BMJ Open

Amena, Nimona; Dechasa, Abebe; Kurke, Abdo; Abdisa, Desalegn; Dugasa, Yonas Gurmu

doi: 10.1136/bmjopen-2023-080252pmid: 39510781

BackgroundManagement of postoperative pain leads to positive patient progress and shortens the duration of hospital stay. There is a lack of information on nurse’s postoperative pain management practice and its associated factors.ObjectiveTo assess postoperative pain management practice and associated factors among nurses working in public hospitals of West Shoa Zone, Oromia, Ethiopia, 2021.DesignAn institutional-based cross-sectional study was employed.SettingStudy was conducted among eight public hospitals (two tertiary hospitals and six secondary hospitals), which were located in West Shoa Zone in Oromia, Ethiopia.ParticipantsTotally 377 participants were selected by using simple random sampling. From this, 277 were men and 100 participants were women. All nurses who were worked in surgical ward, medical wards, minor operation room and major operation room, recovery rooms, emergency, obstetrics and gynaecology wards were included.MethodsData were collected by distributing structured self-administered questionnaires that adapted from different literatures and were entered into Epi data V.3.1 and exported to SPSS V.22 for analysis. Variables with significant association in the bivariate analyses were entered into a multivariable regression analysis to identify the independent factors associated with nurses’ postoperative pain management practice. Significant factors were declared at p<0.05.ResultThe result showed that 66% of nurses had good pain management practice. Nurses favourable attitude towards postoperative pain management (adjusted OR (AOR): 4.698, 95% CI (2.725 to 8.100)), having access to read pain management guideline (AOR: 3.112, 95% CI (1.652 to 5.862)), adequate knowledge of postoperative pain management (AOR: 2.939, 95% CI (1.652 to 5.227)), working at operation room (AOR: 2.934, 95% CI (1.27 to 6.795)) and received training on pain management (AOR: 3.289, 95% CI (1.461 to 7.403)) were significantly associated with the practices of postoperative pain management.Conclusion and recommendation65% of participants (nurses) have a good level of practice of postoperative pain management. Training, access to pain management guidelines, knowledge and attitude are significant factors in postoperative pain management practice. Governmental and other bodies concerned to postoperative care quality needs to show commitment on availing needed training and infrastructures.

Zimbwe, Kauke Bakari; Yona, Yusto Julius; Chiwambo, Charity Alphonce; Chandika, Alphonce Bilola; Kiwelu, Humphrey Sawira; Shabani, Moshi Moshi

doi: 10.1136/bmjopen-2023-083842pmid: 39537568

ObjectiveThis study assessed the trends and patterns of antimicrobial consumption (AMC) from 2020 to 2021, 2021–2022 and 2022–2023 at the Benjamin Mkapa Zonal Referral Hospital (BMH) in Dodoma, Tanzania.DesignA retrospective cross-sectional study was conducted to collect AMC data for three financial years with respective denominators. The data were computed using the AMC Tool 2019 v1.9.0 and defined daily dose per 1000 inhabitants per day (DID).SettingThe BMH, Dodoma, Tanzania.ParticipantsThis study surveyed quantities of antimicrobials procured at the BMH. It did not have any human participants.Outcome measuresAMC was quantified in DID. The comparisons were made based on the DID of all surveyed antimicrobials, taking into account oral and parenteral administration and based on pharmacological classes. Further, DIDs were presented based on the 2023 WHO Access (A), Watch (W) and Reserve (R) (AWaRe) classification.ResultsIn 29 assessed antimicrobials, the DIDs for 2020–2021, 2021–2022 and 2022–2023 were 3.0852, 3.5892 and 3.9213, respectively. The average DID per year was 3.5319, with a mean of 2.4207±1.9765 DID per year. The topmost consumed antimicrobials over the 3 years (doxycycline, azithromycin, amoxicillin/beta-lactamase inhibitors, ampicillin/cloxacillin, amoxicillin/flucloxacillin, ceftriaxone, nitrofurantoin and clarithromycin) account over 90% of consumption. The most highly consumed therapeutic classes were beta-lactam antibacterial penicillins (34.71%), macrolides, lincosamides, streptogramins and others (25.75%), followed by tetracycline (23.88%). The AWaRe categorisation and antimicrobials not recommended (ANR) distribution were as follows: Access-51.61%, Watch-31.96%, Reserve-0.00%, and ANR-16.43%, respectively.ConclusionFor every 1000 patients attending the BMH per day, our study found 2.4207±1.9765 DIDs of an antimicrobial were consumed. The most consumed antimicrobials include doxycycline, azithromycin, amoxicillin/beta-lactamase inhibitor, ceftriaxone and metronidazole. To combat antimicrobial resistance effectively, it is imperative to institute a hospital policy for antimicrobial stewardship that prioritises the utilisation of a hospital formulary and antibiograms for the procurement of antimicrobials at the BMH.

