direct care towards palliative care and to identify their learning needs. DESIGN: Survey design using purposive sampling methods. FINDINGS: Nurses and care assistants (n=222) employed within nine residential aged care facilities in regional Australia completed the survey. The majority had received 'on the job training' and were committed to providing end-of-life care. Differences in the level of confidence to deal with patient/family interactions and manage complex palliative care scenarios were evident between nurses and care assistants (p<0.05). Both nurses and care assistants perceived a need for further education in symptom management and communication, yet their content need differed significantly between groups. CONCLUSIONS: Nurses and care assistants in residential aged care facilities demonstrate commitment to the delivery of palliative care and express a need for increased palliative care competencies. The heterogeneity of roles and educational preparation within the aged care workforce indicate that tailored palliative care education initiatives are required to meet the learning needs of aged care nurses and care assistants, particularly in relation to end-of-life care. These data have implications for skill-mix and model of care development.

How reliable is estimation of glomerular filtration rate at diagnosis of type 2 diabetes?

OBJECTIVE: The Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations previously have been recommended to estimate glomerular filtration rate (GFR). We compared both estimates with true GFR, measured by the isotopic (51)Cr-EDTA method, in newly diagnosed, treatment-naïve subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 292 mainly normoalbuminuric (241 of 292) subjects were recruited. Subjects were classified as having mild renal impairment (group 1, GFR <90 ml/min per 1.73 m(2)) or normal renal function (group 2, GFR >/=90 ml/min per 1.73 m(2)). Estimated GFR (eGFR) was calculated by the CG and MDRD equations. Blood samples drawn at 44, 120, 180, and 240 min after administration of 1 MBq of (51)Cr-EDTA were used to measure isotopic GFR (iGFR). RESULTS: For subjects in group 1, mean (+/-SD) iGFR was 83.8 +/- 4.3 ml/min per 1.73 m(2). eGFR was 78.0 +/- 16.5 or 73.7 +/- 12.0 ml/min per 1.73 m(2) using CG and MDRD equations, respectively. Ninety-five percent CIs for method bias were -11.1 to -0.6 using CG and -14.4 to -7.0 using MDRD. Ninety-five percent limits of agreement (mean bias +/- 2 SD) were -37.2 to 25.6 and -33.1 to 11.7, respectively. In group 2, iGFR was 119.4 +/- 20.3 ml/min per 1.73 m(2). eGFR was 104.4 +/- 26.3 or 92.3 +/- 18.7 ml/min per 1.73 m(2) using CG and MDRD equations, respectively. Ninety-five percent CIs for method bias were -17.4 to -12.5 using CG and -29.1 to -25.1 using MDRD. Ninety-five percent limits of agreement were -54.4 to 24.4 and -59.5 to 5.3, respectively. CONCLUSIONS: In newly diagnosed type 2 diabetic patients, particularly those with a GFR >/=90 ml/min per 1.73 m(2), both CG and MDRD equations significantly underestimate iGFR. This highlights a limitation in the use of eGFR in the majority of diabetic subjects outside the setting of chronic kidney disease.