Baral, Ranju; Otiang, Elkanah; Odiyo, Joseph; Nyawanda, Bryan O; Nyiro, Joyce U; Munywoki, Patrick; Jalang'O, Rose E; Pecenka, Clint

doi: 10.1136/bmjopen-2024-084207pmid: 39578037

ObjectivesTo evaluate the cost of delivering childhood respiratory syncytial virus (RSV) prevention interventions to the health system in Kenya.DesignA prospective (cost projection) activity-based costing study.SettingKenya, national introduction of interventions.ParticipantsNot applicable.InterventionsA single-dose RSV maternal vaccine and a single-dose, long-acting monoclonal antibody (mAb).Primary and secondary outcome measuresCost per eligible target population; cost per dose administered; non-commodity cost of delivery. Costs are reported in 2023 USD.ResultsRSV interventions are expected to be delivered using existing systems: maternal vaccine using the antenatal care platform and the mAb delivered similar to existing birth dose vaccines. Assuming a price of US$3 per dose (for both interventions) and baseline coverage rates averaging 50% for the maternal vaccine and 86% for the mAb, the estimated cost of delivering maternal vaccine was US$1.74 (financial) and US$6.60 (economic) per vaccinated woman, and the cost of delivering mAbs was US$1.56 (financial) and US$6.27 (economic) per vaccinated child. Excluding commodity cost, the cost of delivering maternal vaccine was US$1.32 (financial) and US$2.72 (economic) and that for mAb was US$1.23 (financial) and US$2.48 (economic). Cost differences between the two interventions are driven by the anticipated baseline coverage. Health worker training, service delivery and programme planning and coordination were major cost drivers.ConclusionThis study presents the prospective cost of new RSV intervention introduction and delivery in low-income and middle-income country settings, which is largely unknown. Cost estimates incorporate anticipated health system strengthening activities needed to deliver the future RSV interventions. These cost estimates support country-level and global-level decision-makers evaluating implementation feasibility and intervention affordability.

Di Giacomo, Dina; Sciarra, Luigi; Fusco, Liuba; Robles, Antonio Gianluca; Pernat, Andrej; Romano, Silvio

doi: 10.1136/bmjopen-2023-082459pmid: 39572090

IntroductionThe allostatic load (AL) is a framework for conceptualising the physiological multisystemic impact of prolonged exposure to stress and its related side effects on mental health.Stress due to AL can influence the development and outcomes of cardiovascular diseases. AL increases the risk of coronary and peripherical artery diseases. AL emerges from the detection of emotional dimensions related to the disease, low psychosocial functioning and high rates of psychopathological signs in patients with hypertension or coronary heart disease.Method and analysisThe primary endpoint of the PLAY-UP protocol is the implementation of a multidimensional model underlying the clinical treatment of patients with cardiovascular disease through the integration of medical and psychological clinical variables.PLAY-UP is a cohort study that will last for 24 months. 200 participants will be recruited and divided into three groups: early disease, midterm disease and long disease. All patients will undergo a clinical evaluation based on the detection of biological, medical and psychological indicators and variables. The evaluation battery will comprise three types of measurements: medical, psychological and pharmacological treatments. Clinical and psychological measurements will be processed in an integrated manner through the combination of all variables examined, elaborating the Allostatic Load Index from a longitudinal time perspective. The Allostatic Load Index will be calculated by measuring the z-score.Ethics and disseminationEthical Committee Approval was obtained from CEtRA Abruzzo Region (IT) (ID 0461499/23). The results of the present project will be published in peer-reviewed journals, disseminated electronically and in print, and presented as abstracts and/or personal communications during national and international conferences.

Lin, YeunYi; Leith, Damien; Abbott, Michael; Barrett, Rachael; Bell, Samira; Croudace, Tim J; Cunningham, Scott; Dillon, John; Donnan, Peter; Farre, Albert; Hernández, Rodolfo; Lang, Chim; McKenzie, Stephanie; Mordi, Ify; Morrow, Susan; Munro, Cameron; Philip, Sam; Ryan, Mandy; Wake, Deborah;

Warrington, Lorraine; Holmes, Marie; Gibson, Andrea; Peacock, Rosemary; Rogers, Zoe; Dickinson, Sarah; Holch, Patricia; Hewison, Jenny; Hulme, Claire; Dawkins, Bryony; Woroncow, Barbara; Cucchi, Virginia; Hudson, Eleanor Mae; Brown, Julia; Velikova, Galina; Absolom, Kate

doi:

Mai, Chun-Wai; Sridhar, Sathvik B; Karattuthodi, Mohammed Salim; Ganesan, Perishithaa M; Shareef, Javedh; Lee, E Lyn; Armani, Keivan

doi: 10.1136/bmjopen-2024-087064pmid: 39500605

IntroductionPharmacogenomic testing (PGx) plays a crucial role in improving patient medication safety, yet ethical concerns and limitations impede its clinical implementation in the primary care settings.AimsTo systematically review the current state of PGx in the primary care settings and determine the enablers and challenges of its implementation.DesignA scoping review was carried out by adhering to Arksey and O’Malley’s 6-stage methodological framework and the 2020 Joanna Briggs Institute and Levac et al. Data sourcesCochrane Library, EMBASE, Global Health, MEDLINE and PubMed were searched up to 17 July 2023.Eligibility criteriaAll peer-reviewed studies in English, reporting the enablers and the challenges of implementing PGx in the primary care settings were included.Date extraction and synthesisTwo independent reviewers extracted the data. Information was synthesised based on the reported enablers and the challenges of implementing PGx testing in the primary care settings. Information was then presented to stakeholders for their inputs.Results78 studies discussing the implementation of PGx testing are included, of which 57% were published between 2019 and 2023. 68% of the studies discussed PGx testing in the primary care setting as a disease-specific themes. Healthcare professionals were the major stakeholders, with primary care physicians (55%) being the most represented. Enablers encompassed various advantages such as diagnostic and therapeutic benefits, cost reduction and the empowerment of healthcare professionals. Challenges included the absence of sufficient scientific evidence, insufficient training for healthcare professionals, ethical and legal aspects of PGx data, low patient awareness and acceptance and the high costs linked to PGx testing.ConclusionPGx testing integration in primary care requires increased consumer awareness, comprehensive healthcare provider training on legal and ethical aspects and global feasibility studies to better understand its implementation challenges. Managing high costs entails streamlining processes, advocating for reimbursement policies and investing in research on innovation and affordability research to improve life expectancy.

Bruun, Caroline Fussing; Zarp, Jeff; Lyng Forman, Julie; Coello, Klara; Miskowiak, Kamilla Woznica; Vinberg, Maj; Faurholt-Jepsen, Maria; Kessing, Lars Vedel

doi: 10.1136/bmjopen-2024-084105pmid: 39557557

IntroductionAccumulating data support the association between increased inflammation and bipolar disorder (BD), and preliminary data suggest that augmentation with low-dose aspirin (LDA) may protect against the onset and deterioration of BD via anti-inflammatory pathways. The A-bipolar randomised controlled trial (RCT) aims to investigate whether adding LDA to standard treatment improves day-to-day mood instability (MI) in BD.Methods and analysisA two-arm, triple-blind, parallel-group, superiority RCT including 250 patients with newly diagnosed BD treated at the Copenhagen Affective Disorder Clinic, Denmark. Participants are randomised 1:1 to either 150 mg of acetylsalicylic acid daily (LDA) or a placebo for six months in addition to their regular treatment. Mood instability, calculated from daily smartphone-based mood evaluations, is the primary outcome measure due to its internal validity as a real-life measure for patients and external validity as it reflects patients’ illness severity and functioning. Analyses will be conducted as intention-to-treat analyses using a linear mixed model including time (categorical) and the time–treatment interaction as fixed effects and with an unstructured covariance pattern to account for repeated measurements on each study participant. The trial is Good Clinical Practice monitored.Ethics and disseminationThe Danish Research Ethics Committee (H-21014515) and the data agency, Capital Region of Copenhagen (P-2021-576) approved the trial. Results will be published in peer-reviewed journals.Trial registration numberNCT05035316.

Bola Siafa, Antoine; Choffor-Nchinda, Emmanuel; Andjock-Nkouo, Yves Christian

doi: 10.1136/bmjopen-2024-085883pmid: 39557548

IntroductionTonsillitis is a self-limiting inflammatory process of the tonsils. In high-income countries, guidelines have been developed to decide if a patient needs an antibiotic or not. These guidelines help to reduce unnecessary antibiotic prescriptions and prevent the development of antimicrobial resistance (AMR). In low- and middle-income countries (LMICs), medical practitioners have the tendency to prescribe antibiotics in all cases of tonsillitis; there is an overprescription of antibiotics. These prescriptions are probably unjustified and seem to be responsible for the increased AMR seen in developing countries. The aim of this review will be to estimate the proportion of unjustified antibiotic prescriptions in LMICs.Methods and analysisWe will conduct a systematic review of all observational studies on the diagnosis and treatment of tonsillitis in LMICs. The selected database will include PubMed, Web of Sciences Global Index Medicus and the Grey literature. The search will include studies published from January 2012 until December 2024. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and bias will be assessed by a Risk of Bias Assessment Tool for observational studies by Hoy et al. A meta-analysis will be conducted for homogeneous studies, eventually using the random effect model. Subgroup analysis will include a period of study, study quality, countries and/or subregions of LMICs involved, study setting, age of participants, tools and definition used.Ethics and disseminationFormal ethical approval is not required, as primary data will not be collected. The results will be disseminated through peer-reviewed publications and presented at scientific conferences.PROSPERO registration numberCRD 42022384957

Jianvitayakij, Soontaree; Niyomyart, Atsadaporn; Junsawang, Chuenjit; Bualoy, Wunwisa; Butsing, Nipaporn; Monkong, Supreeda; Voss, Joachim G

doi: 10.1136/bmjopen-2024-090956pmid: 39521459

ObjectivesAntibiotic resistance poses a major global public health threat. However, research on this issue is limited, especially among nursing students. This study aims to examine knowledge of antibiotics and antibiotic resistance, antibiotic use, and eHealth literacy in Thailand.DesignA cross-sectional study was conducted using an online self-administered questionnaire. The WHO Antibiotic Resistance: Multi-Country Public Awareness Survey and the eHealth Literacy Scale were used. Descriptive and multiple regression analyses were performed.SettingThailand’s North, South, Central and Northeast between January and February 2024.ParticipantsA total of 1180 nursing students aged 18 or older, from first to fourth year and fluent in Thai, were invited to participate.ResultsThe participants were mostly female (89.8%), with an average age of 20.64±1.81 years. Over half of the respondents (67.7%) have used antibiotics, mistakenly believing that antibiotics could treat colds and influenza (70.3%), malaria (66.8%), measles (63.6%) and sore throats (60.9%). About 71.5% recognised the impact of antibiotic resistance on themselves and their families, but 93.1% incorrectly believed antibiotic resistance means the body resists antibiotics. Participants scored 35.92±4.21 out of 40 on eHealth literacy. In a multiple regression analysis, three factors predict knowledge of antibiotic resistance: knowledge of antibiotics (B=0.199, p<0.001, 95% CI 0.165 to 0.234), eHealth literacy (B=0.078, p<0.001, 95% CI 0.056 to 0.100) and academic year (B=0.271, p<0.001, 95% CI 0.184 to 0.358), with knowledge of antibiotics being the most impact (β=0.318). These three variables explained 23.7% of the variance in antibiotic resistance knowledge scores.ConclusionsDespite high eHealth literacy, nursing students hold misconceptions about antibiotic treatable conditions and insufficient knowledge of antibiotic resistance. This highlights the need to integrate antibiotic contents into nursing curricular and enhance eHealth literacy for better access and navigate health information.